传染病防治药品遴选评价指标体系的构建

目的构建传染病防治药品遴选评价指标体系。方法在文献研究的基础上,运用德尔菲法邀请相关领域20名专家进行咨询,对咨询结果进行分析,建立指标体系。结果两轮专家咨询的专家积极系数均为100%;专家权威系数分别为0.82,0.85;专家协调系数分别为0.476,0.578(P<0.05);最终构建的指标体系包括5个一级指标、25个二级指标,一级指标及其权重分别为有效性(0.3184)、安全性(0.2658)、创新性(0.0579)、可及性(0.1316)、适宜性(0.2263)。结论采用德尔菲法构建的传染病防治药品遴选评价指标体系专家的集中程度和协调程度高,可为传染病防治药品的遴选提供参考依据。

Strategy and technology to prevent hospital-acquired infections:Lessons from SARS,Ebola,and MERS in Asia and West Africa

Hospital-acquired infections(HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome(MERS), and severe acute respiratory syndrome(SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.

Prediction and prophylaxis of hepatocellular carcinoma occurrence and postoperative recurrence in chronic hepatitis B virus-infected subjects

Hepatocellular carcinoma(HCC) is one of the most common and highly fatal malignancies worldwide. Chronic infection with hepatitis B virus(HBV) is a major cause of HCC. High HBV replication rate and related non-resolving inflammation are the major risk factors of HCC occurrence and postoperative recurrence. Early prophylactic options are effective in reducing HCC occurrence and improving survival. Therefore, it is important to identify HBV-infected patients who are at a higher risk of developing HCC and HBV-HCC patients who are more likely to relapse after surgery, thus providing them with more precise prophylactic strategies. Several prediction models of HCC occurrence have been constructed, with satisfactory predictive accuracy and discriminatory ability. However, there is a lack of consensus for their clinical implementation. Several staging systems have been proposed for HCC prognosis. However, the accuracy of these staging systems based on demographic characteristics and clinical measurements needs to be further improved, possibly by systematically incorporating viral and inflammatory factors. Since antiviral treatments are effective in promoting liver function reserve, reducing HCC occurrence and prolonging postoperative survival in some HBV-infected subjects, it is very important to identify subgroups of HBV-infected patients who would most benefit from antiviral treatment.

The role of hazard vulnerability assessments in disaster preparedness and prevention in China

China is prone to disasters and escalating disaster losses. Effective disaster mitigation is the foundation for efficient disaster response and rescue and for reducing the degree of hazardous impacts on the population. Vulnerability refers to the population's capacity to anticipate, cope with, and recover from the impact of a hazardous event. A hazard vulnerability assessment(HVA) systematically evaluates the damage that could be caused by a potential disaster, the severity of the impact, and the available medical resources during a disaster to reduce population vulnerability and increase the capacity to cope with disasters. In this article, we summarized HVA team membership, content(disaster identification, probability and consequences), and methods and procedures for an HVA that can be tailored to China's needs. We further discussed the role of epidemiology in an HVA. Disaster epidemiology studies the underlying causes of disasters to achieve effective disaster prevention and reduction. In addition, we made several recommendations that are already in practice in developed countries, such as the U.S., for future implementation in China and other developing countries. An effective HVA plan is crucial for successful disaster preparedness, response, and recovery.

Increased circulating level of interleukin-6 and CD8+T cell exhaustion are associated with progression of COVID-19

Background: Coronavirus disease 2019(COVID-19)is pandemic.It is critical to identify COVID-19 patients who are most likely to develop a severe disease.This study was designed to determine the clinical and epidemiological features of COVID-19 patients associated with the development of pneumonia and factors associated with disease progression.Methods:: Seventy consecutive patients with etiologically confirmed COVID-19 admitted to PLA General Hospital in Beijing,China from December 27,2019 to March 12,2020 were enrolled in this study and followed-up to March 16,2020.Differences in clinical and laboratory findings between COVID-19 patients with pneumonia and those without were determined by theχ2 test or the Fisher exact test(categorical variables)and independent group t test or Mann–Whitney U test(continuous variables).The Cox proportional hazard model and Generalized Estimating Equations were applied to evaluate factors that predicted the progression of COVID-19.Results: The mean incubation was 8.67(95%confidence interval,6.78–10.56)days.Mean duration from the first test severe acute respiratory syndrome coronavirus 2-positive to conversion was 11.38(9.86–12.90)days.Compared to pneumonia-free patients,pneumonia patients were 16.5 years older and had higher frequencies of having hypertension,fever,and cough and higher circulating levels of neutrophil proportion,interleukin-6,low count(<190/µl)of CD8+T cells,and neutrophil/lymphocyte ratio.Thirteen patients deteriorated during hospitalization.Cox regression analysis indicated that older age and higher serum levels of interleukin-6,C-reactive protein,procalcitonin,and lactate at admission significantly predicted the progression of COVID-19.During hospitalization,circulating counts of T lymphocytes,CD4+T cells,and CD8+T cells were lower,whereas neutrophil proportion,neutrophil/lymphocyte ratio,and the circulating levels of interleukin-6,C-reactive protein,and procalcitonin were higher,in pneumonia patients than in pneumonia-free patients.CD8+lymphocyte count in pneumonia patients did not recover when discharged.Conclusions: Older age and higher levels of C-reactive protein,procalcitionin,interleukin-6,and lactate might predict COVID-19 progression.T lymphocyte,especially CD8+cell-mediated immunity is critical in recovery of COVID-19.This study may help in predicting disease progression and designing immunotherapy for COVID-19.