Sichuan provincial health emergency team has completed a number of domestic emergencies, as well as the emergency medical rescue of the Nepal earthquake, since constructured. It established a great industry image, moreover, the people’s health and safety of life were ensured. This paper summarized the experience of Sichuan provincial health emergency team construction, to provide scientific evidence of optimizing health emergency team construction in China.
Objective To analyze literatures reported allele frequencies of CYP2C191,2,3 for healthy Asian populations, and to provide evidence-based data for further personalized drug therapy and pharmacogenomics research. Methods Relevant articles were electronically retrieved from digital databases of PubMed, EMbase, The Cochran Library, CNKI, WanFang Data, VIP and CBM, and the articles reporting the allele frequencies of CYP2C19 were included. According to the inclusion and exclusion criteria, the data of the allele frequencies of the gene were extracted, pooled, and analyzed. Results A total of 41 articles were included, involving 9 841 healthy Asians from 17 countries. Analyses were conducted according to regional features, based on China, East Asia (China, Korea and Japan), Southeast Asia (Vietnam, Thailand, Malaysia, Singapore, Myanmar, Indonesia and Philippines), South Asia (India), and West Asia (Palestine, Lebanon, Saudi Arabia, Turkey, Iranian and Jordan). The major results showed that the allele frequencies of CYP2C191,2,3 were 61.3%, 32.1% and 6.6% (Chinese, n=4170); 61.0%, 31.2% and 7.8% (East Asians, n=5879); 67.6%, 28.8% and 3.7% (East South Asians, n=1985); 64.0%, 35.2% and 0.8% (South Asians, n=679); and 87.3%, 12.1% and 0.6% (West Asians, n=1298), respectively. Based on the included 9841 healthy Asians from 17 countries, the total allele frequencies of CYP2C191,2,3 were 66.0%, 28.4% and 5.5%, respectively. Conclusion The allele frequencies of CYP2C191,2,3 2 fairly differ in ethnic groups in China, as well as in regions in Asia. Besides, genetic variation is impacted by geographical factors such as regions and environment.
ObjectivesTo compare different formula calculated dosages with the actual doses of warfarin from patients in Beijing Hospital so as to investigate suitable warfarin dosing models for Chinese patients.MethodsOne hundred and three Chinese patients with long-term prescription of warfarin were randomly selected from Beijing Hospital from July 2012 to May 2013. The CYP2C9 and VKROC1 genotypes and basic statistical information were collected. SPSS 18.0 software was used to compare the differences between different formula calculated dosages and the actual dosages of warfarin.ResultsFive genotypes were found in 103 patients, including: CYP2C9 AA genotype + VKORC1 AA genotype (n=72, 69.9%), CYP2C9 AA genotype + VKORC1 AG genotype (n=17, 16.5%), CYP2C9 AC genotype + VKORC1 AA genotype (n=10, 9.7%), CYP2C9 AC genotype + VKORC1 AG genotype (n=3, 2.9%) and CYP2C9 AA genotype + VKORC1 GG genotype (n=1, 1%). Compared with the actual dosages of warfarin, the degree of coincidence was highest for dosages calculated by Jeffrey’s formula.Conclusions Using Jeffrey’s formula to calculate warfarin dosages may be more suitable for Chinese patients with using long-term warfarin. Due to limited sample size, prospective and large sample size studies are required to verify the above conclusion.
Objective To provide the China Essential Drugs List with evidence-based data for selecting the antihypertensive drugs in ARBs category. Methods With following search terms such as losartan, atenolol and clinical trial, the relevant clinical trials on losartan and atenolol for treating hypertension in both Chinese and English languages were collected from the EMbase, PubMed, The Cochrane Library, website of clinicaltrials.gov, CNKI, VIP and CBM. Results A total of 52 studies were pooled in this systematic review, of which most focused on the losartan intervention for endpoint reduction in hypertension (LIFE) study. The main results were that: a) With the same effects in lowering blood pressure, losartan was superior to atenolol in toleration and reducing left ventricular hypertrophy; b) Losartan was more effective than atenolol in preventing cardiovascular and cerebrovascular events, especially better in preventing new-onset stroke; c) Losartan was superior to atenolol in the patients complicated with or without diabetes mellitus, with or without atrial fibrillation, and with low hemoglobin or high blood uric acid, as well as in the patients co-treated by aspirin or hydrochlorothiazide; d) No matter either losartan or atenolol used in the aggressive antihypertensive therapy, the risk of sudden cardiac death got increased in hypertensive patients with prolonged QRS duration; e) Losartan was superior to atenolol in treating patients with smoking and drinking habits; and f) There were no significant differences between losartan and atenolol in hypertensive patients of black people, different genders, as well as the patients with mutant angiotensin-converting enzyme (ACE) gene. Conclusion Losartan has the same antihypertensive effects as atenolol dose, but it is more effective in reducing left ventricular hypertrophy, and has more benefits to hypertensive patients beyond lowering blood pressure, such as, reducing urine protein and uric acid rather than high density lipoprotein.
Objective To systematically evaluate anti-platelet effect of clopidogrel influenced by CYP2C192,3 polymorphism in patients with cardiovascular diseases, in order to provide references for its safe medication. Methods Literature was retrieved in electronic databases covering EMbase, PubMed, The Cochrane Library, CBM and CNKI from establishment dates to November, 2011. Observational studies and clinical trials were included, cross-checked, assessed and pooled for meta-analysis. meta-analysis was performed using the software RevMan 5.1. Results A total of 13 articles including 14 trials (n=36 855) were included. The results of meta-analysis showed that: a) there was no significant difference in the incidences of cardiovascular events between CYP2C192,3 carriers and CYP2C191 carriers; b) the risk of stent thrombosis in CYP2C192,3 carriers was significantly higher than that in CYP2C191 carriers (Plt;0.000 1), and the relative risk of CYP2C192,3 carriers increased 92% within one month (Plt;0.000 1); c) as for bleeding events, there were no significant differences between CYP2C192,3 carriers and CYP2C191 carriers. Conclusion Compared with CYP2C191 carriers, CYP2C192,3 carriers have a higher risk of stent thrombosis in clopidogrel-treated patients, but there are few differences in cardiovascular and bleeding events between the two carriers. Therefore, CYP2C192,3 carriers with cardiovascular diseases and ready to receive PCT are suggested to pay more attention to stent thrombosis when using clopidogrel. We propose that patients with cardiovascular diseases and ready to receive PCT should have CYP2C19 tests to determine the use of antiplatelet drug (clopidogrel) to avoid thrombus.
ObjectivesTo systematically review the efficacy and safety of direct oral anticoagulants (DOAC) on preventing venous thromboembolism (VTE) after major orthopedic surgery (MOS).MethodsThe Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and CBM databases were electronically searched for randomized controlled trials (RCTs) on the efficacy and safety of DOAC on preventing VTE after MOS from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 22 RCTs involving 41 244 patients were included. The results of meta-analysis showed that: the rate of symptomatic deep vein thrombosis (DVT) after MOS in rivaroxaban (Peto OR=0.54, 95%CI 0.35 to 0.82, P=0.004) and apixaban (Peto OR=0.49, 95%CI 0.26 to 0.92, P=0.03) were lower than enoxaparin. Additionally, the rate of symptomatic pulmonary embolism (PE) after MOS in rivaroxaban was lower than enoxaparin (Peto OR=0.53, 95%CI 0.29 to 0.96, P=0.04), however, in major bleeding after MOS rivaroxaban was significant higher than enoxaparin (Peto OR=1.98, 95%CI 1.30 to 3.01, P=0.001).ConclusionsCurrent evidence shows that rivaroxaban and apixaban is superior to enoxaparin on preventing symptomatic DVT after MOS. Rivaroxaban is superior to enoxaparin on preventing symptomatic PE, however, the risk of major bleeding is higher than enoxaparin. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectivesTo systematically evaluate the effects of second-generation ALK-inhibitors: Ceritinib and Alectinib on ALK+ NSCLC patients.MethodsPubMed, EMbase, The Cochrane Library, WanFang Data, ClinicalTrials.gov and VIP databases were systematically searched for clinical trials containing treatment of two principal second-generation ALK-inhibitors for ALK (+) NSCLC patients from inception to December 31st, 2017. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias included in the studies. Stata 12.0 software was used for meta-analysis.ResultsEleven studies were included. Meta-analysis showed that the ORR of all was 57% (95%CI 0.48 to 0.66, P<0.001). The ORR of patients with Crizotinib-resistance was 51% (95%CI 0.44 to 0.57,P<0.001). The IDCR of patients who had brain metastases was 78% (95%CI 0.71 to 0.86,P<0.001).ConclusionsThe second-generation ALK-inhibitors has effect on ALK (+) NSCLC. Due to limitation of the included studies, more larger sample studies are required to verify above conclusions.
Emergency medical rescue system is an important part of public health and urban security system. Based on the emergency medical rescue practice of" 6·24”sudden high mountain collapse disaster in Diexi town of Mao county, this article mainly analyzes, summarizes and puts forward the countermeasures and suggestions for the emergency medical rescue system, which has been sharpened, explored and established in numerous disasters in Sichuan province.
ObjectivesTo systematically review the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on hypercholesteremia.MethodsDatabases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and CBM were searched electronically for randomized controlled trials (RCTs) of PCSK9 inhibitor on the treatment of hypercholesteremia from inception to June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 42 RCTs involving 90 058 patients were included. Alirocumab, evolocumab, bococizumab and LY3015014 were retrieved. Placebo, statin or ezetimibe were used to treat the patient in the control group. The efficacy results showed that there were significant differences between alirocumab combined statin and placebo combined statin (MD=−49.89, 95%CI −56.34 to −43.44, P<0.00001) or evolocumab combined statin and placebo combined statin (MD=−56.54, 95%CI −61.09 to −52.00, P<0.00001) in reducing LDL-C levels. There was significant difference between alirocumab combined statin and ezetimibe combined statin (MD=−29.41, 95%CI −36.08 to −22.75, P<0.00001) in reducing LDL-C levels. The results of Safety showed that there were no significant differences between alirocumab and placebo (RR=0.99, 95%CI 0.97 to 1.01, P=0.37) or evolocumab and placebo (RR=1.05, 95%CI 1.00 to 1.10, P=0.07) in the incidence of adverse events (AEs). There was significant difference between bococizumab and placebo (RR=1.09, 95%CI 1.01 to 1.18, P=0.03) in the incidence of AEs. There was significant difference between evolocumab and ezetimibe (RR=0.89, 95%CI 0.80 to 0.99, P=0.04) in the incidence of AEs. There was no significant difference between alirocumab and statin (RR=0.93, 95%CI 0.84 to 1.03, P=0.90) in the incidence of AEs.ConclusionsPCSK9 inhibitor can reduce LDL-C levels in patients with hypercholesterolemia and has good safety. Due to the limitation of the quantity and quality of the included studies, the above conclusions are needed to be verified by more high quality studies.
ObjectiveTo investigate the effect of ADAM33 gene silencing in VSMCs on the proliferation and lumen formation of airway vascular endothelial cells (VECs) in a co-culture system and the possible regulatory mechanism. MethodsThe Human aortic smooth muscle cells (HASMCs) and human pulmonary microvascular endothelial cells (HPMECs) were used to construct a cell co-culture system. ADAM33 gene expression was silenced by lentivirus transfection technique, and the subjects were divided into endothelial cell blank group, co-culture group, co-culture +shRNA negative control group, and co-culture + ADAM33-SHRNA group. The expressions of sADAM33, VEGFA,VEGER2, ang-1 and ang-2 in co-culture system were detected by ELISA. The proliferation and lumen formation of HPMECs were observed by CCK-8 and Transwell experiments. The protein expression of Tie2, PI3K, Akt, and mTOR key molecules in Tie2/PI3K/Akt/mTOR signaling pathway and the phosphorylation levels of AKT and mTOR were detected by Western-blotting method. Results① Compared with the co-culture group (0.851±0.036) and the co-culture + shRNA negative control group (0.828±0.047), the OD value of the co-culture + ADAM33shRNA group (0.699±0.038) was significantly decreased (P<0.05). ② Compared with the co-culture group (159.169±15.740) and the co-culture +shRNA negative control group (157.357±21.612), the tube length of the co-culture +ADAM33shRNA group (120.812±2.791) was also significantly decreased (P<0.05). ③ After ADAM33 gene expression of HASMCs was silted in co-culture system, the expression levels of VEGFA, VEGFR2, ang-1 and ang-2 were significantly decreased (P<0.05), while the expression levels of Tie2, PI3K, P-Akt and P-mtor were decreased (P<0.05). ConclusionsSilencing the expression of the ADAM33 gene could reduce the release of sADAM33 from the membrane of the airway VSMCs, regulate the proliferation and lumen formation of airway VECs by reducing the expression of VEGF/VEGFR and inhibiting the activities of the Tie2/PI3K/Akt/mTOR signaling pathways,and then participate in airway vascular remodeling in asthma.