OBJECTIVE To explore the main factors influencing the blood concentration of duloxetine， and provide a scientific basis for the individualized use of duloxetine. METHODS Retrospective analysis was conducted on 434 inpatients with depressive disorders at the First Hospital of Hebei Medical University， who were treated with duloxetine and underwent blood concentration monitoring between January 2022 and April 2024. The study examined the impact of various factors， including gender， age， body mass index （BMI）， gene phenotypes， combined medication， drug type （original/generic）， and genotyping results of gene single nucleotide polymorphism loci， on blood concentration and the concentration-to-dose （C/D） after dose adjustment. RESULTS The blood concentration of duloxetine was 76.65 （45.57， 130.31） ng/mL， and C/D was 0.96 （0.63， 1.60） ng·d/（mL·mg）. The blood concentration of duloxetine was positively correlated with the daily dose of administration （R2＝0.253 7， P＜0.001）. Blood concentration of duloxetine in 38.94% of patients exceeded the recommended range specified in the guidelines. Gender， age， BMI， combined use of CYP2D6 enzyme inhibitors， and CYP2D6 and CYP1A2 phenotypes had significant effects on C/D of duloxetine （P＜0.05）. CONCLUSIONS The patient’s age， gender， BMI， combined medication， and genetic phenotypes are closely related to the blood concentration of duloxetine.

Objective To investigate the global burden of visceral leishmaniasis (VL) from 1990 to 2021 and predict the trends in the burden of VL from 2022 to 2035, so as to provide insights into global VL prevention and control. Methods The global age-standardized incidence, prevalence, mortality and disability-adjusted life years (DALYs) rates of VL and their 95% uncertainty intervals (UI) were captured from the Global Burden of Disease Study 2021 (GBD 2021) data resources. The trends in the global burden of VL were evaluated with average annual percent change (AAPC) and 95% confidence interval (CI) from 1990 to 2021, and gender-, age-, country-, geographical area- and socio-demographic index (SDI)-stratified burdens of VL were analyzed. The trends in the global burden of VL were projected with a Bayesian age-period-cohort (BAPC) model from 2022 to 2035, and the associations of age-standardized incidence, prevalence, mortality, and DALYs rates of VL with SDI levels were examined with a smoothing spline model. Results The global age-standardized incidence [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)], prevalence [AAPC = -0.06%, 95% CI: (-0.06%, -0.06%)], mortality [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)] and DALYs rates of VL [AAPC = -2.38%, 95% CI: (-2.44%, -2.33%)] all appeared a tendency towards a decline from 1990 to 2021, and the highest age-standardized incidence [2.55/10⁵, 95% UI: (1.49/10⁵, 4.07/10⁵)], prevalence [0.64/10⁵, 95% UI: (0.37/10⁵, 1.02/10⁵)], mortality [0.51/10⁵, 95% UI: (0, 1.80/10⁵)] and DALYs rates of VL [33.81/10⁵, 95% UI: (0.06/10⁵, 124.09/10⁵)] were seen in tropical Latin America in 2021. The global age-standardized incidence and prevalence of VL were both higher among men [0.57/10⁵, 95% UI: (0.45/10⁵, 0.72/10⁵); 0.14/10⁵, 95% UI: (0.11/10⁵, 0.18/10⁵)] than among women [0.27/10⁵, 95% UI: (0.21/10⁵, 0.33/10⁵); 0.06/10⁵, 95% UI: (0.05/10⁵, 0.08/10⁵)], and the highest mortality of VL was found among children under 5 years of age [0.24/10⁵, 95% UI: (0.08/10⁵, 0.66/10⁵)]. The age-standardized incidence (r = -0.483, P < 0.001), prevalence (r = -0.483, P < 0.001), mortality (r = -0.511, P < 0.001) and DALYs rates of VL (r = -0.514, P < 0.001) correlated negatively with SDI levels from 1990 to 2021. In addition, the global burden of VL was projected with the BAPC model to appear a tendency towards a decline from 2022 to 2035, and the age-standardized incidence, prevalence, mortality and DALYs rates were projected to be reduced to 0.11/10⁵, 0.03/10⁵, 0.02/10⁵ and 1.44/10⁵ in 2035, respectively. Conclusions Although the global burden of VL appeared an overall tendency towards a decline from 1990 to 2021, the burden of VL showed a tendency towards a rise in Central Asia and western sub-Saharan African areas. The age-standardized incidence and prevalence rates of VL were relatively higher among men, and the age-standardized mortality of VL was relatively higher among children under 5 years of age. The global burden of VL was projected to continue to decline from 2022 to 2035.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for adult severe tetanus by comparing the NLR in patients with severe and mild tetanus.Methods:A total of 65 adult tetanus patients from the Linyi Central Hospital from January 2009 to December 2020 were enrolled. The patients were divided into two groups including mild group and severe group according to the Ablett classification. The general conditions, laboratory data, and NLR of patients in two group were retrospectively compared using independent samples t test. Multivariate logistic regression analysis was used for the analysis of risk factors for severe tetanus. Spearman correlation method was used for the analysis of the correlation between risk factors and Ablett grades. Receiver operator characteristic (ROC) curve was used for the evaluation of the predictive value. Results:Among the 65 tetanus cases, 34 was in mild group and 31 in severe group. The latency period of patients in severe group was (7.00±3.19) d, which was shorter than that in mild group ((9.18±2.59) d), and the difference was statistically significant ( t=3.03, P=0.004). The NLR of patients in severe group was 4.251±1.936, which was higher than that of mild group (2.533±1.026) , and the difference was statistically significant ( t=4.41, P<0.001). Multivariate logistic regression analysis showed that NLR and latency period were independent risk factors for tetanus severity (odds ratio ( OR)=2.359, 95% confidence interval ( CI) 1.415 to 3.934, P=0.001 and OR=0.748, 95% CI 0.599 to 0.936, P=0.011, respectively). In tetanus patients, the NLR level was positively correlated with Ablett grade ( r=0.644, P<0.001). The ROC curve showed that NLR had good predictive value for adult severe tetanus at a cut-off value of 2.471 (area under the curve (AUC)=0.787), with the sensitivity and specificity of 87.1% and 61.8%, respectively. When combining NLR with latency period (cut-off value of 7.5 d), predictive efficiency was further improved (AUC=0.832) with the sensitivity of 87.1% and specificity of 67.6%( Z=3.43, P<0.001). Conclusions:NLR has a good predictive value for adult severe tetanus, and the predictive efficiency is further improved when combined with latency period.

OBJECTIVE： To evaluate the economics of the full coverage policy for hypoglycemic essential medicines in Taizhou city， and to provide reference for improving medicine accessibility and essential medicine system in China. METHODS： The electronic health records and financial input data of diabetic patients were extracted from different districts and counties of Taizhou city during 2009-2016. In cohort study design， taking the implementation time of each district and county’s policies as the breakpoint， the data recorded annually were processed as annual data， forming the cohort data for 1 year before （baseline year） and 3 years after the implementation of the policies. According to the choice of free medicines after the implementation of the policy， they were divided into policy group and control group. Propensity score matching was used to balance the differences between two groups to get the final sample， and then the economics of the policy was evaluated with the methods of difference-in-differences. The cost and benefit of implementation policy were calculated. RESULTS： Totally 14 744 people of each group were got by propensity score matching. The mean annual financial expenses on free medicine per capita were 263.8 yuan. Compared with baseline year， mean annual medicine expenses per capita reduced by the policy were 649.2 yuan， and mean annual hospitalization expenses per capita were 624.7 yuan. Thus the input-output ratio of the policy was 1 ∶ 4.8. CONCLUSIONS： The implementation of the policy is beneficial to reduce the cost burden of patients and economical. It can be popularized and sustained through scientific design combined with relevant policies.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective: To investigate the molecular epidemiological characteristics of Human Calicivirus (HuCV) infection among children less than 5 years in Kunming city, Yunnan province, it might be provide effective evident for prevention and control the diarrhea related with HuCV infection. Methods: Four sentinel hospitals were recruited in the study from Kunming city, Yunnan province, 850 diarrhea cases and 170 non-diarrhea subject were recruited in this study from 2014 to 2015. RT-PCR was performed to screen HuCV infection, and gene sequencing was used to ensure positive infection subtypes and genotypes. Results: The positive rate of HuCV was higher in children with diarrhea than in non-diarrhea children (11.5%, 98/85; 4.7%, 8/170, χ²=7.083, P=0.008), and the positive rate of Norovirus (NoV) GII was higher in non-diarrhea children were (11.1%, 94/85; 4.7%, 8/170, χ²=6.353, P=0.012). There was no significant difference in the positive rate of NoV GI (0.1%, 1/850; 0.0%, 0/170, P=0.833) and Sappovirus (0.4%, 3/850; 0.0%, 0/170, P=0.578) in diarrhea children and non-diarrhea children. GII.P4 (10%, n=102) was the most important genotype of NoV GII detected in diarrhea and non-diarrhea individuals. Despite no significant difference in Norovirus GII infection between different age groups (χ²=0.038, P=0.846) and sex(χ²=0.620, P=0.733), infection rate of NoV GII varied with season (χ²=9.867, P=0.020), having close relationship with diarrhea in autumn (15.6%), primarily caused by GII.4 and GII.12 genotype (χ²=8.881, P=0.031; χ²=7.917, P=0.039). Conclusions NoV GII diarrhea had higher epidemic rate, which was caused by multiple genotypes, GII.P4 was a dominant genotype, and was a major pathogenic agent of diarrhea in infants f in Kunming city.