Clinical features of pertussis and risk factors of severe pertussis in children / 中国小儿急救医学

Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.

Cost-Effectiveness of First-Line Versus Second-Line Pembrolizumab or Chemotherapy in Patients With Microsatellite-Instability-High/Mismatch Repair-Deficient Advanced Colorectal Cancer.

Background: Pembrolizumab is a guideline-recommended, both first- and second-line treatment option for microsatellite-instability-high (MSI-H)/mismatch repair-deficient (dMMR)advanced colorectal cancer patients. The aim of the present study is to investigates the health and economic outcomes of three treatment strategies with or without pembrolizumab in MSI-H/dMMR advanced colorectal cancer to define the best treatment strategy from the perspective of the US payer. Methods: A microsimulation model was developed to estimate the cost and effectiveness of three treatment strategies: 1) pembrolizumab used as first-line, 2) pembrolizumab used as second-line and, 3) chemotherapy. Life years (LYs), quality-adjusted LYs (QALYs) and lifetime costs were estimated. Results: The model projected that patients receiving pembrolizumab in the first-line setting gained 5.579 QALYs; this value was 1.501 and 3.941 QALYs more than that for patients receiving pembrolizumab in the second-line setting and chemotherapy, respectively. First-line pembrolizumab strategy dominated second-line pembrolizumab strategy. Compared with chemotherapy, first-line pembrolizumab strategy yielded an incremental cost of $50613.7, which resulted in an ICER of $13441 per QALY. Conclusion: For patients with MSI-H/dMMR advanced colorectal cancer, reserving pembrolizumab for second-line line use is dominated by its first-line use, and first-line use of pembrolizumab is cost-effective compared with chemotherapy.

Health economics analysis for 18F-fluorodeoxyglucose positron-emission tomography compared with computed tomography in lung cancer / 中南大学学报(医学版)

Compared with conventional imaging, 18F-fluorodeoxyglucose positron-emission tomography compared with computed tomography (18F-FDG PET/CT) possesses higher sensitivity and specificity in the diagnosis of solitary pulmonary nodule (SPN) and lung cancer. From the perspective of health economics, PET/CT is more suitable strategy for diagnose of SPN with intermediate probability of malignancy, and has good health economics value in preoperative staging diagnosis and follow-up after radiotherapy and chemotherapy of lung cancer. The evaluation method, effect index and comparison method used in the health economics research of PET/CT for lung cancer diagnosis and treatment are cost-effect analysis, life year and incremental cost-effect ratio, respectively. Case tracking and follow-up was a means of early studies on PET/CT health economics, and in recent years mathematical models are used in most studies.

Study on the Effects and Mechanism of Yinlan Tiaozhi Formula on Macrophage Foaming / 世界科学技术-中医药现代化

Objective: To investigate the inhibitory effect of macrophage foaming by Yinlan Tianzhi formula (YLTZ) and to explain its effects on lipid-induced inflammation and LXRα-ABCA1 signal pathway. Methods: The model of macrophage foaming was induced by incubating the RAW264.7 cells or BMMs with ox-LDL (50 mg·L-1). The serum containing YLTZ was prepared. The cells were divided into blank group, model group, and drug group. After drug intervention, MTT method was used to detect cell proliferation. The lipid accumulation in cells was observed by oil red O staining, and GPO-PAP method was used to determine the total cholesterol content in cells. Protein and mRNA levels were determined by Western blot and RT- qPCR. Results: Compared with control group, after YLTZ treatment, the lipid level was significantly decreased, and the level of mRNA and protein of LXRα and ABCA1 were significant increased. The expression of inflammatory factor COX2 and iNOS was significantly decreased. Conclusion: YLTZ inhibits macrophage foaming through enhancing LXRα-ABCA1 pathway and suppressing of inflammatory response.

Overuse-induced patella-patellar tendon junction injuries:histological characteristics and growth factor expression levels / 中国组织工程研究

BACKGROUND: Although overuse-induced patella-patellar tendon junction injury is a common disease, its pathogenesis and healing mechanism remain unclear.OBJECTIVE: To establish an overuse-induced injury animal model by a repetitive traction at the patellar tendon insertion,and to explore its pathogenesis and healing mechanism based on histomorphology and growth factor expression levels.METHODS: Twenty-eight New Zealand rabbits were randomly divided into four groups: the rabbit left and right posterior limbs without any intervention as controls (n=4); cyclic loading training targeting the left posterior limb was done in model,healing and training groups (n=8 per group) for 4 weeks. Afterwards, the rabbits in the model group were killed immediately, rabbits in the healing group relaxed for another 4 weeks and then were killed, while rabbits in the training group were subjected to 4-week low-intensity training. The histological changes and growth factor expression levels during patella-patellar tendon junction injury and healing after load training were observed.RESULTS AND CONCLUSION: Compared with the control group, in the model group, the cells and collagenous fibers arranged in disorder, and the tidemark disappeared. The healing and training groups healed incompletely, but showed better histological changes than the model group. The thickness of fibrocartilage and basic fibroblast growth factor level in the control group were significantly lower than those in the other three groups (P < 0.05). The cell density and vascular endothelial growth factor level in the model group were significantly higher than those in the control and healing groups (P < 0.05). These results show that the animal model of overuse-induced patella-patellar tendon junction injury cannot return to normal after 4 weeks of rest, but the low-intensity training is conductive to healing quality.

Effect of different resting time on patella-patellar tendon healing after acute injury / 中国组织工程研究

BACKGROUND:Patella-patellar tendon junction (PPTJ) injuries are a common disease in athletes and vulnerable to re-injury. Post-injury training is a double-edged sword. OBJECTIVE:To examine the effect of post-injury resting days on the quality of healing in PPTJ in view of histomorphology, expression levels of growth factor and collagen, and muscle tension. METHODS:Forty New Zealand white rabbits were randomly divided into control, and five post-injury training groups representing different time to restart training after acute injury:the rabbits restarted training at 24 (PIT24), 48 (PIT48), 72 (PIT72), 96 (PIT96) and 120 (PIT120) hours, respectively. All post-injury training groups received acupuncture at the PPTJ and then underwent 4-week low-intensity training. Afterwards, all rabbits were killed to take specimens for hematoxylin-eosin, safranin O and immuohistochemical staining. The muscle tension and hardness were detected using Myoton-3. The thickness of fibrous cartilage zones, cell density, as well as the expression levels of vascular endothelial growth factor and collagen were measured on Metamorph software. RESULTS AND CONCLUSION:Compared with the control group, in the PIT groups, the collagens arranged in disorder, and decreased cell density, increased mucopolysaccharide andrising tidephenomenon appeared. The fibrocartilage in the PIT24 and PIT120 groups was significantly thicker than that in the control group (P<0.05). The ratio of collagen type Ⅰ/Ⅲ was significantly decreased in the PIT24 and PIT48 groups compared with the control group (P<0.05), and the highest in the PIT72 group. The expression level of vascular endothelial growth factor in the PIT48, PIT72 and PIT96 groups was significantly higher than that in the control group (P<0.05). The muscle tension was negatively correlated with the collagen ratio (r=-0.538;P<0.01) and chondrocyte density (r=-0.570;P<0.01), while muscle hardness was positively correlated with the expression level of vascular endothelial growth factor (r=0.613;P<0.01). Our results suggest that different resting time makes significant differences in the PPTJ healing and the 72-hour resting is the best choice. Moreover, muscular properties are related to the cel density, collagen synthesis and growth factor expression, which can be used as a non-invasive indicator to guide post-injury training and prevent recurrence.

Effects of No.1 Weiyan Decoction on hypoxia and hypoxic tolerance in gastric mucosal epithelial cells in rats with gastric precancerous lesion / 中成药

AIM To study the effects of No.1 Weiyan Decoction (Codonopsis Radix,Paeoniae Radix alba,Taraxaci Herba,etc.) on hypoxia and hypoxic tolerance in gastric mucosal epithelial cells in rats with precancerous lesion of gastric cancer (PLGC).METHODS Forty rats were randomly divided into normal,model,Vitacoenzyme Tablets and No.1 Weiyan Decoction groups.Except for the normal group,the rats in the other groups were given with N-methyl-N'-nitro-N-nitrosoguanidine and Little Chengqi Decoction to establish a PLGC rat model.Ten weeks after the administration,the gastric mucosal epithelial microvascular ultrastructure was observed,the expressions of Hif1a mRNA,HIF-1 α protein and VEGF protein in gastric mucosal epithelium were detected.RESULTS Compared with the normal group,the number of microvasculatures in gastric mucosal epithelium was decreased;lumen was severely stenosed or expansive;inner wall was not smooth and had adhesion;vascular endothelial cells were swollen;the expression of Hif1α mRNA showed an increasing trend;the expressions of HIF-1α protein and VEGF protein were anomalous in the model group.Compared with the model group,the gastric mucosal vascular lesion of PLGC rats was improved,and the expressions of Hif1a mRNA,HIF-1α protein and VEGF protein were significantly decreased in the No.1 Weiyan Decoction group.CONCLUSION No.1 Weiyan Decoction can improve hypoxia and hypoxia tolerance,and induce angiogenesis in gastric mucosal epithelium in PLGC rats.

Cost-utility analysis of the newly recommended adjuvant chemotherapy for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Gastric Cancer.

BACKGROUND: Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was first recommended for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Gastric Cancer, but the economic influence of this therapy in China is unknown. OBJECTIVE: The aim of the present study was to determine the cost-effectiveness of adjuvant chemotherapy with capecitabine and oxaliplatin after a gastrectomy with extended (D2) lymph-node dissection, compared with a D2 gastrectomy alone, for patients with stage II-IIIB gastric cancer. METHODS: On the basis of data from the CLASSIC trial, a Markov model was created to determine economic and clinical data for patients in the chemotherapy and surgery group (CSG) and the surgery-only group (SOG). The costs, presented in 2010 US dollars and estimated from the perspective of the Chinese health-care system, were obtained from the published literature and the local health system. The utilities were based on published literature. Costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) were estimated. A lifetime horizon and a 3 % annual discount rate were used. One-way and probabilistic sensitivity analyses were performed. RESULTS: For the base case, the CSG compared with SOG would increase LYs and QALYs in a 3-, 5-, 10- or 30-year time horizon (except the QALYs at 3 or 5 years). In the short run (such as in 3 or 5 years), the medical costs would increase owing to adjuvant chemotherapy of capecitabine plus oxaliplatin after D2 gastrectomy, but in the long run the costs would decline. The ICERs suggested that the SOG was dominant at 3 or 5 years and the CSG was dominant at 10 or 30 years. The one-way sensitivity analysis showed that the utility of disease-free survival for 1-10 years for the SOG and the cost of oxaliplatin were the most influential parameters. The probabilistic sensitivity analysis predicted a 98.6 % likelihood that the ICER for the CSG would be less than US$13,527/QALY (three times the per capita gross domestic product of China). CONCLUSION: For patients in China with resectable disease, our results suggest that adjuvant chemotherapy with capecitabine plus oxaliplatin after a D2 gastrectomy is cost-saving and dominant in the long run on the basis of a current clinical trial, compared with treatment with a D2 gastrectomy alone.

Development of residual voltage testing equipment / 中国医疗器械杂志

For the existing measurement methods of residual voltage which can't turn the power off at peak voltage exactly and simultaneously display waveforms, a new residual voltage detection method is put forward in this paper. First, the zero point of the power supply is detected with zero cross detection circuit and is inputted to a single-chip microcomputer in the form of pulse signal. Secend, when the zero point delays to the peak voltage, the single-chip microcomputer sends control signal to power off the relay. At last, the waveform of the residual voltage is displayed on a principal computer or oscilloscope. The experimental results show that the device designed in this paper can turn the power off at peak voltage and is able to accurately display the voltage waveform immediately after power off and the standard deviation of the residual voltage is less than 0.2 V at exactly one second and later.

Discussions on setbacks and countermeasures of medical devices clinical trials in China / 中华医院管理杂志

By means of literature review of existing laws and regulations,an analysis was made on main setbacks found in the clinical trials and regulation of medical devices in China.The authors proposed to enact and improve such laws and regulations as soon as possible.

Screening Technology for Traditional Chinese Medicine New Drug and Practice / 世界科学技术-中医药现代化

This article focused on summarization of the available new screening technology for traditional Chinese medicine (TCM) new drug, including high throughput screening (HTS), biological chip, molecular biological chro-matography, high content screening (HCS), network pharmacology, proteomics, and computer-aided drug design (CADD). And in this review, one example that we applied CADD technology (such as molecular docking, pharma-cophore and molecular similarity) in lipid-lowering TCM new drug development was given. Based on the mechanism of lipid metabolism, CADD technology provided a good method on the prescription optimization and mechanism study. In addition, TCM new drug development proposal which displayed in this paper may provide a useful strategy for screening of TCM new drug.

The role of serum procalcitonin in etiology diagnosis of sepsis in children / 中国小儿急救医学

Objective To investigate the serum procalcitonin (PCT) levels in sepsis caused by the bacteria,virus and mycoplasma and explore the role of PCT in etiology diagnosis of sepsis in children.Methods Three hundreds and thirty critically ill children with sepsis caused by bacteria,virus and mycoplasma admitted in PICU of Hunan Children' s Hospital from Feb 1,2011 to Sep 1,2012 were reviewed and analyzed.The PCT levels were measured at admission and day 3.The differences in accidence of sepsis caused by bacteria,viruses and mycoplasma according to different serum PCT levels were analyzed.The differences of PCT levels at admission and day 3 in sepsic children caused by bacteria,viruses and mycoplasma were analyzed.Results The level of serum PCT in sepsis caused by bacterial infection were distinctly increased,caused by virus and mycoplasma infections was not obvious but the increases of serum PCT [0.71 (8.14)ng/ml,0.15 (1.68) ng/ml,0.28 (1.89) ng/ml].According to various PCT levels(0.05 ～ ng/ml,0.5 ～ng/ml,2 ～ ng/ml,10 ～ 300 ng/ml),the differences of accidence of sepsis caused by bacteria,virus and mycoplasma were also statistically significant(x2 =84.50,P ＜ 0.01).The PCT level of septic children caused by bacterial infection in day 3 was significantly decreased compared with that at admission [0.32 (5.68) ng/ml vs 0.71 (8.14) ng/ml] (U =19.34,P ＜0.05).Conclusion PCT plays a certain role in etiology diagnosis of sepsis in children.The increased PCT levels which can be reduced by anti-inflammatory treatment indicate the likelihood of bacterial infection and sepsis.The increase of PCT induced by viral and mycoplasma infections is not obvious,but bacterial infection can not be completely ruled out.

Effect of Supercritical Fluid Carbon Dioxide Extracts from Pericarpium Zanthoxyli on in- Vitro Activity of Guinea Pig Trachea / 中药新药与临床药理

Objective To investigate the effect of Pericarpium Zanthoxyli (HJ) on guinea pigs trachea in vitro and its therapeutic mechanism. Methods The actions of HJ on the contraction of normal trachea and on the spasm of spasmodic tracheas caused by acetylcholine (Ach) and histamine phosphate (HIS), as well as the actions on intracellular Ca2+ - dependent contraction and extracellular Ca2+ - dependent contraction induced by HIS were observed. Results HJ could inhibit the guinea pigs trachea contraction , antagonize the contraction of trachea spasm induced by Ach and HIS , restrain the extracellular Ca2+ - dependent contraction induced by HIS in a dose- dependent manner. Conclusion HJ has an antiasthma effect.

Comparative Study on Therapeutic Effect of Qingre Anchuang Tablets Processed by New or Old Technology on Rabbit Ear Acne / 中药新药与临床药理

Objective To compare the therapeutic effect of Qingre Anchuang Tablets(QAT) processed by new or old technology on rabbit ear acne.Methods Experimental rabbit ear acne was induced by coal tar.After the modeling,the rabbits were administrated with QAT processed by new or old technology.The thickness,weight and PGE2 level of the acne ear were measured,and the pathological changes of the acne ear were also examined.Results QAT processed by new or old technology could decrease the thickness,weight and PGE2 level of the ear significantly,and relieve the pathological changes of the acne ear.The effects of QAT processed by new technology was better than that of QAT processed by old technology.Conclusion QAT processed by new technology has a better therapeutic effect on rabbit ear acne than QAT processed by old technology.

Experimental Study on Improvement Action of Katong Tablets Radix Astragali seu Hedysari,Radix et Rhizoma Rhei,etc.)on Blood Rheology of Animals / 中成药

After Katong Tablets(the equivalent dosage of over two times of adult daily administra- tion)were infused into the animal stomach for successive 10 days,it could strongly improve the increase of blood rheology of rat induced by adrenaline plus ice water or of rat with the deficiency of vital energy and blood stasis induced by swimming in successive days,and sig- nificantly strengthen the malformation ability of red cells of senile rat,inhibit the vitro circu- lation thrombosis of arteria carotis and jugular vein of normal rats,decrease the aggregate function of thrombocyte of rabbit induced by ADP.It showed the similar action strength with the control drug Kanlan Tablets.