Objective To study the efficacy and safety of combined anti-tuberculosis regimen containing bedaquiline in the treatment of multidrug-resistant tuberculosis (MDR-TB). Methods A total of 69 MDR-TB patients treated by joint regimen combined bedaquiline with other anti-tuberculosis drugs between March 2018 and August 2019 in Public Health Clinical Center of Chengdu were taken as the trial group, and 60 MDR-TB patients received treatment without bedaquiline between June 2016 and December 2017 in the same hospital were taken as the control group. The efficacy and safety of the two groups were compared. Results The 69 patients in the trial group included 44 males and 25 females, aged from 21 to 63 years, with an average of (34.6±11.0) years; 58 patients (84.1%) completed the 24-week treatment with bedaquiline, while 11 patients did not complete the treatment, including 3 deaths (4.3%), 1 loss of follow-up (1.4%), 1 withdrawal from the study (1.4%), and 6 discontinuation due to adverse events (8.7%). Among the 54 patients with positive results of tuberculosis on baseline sputum culture, 49 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 90.7%), and the median negative conversion time was 13.0 weeks. The 60 patients in the control group included 45 males and 15 females, aged from 16 to 66 years, with an average of (35.5±13.2) years. Among the 53 patients with positive results of tuberculosis on baseline sputum culture, 30 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 56.6%), and the median negative conversion time was 12.0 weeks. The negative conversion rate of sputum bacteria in the trial group was significantly higher than that in the control group (χ2=16.133, P<0.001). The most common adverse reactions in the trial group were liver function abnormalities (42 cases, 60.9%), prolonged QTc interval (37 cases, 53.6%), electrolyte disturbances (20 cases, 29.0%), and blood system damage (20 cases, 29.0%). In the 37 patients who experienced prolonged QTc interval, there were 8 patients with QTc intervals≥500 ms and 29 patients with QTc intervals ≥450 ms and <500 ms, with a median occurrence time of 16.0 weeks, among whom 25 patients experienced prolonged QTc interval in 4-48 weeks after the withdrawal of bedaquiline. Conclusion The negative conversion rate of tuberculosis sputum culture of patients with MDR-TB treated by bedaquiline combined with other anti- tuberculosis drugs is high, but electrocardiogram should be closely monitored during and after the treatment in order to guard against the potential cardiac toxic effects of bedaquiline.
Objective To assess the efficacy of lamivudine in patients with HBeAg positive chronic hepatitis B.Methods MEDLINE, SCI, Current Content Connect, The Cochrane Library, and Chinese Biomedical Database were searched from the beginning to September 2005, and the references of eligible studies were manually screened. R.andomized controlled trials comparing lamivudine with non-antiviral interventions （ placebo, no treatment and standard care ） in patients with chronic hepatitis B were eligible for inclusion. Two investigators independently assessed the quality and extracted the data. Heterogeneity was examined by Chi-square test. Fixed and random effect meta-analysis were used to pool the data. Subgroup analyses were used in treatment course. Results Eleven R.CTs were included （ n = 1 237 ）. All reported the effect of lamivudine （100 mg/d） , and one of them included lamivudine （25 mg/d）. The treatment duration of 52 weeks and less than 26 weeks were reported in eight and three RCTs, respectively. Six RCTs adequately applied randomization, while other five RCTs were not reported in detail. Four RCTs adequately enforced allocation concealment, five RCTs enforced blinding bitterly. The others were not reported in detail. It was found by meta-analysis that, compared with the control, lamivudine （100 mg/d, 52 W） could significantly clear HBeAg [42.6% vs. 13% , RR 3.20, 95% CI （2.33, 4. 38）] and clearHBVDNA [71.78% vs. 20, 36%, RR3.42, 95%CI （2.80,4.19）], normalize ALT [65% vs. 34.9%, RR1.91, 95%CI （1.64,2.21）], achieve HBeAgseroconversion [16.1% vs. 7.29% , RR2.12, 95%CI （1.24,3.80） ] and histology response [57. 9% vs. 26.2%, RR 2. 17, 95% CI （ 1.67,2.81 ） ] ; Lanfivudine （100 mg/ d, 12 W） could effectively clear HBV DNA [ 50.7% vs 3.92% , RR 8.68, 95% CI （1.72,43.74 ） ] , but was not effective in loss of HBeAg, HBeAg seroconversion and normalization of ALT, Lamivudine （25 mg/d） could effectively clear HBV DNA [97.7% vs. 22.2% , RR 4.41, 95% CI （2.86,6.79） ] and improve histology response [59.3% vs. 30% , RR1.98, 95% CI （1.31,2.99 ） ], but was not effective in HBeAg seroconversion. Conclusions Lamivudine （100 mg/ d） is effective in clearing HBV DNA and HBeAg, normalizing ALT and achieving HBeAg seroconversion.
Objective To describe the design and application of an emergency response mobile phone-based information system for infectious disease reporting. Methods Software engineering and business modeling were used to design and develope the emergency response mobile phone-based information system for infectious disease reporting. Results Seven days after the initiation of the reporting system, the reporting rate in the earthquake zone reached the level of the same period in 2007, using the mobile phone-based information system. Surveillance of the weekly report on morbidity in the earthquake zone after the initiation of the mobile phone reporting system showed the same trend as the previous three years. Conclusion The emergency response mobile phone-based information system for infectious disease reporting was an effective solution to transmit urgently needed reports and manage communicable disease surveillance information. This assured the consistency of disease surveillance and facilitated sensitive, accurate, and timely disease surveillance. It is an important backup for the internet-based direct reporting system for communicable disease.
【摘要】目的介紹華西醫院支援西部地區衛生工程項目的實踐和成效。方法過去5年間，華西醫院響應國家號召，通過各種幫扶形式，開展了一系列對口支援活動。結果華西醫院利用自身的資源優勢，通過各種幫扶形式，提高基層醫院的醫療救治水平和綜合服務能力，為建立城市支援農村衛生工作的長效機制進行了積極的實踐和探索，取得顯著成效。結論基層衛生事業與人民健康需求和現代醫學進步存在著相當的差距，醫療體制改革對部屬部管醫院的對口支援提出了更高的要求，對口支援的許多細節還需要我們去進一步完善。【Abstract】Objective To introduce the practice and progress of the supportive rural hygiene program of West China Hospital. Methods In the past five years, West China Hospital had made a lot of supportive rural hygiene practice. Results West China Hospital made good use of its own advantages in resources to develop the treatment level and the comprehensive service capability of primary hospital. West China Hospital did a lot of practice to establish the effective system of assistance of city medical care to rural areas, and had already achieved remarkable effects. Conclusionre is a lot of disparity between the basic public health or the requirement of people and the modern medicine progress. Many details for support should be further consummated.
ObjectiveTo analysis the situation of health management service project for patients with hypertension in basic public health service project of Sichuan province from 2015 to 2016, and to provide enhancing suggestions for community prevention of hypertension.MethodsA total of 42 health clinics or community health service centers, 21 counties and 21 cities were extracted each year by method of multistage stratified random sampling from 2015 to 2016. In each institution, we sampled 10 residents, health records of hypertension. Telephone survey was used to judge the accuracy and standard ability of services the patients received according to the national basic public health service specifications, such as personal information, physical examing records, follow up information.The blood pressure of the last follow-up was recorded.ResultsRate of the managed hypertension was from 42.09% to 40.31% (χ2=115.33, P<0.05), rate of the records with accurate information was from 84.29% to 88.79% (χ2=1.94, P=0.16), and rate of the patients received normative services was from 69.49% to 72.33% (χ2=0.54, P=0.57). The control rate of blood pressure was from 82.66% to 85.37% (χ2=0.52, P=0.48). The standardization of the service could obviously improve blood pressure control rates (χ2=22.61, P<0.05).ConclusionProgress has been achieved in health management service of hypertension in Sichuan province from 2015 to 2016, however the standardization of the service is needed to be further enhanced.
Objective To assess the effectiveness and safety of photodynamic therapy (PDT) for patients with nonresectable bile duct cancer. Methods Two reviewers independently searched The Cochrane Library (issue 4, 2006), MEDLINE (1966 to February 2007), CNKI (1994 to February 2007) and VIP (1989 to February 2007), respectively. The quality of included studies was assessed according to the guidance in the Cochrane Handbook of Systematic Reviews of Interventions. Results Two randomized controlled trials involving 71 patients with nonresectable bile duct cancer met the inclusion criteria and were included. Both of these trials reported that the median survival time in patients who were treated with endoprostheses and PDT was longer than for those treated with endoprostheses alone (493 days versus 98 days, and 21 months versus 7 months, in the two trials respectively) One trial reported that the global quality of life in patients in the PDT with endoprostheses group was significantly better than that for the endoprostheses alone group: the difference of Karnofshy index between the two groups was 25.4 (14.4-36.3). The other trial reported no difference between the two groups. No severe adverse effects were observed during either trial. Conclusion Current evidence demonstrates that PDT can improve the survival time of patients with nonresectable bile duct cancer, and reduce the burden of treatment. The treatment might increase biliary infectious rate, but this can be managed by antibiotics therapy. No severe adverse effects are observed. More randomized controlled trials, with large sample sizes, may lead to more accurate results.
To investigate the effectiveness of T-locking plate in treating medial clavicle fracture so as to find out a therapy with safety and stabil ity. Methods Between October 2006 and January 2009, 13 patients with medial clavicle fracture were treated with open reduction and T-locking plate fixation. There were 9 males and 4 females, aged 18-68 years (mean, 47 years), including 7 cases of traffic accident injury, 4 cases of fall ing injury from height, and 2 cases of heavy object hit injury. The locations were left side in 5 cases and right side in 8 cases. All cases were closed fracture. The disease duration was 1 hour to 14 days. Results All incisions healed by first intention after operation. The X-ray films showed good reduction of fracture and internal fixation. All the 13 patients were followed up 12-18 months (mean, 15 months). The average fracture heal ing duration was 8 weeks (range, 6-12 weeks). No compl ication of infection, nerve or blood vessel injury, hemopneumothorax, or internal fixation loosening or failure occurred. The anatomical medial clavicle structure as well asappearances and functions were restored. According to Rockwood’s score method, the results were excellent in 11 cases and good in 2 cases. Conclusion The internal fixation of T-locking plate in treating medial clavicle fracture has the advantages of good stabil ity and low risk. Besides, the patients can do functional exercises early and the shoulder joint function can be improved in great degree.
Objective To systematically review the psychological resilience intervention in China, so as to evaluate its effectiveness. Methods Studies published as of October 2012 were searched in CBM, VIP, CNKI and WanFang Data. The randomized controlled trials (RCTs) and controlled before-and-after trials (CBAs) about psychological resilience intervention were included. Two reviewers independently performed screening, quality assessment and data extraction, and then reached a consensus after cross-check and discussion. Qualitative synthesis was adopted instead of meta-analysis for the existed significant deviations in outcomes of included studies. Results A total of 8 studies including 3 RCTs and 5 CBAs were included for the analysis. All the studies referred to the objects of students, including 6 for college students, 1 for secondary school students and 1 for left behind students in rural junior school. All 8 studies evaluated the effectiveness of group psychological guidance, 1 of which also compared the outcomes of psychological lectures. All the included trials suggested that group psychological guidance and psychological lectures might significantly improve the psychological resilience of subjects. Conclusion Current studies on psychological resilience intervention are limited, the measure has been taken seems relatively single, which mainly focuses on students and lacks of high-quality research design. It suggests take more diverse psychological resilience interventions for different population, and evaluate both short-term and long-term effectiveness by performing large sample, strictly designed and high-quality trials.
Time-to-event outcomes are a key component in survival analyses. Effect modification by time, also known as interaction between effect and time, can exist in time-to-event data and influence the analysis process. Our objective is to discuss the proper methods to conduct evidence synthesis of time-to-event data when effect modification by time exists.
Objectives To evaluate the effectiveness of different antidepressant drugs in addition to standard clinical care in the prevention of postnatal depression. To compare the effectiveness of different antidepressant drugs and with any other form of intervention for postnatal depression i.e. hormonal, psychological or social support. To assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant.Methods The register of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group.Randomised studies of antidepressants alone or in combination with another treatment, compared with placebo or a psychosocial intervention in non-depressed pregnant women or women who had given birth in the previous six weeks (i.e. women at risk of postnatal depression). Data were extracted independently from the trial reports by the authors.Missing information was requested from investigators wherever possible. Data were sought to allow an intention to treat analysis.Results Two trials fullled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression.Nortriptyline (n=26) did not show any benefit over placebo (n=25). Sertraline (n=14) reduced the recurrence of postnatal depression and the time to recurrence when compared with placebo (n=8). Intention to treat analyses were not carried out in either trial.Conclusions It is not possible to draw any clear conclusions about the effectiveness of antidepressants given immediately postpartum in preventing postnatal depression and, therefore, cannot be recommended for prophylaxis of postnatal depression, due to the lack of clear evidence. Larger trials are needed which also include comparisons of antidepressant drugs with other prophylactic treatments to reect clinical practice, and examine adverse effects for the foetus and infant, as well as assess womens’ attitudes to the use of antidepressants at this time.
