November 2013, Volume 16, No.32 Abstracts
Tortuous History and Revelation of International Primary Health Care
ZHOU Ye-qin,QIAN Dong-fu.School of Health Policy and Management,Nanjing Medical University,Nanjing 210029,China
【Abstract】 The development of international primary health care(PHC)has experienced a tortuous course from initial comprehensive PHC to selective PHC and again to comprehensive PHC.Although China′s community health services are consistent with comprehensive PHC on the policy objectives,it is,in reality,consistent with selective PHC.Therefore,the development of community health services should be aimed to comprehensive PHC.
【Key words】 Community health services；Primary health care；Comprehensive primary health care；Selective primary health care
Drug Resistance of Mycoplasma Pneumoniae:A Study of Current Situation in the World
DONG Yan-qing，XIN De-li.Beijing Tropical Medicine Research Institute，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
【Abstract】 Mycoplasma pneumoniae(MP)is a common pathogen responsible for respiratory tract infections in children and adolescents.Macrolides antibiotic is the first-line drug for respiratory infections caused by MP.However,MP has shown resistance to macrolides antibiotic worldwidely in recent years，especially in Europe，USA and Asia.The point mutation of 23S rRNA domain V is the main mechanism of MP drug resistance.
【Key words】 Mycoplasma pneumoniae；Macrolides；Drug resistance，microbial；RNA，ribosomal，23S；Point mutation；Review
A Real-Time PCR Approach for Genotype of 2063 in Mycoplasma Pneumoniae
LI Jing-yi，SUN Lan，QIN Xuan-guang，et al.Beijing Tropical Medicine Research Institute，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
【Abstract】 Backgrounds Mycoplasma pneumoniae(MP)is a main cause of child community-acquired pneumonia.MP drug resistance to common-used macrolides is increasing,but the traditional method inspecting its resistant strains relies on time consuming and labor-intensive procedure.Objective To set up a new real time approach for point mutation of 2063 in 23S rRNA of MP.Methods The allelic discrimination of 2063 point mutation of MP was detected by real-time PCR target 23S rRNA.Results The limits of real-time fluorogenic quantitative PCR detecting sensitive and drug-resistant strains were 6,60 copies，respectively.Specific tests showed that only mycoplasma genitalium amplified.Compared with the results of 23S rRNA nested PCR sequencing,the sensitivity,specificity,positive predictive value,negative predictive value of real-time fluorogenic quantitative PCR identifying 2063 allele of 43 MP isolates were all 100%,MP positive detection rate,drug resistance rate of 12 nasopharyngeal swabs were 10/12,4/12,respectively.Loci 2063A,2063G were found simultaneously in 1 specimen.Conclusion This research has established preliminarily a real-time fluorogenic quantitative PCR method for fast diagnosis of MP infection and judgment of its resistance genotypes,which is of high sensitivity.
【Key words】 Mycoplasma pneumonia；Macrolides；Drug resistance，microbial；Polymerase chain reaction；Point mutation
Drug Resistance of MP and Its Mechanism:A Study of Children in Beijing District in 2011
JIANG Yue，LIU Xi-jie，QIN Xuan-guang，et al.Beijing Tropical Medicine Research Institute，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
【Abstract】 Backgrounds Macrolides（MLs）are considered as the first choice for the treatment of Mycoplasma pneumoniae（MP）-associated respiratory diseases in children and adolescents，but Macrolide-resistance to MP has increased gradually in recent years.Objective To investigate prevalent condition of the Macrolide-resistant MP in Beijing Distrect in 2011 and its molecular mechanism.Methods The throat swab specimens of 205 MP children admitted to Pediatric Departments of Beijing Friendship Hospital and Chaoyang Hospital in the year of 2011 were collected and cultured,and drug sensitivity test performed.Nested PCR amplification method(nPCR)was used to identify MP resistance loci.Results In collected 205 MP strains,there were 59 strains of MP culture positive(28.8%)；122 strains of 23S rRNA nPCR positive(59.5%),including 19 sensitive strains,103 drug-resistance strains,with a rate of 84.4%,which were all A2063G point mutations in 23S rRNA V domain.Totally 26 positive MP strains were established,including 2 sensitive strains〔erythromycin minimum inhibitory concentration(MIC)≤0.01 mg/L〕,24 drug-resistance strains(MIC=32.00-256.00 mg/L),with a drug-resistance rate of 92.3%.And 26 isolates had no gene changes in 23S rRNA Ⅱ domain and had A2063G point mutations in 23S rRNA V domain.One sensitive strain and MP standard strain FH had point mutations at 162 loci C-A and 430 loci A-G of ribosomal protein L4,1 sensitive strain had point mutation of 209 loci A-T;26 isolates all had 508 loci T-C point mutation of ribosomal protein L22.Conclusion MP is widely prevalent in children and its resistance to MLs is serious.Point mutation in domain Ⅴ of 23S rRNA is the main molecular mechanism.But point mutation in ribosomal protein and the change of amino acid remains unclear，which requires further investigation.
【Key words】 Mycoplasma pneumoniae；Macrolides；Drug resistance，microbial；Molecular mechanisms of pharmacological action
Relationship of Antithyroid Drug Induced Agranulocytosis to Plasma ANCA and ANGA
YANG Jing,ZHOU Ling-zhi,ZHONG Jing,et al.Department of Endocrinology,the First Affiliated Hospital of South China University,Hengyang 421001,China
【Abstract】 Objective To explore the relationship of antithyroid drug(ATD)induced agranulocytosis to plasma anti-neutrophil cytoplasmic antibodies(ANCA)and anti-neutrophil granulocyte antibodies(ANGA).Methods A total of 103 primary hyperthyroidism patients treated with ATD were divided into groups A(with ATD-induced agranulocytosis,n=38),B(without agranulocytosis after administration of ATD for 12 weeks,n=65，form January 2011 to January 2013).Antigen-specific ELISA method was used to determine myeloperoxidase ANCA(MPO-ANCA),proteinase 3 ANCA(PR3-ANCA)and ANGA.Results In group A,MPO-ANCA positive rate was 21.1%(8/38),PR3-ANCA positive rate 10.5%(4/38),ANGA positive rate 28.9%(11/38);In group B 3.0%(2/65),1.5%(1/65),1.5%(1/65),respectively.The positive rates of MPO-ANCA,PR3-ANCA and ANGA were higher in group A than in group B(P＜0.05).ANCA detection rate was higher in patients administrating PTU than in those administrating MMI in group A(P=0.022),but the difference of ANGA detection rate was not significant(P=0.135).Conclusion MPO-ANCA,PR3-ANCA,and ANGA are correlated with ATD-induced agranulocytosis.ANCA and ANGA may play an important role in the pathogenesis of ATD-induced agranulocytosis.
【Key words】 Agranulocytosis;Antithyroid agents;Anti-neutrophil cytoplasmic antibody;Anti-neutrophil antibody
Ischemic Stroke Subtype Classification：A Comparative Study of TOAST，ASCO and CISS
FU Na-na，SHI Zheng-hong.Department of Neurology，the Second Hospital of Lanzhou University，Lanzhou 730030，China
【Abstract】 Objective To compare the differences in ischemic stroke subtype classification criteria including TOAST，ASCO and CISS.Methods A total of 249 patients with acute ischemic stroke treated in our hospital from July 2012 to November 2012 were included in our study.They were classified according to TOAST，ASCO and CISS.The differences were compared among the three approaches.Results ASCO and CISS assigned fewer patients as cause undetermined（P＜0.0001，P=0.0007），with increased assignment of large artery atherosclerosis（P＜0.0001）compared with TOAST.The proportions of small-vessel occlusion and cardioembolism increased using ASCO compared with using TOAST（the relative increase rate：28.1%，P＜0.0001；50.0%，P=0.0047）.The proportion of penetrating artery disease decreased by 21.9% using CISS,compared to using TOAST（P＜0.0001）.Comparison between CISS and ASCO showed that there was significant difference in the proportions of penetrating artery disease（small-vessel disease），cardioembilism and stroke of undetermined etiology（P＜0.05）,but no significant difference in large artery atherosclerosis and other etiology（P＞0.05）.The consistency level between the three classification systems ranged from fair to excellent.Conclusion Consistency can be found among the three approaches.However,ASCO and CISS are more scientific，reasonable and accurate than TOAST.ASCO is with more comprehensive etiological information of stroke,while CISS provides more information on the pathogenesis of stroke.
【Key words】 Stroke；TOAST；ASCO；CISS；Causative classification system；Otherness；Consistence
Prognostic Values of Serological Index Combined with Marrow Morphology in Myelodysplastic Syndrome
LI Wen-wen，LI Yan，WANG Xiao-min.Department of Hematology,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China
【Abstract】 Objective To study the prognostic value of laboratory parameters including mean corpuscular volume(MCV),serum lactate dehydrogenase(LDH),β2-microglobulin(β2- MG),serum ferritin(SF),Vitamin B12(VitB12) combined with marrow morphological analysis in patients with myelodysplastic syndrome(MDS).Methods The serological indexes and features of marrow morphology of 152 MDS patients visiting this hospital from September 2006 to July 2012 were analyzed retrospectively.Univariate and multivariate analyses were used to study the relationship between the above indexes and survival,and further the screened prognostic indexes used to reassess patients′ prognoses.Results Sixty-eight MDS patients died(44.7%),with a median survival of 12 months.By univariate analysis,the levels of serum LDH,β2-MG and SF,tri-lineage myelodysplasia and multinucleated erythrocytes,false pelger nucleus,lymphoid small megakaryocytes,single round nuclear megakaryocyte dysplasia were influencing factors of survival.Peripheral MCV,serum VitB12 and other dysplasias were not related to survival(P＞0.05).By multivariate Cox regression analysis,SF,false pelger nucleus,lymphoid small megakaryocytes were independent risk factors of MDS International Prognostic Scoring System(IPSS) prognoses.The above survival influencing factors were used combinedly to score patients′ prognoses(independent risk factors scored 1.0 point,the other factors scored 0.5 points),the scores were positively correlated with IPSS(r=0.626,P＜0.001).The patients were divided,based on the scores,into 3 groups(0～1.5 points，2.0～3.5 points，≥4.0 points),there was significant difference in survival in 3 groups(Log-rank χ2=101.870，P＜0.001).Conclusion Combined use of LDH,β2 - MG,SF and marrow morphology analysis is of great clinical value for prognostic judgment of MDS patients.
【Key words】 Myelodysplastic syndromes；Lactate dehydrogenases；beta 2-microglobulin；Lactoferrin；Morphology；Prognosis
Association between Omentin-1 and Coronary Heart Disease Risk in Men with Type 2 Diabetes Mellitus
TIAN Yan-feng，SUN Wen-xiu,BAO Wei-jing.Hospital of Beijing Technology University，Beijing 100083，China
【Abstract】 Objective To investigate the association between plasma omentin-1 levels and incidence of coronary heart disease(CHD) among men with confirmed type 2 diabetes mellitus(T2DM).Methods 154 men with T2DM aged from 46 to 71 and admitted to the Hospital of Beijing Technology University from March 2010 to March 2012 were selected.No one was with CHD at the beginning，and then the two-year following up was performed.Age，body mass and smoking history were recorded and BMI was calculated.HbA1c，blood lipid，fasting blood glucose，insulin，liver function and omentin-1 were detected.According to the quartile of omentin-1，the patients were divided into four groups，namely group one(1.40-10.26 μg/ml)，group two(10.27-13.91 μg/ml)，group three(13.92-19.79 μg/ml) and group four(19.80-54.77 μg/ml).The general data of the four groups were compared.The patients were then divided into non-outcome event group and outcome event group，and the general data and clinical data two years later were compared between the two groups.Association between omentin-1 and CHD was analyzed with Cox proportional-hazards analysis.Results (1)Age，BMI，alcohol consumption，use of insulin，family history of myocardial infarction，course of T2DM，TG，HDL-C，ApoB100，CRP and fibrinogen in the four groups all showed statistically significant differences(P＜0.05).(2)During the two-year following up of the 154 patients，17 cases had CHD.The omentin-1 and HDL-C levels in outcome event group were significantly lower than those of the non-outcome event group(P＜0.05).(3)After adjustment for alcohol consumption，BMI，age，exercise，myocardial infarction history，hypertension history and other factors，omentin-1 was associated with a decreased risk for CHD events〔RR=0.70，95%CI(0.52，0.94)〕.After further adjustment for HDL-C，omentin-1 level was still related to the risk of CHD〔RR=0.77，95%CI(0.58，0.97)〕.(4)Compared with group one with low level omentin-1，group four with high level omentin-1 had lower risk of CHD〔RR=0.51，95%CI(0.26，1.00)〕.Conclusion The level of omentin-1 is closely linked with the presence of CHD and omentin-1 serves as a novel biomarker for CHD.
【Key words】 Omentin-1；Diabetes mellitus，type 2；Men；Cardiovascular disease；Risk factors；Proportional hazards models
Incidence and Related Influencing Factors of Chronic Kidney Disease among Pregnant Women with Serious Diseases in ICU
ZHAO Yu-hong，JI Kai-qiang，ZANG Bin，et al.Department of Nephrology，Shengjing Hospital of China Medical University，Shenyang 110031，China
【Abstract】 Objective To investigate the incidence and related influencing factors of chronic kidney disease(CKD) among pregnant women with serious diseases in ICU.Methods A total of 358 pregnant women with serious diseases who were admitted to adult ICU in Shengjing Hospital of China Medical University from 2007 to 2010，were selected and followed up until 2011.The CKD incidence was investigated during the follow-up period.The patients were divided into CKD and non-CKD group according to CKD diagnosis standard.The clinical data and etiology were compared between two groups，and influencing factors of CKD among pregnant women with serious diseases were analysed using Logistic regression.Results (1)There were 56 cases of CKD in 358 patients，and the incidence rate was 15.6%.(2)CKD group were significantly older than non-CKD group，pregnant weeks of CKD group were significantly less than those of non-CKD group，the level of serum creatinine was significantly higher than that of non-CKD group，and the prevalences of anemia，hypertension，diabetes，lower limb vascular diseases and proteinuria in CKD group were significantly higher than those in non-CKD group，the proportions in history of heart disease or stroke，congestive heart failure or heart failure in CKD group were significantly higher than those in non-CKD group(P＜0.05).(3)Etiology of CKD：preeclampsia(33.9%，19/56)，pregnancy-induced hypertension(23.2%，13/56)，placental abruption(12.5%，7/56)，others(30.4%，17/56).(4)CKD′s influencing factors：age of pregnant women，pregnant weeks，pregnancy complicated with AKI，pregnancy complicated with heart disease，pregnancy complicated with hypertention and perinatal death entered into regression equation(P＜0.05).Conclusion The incidence of CKD among pregnant women with serious diseases can not be ignored.The main causes of CKD are preeclampsia，pregnancy-induced hypertension and placental abruption.Advanced age，shorter pregnancy time，pregnancy complicated with AKI，pregnancy complicated with heart disease，pregnancy complicated with hypertention are the risk factors of CKD among pregnant women with serious diseases.
【Key words】 Pregnancy；Critical illness；Intensive care units；Renal insufficiency，chronic；Risk factors；Prognosis
Clinical Characteristics，Treatment，and Prognosis of ANCA-associated Vasculitis in Patients with Renal Injury
WANG Li，ZHANG Gai-hua，ZHAO Yu，et al.Department of Nephrology，Guang′anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China
【Abstract】 Objective To analyze the treatment and prognosis of anti-neutrophil cytoplasmic antibody（ANCA）-associated vasculitis（AAV）in patients with renal injury.Methods There were 43 patients of AAV with renal injury diagnosed in Department of Nephrology in Guang′anmen Hospital from April 2004 to April 2011 included in our study.The clinical characteristics，pathological and laboratory indexes，and the treatment