Objective To systematically review the correlation between CYP3A5 genotypes and blood levels of tacrolimus (FK506) in renal transplant recipients. Methods Such databases as PubMed (January 1966 to July 2013), Sciverse (January 1823 to July 2013), The Cochrane Library (Issue 7, 2013), CNKI (January 1994 to July 2013), VIP (January 1989 to July 2013), CBM (January 1978 to July 2013) and WanFang Data (January 1995 to July 2013) were electronically searched for studies about the correlation between CYP3A5 genotypes and FK506 (blood concentration/dose-respones relationship) in renal transplant recipients. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 12 articles involving 956 patients were included. The results of meta-analysis showed that, after renal transplantation, there was a high dose-adjusted concentration of CYP3A5 3/3 carriers on the 7th day (MD= 54.61, 95%CI –67.67 to –41.54, Plt;0.000 01), in the 1st month (MD= –74.84, 95%CI –83.39 to –66.29, Plt;0.000 01), in the 3rd month (MD= –96.09, 95%CI –107.55 to –84.64, Plt;0.000 01), in the 6th month (MD= –107.30, 95%CI –125.65 to –88.95, Plt;0.000 01), and in the 1st year (MD= –78.32, 95%CI –123.02 to –33.61, P=0.000 6). The dose-adjusted concentration of FK506 in CYP3A5 3/3 patients was higher than the other genotypes, while the dose-adjusted concentration of FK506 in CYP3A5 1/1 patients was low. Conclusion The blood concentration as well as dose-respones relationship of FK506 are associated with CYP3A5 genotype in renal transplant recipients. We propose that patients with renal transplantation should receive CYP3A5 genotypes test to determine the use of FK506 as an immunosuppressant, so as to guide its clinical application.
Objective To investigate the performance of Essential Medicine List (EML) policy over the past one year in Xintian Township Health Center (XTHC), so as to provide references for the delivery, storage and compensation mechanism of essential medicine for township hospitals. Methods Focus interview combined with a questionnaire was carried out to investigate the supply and usage of EML, the situation of both diagnosis-treatment services and the income-expenditure change before and after EML policy. Results a) It showed that there was an increasing trend with the preparation rate of EML from 62.2% before implementation to 87.3% after, and the proportion of EML income to total medicine expenses increased from 39.3% to 90.6% in XTHC. But problems still existed such as incomplete and old variety of medicine; b) The numbers of outpatient-time and inpatient-time kept growing, while medical cost for both average clinic cost and average hospitalization cost decreased to different extent; c) Although the gross income increased slightly, this center was still running in the red with the limited amount of financial assistance; and d) The proportion of medical care and drug kept decreasing while the proportion of drug cost and examination cost kept increasing. Compared with the situation in 2009, the proportion of examination cost from 2010 to 2011 had increased by 30%, and it still remained at the previous level after EML implementation. Conclusion The implementation of EML does not completely change the predicament of “Make compensation for doctors by selling drugs” in township health center. Owing to the sale policy of zero price difference and the poor performance of compensation for township health centers, XTHC is still running under deficit. Evidence-based medicine selection and research on compensation mechanism for underdeveloped areas are urgently needed.
Objective To introduce a method of preoperative three-dimensional measurement by echocardiography to guide the surgical resection of hypertrophic obstructive cardiomyopathy (HOCM) and its long-term follow-up effect. MethodsBefore operation, each patient underwent transthoracic echocardiography to measure the length, width and thickness of diastolic ventricular septum hypertrophy on the long axis, short axis and four chamber sections, in order to establish three-dimensional measurement data of myocardial hypertrophy, and quantitatively estimate the location, depth and range of myocardium to be removed between 2014 and 2022 in our hospital. According to the quantitative data during operation, the hypertrophic myocardium of ventricular septum was resected to dredge the left ventricular outflow tract. ResultsForty-three patients were recruited, including 22 males and 21 females, aged 18-78 (49.2±5.1) years. Eighteen patietns underwent mitral valve surgery at the same time. All patients were satisfied with the relief of left ventricular outflow tract obstruction. Postoperative transesophageal echocardiography showed that the left ventricular outflow tract pressure gradient decreased significantly (94.2±28.1 mm Hg vs. 6.7±4.7 mm Hg, P<0.05). There was no ventricular septal perforation or complete atrioventricular block during the operation, and no one needed a secondary aorta-clamp for re-operation to remove hypertrophic myocardium again. Postoperative echocardiography showed that the mitral valve closed well or only had mild regurgitation, and the mitral systolic anterior motion sign basically disappeared. After 1.0-8.5 years of follow-up, the average pressure difference of left ventricular outflow tract remained below 10 mm Hg, and the clinical symptoms disappeared or improved significantly. Conclusion The quantitative prediction of the resection range of hypertrophic myocardium by three-dimensional measurement of preoperative echocardiography can accurately guide the surgical range of HOCM, avoid multiple blocking of aorta during operation, relieve left ventricular outflow tract obstruction to the greatest extent, and obtain better long-term results.
Objective To systematically review the efficacy of long-acting antibacterial material in the prevention of secondary urinary infection. Methods PubMed, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of long-acting antibacterial material in the prevention of secondary urinary infection from inception to November, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 16 RCTs were included. The results of meta-analysis showed that: the long-acting antibacterial material group was superior to the general intervention group in morbidity of secondary urinary infection (Peto OR=0.17, 95%CI 0.13 to 0.23, P<0.000 01), and bacterial positive rate of secondary urinary infection (Peto OR=0.15, 95%CI 0.08 to 0.27,P<0.000 01). Conclusion Current evidence shows that long-acting antibacterial material can effectively reduce the infection rates of secondary urinary infection. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.