Objective To analyse both micro level and macro level factors influencing maternal mortality in order to set the priority to lowering maternal mortality. Method The results of an analysis of maternal mortality were reported, based on a conceptual model that combines micro level and macro level variables taken from demographic, sociological and epidemiological research. Multi level analysis techniques were used to analyse the 1997 linked county level maternal death data and related county level social demographic and health resources data in 114 counties of 5 remote and poverty stricken provinces. Results The maternal mortality rate in research areas was as high as 159.3/100 000. The main factors influencing maternal mortality were institutional delivery rate, population density, percentage of minority population, and percentage of village without village doctor. Conclusion To advocate institutional delivery rate, to pay greater attention to minority and low population density area, and to standardised village doctors' responsibility are recommended strategies to lowering maternal mortality in remote and poverty stricken areas of China.

Objective To understand the trends of institutional delivery in recent 30 years in China and find out the main social and demographic factors. Methods Two-staged PPS method was employed for sampling; Uniform questionnaire was drafted and direct interview was adopted to collect the information. Results The institutional delivery rate was increasing rapidly with time, especially from 1990's, which had climbed to 82% in the last three years, but it was still unsatisfactory in the central and western areas. Meanwhile, most women who delivered outside the hospital were assisted only by birth attendants/village doctors or family members/friends in labor. Factor analysis showed that the women s education and occupation and their husbands, the gap of education between the couples, and the antenatal care could significantly affect their choice for where to deliver. Conclusions Great improvement had been achieved in the last several decades, and both individual characteristics, community and health facility could have influences on the women s decision on where to give birth.

Objective To investigate the status of breastfeeding rate at discharging hospital and analyze influence of obstetrical service quality on breastfeeding rate, in order to improve the quality of obstetrical service and increase the breastfeeding rate. Methods A total number of 1 123 mothers who have 6~12 months babies were investigated through questionnaire including obstetrical service accepted, situation of breastfeeding rate at discharging hospital, mother's breastfeeding knowledge and behaviors with across-sectional method from August to October in 2000. Seven cities were chosen as the research site including Beijing, Changchun, Huhehaote, Xi'an, Luoyang, Kunming and Xiamen. The data were analyzed with SPSS/PC 10.0 statistical software. Results The exclusive breastfeeding rate was 52%, the full breastfeeding rate was 73% at discharging hospital. The influencing factors of breastfeeding rate at discharging hospital include mother's age, medical expenditure type, caesarean section, breastfeeding on demand, neonatal status, having milk bottle, feeding milk-powder and sweeten water in obstetrical wards, mother's breastfeeding knowledge and behavior, et al. Conclusions Breastfeeding rate at discharging hospital was low and it was related with quality of obstetrical service. So it is important to improve the quality of obstetrical service and health education on breastfeeding, in order to enhance the breastfeeding rate.

Objective To analyze the descending trend of maternal mortality ratio (MMR) and its related influencing factors in order to improve the descending speed of MMR. Methods The influencial factor analysis and u test were made on data collected from 232 rural counties of eight provinces in China. Results MMR had shown remarkable reduction from 1995 to 2000, a drop by 51.33%. However, there was still a gap if compared with the ratio of the whole country. Major causes influencing the descending speed of MMR include the high speed of economic development, more expenditure of health, quality of maternal service, such as the ratio of hospital delivery, cleaning delivery, prenatal and postnatal health care. Conclusion In order to accelerate the descending speed of MMR, attempts to increase the improvement speed of maternal health care, quality of maternal service and more expenditure of health should be made.

ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.

Objective To detect the mutation of STK11 in a family with Peutz-Jeghers syndrome.Methods Genomic DNA was extracted from peripheral blood and harmatoma polypus of all the patients,and 9 exons and noncoding regions of STK11 were amplified by PCR.Cycle sequencing was used to analysis the DNA sequence,and western blot was used to detected the mutational STK11 protein in the harmatoma polypus.Results The 21th codon CAG in exon 5 of STK11 gene transformed to TAG in all the patients,which translated into a truncated STK11 protein.Conclusion This novel mutation is the pathogeny of PJS in this family,which could be an indicator for the diagnosis of PJS in this family.And it may lead to a higher risk of cancer in patients.

OBJECTIVETo provide insight on psychosocial factors underlying utilization of health services of women whom perceived reproductive tract infection (RTI) symptoms.

METHODSA cross-sectional study, adopted Aday and Andersen's Social Behaviour Model was conducted in 1998 - 1999 in China. Hebei province and Beijing were purposely chosen as the research sites. All eligible married women aged 21 to 60, 864 subjects, were interviewed in person.

RESULTSFindings showed that the percentage of self-reported symptoms of RTIs was 35.6 in urban compared to 46.8 in the rural areas. The proportion of women with RTIs who utilized health services was 27.5 versus 26.7 percent among the two groups. Urban women, mostly 'white collar' class, with free medical service, satisfied with health providers, receiving information from health provider and having severe current experience RTIs, were more likely to use health services. Rural women, however, having both severe prior experience and current experience of RTIs, high family income, having much knowledge about self-medication, perceiving less social stigma of getting RTIs, and perceiving severity of RTIs, were more likely to use health services.

CONCLUSIONThese findings showed that there was a great need on providing culturally acceptable reproductive health education at different places so as to improve women's ability of self-care. Regular medical check-up for women is also important for improving the quality of health service. Reform on health insurance seemed necessary. Factors as social stigma related to RTIs, giving women social and moral support also need to be taken into account.

Adult ; China ; Cross-Sectional Studies ; Female ; Health Services ; utilization ; Health Services Research ; statistics & numerical data ; Humans ; Infection ; therapy ; Male ; Middle Aged ; Rural Health ; statistics & numerical data ; Urban Health ; statistics & numerical data

OBJECTIVETo provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.

METHODSA cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed.

RESULTSThe percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs.

CONCLUSIONThe prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

Adult ; China ; Cross-Sectional Studies ; Female ; Genital Diseases, Female ; therapy ; Health Services Needs and Demand ; Humans ; Infection ; therapy ; Middle Aged ; Rural Health ; Urban Health ; Women's Health Services ; utilization

Objective To evaluate the feasibility of endoscopic resection and closure for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.Methods Included in the study were 46 patients with gastric submucosal lesions originating from the muscularis propria layer, detected by gastroscopy and endoscopic ultrasonography.The lesions were removed by endoscopic resection and closure, which were further diagnosed as stromal tumor by means of pathologic and immunohistochemical examinations.The patients were followed up with endoscopy for evaluation of therapeutic effect and complications.Results All lesions were successfully removed, with serosa layer remained in 2 cases and full layer resection in other 44, which were all closed by endoscopic clips.Combination managements of acid suppression,gastrointestinal decompression and intravenous antibiotics were applied in all patients.Pathology reports confirmed complete resection of all lesions, with 0.5 to 3.7 cm in diameter.Normal diet was restored in 44 patients 48 ～ 72 h after the procedure.Pneumoperitoneum and focal peritonitis occurred in 2 cases, one of which underwent rupture and was clamped again.The 2 patients recovered after 10-12 days of conservative treatments.Follow-up endoscopy revealed white ulcerous scar in all cases.Conclusion Endoscopic resection and closure therapy is a safe, economic and less invasive treatment for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.

Objective To establish a prokaryotic expression system of interstitial lung disease associated autoantigen human bactericidal/permeability-increasing fold-containing B1 (BPIFB1), providing tools for the study on its function in immune responese. Methods The coding region of BPIFB1 gene was amplified with specific primers from recombinant pGEM-C20ORF114 plasmid and cloned into the pET28a-MBP-His and pGEX-5X-1 vectors. The recombinant pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST plasmids were transfected into Top10 cells. The positive clones were selected and sequenced. The correct clones of pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST were transfected into prokaryotic expression strain Rosetta (DE3) and induced by Isopropyl β-D-Thiogalactoside (IPTG). The expression of recombinant BPIFB1 fusion protein was analyzed by SDS-PAGE and Western blotting, and purified by urea modified and renaturation and affinity chromatography of nickel NTA-resin. Results The polymerase chain reaction (PCR) produced specific product with the molecular weight equivalent to that of BPIFB1. The recombinant pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST plasmids were cloned by double restriction enzyme digestion and ligation and confirmed by sequencing. The SDS-PAGE result showed that both BPIFB1-MBP and BPIFB1-GST fusion proteins were mainly expressed in the form of inclusion bodies. The Western blotting result revealed that the recombinant BPIFB1-MBP-His protein could be recognized by Anti-6 ×His antibody. The purified soluble BPIFB1-MBP fusion protein was obtained by urea denaturation, affinity chromatography of nickel NTA-resin and then renaturation after purification. Conclusion The BPIFB1 prokaryotic expression system is established by construct recombinant plasmid pET-BPIFB1-MBP-His, and an approach of renaturation after nickel resin affinity purification in denatured condition.