Tuberculous meningitis is an important global medical problem which gives rise to high morbidity and mortality. It is the most severe form of extrapulmonary Mycobacterium tuberculosis. Comprehensive prevention effort, prompt diagnosis and rational treatment are all keys to improving treatment outcomes; yet many unsolved problems remain. On the other hand, the new problems, such as HIV co-infection and drug-resistance are posing important challenges. This review outlines the epidemiology, pathogenesis, diagnosis, management and prognosis of tuberculous meningitis. We mainly focus on research carried out in the recent decades, giving special attention to the work done among the Asian populations
Tuberculosis, Meningeal

China ; Education, Medical ; Occupational Health

Objective:To:investigate the curative effects and cost of sequential treatment of children communityacquired pneumoni(CAP) with azithromycin. Method:118 cases of CAP from this hospital were divided into two groups: sequential azithromycin therapeutic group (Group A) and iv ceftazidime group (Group B). Their clinical effect was observed and cost minimization analysis was carried out. Result:The total costs were 612?7. 3 yuan and 819?8. 2 yuan(P 0.05) in Group A and Group B respectively. Conclusion: The sequential azithromycin scheme is a better one to treat CAP.

Objective To study the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from cardiac arrest using a meta-analysis.Methods We searched the MEDLINE (1966-April 2012),OVID (1980 to April 2012),EMBASE (1980 to April 2012),Chinese bio-medical literature & retrieval system (CBM) (1978 to April 2012),Chinese medical current contents (CMCC) (1995 to April 2012),and Chinese medical academic conference (CMAC) (1994 to April 2012).Studies were included (1) the study design was a randomized controlled trial (RCT); (2) the study population included patients successfully resuscitated from cardiac arrest,and received either conventional post-resuscitation care with normothermia or mild hypothermia; (3) the study provided data about good neurologic outcome and survival till hospital discharge.Relative risk (RR) and 95％ corfidence interval (CI) were used to pool the effect.Results The study included four RCTs with a collected total of 417 patients successfully resuscitated from cardiac arrest.Compared to conventional post-resuscitation care with normothermia,patients in the hypothermia group were more likely to have good neurologic outcome (RR =1.43,95％ CI 1.14 ～ 1.80,P =0.002) and were more likely to survive till hospital discharge (RR =1.32,95％ CI 1.08 ～ 1.63,P =0.008).From all over the studies there was no significant difference in reported adverse events between the normothermia and hypothermia group (P ＞ 0.05).There did not exist heterogeneity and publication bias.Conclusions Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from cardiac arrest.

Animals ; Aorta ; metabolism ; pathology ; Atherosclerosis ; etiology ; metabolism ; pathology ; Cholesterol, Dietary ; Male ; Matrix Metalloproteinase 2 ; metabolism ; PPAR gamma ; agonists ; Rabbits ; Random Allocation

Objective To explore the clinic value and efficacy of color Doppler ultrasound guided percutaneous microwave/radiorequency thermoablation for secondary hyperparathyroidism. Methods Fifty-six cases of secondary hyperparathyroidism who came from nephrology department of Beijing Friendship Hospital in the period of September 2012 to September 2013 were treated by color Doppler ultrasound guided percutaneous microwave/radiorequency thermoablation. One hundred and thirty-eight glands underwent this treatment and were evaluated by contrast enhanced ultrasound before, during and after operation. The levels of serum parathyroid hormone (PTH) were measured before and at 1 week, 1 month, 6 months and 1 year after treatment. Results The whole 56 cases achieved 1 month follow-up and 34 cases and 12 cases achieved 6 months and 1 year follow-up, respectively. Two special cases had been excluded. The PTH levels of 54 cases were signiifcantly different between after and before treatment [(369.5±183.4) ng/L vs (1321.6±471.4) ng/L, t=10.727, P=0.000]. The PTH levels continued to fall at the ifrst week after treatment, but there was no statistical signiifcance between the ifrst week and the ifrst day after treatment [(324.6±172.8) ng/L vs (369.5±183.4) ng/L], while there was signiifcantly different between the ifrst week after treatment and before treatment [(324.6±172.8) ng/L vs (1321.6±471.4) ng/L, t=9.364, P=0.000]. The PTH levels increased from (324.6±172.8) ng/L to (332.5±164.9) ng/L at 1 week and 1 month after ablation, while there was no signiifcant difference.But there is signiifcantly different between 1 month after treatment and before treatment (t=11.348, P=0.000). The PTH level at 6 months after treatment [(205.2±136.3) ng/L] and 1 year after treatment [(177.1±171.5) ng/L] had signiifcant difference compared with the value before treatment (t=8.737, P=0.000; t=7.655, P=0.017). Conclusion Color Doppler ultrasound guided percutaneous microwave/radiorequency thermoablation can be considered as a feasible and effective nonsurgical alternative treatment for secondary hyperparathyroidism patients.

Objective To investigate the effect of aspirin on the incidence of thromboembolism in hypertensive patients associated with paroxysmal atrial fibrillation.MethodsFour hundred hypertensive patients with paroxysmal atrial fibrillation (mean age 59 years) free of thromboembolic events were randomized assigned to receive aspirin (0.3 g/d) or placebo. Cerebral thromboembolism,including transient ischemic attack and embolism of peripheral arteries were defined as primary outcomes. Event-free survival curves were estimated by Kaplan-Meier curve. Results During 3.6 years follow-up,primary outcomes occurred in 61 patients (4.3% per year). Aspirin significantly reduced the incidence of primary outcome as compared with placebo group( 9.0% vs 21.5%,P

This paper presented the conventional methods for signal detection of adverse drug reactions (ADRs) and their applications, the research progress in ADRs signal mining based on healthcare big data, and briefed the methods and uses of ADRs prediction using machine learning technology in the era of healthcare big data.The conclusion was that deep learning, as a fast growing tool in machine learning, will become hotspot of research, expected to help with ADRs signal mining and rational clinical drug use.

Objective To explore the incidence,features and outcomes of in-hospital sudden cardiac death (SCD) in order to determine the predictors of survival. Methods The clinical data of 69 patients with cardiac arrest hospitalized from January 2008 through December 2010 were retrospectively analyzed.Information on genders,age,types of arrhythmia was collected and further analyzed to determine these factors associated with the occurrence and outcomes of in-hospital cardiac arrest. Results The overall incidence of SCD was 47.3 / 100 000 per year and 17.4％ of them.survived at discharge.The occurrence rate was higher in male than that in female (66.7％ vs.33.3％,P ＜0.01 ),whereas difference in gender did not affect the discharge rate ( P ＞ 0.05 ). Survivors from in-hospital cardiac arrest were significantly younger than non-survivors (man:62.57 ± 12.83 years vs.75.56 ± 10.55 years; women:60.36 ± 13.24years vs.69.53 ± 11.72 years,P ＜ O.01 ).From 62 ECG records of SCD patients,the incidence of nonshockable rhythms was higher than that of shockable rhythms.Compare to the non-shockable rhythms,the shockable rhythms brought a higher rate of restoration of spontaneous circulation (ROSC) (54.5％ vs.24.5％,P ＜0.05),whereas survival rates at discharge between two groups were not statistically different ( 18.2％ vs.18.4％,P ＞ 0.05 ).Conclusions Non-shockable rhythms were more common in patients suffering from in-hospital cardiac arrest.Although defibrillation treatment contributed benefit to ROSC among patients with ventricular fibrillation or pulseless ventricular tachycardia,high-quality CPR and post-cardiac arrest care may play a more critical role in the outcomes of in-hospital sudden cardiac death.

Objective To observe the efficacy and safety of tiopronin supplemented with chemotherapy in treating advanced breast cancer.Methods Sixty patients with advanced breast cancer were randomly divided into two groups:treatment group(n = 28) and control group (n = 32).Two groups were treated the same of NVB + DDP,the treatment group was supplemented with tiopronin,given for 10 days.Efficacy,toxicity in two groups were compared.Results The effective rate in the treatment group and the control group were 46.4% and 46.9% respectively, with no significant difference between the two groups ,P > 0.05.But the improved quality of life of patients in the treatment group was higher than that in the control group, P < 0.05.The rate of adverse reaction in liver function damaged (9.4%)and leucocyte lassitude(46.4%) were apparent lower than those in the control group(31.2% ,81.2% ),with significant difference between the two groups(P < 0.05, P < 0.01).Conclusion Tiopronin supplemented with chemotherapy show apparent effect in decreasing the adverse reaction of chemotherapy,improving the quality of life and not influence efficacy in advanced breast cancer.So tiopronln may act as protective drug for chemotherapy and deserve further testing in the clinic.