Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports

BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.

Transarterial Chemoembolization Combined with Apatinib for Treatment of Advanced Hepatocellular Carcinoma:Analysis of Survival and Prognostic Factors

Objective Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2.The goal of this study was to evaluate overall survival(OS)after a combination of transarterial chemoembolization(TACE)and apatinib in patients with advanced hepatocellular carcinoma(HCC)and to identify the factors affecting patient survival.Methods Fifty-one patients with advanced HCC who received TACE in combination with apatinib in our hospital from June 2015 to May 2017 were enrolled.The OS and progression-free survival(PFS)were calculated using the Kaplan-Meier method.The log-rank test and Cox regression model were used to determine the factors affecting OS.Results The median OS and PFS of the patients were 15 months and 10 months,respectively.The 1-,2-,and 3-year survival rates were 64.7%,23.5%,and 1.8%,respectively.Univariate survival analysis showed that patients with Child-Pugh A(P=0.006),reduction rate of proper hepatic artery(P=0.016),hand-foot syndrome(P=0.005),secondary hypertension(P=0.050),and without ascites(P=0.010)had a better OS.Multivariate analysis showed that hand-foot syndrome(P=0.014),secondary hypertension(P=0.017),and reduction rate of proper hepatic artery(P=0.025)were independent predictors of better OS.Conclusion TACE combined with apatinib is a promising treatment for advanced HCC.Hand-foot syndrome,secondary hypertension,and the reduction rate of proper hepatic artery were associated with a better OS.

正负故障子空间矩阵的故障辨识方法研究

故障子空间矩阵是基于主元分析故障辨识的常用方法。但常规的故障子空间矩阵仅能描述当故障发生时哪些变量偏离了它们的正常值。当两种故障类型具有相同的故障变量时,故障子空间矩阵不能将它们区分。为了进一步提高故障子空间矩阵的辨识能力,本文提出正负故障子空间矩阵法。新方法不仅揭示了故障变量,并且可以反映变量的变化趋势,这使得故障子空间矩阵所代表的故障类型更加具体。首先,以监测统计量最小为优化目标求出各种故障状态下变量的幅值向量。其次,通过幅值向量求出变量的重构值和符号矩阵。然后,根据重构贡献率最小找到对应的故障子空间矩阵,并将该矩阵与符号矩阵相乘得到正负故障子空间矩阵。最后,根据有方向故障子空间矩阵完成故障辨识。通过对翻车机液压系统的故障辨识结果证明该方法具有较高准确性和普适性。

Type II Abernethy malformation with cystic fibrosis in a 12-year-old girl:A case report

BACKGROUND Abernethy malformation,also known as congenital extrahepatic portosystemic shunt,is an uncommon malformation resulting from aberrant development of the portal venous system.Cystic fibrosis(CF)is an autosomal recessive genetic disease caused by mutations in the CFTR gene.It mainly affects the exocrine glands of the respiratory,digestive and reproductive systems.It is considered extremely rare in the Asian population.We present a clinical case involving a pediatric patient of Asian descent who was diagnosed with Abernethy malformation and CF.CASE SUMMARY A 12-year-old girl presented with a medical history of recurring respiratory infections and hemoptysis,and chest computed tomography(CT)showed bronchiectasis.Whole exome sequencing was performed for the patient,yielding findings that revealed a compound heterozygous variant of the CFTR gene:c.233_c.234insT/p.Trp79fsTer3(maternal origin);c.2909G>A/p.Gly970Asp(paternal origin).CF was diagnosed.The physician’s attention was drawn to the presence of splenomegaly during disease progression.Abdominal enhanced CT revealed splenomegaly,compression of the left kidney,and multiple tortuous dilated vascular shadows were seen at the splenic hilum,which flowed back into the left renal vein and portal vein,suggesting Abernethy malformation type II.Intraoperatively,the abnormal blood flow was seen to merge into the inferior vena cava through the left renal vein without hepatic processing,and the pathology of liver biopsy showed hypoplastic,dilated or absent portal vein branches,both of which supported the diagnosis of Abernethy malformation type II.This represents the initial documented instance of Abernethy malformation accompanied by a CFTR gene mutation in the existing body of literature.CONCLUSION Coexisting Abernethy malformation and CF are rare.Detailed medical history information,abdominal enhanced CT,venography and genetic testing contribute to diagnosis as well as differential diagnosis.

Bedaquiline-containing regimens in patients with pulmonary multidrug-resistant tuberculosis in China:focus on the safety

Background:World Health Organization recommends countries introducing new drug and short treatment regimen for drug resistant tuberculosis(DR-TB)should develop and implement a system for active pharmacovigilance that allows for detection,reporting and management of adverse events.The aim of the study is to evaluate the frequency and severity of adverse events(AEs)of bedaquiline-containing regimen in a cohort of Chinese patients with multidrug-resistant(MDR)/extensively drug-resistant(XDR)-TB based on active drug safety monitoring(aDSM)system of New Drug Introduction and Protection Program(NDIP).

可变形微区增强丁苯橡胶及其机理

基于丁腈橡胶中腈基与金属离子的配位作用,设计了一种全新的含可变形微区的橡胶,即金属配位交联丁腈橡胶(NBR)作为可变形微区增强丁苯橡胶.随着可变形微区中配位键含量的提升,橡胶的强度和模量快速提高.引入20 wt%的丁腈橡胶,丁苯橡胶的强度和模量分别提升2.6倍和3.2倍.这一体系的增强机理主要是金属配位交联NBR作为强但可变形微区,一方面模量更高的微区由于流体力学效应,使得橡胶整体模量提高;另一方面,在外力作用下,应力通过强的界面相互作用传递到微区,致使其在样品断裂之前发生强迫高弹形变,耗散机械能,从而显著增强橡胶.微区中强迫高弹形变可通过高温松弛回复,从而恢复力学性能.本工作为通过可变形微区的设计实现非极性橡胶的增强提供了一种新途径.

The effectiveness of E-learning in continuing medical education for tuberculosis health workers: a quasi-experiment from China

Background:Given the context of rapid technological cha nge and COIVD-19 pan demies,E-lear ning may provide a unique opportunity for addressing the challenges in traditional face-to-face continuing medical education(CME).However,the effectiveness of E-learning in CME interventions remains unclear.This study aims to evaluate whether E-learning training program can improve TB health personnel's knowledge and behaviour in China.

Process evaluation of E-learning in continuing medical education:evidence from the China-Gates Foundation Tuberculosis Control Program

Background:E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education(CME).The China-Gates Foundation Tuberculosis(TB)Control Program implemented online training forTB health workers in three provinces of China.We aim to evaluate the implementation of E-learning CME programs,analyse the barriers and facilitators during the implementation process,and to provide policy recommendations.