Objective To investigate the efficacy of voriconazole in the treatment of pulmonary tuberculosis complicated with chronic pulmonary aspergillosis(CPA)based on CYP2C19 gene polymorphism detection and examine the factors affecting the efficacy for improving targeted therapy in clinical practice.Methods A total of 207 patients with pulmonary tuberculosis complicated with CPA treated in the Third People's Hospital of Kunming from December 2018 to November 2022 were randomly assigned to an observation group(105 cases)or a control group(102 cases).The patients in the control group received standard voriconazole treatment,while the patients in the observation group had their voriconazole regimen tailored based on CYP2C19 genotyping results.Plasma drug concentration levels,efficacy,and safety were compared between the two groups and in terms of CYP2C19 genotypes.Logistic regression analysis was used to identify the factors affecting treatment efficacy.Results The observation group showed significantly higher plasma voriconazole concentrations and overall antifungal efficacy compared to the control group(P＜0.05).In the observation group,CYP2C19 genotyping identified 37 extensive metabolizers(EM),47 intermediate metabolizers(IM),and 21 poor metabolizers(PM).Plasma concentration of voriconazole did not show significant difference between EM and IM(P＞0.05),but both PM and IM were associated with significantly lower plasma concentration of voriconazole than PM(P＜0.05).The clinical efficacy rate was 100％for PM,91.5％for IM,and 83.8％for EM(P＜0.05).The incidence of adverse events did not show significant difference among the three genotypes(P＞0.05).Logistic regression analysis revealed that lung cavitation,hypoalbuminemia,and agranulosis were significantly correlated with therapeutic efficacy(P＜0.05).Conclusions CYP2C19 gene polymorphism detection is valuable in clinical practice.It can inform anti-aspergillus therapy with voriconazole to effectively improve symptoms and clinical efficacy in patients with pulmonary tuberculosis complicated with CPA.Meanwhile,clinicians should be aware of the factors such as hypoproteinemia,agranulocytosis,and lung cavitation that may affect the efficacy of voriconazole.

Objective To investigate the efficacy of voriconazole in the treatment of pulmonary tuberculosis complicated with chronic pulmonary aspergillosis(CPA)based on CYP2C19 gene polymorphism detection and examine the factors affecting the efficacy for improving targeted therapy in clinical practice.Methods A total of 207 patients with pulmonary tuberculosis complicated with CPA treated in the Third People's Hospital of Kunming from December 2018 to November 2022 were randomly assigned to an observation group(105 cases)or a control group(102 cases).The patients in the control group received standard voriconazole treatment,while the patients in the observation group had their voriconazole regimen tailored based on CYP2C19 genotyping results.Plasma drug concentration levels,efficacy,and safety were compared between the two groups and in terms of CYP2C19 genotypes.Logistic regression analysis was used to identify the factors affecting treatment efficacy.Results The observation group showed significantly higher plasma voriconazole concentrations and overall antifungal efficacy compared to the control group(P＜0.05).In the observation group,CYP2C19 genotyping identified 37 extensive metabolizers(EM),47 intermediate metabolizers(IM),and 21 poor metabolizers(PM).Plasma concentration of voriconazole did not show significant difference between EM and IM(P＞0.05),but both PM and IM were associated with significantly lower plasma concentration of voriconazole than PM(P＜0.05).The clinical efficacy rate was 100％for PM,91.5％for IM,and 83.8％for EM(P＜0.05).The incidence of adverse events did not show significant difference among the three genotypes(P＞0.05).Logistic regression analysis revealed that lung cavitation,hypoalbuminemia,and agranulosis were significantly correlated with therapeutic efficacy(P＜0.05).Conclusions CYP2C19 gene polymorphism detection is valuable in clinical practice.It can inform anti-aspergillus therapy with voriconazole to effectively improve symptoms and clinical efficacy in patients with pulmonary tuberculosis complicated with CPA.Meanwhile,clinicians should be aware of the factors such as hypoproteinemia,agranulocytosis,and lung cavitation that may affect the efficacy of voriconazole.

Objective:To explore the application value of inventory management model of medical consumables based on the joint inventory management(JMI)theory in the informationization management for medical consumables.Methods:By analyzing the existed problems in the management for medical consumables,and establishing a JMI model information system,the strategy of inventory management of JMI model was formulated to conduct predictive regulation and control,and management for distribution on the requirement of medical consumables.A total of 1200 batches of medical consumables that were used in clinical practice at Heyuan People's Hospital from October 2022 to September 2024 were selected.Based on different inventory management modes,593 batches of medical consumables from October 2022 to September 2023 were managed by using the conventional independent inventory management mode,and 607 batches of medical consumables from October 2023 to September 2024 were managed by using the inventory management model(model management)based on JMI theory for informationization management for medical consumables.The efficiency and quality of management for inventory between two kinds of inventory management modes were compared.Results:The ratio of monthly average consumables to inventory of medical consumables of using the model management mode was 0.468±0.060,which was higher than that of the independent inventory management mode.The monthly average times of emergency ordering,the monthly average times of stockouts,and monthly average times of non-emergency ordering were respectively(23.84±6.02),(5.69±2.28)and(20.57±2.66)times,all of which were lower than those of the independent inventory management mode,and the differences were statistically significant(t=11.249,7.539,8.854,9.654,P<0.05).The consumed times of inbound,information verification,query and statistics,and outbound of medical consumables of adopting the model management mode were respectively(1.18±0.40),(0.25±0.06)h,(0.73±0.35)h,and(0.53±0.22)h,all of which were lower than those of the independent inventory management mode,and the differences were statistically significant(t=50.621,87.351,61.524,43.806,P<0.05).Conclusion:The application of inventory management model for medical consumables based on the JMI theory in informationization management for medical consumables can improve management efficiency for inventory,and optimize structure of inventory,and reduce costs of inventory,and decrease the frequency of temporary procurement for medical consumables.

Objective:To explore the application value of inventory management model of medical consumables based on the joint inventory management(JMI)theory in the informationization management for medical consumables.Methods:By analyzing the existed problems in the management for medical consumables,and establishing a JMI model information system,the strategy of inventory management of JMI model was formulated to conduct predictive regulation and control,and management for distribution on the requirement of medical consumables.A total of 1200 batches of medical consumables that were used in clinical practice at Heyuan People's Hospital from October 2022 to September 2024 were selected.Based on different inventory management modes,593 batches of medical consumables from October 2022 to September 2023 were managed by using the conventional independent inventory management mode,and 607 batches of medical consumables from October 2023 to September 2024 were managed by using the inventory management model(model management)based on JMI theory for informationization management for medical consumables.The efficiency and quality of management for inventory between two kinds of inventory management modes were compared.Results:The ratio of monthly average consumables to inventory of medical consumables of using the model management mode was 0.468±0.060,which was higher than that of the independent inventory management mode.The monthly average times of emergency ordering,the monthly average times of stockouts,and monthly average times of non-emergency ordering were respectively(23.84±6.02),(5.69±2.28)and(20.57±2.66)times,all of which were lower than those of the independent inventory management mode,and the differences were statistically significant(t=11.249,7.539,8.854,9.654,P<0.05).The consumed times of inbound,information verification,query and statistics,and outbound of medical consumables of adopting the model management mode were respectively(1.18±0.40),(0.25±0.06)h,(0.73±0.35)h,and(0.53±0.22)h,all of which were lower than those of the independent inventory management mode,and the differences were statistically significant(t=50.621,87.351,61.524,43.806,P<0.05).Conclusion:The application of inventory management model for medical consumables based on the JMI theory in informationization management for medical consumables can improve management efficiency for inventory,and optimize structure of inventory,and reduce costs of inventory,and decrease the frequency of temporary procurement for medical consumables.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.