Chinese Journal of Evidence-Based Medicine

Stomach cancer is a malignancy arising from the stomach mucous epithelium. It accounts for 95% of all stomach malignancy cancer. The prevalence of stomach cancer is high in China and the treatment is debated, especially regarding choice of chemotherapy and treatment duration. In order to identify the best treatment and follow-up for patient with stage T2N0M 0 stomach sinus cancer, we searched MEDLINE, SUMsearch, The Cochrane Library (Issue 4, 2004), Clinical Evidence (Issue 4, 2003) and CBMdisc (1981-2004). A total of 3 systematic reviews, 28 randomized controlled trails, 3 cohort studies and 3 observational studies were identified. We evaluated the quality of included studies. All studies were divided into 5 grades by the levels and grades of recommendation. We drew a conclusion by synthesizing the results of included studies: The primary treatment for the patient was surgery treatment including gastric deuto-total resection and D1 lymph node dissection. There was no evidence supporting chemotherapy use in either systematic or abdominal cavity after surgery. The survival rate was high in 5 years and 10 years, so the follow-up time should not be long and the follow-up infermission should not less than 1 year. Follow-up included the dynamic and delayed MR sequence with Gd-DTPA, the level of serum CA199, endoscope, and stool occult blood test.

A core outcome set (COS) is an agreed minimum set of outcomes that should be reported in all clinical trials in specific areas of health care. The use of COS can reduce the heterogeneity of outcomes reporting in different trials and enhance evidence synthesis in systematic review/meta-analysis by including more studies with the same outcome. It can also enhance the value of trials and reduce cost waste to some extent. Recently, Core Outcome Measures in Effectiveness Trials (COMET) initiative has developed the COMET handbook (version 1.0). This handbook discussed the problems of COS research and made some recommendations. This paper interprets the COMET handbook (version 1.0) and analyses its insight on the construction of TCM clinical research COS, combined with the characteristics of TCM clinical research, in order to provide a reference for related researchers. © 2017, West China University of Medical Science. All rights reserved.

Objective To evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. Methods All patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. Results A total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days / 306 415.0 days), 64.9% (198 856.0 days / 306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times / 6 461 times), 62.6% (4 047 times / 6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. Conclusion It is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.

Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.

Objective: To systemically evaluate the accuracy of f/t-PSA for diagnosing prostate cancer with a t-PSA level of 4-10ng/mL through meta-analysis. Methods: A literature search of CBM, VIP, CNKI and Wanfang Data from 1999 to 2009 was performed. Related journals were also searched manually. Two reviewers independently assessed trial quality according to QUADAS items. Heterogenous studies and meta-analysis were conducted by Meta-Disc1.4 software. The analysis was based on different critical values of f/t-PSA (0.1, 0.15, 0.2, 0.25, and 0.3). Results: Total 18 studies involving 2217 subjects were included. No threshold effect was found. But there was heterogeneity due to other factors. The meta-analysis showed that, the sensitivity of f/t-PSA with the critical value of 0.15 for the diagnosis of prostate cancer with a t-PSA level of 4-10ng/mL was 75% (95%CI 70%-79%), and the specificity was 81% (95%CI 78%-84%). The area under SROC curve was 0.883 5, and the Q index was 0.814 0. Conclusion: The f/t-PSA is a better index for diagnosing prostate cancer with t-PSA levels between 4 and 10ng/mL. And it is reasonable to consider 0.15 as a more suitable critical value.

Objective: To formulate an evidence-based conclusion concerning ultrasound screening for fetal malformations for a pregnant woman after 12 gestational weeks. Methods: Based on the clinical problem of whether pregnant women need ultrasound screening for fetal malformations after 11-14 gestational weeks, we used "ultrasound or sonography and prenatal or fetal at first trimester or 11-14 weeks; ultrasound exposure; fetal development" as the keywords and searched The Cochrane Library (Issue 4, 2008), MEDLINE (1981 to 2008), ACP Journal Club (1991 to 2008), and BMJ Clinical Evidence (1999 to 2008) for systematic reviews, randomized controlled trials (RCTs) and controlled clinical trials. The methodological quality of the included studies was assessed to identify the current best evidence. Results: Three systematic reviews, two RCTs and ten cohort studies were retrieved. The results showed ultrasound screening detected different fetal malformations in the first, second and third trimester. Not all of the fetal malformations could be detected through prenatal ultrasound screening. Nuchal translucency (NT) measurement as a tool for screening chromosomally abnormal fetuses and detecting fetal malformations by ultrasound proved to be effective if performed within 11-14 gestational weeks. The routine second trimester screening, however, could not be replaced by a detailed ultrasound examination at 11-14 gestational weeks. Most of the trials concluded that the effect of ultrasound on a fetus was not harmful. Conclusion: The findings of this study should reassure physicians and parents alike that ultrasound screening is an appropriate option for the pregnant women after 12 gestational weeks.

Objective To systematically review the diagnostic value between serum human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125) for endometrial cancer (EC). Methods We electronically searched databases including PubMed, The Cochrane Library, Web of Science, ScienceDirect, EBSCO, CNKI and VIP to collect diagnostic accuracy studies of serum HE4 and/or CA125 versus golden standard (pathology) for EC from inception to August 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS-2 tool. Then, meta-analysis was performed by Meta-Disc 1.4 software. Results A total of 20 studies involving 4 351 participants were included. The results of meta-analysis showed that: the pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), and negative likelihood ratio (–LR), and diagnostic odds ratio (DOR) of HE4 in the diagnosis of EC were 0.56 (95%CI 0.54 to 0.58), 0.89 (95%CI 0.88 to 0.90), 6.19 (95%CI 4.31 to 8.88), 0.49 (95%CI 0.44 to 0.56), and 14.27 (95%CI 9.50 to 21.42), respectively. The area under the curve (AUC) of SROC was 0.855 9. The pooled Sen, Spe, +LR, –LR, and DOR of CA125 in the diagnosis of EC were 0.33 (95%CI 0.31 to 0.34), 0.80 (95%CI 0.78 to 0.82), 2.07 (95%CI 1.45 to 2.95), 0.83 (95%CI 0.76 to 0.91), and 2.65 (95%CI 1.63 to 4.32), respectively. The SROC AUC was 0.657 5. Conclusions Compared with CA125, HE4 has higher diagnostic accuracy for EC. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Objective To systematically evaluate the efficacy and safety of 125I seed interstitial implantation for lung cancer. Methods We searched PubMed, The Wiley Online Library, Elsevier, CNKI, VIP and WanFang Data from inception to February 2014 to collect randomized controlled trials (RCTs) of 125I seed interstitial implantation in the treatment of lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using RevMan 5.1 software. Results A total of 23 RCTs involving 1 492 patients were included. The results of meta-analysis showed that: the effective rate （OR=3.43，95%CI 2.71，4.33，P<0.000 01), 1 year survival rate (OR=2.83, 95%CI 2.03 to 3.95, P<0.000 01) and 2 year survival rate (OR=2.49, 95%CI 1.60 to 3.88, P<0.000 01) in the 125I seed interstitial implantation group were higher than those in the control group, but the rate of postoperative complications was higher than that of control group (OR=19.72, 95%CI 11.63 to 33.45, P<0.000 01). In addition, there were no significant differences between both groups in the 3 year survival rate (OR=2.45, 95%CI 0.21 to 28.89, P=0.48) and the adverse reaction rate (OR=0.74, 95%CI 0.52 to 1.05, P=0.09). Conclusion 125I seed interstitial implantation is effective in the treatment of lung cancer. It can improve treatment efficiency and shorttime survival rate, but may increase the rate of complications such as pneumothorax, seed malposition, bleeding and so on. Due to the limited quality and quantity of included studies, more high quality and larger sample studies are needed to verify the above conclusion.

Objective: To investigate the etiological and clinical characteristics of 1298 cases with spontaneous intracerebral hemorrhage. Methods: A retrospective analysis was conducted to investigate the epidemiology and clinical characteristics of 1298 patients who suffered from spontaneous intracerebral hemorrhage and were hospitalized in Neurology Dept. of Anhui Provincial Hospital from 2005 to 2009. Results: Among 1 298 patients, 822 (63.33%) were male while 476 (36.67%) were female. The constituent ratio of male and female patients was significantly different; the patients mainly suffered from spontaneous intracerebral hemorrhage in winter and spring which was commonly caused by hypertension accounting for 65.87% and was mostly happened on basal ganglia site (n=895, 68.95%). Conclusions: The incidence of spontaneous cerebral hemorrhage is related with age, season and hypertension, it is very important to be prevented effectively and to well control the blood pressure.

Objective: To discuss the safety and effectiveness of removing esophageal foreign bodies in children by using Foley catheter. Method: Retrospective analysis on the effect, operation method, complication and the types of foreign bodies of 138 cases of removing esophageal foreign bodies in children by using Foley catheter, which happened from January 1998 to January 2008 in Department of Otorhinolaryngology, the Third People's Hospital of Chengdu. Result: Among these 138 cases with esophageal foreign bodies, 126 cases (91.3%) were successfully taken out by using Foley catheter without anaesthesia, 7 cases were applied esophagoscopy under general anaesthesia, and 5 cases were cured owing to the slipping of foreign body into stomach. The operating time for Foley catheter was 5.1 minutes in average, and there's no complicating disease in any case. The hard esophagoscope operation lasted for 15 minutes in average and one case was accompanied by dyspnea. The foreign bodies in 138 cases were coin (98 cases), button (14 cases), chess and I-go piece (13 cases), key-ring (4 cases), plastic bottle cap (3 cases), oblate battery (3 cases) and ring (3 cases), respectively. Conclusion: Foley catheter is safe and effective for removing esophageal obtuse-rounded foreign bodies in children.

Objectives To estimate the elasticity of demand price elasticity and demand income of urban and rural residents’ self-purchase drug use and expenditure, and to analyze the sensitivity of self-purchase drug use and expenditure to the price change of drug purchase, resident income and medical institutions. Methods The data were derived from the fifth health service survey in Heilongjiang province in 2013. The Probit model was used to obtain the partial regression coefficients of the control variables in the regression model, and the demand elasticity of the self-purchase drug use was further measured by the partial regression coefficients, and the demand elasticity of self-purchase expenditure was obtained by the logarithmic regression model. Results A total of 5 289 households (14 431 persons) were included. The demand for self-purchase drug use of Heilongjiang province was 0.374 (P=0.000), the cross-price elasticity of self-purchase drug utilization and service was –0.184 (P=0.000), and the income elasticity was 0.083 (P=0.172). Since the price elasticity of the self-purchase drug expenditure was 0.675 (P=0.000), the income elasticity was 0.144 (P=0.069). Conclusions The use of self-purchased drugs in Heilongjiang province lacks price elasticity and is a necessity. There is a complementary relationship between the use of self-purchase drugs and medical institutions. © 2019, West China University of Medical Science. All rights reserved.

Objective To systematically review the association between 14 bp insertion/ deletion polymorphism of HLA-G gene and preeclampsia (PE). Methods We electronically searched in the following databases: PubMed, Web of Science, EMbase, CBM, CNKI, WanFang Data, and VIP to collect all the case-control trials on the association between 14 bp insertion/ deletion polymorphism of HLA-G gene and PE. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 10 studies were recruited. The results of meta-analysis showed that, the preeclampsia group was higher than the control group in the frequencies of HLA-G +14 bp haplotype in the fetus and fathers and the frequencies of HLA-G +14 bp/+14 bp genotype in fathers, but its frequencies of fetal HLA-G -14 bp haplotype was significantly lower. Their pooled OR and 95%CI were 1.42 (1.10 to 1.84), 1.54 (1.25 to 1.90), 2.00 (1.19 to 3.38), and 0.67 (0.54 to 0.82). Compared with the control group, in the preeclampsia group the frequencies of HLA-G +14 bp/+14 bp genotype in fetus were higher, while the frequencies of HLA-G -14 bp/-14 bp genotype were lower (OR=1.75, 95%CI 1.11 to 2.77; OR= 0.57, 95%CI 0.41 to 0.81). In the preeclampsia group, the frequencies of mother (+14 bp/-14 bp)/ fetal (+14 bp/+14 bp) were higher than the control group (OR= 3.77, 95%CI 1.40 to 10.11), while those of mother (-14 bp/-14 bp)/ fetal (-14 bp/-14 bp) and those of father (-14 bp/-14 bp)/fetal (-14 bp/-14 bp) were lower (OR=0.52, 95%IC 0.31 to 0.85; OR=0.33, 95%CI 0.15 to 0.75). Conclusion Paternal and fetal 14 bp insertion/ deletion polymorphism of HLA-G gene might be associated with preeclampsia. And maternal-fetal genotype compatibility analysis might provide new clues for the pathogenesis research and clinical diagnosis of preeclampsia.

Objective: To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods: According to the principles of evidence-based clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results: Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient's clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion: Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.

Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan- Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.

Objective: To evaluate the effect of urgent psychological crisis intervention for 148 patients who were transferred to other provinces to receive treatment after the Wenchuan earthquake. Methods: We randomly selected 148 patients from the disaster area who received treatment in The Third Hospital of Mianyang City and then transferred to other provinces. A self-designed questionnaire, SAS, and SDS scales were administered to all patients 7 days and 1 day before their transfer. After the initial assessment, all patients received urgent psychological interventions including catharsis, leading, explanation, and cognition reconstruction. Results: After psychological intervention, both the full score and the standardized score of SAS and SDS declined significantly (P<0.01). Conclusion: Earthquake sufferers who were transferred to other provinces to receive treatment had psychological problems. Crisis psychological intervention may have improved their psychological status effectively.

Objective To evaluate the clinical value of ultrasound-guided percutaneous co-axial technique in liver tumor biopsy. Methods The clinical data of patients who received ultrasound-guided percutaneous co-axial liver tumor biopsy from March 2015 to December 2016 in West China Hospital of Sichuan University were collected to retrospectively analyze the outcomes of biopsy success rate, sampling number, pathology diagnostic rate and incidence of complications. Results A total of 150 patients involving 99 males and 51 females were included, with a mean age of 54.9±4.5 years. The mean tumor size was 2.4±1.2cm. The ultrasound-guided liver tumors biopsy success rate was 100% (150/150). The mean sampling frequency was 2.4±0.6 times. Complications after biopsy included mild local pain (37%, 56/150) and bleeding (0.7%, 1/150). Conclusion Ultrasound-guided co-axial biopsy is an simple, safe and efficient image-guided biopsy technique which allows multiple sample acquisition and reduces complications. © 2018, West China University of Medical Science. All rights reserved.

Objective To understand the distribution of demographic sociological characteristics and co-morbidities among primiparous and multiparous pregnant women under the China's universal two-child policy, to provide baseline data for clinical high-risk management and medical resources allocation. Methods We included pregnant women from 24 hospitals in 16 provinces (municipality, autonomous region) of China and collected their demographic sociological characteristics and obstetrics information by questionnaires between September 19th, and November 20th, 2016. Then, we used descriptive analysis to present the distribution of demographic sociological characteristics and pregnancy co-morbidities among primiparous and multiparous women and compared differences between groups by t test or Chi-square test. Results Among 12 403 investigated pregnant women, 8 268 (66.7%) were primiparous and 4 135 (33.3%) were multiparous, with highest proportion in East (931/2 008, 46.4%) and lowest in Northeast (385/2 179, 17.7%). Multiparous women, comparing to primiparous women, were more likely to be elderly than 35 years (accounting for 30.6% vs. 6.5%), lower educated with high school or below (29.7% vs. 16.9%), occupied in physical labor or unemployed (49.2% vs. 42.5%), non-local residents (12.7% vs. 10.5%), family annual income higher than 120 thousand yuan (41.3% vs. 33.3%), pre-pregnancy body mass index≥24 kg/m² (13.6% vs. 9.9%), history of artificial abortions (44.9% vs. 24.0%), or pregnancies≥4 times (23.8% vs. 3.1%) and were less likely to receive assisted reproductive technology (2.3% vs. 4.7%). The most common co-morbidities were gynecology disease (5.5%), thyroid disease (5.4% in all women), blood system disease (5.0%), digestive system disease (4.2%) and hepatitis B infection (2.5%). Multiparous women, comparing to primiparous women, had higher proportions with blood system disease (5.7% vs. 4.7%), hepatitis B infection (3.1% vs. 2.2%) and chronic hypertension (0.6% vs. 0.2%), but lower proportions with thyroid diseases, polycystic ovary syndrome, and immune system diseases, whose distribution also showed regional differences. Conclusion There existed distribution differences regarding demographic sociological characteristics and co-morbidities proportions between primiparous and multiparous women. Therefore, we should improve clinical risk management and medical resources allocation based on pregnant women’s baseline and gestational characteristics. © 2020 West China University of Medical Science. All rights reserved.

Objective To evaluate anti-platelet effect of clopidogrel influenced by CYP2C19*17 polymorphism in patients with cardiovascular disease. Methods We electronically searched EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov, CNKI, CBM, WanFang Data and VIP databases for cohort studies about the anti-platelet effect of clopidogrel influenced by CYP2C19*17 polymorphism in patients with cardiovascular disease from inception to October 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software Rev- Man 5.2. Results A total of seven studies involving 12 116 patients were finally included. Three were 5 579 CYP2C19*17 carriers and 6 538 non-carriers. The results of meta-analyses showed that, compared with the CYP2C19*17 non-carriers, lower rate of cardiovascular events (OR=0.85, 95%CI 0.73 to 0.99, P=0.03) and higher bleeding events (OR=1.25, 95%CI 1.05 to 1.50, P=0.01) were found in the CYP2C19*17 carriers. Conclusion CYP2C19*17 carriers is with lower cardiovascular events and higher bleeding events than the CYP2C19*17 non-carriers.

Objective To explore the correlation between interleukin-6 (IL-6) 174G/C polymorphism and ischemic stroke risks. Methods Systematic searches of electronic databases as CBM, CNKI, PubMed, MEDLINE and EMbase were performed. Meta-analysis was conducted by using RevMan 5.1.2 and Stata 11.0 software. Te pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were performed. Publication bias was tested by funnel plot, Egger's regression test and Begg's test. Sensitivity analysis was made by repeating the fixed effects model or random effects model Meta-analysis with each of the studies individually removed. Results A total of 11 publications with 12 studies were identified. Te results of meta-analyses showed no significant difference was found in the correlation between IL-6 174G/C polymorphism and ischemic stroke risks (for G/C vs. G/G: OR=0.98, 95%CI 0.78 to 1.24; for C/C vs. G/G: OR=0.75, 95%CI 0.38 to 1.50; for dominant inheritance model: OR=0.93, 95%CI 0.68 to 1.28; for recessive inheritance model: OR=0.80, 95%CI 0.45 to 1.42). In the subgroup analyses on ethnicity, no significant correlation was found. But in the subgroup analyses on source of control population, the hospital-based subgroup showed IL-6 174G/C polymorphism was the protective factor of ischemic stroke (for G/C vs. G/G: OR=0.56, 95%CI 0.40 to 0.79; for C/C vs. G/G: OR=0.17, 95%CI 0.11 to 0.27; for dominant inheritance model: OR=0.40, 95%CI 0.29 to 0.55; for recessive inheritance model: OR=0.24, 95%CI 0.16 to 0.37). Conclusion Meta-analysis strongly suggests that the correlation between IL-6 174 G/C polymorphism and ischemic stroke is not significantly different.

Objective To evaluate the cost effectiveness of human papillomavirus vaccine (HPV) for treating cervical cancer. Methods We constructed a Markov model to evaluate the cost-effectiveness of HPV versus Chinese healthy women aged 18 to 25 for treating Cervical Cancer. We calculated the clinical benefits and cost-effectiveness and judged the results based on willing to pay. Sensitivity analysis was made for parameters like cost, discounting rate and vaccine efficacy. Results HPV vaccination was a cost-effective option under the local willing to pay value with the incremental cost utility ratio 43 489 per QALY gained. It proved that vaccination was an economic and effective solution. Conclusion Given the results of Markov model, the cost effectiveness of HPV vaccination of Chinese women aged 18 to 25 is positive. Considering the data sources and model hypothesis, this report has some limitations. Further studies are warranted. © 2017, West China University of Medical Science. All right reserved.

Objective To evaluate diagnostic value of 18F-FDG PET/CT for breast cancer and axillary lymph node metastases.Methods Literature search was conducted in PubMed (1966 to 2013.10, EMbase (1974 to 2013.10), The Cochrane Library (Issue 8, 2013), Web of Science (1950 to 2013.10), CBM (1978 to 2013.10), WanFang Data (1990 to 2013.10) and CNKI (1994 to 2013.10) to retrieve the diagnostic studies about PET/CT in the diagnosis of breast cancer and axillary lymph node metastasis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using Meta-DiSc 1.4 software.Results A total of 25 studies involving 2 089 patients met the eligible criteria. With the comparison of pathological results used as the gold standard, pooled sensitivity (Sen) and specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (–LR), pooled diagnostic odds ratio (DOR) and the area under (AUC) of the summary receiver-operating characteristic curve (SROC) were: a) for diagnosing breast cancer, 0.69 (95%CI 0.60 to 0.76), 0.98 (95%CI 0.94 to 1.00), 10.75 (95%CI 4.10 to 28.16), 0.16 (95%CI 0.02 to 1.13), 56.76 (95%CI 17.50 to 184.14), 0.962 6; and b) axillary lymph node metastases, 0.63 (95%CI 0.59 to 0.66), 0.92 (95%CI 0.91 to 0.94), 6.01 (95%CI 4.07 to 8.89), 0.39 (95%CI 0.30 to 0.50), 17.35 (95%CI 10.58 to 28.46), 0.866 4.Conclusion 18F-FDG PET/CT has a middle-degree sensitivity and relatively good specificity in diagnosing breast cancer and axillary lymph node metastases which can be regarded as an effective and feasible method for preoperative staging of breast cancer.

Objective To systematically review the diagnostic accuracy of 18F-FDG PET dual time point scan in identifying benign and malignant lung lesions, in order to necessity and clinical value of dual time point scan. Methods We electronically searched PubMed, EMbase, The Cochrane Library, WanFang Data, CNKI and CBM for diagnostic tests on 18F-FDG PET dual time point scan vs. surgery or needle biopsy (gold standard) from January 1990 to November 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then statistical analysis was performed to calculate pooled effect sizes of sensitivity (SEN) and specificity (SPE), and area under the curve (AUC) of summary receiver operating characteristics (SROC), followed by sensitive analysis and subgroup analysis. Results A total of 19 domestic and foreign studies were totally included, involving 1 225 lesions. The results of meta-analysis showed SEN 0.82 (95%CI 0.79 to 0.85) and SPE 0.74 (95%CI 0.71 to 0.78) regarding 18F-FDG PET dual time point scan in identifying benign and malignant lung lesions. The results of sensitive analysis showed that: a) after eliminating studies in which tuberculosis in the benign lesions accounted for more than 50%, it showed pooled SEN 0.81 (95%CI 0.77 to 0.84), pooled SPE 0.76 (95%CI 0.72 to 0.80), and AUC 0.850 3; b) after eliminating studies in which sample size was less than 50 cases, it showed pooled SEN 0.78 (95%CI 0.74 to 0.82), pooled SPE 0.78 (95%CI 0.74 to 0.82), and AUC 0.814 1; and c) after eliminating studies in which iSUV was more than 2.5, it showed pooled SEN 0.67 (95%CI 0.55 to 0.78), pooled SPE 0.66 (95%CI 0.54 to 0.77), and AUC 0.779 8. Conclusion 18F-FDG PET dual time point scan has intermediate value in identifying benign and malignant lung lesions, which is almost as good as single time point scan, so it's unnecessary to apply it as a clinical routine test.

Objective To systematically review the safety of different types of COVID-19 vaccines in the population. Methods Web of Science, PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) which reported safety of COVID-19 vaccines in population. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 5 RCTs involving 2 431 subjects were included. The results of the meta-analysis showed that COVID-19 vaccines developed more fever symptoms than placebo (RR=2.21, 95%CI 1.38 to 3.54, P=0.000 9). However, there was no significant difference in the incidence of adverse reactions (RR=1.28, 95%CI 0.96 to 1.70, P=0.10), injection site adverse reactions (RR=1.47, 95%CI 0.65 to 3.36, P=0.36) and systemic adverse reactions (RR=0.96, 95%CI 0.78 to 1.17, P=0.66) between two groups. Conclusions Current evidence shows that COVID-19 vaccines are sufficiently safe. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions. © 2021 West China University of Medical Science. All rights reserved.

Objective To systematically review the prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 pandemic. Methods The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect cross-sectional studies on the prevalence of depression and anxiety among health care workers from December 2019 to April 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 21 cross-sectional studies were included, involving 38 372 participants. Meta-analysis results showed that during the COVID-19 epidemic, the prevalence of depression and anxiety among health care workers in designated hospitals were 31.00% (95%CI 0.25 to 0.37) and 44.00% (95%CI 0.34 to 0.53). The results of subgroup analysis showed that individuals of female, married, bachelor degree or above, nurses, junior professional titles, and non-first-line medical staff had higher prevalence of depression and anxiety. Conclusions During the COVID-19 pandemic, the incidence of depression and anxiety among health care workers in designated hospitals remain high. Therefore, more attention should be paid to the mental health of health care workers in designated hospitals. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusions. © 2021 West China University of Medical Science. All rights reserved.

Objective: To provide references to control the cost of stroke inpatients by analysing pertinent factors of stroke inpatients. Methods: According to the models of Anderson and Newnan, univariable analysis and multivariable statistical analysis were applied to a number of factors including predisposing factors, enabling factors, and needs factors in 1 969 stroke inpatients of two third level first-class hospitals in Chongqing. Results: Among the 1 969 stroke inpatients, 64% had a history of hypertension, and 50% exhibited hypertension during their stay in hospital. Expenditure on medication consumed the highest costs (51%). Length of stay was the most important factor affecting inpatient expense, additional factors were number of surgical operation, nurse type, Rankin score, number of complications etc. Conclusions: Complex measures focusing on hypertension to prevent and control of stroke are recommended. Reducing unnecessary stay in hospital and appropriate prescribing are important methods to reduce cost of stroke inpatients.

Objective To analyze the latest epidemiological status of breast cancer in China, trends in morbidity and mortality from 1990 to 2019, and related prognostic risk factors. Methods Data on incidence and mortality of Chinese female breast cancer, their related age-standardized rates (ASRs) from 1990 to 2019, and attributable risk factors were obtained from the Global Burden of Disease (GBD) database, and data on disability-adjusted life years (DALYs) of 34 provinces in China were obtained from literature. Joinpoint regression analysis was used to analyze the trends of ASRs. The exposure levels of each attributable risk factor and the increased cancer burden were analyzed. Results The incidence of breast cancer in Chinese females increased annually, from 17.07/100 000 in 1990 to 35.61/100 000 in 2019, while the mortality rate initially increased and decreased, and then exhibited an upward trend after 2016 and there was no obvious variation from 1990 (9.16/100 000) to 2019 (9.02/100 000). Among the 34 provinces of China, Shandong Province had the most serious breast cancer burden, while Macao Special Administrative Region had the lowest. Among the seven prognostic risk factors, high body mass index (BMI) contributed the most to the breast cancer burden and the exposure risk of a diet high in red meat had shown a significant increasing trend in the past 30 years. Therefore, the disease burden caused by a high red meat diet would be increasing. Conclusions The incidence rate of breast cancer in Chinese females is increasing. With the development of social economy and the change of people’s dietary habits, the breast cancer burden in China trends to become heavier and heavier. Therefore, it is necessary to conduct the "three early" prevention and treatment and advocate healthy and reasonable diet and living habits to reduce the burden of breast cancer to improve prognosis and quality of life. © 2021 West China University of Medical Science. All rights reserved.

Objectives To estimate the latest burden of disability adjusted life years (DALYs) for liver cancer in China and the long-term trend, and to make future prediction. Methods Based on the visualization platform of Global Burden of Disease 2016, data on the DALYs for liver cancer in China was extracted. The very recent status in 2016 and the previous trend from 1990 to 2016 were described, using annualized rate of change (ARC). The burden from 2017 to 2050 was further predicted by combining the ARC and the Chinese population data projected by the United Nation. Results In 2016, the total DALYs for liver cancer in China was estimated as 11 539 000 person years (accounting for 54.6% of the global burden), and years of life lost (YLLs) and years lived with disability (YLDs) contributed 98.9% and 1.1%, respectively. The age-standardized DALY rate was 844.1 per 100 000 (3.0 times of the global average) and the maleto-female ratio was 3.4. The DALY rate continuously increased from 1990–2016 (ARC=0.57%), particularly in recent 5 years (ARC=1.75%). Among the DALYs for all cancers, liver cancer contributed approximately 20% and constantly remained as the top 2 (ranking as the number one before year 2005). There were inverse trends in gender, with increasing in males and decreasing in females (ARC was 0.77% and –0.11%, respectively). Hepatitis B infection continually kept the leading cause of DALYs for liver cancer (accounting for nearly 57%), and the DALY rate was gradually increasing (ARC=0.43%). Although the peak age of DALY rate was stable at 65to 69 years, the peak age of the DALYs changed from 55 to 59 years in 1990 to 60 ~ 64 years in 2016. In 2050, the estimated DALYs for liver cancer in China will reach 14.37 million person years, 20.0% more than that in 2017. Conclusions The DALYs caused by liver cancer in China exceeds the overall burden of all other countries in the world, and accounts for 1/5 of DALYs for all cancers in local population. The burden in males has been continuously rising, and the leading cause remained unchanged as hepatitis B infection. With population aging, the DALYs for liver cancer in China will be incessant to increase, suggesting the necessity to implement continuous effort in risk factors prevention (e.g. hepatitis B infection), and efficient management in high risk population of liver cancer. © 2018, West China University of Medical Science. All rights reserved.

Objective To analyze the trends of incidence, mortality, and burden of disease of cervical cancer in Chinese females from 1990 to 2019. Methods The global burden of disease database (GBD) and China health statistics yearbook data was used to analyze the incidence, standardized incidence, mortality, standardized mortality, urban and rural mortality, and burden of cervical cancer among Chinese females using Excel, SPSS 21.0 and Joinpoint Regression Program 4.8.0.1. Results The standardized incidence of cervical cancer among Chinese females increased from 9.21/ 100 000 in 1990 to 12.06/100 000 in 2019, and the standardized mortality decreased from 8.40/100 000 to 7.36/100 000. The standardized mortality of cervical cancer in 2018 decreased when compared with 2015 in both urban and rural areas. Changes in age-group incidence and mortality indicated that there was a younger trend in cervical cancer. The disease burden indicators (DALY, YLL, and YLD) were increased from 86.49, 84.01, and 1.52 ten thousand person/years to 162.22, 157.40, and 4.83 ten thousand person/years, in which the YLD increased the most (217.76%). The APC of DALY, YLL and YLD were 2.39%, 2.56% and 4.25%, respectively. The proportion of cervical cancer disease burden in female cancer increased in 2019 compared with 1990. And DALY, YLL and YLD increased in the age group of 40 or over, in which DALY of the age group 50-54 increased 167.15%. Conclusions The situation of cervical cancer is not optimistic in China. Although the mortality of cervical cancer has decreased in recent years, the number of cases and mortalities is still increasing. Not only the burden of disease is continuously increasing, there is also a younger trend in cervical cancer. Active preventive measures should be taken to reduce the burden of cervical cancer. © 2021 West China University of Medical Science. All rights reserved.

Objectives To determine the health benefit of elbasvir/grazoprevir versus peginterferon combing with ribavirin (PR regimen) for Chinese chronic hepatitis C patients with genotype 1b infection. Methods Markov cohort state-transition models were constructed to conduct cost utility analysis. Sensitivity analyses were performed based on base-case analysis. Results Elbasvir/grazoprevir was dominant versus PR, resulting in higher QALYs and lower costs for both noncirrhotic patients (13.867 5 QALYs, 82 090.82 RMB vs. 12.696 2 QALYs, 122 791.55 RMB) and cirrhotic patients (12.841 6 QALYs, 225 807.70 RMB vs. 8.892 4 QALYs, 326 545.01 RMB). Elbasvir/grazoprevir was economically dominant in nearly 100% among all patients within the range of threshold from 0 to 161 805 RMB/QALY. Conclusions Elbasvir/grazoprevir was dominant in treatment of genotype 1b chronic hepatitis C infection in China. © 2018, West China University of Medical Science. All rights reserved.

Objective To systematically review the correlation between the expression of hypoxia inducible factor-1α (HIF-1α) protein and different clinical pathological features of renal cell cancer. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, VIP, CBM and WanFang Data from inception to June 2015 to collect case-control studies investigating the correlation between HIF-1α protein expression and different clinical pathological features of renal cell cancer. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 8 case-control studies involving 429 cases of renal cell cancer and 130 cases of normal renal tissue were included. The results of meta-analysis showed that: HIF-1α protein expression was higher in the renal cell cancer group than that in the normal renal tissue group (OR=16.76, 95%CI 8.53 to 32.92, P<0.000 01); HIF-1α protein expression was higher in the lymph node metastasis group than that in the non-lymphnode metastasis group (OR=4.33, 95%CI 2.53 to 7.39, P<0.000 01); HIF-1α protein expression was higher in the TNM III-IV group than that in the TNM I-II group (OR=0.30, 95%CI 0.18 to 0.51, P<0.000 1); HIF-1α protein expression was higher in the Fuhrman pathology classification G3+G4 group than that in the G1+G2 group (OR=0.54, 95%CI 0.29 to 0.98, P=0.04). However, there were no significant differences in HIF-1α protein expression between the age ≥50 group and the age <50 group (OR=1.09, 95%CI 0.54 to 2.19, P=0.82), and between the male group and the female group (OR=0.77, 95%CI 0.48 to 1.25, P=0.29). Conclusion HIF-1α protein expression is significantly correlated to the clinical stage and pathological grading of renal cell cancer. It is possibly involved in the initiation and development of renal cell cancer. Due to the limited quantity and quality of included studies, the above conclusion needs to be further verified by more high quality studies.

Objective To investigate the association between IL-1β gene -511C/T polymorphisms and the risk of chronic obstructive pulmonary disease (COPD). Methods Such databases as PubMed, EMbase, CNKI, CBM, VIP and WanFang Data were searched for the studies on the association between IL-1β gene -511C/T polymorphisms and the risk of COPD up to May 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Ten meta-analysis was performed using RevMan 5.0 sofware. Results A total of 10 case-control studies from 9 articles involving 1 171 cases and 1 268 controls were included. Te results of meta-analysis showed that, no signifcant association was found between IL-1β gene -511C/T polymorphisms and the risk of COPD: TT+CT vs. CC: OR=1.06, 95%CI 0.66 to 1.70, P=0.82; TT vs. CT+CC: OR=0.87, 95%CI 0.60 to 1.26, P=0.32; TT vs. CC: OR=0.95, 95%CI 0.51 to 1.75, P=0.86; CT vs. CC: OR=1.10, 95%CI 0.71 to 1.70, P=0.15; T vs. C: OR=0.97, 95%CI=0.72 to 1.30, P=0.84. Te results of subgroup analysis by ethnicity showed that, no significant association was found between IL-1β gene -511C/T polymorphisms and the risk of COPD among Caucasians and Asians. Conclusion IL-1β gene -511C/T polymorphisms might not contribute to the risk of COPD.

Objectives To investigate the prevalence of mycoplasma pneumonia (MP) in the pediatric outpatient department of Shanghai Pudong New District Zhoupu Hospital and its relationship with the concentration of fine particulate matter (PM 2.5) in the air. Methods Patients with respiratory tract infection, from one month to 15 years old, diagnosed in the pediatric department of Shanghai Pudong New District Zhoupu Hospital from May 2016 to April 2017 were enrolled. Mycoplasma pneumonia antibody was detected by colloidal gold assay, and mycoplasma antibody was detected after 1 week of negative test. PM 2.5 index of the same period was also collected. SAS 9.1.3 software was used for statistical analysis. Results A total of 3 862 children were enrolled, of which 947 were positive for MP, with a positive rate of 24.52%. The positive rates of each age group were 10.02% for the one month to one year old group, 23.51% for the 1 to 4 years old group, 31.70% for the 4 to 7 years old group, and 22.81% for the 7 to 15 years old group. The positive rate of each age group had statistically significant difference (χ2=86.120 0, P<0.000 1). The positive rates of spring, summer, autumn, and winter were 25.06%, 20.43%, 19.52 and 33.61%, respectively. The difference was statistically significant (χ2=67.1446, P<0.000 1). Combining the PM 2.5 index in Shanghai Pudong area from May 2016 to April 2017, the positive correlation between PM 2.5 and positive rate of MP was found (r=0.9007, P<0.001). Conclusions The positive rate of MP in Shanghai Pudong area is 24.52%, and reach its highest level in the preschool children and in winter. It is positively correlated with the PM 2.5 index as well. © 2018, West China University of Medical Science. All rights reserved.

Objective To estimate the incidence of post-myocardial infarction depression among Chinese acute myocardial infarction (AMI) patients by meta-analysis and to provide references for the management of AMI patients. Methods We searched databases including PubMed, The Cochrane Library (Issue 6, 2016), CNKI, CBM, WanFang Data and VIP from January 2000 to July 2016, to collect literature regarding the incidence of post-myocardial infarction depression among patients with AMI. Two reviewers independently screened literature, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed by using Comprehensive Meta Analysis (CMA) 2.0 software. Results Totally, 22 cross-sectional studies were included, involving 2 986 AMI patients, of which 1 239 were post-myocardial infarction depression patients. The overall incidence of post-myocardial infarction depression among the AMI patients was 42.7% (95%CI 36.3% to 49.4%). There was no statistical differences observed when the studies were stratified by sex, regions, scales and years (all P values>0.05). Conclusion In China, the incidence of postmyocardial infarction depression is high and rising year by year roughly among AMI patients. The status should be paid more attention. © 2017, West China University of Medical Science. All right reserved.

Objective To explore the prevalence, awareness, treatment and control of hypertension in island of China. Methods Literatures regarding the prevalence and treatment of hypertension in island of China were retrieved in PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CNKI, WanFang Data and CBM from January 2000 to December 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and extracted data. Then the pooled rates were conducted by Comprehensive Meta-Analysis software using inverse variance method. Results Nine studies involving 926 836 samples were included. The results of meta-analysis showed the pooled rates of prevalence, awareness, treatment and control were 32.0% (95%CI 18.8% to 48.8%), 47.4% (95%CI 29.7% to 65.8%), 38.0% (95%CI 23.1% to 55.5%) and 10.0% (95%CI 4.3% to 21.7%), respectively. Whether in 60 or 65 as the threshold value, the prevalence of hypertension in old people was higher than that in young people. Conclusion The prevalence of hypertension is about 32% and much higher in island regions of China, while the awareness, treatment and control rates are so lower in these regions. The relevant public health policy should pay more attention to improve primary health care in these regions.

Objectives To analyze the average daily medical expenditures for primary liver cancer in China from 2002 to 2011. Methods This study employed retrospective survey on multiple centers from 12 provinces and cities in China from 2002 to 2011, based on the continuous data from the Cancer Screening Program in the Urban China Project. The average daily medical expenditures of primary liver cancer patients and influencing factors were analyzed. Results A total of 11 045 liver cancer patients from 12 provinces and cities were included, with an average age of 55 and an average duration of hospitalization of 16.76 days. The average daily medical expenditures of liver cancer patients during the 10 years was 1 251 yuan (95%CI 1 236 to 1 266). The average daily medical expenditures was significantly different in regions (1 356 yuan in the east region, 1 209 yuan in the middle region and 1 068 yuan in the west region), types of hospital (1 341 yuan in general hospitals, 1 213 yuan in specialized hospitals) and hospital levels (1 293 yuan in 3A grade hospital, 805 yuan in non-3A grade hospital) (P<0.05). The average daily medical expenditures were 1 253 yuan for stage Ⅰ, 1 169 yuan for stage Ⅱ, 1 167 yuan for stageⅢ and 1 092 yuan for stage Ⅳ (P<0.05). From 2002 to 2011, the average daily medical expenditures of hospitalization increased from 1 079 yuan (95%CI 1 021 to 1 136) to 1 549 yuan (95%CI 1 486 to 1 613), with an average growth rate of 3.69%. Since 2007, a continuous growth was observed. Subgroup analysis suggested there were obvious differences in growth patterns between different regions and hospitals, as well as differences between various treatments. Conclusions The average daily medical expenditures of liver cancer in China had been increasing from 2002 to 2011 and there were significant differences between various regions and hospital levels. Combined with data on the change of duration of hospitalization, it can provide reference for the economic evaluation of the nation’s prevention and treatment policies for liver cancer. © 2018, West China University of Medical Science. All rights reserved.

Objective To acquire the flow law of outpatient and emergency visits in a large general hospital. Methods By sampling monthly amount of outpatient and emergency from January 2005 to December 2013 of a large general hospital in Guangzhou, the trend of the time series was analyzed and calculated the seasonal index of the amount of hospital outpatient and emergency visits with the use of long-term trends method. Result The flow law of patients in the hospital outpatient and emergency was significantly affected by seasonal factors, and different month had its own variation characters. The seasonal indexes were the highest in March, July, August, November and December (seasonal index >105%), while the lowest in January, February, October (seasonal index <95%). Conclusion Based on analysis of the outpatient and emergency visits and causes with hospitals, decision makers and hospitals should make reasonable allocation of medical resources and provide evidence for the scientific decisions of hospital management. Thus, ensure the safety of patients.

Objective To investigate inpatient disease constitution in Traditional Chinese Medicine (TCM) Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2010, in order to provide baseline data for medicine allocation of hospitals in western China and development of TCM hospitals. Methods A questionnaire combined with a subject interview was carried out, and the case records of inpatients from 2008 to 2010 were collected. The diseases in discharge records were classified according to International Classification of Diseases (ICD-10) based on the first diagnosis. Data including general information of the inpatients, discharge diagnosis etc. were rearranged and analyzed by Excel software. Results a) The top four systematic diseases seen commonly from 2008 to 2010 were as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases were hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. Respiratory system diseases ranked the third in 2009 and 2010 from the fourth in 2008, and circulatory system diseases had ranked the first during the past three years; b) The following diseases as hypertension, bronchial emphysema and other chronic obstructive pulmonary diseases, diabetes, fractures, airway (bronchus, lung) cancer, and viral hepatitis were commonly seen in males rather than in females. By contrast, intervertebral disc disease, gallstone disease and cholecystitis, and anemia were commonly seen in females; and c) Hypertension was commonly seen in the aged above 60 years old; intervertebral disc disease mainly focused on the patients at the age of 15 to 59; and bronchial emphysema and other chronic obstructive pulmonary diseases, airway (bronchus, lung) cancer involved in the patients who were mostly over 60 years old. Conclusion a) The top four systematic diseases seen commonly from 2008 to 2010 are as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases are hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. So these diseases should be taken into well consideration when making development plans by hospital and complementing essential drugs list by local development; b) Chronic diseases become the main disease for troubling Xinjiang population; and c) Male and female are susceptible to different diseases which should be rationally avoided in order to prevent the induced occurrence.

Objective To analyze the clinical characteristics and geographical distribution of Keshan disease in Chongqing city for prevention and disease control. Methods We collected the clinical data of patients with Keshan disease from 2008 to 2012 in Liangping, Shizhu, Fengdu and Dianjiang counties as well as Wanzhou district of Chongqing city including the medical history, physical examination, results of laboratory tests to analyze the clinical characteristics and geographical distribution. Results Fifty-eight patients were included from Liangping (n=21), Shizhu (n=25), Fengdu (n=11) and Dianjiang (n=1). The number of patients with potential and chronic Keshan disease was 16 and 42, respectively. The average age of patients was 54.91±15.53 years. The proportion above age 60 was 32.76% and below age 10 was 3.45%. The patients had main clinical signs as heart enlargement (36.76%), low-weak first heart sound (22.41%), systolic murmur (10.34%), arrhythmia (8.62%), etc. Abnormal ECG detection rate was 98.28%, with common types followed by sinus rhythm (37.93%), complete right bundle branch block (25.86%), ST-T changes (24.14%), left ventricular hypertrophy (15.52%), atrial fibrillation (13.79%), occasional ventricular premature (10.34%), T changes (10.34%), sinus bradycardia (8.62%), and incomplete right bundle branch block (6.90%). X-ray results showed that heart enlargement accounted for 82.76%. The ratios of mild, moderate and significant expansion of the heart were 46.55%, 27.59%, and 8.62%, respectively. Conclusion In recent years, most patients with Keshan disease in Chongqing are chronic type at older age. The main clinical symptom is heart enlargement with high abnormal ECG detection rate.

Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients' own expense.

Objective: To compare the newest essential medicine lists (EMLs) of China and the World Health Organization (WHO) in 2009, so as to provide the evidence for the selection, adjustment and implementation of the newest national EML of China. Methods: Differences in the procedures of selection, implementation and the categories as well as the number of medicines in 2009 EMLs of the WHO and China were compared by descriptive analysis. Result: Principles and procedures of selecting and updating EML of China were based on those of the WHO EML. However, the transparency of procedures, methods of selection, and evidence of efficacy, safety, cost-effectiveness and suitability were not enough. Essential medicines of the WHO were categorized by the Anatomical-Therapeutic-Chemical (ATC) classification system, while those of China were classified by clinical pharmacology. Twenty-one identical categories of the first class were found in the two lists. There were 8 and 3 unique categories in the WHO EML and China EML, respectively. A total of 358 and 255 medicines (including medicines in its explanation) were included in the EMLs of the WHO and China, respectively, with 133 identical medicines as well as 206 and 108 unique medicines. There were 51 antiinfective medicines in China EML, accounting for half of the WHO EML. Forty medicines were the same in both lists, and 11 and 60 anti-infective medicines were unique in EMLs of China and the WHO, except for 40 identical medicines. Among them, 22 and 31 antibacterials were included in the lists of the WHO and China with 17 identical medicines. Antifungal, antituberculosis and antiviral medicines in China EML were fewer than those in the WHO EML. The numbers of the identical medicines acting on the respiratory, digestive, and nervous systems and hormones in the both lists were 1, 7, 9, and 17, respectively, while the unique ones in China EML were 6, 12, 7, and 14, respectively. However, most of them were selected without adequate evidence in efficacy and safety. The medicines acting on cardiovascular system were 19 and 29 in both lists with 14 identical medicines. Some antihypertensive and antiarrhythmic medicines were included in China EML with similar mechanism, whereas some of them were excluded by the EML. Conclusion: The total numbers of both EMLs are close to each other with half of the identical medicines. The selection of China EML mostly meets the needs of disease burden in China. However, the transparency of selection and evidence are not enough. We suggest that health authorities should cooperate with other stakeholders to promote the transparency of selection, to enhance the capacity of producing high-quality evidence, to develop related technical documents and guidelines, and to disseminate and monitor the implementation of EML.

Objective To analyze the measles epidemic characteristic, so as to provide scientific evidence for the strategy of controlling and eliminating measles. Methods The data of measles cases was collected from the national epi- demiological investigation and surveillance report system, and the measles epidemiological characteristic as well as the efficacy of measles control strategy were analyzed through descriptive studies. Results The total number of the reported measles cases reached 309 in 2009, the incidence rate was 5.1 per 100 000 population and declined by 71.26% compared with the year of 2008. Seasonal peak in 2009 appeared from January to April. The infants less than eight months old as well as the patients more than 15 years old were the main suffering population, which accounted for 33.98% (105/309) and 49.51% (153/309) of the total, respectively. The patients having no or having unclear measles vaccination history ac- counted for 93.2% (288/309). The cases of floating population accounted for 9.71% (30/309). Conclusion It has been demonstrated that vaccine immunization activities are important measures to eliminate measles. To achieve the goal of measles elimination, not only does the children routine immunization have to be performed, but also the strengthened immunization has to be carried out for the key crowd in key areas.

Objective To investigate the essential healthcare system performance in Xinjin county of Chengdu city from 2009 to 2010, so as to provide baseline data for further study. Methods The general information of the essential healthcare, such as the numbers of out and in-patients, service and profits were collected and then analyzed using the software of Microsoft Excel 2003 and SPSS 13.0. Results a) The results showed that the numbers of out and in-patients were in the rank of the county, township and community hospital. The numbers of out and emergency patients has been decreased 31.0% and 25.3% in the community hospital from 2009 to 2010, while patients in the county and township hospital has been increased. The numbers of in-patients has been increased by year; b) hospital bed occupancy has been increased by year, and the hospital bed occupancy of county hospitals was 8% lower than national level in 2009, 33.5% higher in 2010, the hospital bed occupancy of township hospitals from 2009 to 2010 was higher than national level, the ones of community hospital was lower than national level; c) there is an annual decreasing tendency for average days for hospitalization in county and community hospital, which were higher than national level; d) it was lower than national average rate; e) the inpatient fee per time was lower than national average rate; f) in the components of the in-patients expense, drug expense, operation expense and diagnose expense were constituted more than 86% in all eight costs; and g) the receipts and expenditure of Xinjin hospital throughout the year increased by years, the income and expenses showed 39.3% and 37.7%. Conclusion The hospital bed occupancy, average hospitalization days and the inpatient fee per time in Xinjin county of Chengdu city during 2009-2010, were higher than national level. The overall health performance of hospitals in Xinjin county was satisfied. However, there was significant difference between the best and the worst. In order to distribute health resources, both benefit and efficient should be emphasized.

Objectives To investigate the utilization of essential medicines and antibiotics in primary healthcare system of Xinjin county of Chengdu city from 2009 to 2011. Methods The data of utilization of all the medicines, essential medicines and antibiotics was collected from 17 hospitals of Xinjin primary healthcare system. Microsoft Excel 2003 was used to analyze the data. Results Compared with 2009, the total costs of medicines and essential medicines increased by 72.27% and 135.4% respectively in 2010. After the implementation of essential medicine policy in 2010, the proportion of essential medicines accounted for more than 90% in community healthcare centers (CHCs) and township hospitals (THs) and over 50% in county-level hospitals in 2011. In 2010, the average cost per prescription among outpatients increased by 3.51% in total, but deceased by 16.23% in CHCs/THs (RMB 15.09 yuan per prescription). In July of 2011, the policy to control the use of antibiotics was implemented in Xinjin county. The use of antibiotics decreased, but still accounted for over 30% in 9 out of 13 CHCs/THs. The use of bigeminy antibiotics and trigeminy antibiotics accounted for 0.42 to 5.56% and 0 to 0.44%, respectively. Conclusions The use of essential medicines increases in Xinjin county and met the national requirements. The average cost per prescription among outpatient decreases in THs and CHCs. After controlling the use of antibiotics, the proportion and cost of antibiotics is still very high, and irrational use of antibiotics probably still exists. The training and guide for evidence-based rational use of medicine should be enhanced in future.

Objective: To compare the 2009 edition national essential medicine list (part of basic medicine and heath institution) in China and WHO model list of essential medicines for children update in 2010, so as to provide the evidence for model list of essential medicines for children of China. Methods: We compared the difference in composition of content, the categories, specific drugs, formulation, and introduction and sign of list by descriptive analysis. Results: (1) WHO model list of essential medicines for children were comprised with core and complimentary lists, which were not in the 2009 edition national essential medicine list of China; (2) The 2009 edition essential medicine lists of China included 20 categories in WHO model list of essential medicines for children ,while lacked of antineoplastic agents, blood products, disinfectants, peritoneal dialysis fluid and specific medicines for neonatal care; (3) The average conincidence rate with WHO model list of essential medicines for children of the same drugs was 52.61%. There were 15 categories in the interval of 20%-80%, which accounted for 75%. The average conincidence rate with 2009 edition national essential medicine list of China was 44.19%. There were 11 categories in the interval of 20%-50%,which accounted for 55%. the same drugs of regulate water, electrolyte and acid-base balance in the two list accounted for more than 80% of WHO model list of essential medicines for children. Drugs of ear, nose and throat were totally different. (4) The 2009 edition essential medicine list of China didn't have specification and sign of drug for children, age limitation, instruction of list, suitable drug formulations for children such as suspension, syrup, drops, granules, scored tablets, etc. Conclusion: 2009 edition national essential medicine list of China can't meet the demand of children. WHO model list of essential medicines for children which bases on global burden of disease, can not be copied into China. We suggest to reference from WHO model list of essential medicines for children to carry out selecting essential medicines for children in China, formulating essential medicine list for children in China which bases on burden of children disease and clinical demand in China to improve rationality of drugs in children.

Objective To analyze the main input and output of healthcare reform in China, and to provide references for improving the policies and measures of healthcare reform in China in future. Methods Data from the National Health Services Survey, and the China Statistical Yearbook etc. was collected to compare and analyze the allocation of health resources, health status of residents, health service utilization, and medical burden before and after healthcare reform. Results During the reform from 2009 to 2013, hospital health and technical personnel increased year by year. In 2013, the proportion of health and technical personnel in hospitals was up to 61.4% of the total national health technical personnel. In 2013, 65.19% of government expenditure on healthcare was used for disease treatment, and only 14.59% was used for disease prevention. Compared with the year of 2008, the two-week prevalence rate of residents increased by 5.2%, the chronic disease prevalence rate increased by 9% in 2013. Compared with the year of 2009, the annually diagnosed and treated patients increased 18.2 billion person-time, the annually discharged patients increased 59.65 million person-time in 2013. The individual residents paid 52.49% of total medical expenses. Conclusion Since the healthcare reform, China’s central and local governments have imputed a large number of health resources into hospitals for “disease treatment”. That partly improved the utilization of residents’ health service, but the two-week prevalence rate and chronic disease prevalence rate are rapidly growing. There is still high burden of medical expenses for the residents. China’s healthcare model should be changed from “treatment-centered” to “prevention-centered” in future.

Objective To comprehensively evaluate the essential public health service in Xinjin county of Chengdu from 2009 to April 2011, so as to provide evidence for improving primary healthcare system reform in Chengdu city. Methods The data was collected from the Xinjin county-wide health information system. The electronic health records, chronic disease management, childbirth management and mental health were quantitatively described and compared. Results a) In 2010, 88 772 residents had the physical examination and health assessment, among which, 14 497 (16%) were detected with some health problems. The average cost per positive detection was RMB 122.5 yuan. b) Up to April 2011, 98.2% of people in Xinjin county have their health records but the proportions were ranged from 68.08% to 109.02% in different primary healthcare providers. The details of the most health records were incomplete. c) 7 318 patients with hypertension and 2 187 diabetes mellitus were detected, and among them, 90.1% of patients with hypertension and 95.1% of patients with diabetes had their health records for chronic diseases management. d) The rate of stillbirth or neonatal mortality was lower than 4‰. There was no maternal death in the 8 years. But the cesarean section rate was about 61%. e) 97.3% of the patients with mental disorders were supervised in 2010, which was reduced by 2.7% compared to 2009. Conclusions a) There is low proportion of all the residents in Xinjin having physical examination and health assessment and the rate of diseases detection is low as well. b) There is very wide coverage of health records for residents in Xinjin county, nearly universal coverage. c) The health records for the chronic disease patients were well-established, but the early detection rate of the chronic diseases is low. d) High proportion of the patients with mental disorders is supervised. e) The strategy that only county-level hospitals could provide obstetrical service instead of township hospitals is successful to reduce the neonatal mortality and maternal mortality. However, the cesarean section rate is high. f) It acts, to some extent, as a model to successfully improve the essential public health service and management based on the conuty-wide healthcare information system. However, the data quality, data mining and data utilization should be further improved.

Objective: To determine the extent of off-label drug use in pediatric outpatients of West China Second University Hospital in 2010, and to analyze its possible risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China and developing policy of off-label drug use. Methods: The stratified random sampling was conducted to select prescriptions of children aged 0 to 18 years in pediatric outpatients of the West China Second University Hospital in 2010. According to drug instructions, off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs. In addition, an analysis was conducted to check the relationship between off-label use and following possible risk factors: age, sex, essential medicines and over-the-counter drugs. Results: A total of 2 640 prescriptions with 8 588 medical advices involving 329 drugs were extracted and analyzed, with incidence rates of off-label drug use accounting for 76.59%, 40.88% and 83.89%, respectively. The main categories of off-label drug use were no pediatric information (35.57%), indication (25.44%), and dosage (25.31%). The top 2 age groups with highest incidence rate of off-label drug were neonates (54.35%) and adolescents (49.64%). The top 4 drugs with highest incidence rate of off-label drug were respiratory system medicines (48.12%), Chinese patent medicines (48.12%), digestive and metabolic system medicines (33.36%), and systemic anti-infectives (16.27%). The off-label use risks in all age groups in the hospital were indifferent, and the essential medicines and prescription medicines were likely to present higher risks of drug off-label. Conclusion: Off-label drug use in pediatric outpatients is common with growth trend in pediatric outpatients of the West China Second University Hospital. On the one hand, drug instructions lack pediatric information, and on the other hand, it's badly in need of developing relevant legislation, regulations or guidelines to regulate off-label drug use, providing more evidence by conducting clinical trials on pediatric drugs, encouraging the development and production of the applicable drugs and dosage forms for children, and establishing the children essential medicine list, so as to avoid doctor's professional risk and ensure the safety of pediatric drug use.

Objective To determine the extent of off-label drug use in Pediatric Wards of West China Second University Hospital in 2010 and analyze its risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China, and for making policies of off-label drug use. Methods The proportionate stratified random sampling was conducted to select medical advice and discharge medication for hospitalized children in Pediatric Wards in 2010. According to drug instructions, the off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs and wards. In addition, a logistic regression was done that modeled the odds of receiving an off-label prescription as a function of the following possible risk factors: age, sex and the rank of doctors. Results The total 749 children were selected, and 14 374 prescriptions involving 385 drugs were analyzed. The rate of off-label drug use was 98.00%, 78.96% and 88.05% in children, prescriptions and drug categories, respectively. The main categories of off-label drug use were no pediatric information (29.41%), indication (18.35%), dosage (17.61%) and dosage range (±20%) (13.52%). The top 2 age groups of off-label drug use were adolescents (83.56%) and children (80.58%). The top 4 drugs of off-label use were those for alimentary tract and metabolism (82.28%), anti-infectives for systemic use (75.06%), blood and blood forming organs (79.27%) and respiratory (58.27%). The top 2 wards of off-label drug use were Pediatric Hematology (88.27%) and Neonates (79.12%). In hospital, children, adolescents and male patients had higher risk factors of off-label drug use, and doctors with senior rank prescribed more off-label prescriptions than those with intermediate rank. Conclusion: The off-label drug use in Pediatric Wards is common in West China Second University Hospital. On the one hand, drug instructions lack the pediatric information, and, on the other hand, it's badly in need of developing relevant legislations, regulations or guidelines to regulate off-label drug use, in order to avoid doctor's professional risks and ensure the safety of pediatric drug use.