不同生产厂家的同种抗菌药物临床疗效的比较

目的:通过比较不同生产厂家的同种抗菌药物的临床疗效的差异,以探讨初步建立国家基本药品零售价格和疗效之间的数学模型。方法:选取本院2013年7月-2014年3月期间社区获得性肺炎(CAP)患者150例,采用简单随机数学表法将患者分为两组,每组各75例。治疗组在常规治疗方案基础上采用头孢曲松(赛扶欣),对照组在常规治疗方案基础上采用头孢曲松(泛生舒复),比较两组患者达到同等疗效时的治疗时间(等疗效时间)、药物不良反应率、治疗费用、住院时间、退热时间的差异。结果:两组患者在治疗总有效率、等疗效时间、住院时间、退热时间方面比较差异均无统计学意义(P>0.05);治疗组治疗费用明显低于对照组,比较差异有统计学意义(P<0.05);治疗组药物不良反应率明显高于对照组,比较差异有统计学意义(P<0.05)。结论:赛扶欣与泛生舒复治疗CAP患者的临床疗效相近,但赛扶欣用于CAP治疗费用较低,但治疗期间出现的药物不良反应发生风险较高。

Effect of b value on monitoring therapeutic response by diffusion-weighted imaging

AIM： To explore the diffusion gradient b-factor that optimizes both apparent diffusion coefficient （ADC） measurement and contrast-to-noise （CNR） for assessing tumor response to transarterial chemoembolization （TACE） in a rabbit model. METHODS： Twelve New Zealand white rabbits bearing VX2 tumors in the liver were treated with TACE. Diffusion-weighted imaging （DWI） with various b values was performed using the same protocol before and 3 d after treatment with TACE. ADC values and CNR of each tumor pre- and post-treatment with different b factors were analyzed. Correlation between ADC values and extent of necrosis in histological specimens was analyzed by a Pearson＇s correlation test.RESULTS： The quality of diffusion-weighted images diminished as the b value increased. A substantial decrease in the mean lesion-to-liver CNR was observed on both pre- and post-treatment DW images, the largest difference in CNR pre- and post-treatment was manifested at a b value of 1000 s/mm^2 （P = 0.036 ）. The effect of therapy on diffusion early after treatment was shown by a significant increase in ADCs （P = 0.007）, especially with large b factors （≥ 600 s/mm^2）. The mean percentage of necrotic cells present within the tumor was 76.3%-97.5%. A significant positive correlation was found between ADC values and the extent of necrosis with all b values except for b200, a higher relative coefficient between ADC values and percentage of necrosis was found on DWI with bl000 and b2000 （P = 0.002 and 0.006, respectively）. CONCLUSION： An increasing b value of up to 600 s/mm^2 would increase ADC contrast pre- and post-treatment, but decrease image quality. Taking into account both CNR and ADC measurement, diffusion-weighted imaging obtained with a b value of 1000 s/mm^2 is recommended for monitoring early hepatic tumor response to TACE.

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM:To evaluate the effect of prokinetic drugs on electrogastrography(EGG) parameters according to symptomatic changes in patients with functional dyspepsia(FD).METHODS:Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010.We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment.We also measured cutaneous pre-prandial and postprandial EGG recordings including percentage of gastric waves(normogastria,bradygastria,tachygastria),dominant frequency(DF),dominant power(DP),dominant frequency instability coefficient(DFIC),dominant power instability coefficient(DPIC),and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.RESULTS:Fifty-two patients(70%) achieved symptomatic improvement after prokinetic drug treatment.Patients who had normal gastric slow waves showed symptom improvement group after treatment.Postprandial DF showed a downward trend in the symptom improvement group,especially in the itopride group.Post-prandial DP was increased regardless of symptom improvement,especially in the itopride group and mosapride group.Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment.The EGG power ratio was increased after treatment in the symptom improvement group(0.50 ± 0.70 vs 0.93 ± 1.77,P = 0.002),especially in the itopride and levosulpiride groups.CONCLUSION:Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity,and EGG could be a useful tool in evaluating the effects of various prokinetics.

Meta-analysis of mNGF therapy for peripheral nerve injury： a systematic review

Objective： To assess the efficacy and safety of mouse nerve growth factor （mNGF） in patients with peripheral nerve injury. Methods： Such electronic database as Cochrane Library （Issue 1,2011）, Medline （1950-2011）, Embase （1980- 2011）, National Knowledge Infrastructure （ 1979 -2011 ） were searched and meanwhile relevant journals such as Chinese Journal of Orthopaedics, Chinese Journal of Microsurgery, Chinese Journal of Neurosurgery, ere were searched as well to collect all randomized controlled trials and quasi-randomi- zed controlled trials of mNGF on patients with peripheral nerve injury. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions and the data were extracted by two reviewers independently. Meta- analysis was conducted by RevMan 5.1 software. Results： Forty-one studies involving 3 304 patients with peripheral nerve injury were included. The results of meta-analysis showed that： （1） the total effective rate ofperipheral nerve injury treatment in mNGF group was obviously higher than that in control group （OR=6.36, 95% C1 4.96-8.15, P〈0.01）; （2） the scores of activities of daily living （ADL） in mNGF group was significantly higher than that in control group （weighted mean difference=1.97, 95% CI 1.33- 2.61, P〈 0.0 l）; （3） the incidence of adverse reaction in mNGF group was higher than that in control group, （OR= 1.66, 95% CI 1.61-2.38, P=0.006）, but the adverse effects were mild, which could be relieved without specific treatment or just given symptomatic treatment, and disappeared at the end of treatment. Conclusions： The mNGF therapy is effective for peripheral nerve injury. It can obviously improve patient＇s ADL. Though the incidence of adverse reaction in mNGF treatment group is higher than that in control group, this does not influence the treatment outcomes.

Semiparametric estimation of average treatment effect through a random coefficient dummy endogenous variable model

This paper provides an estimation procedure for average treatment effect through a random coefficient dummy endogenous variable model. A leading example of the model is estimating the effect of a training program on earnings. The model is composed of two equations:an outcome equation and a decision equation.Given the linear restriction in outcome and decision equations,Chen(1999) provided a distribution-free estimation procedure under conditional symmetric error distributions. In this paper we extend Chen's estimator by relaxing the linear index into a nonparametric function,which greatly reduces the risk of model misspecification. A two-step approach is proposed:the first step uses a nonparametric regression estimator for the decision variable,and the second step uses an instrumental variables approach to estimate average treatment effect in the outcome equation. The proposed estimator is shown to be consistent and asymptotically normally distributed. Furthermore,we investigate the finite performance of our estimator by a Monte Carlo study and also use our estimator to study the return of college education in different periods of China. The estimates seem more reasonable than those of other commonly used estimators.

Study on the Drug Selection Law for Treatment of Chronic Gastritis with Spleen Deficiency and Stomach Dryness by Complex System Entropy Cluster

Objective:To study on Prof. GAO Zhong-ying’s drug selection law for treatment of chronic gastritis with data mining technique. Methods: The 407 medical records of chronic gastritis treated by Prof. GAO Zhong-ying were collected and the study on these drugs in the recipes was carried out with data mining method. Among them, the recipe composed of one drug was studied with frequency statistical method, correlativity between drug pairs with improved mutual information, correlativity among multi-drugs with complex system entropy cluster technique. Results: In treatment of chronic gastritis by Prof. GAO Zhong-ying there were 30 drugs with a higher use frequency of over 38 times, 94 commonly-used drug pairs with correlation coefficient of over 0.05, 11 commonly-used drug core combinations. Conclusion: The results attained with data mining technique for studying experience of famous and old TCM physicians conform to the clinical practice and the method is of an important significance for summarization of famous and old TCM physicians’ experiences.

Effects of Duhuojisheng Tang and combined therapies on prolapse of lumbar intervertebral disc:a systematic review of randomized control trails

OBJECTIVE： A systematic review of the literature was conducted to evaluate the curative effect and safety of Duhuojisheng Tang on prolapse of the lumbar intervertebral disc. METHODS： The databases of PubMed, China Na- tional Knowledge Infrastructure （CNKI）, Chinese Sci- entific Journals Database （VlP）, Chinese Biomedical Literature Database （CBM） and Chinese Medical Ci- tation Index （CMCl） were searched up to January 30, 2012. Randomized controlled trials were select- ed to compare Duhuojisheng Tang with one ormore of the following treatments： traction, acu- puncture, massage, cupping and Western medical treatment. The quality-evaluating standard and the software RevMan 5.1 in Cochrane coordinative net were used to analyze the data. The effective index- es of the results were clinical curative rate, effective- ness of alleviating clinical symptoms and adverse reaction. RESULTS： Thirty-one randomized controlled trials of low quality, involving 3915 patients were system- atically evaluated. Statistical analyses showed that good curative effect was achieved in both the group using Duhuojisheng Tang alone and with combined therapies. CONCLUSION： Using Duhuojisheng Tang alone or combined with other therapies can effectively im- prove pain, leg-raising height and other clinical symptoms of patients with prolapse of lumbar in- tervertebral disc. Due to low methodological quali- ty of the articles, no exact recommendations can be made.

Injections of ginkgo in the treatment of cerebral infarction: a systematic review and network Meta-analysis

OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/treated by GI were searched in China National Knowledge Infrastructure Database, Wanfang, China Science and Technology Journal Database, Web of Science, Cochrane library, Embase, PubMed and Chinese Biomedical Literature Database, with the publication data no later than April, 2016. The Co- chrane risk of bias method was used to evaluate the methodological quality of the RCTs. The data were analyzed by Review Manager 5.3, Stata 13.0, and WinBUGS 14 software.RESULTS： Totally 37 RCTs involving 4330 patients were included. By direct comparison, the results of GI group were significantly superior to the routine WM group in the total effective rates [OR = 3.61, 95% CI （2.93, 4.44）, P 〈 0.0001], the neural function defect score （NFDS） [MD = - 4.39, 95% CI （- 5.47, - 3.32）, P 〈 0.0001]. Network Meta-analysis （NMA） results showed that, between S GIs in efficacy, the difference comparing ginaton injections （GbE） to ginkgo-dipyidamolum injections （GD） [OR = 1.74, 95% CI （0.73, 3.65）], shuxuening injections （SXN） [OR = 1.06, 95% CI （0.609, 1.697）] or ginkgolides in- jections （GK） [OR = 4.711, 95% CI （1.178, 13.21）] reach statistical significance; the difference compar- ing GD to GK reach statistical significance [OR = 2.791, 95% CI （0.866, 6.908）]; the difference com- paring SXN to GK reach statistical significance [OR = 4.537, 95% CI （1.203, 12.41）]. Besides, there was no difference between 4 GIs in NFDS. Proba- bility ranking result showed a great possibility for GK [Surface under the Cumulative Ranking curve （SUCRA） = 80.3%] in improving the total effective rates, which were followed by GD （SUCRA = 73.34%）, SXN （SUCRA = 46.59%）, GbE （SUCRA = 45.46%）, floium ginkgo extract and tertram ethy- pyrazine sodium chloride injections （FT） （SU- CRA = 35.64%）. However, GK （SUCRA = 80.3%） or GbE （SUCRA = 69.4%） was better than other GIs in reducing NFDS.GK ＋ WM is the best treatment measures to reduce NFDS in cerebral infarction, which were followed by SXN ＋ WM （SUCRA = 51.6%）, GD ＋ WM （SUCRA = 48.1%）. CONCLUSION： GIs was more effectiveness on CI than the routine Western Medicine. But based on the limitations of the study, more high-quality ran- domized controlled trials will be necessary.

Traditional Chinese Medicine for the treatment of influenza: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE: To justify the clinical use of Traditional Chinese Medicine(TCM) in the treatment of influenza.METHODS: MEDLINE, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang Database and the Cochrane Database of Systematic Reviews were searched from thedate of inception until January 1,2013, for the literature on treatment of influenza with TCM.RESULTS: A total of 7 randomized controlled trials were identified and reviewed. Of these trials, 2 compared a(modified) prescription of TCM with oseltamivir and 5 compared a patent traditional Chinese drug with oseltamivir. Based on the Meta-analysis,compared to oseltamivir, the(modified) prescription had similar effect in defervescence [WMD=5.66, 95% CI(﹣32.02, 43.35), P=0.77] and viral shedding [WMD=﹣ 6.21, 95% CI(﹣84.19, 71.76), P=0.88], and the patent traditional Chinese drug also had similar effect in viral shedding [WMD=﹣ 0.24,95% CI(﹣4.79, 4.31), P=0.92] but more effective in defervescence [WMD=﹣4.65, 95%CI(﹣8.91, ﹣0.38),P=0.03].CONCLUSION: TCM has potential positive effects in the treatment of influenza.

Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux

OBJECTIVE:To assess the effectiveness and safety of Traditional Chinese Medicine(TCM) treatment of non-acute bronchial asthma complicated by gastroesophageal reflux.METHODS:We searched databases from MEDLINE,Cochrane Library,CNKI,VIP,CBM,Wanfang Data,and TCM Database Systems.All randomized,controlled trials(RTCs) of TCM treatment of non-acute asthma complicated by gastroesophageal reflux were included.Data were independently collected by two reviewers.The standards for assessing quality described in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate articles.Meta-analyses were conducted using RevMan 5.0.17 software.Heterogeneity was assessed,and a corresponding effects model was used to merge and analyze results.Indexes used to evalu-ate curative effects were:clinical efficacy,symptom scores,pulmonary function values,and adverse incidents.Effectiveness was indicated using risk ratio(RR) or mean difference(MD),and 95% confidence intervals(CIs) were calculated.RESULTS:Six RCTs were included,involving 304 patients with non-acute asthma complicated by gastroesophageal reflux.The treatment groups received Chinese drugs alone or TCM combined with standard Western medical treatment,and the control groups received standard Western medical treatment alone.Standard Western medical treatment included anti-inflammatory drugs and bronchodilators for asthma,and drugs to promote gastric peristalsis and inhibit gastric acid production for gastroesophageal reflux.Methodological quality was low in all six RCTs.Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group(RR:1.43,95%CI:1.10 to 1.87 vs RR:1.51,95% CI:1.09 to 2.08).One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group(MD:-1.10,95% CI:-2.04 to-0.16).Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group(RR:-3.70,95% CI:-4.30 to 3.10 vs RR:-5.30,95% CI:-6.32 to-4.28).One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group(P< 0.05).No differences were seen in the various indexes between groups in the other RCTs.No adverse reactions,dropout rates,or follow-up rates were reported in any of the RCTs.CONCLUSIONS:The clinical symptoms ofnon-acute asthma complicated by gastroesophageal reflux can be improved by some Chinese drugs.Curative effects can be increased by combining the use of TCM with Western medicine.Because of the small quantity and low quality of research reported to date,it is necessary to conduct further RCTs to confirm these results.The results of this systematic review indicate that the quality of future clinical trials should be improved by including larger patient numbers,correctly randomizing patients into study groups,using blinding methods to measure and assess outcomes,and using accepted indexes to evaluate curative effects.