Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis.

BACKGROUND: Serum cryptococcal antigen (CrAg) test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus (HIV) adult patients with pulmonary cryptococcosis and its clinical features. METHODS: One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive (CrAg+ group) and 29 were negative (CrAg- group). It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio (OR) was used to measure correlation. Student's t- test was obtained to analyze continuous variable. RESULTS: No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups (P > 0.05 in all). Nevertheless, diffuse extent lesion was 82.1% in CrAg+ group and 10.3% in CrAg- group (χ2 = 40.34, P < 0.001; OR = 39.87). CONCLUSIONS: Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.

[Influence of neonatal diseases and treatments on the development of cerebral palsy in preterm infant].

OBJECTIVE: To investigated the risk factors of cerebral palsy development in preterm infants. METHODS: This study included 203 preterm infants (gestation age < 37 weeks) diagnosed with cerebral palsy (CP) and 220 preterm infants without cerebral palsy or any other severe neurological disorders during April 2005 to August 2011. The risk factors in the development of cerebral palsy, including the diseases of premature infants and the treatments in neonatal period, were analyzed by multiple logistic regression analysis. RESULTS: Multivariate logistic analysis for the risk factors associated with cerebral palsy in neonatal period found significant differences in the occurrence of periventricular leukomalacia (PVL, OR = 39.87, P < 0.05), hypoxia-ischemic encephalopathy (HIE, OR = 4.24, P < 0.05), hypoglycemia of neonatal (OR = 2.18, P < 0.05), neonatal hyperbilirubinemia (OR = 1.72, P < 0.05), continuous positive airway pressure (CPAP, OR = 0.21, P < 0.05). CONCLUSION: The factors including PLV, HIE, hypoglycemia, and neonatal jaundice may increase the risk in the development of CP in preterm infant, while CPAP may decrease the risk of cerebral palsy.

[Application of amplitutude integrated electroencephalography for early diagnosis of brain injury in premature infants].

OBJECTIVE: To study the characteristics of amplitude integrated electroencephalography (aEEG) in preterm infants with brain injury. METHODS: This study included 62 cerebral damage infants with 28-36 weeks gestational age (GA), and another 51 normal infants in control group, aEEG recording was performed to each infant during the first 48 h of life, the duration of each recording was at least 2 h. The features of aEEG, such as continuity(Co), sleep-wake cycling (Cy) and amplitude of the lower border (LB), were evaluated by semiquantitative analysis and compared between the two groups. RESULTS: All the aEEG features were found having significantly lower values in brain injuries group (P < 0.05). Logistic regression of aEEG features to the presence of brain injury revealed that only Cy was significantly correlated to the outcome (OR = 0.217, P < 0.05). ROC curve demonstrated Cy of the best sensitivity and specificity with 0.769 AUC. Co, LB yielded 0.677, 0.602 AUC respectively. Correlation analysis of GA to Co, Cy, LB and total score showed significantly correlated, the correlation coefficient for Co, Cy, LB and total scores were 0.546, 0.488, 0.536, 0.588 respectively (P < 0.05). CONCLUSION: The Cy in the initial aEEG is predictive for brain injury in premature infants with 28-36 weeks GA. The older the GA at birth, the more mature the aEEG pattern in premature neonates.

[Recurrence and surgical salvage of sinonasal squamous cell carcinoma].

OBJECTIVE: To analyze the significant clinicopathologic factors related to tumor recurrence in patients with sinonasal squamous cell carcinomas (SCC) and to evaluate the effectiveness and plausibility of surgical salvage in the recurrent cases. METHODS: The clinicopatholgic data of 107 patients with primary sinonasal SCC treated from 1996 to 2007 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to define the risk factors related to tumor recurrence. Salvage surgery with was selectively carried out in the recurrent sinonasal SCC using different surgical approaches, including lateral rhinotomy midfacial degloving or combined craniofacial approach. Immediate reconstruction of major surgical defects were performed with latissimus dorsi flap, pectoralis major myocutanneous flap, temperalis fasciomuscular flap, free rectus abdominis flap and free radial forearm flap. All patients were routinely follwed up and 5-year survival were calculated using directly calculating method and Kaplan-Meier's method. RESULTS: The 5-year survival rate of 107 cases was 52.3% (56/107). Local recurrence was the most common pattern of tumor relapse. Forty-four of the 107 cases had recurrence. Logistic regression analysis showed the T stag was the most important impacting factor for tumor recurrence (OR = 0.258, P = 0.001). Of 44 cases with recurrence, 33 cases underwent salvage surgery and the 5-year survival rate after salvage surgery was 29.1%. CONCLUSIONS: T stag is the most important impacting factor for tumor recurrence. Salvage surgery with immediate reconstruction of major surgical defects should be carried out in the selective cases of recurrent sinonasal SCC.

[Multi-modalities for reconstruction of circumferential defects in the pharyngoesophageal region].

OBJECTIVE: To investigate the feasibility of multi-modalities in the reconstruction of circumferential defects after resection of cancers in pharyngoesophageal regions, and to compare the pros and cons between different surgical procedures. METHODS: According to the nature and extend of defects, five different methods including pectoralis major myocutaneous flap, laryngeal tube replacement, free jejunum, free forearm flap and gastric pull-up were used to reconstruct the circumferential pharyngoesophageal defects in 72 patients. Function of deglutition and restoration of swallowing was regularly followed up and objectively evaluated. RESULTS: A total of 35 cases of pectoralis major myocutaneous (PM) flaps, 8 cases of laryngeal tube replacement, 12 cases of free jejunum, 12 cases of free forearm flaps and 16 cases of gastric pull-up were performed. Different complications including wound infection, pharyngeal fistula, partial necrosis of PM flap, partial necrosis of gastric wall, stricture of anastomotic site were encountered in 15 cases. All patients survived the operation except one due to partial necrosis of the gastric wall. Two of 4 patients who developed anastomotic stricture can ingest half-liquid food, the remaining cases regained normal deglutition function. The mean postoperative follow-up time was 1. 6 years with 2-year survival rate of 45.3%. CONCLUSIONS: Circumferential defects resulting from resection of carcinomas in pharyngoesophageal region can be reconstructed with different operative techniques depending on the nature and extend of the defects. Once the operative indications are properly selected, the good reconstructive results are to be achieved.

[Epidemiological analysis of the maternal mortality surveillance data (1996-2000) in China].

OBJECTIVE: To investigate the epidemiological attributes of maternal mortality in China from 1996 to 2000 and its variance between urban and rural areas. METHODS: The data were collected through a population-based epidemiological survey by the national maternal mortality surveillance network, which covered about 80 million people in 31 jurisdictions in China. RESULTS: There were 1704 maternal deaths being reported from 1996 to 2000 by the surveillance network, among which 341 were in urban areas and 1363 in rural areas. In the urban reported deaths, 69.9% happened in those who had completed junior high schools and 74.5% happened in plain areas. In the rural reported deaths, 73.3% happened in those who had only completed primary schools and 65.1% happened in mountain areas. Of the total reported deaths, 76.8% deaths occurred in postpartum, 40% gave birth at home, and 28.9% received no prenatal care at all. By contrast, in the rural areas, homed deliveries were accounted for 58.5% of the reported death; 35.5% died at home; 33.1% were attended by untrained midwives 31.8% had no prenatal care. CONCLUSION: Poor education, geographic remoteness, insufficient prenatal care, and lower hospitalization rate are main factors contributing to maternal mortality in China.

[Analysis of under 5 years old children mortality and the leading death cause in China from 1996 to 2000].

OBJECTIVE: To study the trend of under 5 years old children mortality and the leading cause of the deaths in China from 1996 to 2000. METHODS: The data presented in this report were obtained from the national child mortality surveillance network, including 116 counties (cities) throughout China. The target population was all children under 5 years old in the monitored areas whose mothers or fathers had resided in the area for at least one year. The data were collected and reported by health workers at the three-level network. RESULTS: The neonatal mortality rate (NMR), infant mortality rate (IMR) and under 5 years old mortality rate (U(5)MR) in China dropped to 22.8, 32.2, 39.7 per 1,000 live births in 2000, respectively (they were 24.0, 36.0, 45.0 respectively in 1996), which declined 5.0%, 10.6%, 11.8% from 1996 to 2000, respectively. In urban areas, NMR, IMR and U(5)MR dropped to 9.5, 11.8, 13.8 per 1,000 live births in 2000, respectively (they were 12.2, 14.8, 16.9 respectively in 1996), which declined 22.1%, 20.3%, 18.3% from 1996 to 2000, respectively. In rural areas, NMR, IMR and U(5)MR dropped to 25.8, 37.0, 45.7 per 1,000 live births in 2000, respectively (they were 26.7, 40.9, 51.4 respectively in 1996), which declined 3.4%, 9.5%, 11.1% from 1996 to 2000, respectively. There was a steady decline in the U(5)MR due to diarrhea, pneumonia, neural tube defects and drowning in China. CONCLUSION: In urban/rural areas, the overall decline in NMR, IMR and U(5)MR from 1996 to 2000 was spectacular. Especially the U(5)MR due to avoidable deaths such as pneumonia and diarrhea was dropped markedly in rural areas.

[Secular trends of hypospadias in Chinese perinatals].

OBJECTIVE: To investigate the secular trends in the prevalence rate of hypospadias in Chinese perinatals and explore its possible influencing factors. METHODS: Data were taken from Chinese Birth Defects Monitoring Network, a hospital-based congenital anomalies registry system. All live or still births at or beyond 28 weeks of gestation were assessed within 7 days after delivery in the period from 1987 to 2001. RESULTS: 1999 cases of hypospadias were identified among 3,769,464 male births, the crude prevalence rate being 5.30 per 10,000 births. And an increasing secular trend was observed both in urban and rural areas. In recent years, an increase in rate of hypospadias was found in coastal provinces and inland provinces, but not in remote border provinces. Faster increase was seen in urban areas and coastal areas, compared with that in rural areas and inland areas respectively. CONCLUSION: The prevalence rates of hypospadias in Chinese perinatals from 1987 to 2001 showed an upward tendency.

[Epidemiological analysis of polydactylies in Chinese perinatals].

OBJECTIVE: To investigate the epidemiologyical characteristics of polydactyly. METHODS: The method of Hospital-based surveillance within Chinese Birth Defects Monitoring Network (CBDMN) was adopted. All perinatals (from 28 weeks of gestation to a period of 7 days after birth) in the participating hospitals were investigated from 1996 to 2000. RESULTS: A total of 2097 cases were identified in 2218616 perinates, the prevalence was 9.45 per 10000. The prevalence of male was significantly higher than the female's. The urban prevalence was 9.60 per 10000, and the rural prevalence was 9.05 per 10000. Significant difference and increasing time trend were observed in annual prevalence rate during 1996-2000. Of the 2097 cases, 1853 (88.4%) were in the isolated form, and the rest (11.6%) of them were combined with other defects. Among 1942 perinatals affected by polydactyly, 679 (34.96%) cases occurred in the left limbs, 886 (45.62%) cases occurred in the right limbs, and 377 (19.41%) cases occurred bilaterally. CONCLUSION: The prevalence rates of polydactylies in Chinese perinatals show male predominance and geographic variations. Most of the polydactyly cases were in the from of single defect; however, those accompanied by other defects had a higher perinatal fatality rate.

[Impacts of birth defects on perinatal deaths in Chinese population].

OBJECTIVE: To examine the time trends of perinatal mortality and the frequency of birth defects occurring in perinatal deaths, and to provide a national perspective on the impacts of congenital anomalies on perinatal mortality from 1990 through 2001. METHODS: Data were from Chinese Birth Defects Monitoring network-a hospital-based congenital anomalies registry system. During 1990 - 2001, all live or still births with 28 weeks of gestation or more, born in monitoring units, were studied within 7 days after delivery. The proportion of perinatal deaths due to birth defects, which was defined as the number of perinatal deaths associated with congenital anomalies per 100 perinatal deaths, was calculated by birth area (urban versus rural), geographic-economic status (coast areas, inner land areas and remote areas), to evaluate the impacts of birth defects on perinatal mortality. RESULTS: Perinatal mortality declined from 22.85 per 1000 in 1990 to 13.26 per 1000 in 2001, which showed a significant downward trend. Similar trend was also observed in the rate of stillbirth and the ratio of early neonatal death. However, the proportion of perinatal deaths due to birth defects had an increasing trend although the perinatal birth defects-specific death rate was declining, especially during 1996 - 2001. This result was also seen in urban and rural area, in coast regions, in inner land regions and in remote regions of China. Higher rate of birth defects occurring in perinatal deaths was observed in urban area than in rural area. Significant difference of this rate was also found among different geographic-economic regions, with the highest one in inland regions. CONCLUSION: Birth defects were accounted for an increasing proportion of perinatal deaths in China, and had become one of the major causes of perinatal deaths.

[Maternal mortality in rural areas of China].

OBJECTIVE: To understand with clearness the trend and epidemiological characteristics of maternal mortality, as well as the leading causes of maternal deaths in rural areas of China from 1996 to 2001. METHODS: The data analyzed were those from the population-based epidemiological survey conducted by the national maternal mortality surveillance network which covered a total population of about 35,000,000 in China. RESULTS: The maternal mortality ratio (MMR) in rural areas of China dropped by 28.4% from 86.4 per 100,000 live births in 1996 to 61.9 in 2001. The leading causes of maternal deaths were obstetric hemorrhage, preeclampsia and embolism of amniotic fluid. The MMR for obstetric hemorrhage decreased from 48.3 per 100,000 live births in 1996 to 33.0 in 2001. The pregnant women mainly gave childbirths and died in their home, accounting for 44.6% and 30.1% respectively in 2001. CONCLUSION: The MMR showed a downward trend in rural areas of China during the period from 1996 to 2000, and so also did the MMR for obstetric hemorrhage. Reducing obstetric hemorrhage and increasing the rate of hospitalized delivery are the most important methods for reducing the MMR in rural areas in China.

[Effects of a comprehensive health education program on reproductive tract infections/sexually transmitted diseases intervention among reproductive age population in the rural areas of China].

OBJECTIVE: To evaluate the effectiveness on comprehensive health education intervention program regarding reproductive tract infections/sexually transmitted diseases (RTIs/STDs) among reproductive age population in the rural areas of China. METHODS: Data were generated from the Reproductive Health/Family Planning Project implemented by the State Family Planning Committee and the Ministry of Health from 1998 to 2002, which covered 32 counties in 22 provinces. A quasi-experimental design was used. Six counties were selected from 32 project counties as intervention group, while 6 non-project counties were taken as controls which were similar in number of population and economic level to the counties as selected. Subjects of the study were mothers with children under 3 years and men under 35 years of age. A total number of 675 mothers and men were interviewed using a structured questionnaire by strictly trained investigators. Logistic model was used to compare the difference of knowledge on RTIs/STDs between intervention group and control group. OR value was used to describe the degree of the difference. RESULTS: Over the 18 month intervention period, persons in the intervention group had more knowledge of RTIs/STDs than those in control group. Logistic regression analysis indicated that intervention was significantly associated with better knowledge on factors as transmission, risks, symptoms, management and prevention of RTIs/STDs with 95% CI of OR as 2.4 - 6.4, 2.0 - 4.8, 3.0 - 6.4, 1.9 - 5.7 and 1.8 - 6.8 respectively, after controlling the demographic factors. Level of education was an important factor influencing the subjects to receive knowledge on RTIs/STDs. CONCLUSION: Comprehensive health education intervention programs had significant impact on knowledge about RTIs/STDs among the target population, indicating that the Reproductive Health/Family Planning Project implemented in the rural areas of China had been successful.

[Analysis of maternal mortality in China from 1996 to 2000].

OBJECTIVE: To study the trend and characteristics of maternal mortality in China from 1996 to 2000. METHODS: Population-based epidemiological survey in 116 monitoring units in China were used. RESULTS: Maternal mortality in China dropped by 17.1% from 63.9 per 100,000 live births in 1996 to 53.0 in 2000, in rural area dropped by 22.2% from 86.4 per 100,000 live births to 67.2, and in urban area only 1.0% from 29.2 per 100 000 live births to 28.9, the leading causes of maternal mortality in China are hemorrhage, preeolampsia/eclampsia and amniotic fluid embolism the maternal mortality due to hemorrhage in national level and rural level has declined by 33.8%, 34.9% respectively. CONCLUSION: The maternal mortality appears a declined trend on both the national and rural levels in China from 1996 to 2000, the maternal mortality due to hemorrhage dose also, bur the maternal mortality in urban area keeps unstable.

[Epidemiological investigation of perinatals affected by transverse facial cleft in China].

OBJECTIVE: To study the epidemiological features of transverse cleft and its multiple congenital anomaly (MCA) patterns in China. METHODS: From 1987 through 1992, hospital-based cluster sampling method was adopted for collecting data. During that period all live or stillbirths with 28 weeks of gestation or more were assessed within 7 days after delivery. RESULTS: 94 cases of transverse facial cleft were identified among 4,489,692 births, so the prevalence rate of transverse facial cleft at birth was 0.21/10(4). The prevalence rates in urban areas and in rural areas were 0.20/10(4) and 0.23/10(4), respectively. And the rates in male and female births were both 0.21/10(4). 69 cases occurred with other malformations, among which the anomalies of ear were the most frequent association (53.6%). The perinatal fatality rate was 46.9%, a significant difference of fatality rate was found between isolated forms (16.0%) and associated forms of transverse facial cleft (58.0%). CONCLUSIONS: The prevalence rate of transverse facial cleft in China is more than the estimated rate. No significant differences are found between urban and rural areas, and between male and female births. Most of transverse facial clefts are associated forms, often as one feature of other syndromes.

[Clinical features of 3798 perinatals suffering from syndromic neural tube defects].

OBJECTIVE: To investigate the patterns and associated malformations in neural tube defects (NTDs) cases. METHODS: From 1987 to 1995, hospital-based cluster sampling method was adopted for collecting data. During that period all live or still births with 28 weeks of gestation or more were assessed within 7 days after delivery. RESULTS: Three thousand seven hundred and ninety eight syndromic NTDs were identified, among which anencephaly, spina bifida and encephalocele were 997, 2394 and 407 respectively. 51.3% associated abnormalities of NTDs appeared in muscle and skeletal system, 19.6% in face, ear and neck, and 9.3% in urinary-genital system. Congenital talipes equinovarus, cleft lip with cleft palate, gastroschisis, talipes valgus, undescended testicle were frequently combined with NTDs. The most frequent association in schisis type of NTDs was NTDs accompanied by cleft lip with or without cleft palate (67.5%), followed by anencephaly with cleft palate (8.3%) and anencephaly with omphalocele (6.6%). Of all syndromic NTDs, the rate of low birth weight was 36.9%, of perinatal mortality was 71.2% and the ratio 33.1% patients were diagnosed prenatally. CONCLUSIONS: Approximately one third of NTDs may be associated with other system's malformation. Syndromic NTDs has a high perinatal mortality rate and a poor prognosis.