Meropenem in treatment of neonatal carbapenem-resistant Klebsiella pneumoniae sepsis: An analysis of 27 cases / 第二军医大学学报

Objective To explore the efficacy of meropenem in the treatment of neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) sepsis and its influencing factors, so as to provide reference for reasonable use of antibiotics in clinic. Methods A total of 27 neonates who were diagnosed as CRKP sepsis in Shanghai Children’s Hospital from Jun. 2014 to Jun. 2018 were included in this retrospective study. The clinical efficacy of meropenem was evaluated and the patients were divided into two groups: meropenem monotherapy effective group and meropenem monotherapy ineffective group who required other antibiotics for combination therapy. The perinatal factors, prior exposure to carbapenems and other clinical characteristics were compared between the two groups. Results The effective rate of meropenem monotherapy in treating neonatal CRKP sepsis was 48.1% (13/27), and the overall effective rate was 74.1% (20/27) when another antibiotic was added. The incidences of open wound after surgery (7/14 vs 1/13), septic shock (7/14 vs 1/13), positive culture of sterile coelomic fluid (6/14 vs 0/13), and invasive mechanical ventilation (10/14 vs 1/13) were higher in meropenem monotherapy ineffective group than in meropenem monotherapy effective group (all P0.05), and the diameter of CRKP inhibition zone in meropenem monotherapy ineffective group was smaller than that in meropenem monotherapy effective group ( [9.14±3.37] mm vs [12.85±5.27] mm, P0.05). Conclusion Meropenem monotherapy is effective for treatment of neonatal CRKP sepsis. Other antibiotics are recommended when the patients also have open wound after surgery, septic shock, positive culture of sterile coelomic fluid, invasive mechanical ventilation, or smaller inhibition zone of CRKP on meropenem.

Genetic Polymorphisms of 18 Autosomal STR loci in Changsha Han Population / 法医学杂志

OBJECTIVES@#To investigate the genetic polymorphisms of 18 autosomal short tandem repeats （STR） loci in Changsha Han population, and explore the population genetic relationships and evaluate its application value in forensic medicine.@*METHODS@#The DNA of 2 004 unrelated individuals in Changsha Han population were amplified using Goldeneye®DNA ID System BASIC, and the PCR products were analyzed by electrophoresis using 3130xl genetic analyzer. The fragment sizes of alleles were analyzed subsequently by GeneMapper® ID v3.2. The frequency data and forensic genetic parameters ［observed heterozygosity （Ho）, expected heterozygosity （He）, power of discrimination （DP） and polymorphic information content （PIC）］ of 18 STR loci were statistically analyzed. Total probability of discrimination （TDP）, probability of exclusion in trio cases （PEtrio） and probability of exclusion in duo cases （PEduo） were calculated by Cervus 3.0. Hardy-Weinberg equilibrium and linkage disequilibrium of the loci were detected by Arlequin v3.5. The results were compared with the available data of other populations from different races and regions.@*RESULTS@#The power of discrimination （DP）, and the polymorphic information content （PIC） of each locus of Changsha Han population ranged from 0.783 6 to 0.987 9 and 0.549 4 to 0.914 5, respectively. The TDP, cumulative probability of exclusion in trio cases （CPEtrio） and cumulative probability of exclusion in duo cases （CPEduo） were 0.999 999 999 999 999 999 999 865 2, 0.999 999 979 and 0.999 988 325, respectively. According to the Nei's DA genetic distance, the genetic distance between Changsha Han and Hunan Han populations was the smallest （0.014 1）, while it was the largest （0.041 8） between Changsha Han and Xinjiang Kazakh populations.@*CONCLUSIONS@#The 18 STR loci shows abundant genetic polymorphisms in Changsha Han population. The study of genetic diversity among different populations has an important meaning for the research of their origins, migrations and their relationships.

Analysis of Steroid Hormone by Low Temperature Plasma Mass Spectrometry / 分析化学

A device to produce low temperature plasma ( LTP) was designed and constructed to serve as the ion source of a high resolution mass spectrometry, and was applied to qualitatively analyze the steroid samples. In comparison with conventional electrospray ionization mass spectrometry, low temperature plasma mass spectrometry ( LTP-MS) had some advantages such as simple sample pretreatment and less interference. Mass spectrometry and tandem mass spectrometry were used to characterize the steroid samples in this research, and it was found that the structural stability of each steroid sample was presented in its mass spectrum, while in the tandem mass spectra there were more fragments of H2 O lost. And then the fragmentation process of typical steroid samples in collision induced dissociation ( CID ) was discussed based on theoretical calculation. In addition, by comparing tandem mass spectrometry and the fragmentation process, a pair of isomers of testosterone and dehydroepiandrosterone could be distinguished successfully.

Study on social determinants and health-related quality life among the 'empty nest' (lonely) elderly Chinese people / 中华流行病学杂志

Objective To study the social determinants and health-related quality of life among the Chinese 'empty nest' (lonely) elderly.Methods A total of 4995 elderly,aged 60 or over were recruited in rural and urban areas of Zhejiang province,under a cluster sampling method.Stepwise logistic regression analysis was performed to analyze the social determinants on the 'empty nest' elderly.Health-related quality of life was assessed by SF-36 and compared between the ' empty nest' and 'non-empty nest' elderly,using multiple linear regression analysis after adjusting for confounding factors.Results Comparing with the 'non-empty nest' elderly,the characteristics of the empty nest population were as follows:age at 70 to 79 (P= 0.0417),having higher education level (P＜0.0001),living in rural area (P＜0.0001),lower income level (P=0.0178,P=0.0049),with higher level of satisfaction of life (P= 0.0070,P= 0.0035 ) and lower level of depressive mood (P=0.0371).'Empty nest' elderly people had lower scores of SF-36 in BP (P=0.0032) dimension of physical function,and RE (P=0.0033) dimension of psychological function as well as MCS (P=0.0342) after adjusting for age,gender,marriage status,education level,residential areas,personal income,scores for satisfaction of life and depressive mood.Conclusion The ' empty nest' elderly people with the characteristics such as higher education level,lower income level and living in the rural areas should be under greater concern,especially on those people with lower health-related quality of life or poorer psychological function.

Factors associated with attitudes toward tobacco control policy in public places among adults in three counties of China / 中华流行病学杂志

Objective To investigate the attitudes of urban and rural community members toward total banning on smoking in public places and to explore the factors associated with these attitudes, in three counties/cities in China. Methods A cross-sectional study was conducted in three counties/cities in 2004, including Xin' an county of Henan province, Anyi county of Jiangxi province, and Mianzhu city of Sichuan province. A total of 5642 residents at age of 18-69 years old were interviewed face-to-face with a uniform questionnaire by locally-trained interviewers, through a random three-stage stratified sampling in each county. Factors were assumed to be associated with attitudes, using chi-square test in univariate analysis and non-conditional logistic regression model in multivariate analysis. Results The prevalence of current smoking among respondents was 44.3%. 80.7% (1379/1709) of the current smokers reported smoking often or sometimes in public places. Only 9.6% (479/4983) of the respondents reported that their indoor workplaces had totally banned on smoking. 43.5% of the respondents supported a total smoking ban strategy in pubic venues. The results of multivariate logistic regression model showed that eight factors were significantly associated with support for the total smoking ban in public places included region, residency, age, gender, education, smoking status, awareness about passive smoking hazards, and hearing of any message on tobacco control through media differences of rates regarding the factors as: residents in urban to rural areas (OR=1.29), elderly to youngsters (30-49 vs. 18-29, OR=1.46; 50-69 vs. 18-29, OR=1.71), female to male(OR=1.27), high-educated to less-educated ones, quitters to current smokers (OR=1.90), nonsmokers to current smokers (OR=2.01). Those who know messages on health hazards of passive smoking (OR=2.26), or heard of message on tobacco control through media (OR= 1.43). Conclusion Results from our study revealed that a thorough smoke-flee policy in public places should be developed and implemented in these three counties/cities.

A novel GJA8 mutation in a Chinese family with autosomal dominant congenital cataract / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the mutations in the gap junction protein alpha3/alpha8 gene (GJA3 or GJA8) in the Chinese family with autosomal dominant congenital cataract (ADCC).</p><p><b>METHODS</b>All subjects(5 family members and 100 unrelated control individuals)were undergone comprehensive ophthalmic examination, and genomic DNA was extracted from peripheral blood (5 mL). The exons and flanking introns of GJA3/GJA8 genes were amplified by polymerase chain reaction (PCR). Purified PCR products were then sequenced directly for screening disease-causing mutations.</p><p><b>RESULTS</b>Upon bidirectional sequence analysis, a G-->A transition at nucleotide 138 (c.138G>A)in exon 2 of GJA8 was found, resulting in synonymous mutation of glycine (GGG) to glycine (GGA). An additional G-->T transvertion at nucleotide 139 (c.139G>T) in exon 2 of GJA8, resulting in a missense mutation of asparagines (GAU) to tyrosine (UAU) at codon 47 (D47Y). These two alterations were not seen in all unaffected members and 100 unrelated control individuals. Bioinformatic analyses also showed that a highly conserved region was located at Asp47. Meanwhile no sequence variations for GJA3 were detected from the 3 affected members.</p><p><b>CONCLUSION</b>A novel disease-causing mutation (D47Y) of GJA8 gene in a Chinese family with ADCC is reported.</p>

Reliability and validity of a Short-Form Health Survey Scale (SF-36), Chinese version used in an elderly population of Zhejiang province in China / 中华流行病学杂志

Objective To evaluate the validity and reliability of a Chinese version on the Short-Form Health Survey Scale (SF-36) among elderly population. Methods Questionnaire including SF-36 Chinese version was administered in a cross-sectional study from October to December 2007. 4241 elderly people over 60 years old from rural and urban area in Zhejiang province were face-to-face interviewed by welltrained investigators, and then analyses on correlation, reliability, factors, t-test and one-way ANOVA were made to evaluate on reliability and validity of the scale. Results The SF-36 Chinese version had good split-half reliability (r=0.91, P<0.001 ) and all the internal consistency Cronbach's alpha coefficients exceeded 0.8 except for VT (α=0.65), SF(α=0.65) and MH (α=0.40). The correlative coefficients between each item and its domain were all greater than the 0.4 thresholds except item 9-2, and they were greater than the correlation between the item and other domains for all but item 9-8. These results demonstrated that the SF-36 Chinese version had good convergent validity and discriminant validity. The distribution of 35 items in 6 public factors (the cumulative variance=67.04 %) extracted from them was consistent with the basic conceived concept. All domains except MH had good validity to discriminate different categories. Conclusion The SF-36 Chinese version had good reliability and validity. It was acceptable for the evaluation on quality of life in elderly population, but the reliability and validity of MH were relative low and the items such as 9-2, 9-8 in MH and 3-1 in PF were not suitable for Chinese elderly population.

Exploring barriers to implementation of smoking policies: a qualitative study on health professionals from three county-level hospitals / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study was to identify factors limiting the implementation of smoking policies in county-level hospitals.</p><p><b>METHODS</b>We conducted qualitative interviews (17 focus groups discussions and 6 one-to-one in depth interviews) involving 103 health professionals from three target county-level hospitals. A combination of purposive and convenience sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. The transcripts were analyzed for themes and key points.</p><p><b>RESULTS</b>The main themes that emerged suggested that both smokers and non-smokers viewed smoking very negatively. However, it was clear that, underlying this acceptance of the health risks of smoking, there was a wide range of beliefs. Most of the health professionals pointed out that, as smoking was legal, addictive, and influenced by social norms, currently it was almost unrealistic to expect all smokers to give up smoking or not to smoke in the hospitals. Furthermore, they were concerned about the potentially detrimental effects of providing counseling advice to all smokers on the interpersonal relationship among colleagues or between doctors and patients. In addition, low level of employee participation influenced the sustainable implementation of smoking policies.</p><p><b>CONCLUSIONS</b>Simply being aware of the health risks about smoking did not necessarily result in successful implementation of the smoking policies. Application of comprehensive intervention strategies such as implementing smoking policies in public places at the county level, creating supportive environments, promoting community participation, and conducting health education, may be more effective.</p>

Validity of diagnostic evidence for deceased cases in hospitals / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To determine the validity of the diagnostic evidence for deceased cases in hospitals.</p><p><b>METHODS</b>All information collected from medical records of the deceased cases in tertiary care health facilities was input into our database. Four diagnosis levels were determined based on level of diagnostic evidence: level I was based on autopsy, pathology or operative exploration, level II on physical and laboratory tests plus expert clinical judgment, level III on expert clinical judgment, level IV on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined.</p><p><b>RESULTS</b>Among the 2102 medical cases for verbal autopsy study, only 26 (1.24%) afforded diagnostic evidence for level III. Among the level III evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level IV.</p><p><b>CONCLUSION</b>Level I diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level II or III diagnostic evidence.</p>

The current status of passive smoking in Chinese families and associated factors / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the prevalence of passive smoking in Chinese families and discuss its associated factors, as to providing scientific evidence for establishing tobacco control measures in China.</p><p><b>METHOD</b>Cross-sectional survey: from June to September, 2004, we randomly selected six counties in three different provinces ( Mianzhu and Xichong of Sichuan Province; Anyi and Hukou of Jiangxi Province; Xinan and Yanshi of Henan Province) and performed face-to-face questionnaire survey on citizens between 18 and 69 years old. All the data were double independently input by professional data entry company to ensure data accuracy. The prevalence of home passive smoking exposure in families with different demographic characteristics was described by using prevalence, and the possible correlated factors of home passive smoking exposure as independent variables, multiple factors were analyzed using Logistic Stepwise Regression Analysis method.</p><p><b>RESULTS</b>The analysis on 8142 nonsmokers revealed that the rate of passive smoking was 28.42%, with 27.38% of male and 28.93% of female suffering from passive smoking. All 87.19% of the smokers would smoke in front of their families. As many as 42.14% of the nonsmokers would offer cigarettes to their guests, while about 46.82% of the nonsmokers would suggest smokers to smoke outdoor. Home restriction on tobacco was extremely rare and only 6.33% of all the families completely forbade smoking. Multivariate logistic regression analysis of non-conditions revealed that, there was a lower level of involuntary tobacco smoke exposure in female, older age group, lower education level, divorced, or widowed families. There was no difference in involuntary tobacco smoke exposure between town dwellers and county dwellers, but such difference did exist in different districts.</p><p><b>CONCLUSION</b>The three provinces under investigation should have severe involuntary tobacco smoking exposure. Gender, age, literacy level, occupation and region should be all factors that influence the status of involuntary tobacco smoking exposure in different families. There is a high percentile that smokers would smoke in front of their families and kids and a relative low pressure against smoking from nonsmokers. Cigarette offering is very prevalence. The knowledge and attitude about passive smoking should be separated from the situation of passive smoking exposure.</p>

Passive smoking in China: contributing factors and areas for future interventions / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To reduce tobacco consumption and exposure to passive smoking in China.</p><p><b>METHODS</b>Discussion consisting of 80 focus groups and 35 interviews were held in three rural intervention counties of Jiangxi, Henan, and Sichuan Provinces. Participants came from hospitals, schools, rural areas, and urban areas.</p><p><b>RESULTS</b>Tobacco use and exposure to passive smoking were widely prevalent in the investigated schools, hospitals, county towns, and rural areas. Knowledge of the risks for passive smoking on health is lacking, especially in rural areas. Barriers to the control of tobacco use in public places include reluctance of administrators to implement tobacco control policies, lack of consistent policies, difficulties with regulations and enforcement, and reluctance of non-smokers to exercise their right to clean air.</p><p><b>CONCLUSION</b>To curb the current tobacco epidemic in China, tobacco control efforts must focus on reducing exposure to passive smoking. A strategy should be formulated to reduce the factors that contribute to tobacco use and exposure to passive smoking.</p>

Clinical analyses of emergency neoplasty on 102 patients with corneal penetrating injury / 上海第二医科大学学报

Objective To evaluate the clinical effects of emergency neoplasty on corneal penetrating injury. Methods A total of 102 cases of corneal penetrating injury were investigated.The patients underwent micro-trauma technique suture,optical iridectomy,extraction of anterior segment foreign bodies,nepheloid lens removal,and artificial lens implantation.The vision of pre-and post-surgery was compared and relationship between injury location and recovery was analyzed. Results The injury of cornea repaired completely 1 month after surgery.Cross infection was not found in the patients with one-year long follow-up(80% of all patients).The vision of all patients raised.The injury in center and nasal side affected vision significantly. Conclusion Timely surgery to corneal penetrating injury may be considered in order to improve the recovery of the traumatic eyes.

Quantitative analysis of factors affected mortality trend in Chinese, 2002 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explain trend of death in Chinese by quantitative analysis of demographic and non-demographic factors and estimate the proportion of contribution of non-demographic and demographic factors.</p><p><b>METHODS</b>Using census data and death causes data of National Disease Surveillance Points at 1991 and 2000 to calculate the proportion of contribution of demographic and non-demographic factors and to change on various death causes from 1991 to 2000 by methods of decomposing the differences of death rates.</p><p><b>RESULTS</b>The death rate showed a rapid decrease during 1950 - 1975, mainly owing to the contribution of non-demographic factors, including economic development, popularization of education and health service, especially the "patriotic hygiene movement". During 1991 - 2000, the death causes of lung cancer, liver cancer, breast cancer, chronic heart disease, stroke, diabetes and traffic accident had been increasing. The increase of deaths caused by these diseases were contributed to the non-demographic factors including 63% of the increase on lung cancer and 88% of increase on death rate of traffic accidents.</p><p><b>CONCLUSION</b>The study showed that the risk factors had contributed to the increase of death rates, including behavioral risk factors described in the preceding 5 papers as smoking and passive smoking, unhealthy diet, sedentary life style, violating traffic regulation etc. In order to reduce the death rates on cancer, heart diseases, diabetes, traffic accidents, emphasis should be also laid on the change of unhealthy behaviors.</p>

Implementation of second prevention measures on chronic diseases in Chinese, 2002 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the implementation of secondary prevention measures (blood pressure measure, test of blood lipid, and screening test for breast cancer and cervix uteri) on chronic diseases in different populations.</p><p><b>METHODS</b>The indicators on proportion of receiving blood pressure measurement, tests on blood lipid, screening of breast cancer and cervix uteri in research samples, as well as awareness of the risk of hypertension and hyper lipid were calculated based on results from 1BRFS questionnaire by weight on age structures from 2000 census.</p><p><b>RESULTS</b>22% and 5% of people under research understood the risk of hypertension and hyper lipid on their health. In addition, proportion of receiving these screening tests in sample populations were low. Secondly, the main target population including females over 50 years old but the proportion of screening breast cancer among those females over 50 years old was lower than that in females over 25 years old. Besides educational, occupational and geographic factors, the types of medical insurance for people also were important factors affecting the proportion of receiving screening tests.</p><p><b>CONCLUSION</b>Screening tests were important second prevention measures for reducing severity of the diseases. Except blood pressure tests among people over 35 years old, proportions of receiving other screening tests were very low. There were significant differences of receiving these screening tests in people by education occupation, geographic areas and types of medical insurance. In addition, the policy of screening was not clear on target orientation. It is necessary for developing guideline of screening to guide the screening programs.</p>

Effects of co-grafts of bone marrow stromal cells and nerve growth factor suspension on repair of spinal cord injury / 中华创伤骨科杂志

Objective To investigate effects of co-grafts of bone marrow stromal cells (BMSCs) combined with nerve growth factor (NGF) suspension on repair of spinal cord injury (SCI) in adult rats so as to determine whether the co-grafts are more effective than a single protocol.Methods Spinal cords of adult rats (n=32) were injured by the modified Allen's method.One week after injury,the injured cords were injected with Dubecco-modified Eagles Medium,BMSCs,NGF,and BMSCs plus NGF respectively.One month and two months after injury,rats were respectively sacrificed-and their injured cord tissues were sectioned to identify the transplanted cells under fluorescent microscopy.We observed axonal regeneration and differentiation of BMSCs through immunocytochemical staining conducted with neurofilament (NF) and Neuron-Specific Nuclear Protein (NeuN) and glial fibrillary acidic protein (GFAP).We measured the cavity volume by staining with hematoxylin-eosin (HE).At the same time,rats were subjected to behavioral tests using the open-field BBB (blood brain battier) scoring system.Results One month and two months after transplantation,immunocytochemical staining showed that transplanted cells partially expressed NeuN and GFAP.At the same time,significant reduction in lesion area (P＜0.05) and improvement in BBB lo- comotor rating scale (P＜0.05) were observed in the cases that received implantation,as compared with those that received vehicle injection.More importantly,further reduction in lesion area and improvement in function were ob- served in the combined treatment group.Conclusions BMSCs can differentiate into neurons and astroeytes. BMSCs and NGF can reduce lesion size,promote axonal regeneration and improve functional recovery,and may have a synergistic effect.