AME survey-003 A1-part1: in current China, do you regret you joined the medical profession.

BACKGROUND: The medical workforce constitutes the foundation of the provision of health services in all countries. The effectiveness of health systems and the quality of health services are directly related to the performance of health workers. Satisfaction level of the job affects the quality of care for patients. An anonymous on-line survey was conducted with the aim to obtain a better understanding of the current morale of Chinese medical professionals. METHODS: An online cross-sectional questionnaire based survey was conducted during the period of Sep 10-23, 2015, via the platform provided by DXY (www.dxy.cn), which is the largest medical and paramedical related website in China. In addition to demographics of the participants, a particular question was asked to the participants, in current China do you regret you joined the medical profession? This initial report analyzed the relationship between the participants with 'No' or 'Yes' answers to their demographic characteristics. RESULTS: In total 2,356 DXY users completed the survey, including 1,740 males (73.82%) and 617 females (26.18%), with a mean age of 31.96±7.03 yrs. There were more participants from relatively economically developed eastern coast areas. The N/Y (no regret participants vs. regretted participants ratio) ratio for all participants was 1.06 (P=0.181). The N/Y ratio of males and females was 1.04 and 1.11 respectively, and there was no significant difference in this ratio among them. There were 1,549 participants from IIIA hospitals (65.72%, N/Y ratio =1.15, P=0.008), followed by IIIB & IIA hospitals (25.46%, N/Y ratio =0.87, P=0.086), IIB & II C hospitals (3.7%, N/Y ratio =0.83, P=0.394), and lastly 1A & 1B clinics (2.6%, N/Y ratio =1.35, P=0.249). A total of 1,323 participants (56.13%) were trainee doctors with N/Y ratio of 1.19 (P=0.002), followed by lecturer-level attending specialists (27.79%, N/Y ratio =0.81, P=0.009), associate principle doctors (12.43%, N/Y ratio =1.01, P=0.953), and lastly principle doctors (3.73%, N/Y ratio =1.59, P=0.033). Specialties with less stressful workload such as radiology and traditional Chinese medicine have the highest job satisfaction, while doctors in accident and emergency cluster have the least job satisfaction. Medical professionals from Yunnan, Gansu and Shanxi have relatively higher positive response (higher N/Y ratio), despite the fact that these are not the economically advanced regions in China; while Jiangsu, an economically advanced province, had relatively higher negative response (lower N/Y ratio). CONCLUSIONS: The morale of majority medical professional in China mainland is likely to be positive. Job satisfaction is inversely related to work related stress level, but may not related to the absolute income.

Folic acid supplementation and dietary folate intake, and risk of preeclampsia.

BACKGROUND/OBJECTIVES: Folic acid supplementation has been suggested to reduce the risk of preeclampsia. However, results from few epidemiologic studies have been inconclusive. We investigated the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of preeclampsia. SUBJECTS/METHODS: A birth cohort study was conducted in 2010-2012 at the Gansu Provincial Maternity & Child Care Hospital in Lanzhou, China. A total of 10,041 pregnant women without chronic hypertension or gestational hypertension were enrolled. RESULTS: Compared with nonusers, folic acid supplement users had a reduced risk of preeclampsia (OR=0.61, 95% CI: 0.43-0.87). A significant dose-response of duration of use was observed among women who used folic acid supplemention during pregnancy only (P-trend=0.007). The reduced risk associated with folic acid supplement was similar for mild or severe preeclampsia and for early- or late-onset preeclampsia, although the statistical significant associations were only observed for mild (OR=0.50, 95% CI: 0.30-0.81) and late-onset (OR=0.60, 95% CI: 0.42-0.86) preeclampsia. The reduced risk associated with dietary folate intake during pregnancy was only seen for severe preeclampsia (OR=0.52, 95% CI: 0.31-0.87, for the highest quartile of dietary folate intake compared with the lowest). CONCLUSIONS: Our study results suggest that folic acid supplementation and higher dietary folate intake during pregnancy reduce the risk of preeclampsia. Future studies are needed to confirm the associations.

Phase II study of bevacizumab and erlotinib in the treatment of advanced hepatocellular carcinoma patients with sorafenib-refractory disease.

BACKGROUND: The combination of bevacizumab (B) and erlotinib (E) has shown promising clinical outcomes as the first-line treatment of advanced HCC patients. We aimed to evaluate the efficacy and safety of using combination of B + E in treating advanced HCC patients who had failed prior sorafenib treatment. METHODS: Eligible advanced HCC patients with documented radiological evidence of disease progression with sorafenib treatment were recruited. All patients received bevacizumab(B) at 10 mg/kg every 2 weeks with erlotinib(E) at 150 mg daily for a maximum of 6 cycles. Response assessments using both RECIST and modified RECIST criteria were performed after every 6 weeks. The primary endpoint was clinical benefit (CB) rate and a Simon two-stage design was employed. RESULTS: The trial was halted in the first stage according to the pre-set statistical criteria with 10 patients recruited. The median age was 47 years (range, 28-61) and all patients were in ECOG performance status 1. Eighty percent of patients were chronic hepatitis B carriers and all patients had Child A cirrhosis. Among these 10 patients, none of the enrolled patients achieved response or stable disease. The median time-to-progression was 1.81 months (95 % confidence interval [C.I.], 1.08-1.74 months) and overall survival was 4.37 months (95 % C.I., 1.08-11.66 months). Rash (70 %), diarrhea (50 %) and malaise (40 %) were the most commonly encountered toxicities. CONCLUSION: The combination of B + E was well tolerated but had no activity in an unselected sorafenib-refractory advanced HCC population. Condensed abstract The combination of bevacizumab and erlotinib had no clinical activity in sorafenib-refractory HCC population.

The significance of early alpha-fetoprotein level changes in predicting clinical and survival benefits in advanced hepatocellular carcinoma patients receiving sorafenib.

BACKGROUND: he role of serum alpha-fetoprotein (AFP) changes in predicting the treatment outcomes of advanced hepatocellular carcinoma (HCC) patients to sorafenib remains unknown. METHODS: Serum AFP was collected prospectively at baseline and subsequent follow-up visits in parallel with clinical and survival outcomes. AFP response was defined as a relative drop of AFP >20% of the baseline level after 6 weeks of sorafenib. The relationship between AFP response and the treatment outcomes was first explored in patients who received sorafenib in a phase II study. Subsequently, an independent validation set of patients were obtained to validate the association of AFP response to clinical outcomes. RESULTS: Included in the exploration and validation sets for analysis were 41 and 53 patients, respectively, with baseline AFP level >20 µg/L. In the exploration cohort, AFP response was significantly associated with clinical benefit (CB) rate (relative chance 3.4, 95% confidence interval [CI], 1.1-11.1), and multivariate analysis indicated that AFP response was associated with significantly better progression-free survival (PFS) (hazard ratio [HR], 0.31; 95% CI, 0.13-0.76) and marginally better overall survival (OS) (HR, 0.30; 95% CI, 0.09-1.02). When applying AFP changes in the validation set, significant associations were again found between AFP response with CB rate (relative chance, 5.5; 95% CI, 2.3-13.6) and PFS (HR, 0.12; 95% CI, 0.04-0.30) but not OS (HR, 0.61; 95% CI, 0.27-1.26). CONCLUSION: Drop in AFP level at 6 weeks is an exploratory early surrogate for both CB and PFS in advanced HCC patients receiving sorafenib.

The use of Chinese herbal medicine to improve quality of life in women undergoing chemotherapy for ovarian cancer: a double-blind placebo-controlled randomized trial with immunological monitoring.

BACKGROUND: This study aimed to evaluate traditional Chinese medicine (TCM) in improving quality of life (QOL), reducing chemotoxicity and modulating immune function in patients undergoing chemotherapy. PATIENTS AND METHODS: Patients with ovarian cancer were randomized to receive either TCM or placebo in addition to standard chemotherapy. The primary outcome was global health status (GHS) score, assessed by European Organization for Research and Treatment of Cancer questionnaire, while the secondary outcomes were other QOL items, chemotoxicity according to World Health Organization criteria and alterations in immune function as measured by immune cells count and the numbers of cytokines-secreting cells. RESULTS: There was no significant difference in the GHS between the two groups. With adjustment for stage, chemotherapy type, disease status, age and baseline value, emotional function, cognitive function and nausea and vomiting were found to be worse or less improved in the TCM group compared with placebo group after six cycles of chemotherapy. The TCM group had less neutropenia after three cycles (0% grade 4 neutropenia versus 28.6%). There were no other significant differences in terms of chemotoxicity. Lymphocyte counts and cytokine activities decreased less in the TCM group. CONCLUSIONS: TCM did not improve QOL but did have some effects in terms of maintaining immune function.

Essential oil of three Uvaria species from Ivory Coast.

Different parts of Uvaria ovata (Dunals) A, U. anonoides Baker f. and U. tortilis A. Chev were collected from Ivory Coast, in Toumodi (center), Agboville (south-east) and Sikensi (south), respectively. The essential oils, obtained by hydrodistillation using a Clevenger-type apparatus, were investigated by CG and CG/MS. The proportion of the chromatographed constituents identified varied from 92.5% to 98.5%. For U. ovata, the root bark oil comprised mainly camphene (10.2%), beta-pinene (10.1%), epi-alpha-cadinol (13.2%) and intermedeol (9.7%), while the oil of the stem bark was dominated by epi-alpha-cadinol (27.3%), intermedeol (11.9%) and benzyl benzoate (13.4%). The oil of the leaves showed beta-caryophyllene (15.6%), germacrene D (24.2%) and benzyl benzoate (18.3%) as the most abundant constituents. The leaf oil of U. anonoides was rich in 2,5-dimethoxy-p-cymene (15.5%), bicyclogermacrene (21.3%) and benzyl benzoate (8.7%), while, gamma-terpinene (31.7%), beta-caryophyllene (23.9%) and germacrene D (15.8%) constituted the main components of the stem bark oil of U. tortilis.

Analysis of luteolin in Elsholtzia blanda Benth. by RP-HPLC.

The total luteolin content in Elsholtzia blanda Benth. extracts (EBBE) was determined using reversed phase HPLC. C18 was used as the packing material and 0.01 M phosphate buffer (pH 2)-tetrahydrofuran-isopropanol (70:30:5) as the mobile phase with detection wavelength 360 nm. The recovery of the method was 96.4%-101.8%, and the assay was linear at concentrations from 5 to 200 microg/ml (r = 0.9999). The results indicated that the content of luteolin in EBBE extracted under different conditions varied significantly. This method can be used to optimize the extraction procedure and determine the content of luteolin in Elsholtzia blanda Benth. extracts.

Disposition of quercetin and kaempferol in human following an oral administration of Ginkgo biloba extract tablets.

Ten adult volunteers with an average age 28 years were given a single oral dose of six tablets of Ginkgo biloba extract. Quercetin and kaempferol in different period of human urine were determined by using RP-HPLC. The results showed the elimination rate constant k and the absorption rate constant ka of quercetin were slightly more than that of kaempferol; and the absorption half-life (t(1/2a)), the elimination half-life (t(1/2)) and t(max) of quercetin were less than that of kaempferol, the differences were, however, not statistically significant. The mean values of ka were 0.61 h(-1) and 0.55 h(-1), t(1/2a) 1.51 h and 1.56 h, k 0.37 h(-1) and 0.30 h(-1), t(1/2) 2.17 h and 2.76 h, T(max) 2.30 h and 2.68 h for quercetin and kaempferol, respectively, which mean absorption and elimination of quercetin and kaempferol are 0.17% and 0.22%, respectively. Quercetin and kaempferol are excreted in the human urine mainly as glucuronides.

Determination of quercetin and kaempferol in human urine after orally administrated tablet of ginkgo biloba extract by HPLC.

A sensitive, simple and accurate method was developed for determination of quercetin and kaempferol in human urine by reversed phase high performance liquid chromatography. The urine samples were analyzed on C18 column. Quercetin and kaempferol were analyzed simultaneously with good separation. UV detector was set at 380 nm. There was a linear relationship between chromatographic area of analytes and concentration of analytes over the concentration range 1.638-81.90 and 1.872-93.60 ng/ml for quercetin and kaempferol, respectively. The recovery of the assay was 99.7+/-6.2 and 97.4+/-7.2% for quercetin and kaempferol, respectively. The within-day and between-day coefficients of variation were less than 9.7 and 16.5% (RSD), respectively. The limit of detection was 1.0 ng/ml for quercetin and 1.1 ng/ml for kaempferol. The limit of quantitation was 1.61+/-0.11 ng/ml (n=5) for quercetin and 1.85+/-0.11 ng/ml (n=5) for kaempferol. The method developed has been applied to determine quercetin and kaempferol after orally administrated tablet of Ginkgo biloba extract in human urine.

Accuracy of radiographic assessment for the diagnosis of invasion depth in small invasive colorectal cancer.

Radiographic findings of 113 submucosally invasive colorectal cancers (CRCs) 10 mm. 47 CRCs had invaded the submucosa superficially while 66 CRCs had invaded deeply. The concordance rate in the assessment of radiology was 90.3% in smooth surface, 92.9% in central barium fleck, 90.3% in fold convergency and 79.6% in eccentric rigidity. Positive predictive value of central barium fleck for deep submucosal invasion was significantly higher in CRCs>10 mm than in those 10 mm. These findings suggest that barium radiography is a procedure which can give useful information in prediction of invasion depth in CRCs

Value of virtual computed tomographic colonography for Crohn's colitis: comparison with endoscopy and barium enema.

BACKGROUND: Crohn's colitis, frequently accompanied by stenosis or narrowing, can be difficult to assess through conventional methods. We evaluated the usefulness of virtual computed tomographic colonography (CTC) for the detection of colonic lesions due to Crohn's disease. METHODS: Forty-two lesions in 33 patients with Crohn's disease were examined by CTC and barium enema (BE). Twenty-two patients also were examined by colonoscopy (CS). The visualization ability of CTC was compared with those of the other two methods. RESULTS: In the visualization of elevated lesions, there was no significant difference between CTC and BE (18 of 20, p = 0.487) or between CTC and CS (15 of 16, p = 0.99); however, ulcerative lesions were less often visualized by CTC. However, CTC enabled identification of serious lesions in the colon proximal to the stenosis in nine patients and was superior to BE and CS in terms of its ability to visualize the proximal site of the stenosis (p = 0.003). CONCLUSION: CTC is clinically useful for the evaluation of Crohn's colitis, especially those with stenotic lesions.

Invasive colon cancer derived from a small superficial depressed cancer: report of a case.

A 64-year-old male in May 1997 was diagnosed by colonoscopy and a barium enema examination as having an invasive cancer in the transverse colon. Pathologic study of the resected surgical specimen revealed a well-differentiated adenocarcinoma invading the muscularis propria. He had a colonoscopic examination in 1991 and was diagnosed as having multiple adenomas, which were endoscopically removed. After that he had annual colonoscopy or barium enema examination follow-ups. At endoscopy in February 1994, a superficial depressed cancer 6 mm in diameter had been detected. However, the cancer was not seen again in several endoscopic examinations until one in 1997. Because the location of the lesion detected in 1994 and that of the invasive carcinoma detected in 1997 were identical, it was considered that the superficial depressed cancer developed, 40 months later, to an advanced cancer. Doubling time was calculated as 8.4 months.

Rheumatoid arthritis accompanied by colonic lesions.

A 69-year-old woman with a 6-year history of rheumatoid arthritis treated solely with an orally administered NSAID had slowly progressing persistent mild abdominal pain and diarrhea, accompanied with marked sing of inflammation as well as hypoproteinemia due to protein-losing gastroenteropathy. Examinations of the large intestine revealed variously shaped ulcerative lesions, centered around the left hemicolon, as well as luminal narrowing. The course of the disease and the shape of the lesions strongly suggested involvement of rheumatoid vasculitis; oral administration of prednisolone was effective.

Phlebosclerotic colitis: value of radiography in diagnosis--report of three cases.

Three cases sharing the following radiologic features are reported: (a) abdominal conventional radiography-vascular calcifications at the right hemicolon, (b) abdominal computed tomography-colonic wall thickening and venous calcifications, and (c) barium enema examination-luminal narrowing of the right hemicolon and thumbprinting. There were no clinical or laboratory findings suggestive of portal hypertension. The disease entity, "phlebosclerotic colitis," should be differentiated from ordinary ischemic colitis.

Crohn's disease of aphthous type: serial changes in intestinal lesions.

In Crohn's disease (CD), aphthous lesions are regarded as possible precursors of typical intestinal involvement. To determine the natural course of intestinal lesions in CD of aphthous type, the clinical course of 10 patients was retrospectively investigated during a period ranging from 6 to 16 years after diagnosis. The criterion for inclusion was confirmed aphthous lesions within the gastrointestinal tract with histologically verified epithelioid granuloma. The degrees of aphthous lesions in the small intestine and the colon were graded by small bowel radiography, barium enema examination and colonoscopy. Five patients developed typical CD during a period ranging from 0.8-3.3 years. The site of involvement was the ileum in three patients, the colon in one patient and both the ileum and the colon in one patient. Typical small intestinal CD occurred in four of seven patients with marked aphthous lesions of the small intestine, whereas colonic CD occurred in two of eight patients with such aphthous lesions of the colon. These findings suggest that CD of aphthous type is not necessarily a precursor of clinically overt disease. This may especially be the case for colonic aphthous lesions.

[Angiotensin II participates in stress-induced high blood pressure via stimulating hypothalamic vasopressin synthesis and release].

Experiments were carried out in male Sprague-Dawley rats. The animals were randomly divided into three groups: control, stressed and stress + captopril. Stress stimulations were composed of repeated electric foot-shock combined with noise, twice one day (2 h each session) for 15 consecutive days. Animals in the stress+captopril group were administered with captopril (50 mg/kg.d) intraperitoneally. The results showed that at the end of the 15-day experiment the systolic pressure of the tail artery in stressed rats was significantly higher than that of the control rats, i.e., 19.75+/ C1.0 kPa (n=8, P<0.05) versus 16.32+/ C0.55 kPa (n=7); the vasopressin (AVP) mRNA level in the hypothalamus of the stressed rats also increased significantly compared with that of the control rats, i.e., 12990.33+/ C1533.58 (n=6, P<0.001) versus 7332.66+/ C522.65 (n=6). However, in the stress + captopril rats, both the tail artery systolic pressure and hypothalamic AVP mRNA level were significantly higher than those of the control rats, but lower than those of the stressed rats. In the control rats, no significant change in mean blood pressure (MBP) was observed after intracerebroventricular (icv) injection of 0.3 microgram of d(CH(2))(5)Tyr(Me)AVP, a selective AVP V(1) receptor antagonist; however, a decrease in MBP was observed in both stressed and stress+captopril rats (P<0.05), but the decrease in stress+captopril rats was more obvious than that of the stressed rats after icv a same dose of d(CH(2))(5)Tyr(Me)AVP. These results indicate that the endogenous renin-angiotensin system participates in the mechanism of the stress-induced high blood pressure in rats, and that the effect of Ang II is mediated mainly by stimulating hypothalamic AVP synthesis and release, which in turn result in an increase in blood pressure by acting on the central V (1) receptors.

The role of total parenteral nutrition in the management of patients with acute attacks of inflammatory bowel disease.

The aim of this study was to evaluate the effects of the prolonged duration of total parenteral nutrition (TPN) on the clinical, laboratory, and nutritional parameters and short-term outcome in acute attacks of ulcerative colitis and Crohn's colitis, and the difference in the response to TPN between the two diseases. Twenty-two patients with severely and moderately active ulcerative colitis (8 severe and 14 moderate) and 12 patients with Crohn's colitis were analyzed retrospectively. Eleven of 22 patients with ulcerative colitis were treated with TPN and corticosteroids (TPN group). The remaining 11 patients were treated with corticosteroids alone and hospital meals (oral diet group). Both groups were matched regarding disease severity at pretreatment. The clinical characteristics, and the initial and total dosages of corticosteroids for 3 weeks were similar between the two groups. The authors compared the changes in the clinical, inflammatory, and nutritional parameters and short-term outcome between the TPN and the oral diet groups with ulcerative colitis. The same evaluations were also made for 12 patients with Crohn's colitis who received TPN (CD group). The TPN group did not show any significant improvement in the clinical parameter, inflammatory signs, or nutritional state compared with the oral diet group with ulcerative colitis. The remission rate after 3 weeks of therapy and a colectomy rate also showed no significant difference between the two groups. In contrast, TPN resulted in a disappearance of clinical symptoms and an improvement in both the inflammatory and nutritional parameters in the CD group. Only one of the 12 patients with Crohn's colitis underwent colectomy. TPN induced no additional benefit in corticosteroid therapy in an acute attack of ulcerative colitis. In contrast, TPN may have primary effects on Crohn's colitis.

[Changes in vasopressin V1 receptor mRNA level in rats with high blood pressure induced by chronic stress].

Using reverse transcription polymerase chain reaction (RT-PCR) combined with Southern blotting hybridization technique, the AVP V1 receptor mRNA was found to be widely distributed in central neuronal system and other tissues of rats, such as cerebral cortex, hypothalamus, medulla, liver and kidney. The receptor mRNA levels in the cortex, hypothalamus and medulla were decreased significantly in chronically stressed rats, as compared with normal controls (cortex: P < 0.05; hypothalamus: P < 0.01; medulla: P < 0.001). But no significant change was observed in tissues of heart, liver and kidney (heart: P > 0.05; liver: P > 0.05; kidney: P > 0.05). These results suggest that chronic stress may lead to a decrease of AVP V1 receptor density in the CNS as a result of decreased synthesis.

[Effect of stressful stimulations on hypothalamic vasopressin mRNA level of rats].

Experiments were carried out in stressful foot shock and noise stimulated male Sprague Dawlay rats. 3'-end digoxigenin-labeled 26 mer oligonucliotide probe was used to detect the vasopressin (AVP) mRNA in hypothalamic tissues. Dot blotting technique was used in the assessment of AVP mRNA level. The results showed that the tail systolic arterial pressure of rats increased gradually after stressful stimulations of foot shock in combination with noise. The difference in tail systolic blood pressure between control and stimulated rats was statistically significant after 5-day stimulation. By the ninth day, the systolic blood pressure of the stressed rats reached the highest level and maintained thereafter for several days. No significant difference was observed in the AVP-mRNA level between control and stressed rats by the time when stimulated for 4 days, but it significantly increases when stimulated for 6 days or longer (by the 6th day: P < 0.005; by the 15th day: P < 0.001). No difference was found in plasma osmolalities between control and stressed animals. These results indicate that the stressful foot shocks in combination with noise stimulations may cause an increase in AVP-mRNA level in the hypothalamus, which was accompanied by an increase in systolic arterial pressure. The mechanism of increase in AVP-mRNA level upon stress stimulation remains to be elucidated.

[Effects of gonadal steroid hormones on hypothalamic vasopressin mRNA level in male and female rats].

Experiments were carried out in 10-11-week old gonadectomized male and female Sprague-Dawley rats. Dot-blot analysis and 3'-end digoxigenin-labeled 26 meroligonucleotide probe was used in detecting the mRNA level hypothalamic vasopressin (AVP). The basal hypothalamic AVP-mRNA level in the sham-operated intact males was 45% higher than that in the sham-operated intact females (P < 0.05). Plasma osmolality was also higher in the sham-operated intact males than in the sham-operated intact females (P < 0.05). The hypothalamic AVP-mRNA level in ovariectomized rats was 30% higher than that in sham-operated intact females (P < 0.05). Although the hypothalamic AVP mRNA level tended to be lower in castrated males than in sham-operated intact males, the difference was not statistically significant. The difference in plasma osmolality between gonadectomized males and females was statistically insignificant. In castrated males, hypothalamic AVP-mRNA level was decreased following sc injection of estradiol (P < 0.05), but testosterone, progesterone or a combination of estradiol and progesterone were without effect. In ovariectomized rats, sc injection of estradiol or a combination of estradiol and progesterone resulted in a decrease in hypothalamic AVP-mRNA level (P < 0.01), but progesterone or testosterone had no effect. The difference in plasma osmolality between gonadal steriod hormones-treated rats and vehicle-treated rats was not statistically significant. These findings indicate that gonadal steriod hormones can affect hypothalamic AVP-mRNA level in rats, through some central mechanism.