Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-24 Cooperative journals: 《中国全科医学》
Abstract： Background Rifampicin-resistant/multidrug-resistant tuberculosis（RR/MDR-TB）is featured by challenges in the treatment，low cure rate，and high infectivity. Fluoroquinolones（FQs），as the core drugs for the treatment of RR/MDR-TB，have a severe trend of resistance. Analyzing influencing factors for FQs can help to increase the cure rate of RR/MDR-TB and to control the occurrence of the pre-extensive drug resistance（pre-XDR）and extensive drug resistance（XDR）. Objective To analyze the drug resistance of FQs in hospitalized patients with pulmonary tuberculosis and the influencing factors，and to construct and validate a Nomogram prediction model for the risk factors of drug resistance of FQs. MethodsA total of 583 patients with pulmonary tuberculosis who were hospitalized in Guiyang Public Health Clinical Center from January 2021 to February 2022 and tested for drug sensitivity were retrospectively selected as study subjects. They were divided into the initial treatment group（296 patients）and the retreatment group（287 patients）according to the history of previous treatment. Moreover，they were divided into the FQs-resistant group（63 patients）and FQs-sensitive group（520 patients）according to their FQs-resistance status. The distribution of total resistance to 13 antituberculosis drugs in 583 patients was analyzed，and the baseline characteristics of patients in the FQs-resistant group and FQs-sensitive group were compared. After screening the characteristic variables using least absolute shrinkage and selection operator（LASSO）regression model，multivariate Logistic regression was performed to analyze the independent risk factors for the resistance of FQs. A Nomogram prediction model was constructed，and its performance was validated by calculating the area under the curve（AUC）of receiver operating characteristic（ROC），and plotting the calibration curve. Results Among 583 patients，520 cases were sensitive to FQs and 63 cases were resistant（resistance rate of 10.81%）. The resistance rate of FQs was secondary to the total resistance rate of first-line antituberculosis drugs，including the isoniazid（36.36%），rifampicin（32.76%），streptomycin（21.61%），and ethambutol（12.86%）. The resistance rates of rifampicin，isoniazid，ethambutol，streptomycin，levofloxacin，moxifloxacin and rifampicin resistance（RR），multidrug resistance（MDR），and pre-XDR were significantly higher in patients of the retreatment group than those of the initial treatment group（P<0.05）. The proportions of patients with ethnic minorities，retreatment，acquired immunodeficiency syndrome（AIDS），history of drug abuse，cavitation，hemoptysis，history of irregular anti-TB and MDR were significantly higher in the FQs-resistance group than those of the FQs-sensitive group（P<0.05）. Through LASSO regression，six variables of ethnicity，treatment history，AIDS，drug abuse history，hemoptysis，and MDR were screened out as influencing factors. Multivariate Logistic regression analysis showed that ethnicity（OR=2.313，95% CI=1.153-4.640，P=0.018），retreatment（OR=1.892，95%CI=1.005-3.560，P=0.048），hemoptysis（OR=1.941，95%CI=1.087-3.465，P=0.025），and MDR（OR=3.342，95% CI=2.398-7.862，P<0.001）were the independent risk factors for FQs resistance in patients with pulmonary tuberculosis. Logistic regression equation Logit（P）=-3.571+0.838×ethnicity+0.638×treatment history+0.663×hemoptysis+1.468×MDR. Based on which a risk Nomogram prediction model was constructed with an AUC of 0.796（95%CI=0.717-0.876）. The Bootstrap method validated the mean absolute error of 0.015，and the predictive model had good calibration ability by the Hosmer-Lemeshow goodness-of-fit test（χ2=3.426，P=0.489）. Conclusion Our findings suggest a high resistant rate of FQs in patients with pulmonary tuberculosis. Ethnic minorities，retreatment，hemoptysis，and MDR are independent risk factors for FQs resistance in patients. The constructed Nomogram prediction model has a good predictive value for FQs resistance in patients with pulmonary tuberculosis. Our study offers new insights into the clinical diagnosis of drug-resistant tuberculosis and the development of rational treatment regimens for RR/MDR-TB.
Subjects: Other Disciplines >> Synthetic discipline submitted time 2023-03-19 Cooperative journals: 《中国科学院院刊》
Abstract： Earth observation (EO) data, as the basic and strategic resource of a country, plays an important role in national economy, social development, and defense security, and a new era opportunity of the transition from a “great country of data” to a “strong country of data” is coming to China. This paper summarizes the existing conditions and recent trends of opening and sharing of EO data from both international and domestic perspectives, and then analyzes the problems and challenges of opening and sharing EO data in China. Finally, three suggestions are proposed to promote the opening and sharing of China’s EO data, namely, (1) the construction of data governance system needs to be strengthened to consolidate the foundation for opening and sharing EO data; (2) a sustainable data sharing ecosystem needs to be maintained from regulation and technology; (3) the innovative service modes of data sharing should be created to deepen the application of EO data. By strengthening the data opening and sharing, the potential value of China’s EO big data can be discovered and the strategic role of EO data can be fully motivated. Therefore, the international competitiveness of China’s big EO data will be effectively enhanced.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-01 Cooperative journals: 《中国全科医学》
SU Jin
SHOU Juan
GU Wenqin
YI Chuntao
XU Liping
CHENG Lili
DING Hongjuan
ZHOU Peng
WU Yinghua
QIN Jie
XUE Bin
WEI Baichuan
WANG Qian
PENG Yan
CHENG Yimin
YANG Lan
WEI Yangyang
WANG Lei
QI Jinlin
SHAO Ying
Abstract： Background With the gradual deepening of the comprehensive reform of community health services，the prevention and control of single diseases for the entire population in the community is also constantly being optimized，However，there is still a lack of appropriate evaluation methods in the community to reflect its prevention and control effectiveness evaluation. Objective By analyzing and exploring the cost effect of the existing whole-population prevention and control measures of osteoporosis in Fenglin community，from2016 to 2022，this paper answers the initial results and possible problems of the whole population prevention and control of single disease in the community. Methods This study conducted a cost-effectiveness analysis on 4293 community residents who received osteoporosis prevention and treatment in Fenglin Community from 2016 to 2022. Divide the research object into three states based on bone density values: healthy，low bone mass，and osteoporosis，and construct a Markov model to analyze the influencing factors of different state transitions. And based on the predicted values of the Markov model combined with quality adjusted life years （QALY），the increment of quality adjusted life years（QALY） is calculated. All costs invested in prevention and control work from 2016 to 2022 are counted，and the effectiveness of prevention and control is evaluated by the cost/quality adjusted life year increment ratio. Quality adjusted life years （QALY）are obtained by calculating the health utility value and expected life determined through literature search. Results The total cost of osteoporosis prevention and treatment in Fenglin community was 33，814，102.15 yuan. The total quality-adjusted life years of 4293 community osteoporosis prevention and treatment population were 77098.2889 at the first diagnosis，the average per capita was 17.959，and the standard deviation was 9.34. At the second diagnosis，the total quality-adjusted life years were 79616.9361，the mean per capita was 18.546，the standard deviation was 9.342，and the difference between the two diagnoses was 2，518.6472. The incremental cost-effectiveness ratio （ICER） is 2，132.9070 yuan /QALY，and the incremental cost#2;effectiveness ratio （ICER） is less than 1 times （66，965.10 yuan） per capita GDP，indicating that the intervention scheme is fully cost-effective. Conclusion This study combined Markov model and quality-adjusted life years （QALY） to make a preliminary evaluation of the prevention and treatment effect of osteoporosis in Fenglin community. The results showed that the intervention program of osteoporosis prevention and treatment in Fenglin community was worth investing， and provided a certain basis for the accurate prevention and treatment decision of osteoporosis in the future.
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