National Clinical Center Research Articles

Cardiovascular comorbidities among patients with psoriasis: a national register-based study in China

This study aims to illustrate epidemiology of comorbid CVD in the real-world clinical setting of patients with psoriasis in China. We used data of adult patients with psoriasis who were registered in the register of China National Clinical Center for Skin and Immune Diseases between August 2020 and September 2021. Psoriasis was clinically diagnosed following the national guidelines. Univariate and multivariate logistic regression models were used to examine the factors associated with comorbid CVD in patients with psoriasis. Of the 11,560 psoriasis patients (age ≥ 18 years, mean age 41.87 years, 64.88% males), 236 were ascertained with CVD, with the overall prevalence being 2.62%. Multivariate logistic regression analysis suggested that the odds ratio (95% confidence interval) of CVD in psoriasis patients was 2.27 (2.03–2.54) for older age (per 10-year increment), 0.65 (0.48–0.90) for female, 2.07 (1.39–3.06) for obesity (BMI ≥ 28 vs. < 24 kg/m2), 2.55 (1.85–2.52) for smoking, 7.63 (5.86–9.94) for hypertension, 4.27 (3.76–4.85) for diabetes, 1.14 (1.00–1.30) for having a history of drug allergy, 2.27 (1.61–3.20) for having family history of psoriasis, and 1.76 (1.16–2.67) for severe disease (severe vs. mild) with a dose–response relationship (Ptrend < 0.001). In patients with psoriasis, comorbid CVD was associated with smoking, obesity, hypertension, diabetes, history of drug allergy, family history of psoriasis, and the psoriasis severity.

Indicators of Central Hemodynamics During Simultaneous Laparoscopic Operations in the Combination of Chronic Calculous Cholecystitis and Gynecological Diseases

Currently, a combination of various surgical and gynecological pathologies in one patient is not uncommon. In this regard, performing simultaneous operations seems to be a more optimal method of choice. After all, the main advantage of simultaneous operations is the ability to reduce the load on the patient’s body and simultaneously perform two or more different interventions, which helps reduce treatment and recovery time. Under observation were 197 patients who underwent simultaneous operations in the period from 2019 to 2023. The studies were carried out on the basis of the National Clinical Center of the Ministry of Health of the Kyrgyz Republic, the MC KG private clinic and the Medi private clinic.

Academic Days of the National Clinical Center for Children's Neuropsychomotor Recovery “Dr. Nicolae Robănescu”, Bucharest, 14-15 September 2023 - Congress Abstracts

Academic Days of the National Clinical Center for Children's Neuropsychomotor Recovery “Dr. Nicolae Robănescu”, Bucharest, 14-15 September 2023 - Congress Abstracts

Findings regarding emotion regulation strategies and quality of life's domains in families having children with spinal muscular atrophy.

The severity of motor impairment and the psycho-emotional and social consequences of spinal muscular atrophy (SMA) impact both children and their families, who must adapt using cognitive-emotional strategies. We aimed to determine whether the domains of quality of life and the consequent emotion regulation strategies could be related, and if so, to what quantitative, at a statistically significant level. This study was conducted at the Dr. N. Robanescu National Clinical Center of Neurorehabilitation for Children and included 33 mothers questioned using the PedsQL-Family Impact Module (PedsQL-FIM) and Cognitive Emotion Regulation Questionnaire (CERQ). Statistical analysis of PedsQL-FIM data showed high positive Spearman’s rho correlations between communication and social functioning (p=0.719), daily activities and cognitive functioning (p=0.704), family relationships and daily activities (p=0.705). The analysis of the Spearman’s rho correlation coefficients reflected some moderate positive correlations between CERQ subscales: self-blame and catastrophizing (p=0.577), acceptance and refocus on planning (p=0.577), acceptance and putting into perspective (p=0.532), refocus on planning and positive reappraisal (p=0.630), positive reappraisal and putting into perspective (p=0.609). Maladaptive strategies affect family relationships, cognitive and social functioning, emotional functioning, and communication inside the family. Positive correlations were found between the adaptive strategies (acceptance, refocus on planning, putting into perspective, positive reappraisal) in the participants within our study group, showing their interest in attitude changing and actively solving the family tasks related to children’s illness.

Analysis of 17 years of surgical treatment for chronic limb ischemia in a Chinese National Clinical Center for Geriatric Disorders (2002 to 2018)

ObjectiveThe purpose of this study was to determine the trends in patient numbers, procedures numbers, amputation rate, length of stay (LOS) and hospitalization expenses in a National Clinical Research Center for Geriatric Disorders over 17 years (2002–2018). MethodsThe data of inpatients with chronic lower extremity ischemia caused by atherosclerosis in Xuanwu Hospital from 2002 to 2018 was reviewed. Results5137 patients were reviewed, of whom 58% (2976/5137) were diabetic. The numbers of annual inpatients, endovascular treatment cases, and mean hospitalization expenses increased over time, and the mean LOS progressively decreased. The amputation rate decreased from 8.12% in 2002 to 2007 to 0.87% in 2008 to 2018 (P < .0001). The mean LOS decreased from 28.20 days in 2002 to 2007 to 11.12 days in 2008 to 2018 (P < .0001). The mean hospitalization expenses rose from 54,466.94 yuan in 2002 to 2007 to 76,469.40 yuan in 2008–2018 (p = .0013). There were no significant differences in mean LOS and mean hospitalization expenses between the diabetic and the non-diabetic groups. In the diabetic subgroup, the amputation rate decreased from 8.83% in 2002 to 2007 into 0.99% in 2008 to 2018 (P < .0001). ConclusionFrom 2002 to 2018, the number of inpatients with atherosclerotic chronic lower limb ischemia increased gradually, and the number of endovascular treatments increased significantly; concomitantly, the amputation rate and mean LOS decreased, and the mean hospitalization expenses increased. The decreased amputation rate may be related to increased implementation of endovascular treatment or angiogenesis therapy.

Chinese expert brief consensus on newborn screening of inherited metabolic disorders during the novel coronavirus infection epidemic.

Novel coronavirus (2019-nCov) infection (COVID-19) rapidly spread across China and 25 countries in the worldwide, which infected not only adults but also children, even neonates. Each year, about 15 million newborns are delivered in China. Newborn screening (NBS) helps effectively prevent some mental retardation, premature death, and adverse outcomes in the early stage of baby, which could detect some inherited metabolic disorders (IMDs). During this COVID-19 epidemic, how to balance the risk of infected 2019-nCov and the risk of disability and teratogenesis of IMDs. Expert members of NBS extra quality assessment in National Clinical Center of Laboratory (NCCL) give a brief consensus for NBS of IMDs in the COVID-2019 epidemic, hoping that the brief consensus could be reference for NBS of IMDs in the other epidemic areas or periods all over the world.

An Overview of Tuberculosis-Designated Hospitals in China, 2009-2015: A Longitudinal Analysis of National Survey Data.

Design A national tuberculosis- (TB-) designated hospital survey was conducted in 2015 to identify significant changes since 2009 in implementation of TB-testing services within hospitals of various types and administrative levels in various regions in China. Methods In 2015, all TB-designated hospitals were required to complete questionnaires designed by the National Clinical Center for TB. Community hospitals also completed simplified questionnaires as part of the study. Results Overall, in 2015 there were 1685 TB-designated hospitals in China, consisting of 1335 (79.2%) county-level hospitals and 350 (20.8%) hospitals at the prefecture level and above. The percentage of counties with TB-designated hospitals in the western region (57.4%) was significantly lower than corresponding percentages for eastern and middle regions (70.3% and 96.5, respectively). Based on data recorded on hospital surveys in both 2009 and 2015, significant differences were noted between years in proportions of general hospitals with TB wards and of specialized infectious disease hospitals (P < 0.01). Of 1256 county-level laboratories conducting smear microscopy, only 979 (79%) performed external quality control evaluations of test results in 2015. For prefecture-level hospitals, 70% (234/334), 76% (155/203), and 67% (66/98) of hospitals obtained external quality control validations of smear microscopy, phenotypic DST, and molecular test results, respectively. Conclusions Although China's health reform efforts have resulted in improved TB patient access to quality health care, more attention should be paid to balancing the distribution of medical facilities across different regions. In addition, laboratory capabilities and quality control systems should be strengthened to ensure delivery of high-quality laboratory services by TB-designated hospitals throughout China.

In Vitro Drug Susceptibility of Bedaquiline, Delamanid, Linezolid, Clofazimine, Moxifloxacin, and Gatifloxacin against Extensively Drug-Resistant Tuberculosis in Beijing, China.

Extensively drug-resistant tuberculosis (XDR-TB) is a deadly form of TB that can be incurable due to its extreme drug resistance. In this study, we aimed to explore the in vitro susceptibility to bedaquiline (BDQ), delamanid (DMD), linezolid (LZD), clofazimine (CLO), moxifloxacin (MFX), and gatifloxacin (GAT) of 90 XDR-TB strains isolated from patients in China. We also describe the genetic characteristics of XDR-TB isolates with acquired drug resistance. Resistance to MFX, GAT, LZD, CLO, DMD, and BDQ was found in 82 (91.1%), 76 (84.4%), 5 (5.6%), 5 (5.6%), 4 (4.4%), and 3 (3.3%) isolates among the XDR-TB strains, respectively. The most frequent mutations conferring fluoroquinolone resistance occurred in codon 94 of the gyrA gene (57.8%), and the strains with these mutations (69.2%) were associated with high-level MFX resistance compared to strains with mutations in codon 90 (25.0%) (P < 0.01). All 5 CLO-resistant isolates exhibited ≥4-fold upward shifts in the BDQ MIC, which were attributed to mutations of codons 53 (60.0%) and 157 (20.0%) in the Rv0678 gene. Additionally, mutation in codon 318 of the fbiC gene was identified as the sole mutation related to DMD resistance. In conclusion, our data demonstrate that the XDR-TB strains exhibit a strikingly high proportion of resistance to the current anti-TB drugs, whereas BDQ, DMD, LZD, and CLO exhibit excellent in vitro activity against XDR-TB in the National Clinical Center on TB of China. The extensive cross-resistance between OFX and later-generation fluoroquinolones indicates that MFX and GAT may have difficulty in producing the desired effect for XDR-TB patients.

Prevalence and treatment outcome of extensively drug-resistant tuberculosis plus additional drug resistance from the National Clinical Center for Tuberculosis in China: A five-year review

The objective of this study was to explore the prevalence and primary clinical outcomes of extensively drug-resistant tuberculosis plus addition resistance to all drug tested (XDR-TB-Plus) between 2011 and 2015 in Beijing Chest Hospital. We retrospectively reviewed the drug susceptibility testing (DST) results of clinical Mycobacterium tuberculosis (MTB) strains from TB patients seeking health care in the National Clinical Center for Tuberculosis, between 2011 and 2015. The medical records of patients classified as XDR-TB-Plus were reviewed, including demographic characteristics, treatment regimen, and treatment outcome. Of 9544 MTB isolates, there were 3376 (35.4%), 842 (8.8%) and 61 (0.64%) isolates identified as multidrug resistant tuberculosis (MDR-TB), extensively drug resistant tuberculosis (XDR-TB) and XDR-TB-Plus, respectively. The proportion of XDR-TB showed significant increase from 6.3% in 2011 to 9.1% in 2015 (Chi-square trend 5.94, P=0.015). Similarly, the proportion of XDR-TB-Plus seemed to increase from 0.46% in 2011 to 0.74% in 2015, while the increasing trend was not significant (Chi-square trend 1.50, P=0.221). The most frequently prescribed anti-TB drug was moxifloxacin (18/29, 62.1%), followed by protionamide (16/29, 55.2%), clofazimine (15/29, 51.7%), and pyrazinamide (15/29, 51.7%). Patients receiving regimens containing linezolid (LZD) were almost 27 times more likely to have favorable treatment outcome compared with those receiving regimens without LZD [odds ratios=27.00; 95% CI=2.50-291.19; P=0.003]. In conclusion, our data have demonstrated that the proportion of XDR-TB has significantly increased over the past five years in Beijing Chest Hospital. In addition, the XDR-TB-Plus patients were more likely to reach favorable clinical outcome under the treatment of regimen containing LZD.

Watch and Wait Management of Inactive Cystic Echinococcosis - Does the Path to Inactivity Matter - Analysis of a Prospective Patient Cohort.

BackgroundOverdiagnosis and overtreatment are rarely discussed in the context of NTDs despite their relevance for patients under the care of health services with limited resources where the risks of therapy induced complications are often disproportionate to the benefit. The advantages of cyst staging-based management of patients with cystic echinococcosis (CE) are not yet fully explored. Questions are: Do inactive cysts (CE 4 and CE 5) need treatment and is there a difference between cysts which reach CE4 and CE5 naturally or by benzimidazole therapy?Methodology/Principal findingsAnalysis of long-term follow-up data from a prospective CE patient cohort of 223 patients of a national clinical center for echinococcosis. The event of interest “relapse” was defined as the reversal of a cyst from an inactive stage (CE4, CE5) back to an active stage. The watch &wait (ww) group included 30 patients with 46 inactive cysts who never received medical treatment. The benzimidazole-treated (med) group included 15 patients with 17 cysts. There was no relapse in the ww-group whereas 8/17 cysts showed relapse within 18 months after treatment in the med-group. Loss to follow-up was 15.5%.ConclusionsData from the watch & wait group impressively show how stable naturally inactivated cysts are in contrast to cysts which reach inactivity through treatment with benzimidazoles. A substantial proportion of patients can be spared from treatment through cyst staging. Cysts which inactivated through a natural course do not relapse with very high likelihood. We recommend follow up of 5 years to confirm the stability of the inactive stage. Cysts driven into inactivity through benzimidazole therapy instead need careful monitoring to identify those which reactivate (around 50% within 18 months). 5 years follow-up appears safe to make a final decision on the need for further monitoring.

Altered Serum IgE and IgG4 Response to Dermatophagoides Pteronyssinus Allergens during Specific Immunotherapy

A T U R D A Y Baoqing Sun, MHA, Zheng Peiyan; The First Affiliated Hospital of Guangzhou, Guangzhou, China, State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China. RATIONALE: We investigated the changes in serum-specific IgE (sIgE) and IgG4 (sIgG4) against house dustmite (HDM) and its components Der p 1 and Der p 2 during specific immunotherapy (SIT), and evaluated the clinical efficacy thereof. METHODS: We retrospectively analyzed 51 HDM-sensitized children aged 5 to 16 years diagnosed with allergic rhinitis and/or asthma, following 36 monthsofSIT.Wealsocollecteddata fromacontemporarycontrol cohort of 50 patients administered routine medications for HDM allergy. . In the test cases, we recorded the sIgE and sIgG4 levels against thewhole allergen ofHDM(Der p), Der p 1 and Der p 2 at baseline and at 6, 12, 24 and 36 months of SIT. RESULTS: The serum sIgE response increased up to 6 months of SIT, but subsequently declined. At 36 months, the anti-Der p 1 and anti-Der p 2 sIgEs plummeted below the baseline. During SIT, the increased serum sIgG4 responsewas the greatest against Der p, followed byDer p 1 and Der p 2. The decline in sIgE/sIgG4 ratio for Der 1 was higher than for the other allergensmaximumdecline. Comparedwith older children, children aged 5 to 8 manifested a clearer sIgG4 response, especially against Der p 1 and Der p 2 versus Der p. CONCLUSIONS: SIT for HDM stimulated an early sIgE and sIgG4 response against HDM allergens. with a progressive decline in the ratio of sIgE/sIgG4, especially against Der p 1. Younger children may manifest a more rapid response to SIT than older ones. S 197 Conjunctival Provocation Test in Daily Practice: Four Ocular Symptoms Vs Ocular Pruritus Score System