Youping Li

Histidine-tryptophan-ketoglutarate solution vs. University of Wisconsin solution for liver transplantation: A systematic review

University of Wisconsin (UW) solution has been recognized as the gold standard in liver preservation, but its limitations are becoming obvious, such as risk of biliary complications and its high cost. Alternatively, the effects of histidine‐tryptophan‐ketoglutarate (HTK), such as improved biliary protection and low cost, have been observed. This systematic review is conducted to compare the efficacy and safety of these 2 solutions. Databases from 1966 to June 2006 were searched. Randomized clinical trials (RCTs) and cohort studies comparing HTK and UW solutions for liver transplantation were included. Ten articles including 11 comparisons (1,200 patients) met the inclusion criteria, containing 2 RCTs and 9 cohort studies. No marked differences existed between the 2 groups in patient and graft survival rates, acute rejection, primary nonfunction, primary dysfunction, delayed graft function, and ALT and AST levels after transplantation. The only positive result was observed in the bile production after deceased donor liver transplantation (DDLT), which was statistically significantly higher in HTK group than that of UW group (95% confidence interval, 18.65‐57.47; P = 0.0001). Although the difference in biliary complications between the 2 groups did not reach statistical significance, HTK was thought to be more effective for biliary tract flush and prevention of biliary complications in some studies. There was no statistically significant difference of effects (except bile production) between HTK and UW. But trends were documented in some studies for the superiority of HTK in biliary tract flush, prevention of biliary complications, and cost saving. Adequately powered RCTs with longer follow‐up periods are required to evaluate the long‐term effect of these 2 solutions. Liver Transpl 13:1125–1136, 2007.

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.

Mycobacterium vaccae as Adjuvant Therapy to Anti-Tuberculosis Chemotherapy in Never-Treated Tuberculosis Patients: A Meta-Analysis

Objective To evaluate the effectiveness and safety of heat-killed M.vaccae added to chemotherapy of never-treated tuberculosis (TB) patients. Methods The databases of Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, SCI, CBM, VIP and CNKI were searched. Randomized controlled trials (RCT) and Controlled clinical trials (CCT) comparing M.vaccae with or without a placebo-control injection as adjuvant therapy in the chemotherapy of never-treated TB patients were included. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 5.0 software by The Cochrane Collaboration. Results Fifty four studies were included. At the end of the follow-up period, Pooled RR (Risk Ratio) and its 95% CI of sputum smear conversion rate were 1.07 (1.04, 1.10) in TB patients without complications, 1.17 (0.92, 1.49) in TB patients with diabetes mellitus, 1.02 (0.94, 1.10) in TB patients with hepatitis B, and 1.46 (0.21, 10.06) in TB patients with pneumosilicosis. In elderly TB patients the RR was 1.22 (1.13, 1.32). Analysis of each time point during the follow-up period showed that M.vaccae could help to improve the removal of acid-fast bacilli from the sputum, and promote improvement of radiological focal lesions and cavity closure. Compared with the control group, the differences in levels of immunological indicators of Th1 such as IL-2 and TNF-α were not statistical significant (P = 0.65 and 0.31 respectively), and neither was that of IL-6 produced by Th2 (P = 0.52). An effect of M.vaccae of prevention of liver damage was found in TB patients with hepatitis B (RR 0.20 and 95% CI (0.12, 0.33). No systemic adverse events were reported. Conclusion Added to chemotherapy, M.vaccae is helpful in the treatment of never-treated TB patients in terms of improving both sputum conversion and X-ray appearances.

Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review.

Please cite this paper as: Li L, Wen J, Wang L, Li YP, Li Y. Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG 2011;118:400–409.

Consolidated standards of reporting trials (CONSORT) for traditional Chinese medicine: current situation and future development

The reporting standards for randomized controlled trials were first published in 1996 by a group of scientists under the name “CONSORT,” which means consolidated standards of reporting trials. Revisions followed in 2001 and 2010. A draft of the CONSORT for traditional Chinese medicine (TCM) was published in both Chinese and English in 2007. After publication of the draft, comments were solicited from the medical community. Some papers did raise concerns about which items should be included in the CONSORT for TCM such as the rationale of the trial design, intervention, outcome assessment, and adverse events. We have now reached the next step which is the finalization of the CONSORT for TCM. Three tasks remain. First, the major changes in CONSORT statement 2010 should be integrated into the CONSORT for TCM. Second, Chinese drugs from minerals and animals should be included in the guidelines. Finally, agreement must be reached among the working groups. Once the draft is finalized, wide dissemination and co-publication will be considered.

Adverse drug reactions and adverse events of 33 varieties of traditional Chinese medicine injections on National Essential medicines List (2004 edition) of China: an overview on published literatures

Objectives We conducted a literature review on adverse drug reactions (ADRs) related to 33 kinds of traditional Chinese medicine injections (CMIs) on Chinas National Essential medicines List (2004 edition). We aimed to retrieve basic ADR information, identify trends related to CMIs, and provide evidence for the research, development, and application of CMIs.

Time and spatial distribution of multidrug-resistant tuberculosis among Chinese people, 1981–2006: a systematic review

OBJECTIVES We aimed to investigate trends in the prevalence of multidrug-resistant tuberculosis (MDR-TB) among Chinese people from first report to 2006, and to detect the high prevalence regions in order to guide control efforts. MATERIALS AND METHODS The CBM, VIP, CNKI, and MEDLINE databases were searched through both keywords and subject headings. The literature was screened, and two investigators assessed the quality and extracted the data. Trends in MDR-TB prevalence in three groups--primary, acquired, and combined MDR-TB--were examined separately, using the Cochran-Armitage trend test. Differences were tested with the Kruskal-Wallis test. High prevalence provinces were explored through comparison of the 95% confidence interval (95% CI) with the national average level. RESULTS Overall 169 studies were included, with 165 in Chinese and four in English. One hundred and sixteen studies concerned primary MDR-TB, 103 acquired MDR-TB, and 130 combined MDR-TB, with total positive Mycobacterium tuberculosis (MTB) isolates of 110 076, 25 187, and 150 233, respectively. The prevalences of MDR-TB in the three groups in 2005 were 2.64-, 6.20-, and 3.84-times that of 1985, respectively, all showing an upward trend (p<0.05). The prevalences among the three groups were significantly different (p<0.05), with acquired drug resistance (27.5%, 95% CI 26.9-28.1%) much higher than primary drug resistance (4.3%, 95% CI 4.2-4.4%), and combined resistance (9.9%, 95% CI 9.8-10.1%) in between. The top three prevalence regions for primary, acquired, and combined MDR-TB were distributed in the zone from the northeast to the southwest of China, with Hebei, Tibet, and Shanxi having an extremely high prevalence. CONCLUSIONS The prevalence of MDR-TB among the Chinese people has shown an upward trend since 1985. It is necessary to continue to monitor this trend in China. Special attention should be paid to provinces distributed in the zone from the northeast to the southwest of China for MDR-TB surveillance, research, and control.

Comparative cost-effectiveness of antiviral therapies in patients with chronic hepatitis B: A systematic review of economic evidence

Background and Aim:  Economic efficiency of the alternative antiviral therapies for chronic hepatitis B has not been systematically investigated and their quality remains unknown. The aim of the present study was to systematically overview economic evidence of antiviral therapies for chronic hepatitis B.

Analysis of 1856 inpatients and 33 deaths in the West China Hospital of Sichuan University from the Wenchuan earthquake.

Objective To describe the 1861 injured inpatients and deaths in the West China Hospital of Sichuan University after the Wenchuan earthquake, to provide evidence to help improve emergency plans for earthquake, and the establishment of state‐level regional medical centers. Methods The analyses use, data provided by the Department of Information of the hospital up until 23 July 2008. Microsoft Excel for data input and SPSS 11.5 for statistical analysis were used. Results By 23 July, 2728 people from the disaster areas had been treated in the hospital, of whom 872 were admitted to the emergency department and 1856 to the inpatient department (974 men, median age 43 years; 882 women, median age 46 years). Most (82.4%) patients were sent to the hospital within the first two weeks after the earthquake, and the number of inpatients reached its peak on day 8 (976 cases). Most (60.2%) of the inpatients were discharged between day 9 and day 18. The injured patients came mainly from Deyang, Aba Prefecture and Dujiangyan. On admission, the diagnoses were mainly fracture (54.8%), craniocerebral injury (9.8%), and thoracoabdominal injury (7.5%). Thirty‐three patients died, including five who were dead on arrival at the hospital, one death in the emergency department, and 27 inpatient deaths. Conclusion The development of an emergency plan for medical rescue after an earthquake disaster is an essential step to enhance emergency response capability, to improve the scientific process of field triage, transport and transfer, and to ensure the rational allocation and application of healthcare resources after large disasters in the future.

Epidemiological analysis of pulmonary tuberculosis in Sichuan Province, China, 2000—2006

OBJECTIVES To investigate the epidemiological features of pulmonary tuberculosis in Sichuan Province, China, for the period 2000-2006. MATERIALS AND METHODS Data from the China Information System for Disease Control and Prevention, the World Health Organization, and the high caseload provinces in China were collected. This was a descriptive study, and the Besag and Newell method was applied. RESULTS From 2000 to 2006, the incidence rate of pulmonary tuberculosis increased from 54 to 103/100,000, the mortality rate increased from 0.02 to 0.30/100,000, and the case-fatality rate increased from 0.04% to 0.29%. The age groups 20-24, 65-69, and 70-74 years had higher incidences. There were more cases and deaths in males compared to females. Peasants contributed the most to caseloads (64%) and deaths (69%) in the total population. The north and west regions of Sichuan Province had higher incidences. Sichuan had a higher incidence, mortality rate, and case-fatality rate than both the national level and Henan Province between 2001 and 2003. It also had a higher prevalence of active tuberculosis and smear-positive pulmonary tuberculosis than the national level and Guangdong Province after 1990. Multidrug-resistant tuberculosis is a major problem in China compared to India and Indonesia. CONCLUSIONS Sichuan should be the most important province in China with regard to tuberculosis prevention and control, especially for male peasants from the north and west regions and the active pulmonary tuberculosis and sputum smear-positive cases. The major challenge is multidrug-resistant tuberculosis.