AIM:To evaluates the effectiveness and safety of the first generation,NS3/4A protease inhibitors(PIs) in clinical practice against chronic C virus,especially in patients with advanced fibrosis. METHODS:Prospective stu...AIM:To evaluates the effectiveness and safety of the first generation,NS3/4A protease inhibitors(PIs) in clinical practice against chronic C virus,especially in patients with advanced fibrosis. METHODS:Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1,treatment-na?ve(TN) or treatment-experienced(TE),who underwent triple therapy with the first generation NS3/4A protease inhibitors,boceprevir(BOC) and telaprevir(TVR),in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up.RESULTS:One thousand and fifty seven patients were included,405(38%) were treated with BOC and 652(62%) with TVR. Of this total,30%(n = 319) were TN and the remaining were TE:28%(n = 298) relapsers,12%(n = 123) partial responders(PR),25%(n = 260) null-responders(NR) and for 5%(n = 57) with prior response unknown. The rate of sustained virologic response(SVR) by intention-to-treatment(ITT) was greater in those treated with TVR(65%) than in those treated with BOC(52%)(P < 0.0001),whereas by modified intention-to-treatment(m ITT) no were found significant differences. By degree of fibrosis,56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients,both TN and TE. In the analysis by groups,the TN patients treated with TVR by ITT showed a higher SVR(P = 0.005). However,by m ITT there were no significant differences between BOC and TVR. In the multivariate analysis by m ITT,the significant SVR factors were relapsers,IL28 B CC and non-F4; the type of treatment(BOC or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients,treated with BOC(46%) or with TVR(45%). 28% of the patients interrupted the treatment,mainly by non-viral response(51%):this outcome was more frequent in the TE than in the TN patients(57% vs 40%,P = 0.01). With respect to severe haematological disorders,neutropaenia was more likely to affect the patients treated with BOC(33% vs 20%,P ≤ 0.0001),and thrombocytopaenia and anaemia,the F4 patients(P = 0.000,P = 0.025,respectively). CONCLUSION:In a real clinical practice setting with a high proportion of patients with advanced fibrosis,effectiveness of first-generation PIs was high except for NR patients,with similar SVR rates being achieved by BOC and TVR.展开更多
The support elderly parents receive from their grown-up children and the care they provide for grandchildren reflect the intergenerational relationships in Chinese families.Using data on only-child families in urban C...The support elderly parents receive from their grown-up children and the care they provide for grandchildren reflect the intergenerational relationships in Chinese families.Using data on only-child families in urban China from a 2015 survey conducted by the Institute of Population and Labor Economics,Chinese Academy of Social Sciences,this paper studies the status of care provided for grandchildren by parents of first-generation only-child in urban China and considers the effects this support has on the elderly.The data shows that over 80%of only-children parents have cared for their grandchildren.Most only-children also provide support for their elderly parents.Care for grandchildren provided by grandparents increases the economic and housekeeping support for the elderly provided by only-children.Only-children are the main beneficiaries of the intergenerational support that comes from the care for grandchildren provided by elderly parents.If the elderly parents have adequate retirement income and have little or no need for financial support,such intergenerational support resembles“altruism”.However,if the elderly parents do not have adequate retirement income,the satisfaction of their needs depends on resources like time and money available to their only-children.展开更多
Background： It remains undetermined whether second-generation drug-eluting stents （G2-DESs） outperform first-generation DESs （G1-DESs） in patients with acute coronary syndrome （ACS）. We aimed to compare the eff...Background： It remains undetermined whether second-generation drug-eluting stents （G2-DESs） outperform first-generation DESs （G1-DESs） in patients with acute coronary syndrome （ACS）. We aimed to compare the efficacy and safety of G I-DES and G2-DES in ACS patients in a high-volume cardiovascular center. Methods： In 2013, 10,724 consecutive patients underwent percutaneous coronary intervention in our institution. We included 4037 patients with ACS who underwent exclusively GI-DES or G2-DES implantation （n - 364 and n - 3673, respectively）. We used propensity score matching to minimize the imbalance between the G1-DES and G2-DES groups and followed patients for 2 years. The efficacy endpoints were major adverse cardiac events （MACEs） and its components including target vessel-related myocardial infarction （TV-MI）, target vessel revascularization/target lesion revascularization （TVR/TLR）, and cardiac death. The safety endpoint was stent thrombosis. Continuous variables were compared by Mann-Whitney U-test, and categorical variables were compared using Pearson＇s Chisquare or Fisher＇s exact test. Kaplan-Meier curves were constructed to compare the event-free survival rates, and multivariate Cox proportional hazards regression analysis was used to assess whether stent type was an independent risk factor for the etticacy and safety endpoints. Results： At the 2-year lbllow-up, the results for MACE and it components, as well as stent thrombosis, were similar for GI-DES and G2-DES （MACE, 5.2% vs. 4.3%,χ^2= 0.514, P= 0.474; TV-M1, 0.8% vs. 0.4%, P 0.407; TVR, 4.9% vs. 3.7%,χ^2=0.939, P 0.333; TLR, 3.8% vs. 2.5%,χ^2=1.610, P = 0.205; cardiac death, 0.3% vs. 0.5%, P= 0.670; and stent thrombosis, 0.5% vs. 0.4%, P 〉 0.999）. Kaplan-Meier analysis indicated similar event-free survival rates between G1-DES and G2-DES alter propensity score matching （all： log-rank P〉 0.05）. Multivariate analysis demonstrated that stent type was not an independent risk factor for the efficacy and safety endpoints （MACE, hazard ratio [HR] - 0.805, 95% confidence interval [CI]： 0.455-1.424, P = 0.456; TV-MI, HR 0.500, 95% Ch 0.101-2.475, P=0.395; TVR, HR - 0.732, 95% CI： 0.403-1.330, P = 0.306; TLR, HR - 0.629, 95% CI：0.313 1.264, P - 0.193; cardiac death, HR = 1.991,95% CI： 0.223-17.814, P - 0.538; and stent thrombosis, HR - 0.746, 95% CI： 0.125-4.467, P = 0.749）.展开更多
文摘AIM:To evaluates the effectiveness and safety of the first generation,NS3/4A protease inhibitors(PIs) in clinical practice against chronic C virus,especially in patients with advanced fibrosis. METHODS:Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1,treatment-na?ve(TN) or treatment-experienced(TE),who underwent triple therapy with the first generation NS3/4A protease inhibitors,boceprevir(BOC) and telaprevir(TVR),in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up.RESULTS:One thousand and fifty seven patients were included,405(38%) were treated with BOC and 652(62%) with TVR. Of this total,30%(n = 319) were TN and the remaining were TE:28%(n = 298) relapsers,12%(n = 123) partial responders(PR),25%(n = 260) null-responders(NR) and for 5%(n = 57) with prior response unknown. The rate of sustained virologic response(SVR) by intention-to-treatment(ITT) was greater in those treated with TVR(65%) than in those treated with BOC(52%)(P < 0.0001),whereas by modified intention-to-treatment(m ITT) no were found significant differences. By degree of fibrosis,56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients,both TN and TE. In the analysis by groups,the TN patients treated with TVR by ITT showed a higher SVR(P = 0.005). However,by m ITT there were no significant differences between BOC and TVR. In the multivariate analysis by m ITT,the significant SVR factors were relapsers,IL28 B CC and non-F4; the type of treatment(BOC or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients,treated with BOC(46%) or with TVR(45%). 28% of the patients interrupted the treatment,mainly by non-viral response(51%):this outcome was more frequent in the TE than in the TN patients(57% vs 40%,P = 0.01). With respect to severe haematological disorders,neutropaenia was more likely to affect the patients treated with BOC(33% vs 20%,P ≤ 0.0001),and thrombocytopaenia and anaemia,the F4 patients(P = 0.000,P = 0.025,respectively). CONCLUSION:In a real clinical practice setting with a high proportion of patients with advanced fibrosis,effectiveness of first-generation PIs was high except for NR patients,with similar SVR rates being achieved by BOC and TVR.
文摘The support elderly parents receive from their grown-up children and the care they provide for grandchildren reflect the intergenerational relationships in Chinese families.Using data on only-child families in urban China from a 2015 survey conducted by the Institute of Population and Labor Economics,Chinese Academy of Social Sciences,this paper studies the status of care provided for grandchildren by parents of first-generation only-child in urban China and considers the effects this support has on the elderly.The data shows that over 80%of only-children parents have cared for their grandchildren.Most only-children also provide support for their elderly parents.Care for grandchildren provided by grandparents increases the economic and housekeeping support for the elderly provided by only-children.Only-children are the main beneficiaries of the intergenerational support that comes from the care for grandchildren provided by elderly parents.If the elderly parents have adequate retirement income and have little or no need for financial support,such intergenerational support resembles“altruism”.However,if the elderly parents do not have adequate retirement income,the satisfaction of their needs depends on resources like time and money available to their only-children.
文摘Background： It remains undetermined whether second-generation drug-eluting stents （G2-DESs） outperform first-generation DESs （G1-DESs） in patients with acute coronary syndrome （ACS）. We aimed to compare the efficacy and safety of G I-DES and G2-DES in ACS patients in a high-volume cardiovascular center. Methods： In 2013, 10,724 consecutive patients underwent percutaneous coronary intervention in our institution. We included 4037 patients with ACS who underwent exclusively GI-DES or G2-DES implantation （n - 364 and n - 3673, respectively）. We used propensity score matching to minimize the imbalance between the G1-DES and G2-DES groups and followed patients for 2 years. The efficacy endpoints were major adverse cardiac events （MACEs） and its components including target vessel-related myocardial infarction （TV-MI）, target vessel revascularization/target lesion revascularization （TVR/TLR）, and cardiac death. The safety endpoint was stent thrombosis. Continuous variables were compared by Mann-Whitney U-test, and categorical variables were compared using Pearson＇s Chisquare or Fisher＇s exact test. Kaplan-Meier curves were constructed to compare the event-free survival rates, and multivariate Cox proportional hazards regression analysis was used to assess whether stent type was an independent risk factor for the etticacy and safety endpoints. Results： At the 2-year lbllow-up, the results for MACE and it components, as well as stent thrombosis, were similar for GI-DES and G2-DES （MACE, 5.2% vs. 4.3%,χ^2= 0.514, P= 0.474; TV-M1, 0.8% vs. 0.4%, P 0.407; TVR, 4.9% vs. 3.7%,χ^2=0.939, P 0.333; TLR, 3.8% vs. 2.5%,χ^2=1.610, P = 0.205; cardiac death, 0.3% vs. 0.5%, P= 0.670; and stent thrombosis, 0.5% vs. 0.4%, P 〉 0.999）. Kaplan-Meier analysis indicated similar event-free survival rates between G1-DES and G2-DES alter propensity score matching （all： log-rank P〉 0.05）. Multivariate analysis demonstrated that stent type was not an independent risk factor for the efficacy and safety endpoints （MACE, hazard ratio [HR] - 0.805, 95% confidence interval [CI]： 0.455-1.424, P = 0.456; TV-MI, HR 0.500, 95% Ch 0.101-2.475, P=0.395; TVR, HR - 0.732, 95% CI： 0.403-1.330, P = 0.306; TLR, HR - 0.629, 95% CI：0.313 1.264, P - 0.193; cardiac death, HR = 1.991,95% CI： 0.223-17.814, P - 0.538; and stent thrombosis, HR - 0.746, 95% CI： 0.125-4.467, P = 0.749）.
