Metformin treatment reduces the incidence of osteoporosis: a two-sample Mendelian randomized study.

It remains unclear whether the association between metformin and osteoporosis (OP) risk is causal. This two-sample Mendelian randomization (MR) study suggests a causal relationship between metformin treatment and a decrease in OP and fracture incidence, as well as an increase in bone mineral density (BMD) in the lumbar spine, femoral neck, and heel. Nonetheless, no significant causal effect is observed on forearm BMD. PURPOSE: We utilize a MR approach to investigate the association between metformin treatment and the risk of OP. METHODS: Metformin treatment was selected as exposures. Outcomes included OP; BMD at the forearm (FA), femoral neck (FN), and lumbar spine (LS); estimated heel bone mineral density (eBMD); and fracture. Summary statistics for exposures and outcomes were obtained from corresponding genome-wide association studies. Inverse variance-weighted (IVW) analysis was mainly applied; the weighted median (WM), penalized weighted median (PWM), maximum likelihood (ML), and MR-Egger regression (MR-Egger) method were also used to obtain robust estimates. A series of sensitivity analyses including Cochran's Q test, MR-Egger regression, leave-one-out analysis, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) were used to detect pleiotropy or heterogeneity. RESULTS: In the main analysis, IVW estimates demonstrated that metformin treatment had a definite causal effect on the risk of OP (odds ratio (OR): 0.859, 95% CI: 0.774-0.953, P = 0.004), LS-BMD (OR: 1.063, 95% CI: 1.023-1.105, P = 0.002), FN-BMD (OR: 1.034, 95% CI: 1.000-1.069, P = 0.049), eBMD (OR: 1.035, 95% CI: 1.023-1.047, P ≤ 0.001), and fracture(OR: 0.958, 95% CI: 0.928-0.989, P = 0.008). However, it did not have an effect on FA-BMD(OR: 1.050, 95% CI: 0.969-1.138, P = 0.237). CONCLUSIONS: This study indicated that metformin treatment is significantly associated with a reduction in the risk of OP, fracture and higher LS-BMD, FN-BMD, and eBMD. However, there was no significant association with FA-BMD.

Elevated Hb A2 is Not Always Indicative of ß-Thalassemia.

Hb A2 levels are usually high in carriers of ß-thalassemia (ß-thal). These levels also provide a sensitive marker for the identification of hemoglobin (Hb) variants. In this study, we aimed to examine two patients from two Chinese families who showed elevated Hb A2 levels but did not show any signs of ß-thal. The HBB variants were analyzed using direct sequencing of HBB and in silico prediction analysis. Moreover, the family's genetic history was investigated. We examined two probands from different Chinese families with elevated Hb A2 levels who were not afflicted with ß-thal, although several nucleotide changes were found at codon 81 (CTC>CTA) (HBB: c.246C>A) in Family 1 and a compound heterozygosity for codon 40 (AGG>AAG) (HBB: c.122G>A) and IVS-II-478 (C>A) (HBB: c.316-373C>A) in Family 2. After investigating the genetic history of both families including the ß-thal aspect, we found that these mutations were not responsible for the elevated Hb A2 levels. It is rarely reported that high Hb A2 level is not indicative of ß-thal. In contrast, low or normal Hb A2 level is always found with ß-thal due to other molecular defects that mask their ß-thal genotype. Our results highlight the importance of considering the genetic factors related and unrelated to ß-thal to improve the accuracy of future genetic counseling.

A score model based on pancreatic steatosis and fibrosis and pancreatic duct diameter to predict postoperative pancreatic fistula after Pancreatoduodenectomy.

PURPOSES: To establish a scoring model for the risk of postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD). METHODS: PD Patients from 7 institutions in 2 independent sets: developmental (n = 457) and validation cohort (n = 152) were retrospectively enrolled and analyzed. Pancreatic Fibrosis (PF) and Pancreatic Steatosis (PS) were assessed by pathological examination of the pancreatic stump. RESULTS: Stepwise univariate and multivariate analysis indicated that pancreatic duct diameter ≤ 3 mm, increased PS and decreased PF were independent risk factors for POPF and Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF). Based on the relative weight and odds ratio of each factor in the POPF, a simplified scoring model was developed. And patients were stratified into high-risk group (22~28 points), medium-risk group (15~21 points) and low-risk group (8~14 points). The receiver operating characteristic curve demonstrated that the Area under the curve for the predictive model was 0.868 and 0.887 in the model design group and the external validation group. CONCLUSIONS: This study establishes a simplified scoring model based on accurately and quantitatively measuring the PS, PF and pancreatic duct diameter. The scoring model accurately predicted the risk of POPF.

A Novel ß-Thalassemia Mutation in a Chinese family: IVS-II-203-205 (TCT>CC) (HBB: c.315+203TCT>CC).

ß-Thalassemia (ß-thal) is one of the most common inherited disorders in southern China. More than 300 ß-globin gene mutations around the world have been reported in the HbVar database. In this study, a novel mutation in a 30-year-old Chinese woman [IVS-II-203-205 (TCT>CC), HBB: c.315+203TCT>CC] was first found by direct sequencing. Subsequently, investigation of her parents' genetic codes was completed, and the results showed that her father also carried this mutation. Based on the features observed in clinical practice, this novel mutation was regarded as a mild phenotype of ß-thal.

Rationality and effectiveness of transarterial chemoembolization as an initial treatment for BCLC B stage HBV-related hepatocellular carcinoma.

BACKGROUND & AIMS: Transarterial chemoembolization (TACE) is recommended as standard care for intermediate hepatocellular carcinoma (HCC). We analyse the rationality and effectiveness of TACE with BCLC B stage HBV-related HCC in a large cohort. METHODS: A total of 1516 patients with BCLC B stage from 7724 HBV-related HCCs who received TACE as initial treatment were retrospectively studied. The treatment response was assessed by the mRECIST criteria. The overall survival was calculated with life-table method and compared with the Mantel-Cox test. The prognostic factors were assessed using Cox proportional hazards. RESULTS: The 1-, 3- and 5-year overall survival rates were 84%, 29% and 19% respectively for all patients. Alpha-foetoprotein, Child-Pugh classification, tumour size and number were independent prognostic factors. The 5-year survival for patients with CR, PR, SD and PD were 39%, 19%, 2% and 0%, respectively (P < 0.0001). Child-Pugh A liver function (P = 0.002) and smaller tumour (P < 0.0001) were associated with CR/PR response. After TACE, the 5-year survival rates for patients who received surgical resection, local ablation, repeated TACE and other therapies were 52%, 29%, 12%, 10% respectively (P < 0.0001). In 328 CR patients, the prognosis of 151 patients received surgical resection is better than 177 patients not undergo liver resection (5-year survival: 52% & 27%, P < 0.0001). CONCLUSIONS: Transarterial chemoembolization is a safe and efficacious treatment for BCLC B stage HBV-related HCC. A low AFP level, small tumour, low tumour number and good liver function predicted good survival. Tumour response after initial TACE, an independent prognostic factor of overall survival, was associated with tumour extent and influenced subsequent treatment.

Conduction system pacing upgrade versus biventricular pacing on pacemaker-induced cardiomyopathy: a retrospective observational study.

Objective: The feasibility of the conduction system pacing (CSP) upgrade as an alternative modality to the traditional biventricular pacing (BiVP) upgrade in patients with pacemaker-induced cardiomyopathy (PICM) remains uncertain. This study sought to compare two modalities of CSP (His bundle pacing (HBP) and left bundle branch pacing (LBBP)) with BiVP and no upgrades in patients with pacing-induced cardiomyopathy. Methods: This retrospective analysis comprised consecutive patients who underwent either BiVP or CSP upgrade for PICM at the cardiac department from 2017 to 2021. Patients with a follow-up period exceeding 12 months were considered for the final analysis. Results: The final group of patients who underwent upgrades included 48 individuals: 11 with BiVP upgrades, 24 with HBP upgrades, and 13 with LBBP upgrades. Compared to the baseline data, there were significant improvements in cardiac performance at the last follow-up. After the upgrade, the QRS duration (127.81 ± 31.89 vs 177.08 ± 34.35 ms, p < 0.001), NYHA class (2.28 ± 0.70 vs 3.04 ± 0.54, p < 0.05), left ventricular end-diastolic diameter (LVEDD) (54.08 ± 4.80 vs 57.50 ± 4.85 mm, p < 0.05), and left ventricular ejection fraction (LVEF) (44.46% ± 6.39% vs 33.15% ± 5.25%, p < 0.001) were improved. There was a noticeable improvement in LVEF in the CSP group (32.15% ± 3.22% vs 44.95% ± 3.99% (p < 0.001)) and the BiVP group (33.90% ± 3.09% vs 40.83% ± 2.99% (p < 0.001)). The changes in QRS duration were more evident in CSP than in BiVP (56.65 ± 11.71 vs 34.67 ± 13.32, p < 0.001). Similarly, the changes in LVEF (12.8 ± 3.66 vs 6.93 ± 3.04, p < 0.001) and LVEDD (5.80 ± 1.71 vs 3.16 ± 1.35, p < 0.001) were greater in CSP than in BiVP. The changes in LVEDD (p = 0.549) and LVEF (p = 0.570) were similar in the LBBP and HBP groups. The threshold in LBBP was also lower than that in HBP (1.01 ± 0.43 vs 1.33 ± 0.32 V, p = 0.019). Conclusion: The improvement of clinical outcomes in CSP was more significant than in BiVP. CSP may be an alternative therapy to CRT for patients with PICM. LBBP would be a better choice than HBP due to its lower thresholds.

Association between brain-derived neurothropic factor variants and asthma in Chinese Han children.

AIM: To identify the markers contributing to genetic susceptibility to asthma in Chinese Han children. METHODS: This study examined the potential association between childhood asthma and seven single nucleotide polymorphisms of Brain-derived Neurotrophic Factor (BDNF) - SNPs, rs16917204, rs6265, rs7103873, rs16917237, rs56164415, rs13306221 and rs10767664 - using the MassARRAY system. The participants, recruited between May 2009 and July 2012, were 319 children with asthma (mean age 9.82 ± 1.57 years) recruited from a hospital paediatric department and 309 healthy controls (mean age 10.25 ± 1.36 years), recruited from the medical examination centre at the same hospital. RESULTS: We observed a significant association for rs6265 (χ(2)  = 9.851, p = 0.002, OR = 1.427, 95% CI = 1.143-1.783), located in exon 4 of the BDNF. Another potential association was observed for rs13306221 (χ(2)  = 4.316, p = 0.038, OR = 1.604, 95% CI = 1.024-2.512) in the promoter region of the BDNF. Strong linkage disequilibrium was observed in block 1 (D' > 0.9). Significantly more G-G-G haplotypes in block 1 were found in children with asthma. CONCLUSIONS: These findings point to a role for BDNF polymorphisms in Chinese Han children with asthma and may inform future genetic or biological studies on childhood asthma.

Totally laparoscopic vs. laparoscopically assisted distal gastrectomy for gastric cancer: a meta-analysis.

BACKGROUND/AIMS: Laparoscopic surgery has become common in the treatment of gastric cancer due to the improvement of both techniques and devices for laparoscopic surgery. This study compares totally laparoscopic distal gastrectomy (TLDG) with laparoscopically assisted distal gastrectomy (LADG) implemented by experienced laparoscopic surgeons. METHODOLOGY: Studies and relevant literature regarding the formation of LADG vs. TLDG were searched in PubMed, Embase and WanFang database. Operative time, bleeding volume, number of retrieved lymph nodes, time to first flatus, duration of postoperative hospitalization and postoperative complications in LADG and TLDG were pooled and compared using a meta-analysis. The odds ratios (ORs) and weighted mean different (WMD) were calculated with 95% confidence intervals (CIs) to evaluate the influence of TLDG. RESULTS: Five recent studies including 652 patients in total were included in this meta-analysis. These studies demonstrated that compared with LADG, TLDG has less bleeding (p <0.05), shorter time to first flatus (p <0.05), and lower rates of postoperative complications (p <0.01). The operation time, the mean number of lymph nodes retrieved and duration of postoperative hospitalization were not statistically significant (p >0.05). CONCLUSIONS: Compared with LADG, TLDG can significantly reduce bleeding, time to first flatus and rates of postoperative complications. Therefore, it was considered a useful technique for patients with gastric cancer.

[Clinical study of double plate system in the treatment of complex proximal humeral fractures in the elderly].

OBJECTIVE: To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery. METHODS: From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups. RESULTS: All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups. CONCLUSION: Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.

Conduction system pacing for ventricular pacing requirement is feasible and effective on patients with hypertrophic cardiomyopathy and cardiac dysfunction.

Objective: We aimed to evaluate the feasibility and safety of his-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with hypertrophic cardiomyopathy (HCM) and heart failure (HF). Methods: Patients with HF and interventricular septal thickness (IVST) ≥ 13 mm resulted from HCM, who accepted conduction system pacing (CSP) with a percentage of ventricular pacing > 40% from May 2018 to April 2022 were consecutively enrolled in our center. LBBP was preferred and HBP was the alternative therapy unless IVST ≥ 16 mm or LBBP failed, whereas LBBP would be the alternative therapy if HBP failed in patients with IVST ≥ 16 mm. All patients were followed up for at least one year. Data including clinical, echocardiographic parameters and electrocardiogram measurements, were collected and evaluated in patients with and without left ventricular ejection fraction (LVEF) < 50%. Results: A total of 27 patients (65.93 ± 9.09 years old) were enrolled and only 3 patients failed in CSP (11.11%) via LBBP (6/13) and HBP (18/21) procedures. LVEF (P = 0.521), left ventricular end-diastolic diameter (LVEDD) (P = 0.816), and QRS duration (P = 0.928) did not worsen after CSP, and left atrial diameter (LAD) (49.58 ± 8.99 mm vs.47.04 ± 9.82 mm, P = 0.045) tended to improve slightly after 19.19 ± 7.71 months follow-up. Of note, LVEF (39.22%±7.51% vs. 45.22%±9.59%, P = 0.015), LVEDD (52.11 ± 10.10 mm vs. 48.33 ± 9.07 mm, P = 0.037), LAD (50.33 ± 8.93 mm vs. 46.11 ± 5.97 mm, P = 0.013) and New York Heart Association (NYHA) grade (2.67 ± 0.5 vs. 1.38 ± 1.02, P = 0.029) improved in 9 patients with LVEF < 50%, whereas LVEF (P = 0.372), LVEDD (P = 0.665), LAD (P = 0.093) and NYHA grade (P = 0.452) did not deteriorate in patients with preserved ejection fraction. Conclusion: CSP was safe and feasible in patients with HCM and cardiac dysfunction, and did not worsen cardiac performance especially in patients with LVEF < 50%. HBP might be an effective alternative to LBBP in patients with significantly thickened interventricular septum.

Transcriptome and metabolome reveal the effects of three canopy types on the flavonoids and phenolic acids in 'Merlot' (Vitis vinifera L.) berry pericarp.

The flavonoids and phenolic acids in grape berries greatly influence the quality of wine. Various methods are used to shape and prune grapevines, but their effects on the flavonoids and phenolic acids remain unclear. The flavonoids and phenolic acids in the berry pericarps from grapevines pruned using three types of leaf canopy, namely, V-shaped, T-shaped, and vertical shoot-positioned (VSP) canopies, were compared in this study. Results showed that the V-shaped canopy was more favorable for the accumulation of flavonoids and phenolic acids. Transcriptome and metabolome analyses revealed that the differentially expressed genes (DEGs) and differentially regulated metabolites (DRMs) were significantly enriched in the flavonoid and phenylpropanoid biosynthesis pathways. A total of 96 flavonoids and 32 phenolic acids were detected among the DRMs. Their contents were higher in the V-shaped canopy than in the T-shaped and VSP canopies. Conjoint analysis of transcriptome and metabolome showed that nine DEGs (e.g., cytochrome P450 98A9 and 98A2) were significantly correlated to nine phenolic acids (e.g., gentisic acid and neochlorogenic acid) and three genes (i.e., chalcone isomerase, UDP-glycosyltransferase 88A1, and caffeoyl-CoA O-methyltransferase) significantly correlated to 15 flavonoids (e.g., baimaside and tricin-7-O-rutinoside). These genes may be involved in the regulation of various flavonoids and phenolic acids in grape berries, but their functions need validation. This study provides novel insights into the effects of leaf canopy on flavonoids and phenolic acids in the skin of grape berries and reveals the potential regulatory networks involved in this phenomenon.

How Psychological Wellbeing and Digital Mental Health Services Intervene the Role of Self-Efficacy and Affective Commitment of University Students in Their Performance?

Student performance is a critical factor in academic achievement. Other factors like the students' self-efficacy, affective commitment, and psychological wellbeing play a significant role in shaping their performance. The present study aims to understand the role of self-efficacy, affective commitment, and psychological wellbeing in the students' performance. To carry out the study, the data were collected from the 308 students currently enrolled in the public sector universities of China. Smart-PLS is used to check the validation of the proposed hypotheses. Partial least square structural equation modeling is used for hypothesis testing. Results of the study show that self-efficacy does not play a role in the student performance in public sector universities; however, the affective commitment of the students plays a significant role in their performance. The psychological wellbeing of the students has a substantial influence on their performance. Furthermore, the results have also indicated that psychological wellbeing is an important indicator of student performance. It has also been revealed that psychological wellbeing significantly mediates the relationship between self-efficacy, affective commitment, and student performance. The students who availed of the digital mental health services were found to have a low relationship between their self-efficacy and performance.

Significance of trypsinogen activation peptides and interleukin-6 in experimental acute pancreatitis.

OBJECTIVE: To explore the feasibility of using plasma trypsinogen activation peptides (TAP) and serum interleukin-6(IL-6) as early markers for predicting the severity of experimental acute pancreatitis. METHODS: Ninety male adult Sprague-Dawley rats were equally randomized into five groups: edema pancreatitis group, treated with retrograde ductal infusion of 3% sodium taurocholate solution; necrosis pancreatitis group, treated with retrograde ductal infusion of 5% sodium taurocholate solution; treatment pancreatitis group, treated with retrograde ductal infusion of 3% sodium taurocholate solution and ulinastatin intravenous infusion half an hour later; control pancreatitis group, treated with 0.9% normal saline retrograde ductal infusion; and sham operation group, treated with sham operation. Rats in each group were equally randomized into three subgroups, which were killed by exsanguination 3, 6, or 24 hours after infusion, and blood specimens were obtained. Serum amylase, plasma TAP, and serum IL-6 were determined. The severity of pancreatitis was scored by two blinded pathologists under microscope. RESULTS: At 3 and 6 hours after infusion, plasma TAP concentration of necrosis pancreatitis group [(4.798±0.169) and (3.999±0.299)nmol/L, respectively]were significantly higher than those of edema pancreatitis group [(2.416±0.148) and (3.356±0.211)nmol/L, respectively] (P<0.01); at 6 hours after infusion, serum IL-6 level of necrosis pancreatitis group [(1339.51±56.43)pg/ml]was significantly higher than that of edema pancreatitis group [(619.07±42.25)pg/ml] (P<0.01). CONCLUSIONS: In this acute pancreatitis model, the peak levels of plasma TAP and serum IL-6 may appear earlier in rats with severer disease. Serum TAP level may be used as a marker for the accurate early prediction of the severity of acute pancreatitis.

Impact of physicochemical properties of engineered fullerenes on key biological responses.

Engineered fullerenes are widely integrated into several commercial and medical products and are now also being recognized as byproducts of many industrial activities. For most applications fullerenes have to be chemically modified. Surface modification of fullerenes can potentially impact their effect on biosystems. The purpose of the current study was to establish criteria to correlate fullerene structure to biological responses. We report studies of cellular responses induced by three different types of fullerenes that provide varying chemical and physical properties such as electronic behavior, solubility, and degree of agglomeration. Using a systematic and multipronged approach for material characterization and employing critical biological endpoints, we determined the impact of the physicochemical properties of fullerenes on cellular interactions. We examined the ability of these fullerenes to regulate intracellular oxidative stress, necrosis and apoptosis in human monocytic THP1 cells. Results indicate that the carboxylate derivatization of fullerenes was the determining factor in their ability to induce apoptosis. In contrast, the dispersion characteristics of fullerenes were found to be more relevant when considering their redox function. We also established a significant role for functionalization-dependent fullerene-regulation of the caspase proteases in the elicited responses. In addition, there was a notable increase in the level of several anti-oxidant enzymes. Collectively, the results clearly indicate that the physicochemical properties of fullerenes significantly influence the elicited biological response, thus impacting future applications. This study is an initial effort to lay the groundwork for routine correlation and predictive analysis on engineered fullerenes, thus expediting their use.

Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme.

In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We combine differences-in-differences with matching methods to obtain impact estimates, using data collected from program administrators, health facilities and households. The scheme has increased outpatient and inpatient utilization, and has reduced the cost of deliveries. But it has not reduced out-of-pocket expenses per outpatient visit or inpatient spell. Out-of-pocket payments overall have not been reduced. We find heterogeneity across income groups and implementing counties. The program has increased ownership of expensive equipment among central township health centers but has had no impact on cost per case.

Arecoline and oral keratinocytes may affect the collagen metabolism of fibroblasts.

BACKGROUND: The characteristic of oral submucous fibrosis (OSF) is related with the disturbance of synthesis and degradation of extracellular matrix. Arecoline, the areca nut (betel nut) component of betel quid, plays a major role in pathogenesis of OSF. But the exact mechanism how arecoline influences the collagen metabolism is unclear. METHODS: Oral keratinocytes and fibroblasts were cocultured and keratinocytes were pre-treated by arecoline. Fibroblasts alone, fibroblasts stimulated by arecoline, fibroblasts cocultured with keratinocytes and fibroblasts cocultured with keratinocyte pre-treated by arecoline were included as the four groups in the present study. The concentration of collagen, the content and activity of matrix metalloproteinase (MMP) and the concentration of tissue inhibitor of metalloproteinase (TIMP) were assessed. RESULTS: The collagen production of fibroblasts decreased when cocultured with keratinocytes; when cocultured with keratinocytes pre-treated by arecoline, fibroblasts produced more soluble collagen than non-pretreated coculture group. MMP-9 was produced only in coculture groups. There was no significant difference in the two coculture groups. The activation ratio of pro-MMP-2 in arecoline pre-treated keratinocytes-fibroblasts coculture group was significantly higher than that of non-coculture groups, but no significant difference existed in the two coculture groups. TIMP-1 produced by arecoline pre-treated keratinocytes-fibroblasts coculture group was significantly higher than those by the other three groups. CONCLUSION: TIMP-1 and the interaction of oral keratinocytes and fibroblasts play important role in pathogenesis of OSF.

At-a-glance - Twenty years of diabetes surveillance using the Canadian Chronic Disease Surveillance System. / Aperçu - Vingt ans de surveillance du diabète grâce au Système canadien de surveillance des maladies chroniques.

In 1999, the Government of Canada, along with the provinces and territories, established the National Diabetes Surveillance System (NDSS) to track rates of diabetes in Canada. The NDSS used a novel method to systematically collect and report national diabetes data using linked administrative health databases. The NDSS has since evolved to become the Canadian Chronic Disease Surveillance System (CCDSS) and provides information on over 20 chronic conditions. This At-a-glance report provides the most up-to-date CCDSS information on diabetes rates in Canada. Currently, 8.8% of Canadians (9.4% male, 8.1% female, aged one year and older) live with diabetes, and approximately 549 new cases are diagnosed each day. Since 2000, the age-standardized prevalence rate has increased by an average of 3.3% per year. The age-standardized incidence rate has remained relatively stable, and all-cause mortality rates among those with diabetes have decreased by an average of 2.1% per year. This suggests that people are living longer with a diabetes diagnosis.

The Canadian Chronic Disease Surveillance System has provided important information on diabetes rates in Canada since 2000. Currently, 8.8% of Canadians (9.4% male, 8.1% female, aged one year and older) live with diabetes. The age-standardized prevalence rate of diabetes has increased over time, whereas the age-standardized incidence rate has remained stable. The all-cause mortality rate among those with diabetes has decreased, suggesting people are living longer with a diabetes diagnosis.

Le Système canadien de surveillance des maladies chroniques fournit des renseignements importants sur les taux de diabète au Canada depuis 2000. Actuellement, 8,8 % des Canadiens (9,4 % des hommes et 8,1 % des femmes d'un an et plus) sont atteints de diabète. Le taux de prévalence du diabète normalisé selon l'âge a augmenté avec le temps, tandis que le taux d'incidence normalisé selon l'âge est demeuré stable. Le taux de mortalité toutes causes confondues chez les personnes atteintes de diabète a diminué, ce qui donne à penser que l'on vit plus longtemps avec un diagnostic de diabète.

[Laboratory diagnosis of an imported case of visceral leishmaniasis in Henan Province].

OBJECTIVE: To analyze the epidemiological and clinical data of an imported case of visceral leishmaniasis in Henan Province, and explore the method of laboratory diagnosis of kala-azar. METHODS: The epidemiological and clinical data of an imported visceral leishmaniasis patient were analyzed. Leishmania donovani bodies in bone marrow smears were observed microscopically. The antibody was detected by using rK39 dipstick test strips. Two pairs of specific primers, K13A-K13B and LITSR-L5.8S, were used to amplify kinetoplast DNA and internal transcribed spacer of rDNA of the parasite, respectively. RESULTS: The patient had been in the epidemic area of visceral leishmaniasis, and had symptoms such as irregular fever, splenomegaly, pancytopenia, and inversed ratio of albumin and globulin. The amastigotes of L. donovani were found in the bone marrow smears, and rK39 test strip was positive, and the PCR products of K13A-K13B and LITSR-L5.8S were 87 bp and 285 bp respectively. The similarities of the two fragment sequences to the corresponding sequences of L. donovani were 94% and 100%, respectively. CONCLUSIONS: The case is diagnosed as visceral leishmaniasis according to the epidemiological data, clinical manifestations and laboratory test results of the patient, and the pathogen is L. donovani.

Immunogenicity and safety of inactivated chromatographically purified Vero cell-derived Japanese encephalitis vaccine in Thai children.

Inactivated mouse-brain-derived Japanese encephalitis vaccine has a worrisome safety profile and the live attenuated vaccine is unsuitable in immunodeficiency. This study aimed to evaluate the immunogenicity and safety of an inactivated chromatographically purified Vero-cell-derived JE vaccine (CVI-JE, Beijing P-3 strain) in children. 152 healthy Thai children, with an average (SD) age of 14.4 (3.8) months, received 3 doses of CVI-JE on days 0, 7-28, and one year. Homologous JE neutralizing antibody titers (NT) were measured. All subjects had seroprotection [geometric mean titer (GMT) 150] 28 days' post 2nd vaccination. The seroprotection rates at 1 year after primary series and and 1 month after the booster were 89.3% (GMT 49) and 100% (GMT 621), respectively. Local and systemic reactions-fever (17.6%), vomiting (8%), and poor appetite (5.3%)-were noted within 28 days' post-vaccination. All these symptoms were self-limited. CONCLUSIONS: CVI-JE is safe, immunogenic, and provided high NT.

Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups.

BACKGROUND: Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study takes a household perspective to investigate receipt of appropriate care and affordability of services for different socio-economic groups with TB symptoms in rural China. METHODS: Secondary analysis of Chinese National Household Health Survey for 2003: 40,000 rural households containing 143,991 individuals, 2,308 identified as TB suspects. OUTCOMES: use of services and expenditure of TB suspects, by gender and socio-economic position, indicated by household income, education, material assets, and insurance status. RESULTS: 37% of TB suspects did not seek any professional care, with low-income groups less likely to seek care than more affluent counterparts. Of those seeking care, only 35% received any of the recommended diagnostic tests. Of the 182 patients with a confirmed TB diagnosis, 104 (57%) received treatment at the recommended level, less likely if lacking health insurance or material assets. The burden of payment for services amounted to 45% of annual household income for the low-income group, 16% for the high-income group. CONCLUSION: Access to appropriate, affordable TB services is still problematic in some rural areas of China, and receipt of care and affordability declines with declining socio-economic position. These findings highlight the current shortcomings of the national TB control programme in China and the formidable challenge it faces if it is to reach all sections of the population, including the poor with the highest burden of disease.