广州市医务工作者对医疗卫生体制改革评价调查分析

通过问卷调查和访谈法，调查分析广州市医务工作者对卫生体制改革的认可程度和总体评价，得出的结论为：卫生体制改革为卫生工作者自身发展和卫生事业的发展创造了条件，但是，医患关系紧张正在影响和阻碍卫生事业的进一步发展。深化广州市卫生体制改革的重点和难点在于调整医患关系，建立和健全全民医疗保障体系。     

Neoadjuvant Chemotherapy With mFOLFOXIRI Without Routine Use of Radiotherapy for Locally Advanced Rectal Cancer

IntroductionAlthough neoadjuvant chemo-radiotherapy (CRT) achieves low local recurrence rates in locally advanced rectal cancer (LARC), it raises a lot of concerns about long-term anal and sexual functions. We explored the efficacy of preoperative chemotherapy with mFOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin, and irinotecan) in patients with LARC.Patients and MethodsPatients with LARC evaluated by pelvic magnetic resonance imaging (MRI) were enrolled in this trial. All received 4 to 6 cycles of mFOLFOXIRI. MRI was performed to assess clinical response after chemotherapy. Patients with mesorectal fascia-positive or ycT4a/b after re-evaluation would receive radiation before surgery, whereas responders would have immediate total mesorectal excision (TME). Adjuvant chemotherapy with mFOLFOX6 (folinic acid, 5-fluorouracil, and oxaliplatin) was recommended. The primary endpoint was the proportion of tumor downstaging to ypT_0-2N₀M₀. The secondary endpoints were pathologic complete response rate (pCR), 3-year disease-free survival rate, and safety.ResultsOverall, 106 patients were enrolled and received neoadjuvant mFOLFOXIRI chemotherapy. A total of 103 participants underwent TME surgery. Among 103 patients who completed at least 4 cycles of preoperative chemotherapy, 2 received short-term radiation before TME, and 12 underwent long-term CRT after MRI evaluation. The pCR rate was 20.4%, and the tumor downstaging rate was 42.7%. Among patients without preoperative long-term radiotherapy, the pCR rate and tumor downstaging rate were 17.4% and 41.3%, respectively. Among the per-protocol population, the tumor downstaging rate was 48.1%, and the pCR rate was 20.3%. The chemotherapy-related toxicity was well-tolerated.ConclusionNeoadjuvant chemotherapy with mFOLFOXIRI and selective radiation does not seem to compromise outcomes in LARC. It could be a reasonable alternative to CRT in previously untreated patients with LARC.     

Treatment Outcomes in Patients With Newly Diagnosed Multiple Myeloma Who Are Ineligible for Stem-Cell Transplantation: Systematic Review and Network Meta-analysis

Many new regimens have been applied to newly diagnosed transplant-ineligible multiple myeloma, but no head-to-head research has been performed to compare the efficacy of these treatments. Currently lenalidomide plus dexamethasone (Rd) is one of the standard treatments. Our aim was to make a comparison of these treatments to Rd by a network meta-analysis. We performed a systematic review and network meta-analysis. We searched PubMed, Embase, and the Cochrane Library for articles published from January 1, 1988, to April 26, 2018, as well as research presented at 5 international conferences (American Society of Clinical Oncology, American Society of Hematology, European Hematology Association, European Society of Medical Oncology, and International Myeloma Working Group) between January 2015 and December 2018. Our interest outcomes were hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Bayesian fixed-effects mixed-treatment comparisons were used for this study. A total of 23 articles describing 10,401 participants were included for this network meta-analysis. Lenalidomide and dexamethasone plus daratumumab (HR, 0.57; 95% credible interval [CrI], 0.43-0.73), daratumumab plus bortezomib, melphalan, and prednisone (HR, 0.59; 95% CrI, 0.36-0.91), and the combination of bortezomib with lenalidomide and dexamethasone (RVd) (HR, 0.72, 95% CrI, 0.56-0.90) all showed significant effect compared to Rd for PFS. RVd demonstrated significant benefit compared to Rd (HR, 0.72; 95% CrI, 0.53-0.96) for OS. Our study results suggested that lenalidomide and dexamethasone plus daratumumab; daratumumab plus bortezomib, melphalan, and prednisone; and RVd showed better efficacy than Rd in PFS; and RVd showed better efficacy than Rd in OS in patients with newly diagnosed transplant-ineligible multiple myeloma in the absence of head-to-head research.     

TRAF4 Promotes Fibroblast Proliferation in Keloids by Destabilizing p53 via Interacting with the Deubiquitinase USP10

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Effectiveness of Tongguan capsules on restenosis after coronary stent implantation: a randomised controlled trial

Background

Although percutaneous coronary intervention (PCI) has become a widely used therapeutic procedure for coronary artery disease, stent restenosis limits the benefits of this revascularisation. The question of how to prevent such events remains unresolved. Empirical evidence suggests that Tongguan capsules, a patented Chinese Medicine, can decrease frequency and duration of angina pectoris attacks; however, evidence supporting its efficacy on restenosis remains inadequate. We aimed to determine whether Tongguan capsules could reduce restenosis incidence in patients after successful stent implantation.

Mapping the HIV and syphilis epidemic and sexual behaviours in men who have sex with men in China: a meta-analysis

Background

Data from national HIV sentinel surveillance are limited for men who have sex with men (MSM) about how geographical differences and sexual behaviours in this population are associated with prevalence of HIV infection in China. Through mapping, we aimed to clarify the pattern of HIV infections in different regions by conducting a spatiotemporal meta-analysis.

Blood pressure at early pregnancy and gestational hypertensive disorders: a prospective cohort study in China

Background

Gestational hypertension and pre-eclampsia are major causes of perinatal mortality. Prediction of gestational hypertension and pre-eclampsia is of great interest because it enables early intervention, thus improving prognosis. Most existing prediction models consist of biomarkers, which might be unavailable in low-resourced countries. We aimed to establish a prediction model of gestational hypertension and pre-eclampsia using data at early pregnancy.

Thrombocytopenia as a Prognostic Marker for Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

BackgroundSystemic lupus erythematosus (SLE) patients often exhibit hematological abnormalities, but the role of thrombocytopenia on the prognosis of SLE shows inconsistent results. The purpose of this meta-analysis was to confirm the impact of thrombocytopenia on mortality and end organ damage in patients with SLE.Materials and MethodsThree electronic databases, PubMed, Embase and Cochrane library were systematically searched to identify the eligible studies from inception to November 2017 in order to evaluate the impact of thrombocytopenia on the prognosis of patients with SLE. The summary odds ratios (ORs) and 95% confidence intervals (CIs) were used to measure the impact of thrombocytopenia on mortality and end organ damage based on the random-effects model.ResultsA total of 8 studies that reported data on 2,158 patients with SLE were included. The summary OR indicated that SLE subjects with thrombocytopenia were significantly associated with an increased risk of mortality (OR: 4.57; 95% CI: 2.28-9.17; P < 0.001) and end-organ damage (OR: 3.31; 95% CI: 1.11-9.86; P = 0.031). Furthermore, the sensitivity analysis indicated stable mortality, while the result for end organ damage was variable. In addition, the patients with thrombocytopenia with disease duration <60 months presented a greater risk for mortality than those with disease duration ≥60.0 months (P = 0.002).ConclusionsPatients with SLE and thrombocytopenia were found to be associated with an increased risk of mortality and end organ damage.     

广州地区241例头癣及病原菌分布情况分析

目的 了解广州地区头癣及其病原菌分布情况。方法 对1997年2月至2010年8月在本院皮肤科诊治的241例头癣患者资料进行回顾性分析。结果 241例头癣患者中白癣179例占74.27%,脓癣34例占14.11%,黑点癣28例占11.62%,未发现黄癣。病原菌中犬小孢子菌182株占80.89%,紫色毛癣菌25株占11.11%,须毛癣菌10株占4.44%,断发毛癣菌3株占1.33%,红色毛癣菌2株占0.89%,石膏样小孢子菌2株占0.89%,疣状毛癣菌1株占0.44%。患者年龄段分层分析结果显示,主要感染人群为学龄前儿童占39.00%。结论 广州地区头癣中白癣所占比例最高;犬小孢子菌为头癣患者的主要致病菌;主要感染人群为学龄前儿童。