ObjectiveTo determine the rehabilitation awareness and needs in patients with disability due to leprosy.Methods4353 patients in 23 fields of 7 provinces were surveyed by interview and questionnaire.Results80% of patients knew general knowledge of disability prevention and rehabilitation, and believed that the self-care could prevent disability; but they seldom carried out the daily self-care practice.90% of patients lacked awareness in early manifestation of leprosy, treatment of the disease, basic cause of disability, and the way to prevent such as plantar ulcers. For needs of rehabilitation education, teaching by medical staff(86%), booklet(81%), video tape(70%) and recording(52%) had been selected.ConclusionThe awareness of rehabilitation and the practice must be combined together. Rehabilitation education should be carried out in advance systemically through different ways.

Objective To compare the effects of snfentanil and fentanyl combined anesthesia on stress responses in pediatric patients undergoing surgical repair of congenital heart defect with cardiopulmonary bypass (CPB) .Methods Twenty-four pediatric patients aged 2-6 yr undergoing surgical repair of congenital heart defect were randomized into 2 groups (n=12 each): sufentanil combined anesthesia group (group S) and fetanyl combined anesthesia group (group F). The patients were premedicated with intramuscular morphine 0.2 mg/kg, scopolamine 0.01 mg/kg and ketamine 5 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg and snfentanil 0.7 μg/kg (in group S) or fentanyl 5 μg/kg (in group F). Tracheal intubation was facilitated with vecuronium 0.15 mg/kg. The patients were mechanically ventilated. PCO_2 was maintained at 35-45 mm Hg. Anesthesia was maintained with propofol infusion at 6-9 mg·kg~(-1)·h~(-1) and intermittent in boluses of midazolam,vecuronium and 3 doses of sufentanil (0.7, 1.5, 1.5 μg/kg) or fentanyl (5, 10, 10 μg/kg). Arterial blood samples were taken after entering the operation room, at 1 min after tracheal intubation, 1 min after splitting of sternum, immediately after rewarming, 10 min after termination of CPB and 24 h after operation for determination of plasma ACTH, cortisol, glucagon, lactic acid and blood glucose. Results The MAP and HR were maintained in the normal range during operation in both groups. The plasma concentrations of ACTH, cortisol, glucaon and lactic acid were significantly lower in group S than in group F. Plasma ACTH cortisol, glucagon, lactic acid and blood glucose increased significantly during operation as compared with the baseline before anesthesia in both groups. Conclusion Sufentanil combined anesthesia can inhibit stress response in pediatric patients more effectively during surgical repair of congenital cardiac defect performed under CPB.

Objective To approach the status of leprosy disabilities in newly detected cases in recent 10 years in China and provide the scientific basis for formulating the preventive strategies. Methods Based upon the individual records from the National Leprosy Recording and Reporting System in National Center for STD and Leprosy Control, 22 437 leprosy cases detected during 1989－ 1998 in China were analyzed in terms of leprosy disability. Results The proportion of disabilities in newly detected leprosy cases in 1989 in whole country was 46.49％ and decreased to 32.31％ in 1998, and the proportions of cases with grade II disabilities were 25.55％ (1989) and 20.23％ (1998). There were 18 provinces where disability rate was more than 40％ . Out of patients with disabilities, those with grades I and II disabilities and with deformities (loss of eyebrow, facial paralysis or saddle nose) accounted for 37.86％ , 60.64％ and 1.5％ , respectively. There were 25 provinces where grade II disabilities accounted for more than 50％ of all patients with disabilities. The disability rates in patients aged under 15 years, 15－ 65 years and over 65 years were 24％ , 39.85％ and 53.33％ . The patients with a delay in detection of 2 years had a disability rate of 29.85％ , and those with a delay of more than 2 years and 5 years had the rates of 48.82％ and 61.17％ , respectively. The disability rate was 52.9％ in patients with leprosy reactions and 46.1％ in patients with a damage of more than 3 nerves. The grade II disability rate in paucibacillary patients(28.99％ ) was significantly higher than that in multibacillary ones (22.04％ ). Conclusion Disability rate of leprosy in newly detected cases is still high although it has decreased in the recent 10 years. The rate is associated with delay in detection, leprosy reaction and leprosy type. It suggests that early detection of leprosy patients, regular treatment with multidrug therapy, and management of leprosy reactions will be the effective measures to prevent disabilities of leprosy.

ObjectiveTo study the epidemiological characteristics of leprosy in China,2001-2010.MethodsData were collected from the database of the national system of leprosy surveillance.A descriptive and comparative analysis was performed.ResultsTotally,15 507 new leprosy cases were detected from 2001 to 2010 with an average case detection rate of 0.118 per 100 000 population.Among these cases,2.7％ were children under 15 years,86.5％ multibacillary,and 22.5％ suffered from grade 2 disability.From 2001 to 2010,a total of 1506 relapse cases were detected,and relapse occurred after multi-drug therapy(MDT) in 464 of these cases.There were significant differences between low and high endemic areas in the proportion of children under 15 years,females,immigrant patients among newly detected patients as well as the proportion of cases of relapse after MDT among all the relapse cases.By the end of 2010,the registered leprosy cases were 6032 with a prevalence rate of 0.450 per 100 000 population,among whom 2886 were under MDT.ConclusionsThe leprosy case detection rate continued to decrease in China from 2001 to 2010 with an unequal distribution.The pocket areas were in Yunnan province,Guizhou province,Sichuan province,Guangdong province,Hunan province and Tibet Autonomous Region.It is warranted to enhance the control of leprosy and reduce the prevalence of disability due to leprosy.

Objective To investigate the psychological status of leprosy people with disability and their expectation towards surgical outcomes before surgical operation.Methods 937 cases from nine provinces，which were covered by the China National Commonweal funded surgical camps, were surveyed by a structure questionnaire designed by the Department of Leprosy Control and Rehabilitation, Institute of Dermatology, the Chinese Academy of Medical Sciences (CAMS).Results Reasons for the patients to refuse the surgical operation included concerns in medical cost (79.19%), unawareness of the free medical surgery program (64.78%), scaring of surgery (48.88%), unwilling to expose their disabilities (46.43%), unwilling to expose their history of leprosy (45.57%), despairing with disability (43.86%), having no ideas on surgical Results (37.46%), believing that disability is an inevitable outcome of the disease (32.98%), and rejecting the operation becasue of age(30.63%). More than 90% of PALs who are willing to accept surgery expected that surgery can improve their physical ability and they may contribute more to their family or become less independent after surgery; however, they thought there was little opportunity to return to work after surgery.Conclusion It is helpful and necessary to understand the psychological status of the leprosy people with disability before surgery.

Objective To analyze the epidemiological features of leprosy in China from 2011 to 2015,and to provide scientific evidences for prevention and treatment strategies.Methods An epidemiological analysis and a trend analysis were conducted based on the national leprosy surveillance data from 2011 to 2015.Results The leprosy detection rate in China decreased from 0.085 per 100 000 in 2011 to 0.049 per 100 000 in 2015,with an average annual decline rate being 12.9％.A total of 4 775 leprosy cases were newly detected during 2011-2015,including 106 (2.2％) children,1 499 (31.4％) females,518 (10.8％) floating people,4 041 (84.6％) multibacillary cases and 1 134 (23.7％) cases with grade 2 disabilities.From 2011 to 2015,328 relapsed cases were reported,including 153 (46.6％) cases recurring after combined chemotherapy.The prevalence rate of leprosy in China decreased from 0.407 per 100 000 in 2011 to 0.235 per 100 000 in 2015,with an average annual decline rate being 12.9％.By the end of 2015,there had been 3 230 registered leprosy cases and 124 counties with a prevalence rate above 1 per 100 000.Conclusions The detection rate and prevalence rate of leprosy in China were both decreasing continuously from 2011 to 2015.The high-epidemic provinces were Yunnan,Guizhou,Sichuan and Guangdong.However,leprosy control in middle-and low-epidemic provinces can not be ignored.

Objective To observe the effect of stump ulcer repairing in people affected by leprosy (PALs). Methods Bone shortening and osteophyte removal were performed in 73 PALs amputees with stump ulcers. Results All the incisions were healed without any delay. During a follow-up period of 3～12 years, no relapse or new ulcers were found in 70 PALs. 3 PALs developed new ulcers, which were healed after debridement, resting, and prosthesis repairing. Conclusion Surgical revision of the bone in amputation stump can change the local distribution of pressure. Postoperative self-care teaching to the PALs and their sustaining daily self-care will finally prevent them from stump ulcer recurring.

BACKGROUND:Many studies have demonstrated that restoration of femoral offset in revision total hip arthroplasty would contribute to the recovery of joint function.OBJECTIVE:To investigate the importance of restoration of femoral offset in revision total hip arthreplasty on the recovery of joint function.METHODS:An observational study was performed at the Department of Orthopedics,Third Affiliated Hospital of Guangzhou Medical University between February 2004 and May 2007.A total of 15 patients with the revision total hip arthroplasty,including 12 males and 3 females,aging 62 75 years,averaging 67 years old,were recruited into this study.Harris evaluation system was used to evaluate joint function.The femoral neck anteversion and the femoral offset were measured by the method of Sakai.The vertical distance from the teardrop line to the most prominent point of the lesser trochanter was measured from each radiograph.References were combined to investigate the effect of restoration of femoral offset in revision total hip arthroplasty on joint function.RESULTS AND CONCLUSION:All the 15 patients were recruited into this study.The duration of follow-up ranged from 24 months to 5 years.We measured the femoral offset on pre- and post-operative radiographs,and the results indicated that the femoral offset of 4 patients were above 4 mm.The femoral offset of 11 patients was restored.The femoral offset were 22-48 (32.21±0.64) mm pre- and 22-57 (36.13±0.82) mm post-operative radiographs,respectively.The mean difference in femoral offset post-operatively was significant (t=0.424,P=0.01 ).Harris scores were good in 4 cases,passable in 2 cases,and poor in 9 cases pre-operatively,and the scores were excellent in 8 cases,good in 4 cases,passable in 2 cases,and poor in 1 case post-operatively.The score of Harris evaluation system in the patient of restoration group and failed restoration group were 88.72±5.3 (80%) and 72.32±6.5 (27%) post-operative at 1 month respectively.The mean difference of the score was significant (χ~2=1.245,P<0.05).The 3 patients had complication,one was the dislocation of hip,and two had the pain of hip.All the patients with complication were in failed restoration of femoral offset,which was above 4 mm.The restoration of femoral offset contributes to the recovery of joint function and reduce complication occurrence after total hip arthroplasty revision.

Objective To detect gene mutations associated with dapsone-,rifampicin-and ofloxacinresistance in lesions of patients with recurring or treatment-resistant leprosy collected from 2010 to 2011.Methods Clinical data and lesional specimens were collected during 2010-2011 from patients with recurring or treatment-resistant leprosy who were diagnosed and reported by provincial centers for leprosy control.Mycobacterium leprae DNA was extracted from the specimens and subjected to PCR for the amplification of folP1,rpoB and gyrA genes.The PCR products were directly sequenced and BLAST program was used to compare the sequence of isolated strains with the reference sequence in GenBank.Results Twenty-four patients were enrolled in this study,including 13 with recurring leprosy and 11 with treatment-resistant leprosy.Twenty-one patients showed positive PCR results in all the three regions.Of these PCR-positive specimens,3 from 1 patient with recurring and 2 patients with resistant leprosy harbored a point mutation,acc (threonine)→gcc (alanine),at codon 53 in the floP1 gene,1 from a patient with recurring leprosy harbored a missense mutation,gat (aspartic acid) → aac (asparagine),at codon 441 in the rpoB gene.Conclusions Mutations are detected in the folP1 and rpoB genes,which are associated with the resistance to dapsone and rifampicin respectively,but not in the ofloxacin resistance-associated gyrA gene,in Mycobacterium leprae isolates from patients with recurring or treatment-resistant leprosy.

Objective To investigate the relationships between genetic polymorphism of CYP2A6 alone or in combination with smoking and hereditary susceptibility to bladder cancer.Methods Based on case-control study,CYP2A6*4 was determined by the nested polymerase chianreaction(nPCR)in 186 patients with bladder cancer and 192 nontumorous controls.The relations between the genetypes of CYP2A6*4 alone or combinated with smoking and bladder cancer was estimated with the X2 test and logistic regression model.Results In the case subjects,the number of the wil/wil genetype was 168,the number of the wil/del genetype was 13,and the number of the del/del genetype was 5.In the control subjects,the number of the wil/wil genetype was 150,the number of the wil/del genetype was 32,and the number of the del/del genetype was 10.The frequency of CYP2A6 del allele was significantly lower in the case Subjects(9.68%)than the controls(21.88%,P＜0.05,OR:0.383).When eombinated with smoking,the risk of bladder cancer in smokers was significantly higher than nonsmoker(P＜0.05,OR=2.322).In smokers,the frequency of CYP2A6 del allele was significantly lower in cases(7.88%)than controls(28.00%,P＜0.05,OR=0.221).In smoking people,the one with CYP2A6 del genotype had a lower risk of bladder cancer than the one with CYP2A6 wild genotype(OR=0.221,95%CI:0.092,0.534).Conclusions Genetic polymorphisms of CYP2A6 are associated with the susceptibility to bladder cancer and have interaction with smoking in carcinogenesis of bladder cancer.Deficient CYP2A6 activity to genetic polymorphism mayreduee bladder cancer risk in smokers.