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China' s process and challenges in achieving the United Nations Millennium Development Goal 5

Xinglin FENG ; Qing YANG ; Ling XU ; Yan WANG ; Yan GUO

Journal of Peking University(Health Sciences).2011;43(3):391-396. doi:10.3969/j.issn.1671-167X.2011.03.016

Objective:China was categorized as one of the 68 countdown countries to achieve the United Nations Millennium Development Goals (MDG) 5. This paper aimed to analyze the situation of maternal survival, and coverage of proven cost effective interventions in China, where specific attention was paid to disparities. Methods: National maternal and child mortality surveillance data were used to estimate maternal mortality ratio (MMR). Coverage for proven interventions was analyzed based on National Health Services Survey, where experts' consultations were made for complementation. Results: There had been a significant reduction of MMR in China, however great disparities existed, with rural Ⅱ to Ⅳ areas experiencing 2 to 5 times higher maternal mortality risks than urban areas and accounting for over 70% maternal mortality burdens. Postpartum hemorrhage, pregnancy associated hypertension, embolism and sepsis were the leading causes, and over 75% of the maternal mortality was caused by preventable or curable causes. Maternal health services utilization decreased in accordance with region' s development level. Socioeconomic factors like financial difficulties were the main obstacles hindering access of care.Even those who made deliveries in hospitals faced different probabilities in receiving qualified care according to their socioeconomic standings. Conclusion: China is on track to achieve MDG 5, however great disparities exist. It is necessary to specifically target rural types Ⅱ to Ⅳ areas. Major causes of maternal mortality which can be prevented or averted through the provision of essential obstetrical care. Yet as compared with maternity health needs, insufficient coverage of maternal and child health (MCH) care services and poor service quality are the leading predisposing factors contributing to maternal mortality in China.

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A case report of varicella-zoster virus infection associated glomerulonephritis and encephalitis

Guming ZOU ; Yipu CHEN ; Wenge LI

Journal of Peking University(Health Sciences).2011;43(6):914-918. doi:10.3969/j.issn.1671-167X.2011.06.027

SUMMARY A 15-year-old boy was admitted with nephritic and nephrotic syndrome,renal dysfunction and decreased serum C3,who suffered from varicella for two months.His renal histopathology revealed endocapillary proliferative glomerulonephritis with podocytes proliferation and severe tubular injury by light microscopy.Direct immunofluorescence showed global granular deposition of IgG,IgA,IgM,C3,Clq and fibrinogen in mesangium and along glomerular capillary wall.Electron microscopic examination showed electron-dense deposits in multiple sites of glomeruli.Furthermore,specific serum IgM antibodies against varicella-zoster virus (VZV) were detected.VZV antigen and mRNA were demonstrated in glomerular and tubular epithelial cells by immunohistochemical staining and in-situ hybridization.Virus particles and virus inclusions were identified by electron microscopy and special staining ( Methylene Blue and Eosion staining or Mann staining).The patient also experienced epileptic episodes and his brain MRI and electroenephalogram indicated herpes encephalitis with secondary epilepsy.Therefore,the diagnosis of VZV-associated glomerulonephritis and encephalitis was established.This is the first case of VZV-associated glomerulonephritis with renal histooathological evidence using in situ hybridization technique.

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Perturbation of the transforming growth factor β system in Turner syndrome

Journal of Peking University(Health Sciences).2012;44(5):720-724. doi:10.3969/j.issn.1671-167X.2012.05.011

Objective:To measure components of the circulating transforming growth factor β (TGFβ)system in patients with Turner syndrome (TS) compared to relevant controls and to ascertain correlation with endocrine and cardiovascular parameters.Methods:TGFβ1,TGFβ2 and endoglin (a vascular TGF receptor component) were measured using enzyme-linked immunoassays in the sera of 40 subjects with TS and 40 healthy volunteer women.The cardiovascular phenotype in TS subjects was extensively characterized by cardiac magnetic resonance (MR) and echo.Results:TGFβ1 levels were about 3-fold higher in TS while TGFβ2 levels were about 3.5-fold higher in controls (P ＜0.000 1 for both).Soluble endoglin levels were 25％ higher in TS (P ＜0.000 1 ).Variation in TGFβ system components was not explained by age,blood pressure,platelet count,thyroid function,body proportions or cardiovascular phenotype.Conclusion:There is profound perturbation of the TGFβ system evident in the circulation of individuals with TS.

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Growing global burden of chronic noncommunicable diseases and an alarming situation in China

Youfa WANG ; Hyunjung LIM ; Yang WU

Journal of Peking University(Health Sciences).2012;44(5):688-693. doi:10.3969/j.issn.1671-167X.2012.05.006

Noncommunicable diseases (NCDs) are the leading causes of death globally,which kill more each year than all other causes combined.It is estimated that 63％ of global total deaths were due to NCDs.Nearly 80％ of NCD deaths occur in low- and middle-income countries.China contributes the largest number of NCD patients and deaths.NCD rates have been increasing at an alarming rate over the past two decades in China and many other countries.Population-wide interventions can help reduce NCD burden and can be cost effective.Improved health care,early detection and timely treatment are also needed for reducing the impact of NCDs.Strong government commitment,adequate investment,and extensive involvement and collaboration of multiple diverse social sectors with health sectors are critical to fight the NCD burden in all countries,especially in low- and middle-income countries.

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Recent development in aerosol devices for pulmonary vaccine delivery

Dongmei LU

Journal of Peking University(Health Sciences).2012;44(5):683-687. doi:10.3969/j.issn.1671-167X.2012.05.005

This review will discuss aerosol device technologies available for pulmonary vaccine deliveries.The possibilities of adopting aerosol-generation for the purpose of pulmonary immunization are described.Aerosol-generation systems might offer advantages in respect to vaccine stability and antigenicity.The noninvasive,relatively safe and low-cost net of pulmonary delivery may provide great benefits to the public health vaccination campaign.

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A more scientific approach to structural fat grafting

Liqun PU

Journal of Peking University(Health Sciences).2012;44(5):678-682. doi:10.3969/j.issn.1671-167X.2012.05.004

Structural fat grafting has been considered as a valid option for soft-tissue augmentation in cosmetic surgery.However,its result has often been considered poor or unpredictable and is largely surgeon dependent.Less desirable outcome after fat grafting is probably due to lack of good surgical technique.In order to help plastic surgeons to gain more insight to this valid fat grafting technique,the author conducted a critical review of the current literature in this subject.To better address the findings of the study,the fat grafting technique was arbitrarily classified into 4 essential steps to determine how the donor sites should be selected and how the fat grafts should be harvested,processed,and placed.It becomes clear that several basics in an established fat grafting technique have gained much of scientific support and should be followed in order to achieve an optimal outcome for our patients.These basics include the proper selection of donor sites,to harvest fat grafts with an atraumatic technique,to process fat grafts with centrifugation in an appropriate setting,and to place fat grafts with a unique fashion.

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Mechanisms of dorsoventral axis formation and its clinical implications

Hong GAO ; Zhenglun ZHU

Journal of Peking University(Health Sciences).2012;44(5):673-677. doi:10.3969/j.issn.1671-167X.2012.05.003

Dorsal-ventral axis formation is one of the earliest and the most important steps of patterning formation during early embryogenesis.The molecular basis of dorsoventral axis formation reflects the fundamental issues of orchestrated cell proliferation and differentiation.Wildly speculated since the Renaissance,the effort of deciphering the mechanisms of dorsal-ventral axis formation has contributed significantly to our current understanding of disease pathogenesis.Here,we focused our discussion on the recent discovery of the convergence of dorsal and ventral signaling pathways during early embryogenesis and its implications in cancer biology and beyond.

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Potential prognostic tumor biomarkers in triple-negative breast carcinoma

Yan PENG

Journal of Peking University(Health Sciences).2012;44(5):666-672. doi:10.3969/j.issn.1671-167X.2012.05.002

Triple-negative (TN) carcinoma is a molecular subtype of breast cancer characterized by the lack of expression of estrogen receptor (ER),progesterone receptor (PR) and HER-2.It is a heterogeneous disease,not only on the molecular level,but also on the pathologic and clinical aspects.TN tumors can be further classified into two subtypes:basal-like,defined as expressing epidermal growth factor receptor (EGFR) and/or cytokeratin (CK) 5/6 by immunohistochemistry,and non-basal-like; the majority of TN tumors are basal-like.TN tumors usually have a more aggressive behaviour and poorer outcome compared with non-TN breast cancers,and lack molecular targets commonly used in targeted therapy,making this group of tumors difficult to treat.Developing novel,effective treatment strategies for these tumors is crucial for improving their prognosis.This review describes a recent study series on prognostic and predictive values of tumor biomarker susing in TN breast cancer patients.TN tumors are associated with significantly higher expression of Ki67 and p53 compared to non-TN tumors.Hormone receptor negativity rather than HER-2 negativity is associated with the increased Ki67 and p53 expression in TN tumors.Furthermore,high expression level of Ki67 ( ＞ 10％ ) but not p53,is significantly associated with nodal metastasis in TN tumors,indicating that Ki67 has better prognostic value than p53.TN tumors with distant metastases are significantly associated with lower expression of androgen receptor (AR) as compared to those with only loco-regional disease ; there is a significant negative correlation between AR and Ki67 expressions among AR expressing TN tumors.Basal-like subtype TN tumors with nodal and distant metastases are associated with significantly higher intratumoral expression of EGFR and CK5/6 as compared to those without metastases.Therefore,increased EGFR and CK5/6 intratumoral expression and decreased AR intratumoral expression,rather than the frequency of their expression,may play a role in the development of metastases and may be predictive of metastatic disease in TN breast cancer patients.Anti-EGFR and anti-AR targeted therapies may provide potential treatment options for TN carcinomas,especially those tumors not responding to chemotherapy.

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Molecular mechanisms of osteoblast-specific transcription factor Osterix effect on bone formation

Chi ZHANG

Journal of Peking University(Health Sciences).2012;44(5):659-665. doi:10.3969/j.issn.1671-167X.2012.05.001

Bone formation is a complex developmental process involving the differentiation of mesenchymal stem cells to osteoblasts.Osteoblast commitment and differentiation are controlled through a multistep molecular pathway regulated by different transcription factors and signaling proteins,including Indian hedgehog,Runx2,Osterix (Osx),and Wnt pathway.Osx is an osteoblast-specific transcription factor required for bone formation.Osx was first discovered as a bone morphogenetic protein-2 inducible gene in mesenchymal stem cells.Osx knock-out mice lack bone completely,and cartilage is normal.This opens a new window to the whole field of how bone forms. The discovery that Osx inhibits Wnt pathway highlights the potential for novel feedback control mechanisms involved in bone formation.Several downstream targets of Osx during bone formation have been identified,including Satb2,vitamin D receptor and vascular endothelial growth factor as well as Dkk(1) and Sost.The delineation of the cascade of events leading to bone formation should provide a molecular basis for the development of new and specific anabolic therapeutic agents for bone deficit conditions,such as osteoporosis and osteonecrosis.This review summarizes the recent advances in understanding the molecular mechanisms of Osx effect on bone formation.Studies since the Osx discovery have provided convincing evidences to demonstrate that Osx is the master gene that controls osteoblast lineage commitment and the subsequent osteoblast differentiation and proliferation.

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Marginal microleakage of cavities prepared with Er:YAG laser on primary teeth in vitro

Yao XIE ; Sun ZHANG ; Lihong GE

Journal of Peking University(Health Sciences).2014;(3):474-477. doi:10.3969/j.issn.1671-167X.2014.03.026

Objective:To investigate the marginal microleakage after cavity preparation by Er:YAG la-ser and conventional bur applying different adhesive systems , conditioning surface with acid etching or not.Methods:In the study, 50 primary teeth were divided into 5 groups.(1) Bur+etch-and-rinse sys-tem, (2) Bur+self-etching system, (3) Er:YAG laser+etch-and-rinse system, (4) Er:YAG laser+self-etching system, (5) Er:YAG laser+none-etched.The class V cavities were all filled with composite resin.The microleakage tests were performed , observed and scored under stereomicroscope .Results:Bur+etch-and-rinse group had higher microleakage than Er:YAG laser +etch-and-rinse group , and Bur+self-etching group had higher microleakage than Er:YAG laser +self-etching group ( P<0 .05 ) . There was no difference between Er:YAG laser+etch-and-rinse group and Er:YAG laser+self-etching group, while they had significantly lower microleakage than that of Er:YAG+none-etched group.Con-clusion:Composite resin restoration showed less marginal microleakage when all-in-one self-etch system was used after irradiation by Er:YAG laser on primary teeth .

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