[Association between blood pressure during 12-28 weeks gestation and pre-eclampsia: predictive value of blood pressure trajectories constructed by latent class growth modeling].

Objective: To explore the associations between blood pressure trajectories during pregnancy and risk of future pre-eclampsia in a large cohort enrolling pregnant women at gestational age of ~12 weeks from community hospitals in Tianjin. Latent class growth modeling (LCGM) was used to model the blood pressure trajectories. Methods: This was a large prospective cohort study. The study enrolled pregnant women of ~12 weeks of gestation in 19 community hospitals in Tianjin from November 1, 2016 to May 30, 2018. We obtained related information during 5 antepartum examinations before gestational week 28, i.e., week 12, week 16, week 20, week 24 and week 28. LCGM was used to model longitudinal systolic (SBP) and diastolic blood pressure (DBP) trajectories. For the association study, the predictors were set as SBP and DBP trajectory membership (built separately), the outcome was defined as the occurrence of preeclampsia after 28 weeks of gestation. Results: A total of 5 809 cases with known pregnant outcomes were documented. After excluding 249 cases per exclusion criteria, 5 560 cases with singleton pregnancy were included for final analysis. There were 128 cases preeclampsia and 106 cases gestational hypertension in this cohort. Univariate logistic regression and multivariate logistic regression showed the higher baseline SBP level and DBP level were related with increased risk of preeclampsia. Four distinctive SBP trajectories and DBP trajectories from 12 weeks to 28 weeks of gestation were identified by LCGM. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for SBP latent classification trajectory_ 4 was 4.023 (95%CI: 2.368 to 6.835, P<0.001), and the OR for SBP latent classification trajectory_3 was 1.854 (95%CI: 1.223 to 2.811, P=0.004). Logistic regression showed that: using the DBP latent classification trajectory_1 as the reference group, the OR for DBP latent classification trajectory_4 was 4.100 (95%CI: 2.571 to 6.538, P<0.001), and 2.632 (95%CI: 1.570 to 4.414, P<0.001) for DBP latent classification trajectory_2. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for DBP_traj_4 was 2.527 (95%CI: 1.534 to 4.162, P<0.001), and the OR for DBP_traj_3 was 1.297 (95%CI: 0.790 to 2.128, P=0.303), and 2.238 (95%CI: 1.328 to 3.772, P=0.002) for DBP_traj_2. Therefore, BP trajectories from 12 weeks to 28 weeks identified by LCGM served as novel risk factors that independently associated with the occurrence of preeclampsia. Receiver operating characteristic (ROC) curve analysis showed incremental diagnostic performance by combing baseline blood pressure levels with blood pressure trajectories. Conclusion: By applying LCGM, we for the first time identified distinctive BP trajectories from gestational week 12 to 28, which can independently predict the development of preeclampsia after 28 weeks of gestation.

Clinicopathological features and prognosis of esophageal squamous cell carcinoma in young patients.

Esophageal squamous cell carcinoma (ESCC) in the young patients is comparatively rare and has not been well studied. We analyzed the clinical and survival data of 127 ESCC patients <40 years at a single high-volume center and compared with those of 4109 ESCC patients ≥40 years who underwent surgery within the same period in this study. The average age was 36.5 ± 0.2 years for the young patient group, with the youngest aged 26 years. Young patients had a higher rate of family history, longer tumors, and a more advanced pT category than their older counterparts. Moreover, more patients in the young group underwent incomplete resection (19.7% vs. 8.9%, P < 0.001) and adjuvant therapy (40.9% vs. 30.8%, P = 0.015). The overall survival (OS) and cancer-specific survival (CSS) between patients <40 years and patients ≥40 years were not significant in the entire group. In the subgroup analysis, the OS and CSS rates for patients <40 years were significantly worse than patients ≥40 years in subgroups of pTNM stage III and incomplete resections. In conclusions, young patients with ESCC were more likely to have family history and present with advanced disease. The survival for young patients with ESCC was poorer than their older counterparts in patients with later stage diseases.

Correlation of VCAM-1 expression in serum, cord blood, and placental tissue with gestational hypertension associated with fetal growth restriction in women from Xingtai Hebei, China.

The aim of this study was to investigate the expression of vascular adhesion molecule (VCAM)-1 in the maternal serum, cord blood, and placental tissue of pregnant women from Xingtai, Hebei, with gestational hypertension (GH) combined with fetal growth restriction (FGR). A total of 108 patients with GH combined with FGR (GH-FGR), 60 patients with GH alone (GH), and 50 healthy pregnant women (control) were recruited to this study. VCAM- 1 expression was detected in the maternal serum and cord blood by enzyme-linked immunosorbent assay, and in the placental tissue by immunohistochemistry. VCAM-1 expression was significantly higher in the maternal serum of patients with GH-FGR (164.38 ± 60.35) and GH alone (103.85 ± 54.47) than in the serum of the control population (46.70 ± 21.79; P < 0.05). On the other hand, VCAM-1 expression in the cord blood of GH-FGR (163.19 ± 69.46), GH (149.82 ± 58.20), and control (128.89 ± 43.59) subjects was not significantly different (P > 0.05). Moreover, the VCAM-1 expression rates were significantly higher and lower in the vascular endothelial and trophoblastic cells of the placenta of patients with GH-FGR (74.71 and 56.1%) and GH (72.98 and 55.36%), respectively, compared to those in the control subjects (46.48 and 95.11%). Therefore, we concluded that VCAM- 1 plays an important role in the development and generation of GH. Additionally, the low VCAM-1 expression in the trophoblastic cell could be correlated to the pathogenesis and progression of GH.

An outbreak of Candida parapsilosis fungemia among preterm infants.

In this article, we describe the first outbreak of Candida parapsilosis fungemia in our hospital. We examined a cluster of four nosocomial cases of C. parapsilosis fungemia that occurred in the neonatal intensive care unit (NICU) of the Affiliated Xingtai People's Hospital of Hebei Medical University over a two-week period. We ascertained patient parameters including clinical characteristics, blood and sputum cultures, and drug sensitivity test results. Cultures from eight blood samples obtained from the four infected preterm infants showed identical characteristics and were identified as C. parapsilosis. In order to determine the infection-related factors and to control the spread of the infection among the population, we immediately initiated the emergency plan. All four of the preterm infants recovered from the infection; there were no deaths. Outbreaks of C. parapsilosis, mostly involving preterm infants of very low birth weight or extremely low birth weight, can and do occur in NICUs. Cultures prepared using multiple samples taken from different patients contribute to a more definitive diagnosis. Established measures that control and prevent the infection, as well as effective and comprehensive treatments, can lead to a favorable outcome. That is to say, improving both disinfection and isolation, as well as interrupting the pathway of transmission, is the key to controlling the spread of infection.

Oriental HLA-A*11:90 detected in a Taiwanese cord blood sample and the haplotype in association with A*11:90 allele.

We report here an HLA-A allele, A*11:90, found in a Taiwanese cord blood sample using DNA sequence-based typing (SBT) protocol after observing an anomalous reaction pattern in a sequence-specific oligonucleotide (SSO) typing exercise. The sequence of A*11:90 is identical to A*11:01:01, the most predominant A*11 variant in Taiwanese, in exon 2 but differs from A*11:01:01 in exon 3 by two nucleotide substitutions at codon 163 (c.487C>G and c.488G>A), resulting R163E. In comparison with the sequence of A*11:02:01, the second most predominant subtype of A*11 in Taiwanese A*11:90 has one nucleotide difference at codon 19 (c.55A>G) in exon 2 resulting K19E and two nucleotides variations at codon 163 (c.487C>G and c.488G>A) in exon 3 resulting R163E. HLA-A*11:90-B*40:02-DRB1*11:01 is the deduced probable HLA haplotype in association with A*11:90. The generation of A*11:90 is thought to involve a DNA recombination event between alleles A*11:01:01 and A*80:01 where A*80:01 donated a fragment of the DNA sequence (from n.t. 487 to n.t. 497) to the recipient sequence of A*11:01:01.

Treatment and prognosis of limited disease primary small cell carcinoma of esophagus.

Primary small cell carcinoma of esophagus (SCCE) is a relatively rare and highly aggressive tumor characterized by early dissemination and poor prognosis. The optimal treatment has not yet been established, and the role of surgery has remained controversial. Most of the limited diseases were treated conventionally by surgery, but the five-year survival rate was still very low. This retrospective study was designed to investigate the clinical characteristics, treatment, and prognostic factors of limited disease SCCE. Clinical data of 40 SCCE patients with clinically limited disease who received transthoracic esophagectomy with lymphadenectomy at the Cancer Hospital of Shantou University Medical College from November 1990 to December 2009 were reviewed to summarize the clinical characteristics and treatment impacted on the survival. Twenty-five cases of the 40 patients were treated with surgery alone, eight cases were treated with surgery + postoperative chemotherapy, four cases were treated with surgery + postoperative radiotherapy, and the other three were treated with surgery + postoperative radiochemotherapy. The Kaplan-Meier and log-rank methods were used to estimate and compare survival rates. Cox's hazard regression model was used to identify the prognostic factors with the entry factors of gender, age (≤ 60 years versus > 60 years), length of the primary lesion (≤ 5 cm versus > 5 cm), location of the primary lesion, macroscopic tumor type, pT, pN, pTNM stage, operation (radical/palliative), and chemotherapy (yes/no). The mean follow-up duration of this series was 24.7 months (1-121 months). Thirty-four patients died of the disease during the follow-up, five were still alive, and one was lost of follow-up. The median survival time of the 40 patients was 13.0 months (95% confidence interval 4.7-21.3), and the 6-, 12-, 24-, 36-, and 60-month overall survival rates (OS) were 77.5%, 56.4%, 28.9%, 23.7%, 10.5%, respectively. In univariate analysis, age (≤ 60 years versus >60 years) (P=0.049), operation (radical/palliative) (P=0.008), and chemotherapy (yes/no) (P= 0.013) significantly influenced the OS of the SCCE patients. In multivariate analysis, operation (P=0.015) and chemotherapy (P=0.031) were independent prognostic factors. The patients who received radical surgery and postoperative chemotherapy had relatively better survival. Surgical resection combined with chemotherapy should be recommended to patients with limited disease SCCE.

CK19 mRNA expression in the bone marrow of patients with esophageal squamous cell carcinoma and its clinical significance.

The 5-year survival rate in resectable patients with esophageal cancer is only 20% to 36%. Regional relapse and distant metastasis are responsible for the failure of treatment and the majority of cancer-related deaths. Earlier detection of metastases, especially micrometastases, has the potential for more accurate risk stratification in subsequent therapy decisions. No effective techniques have yet been found to detect metastases in erroneously thought to have early stage disease. This study was designed to investigate the clinical significance of bone marrow micrometastases detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in patients with esophageal cancer. Expression of CK19 mRNA in the bone marrow of 61 patients with esophageal squamous cell carcinoma (ESCC) and 15 benign pulmonary and esophageal disease patients was assessed via RT-PCR. Correlation of CK19 mRNA expression to the clinicopathologic features and prognosis of the 61 patients was analyzed: 21.3% (13/61) were positive for expression of CK19 mRNA in patients with ESCC. No CK19 mRNA was detected of the 15 benign pulmonary and esophageal disease patients. CK19 mRNA expression did not correlate with the clinicopathologic features of the patients with ESCC, but patients with CK19 mRNA-positive bone marrow had earlier recurrence and shorter survival after surgery. In multivariate analysis, CK19 mRNA was found to be an independent predictor of a poor outcome. CK19 mRNA may be used as a molecular maker to detect bone marrow micrometastases in patients with ESCC and may help to select the proper therapy and predict the prognosis.

Reverse LISS plating for intertrochanteric hip fractures in elderly patients.

BACKGROUND: Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS) in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS. METHODS: We treated 28 elderly patients with a mean age of 82.3 years. According to the Evens classification, there were 2 Type I fractures, 2 Type II fractures, 3 Type III fractures, 13 Type IV fractures, 6 Type V fractures and 2 Type R fractures. All fractures were treated using the reverse LISS. Radiographic and clinical evidence of functional outcome and complications were evaluated. RESULTS: Mean perioperative blood loss was 92.4 milliliters (range 35 to 245 milliliters), and the mean postoperative hospital stay was 8.7 days (range 3 to 14 days).Complications included one minor wound hematoma. Radiographically, no collapses, screw cutouts, or head penetrations were seen. All surviving patients (28 of 28; 100 percent) had uneventful fracture healing with union achieved by six months in all patients. CONCLUSIONS: Use of the Reverse LISS plating for intertrochanteric hip fractures resulted in event-free fracture healing.

Changes in femoral head blood supply and vascular endothelial growth factor in rabbits with steroid-induced osteonecrosis.

The molecular aetiology of steroid-induced osteonecrosis (ON) is unclear. The aim of this study was to investigate changes in the femoral head blood supply and vascular endothelial growth factor (VEGF) protein levels following steroid-induced ON of rabbit femoral heads in the early stage of the disease, and to investigate a possible mechanism for ON. Using a classic protocol, ON was induced in 30 male 28-week old New Zealand white rabbits. An additional 15 untreated rabbits served as controls. Change of blood supply in the proximal femur was assessed by dynamic magnetic resonance imaging and microangiography. The VEGF protein and mRNA levels were assessed by immunohistochemistry and quantitative real-time polymerase chain reaction, respectively. After 6 weeks, the results indicated that VEGF protein and mRNA levels were significantly lower and femoral head blood supply had also decreased significantly in ON(+) rabbits compared with controls. The down-regulation of VEGF may play a critical role in the disease process of ON.

The regenerative effect of platelet-rich plasma on healing in large osteochondral defects.

Platelet-rich plasma (PRP), a platelet concentrate made of autogenous blood, has been used to improve bone and soft tissue defect healing in recent years. The aim of this study was to assess the effect of PRP on articular cartilage defects in a rabbit model. Forty-eight osteochondral defects created in the femoropatellar groove were (a) left untreated, (b) treated with autogenous PRP in a poly-lactic-glycolic acid (PLGA), or (c) with PLGA alone. Platelets were enriched 5.12-fold compared to normal blood in the PRP. After four and 12 weeks, the explanted tissue specimens were assessed by macroscopic examination, micro-computed tomography, and histological evaluation. Macroscopic examination, micro-computed tomography and histology of the newly formed cartilage and bone in the defect differ significantly between the PRP-treated and the untreated groups, and stimulatory effect of PRP on osteochondral formation was observed. In conclusion, PRP in PLGA improves osteochondral healing in a rabbit model.

Treatment of femoral head osteonecrosis in patients with systemic lupus erythematosus by free vascularised fibular grafting.

The purpose of this study was to review the radiographs of symptomatic femoral head osteonecrosis in patients with systemic lupus erythematosus (SLE) and to assess the results of treatment using free vascularised fibular grafting. We retrospectively reviewed 50 patients (80 hips) with SLE who underwent free vascularised fibular grafting for osteonecrosis of the femoral head. All patients were followed up for at least 2 or more years (average, 4.3 years). The mean Harris hip score improved from 72 to 88. At the latest follow-up, we found improved or unchanged radiographs in 12 of initially Stage II hips and in 60 of 64 Stage III or IV hips. No hips failed treatment and underwent total hip arthroplasty. The data suggest that free vascularised fibular grafting was successful in maintaining joint function and in delaying the need for joint replacement procedure.

[A retrospective analysis of 200-cases of otosclerosis].

Objective:To identify the audiological improvement postoperatively and improve the understand of otosclerosis for a better performance of personalized surgical treatment.Method:We retrospectively reviewed a series of 200 cases after surgery for ototsclerosis.The clinical characteristics,pre-and postoperative audiometric results,signs of Carhart notch, Gelle test and the characteristics of high-resolution computed tomography of temporal bone were analyzed retrospectively.Result:73% of patients had tinnitus, while 4% had sense of ear fullness,80.79% had Carhart notch,92.09% had negative result in Gelle test and 45.66% had positive signs on computed tomography. 68% of the patients revealed a type A tympanogram with only 22% type As.Fifty-six cases with laser stapedotomy achieved a the air bone gap at 250 Hz,500 Hz,1 kHz,2 kHz and 4 kHz of 25.54,16.25,13.75,6.34,15.96 dB,respectively. The bone conduction thresholds at 250 Hz,500 Hz,1 kHz,2 kHz improved 2.05,1.51,3.75 and 3.93 dB,respectively. At 4 kHz, bone conduction threshold increased by 1.34 dB.The improvement of bone conduction threshold at 250 Hz,1 kHz,2 kHz was significantly but for the revisions at 500 Hz and 4 kHz.Conclusion:The diagnosis of otosclerosis should be based on the combination of medical history, pure tone audiometry, tympanometry, Carhart notch, Gelle test and high resolution computed tomography of temporal bone.Surgical technique of stapedotomy with Piston artificial auditory ossicle implantation could improve not only the air conduction threshold, but also the bone conduction threshold at 250 Hz,1 kHz,2 kHz.

The effect of grain size of rock phosphate amendment on metal immobilization in contaminated soils.

When rock phosphates (RP) are used to remediate Pb-contaminated soils, their effectiveness is likely affected by their grain size. In this study, the effect of grain size of rock phosphate on the effectiveness of heavy metal immobilization in two contaminated soils was measured in pot experiment. Rock phosphate was used with four different grain sizes: <35, 35-72, 72-133 and 133-266microm. The application rate of rock phosphate in two soils was determined based on P/metals (Pb, Zn, Cu and Cd) molar ratio of 5.0 in the soils. The results showed that rock phosphate of the smallest grain size (<35microm) was superior to all of other grain sizes more than 35microm for reducing uptake in plant (Brassica oleracea L.) shoots for Cd (19.6-50.0%), Pb (21.9-51.4%) and Zn (22.4-34.6%), respectively, as compared with the soil without application of rock phosphate. Sequential extraction analysis indicated that rock phosphate was most effective for soil Pb to induced transformation from non-residual fractions to a residual fraction than that for Zn and Cd. Such transformation was probably through dissolution of Pb associated with exchangeable (EX), organic fraction (OC), acidic fraction (AC) and amorphous Fe and Al oxides-bound (OX) fraction and precipitation of pyromorphite-like minerals. Results suggested that the rock phosphate with small grain size was superior to that with large grain size for in situ remediation technology.

New Anti-Schistosoma Approaches in The People's Republic of China: Development of Diagnostics, Vaccines and Other New Techniques Belonging to the 'Omics' Group.

A new national schistosomiasis elimination programme will be implemented for the period 2016-20. To support this approach, we have performed a systematic review to assess anti-schistosome approaches in The People's Republic of China and defined research priorities for the coming years. A systematic search was conducted for articles published from January 2000 to March 2015 in international journals. Totally 410 references were published in English between 2000 and 2015 related to schistosomiasis after unrelated references and reviews or comments were further excluded. A set of research priorities has been identified for the near future that would improve the progress toward schistosomiasis elimination in The People's Republic of China. In particular, there is a lack of sensitive and specific tests for the detection of schistosomiasis cases with low parasite burdens, as well as an effective vaccine against schistosomiasis, and there is a need for surveillance tools that can evaluate the epidemic status for guiding the elimination strategy. Hence, we think that schistosomiasis control and elimination will be improved in The People's Republic of China through development of new tools.

Soil to plant transfer of 238U, 226Ra and 232Th on a uranium mining-impacted soil from southeastern China.

Both soil and plant samples of nine different plant species grown in soils from southeastern China contaminated with uranium mine tailings were analyzed for the plant uptake and translocation of 238U, 226Ra and 232Th. Substantial differences were observed in the soil-plant transfer factor (TF) among these radionuclides and plant species. Lupine (Lupinus albus) exhibited the highest uptake of 238U (TF value of 3.7x10(-2)), while Chinese mustard (Brassica chinensis) had the least (0.5x10(-2)). However, in the case of 226Ra and 232Th, the highest TFs were observed for white clover (Trifolium pratense) (3.4x10(-2)) and ryegrass (Lolium perenne) (2.1x10(-3)), respectively. 232Th in the tailings/soil mixture was less available for plant uptake than 226Ra or 238U, and this was especially evident for Chinese mustard and corn (Zea mays). The root/shoot (R/S) ratios obtained for different plants and radionuclides shown that Indian mustard had the smallest R/S ratios for both 226Ra (5.3+/-1.2) and 232Th (5.3+/-1.7), while the smallest R/S ratio for 238U was observed in clover (2.8+/-0.9).

Effect of bilateral testicular resection on thymocyte and its microenvironment in aged mice.

AIM: To observe the changes in thymocyte and its microenvironment in aged mice after bilateral testicular resection. METHODS: In male old mice, at the 25th day after testicular resection, the peripheral blood and thymus were collected. Blood and thymus suspension smears were prepared for quantitative histochemistry and immunohistochemistry study under light and electron microscopes. RESULTS: In testes resected mice the size and the weight of thymus were markedly increased. The demarcation between cortex and medulla was clear. The cortex was thickened and the cell density was increased. The ratio of cortex/medulla stereometry was increased. The total cell count, thymocyte count, the percentage of acid alpha-naphthyl acetate esterase (ANAE) positive thymocytes, nonlymphocytes and the rosette formation of macrophages and thymocytes were all increased. The thymocytes surrounded closely to the light thymic epithelial cells, dendritic cells or macrophages. The lymphocytes, particularly the ANAE positive lymphocytes of peripheral blood were increased. CONCLUSION: After bilateral testicular resection, the thymus of aged male mice showed morphological regeneration and the thymocytes and its microenvironment appeared to be definitely improved. It is suggested that testicular resection may improve immune function.

Effects of soil amendments on lead uptake by two vegetable crops from a lead-contaminated soil from Anhui, China.

Previous studies have documented that phosphate compounds of lead (Pb) [e.g., pyromorphite Pb5(PO4)3-(X), where X=OH, F or Cl] are comparatively insoluble, and their formation in Pb-contaminated soil may be a means of reducing the bioavailability and chemical lability of Pb in soil. In this study, the effect of phosphate compound amendments on the bioavailability of Pb in a polluted alkaline soil was examined. A Pb-contaminated soil was treated with hydroxyapatite (HA), phosphate rock (PR), water-soluble P fertilizer (single superphosphate, SSP) and the combination of HA with SSP. The bioavailability of Pb was determined in plant uptake studies with vegetables (Brassica campetris L. var. communis, BC) and Brassica oleracea L. var. acephala, BO) and sequential extraction. The results indicated that the Pb concentrations in both shoots and roots of two vegetable plants decreased with increasing quantities of added P compound, and the HA treatment had the best effect at the level of 5000 mg of P kg(-1)as compared with other treatments in which the Pb concentrations in shoots of BO and BC decreased 51.9% and 65.5%, respectively, and the Pb concentrations in roots of BO and BC decreased 67.3% and 57.2%, respectively, as compared with the control treatment. The SSP treatment had little effect on the Pb concentrations in plant tissues. Sequential extraction results indicated that the addition of soil amendments transform soil Pb from nonresidual fractions to residual fraction substantially. The effect of treatments followed this order at the equivalent P addition: HA>PR>HA+SSP>SSP. The results suggested that HA amendments can lower the bioavailability and increase the geochemical stability of soil Pb, so it has the potential for in situ remediation in Pb-contaminated soils.

Assessment of the effectiveness of different phosphorus fertilizers to remediate Pb-contaminated soil using in vitro test.

The addition of P-containing amendments was found to effectively reduce the bioaccessibility of Pb in soils to the human, using an in vitro test. For all treatments with P additions, the removal of soluble Pb in the small intestinal phase was observed. The effectiveness of various P treatments in the small intestinal phase generally followed this order at the equivalent P addition level: hydroxyapatite (HA)>phosphate rock (PR)>HA+single super-phosphate (SSP)>SSP. The relatively low effectiveness of P amendments at the gastric phase may be explained by the high solubility of pyromorphite at relatively low pH of 1.7, compared with that at the neutral small intestinal pH. Single super-phosphate showed the best performance in minimizing the bioaccessibility of Pb in the gastric phase, possibly due to its highest solubility at pH 1.7. Single super-phosphate showed the best performance in minimizing the bioaccessibility of Pb in gastric phase, possibly due its highest solubility at pH 1.7. However, in the small intestinal phase, SSP appears to be the least effective amendment, possibly due to its lowest Ca supply level to replace Pb form exchangeable sites, as reflected by its lowest molar Ca/P ratio of 1:2. The disagreement of the sequential extraction results with that of the in vitro test results indicated that the sequential extraction was not suitable for the assessment of the effect of P addition on minimizing the bioaccessibility of Pb to human due to the formation of pyromorphite during the extraction procedure. Results from this study also suggested that the time required for the in vitro test might be shortened for fast screening.

International access to the Chinese medical literature through MEDLINE.

This article reviews, for authors publishing in the Chinese literature, the characteristics of MEDLINE users, the format of MEDLINE citations and the main retrieval strategies used with the system. References were retrieved and data collected through MEDLINE searches of the database 1988-June 1992. Thirty-six indexed journals from the People's Republic of China (PRC) were analyzed. The items of a MEDLINE citation are described. Titles of Chinese journals are listed in English as well as Chinese in the annual "List of Serials Indexed" of Index Medicus. Articles from journals in the PRC are indexed at the China MEDLARS Center, Beijing, PRC. For the 36 journals analyzed, 12,530 citations appeared in MEDLINE during the search period. Basic search strategies are described. Users doing author searches may have difficulties with common Chinese surnames, especially if only one given name initial is used. Journal searches of specialty journals, as well as address field searches for publications from a particular institution, may be helpful to scientists planning a visit to China. Effective use of MEDLINE has become an opportunity and responsibility for scientists and physicians over the world. Suggestions for preparation of English titles and abstracts to assure optimal information transfer and retrieval efficiency are: think about your audience; do not waste words; include key features in the title; be consistent with names and affiliations; use MeSH terms; include important non-MeSH terms in text; use structured abstracts; and obtain MEDLINE printouts of your own citations.

Women's health in the People's Republic of China: some challenges of modernization.

OBJECTIVE: To identify aspects of the health of Chinese women throughout their lifespan which may paradoxically be threatened by modernization and to suggest relevant interventions through medical practice, education and research to meet these challenges. DATA SOURCES: Six risk areas were selected as examples: infant sex ratios; tobacco use by girls; respiratory illness plus anemia; psychosocial stress; osteoporosis; and dementia. Articles and other databases, through article citations, and through consultations with Chinese medical professionals. DATA SELECTION: Studies were selected which described clinical investigations, health care policy, or conditions of women in the People's Republic of China (PRC). Preference (but not exclusivity) was given to articles in internationally available publications, in English, and to authors working in the PRC. DATA EXTRACTION: Study quality, specific descriptive information concerning population, samples, and outcome measures were evaluated. DATA SYNTHESIS: Data documenting the present and future significance of these health threats are described, and current and potential interventions to address these problems through medical practice, education and research are outlined. CONCLUSION: Important issues in women's health are currently recognized in the PRC; problems occur in assigning priorities in the face of a large population and limited resources. The Chinese medical community plays a central role in developing and carrying out interventions to protect and promote women's health.