The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.
Amputation ; Lower Extremity ; Indexes ; Prosthesis Implantation ; Surveys

OBJECTIVE: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan for the detection of this rare malignancy. MATERIALS AND METHODS: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). RESULTS: Two cases (cases 1 and 4) were restaged after 18F-FDG PET/CT scan in the initial staging process. Post-treatment 18F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. CONCLUSION: 18F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the 18F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the 18F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.
Adult ; Aged ; Carcinoma, Neuroendocrine/pathology/*radionuclide imaging/therapy ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Middle Aged ; Radiopharmaceuticals/*diagnostic use ; Uterine Cervical Neoplasms/pathology/*radionuclide imaging/therapy ; Vaginal Neoplasms/pathology/*radionuclide imaging/therapy

INTRODUCTIONThe aim of this study was to ascertain the outcomes of chronic hepatitis B (CHB) infection following immunosuppressive therapy in 38 consecutive oriental patients with systemic rheumatic diseases.

MATERIALS AND METHODSThis is a retrospective consecutive, non-comparative study.

RESULTSThe majority of patients were female (26, 68.4%), predominantly Chinese (92.1%), with a mean age 54 +/- 14 years (range, 16 to 87). The mean duration of rheumatic disease was 9 +/- 11 years (range, 0.1 to 48), with rheumatoid arthritis (52.6%) and systemic lupus erythematosus (23.7%) being the most common. The mean duration of CHB infection was 6 +/- 5 years (range, 0.1 to 17), with the majority diagnosed during pre-methotrexate screening (50.0%) and asymptomatic transaminitis following initiation of immunosuppressive therapy (23.7%). Upon diagnosis of rheumatic disease, all patients had normal alanine aminotransferase (ALT). Of these, 18.2% were positive for hepatitis B e antigen (HBeAg) and 78.1% were positive for anti- HBe antibody. Twenty (52.6%) developed ALT elevation, which was more than twice the upper limit of normal in 12 patients. ALT normalised spontaneously in 12 patients without hepatic decompensation or change in therapy. Seven (18.4%) patients received lamivudine for 18 +/- 22 months (range, 2 to 61). Two patients developed YMDD mutation subsequently treated with adefovir (1) and adefovir/lamivudine (1). There were 3 (7.9%) hepatitis B virus (HBV)-unrelated deaths [infection (2), genitourinary malignancy (1)], and 1 from HBV-reactivation complicated by septicaemia. None have developed hepatocellular carcinoma.

CONCLUSIONElevated ALT occurred in 52.6% of patients, with only 18.4% requiring anti-viral therapy for HBV reactivation. HBV-related mortality was low. With the appropriate precautionary measures, prednisolone and immunosuppressants (except methotrexate and leflunomide) may be used safely in patients where clinically indicated.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase ; blood ; Antiviral Agents ; therapeutic use ; Asian Continental Ancestry Group ; Comorbidity ; Female ; Glucocorticoids ; therapeutic use ; Hepatitis B, Chronic ; epidemiology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Lamivudine ; therapeutic use ; Lupus Erythematosus, Systemic ; drug therapy ; Male ; Middle Aged ; Prednisolone ; therapeutic use ; Retrospective Studies ; Rheumatic Diseases ; epidemiology ; Treatment Outcome ; Virus Activation

INTRODUCTIONAdvanced hepatocellular carcinoma (HCC) has a dismal prognosis and is notoriously chemo-resistant. We conducted a Phase II prospective study to evaluate the activity and tolerability of gemcitabine and cisplatin in chemo-naïve advanced hepatocellular carcinoma. The trial considered a "no further interest" response rate of 10% and a target response rate of 30%. Utilising a Simon's minimax two-stage design with a type I error of 0.05 and power of 80%, 25 subjects would be required. Fifteen patients would be needed in stage 1 and if fewer than 2 responses were observed, the trial would be stopped and lack of efficacy claimed.

MATERIALS AND METHODSPatients with advanced HCC, diagnosed based on histology or by World Health Organization (WHO) criteria, were administered gemcitabine 1000 mg/m2 and cisplatin 25 mg/m2 on day 1 and day 8 of a 21-day schedule. Assessment of response based on computer tomography was performed after every 2 cycles of chemotherapy.

RESULTSThe trial was stopped early due to a lack of efficacy. A total of 15 patients were accrued. Twelve patients were hepatitis B positive and the other 3 patients were negative for both hepatitis B and C. Only 1 patient had a history of prior heavy alcohol use. Two patients had Child C liver cirrhosis, 5 patients had Child B cirrhosis, and the remaining 8 patients had Child A cirrhosis. This regime was well tolerated and there was only 1 patient who experienced grade IV toxicities. Only 5 of 15 patients experienced grade III toxicities (nausea and emesis, 1 patient; anemia, 1 patient; thrombocytopenia, 1 patient; and neutropaenia, 2 patients). Only 1 patient experienced a partial response to the combination of gemcitabine and cisplatin. A further 3 patients experienced stable disease and 11 patients progressed on chemotherapy. The median time to progression was 6 weeks. The progression-free curve showed a sharp descent in the initial part of the study, suggesting that many patients had disease progression after enrollment. The median overall survival was 18 weeks.

CONCLUSIONThe progression-free survival and overall survival in our study were extremely short. Based on the results of our phase 2 study, we are unable to recommend further studies utilising gemcitabine and cisplatin combination in patients with advanced HCC.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Hepatocellular ; drug therapy ; etiology ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Disease-Free Survival ; Female ; Humans ; Liver Neoplasms ; drug therapy ; etiology ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Treatment Outcome

Objective: To understand the molecular characteristics of hemagglutinin (HA) and neuraminidase (NA) as well as the disease risk of influenza virus A H7N9 in Guizhou province. Methods: RNAs were extracted and sequenced from HA and NA genes of H7N9 virus strains obtained from 18 cases of human infection with H7N9 virus and 6 environmental swabs in Guizhou province during 2014-2017. Then the variation and the genetic evolution of the virus were analyzed by using a series of bioinformatics software package. Results: Homology analysis of HA and NA genes revealed that 2 strains detected during 2014-2015 shared 98.8%-99.2% and 99.2% similarities with vaccine strains A/Shanghai/2/2013 and A/Anhui/1/2013 recommended by WHO, respectively. Two strains detected in 2016 and 14 strains detected in 2017 shared 98.2%-99.3% and 97.6%-98.8% similarities with vaccine strain A/Hunan/02650/2016, respectively. Other 6 stains detected in 2017 shared 99.1%-99.4% and 98.9%-99.3% similarities with strain A/Guangdong/17SF003/2016, respectively. Phylogenetic analysis showed that all the strains were directly evolved in the Yangtze River Delta evolution branch, but they were derived from different small branch. PEVPKRKRTAR↓GLF was found in 6 of 24 strains cleavage site sequences of HA protein, indicating the characteristic of highly pathogenic avian influenza virus. Mutations A134V, G186V and Q226L at the receptor binding sites were found in the HA. All the strains had a stalk deletion of 5 amino acid residue "QISNT" in NA protein, and drug resistance mutation R294K occurred in strain A/Guizhou-Danzhai/18980/2017. In addition, potential glycosylation motifs mutations NCS42NCT were found in the NA of 9 of 24 strains. Conclusions: HA and NA genes of avian influenza A (H7N9) virus showed genetic divergence in Guizhou province during 2014-2017. The mutations of key sites might enhance the virulence of the virus, human beings are more susceptible to it. Hence, the risk of infection is increasing.
Animals ; Base Sequence ; Birds ; China/epidemiology* ; Genome, Viral ; Hemagglutinin Glycoproteins, Influenza Virus/immunology* ; Hemagglutinins/genetics* ; Humans ; Influenza A Virus, H7N9 Subtype/isolation & purification* ; Influenza in Birds ; Influenza, Human/virology* ; Neuraminidase/genetics* ; Phylogeny ; RNA, Viral/genetics* ; Sequence Analysis, DNA

Objective: To evaluate the prospective association between childhood abuse experiences and depressive symptoms in adolescence. Methods: Students in grade 3 and 4 from three primary schools were selected, with informed consent, through convenience cluster sampling in Bengbu, Anhui province in May 2013. The students' body height, weight were assessed. Childhood abuse experiences including emotional, physical or sexual abuses, as well as depressive symptoms were reported by children themselves. Data on parental educational background and household economic status were collected through parent questionnaire. A follow up was conducted 4 years later after baseline survey. Depressive symptoms were evaluated by using Children's Depression Inventory at baseline survey, and by using Mood and Feeling Questionnaire at follow-up. Logistic regression model was used to analyze the relationship between childhood abuse experiences and depressive symptoms in adolescence. Results: A total of 1 172 students were included in baseline survey, and a follow-up was conducted for 87.1% of them (n=1 021). Among 1 126 students with complete information on childhood abuse experiences at baseline survey, the reported rates of physical, emotional and sexual abuses were 12.8% (144/1 126), 11.1% (125/1 126) and 10.9% (123/1 126), respectively. The prevalence of depressive symptoms at baseline survey and follow-up was 7.0% (82/1 172) and 12.3% (126/1 021), respectively. After adjusted for baseline depressive symptoms, age at follow-up, sex, the only-child in family, household economic status, divorce of parents and BMI, childhood emotional and physical abuse experiences were significant risk factors for depressive symptoms in mid-adolescence, with the ORs were 1.86 (95%CI: 1.03-3.36, P=0.039) and 2.37 (95%CI: 1.39-4.03, P=0.001), respectively. Conclusion: Childhood physical and emotional abuse might increase the risk of depressive symptoms in adolescence.
Adolescent ; Child ; Child Abuse/statistics & numerical data* ; China/epidemiology* ; Depression/epidemiology* ; Female ; Humans ; Male ; Prospective Studies ; Students/statistics & numerical data* ; Surveys and Questionnaires

Objective: To understand the etiological characteristics and drug susceptibility of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis and provide evidence for the prevention and control of infectious mastitis in cows. Methods: The milk sample was collected from a cow with mastitis, which was pretreated with 4% NaOH and inoculated with L-J medium for Mycobacterium isolation. The positive cultures were initially identified by acid-fast staining and multi-loci PCR, then Mycobacterium species was identified by the multiple loci sequence analysis (MLSA) with 16S rRNA, hsp65, ITS and SodA genes. The drug sensitivity of the isolates to 27 antibiotics was tested by alamar blue assay. Results: Two anti-acid stain positive strains were isolated from the milk of a cow with mastitis, which were identified as non-tuberculosis mycobacterium by multi-loci PCR, and multi-loci nucleic acid sequence analysis indicated that one strain was Mycobacterium thermoresistibile and another one was Mycobacterium elephantis. The results of the drug susceptibility test showed that the two strains were resistant to most antibiotics, including rifampicin and isoniazid, but they were sensitive to amikacin, moxifloxacin, levofloxacin, ethambutol, streptomycin, tobramycin, ciprofloxacin and linezolid. Conclusions:Mycobacterium thermoresistibile and Mycobacterium elephantis were isolated in a cow with mastitis and the drug susceptibility spectrum of the pathogens were unique. The results of the study can be used as reference for the prevention and control the infection in cows.
Animals ; Anti-Bacterial Agents/pharmacology* ; Antitubercular Agents/pharmacology* ; Cattle ; Drug Resistance, Bacterial ; Female ; Humans ; Mastitis, Bovine/microbiology* ; Microbial Sensitivity Tests ; Milk/microbiology* ; Mycobacterium/isolation & purification* ; Mycobacterium Infections/veterinary* ; Mycobacterium tuberculosis/drug effects* ; Nontuberculous Mycobacteria/isolation & purification* ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics*

Objective: To investigate the interaction between health literacy, mobile phone dependence and unintentional injuries in middle school students, and to provide guidance for prevention on unintentional injuries in adolescents. Methods: From November 2015 to January 2016, a questionnaire survey was conducted among 22 628 middle school students in Shenyang of Liaoning province, Bengbu of Anhui province, Xinxiang of Henan province, Ulanqab of Inner Mongolia Autonomous Region, Chongqing and Yangjiang of Guangdong province. Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ), Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU), and Unintentional Injuries Assessment Scale and demographic variables were used to measure the health literacy, mobile phone dependence and unintentional injuries among the Chinese middle school students. Results: The detection rates of mobile phone dependence and unintentional injuries were 25.4% and 46.7%, respectively. The rates of unintentional injuries of middle school students with mobile phone dependence and with low, medium and high health literacy were 53.6%, 44.4% and 48.8%, 48.1%, 41.7%. Factors as mobile phone dependence, low and middle health literacy were positively related to unintentional injuries (OR=1.452, 1.196, 1.364). However, the multiplicative interaction between mobile phone dependence and health literacy on unintentional injuries was noticed significant (OR=1.217, 95%CI: 1.041-1.422). Conclusions: Our results showed that the prevalence of unintentional injuries was relatively high in middle school students. Health literacy and mobile phone dependence seemed related to unintentional injuries. Interaction between health literacy and mobile phone dependence on unintentional injuries appeared significant.
Adolescent ; Cell Phone ; China ; Female ; Health Literacy ; Humans ; Male ; Students ; Surveys and Questionnaires

Objective: To explore the developmental characteristics of circadian rhythms in hypothalamus-pituitary-adrenal (HPA) axis during puberty. Methods: A total of 1 070 students from Grade 2-3 in 3 primary schools in Ma'anshan city, Anhui province, were selected for physical examination and circadian rhythm of HPA axis checked from 2015 to 2017. Saliva samples were collected at each of the following three time points: immediately upon wakening, 30 minutes after wakening and bedtime, with the index of circadian rhythm of HPA axis calculated, which including cortisol awake response (CAR), cortisol in puberty priming and diurnal cortisol slope (DCS). Testicular volume, palpation and visual inspection of breast development were used to assess the state of purbety development on boys and girls. Information on gender, date of birth, time to fall asleep, wake-up time and weekly physical activity were gathered through questionnaire survey. Non-parametric test was used to compare the differences of baseline, follow-up period and different adolescent developmental processes of each index on circadian rhythm of HPA axis. Results: During the period of follow-up program and comparing with the continuous undeveloped group, CAR and the changes of CAR showed significantly increase, both in the puberty priming group and continuous development group, with statistically significant differences (CAR: Z=8.551, 4.680, respectively; P<0.01; the changes of CAR: Z=4.079, 2.700, respectively, P<0.01). There were no significant differences noticed in CAR and the changes of CAR between puberty priming group or continuous development group. The area under the curve (AUC) of cortisol in puberty priming group was slightly higher than that in the persistent undeveloped group (Z=2.591, P=0.010). Both the changes of daily cortisol slope (DCS) in puberty priming group and continuing developed group decreased significantly, when comparing with those in continuous undeveloped group (Z=-2.450, Z=-2.151; all P<0.05). There was no significant difference noticed in the changes of cortisol in puberty priming and DCS between different puberty development stages (the changes of AUC: χ(2)=2.747, P=0.253; DCS: χ(2)=4.554, P=0.032). Conclusions: The indexes of circadian rhythm of HPA axis were associated with the development of puberty. Both the cortisol awakening response and the total amount of diurnal cortisol secretion showed an increase, along with the puberty development. The change of diurnal cortisol slope declined with the development of puberty.
Adolescent ; Area Under Curve ; Circadian Rhythm ; Female ; Humans ; Hydrocortisone ; Hypothalamo-Hypophyseal System ; Male ; Pituitary-Adrenal System ; Pregnancy ; Saliva ; Sexual Maturation/physiology* ; Surveys and Questionnaires ; Wakefulness

The microbiological quality of thirty ready-to-eat (RTE) keropok lekor (a sausage shape Malaysian fish product) was evaluated in comparison to microbiological guidelines for ready to eat foods. The two E. coli isolates were subjected to DNA sequencing, identified and tested for their resistance towards fifteen different antibiotics. The survival and growth of the isolated E. coli strains inoculated in keropok lekor at atmospheric air and vacuum packaging were also evaluated. Results revealed that four samples (13.33%) contained Enterobacteriaceae counts that exceeded the recommended allowable counts of 4.0 log10 CFU/g. Unsatisfactory level of coliforms (> 1.7 log10 CFU/g) was also observed in ten of the samples; two of which contained E. coli (2.1 ± 0.17 and 3.7 ± 0.02 log10 CFU/g), suggesting of poor hygiene and sanitation practices. While the ‘Possible E10’ E. coli strain was observably resistant towards Nalidixic acid (30µg) alone, B10 E. coli isolate was worryingly resistant towards Ampicillin (10µg), Ceftazidime (30µg), Ciprofloxacin (5µg), Ceftriaxone (30µg), Nalidixic acid (30µg) and Tetracycline (30µg). This study also revealed that the growth and survival of the ‘Possible E10’ and B10 E. coli strains were not significantly affected by vacuum packaging when stored at both 4°C and 28°C. Therefore, intervention programmes to alert and educate smallmedium enterprisers (SMEs) of keropok lekor producers on food safety as well as potential health risks that can be associated due to inappropriate handling procedures of such product, merits consideration.