Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology.

OBJECTIVES: The aims of this study were to assess aetiology and clinical characteristics in childhood meningitis, and develop clinical decision rules to distinguish bacterial meningitis from other similar clinical syndromes. METHODS: Children aged <16 years hospitalised with suspected meningitis/encephalitis were included, and prospectively recruited at 31 UK hospitals. Meningitis was defined as identification of bacteria/viruses from cerebrospinal fluid (CSF) and/or a raised CSF white blood cell count. New clinical decision rules were developed to distinguish bacterial from viral meningitis and those of alternative aetiology. RESULTS: The cohort included 3002 children (median age 2·4 months); 1101/3002 (36·7%) had meningitis, including 180 bacterial, 423 viral and 280 with no pathogen identified. Enterovirus was the most common pathogen in those aged <6 months and 10-16 years, with Neisseria meningitidis and/or Streptococcus pneumoniae commonest at age 6 months to 9 years. The Bacterial Meningitis Score had a negative predictive value of 95·3%. We developed two clinical decision rules, that could be used either before (sensitivity 82%, specificity 71%) or after lumbar puncture (sensitivity 84%, specificity 93%), to determine risk of bacterial meningitis. CONCLUSIONS: Bacterial meningitis comprised 6% of children with suspected meningitis/encephalitis. Our clinical decision rules provide potential novel approaches to assist with identifying children with bacterial meningitis. FUNDING: This study was funded by the Meningitis Research Foundation, Pfizer and the NIHR Programme Grants for Applied Research.

[Progress in research of deaths and disease burden of major chronic diseases caused by indoor and outdoor air pollution in China].

Health damage including chronic disease caused by air pollution have attracted increasing attention. With the acceleration of industrialization and urbanization, the emission of air pollutants has increased, and its association with chronic diseases has become a research trending topic. Cardiovascular disease, cancer, diabetes, and chronic respiratory disease are the major chronic diseases, causing about 86.6% of the total deaths in China. The prevention and control of chronic diseases, especially the etiologic prevention, is a major public health issue related to national health. This article summarizes the recent progress in research of association of indoor and outdoor air pollution with all-cause mortality, the deaths and disease burden of four major chronic diseases, i.e. cardiovascular disease, cancer, diabetes, and chronic respiratory disease, and puts forward suggestions for the reduction of the burden caused by chronic diseases due to air pollution to provide a theoretical foundation to revise air quality standards in China.

[Assessment of the professional community awareness about innovative diets prescribed for hypertension].

Due to the fact of constantly increasing incidence of arterial hypertension and the large role of nutrition in the treatment and prevention of this disease, the assessment of the awareness of the medical community and patients about the trends in the development of therapeutic and prophylactic diets is relevant. The aim of the research was to assess the physician and patient awareness on the trends in the development of therapeutic and prophylactic diets and different rations prescribed for hypertension prevention. Material and methods. On the SurveyMonkey platform, questionnaires were created for different medical specialties and patient of various departments. Access to the survey was free, the mailing list was carried out through the professional communities of physicians on the Internet. In turn, the doctors-respondents were asked to distribute the link for patients among those who were undergoing treatment or were on dispensary observation for the pathology of the cardiovascular system. Respondents were asked about their attitudes, knowledge, and compliance with existing dietary guidelines. The number of respondents was 300 doctors of various specialties and 300 patients. Results. The most recognizable dietary recommendations among patients were: low-calorie (41.1%), low-carbohydrate (39.4%), vegetarian (39.0%). However, the most popular (the commitment to them was the greatest) were: low in calories (27.6%), low in carbohydrates (25.6%), low in fat (24.4%). Among the doctors, the distribution was as follows - in addition to the classic therapeutic and prophylactic diets prescribed for certain diseases, the most recognizable diets were: Mediterranean (59.8%), low-calorie (59.0%), low-fat (57.3%); and the most commonly prescribed: Mediterranean (47.0%), low-carb (44.4%), low-fat (40.2%). The most recognizable dietary pattern among patients was the low-calorie diet (adherence to it was also maximum). As for physicians, the most recognized and most recommended preventively was the Mediterranean eating pattern. At the same time, the prevalence and recognition of the DASH diet, which, according to the opinion of the world community, has the most pronounced preventive and therapeutic properties, according to the survey, was low (7.3% of the respondents were aware of this diet). Conclusions. According to the results of this work, it is necessary to consider the possibility of combining three diets (low-calorie, Mediterranean and DASH diets) to achieve the maximum therapeutic and preventive effect while maintaining popularity among patients.

[Risk prediction of venous thromboembolism in non-small cell lung cancer patients based on COMPASS-CAT risk assessment model].

Objective: To verify the risk prediction efficacies of COMPASS-cancer associated thrombosis (COMPASS-CAT) risk assessment model and the new prediction probability model established based on COMPASS-CAT for venous thromboembolism (VTE) in hospitalized patients with non-small cell lung cancer (NSCLC). Methods: We retrospectively collected the clinical data of 373 patients with NSCLC admitted to National Clinical Research Center for Cancer/Cancer Hospital from March 2013 to June 2017. All of them were divided into VTE group (63 cases) and non-VTE group (310 cases) according to VTE occurred or not. According to the COMPASS-CAT risk assessment model, all patients were scored and classified by risk. Chi-square test was used to compare the clinical features between two groups, and multivariate logistic regression analysis was used to evaluate the independent risk factors of VTE in NSCLC patients. Based on the COMPASS-CAT risk assessment model, D-dimer≥1.03 mg/L and hemoglobin<10 g/dl were included to construct a new COMPASS-CAT prediction probability model, the ROC curve was also drawn. We used MedCalc software to compare the difference of ROC curves and analyze the application value of different risk assessment models in predicting VTE risk of NSCLC patients. Results: The incidence of VTE was 16.9% (63/373). The COMPASS-CAT score of VTE group was 6.37±3.40, which was higher than 2.74±2.04 of non-VTE group (P<0.001). Univariate analysis showed that the proportion of patients with KPS≤80, COMPASS-CAT≥7, D-dimer≥1.03 mg/L, central venous catheter (CVC), hemoglobin<10 g/L, cardiovascular complications≥2, hyperlipidemia, clinical stages Ⅲ and Ⅳ, KPS≤80 in VTE group was significantly higher than that in non-VTE group (P<0.05). Logistic regression analysis showed that D-dimer≥1.03 mg/L, compass-cat score≥7 and hemoglobin <10 g/dL were independent risk factors for VTE. Based on the COMPASS-CAT risk assessment model, a new risk assessment model of COMPASS-CAT was constructed by incorporating the variables of D-dimer ≥1.03 mg/L and hemoglobin <10 g/dl. The area under ROC curve (AUC) of COMPASS-CAT model and new COMPASS-CAT prediction probability model were 0.745 and 0.804, respectively. Compared with COMPASS-CAT model, AUC of new COMPASS-CAT prediction probability model increased by 0.059, with statistically significant difference(P=0.007). Conclusion: COMPASS-CAT risk assessment model can predict the risk of VTE in NSCLC patients, and the new COMPASS-CAT prediction probability model constructed by COMPASS-CAT model combined with D-dimer and hemoglobin variables can improve the accuracy of screening VTE risk factors in NSCLC patient.

[Prognostic value of Montreal Cognitive Assessment in heart failure patients].

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

[Analysis on the demand, access and related factors of cancer prevention and treatment knowledge among urban residents in China from 2015 to 2017].

Objective: To investigate the demand and access to the cancer prevention and treatment knowledge and related factors among urban residents in China from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of general demographic characteristics, the demand and access to cancer prevention and treatment knowledge, and the influencing factors of the attitude. The Chi-square test was used to analyze the difference of the demand of the cancer prevention knowledge among different groups and the corresponding factors of the cancer prevention and treatment knowledge were analyzed by using the logistic regression model. Results: The proportion of residents who need the cancer prevention and treatment knowledge was 79.5%. The demand rate of the inducement, symptom and diagnosis methods of cancer in the occupational population was highest, about 66.8%, 71.0% and 20.8%, respectively. The demand rate of treatment methods and cost in current cancer patients was the highest, about the 45.9% and 21.9%, respectively. The top three sources to acquire the cancer prevention and treatment knowledge were "broadcast or television" (69.5%), "books, newspapers, posters or brochures" (44.7%) and "family and friends" (33.8%). The multivariate analysis showed that compared with public institution personnel/civil servants, unmarried/cohabiting/divorced/widowed and others, annual household income less than 20 000 CNY, from the eastern region, people without cancer diagnosis and people with self-assessment of cancer risk, the demand rate of cancer prevention and treatment knowledge was higher in enterprise personnel/workers, married, annual household income between 60 000 CNY and 150 000 CNY, from the central region, people with cancer and people with unclear cancer risk (all P values <0.05). Conclusion: There was a high demand for the cancer prevention and treatment knowledge among urban residents in China from 2015 to 2017. The main access to the knowledge is from the radio or television. The occupation, marital status, annual household income, residential region, health status and risk of disease were the main factors of the demand of the cancer prevention and treatment knowledge.

[Exploration and application of occupational disease risk assessment model based on information diffusion theory].

Objective: To research build a kind of occupational disease risk assessment model which provides scientific basis for prevention and control of occupational diseases. Methods: Based on the principle of information diffusion, this paper uses spread function to extend the incomplete gathered information, establishes the mapping relationship between observation samples and risk probability distributions, and constructs the occupational disease risk assessment model, to analyzes the risk data of occupational disease reported cases in Guangdong Province in the past five years. Results: Through evaluation analysis, every year, 200-300 cases of pneumoconiosis probability is 67.77%, 100-200 cases of occupational poisoning probability is 68.52%, 20-40 cases of occupational cancers probability is 71.62%, each year, the incidence of occupation otorhinolaryngology and oral diseases in 200 cases was 62.23%. Conclusion: A model of occupational disease risk assessment based on information diffusion theory is constructed, the evaluation result is basically consistent with the actual situation of occupational disease, which can provide reference for occupational disease prevention and control.

[Objective assessment of mental nerve local anesthesia]. / Ob''ektivnaia otsenka urovnia mestnogo obezbolivaniia podborodochnogo nerva.

AIM: To study the reaction of the mental nerve to selective stimulation of thin nerve fibers by thermal stimuli during conduction anesthesia. MATERIAL AND METHOD: The pilot study involved 24 healthy volunteers: 13 subjects were injected with a 4% solution of articaine-containing anesthetic with a vasoconstrictor in a ratio of 1:200 000 (pH 4.8-5.4) and 11 subjects - a 3% solution of mepivacaine-containing local anesthetic without a vasoconstrictor (pH value 5.8-6.4). The registration of evoked potentials was performed twice: before local anesthesia and 5 minutes after anesthesia. With the help of disposable carpal dental injectors, local anesthesia was performed near the mental foramen in order to anesthetize the innervation region of the mental nerve through a conductive type. The evoked potentials (VP) were recorded on a Nicolet instrument (USA) with Bravo evoked potentials software. The study of thermal EPs was performed using a Contact heat evoked potential stimulator (CHEPS) device ('Medoc Ltd, Ramat Yishai', Israel). The base and peak temperature were set at 33 and 54 °C, correspondingly. RESULTS: The evoked potentials for thermal stimulation demonstrated a significant decrease in the amplitude of all components and the elongation of the LP of the main negative-positive N2-P2 complex after anesthesia compared with the initial thermal EP. The complete disappearance of thermal responses was observed in 14 (58%) of 24 study participants, minor changes were seen in 3 (12.5%) cases only. The total response disappearance was observed in 10 (77%) of 13 participants after articaine and in 3 (27%) of 11 - after mepivacaine (p<0.05), weak changes were registered in 2 (15%) cases in the articaine group and in 1 (9%) case in the mepivacaine group. CONCLUSION: A 4% solution of articaine is somewhat more effective for pain relief of teeth and bone since it often causes deeper anesthesia, and a 3% solution of mepivacaine without a vasoconstrictor is physiologically more suitable for working with soft tissues.

Urban agglomeration (Guangzhou-Foshan-Zhaoqing) ecosystem management under uncertainty: A factorial fuzzy chance-constrained programming method.

In this study, a factorial fuzzy chance-constrained programming (FFCP) method is developed for planning urban agglomeration ecosystem under uncertainty. FFCP cannot only address uncertainties presented as possibility distributions and random variables, but also quantitatively evaluate the individual and the interactive effects of multiple eco-environmental factors on urban agglomeration ecosystem. The FFCP method is applied to planning the Guangzhou-Foshan-Zhaoqing (GFZ) urban agglomeration, one of the most important economic circles of the Pearl River Delta region. With rapid industrialization, urbanization and population growth, a number of eco-environmental issues (e.g., water contamination, air pollution, and ecological deterioration) are becoming more and more serious. Results reveal that (i) the main environmental problem of Guangzhou is water pollution due to excessive chemical oxygen demand (COD) discharge (with a contribution of 53.1%), (ii) Foshan would suffer air pollution due to sulfur dioxide (SO2) emitted from industrial processing and production, and (iii) solid waste disposal would continue to be challenge faced by Zhaoqing. Results also disclose that multiple uncertainties in system components have sound effects on the urban agglomeration ecosystem management as well as eco-environmental constraints have individual and/or joint effects on the system benefit. Different probability levels would lead to changed land-use patterns. Decisions at a lower violation level would lead to an increased reliability in fulfilling ecosystem requirement but with a lower system benefit. The findings can help decision makers to gain insights into tradeoff between economic development and eco-environmental protection as well as generate synergetic development strategies of urban agglomeration in an economic-effective and ecological-harmonious way.

The combination of apolipoprotein E4, age and Alzheimer's Disease Assessment Scale - Cognitive Subscale improves the prediction of amyloid positron emission tomography status in clinically diagnosed mild cognitive impairment.

BACKGROUND AND PURPOSE: Randomized clinical trials involving anti-amyloid interventions focus on the early stages of Alzheimer's disease (AD) with proven amyloid pathology, using amyloid positron emission tomography (amyloid-PET) imaging or cerebrospinal fluid analysis. However, these investigations are either expensive or invasive and are not readily available in resource-limited centres. Hence, the identification of cost-effective clinical alternatives to amyloid-PET is highly desirable. This study aimed to investigate the accuracy of combined clinical markers in predicting amyloid-PET status in mild cognitive impairment (MCI) individuals. METHODS: In all, 406 MCI participants from the Alzheimer's Disease Neuroimaging Initiative database were dichotomized into amyloid-PET(+) and amyloid-PET(-) using a cut-off of >1.11. The accuracies of single clinical markers [apolipoprotein E4 (ApoE4) genotype, demographics, cognitive measures and cerebrospinal fluid analysis] in predicting amyloid-PET status were evaluated using receiver operating characteristic curve analysis. A logistic regression model was then used to determine the optimal model with combined clinical markers to predict amyloid-PET status. RESULTS: Cerebrospinal fluid amyloid-ß (Aß) showed the best predictive accuracy of amyloid-PET status [area under the curve (AUC) = 0.927]. Whilst ApoE4 genotype (AUC = 0.737) and Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) 13 (AUC = 0.724) independently discriminated amyloid-PET(+) and amyloid-PET(-) MCI individuals, the combination of clinical markers (ApoE4 carrier, age >60 years and ADAS-Cog 13 > 13.5) improved the predictive accuracy of amyloid-PET status (AUC = 0.827, P < 0.001). CONCLUSIONS: Cerebrospinal fluid Aß, which is an invasive procedure, is most accurate in predicting amyloid-PET status in MCI individuals. The combination of ApoE4, age and ADAS-Cog 13 also accurately predicts amyloid-PET status. As this combination of clinical markers is cheap, non-invasive and readily available, it offers an attractive surrogate assessment for amyloid status amongst MCI individuals in resource-limited settings.

[Current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS and influencing factors, China, 2011-2015].

Objective: To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China. Methods: Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015. Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China. Results: The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1% (17 784/250 645) in 2011 to 10.3% (54 596/528 226) in 2015 (Z=51.38, P<0.000 1) in China. The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3% (6 641/17 784) in 2011 to 71.0% (38 783/54 596) in 2015, showing a significant rising tendency (Z=96.23, P<0.000 1), but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5%, 338 654/473 630). Multivariate logistic regression analysis showed that the PLWHA who were females, aged ≥50 years, of Han ethnic group, married or had spouse, had the educational level of high school or above, infected through homosexual intercourse, with CD(4)(+)T cells counts ≤500 cells/µl at the first visit, identified to be infected with HIV in medical setting, living in urban areas et al, were more likely to receive free antiretroviral therapy. Conclusions: The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics. It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.

[Functional cardiovascular assessment in dentists performing local anesthesia in out-patient settings]. / Otsenka funktsional'nogo sostoyaniya serdechno-sosudistoi sistemy vrachei-stomatologov pri provedenii mestnogo obezbolivaniya v ambulatornykh usloviyakh.

The article presents the results of the cardiovascular changes assessment using electrocardiography (ECG) monitoring during local anesthesia in GP dentists. Selective ECG monitoring was carried out in 60 dentists aged 25-55 years (1 group - 25-34 y.o.; 2 group - 35-44 y.o.; 3 group - 45-55 y.o.) by means of portable «Valens¼ system. The study of stress index or the index of regulatory systems tension (IT) was conducted for 6 hours in the first day half within 1 working day. IT from 50 to 150 relative units was considered normal. In the first group IT peak was observed at the time of expectation of clinically relevant anesthesia in upper and lower jaw, while in the second and third groups it was associated with pain reaction in the course of treatment despite of clinical signs of anesthesia in the maxilla (IT=20±5.3 and 231±1.4, correspondingly) and mandible (IT=213±2.7 and 223±2.6, correspondingly). In all groups greater IT correlated more with mandible anesthesia events.

The Chinese perspective on pastoral resource economics: a vision of the future in a context of socio-ecological vulnerability.

This paper reviews institutional changes in pastureland use in China over the last 30 years and discusses their impacts on pastoral communities, drawing evidence from case studies of two agro-pastoralist and two pastoralist communities. Those who rely directly on pastureland for their livelihood are vulnerable to the joint effects of pastureland degradation and climate change. The authors argue that a 'top-down' governance structure with no participation from local communities and a 'one size fits all' institutional solution are a poor fit for pastoralism management. The authors conclude that the current institutional environment in China may be leading to decreasing populations, reduced livestock rearing, impoverishment and increasing inequality within pastoral communities. Bearing in mind that pastoral systems have characteristics that are specific to their areas and tailored to their local context, the authors recommend paying greater attention to 'bottom-up', locally specified strategies which can be combined with long-term institutional arrangements that have historically provided pastoralists and agro-pastoralists with the resources to adapt to change.

Après avoir retracé les changements institutionnels introduits par la Chine dans l'utilisation des prairies depuis 30 ans, les auteurs examinent les effets de ces transformations sur les communautés pastorales, tels qu'ils ressortent d'études de cas conduites respectivement sur deux communautés agropastorales et deux communautés strictement pastorales. Les pasteurs dont les revenus dépendent directement du pâturage sont vulnérables aux effets conjoints de la dégradation des prairies et du changement climatique. D'après les auteurs, les structures de gouvernance « du haut vers le bas ¼, où la participation des communautés locales est exclue, et les solutions institutionnelles « à taille unique ¼, ne se prêtent guère à une gestion efficace du pastoralisme. Ils concluent que l'environnement institutionnel actuel en Chine pourrait entraîner un recul démographique, un déclin des élevages ainsi qu'une aggravation de la pauvreté et des inégalités au sein des communautés pastorales. Sachant que les systèmes pastoraux possèdent des caractéristiques spécifiques qui varient en fonction de la région où ils sont implantés et du contexte local, les auteurs recommandent d'accorder une plus grande attention aux stratégies conçues localement « du bas vers le haut ¼, en les associant si besoin aux dispositifs institutionnels à long terme qui fournissent aux pasteurs nomades et aux agropasteurs les ressources nécessaires pour s'adapter au changement.

Sirviéndose de datos obtenidos a partir de estudios monográficos de dos comunidades agropastorales y otras dos pastorales, los autores repasan los cambios institucionales que han experimentado los usos de los pastizales en China en los últimos 30 años y examinan el modo en que ello ha repercutido en las comunidades que viven del pastoreo. Aquellas que dependen directamente de los pastizales para vivir son vulnerables al efecto combinado de la degradación de los pastos y el cambio climático. Los autores postulan que una estructura de gobierno «dirigista¼ y «descendente¼, sin participación de las comunidades locales, así como las soluciones institucionales de «modelo único¼, son fórmulas poco adaptadas a la gestión del pastoreo. Los autores llegan a la conclusión de que el contexto institucional vigente en China puede estar acarreando una mengua de las poblaciones y una reducción de la cría ganadera, así como empobrecimiento y crecientes niveles de desigualdad dentro de las comunidades que viven del pastoreo. Teniendo en cuenta que los sistemas pastorales revisten características que son específicas de cada zona y están adaptadas al contexto local, los autores recomiendan que se preste mayor atención a estrategias «ascendentes¼ y definidas a escala local, que cabe combinar con dispositivos institucionales a largo plazo que históricamente han proporcionado a los grupos pastorales y agropastorales los recursos necesarios para adaptarse al cambio.

[Multi-centric clinical study of trial of labor after cesarean section].

OBJECTIVE: To study the feasibility and safety of trial of labor after cesarean section (TOLAC). METHODS: Retrospective analysis of five medical center of Guangdong province from January 2011 to December 2015 hospitalized delivery information, compare the same scar TOLAC (research group) with the scar pregnancy (control group) pregnancy outcomes, to study the feasibility and safety of TOLAC. RESULTS: (1) During 2011-2015, total delivery 95 600 cases in five medical center, 13 824 cases of thme with uterine scar pregnancy, including 12 027 cases elective repeat cesarean section and 1 797 cases (13.00%, 1 797/13 824) with scar uterus vaginal trial of labor. Among 1 308 cases of vaginal delivery, the success for trial of labor rate was 72.79% (1 308/1 797). From 2011 to 2015, there were increased rate of pregnancy after cesarean section, which were respectively 10.71%, 13.28%, 14.45%, 15.54% and 16.98%. The will of vaginal birth were rising and the rate were respectively 11.85%, 12.25%, 13.49%, 13.82% and 12.93%. (2) There were 489 (27.21%, 489/1 797) cases of scar uterus maternal emergency cesarean section in the trial of labor, reason for "social factors" require for cesarean delivery have 68 cases, the percentage was 13.91% (68/489), compared with control group (7.18%, 206/2 869), the difference was statistically significant difference (χ(2)=27.356, P=0.000). Doctors diagnosed as "aura uterine rupture" in the labor was 11.86% (58/489), compared with that in control group (1.43%, 41/2 869), the differences were statistically significant difference (χ(2)=1 578.223, P=0.000). (3) The incidence of uterine rupture of the research group (0.74%, 9/1 211) was significantly higher than that of control group (0.01%,2/31 200; χ(2)> 2 000, P=0.000). The incidence of postpartum hemorrhage in research group was 6.94% (84/1 211), compared with that in the control group (3.05%, 951/31 200), there was statistically significant difference (χ(2)=16.328, P=0.000). While, there were no statistical significancefor the labor time limit, birth rate of severe asphyxia and neonatal birth weight average differences between two groups (P>0.05). CONCLUSIONS: The rate of pregnancy after cesarean section is increasing year by year, and the will of vaginal birth is increasing, while it still are generally low. TOLAC is safe and feasible, but also significantly higher risk, strictly labor monitoring and can proceed fast cesarean delivery in delivery room is an important guarantee of safe delivery.

[STRUCTURAL, FUNCTIONAL, AND VEGETATIVE CONDITIONS OF PATIENTS WITH STABLE ARTERIAL HYPERTENSION, ITS MASKED FORM, AND WHITE COAT HYPERTENSION].

The character of changing of functional and vegetative characteristics in different clinical variants of arterial hypertension thus far remains obscure. The aim of this work was to study patients with stable arterial hypertension (SAH), its masked form (MH), and white coat hypertension (WCH). We examined 125 patients who were divided into these 3 groups based on results of 24 hr AP monitoring by cardiac rhythm measurement and echocardiography. The study revealed different risk factors of each of the three forms of AH. The main risk factors of WCH are age and disturbed rhythm variability, those of MH are overweigh, obesity, and myocardial dysfunction, while SAH is associated with the advanced age, overweight, obesity, the history of concomitant cardiovascular diseases, and disordered daily profile of AP. It is concluded that different clinical variants of AH result from the changes in the functioning of cardiovascular and vegetative nervous systems associated with different risk factors.

Quantification of azithromycin in human plasma by liquid chromatography tandem mass spectrometry: application to a bioequivalence study.

A specific, sensitive and rapid liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) method has been developed and validated for the determination of azithromycin in human plasma. After deproteinizing the plasma sample with methanol, azithromycin and internal standard (IS: roxithromycin) were separated using a mobile phase comprised of acetonitrile : ammonium acetate buffer (50 mM, containing 0.05% acetic acid)=85:15 on a Hypersil GOLD C18 column (50 mm×2.1 mm ID, dp 1.9 µm). Detection was performed with a tandem mass spectrometer by selective reaction monitoring (SRM) through electrospray ionization. Target ions were monitored at [M+H]+ m/z 749.5→591.5 and 837.7→679.5 in positive electrospray ionization (ESI) mode for azithromycin and IS respectively. Linearity was established for the range of concentrations 2-800 ng/mL with a coefficient of correlation (r) of 0.9996. The lower limit of quantification (LLOQ) was identifiable and reproducible at 2.0 ng/mL. Both intra- and inter-batch standard deviations were less than 15%. The validated method was successfully applied to study the comparative bioavailability of azithromycin for suspension in test vs. reference in healthy Chinese volunteers through the statistical comparison of pharmacokinetic parameters obtained with the two formulations.

Associations between hazard indices of di-n-butylphthalate and di-2-ethylhexylphthalate exposure and serum reproductive hormone levels among occupationally exposed and unexposed Chinese men.

The knowledge on the dose-response relationships between cumulative phthalate exposure and reproductive hormones in human are lacking. To assess the characteristics of the associations between hazard index (HI) of cumulative di-n-butylphthalate (DBP) and di-2-ethylhexylphthalate (DEHP) exposures and serum concentrations of free testosterone (fT), estradiol, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), we used restricted cubic spline function to characterize the dose-response curves between the HI values and reproductive hormones for 74 male workers occupationally exposed to high levels of DBP and DEHP, and 63 male construction workers as comparison group matched for age and smoking status. The median of HI value was 5.30 for exposed workers, 53.0-fold that of unexposed workers (0.10). 89.2% of exposed workers and 1.6% of unexposed workers have HI over 1.00. We observed a borderline significantly negative association between HI and fT in exposed workers (r=-0.195, p=0.096), but not in unexposed workers. The exposed workers showed inverted long-tailed J-shaped fT and FSH curves, and small changes in the LH curve, whereas unexposed workers had inverted and flattened-S-shaped fT and mirror-S-shaped LH and FSH curves. Both T production and hypothalamo-pituitary-testis (HPT) axis function were damaged in workers with high HI of phthalate exposures. HPT feedback function was activated in workers with both high and low HI, and plays an important role in preventing fT level from further decreasing with a rise in HI.