[Comprehensive clinical evaluation of bedaquiline in the treatment of multidrug-resistant tuberculosis].

Objective: To assess the clinical value of bedaquiline in five dimensions: effectiveness, safety, economics, appropriateness, and social benefits, to provide a reference for medical and health insurance-related decisions. Methods: A total of 792 patients with multidrug-resistant tuberculosis who were hospitalized at Wuhan Pulmonary Hospital, Ganzhou Fifth People's Hospital and Jiangxi Chest Hospital between January 2018 and December 2020 were included in the study. Based on a retrospective survey of case data, and each evaluation dimension of bedaquiline was statistically analyzed by causal analysis or chi-square test, using linezolid as the reference drug. Results: In terms of effectiveness, bedaquiline significantly increased treatment success by 23.9% (95%CI:4.8%-43.0%) and shortened treatment duration by 64 days(95%CI:18-109 days). In terms of safety, the incidence of adverse reactions to bedaquiline and the discontinuation rate of adverse reactions (5.11%,4.55%) were significantly lower than those for linezolid (22.49%,15.24%), with statistically significant differences (χ2=27.50,P<0.001;χ2=14.09,P<0.001). In terms of economics, patients treated with bedaquiline had a significantly higher anti-TB drug course cost of RMB 48 209.4 Yuan(95%CI: 28 336.0-68 082.8 Yuan). In terms of appropriateness, the proportion of bedaquiline in patients' initial treatment regimens was lower than that of linezolid (16.7% vs. 86.5%) in the 2020 observation sample, with a statistically significant difference (χ2=238.96,P<0.001). In terms of social benefits, the infection control rate was significantly increased by 27.8% (95%CI:8.2%-47.5%) in patients using bedaquiline. Conclusions: Bedaquiline performed well in terms of efficacy, safety, and social benefits. However, it was less economical and the actual use rate of bedaquiline in clinical practice was lower than that of its counterpart drug, linezolid. Price reductions might be needed to increase the clinical use and performance of bedaquiline in the future.

[Review of factors affecting health-related behaviors].

Health related behaviors are closely related to health outcomes. This paper reviews the studies on factors for health related behaviors worldwide published in recent 15 years, and systematically summarizes the current research status of the factors for health related behaviors. The factors influencing health related behaviors are individual social demographic factors, social cognitive factors of individuals, and social environmental factors. The individual social demographic factors mainly include gender, age, marital status, economic level and educational level. The social cognitive factors of individuals mainly include self-efficacy, health belief, social support and peer influence. The social environmental factors mainly include mass media, accessibility of facilities and level of urbanization, etc.

Cyclic adenosine monophosphate-protein kinase A signal pathway may be involved in pulmonary aquaporin-5 expression in ischemia/reperfusion rats following deep hypothermia cardiac arrest.

We investigated the effects of cyclic adenosine monophosphate-protein kinase A (cAMP-PKA) on the expression of aquaporin 5 (AQP5) in ischemia/reperfusion (I/R) rats following deep hypothermia cardiac arrest. Wistar rats were randomly divided into: a sham control group (subjected to a sham operation); an I/R group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary artery); an H89 group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary vein and artery, and treated with 5 mg/kg H89 for 2 days before the study); and a forskolin group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary vein and artery, and treated with 5 mg/kg forskolin for 2 days before the study). Expression levels of AQP5 mRNA and protein were determined using reverse transcription-polymerase chain reaction and western blotting. Decreased expression of AQP5 was noted in the pulmonary tissues of the I/R group compared with the sham controls. Compared to that in the control group, there was a notable decrease in AQP5 expression in the I/R group. After treating with forskolin, AQP5 expression increased in the forskolin group compared with the I/R group. In the H89 group, AQP5 expression decreased compared with the I/R group. The decreased expression of AQP5 was possibly associated with acute pulmonary injury induced by I/R. The cAMP-PKA signal pathway may be involved in the expression of AQP5 in I/R rats after deep hypothermia cardiac arrest.

Role of Nrf2 signal pathway in rats with deep hypothermia ischemia/reperfusion injury undergoing remote postconditioning.

We investigated the protective effects of remote postconditioning (RPC) in the lungs of rats with deep hypothermia ischemia/reperfusion (I/R) injury and the role of nuclear factor E2-related factor 2 (Nrf2) signaling in this process. Forty-nine rats were randomly divided into a sham control group, deep hypothermia I/R group, RPC group, I/R+all-trans retinoic acid (ATRA) group, I/R+RPC+ATRA group, I/R+tert-butylhydroquinone (tBHQ) group, and I/R+RPC+tBHQ group. Real-time polymerase chain reaction and Western blot analysis were used to examine Nrf2 mRNA and protein expression, respectively. Compared with the sham control group, Nrf2 expression, malondialdehyde (MDA) content, and the wet/dry weight (W/D) ratio were significantly increased in the I/R group, while superoxide dismutase (SOD) activity was significantly decreased. Pulmonary Nrf2 expression and SOD activity was significantly increased, and MDA content and the W/D ratio were significantly decreased in the RPC group compared with the I/R group. Compared with the I/R group, MDA and W/D ratio significantly decreased and SOD activity remarkably increased in I/R+tBHQ group. After ATRA intervention in the I/R+ATRA group, MDA content and W/D ratio increased and SOD activity decreased compared to the I/R group. MDA content and W/D ratio in the RPC+tBHQ group significantly decreased and SOD activity increased compared with in the RPC group (P < 0.01). In the RPC+ATRA group, MDA content and W/D ratio decreased while SOD activity increased compared with the RPC group (P < 0.01). RPC alleviated deep hypothermia I/R injury; the Nrf2 signaling pathway may be involved in the protective effects induced by RPC.

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care.

Background: Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. Methods: The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. Conclusion: The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.

Course and prognosis of myasthenia gravis: a systematic review.

The clinical course of myasthenia gravis (MG) is variable, and spontaneous remission is still uncommon. Knowledge of the prognostic factors may help understand the course of MG and thus optimize its management. A systematic review search was conducted in MEDLINE and EMBASE for English language studies from 1985 through 2009. We identified additional studies by reviewing bibliographies of retrieved articles and hand search main journal of neurology. Studies evaluating variables associated with or predictive of remission in adult patients with MG were included. Because of methodological heterogeneity, we refrained from statistical pooling, instead, a best evidence synthesis was used for summarizing the results. From 1810 potentially relevant studies, 13 cohort studies met the inclusion criteria. The included studies were heterogeneous considerably in sample size, disease duration, follow-up years, definition of remission, and analysis. Study quality was limited by retrospective design in most studies and lack of multivariate analysis. Time of diagnosis from onset (<1 year) showed strong evidence of predicting a better remission. In studies using completely stable remission outcomes, there was strong evidence that age at onset (<40 years) was of prognostic importance. Furthermore, gender showed no association with remission. Time of diagnosis from onset and age at onset were found to be predictors of remission. Gender does not seem to predict the course of MG. Our findings should be interpreted with caution because of the clinical and methodological heterogeneity of included studies.

Surgical treatment for upper or middle esophageal carcinoma occurring after gastrectomy: a study of 52 cases.

Fifty-two patients presenting with upper or middle esophageal carcinoma after gastrectomy between 1980 and 2003 were analyzed retrospectively. Among them, there were five cases of total gastrectomy, six cases of proximal partial gastrectomy and 41 cases of distal subtotal gastrectomy. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included resection of the esophageal lesion with esophageal replacement using non-reversed or reversed gastric tubes (2 and 3 cases respectively), and short or long segment colon (5 and 40 cases respectively); two cases underwent a palliative procedure (jejunostomy). Complications included cervical anastomotic leaks (3 cases), pulmonary infection (3 cases), atelectasis (2 cases) and cordis arrhythmia (5 cases), all of which responded to treatment. In our group, resection of the esophageal lesions and reconstruction of the esophagus was performed in 45 cases (86.5%), exclusion and bypass procedure of esophageal carcinoma and following radiotherapy and chemotherapy in four (7.7%), eternal jejunostomy for intestinal nutrition in two (3.9%) and death occurred in one case (1.9%) due to multiple organ dysfunction syndrome (MODS). Esophageal resection combined with lymph node dissection is indicated for the treatment of upper or middle esophageal carcinoma following gastrectomy. While esophageal substitutes can include non-reversed or reversed gastric tubes as well as short or long segment colon interpositions, we usually recommend the use of colon interposition. The 1-, 3- and 5-year survival rate of cases with resection of the esophageal lesions and reconstruction of the esophagus was 84.6%, 57.7% and 26.7% respectively.

Shenjincao (Palhinhaea cernua) injection for treatment of experimental silicosis of rats.

Shenjincao injection is a traditional Chinese medicine prepared from Palhinhaea cernua (L.) A. Franco et Vasc. by ultrafiltration. Its anti-silicosis action has been investigated both as a prophylactic and for treatment of the disease. Wistar rats were injected intra-tracheally with quartz dust and then divided randomly into groups-treatment and control prophylactic groups and treatment and control disease groups. After five days or eight weeks, respectively, the silica-exposed rats of the two treatment groups were injected intraperitoneally three times a week with shenjincao injection, dose 2.0 mL, for five weeks or 11 weeks, respectively. The rats were then dissected, and the ceruloplasmin content of the serum and the fresh weight, dry weight, collagen content and pathological grade of the lungs were measured. Compared with the corresponding exposed control groups for the same treatment periods the values of these parameters were reduced by 62.8% to 30.7% for rats in the prophylactic treatment group (P < 0.01 for all) and by 50.8% to 30.2% for the diseased group (P < 0.01 for all). The values for the disease-treatment group were also reduced by 37.9% to 25.9% compared with values for the exposed control group before treatment (P < 0.01 or P < 0.05). The effective coefficients for prophylactic treatment were 82.6% to 56.0%; for disease treatment they were 68.8% to 39.8%. These results show that shenjincao injection is efficacious against experimental silicosis not only when used prophylactically but also when used to treat the disease.

[Experiment and clinical significances of papillary myotomy's and septal valvotomy's resuture in the right ventricle].

In this paper, the results of the papillary myotomy and septal tricuspid valvotomy were studied. The 19 dogs were randomly divided into four groups so as to observe the blood supply, healing course, strength and functions of the anterior papillary muscle. It was confirmed that the traumatic rupture of the papillary muscle should be repaired early. In the clinic 31 patients of ventricular septal defect with tricuspid valve pouch were treated by the approach with septal valvotomy and cone papillary myotomy of tricuspid valve. The successful rate of VSD repair was up to 100%. Therefore, this approach is worthy to be used clinically.

[Surgical treatment of abnormal myocardial bundle in the right ventricle].

Thirteen cases of the anomalous right ventricle muscle bundle diagnosed during operation were reported. This is a rare congenital cardiac anomaly. It may be associated with other congenital anomalies, most commonly with ventricular septal defect and pulmonary stenosis but may also be isolated lesions. It exhibits no typical clinical findings. The preoperative misdiagnostic rate was high. Emphasis was on its intracardiac anomaly, some recognizable signs and anatomic relation during the operation.