OBJECTIVE:To understand the main diseases research area and tendency of the literatures published on top-five global biomedicine journals,and provide reference for topics and designs of domestic medical research. METHODS:Studies pub-lished on NEJM,JAMA,BMJ,Lancet and PLoS Medicine from 2004 to 2013 were searched via Web of Science;types of disease were classified by using International Classification of Diseases(version 10)(ICD-10);research types were analyzed according to the rules in clinical epidemiology. RESULTS:Most of studies(25.8%)were published on BMJ;USA(39.1%),UK(25.7%) and Canada(5.1%)were top-three countries for the first authors;circulation system disease,infectious and parasitic diseases,can-cer,endocrine,nutritional and metabolic disease and respiratory system disease were top-five in disease categories list,accounting for 61.7%;ischemic heart disease,HIV-related disease,diabetes,other heart disease and influenza and pneumonia were the main top-five specific diseases;and randomized controlled trials were main study type. CONCLUSIONS:The proportion of the first au-thor for the Chinese literature in the host country is very low. Top-five specific diseases are placed on circulation system disease,in-fectious and parasitic diseases,endocrine,nutritional and metabolic disease and respiratory system disease,with the main study types of randomized controlled trial,cohort study and systematic review.

OBJECTIVE:To systematically review the efficacy and safety of anti-vascular endothelial growth factor(VEGF)in-hibitors in the treatment of retinopathy of prematurity (ROP),and provide evidence-based reference for clinic. METHODS:Re-trieved from PubMed,EMBase,Cochrane Library,CJFD,VIP,CBM and Wangfang Database,randomized controlled trials (RCT) about VEGF inhibitors (test group) versus laser photocoagulation treatment (control group) in the treatment of ROP were collected. Meta-analysis was performed by using Rev Man 5.1 software after data extraction and quality evaluation by Cochrane re-viewers manual 5.1.0. RESULTS:Totally 5 RCTs were included,involving 381 infants and 754 eyes.Results of Meta-analysis showed that the recurrence rate of ROP [RR=0.23,95%CI(0.13,0.42),P<0.001],retinal detachment incidence [RR=0.27,95%CI(0.14,0.51),P<0.001] andresolution of plus signs [MD=-1.31,95%CI(-1.47,-1.14),P<0.001] in test group were signifi-cantly lower than control group,the differences were statistically significant;and there was no significant difference in the refrac-tive errors and the incidence of adverse reactions in 2 groups(P>0.05). CONCLUSIONS:Intravitreal VEGF inhibitors have better efficacy than laser photocoagulation in the treatment of ROP,but the optimal dose and safety need further verification by large-sam-ple and well-designed RCT.

OBJECTIVE:To review therapeutic efficacy of N-acetylcysteine (NAC) for idiopathic pulmonary fibrosis (IPF),and to provide evidence-based reference.METHODS:Retrieved from Central database,PubMed,EMBase,CBM,CJFD,Wanfang database and VIP,randomized controlled trials or semi-randomized controlled trials about NAC (unlimited single drug or combination) vs.placebo/blank control in the treatment of IPF were collected.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane collaboration's bias risk assessment tool(2014 edition).RESULTS:A total of 10 studies were included(2 RCT,8 qRCT),involving 742 patients.Results of Meta-analysis showed that compared to placebo/blank control,NAC couldn't reduce the mortality of IPF patients [OR=1.14,95％ CI(0.50,2.62),P=0.76],but could significantly improve subjective symptom remission rate[OR=3.17,95％ CI (1.98,5.07),P＜0.001] and dyspnea score [SMD =-2.54,95 ％ CI (-5.02,-0.06),P=0.04].CONCLUSIONS:For IPF,NAC can't decrease the mortality of patients,but can relieve main symptoms and dyspnea.

OBJECTIVE To provide a reference for the safe administration of patients with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease. METHODS Clinical pharmacists participated in the diagnosis and treatment of a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease. Given the thrombocytopenia caused by enoxaparin sodium， pharmacists suggested to stop enoxaparin sodium and change it to fondaparinux sodium after a blood routine review. For the patient with fast heart rate and low blood pressure， pharmacists recommended to choose metoprolol and adjust the dosage according to the heart rate， and change furosemide to hydrochlorothiazide. Pharmacists recommended to continue using metoprolol regarding doctors’ plan to replace metoprolol with sotalol before cesarean section. For possible drug interactions in the patient， pharmacists recommended to closely monitor blood potassium and other indicators， and provided drug education. RESULTS The doctors adopted the advice of clinical pharmacists. The patient’s bleeding was controlled， the indicators were kept stable during hospitalization， the gestational week was extended smoothly， and the cesarean section was successfully performed. CONCLUSIONS By participating in the treatment of the patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease， clinical pharmacists formulate individualized medication plans for the patient based on adverse drug reactions， drug interactions and medication education， ensuring the safety and effectiveness of medication.

Objective:To explore the current situation and related factors of negative emotions in mothers of infants aged 0-3 years.Methods:Totally 1 183 mothers of 0-3-year-old infants in 3 communities of a districts and counties were selected.They were investigated with the self-designed demographic information questionnaire and the Depression Anxiety Stress Scale(DASS-21).Multiple linear regression analysis was used to explore the re-lated factors of mothers'negative emotions.Results:The detection rates of mild and above depression,anxiety and stress were 34.74％,46.07％and 18.10％respectively.The multiple linear regression analysis showed that moth-ers with fewer children,higher social prestige/stable occupation,and higher education were more depressed(β=-0.10,0.15,0.16).Mothers with higher social prestige/stable occupation and higher education were more anxious(β=0.14,0.17).Mothers who lived in areas with higher levels of economic and social development,or with higher social prestige/stable occupations and with higher education were more stressed(β=0.10,0.14,0.15).Conclu-sion:The mothers of 0-3-year-old infants have high detection rate of mild negative emotions.The residence,occu-pation,education level and the number of children are related to the negative emotions of mothers.

OBJECTIVE:To evaluate the global existed diarrhea guidelines of children,and provide evidence and methodology reference for clinical practice and the formulation of diarrhea evidence-based guideline of children in China. METHODS:Retrieved from PubMed,Embase,CBM,CNKI,VIP,Wanfang databases and related websites,references included in studies were retrieved additionally from database building to Dec. 2017. The methodological quality of the guideline was evaluated by 2 researchers independently with guideline evaluation toolⅡ(AGREEⅡ). ICC analysis was used to calculate the differences between the evaluation results of 2 researchers and analyze the difference of the guidelines. RESULTS:A total of 1 168 literatures were collected primarily, and 15 guidelines were involved finally,among which 3 guidelines were from USA,2 from British,2 from WHO,each one from Italy,Europe,India,Australia,Malaysia,New South Wales,South Africa and China,respectively. Of 15 guidelines,there were 10 evidence-based guidelines and 5 non-evidence-based guidelines;evidence levels of guidelines and the method of recommendation intensity were different. ICC of 2 researchers were higher than 0.75(P<0.05),indicating good homogeneity among them. The quality of 15 guidelines were not high enough,and the scores of included guidelines in the field of AGREEⅡin descending order were as follows:scope and purpose(84.44%),clarity of presentation(79.82%),stakeholder involvement(45.74%), rigor of development(41.18%), editorial independence (36.39%)and applicability(33.89%). Main prevention and treatment method recommended by guideline included that(1) prevention and treatment of dehydration was the key link in the treatment of children's diarrhea;(2)guidelines generally believed continuous breastfeeding during rehydration could reduce the risk of dehydration in children;(3)zinc preparation was recommended to shorten the course of diarrhea;(4)antibiotics were used rationally, etc. CONCLUSIONS:The quality of global existed diarrhea guidelines of children should be improved. There is no comprehensive diarrhea evidence- based guideline of children in China,and there is a large discrepancy between the situation of pediatric diarrhea therapy in China and WHO standard;it is urgent to establish a standard treatment. It is suggested to formulate high quality pediatric diarrhea guideline in accordance with the national conditions of China,based on standards for international guideline report, comprehensively considering disease burden and characteristics of pediatric diarrhea in China.

Respiratory syncytial virus (RSV) is one of the major pathogens of acute respiratory infections, becoming a huge global burden. Virus-receptor interactions play a key role in the pathogenesis of RSV infection. The distribution of receptors influences the cellular and the tissue tropism of RSV as well as the viral replication and proliferation in the host. However, the RSV receptors are currently unknown, which is one of the reasons that hinders the development of RSV vaccines and therapeutic drugs. In this study, the existing RSV receptors are reviewed with the hope to provide ideas for the research of RSV vaccines and therapeutic drugs.

OBJECTIVE To systematically evaluate the adverse effects of drug-resistant tuberculosis （DR-TB） drugs on pregnant women and fetuses ，so as to provide evidence-based reference for clinical medication. METHODS PubMed，Cochrane Library，Embase，CBM，CNKI，Wanfang database and VIP were searched by computer to collect randomized controlled trials （RCTs），cohort studies ，case-control studies ，case series and case reports about pregnant women exposed to DR-TB drugs. The retrieval time limit was from the establishment of each database to August 20，2021. After selecting the literature and extracting the data，the bias risk assessment tool recommended by 6.2 version of Cochrane system evaluator manual was used to evaluate the quality of the included RCTs ；Newcastle-Ottawa scale was used to evaluate the quality of the included cohort studies and case-control studies ；IHE scale issued by the Canadian Institute of Health Economics （IHE）was used to evaluate the quality of the included case series and case reports. RevMan 5.1 software was used for Meta-analysis of non-comparative binary data. RESULTS A total of 13 literature were included ，including 7 case series and 6 case reports ，involving 203 patients and 204 newborns；among them，there were 6 literature about non-comparative binary data. The results of meta-analysis showed that after exposure to DR-TB drugs，no newborn had birth defects ；the mortality of pregnant women was 0.09[95％CI（0.06，0.15），P＜0.000 01]；the neonatal mortality was 0.02[95％CI（0，0.06），P＜0.000 01]；the incidence of preterm birth was 0.14[95％CI（0.03，0.43），P＝0.02]；the incidence of infants with low birth weight was 0.17[95％CI（0.04，0.51），P＝0.06]；the incidence of growth retardation was 0.15[95％CI（0.09，0.22），P＜0.000 01]；the incidence of stillbirth was 0.05[95％CI（0.02，0.09），P＜0.000 01]；the incidence of abortion was 0.08[95％CI（0.05，0.14），P＜0.000 01]. CONCLUSIONS Pregnant women exposed to DR-TB drugs can cause pregnant women ’s death and abortion ，neonatal death ，premature birth ，infants with low birth weight ，growth retardation and stillbirth，but there is no neonatal birth defect ；these adverse outcomes may be related to the history of DR-TB.

Objective To analyze the distribution and antimicrobial resistance profile of clinical bacterial strains isolated from blood culture in China.Methods Clinical bacterial strains isolated from blood culture from participating hospitals of Blood Bacterial Resistance Investigation Collaborative System (BRICS) during January 2014 to December 2015 were collected.Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods as recommended by US Clinical and Laboratory Standards Institute(CLSI)2018.The data were analyzed with Whonet 5.6 software.Results During the study period,4 801 clinical bacterial isolates were collected from 26 hospitals,of which 1 798 (37.5％) were Gram-positive bacteria and 3 003 (62.5％) were gram-negative bacteria.The top 10 isolates were Escherichia coli (33.8％),coagulase-negative Staphylococcus (19.0％),Klebsiella pneumoniae (11.9％),Staphylococcus aureus (10.1％),Acinetobacter baumannii (4.0％),Pseudomonas aeruginosa (3.8％),Streptococcus (3.0％),Enterobacter sulcus (2.9％),Enterococcus faecium (2.8％) and Enterococcus faecalis (1.8％).Methicillin-resistant Staphylococcus aureus (MRSA) and methicillinresistant coagulase-negative Staphylococcus (MRCNS) accounted for 33.9％ (165/487) and 56.9％ (520/913) of Staphylococcus aureus and coagulase-negative Staphylococcus respectively.No vancomycinresistant Staphylococcus was detected.The resistance rate of Enterococcus faecium to vancomycin was 0.7％ (1/135),and no vancomycin-resistant Enterococcus faecaliss was detected.The positive rates of extendedspectrum β-1actamases(ESBLs)-producing Escherichia coli,Klebsiella pneumoniae and Proteus were 56.9％ (923/1 621),30.1％ (172/572) and 29.2％ (7/24),respectively.The positive rates of carbapenemresistant Escherichia coli,Klebsiella pneumoniae,Enterobacter,Salmonella and Citrobacter were 1.2％ (20/1 621),7.2％ (41/572),4.3％ (6/141),1.5％ (1/67) and 2.9％ (1/34),respectively.The resistance rates of Acinetobacter baumannii to polymyxin and tegacycline were 2.6％ (5/190) and 8.9％ (17/190)respectively,and that of Pseudomonas aeruginosa to polymyxin and fosfomycin were 1.1％ (2/183)and 0.6％ (1/183),respectively.Conclusions The surveillance results from 2014 to 2015 show that the main pathogens of blood stream infection in China are Gram-negative bacteria,while Escherichia coli is the most common pathogen,the detection rate of MRSA is lower than other surveillance data in the same period in China;carbapenem-resistant Klebsiella pneumoniae and Escherichia coli are at a low level as shown in this surveillance.

Objective:To investigate the bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China.Methods:The clinical bacterial strains isolated from blood culture were collected during January 2020 to December 2020 in member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS). Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI, USA). WHONET 5.6 was used to analyze data.Results:During the study period, 10 043 bacterial strains were collected from 54 hospitals, of which 2 664 (26.5%) were Gram-positive bacteria and 7 379 (73.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (38.6%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (9.9%), coagulase-negative Staphylococci (7.5%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.3%), Enterobacter cloacae (2.8%), Enterococcus faecalis (2.6%), Acinetobacter baumannii (2.4%) and Klebsiella spp (1.8%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 27.6% and 74.4%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci were detected. More than 95% of Staphylococcus aureus were sensitive to rifampicin and SMZco. No vancomycin-resistant Enterococci strains were detected. Extended spectrum β-lactamase (ESBL) producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 48.4%, 23.6% and 36.1%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.3% and 16.1%, respectively; 9.6% of carbapenem-resistant Klebsiella pneumoniae strains were resistant to ceftazidime/avibactam combination. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii. The prevalence rate of carbapenem-resistance of Pseudomonas aeruginosa was 23.2%. Conclusions:The surveillance results in 2020 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen, and ESBL-producing strains declined while carbapenem-resistant Klebsiella pneumoniae kept on high level. The proportion and the prevalence of carbapenem-resistant Pseudomonas aeruginosa were on the rise slowly. On the other side, the MRSA incidence got lower in China, while the overall prevalence of vancomycin-resistant Enterococci was low.