Objective To assess the efficacy of two antibiotic prophylactic regimens in a prospective randomized trial in 1 year for patients undergoing insertion of catheters,and to provide the evidence for uniform consensus existing on the timing,route,and choice of antibiotic.Methods During a period of 12 months,78 patients,who consecutively entered the peritoneal dialysis programme,[45 women and 33 men,mean age (48.2?15.7)years] were included.The prophylactic regimens were a single dose of ceftriaxone (1.0 g) given intravenously 30 minutes before surgery (Group A) and given cefazolin (0.25 g/L) i.p.in the each dialysis bag for 3 days postoperatively (Group B).All operations were performed in one room.The wound was observed every day,and body temperature,Count of white blood corpuscle and type,dialysate were examined every day. Results In Group A and B,none of the patients showed peritonitis or wound infection during the post-operative period (within 10 days).One of 39 patients(2.5%) in the group A,and 2 of 39 patients (5.1%) in the group B had exit site infection (P＞0.05).Conclusions There is no significant difference in the incidence of peritonitis and wound infection between two groups. Prophylactic preoperative single-dose antibiotics intravenously do as well as antibiotics given intraperitoneally for peritoneal dialysis catheter insertion,but is much more convenient.

BACKGROUNDThe maximal use of the limited resource to improve peritoneal dialysis (PD) penetration and clinical outcomes is a challenge for all PD centers. In this study, we reported the experience and outcomes in successfully managing a rapidly growing PD center in Southern China.

METHODSA standard PD program with a team consisted of 6 nephrologists (3 doctors were in charge of catheter insertion and in-patients care, the other 3 doctors focused on PD patients' follow-up and education) and 11 nurses in a PD center at Sun Yat-sen University was established for PD patients follow-up in 2005. A prospective and observational study was conducted in all patients undergoing continuous ambulatory PD (CAPD) at our center from January 1, 2006 to December 31, 2009.

RESULTSThe yearly number of prevalent CAPD patients was 297, 409, 547 and 695 in 2006, 2007, 2008 and 2009, respectively. The PD catheter insertion was performed by the nephrologists with open surgical procedure and 94% of catheters were patent at one year. In 841 incident CAPD patients, the survival rates at the end of 1, 2, 3 and 4 years were 94%, 87%, 83% and 76%, respectively, while cumulative technique survival rates (death-censored) were 98%, 95%, 91% and 90%, respectively. Peritonitis rate was 1/68.5 patient months.

CONCLUSIONSBetter patient and technical survival rates as well as lower peritonitis episode have been achieved in our rapidly growing PD center. A standardized PD program, well-trained team members of PD doctors and nurses, and continuous quality improvement of PD are important elements in managing a successful PD program.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory ; statistics & numerical data ; Survival Rate ; Young Adult

OBJECTIVETo discuss the surgical treatment of the giant aneurysms of middle cerebral artery.

METHODSClinical data, surgical methods and outcomes were analyzed in 17 giant aneurysms of middle cerebral artery treated from January 2001 to March 2008. CT scan, CTA, MRA, DSA and 3D-DSA were performed before operations so that we could comprehend the location, size, and shape of aneurysms and compensatory circulation of collateral branches to design the individualized treatment options. All patients had been surgically treated mostly by modified pterional approach, of which, direct clipping of the aneurysms was accomplished in 4 patients, aneurysms trapping or removal after trapping in 4, aneurysms excision or trapping combined with vessels reconstruction in 7, and aneurysms wrapping in 2 cases.

RESULTSCT and MRI revealed the shape and size of aneurysms clearly, while DSA and 3D-DSA could demonstrate the aneurysm's neck and relationship with the adjacent structure. Postoperative neurological function was evaluated according to Glasgow Outcome Scale when patients were discharged. Twelve patients had excellent neurological outcomes. However 4 patients were moderately disabled and one were severely disabled. No patient was dead postoperatively.

CONCLUSIONSIt is necessary to perform elaborate imaging before operations for individualized surgical planning. The temporary occlusion of the parent artery and elimination of intra-aneurysmal thrombus are helpful to clipping the aneurysmal neck. Vessels reconstruction is a new and effective method of treating the giant aneurysms of middle cerebral artery.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; diagnosis ; surgery ; Male ; Middle Aged ; Middle Cerebral Artery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo examine the correlation between the mRNA and proteins expressions of gastrin(GAS), and the association of protein expression of GAS with apoptosis index(AI) and apoptosis regulation gene Fas/FasL, caspases in colorectal cancer.

METHODSThe expressions of GAS mRNA in tumor tissues of 79 cases with colorectal cancer were detected by nested RT-PCR. Cell apoptosis was detected by molecular biology in situ apoptosis detecting technic(TUNEL). Protein expressions of GAS, Fas/FasL, and caspases were detected by immunohistochemical staining (SP method).

RESULTSThe positive correlation was found between the mRNA and proteins expressions of GAS(rGAS=0.99, P<0.01). The mRNA and protein expressions of GAS in well and moderately differentiated cancers were significantly lower than those in poorly differentiated cancers (chi(2)(high vs low)=10.47, 10.23, P<0.01, chi(2)(middle vs low)=6.68, 4.95, P<0.05). The mRNA and protein expressions of GAS in papillary and tubular adenocarcinomas were significantly lower than those in mucinous adenocarcinomas, signet-ring cell carcinoma and undifferentiated carcinoma (chi(2)(papillary vs mucinous and signet-ring)=4.80, 6.22, chi(2)(papillary vs undifferentiation)=5.44, 8.43, chi(2)(tubular vs mucinous and signet-ring)=4.40, 4.38, chi(2)(tubular vs undifferentiation)=4.92, 6.43, P<0.05, respectively). The mRNA and protein expressions of GAS in Dukes' stages A, B were significantly lower than those in Dukes stages C, D (chi(2)=4.84, 4.45, P<0.01). The AI in GAS high and moderate expression groups of colorectal cancer were significantly lower than that in low expression group (q(high vs low)=6.71, q(middle vs low)=4.60, P<0.01). The positive expression rate of FasL was significantly different among GAS high, moderate and low expression groups of colorectal cancer (chi(2)=9.35, P<0.01). The positive expression rate of FasL in GAS high and moderate expression groups was higher than that in low expression group (chi(2)high vs low=6.24, chi(2)(middle vs low)=4.74, P<0.05).

CONCLUSIONSGAS plays an important role in the regulation of cell apoptosis in colorectal carcinoma, whose mechanism may be related to the aberrant expression of Fas/FasL. GAS will be one of the indicators of the biological behavior in colorectal carcinoma.

Adult ; Aged ; Caspases ; metabolism ; Colorectal Neoplasms ; metabolism ; pathology ; Fas Ligand Protein ; metabolism ; Female ; Gastrins ; metabolism ; Humans ; Male ; Middle Aged ; RNA, Messenger ; metabolism ; Young Adult ; fas Receptor ; metabolism

Objective To investigate the characteristics of infecting pathogens,their changes and antimicrobial susceptibilities on CAPD related peritonitis in our peritoneal dialysis(PD) center in the past 15 years.Methods Two hundred and six CAPD related peritonitis episodes in 145 patients from 2000 to 2005 were analyzed and compared with 109 episodes from 1991 to 2000.The causative pathogens,their antimicrobial susceptibilities and outcomes on CAPD related peritonitis from the two periods were retrospectively reviewed and compared.Results Culture negative rate decreased from 60.6% in 1990 s to 47.6% in the last five years (P=0.031 ).Among culture positive peritonitis episodes,the incidence of gram positive bacteria (GPB) peritonitis increased from 25.6% to 39.8% (P=0.059).This was mainly due to a significant increase in coagulase-neagative staphylococcus peritonitis,which significantly increased from 4.7% to 26.9% (P=0.01).Gram negative bacteria (GNB) peritonitis decreased slightly (44.2% vs 34.3%,P=0.322).The incidence of Klebsiella pneumoniae peritonitis significantly decreased (14.0% vs 3.7%,P=0.023),while Pseudomonas aeruginosa and Escherichis coli peritonitis rates slightly increased (4.7% vs 9.3%,P = 0.338;7% vs 18.7%,P=0.072).The decrease of fungal peritonitis rate was not significant (30.2% vs 17.6%,P= 0.123).The comparison of clinical outcomes showed an improvement of total recovery rate from 68.8% in 1990 s to 73.9% for 2000-2005 (P=0.09).The catheter removal rate decreased from 19.2% to 14.3% (P=0.238),and the mortality from 10.1% to 5.4% (P=0.118).In both periods,fungal peritonitis had the poorest results,which all the patients either withdrew from PD or died.Conclusions Compared with that in 1990 s,the culture positive rate for CAPD related peritonitis in 2000-2005 has been greatly improved.Coagulase-negative staphylococcus is the most common causative pathogen.The mortality and catheter removal rate have been markedly reduced in the last five years.Fungal peritonitis is the most important reason for patients' dropout.

Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level II), middle neck (levels III and Va), and lower neck (levels IV and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium-or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P<0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6%, 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.
Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Neck ; pathology ; Neoplasm Invasiveness ; Tumor Burden

BACKGROUNDGetting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors.

METHODSIn August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model.

RESULTSThe two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity.

CONCLUSIONSUrban residents' health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.

China ; Health Services ; utilization ; Healthcare Disparities ; Humans ; Multivariate Analysis ; Urban Health Services

Objective To investigate the characterization of the complete genome of EV71 in Beijing, 2008 and to provide basis for selecting appropriate virus strain to develop vaccine. Methods 12 throat swab samples were collected from children with hand-foot-mouth disease (HFMD). One sample named 08YM-3 was cultured and isolated in vero cells. Viral RNA was extracted and carried out by RT-PCR and 5' , 3' rapid amplification of eDNA ends (RACE) to obtain the sequence from 08YM-3. PCR products were cloned and analyzed. Nucleotide identity between sequences was calculated and sequence alignments were made to generate phylogenetic trees using MegAlign in DNAStar. Results 3 clones were constructed that covered EV71 complete genome. Data from sequences analysis showed that this viral strain named BJ08 shared 95.6%-96.7%, 88.3%-96.1%,78.1%-94.0%,90.8%-94.6%, 85.9%-94.1% and 90.9%-93.9% in 5' UTR, PI, P2, P3, 3' UTR region and complete genome with C4 subtype, respectively. B J08 showed low nucleotides identity (<90%) with other subtypes. Phylogenetic trees established from alignment of the complete genome and VPI region indicated that B J08 belonged to C4 subtype. BJ08 and C4 subtype strains shared the same amino acids in 6 sites in VP1 region, which were associated with EV71 subtype. There was no mutation in VP1 antigen epitope (92-107aa). Conclusion This BJ08 strain belonged to C4 subtype. Further study on EV71 complete genome would have great significance for vaccine research.

BACKGROUNDEnterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) are major causative agents for hand, foot and mouth disease (HFMD). Studies indicate that the frequent HFMD outbreaks result in a few hundreds children's death in China in recent years. The vaccine and other research for HFMD need to be developed urgently.

THE AIMS OF OUR STUDY WEREto explore dynamic development of mother-source neutralizing antibodies against EV71 and Cox A16 in infants from Jiangsu Province, China, and to provide the fundamental data for further establishing of corresponding immunization course.

METHODSPeripheral blood samples were collected from 133 of parturient women once immediately before delivery and their infants at two and seven months of age. Method of micro-dose cytopathogenic effect was used to measure neutralizing antibodies against EV71 and Cox A16, respectively.

RESULTSSeropositive rates of anti-EV71 and anti-Cox A16 in prenatal women were 79.7% (106/133) and 92.5% (123/133), respectively; geometric mean titers (GMTs) were 29.0 and 61.9; 75.9% (101/133) prenatal women were both positive in anti-EV71 and anti-Cox A16; seropositive rates of anti-EV71 and anti-Cox A16 were 25.6% (34/133) and 38.3% (51/133) in infants at two months of age; GMTs were 12.3 and 18.0, respectively. GMTs of anti-EV71 were significantly higher for infants at seven months (82.6) compared with that at two months (P < 0.05), showing infants had inapparently infected by EV71 during two to seven months. Although only one offspring (0.75%) at seven months was found having anti-Cox A16 transfered from maternal, this observation suggested no maternal antibody may remain in infants at seven months.

CONCLUSIONSThe prevalence of EV71 and Cox A16 were relatively high in Jiangsu Province. Bivalent vaccine against both EV71 and Cox A16 should be developed, and the ideal time point for prime immunization for infants is around 2-5 months of age.

Antibodies, Neutralizing ; blood ; immunology ; Cells, Cultured ; Enterovirus ; immunology ; Enterovirus A, Human ; immunology ; Female ; Hand, Foot and Mouth Disease ; immunology ; virology ; Humans ; Infant ; Infant, Newborn

OBJECTIVETo understand the status of knowledge and behavior of drug use among urban and rural residents in 5 provinces in China to suggest priority intervention strategies and measures for drug use health education.

METHODSFrom March to May of 2011, 6159 urban and rural residents were selected from Beijing, Liaoning, Zhejiang, Yunnan, Shaanxi provinces by the multistage stratified sampling method and were investigated by the questionnaires on drug use knowledge and behavior.

RESULTSThe residents' average awareness rate for 11 pieces of basic drug use information was 48.3% (32,750/67,749). The residents' average awareness rate in the rural (40.3%, 9189/22 792) was lower than that in metropolitan (51.9%, 11 483/22 110) and small and middle-sized cities (52.9%, 12,078/22,847) and the differences had statistical significance (χ2=889.30, P<0.01). Overall, 77.0% (4742/6159) of residents purchased drug according to the doctors' prescription; 36.9% (2271/6159) of residents bought by their experiences; 33.3% (2049/6159) of residents did not know whether they had bought faked drugs; 32.7% (2016/6159) of residents did not read instructions carefully before using drug; 83.4% (5134/6159) of residents stored drugs in their house and only 29.2% (1798/6159) of residents would check up expired drugs regularly; 59.6% (3673/6159) of residents changed drug by themselves after suspected adverse reaction of drugs.

CONCLUSIONChinese urban and rural residents' knowledge level of drug use is inadequate and drug use behaviors are not optimistic. Drug use health education should be enhanced among urban and rural residents.

China ; Drug Therapy ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Prescription Drugs ; Surveys and Questionnaires