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 Chinas 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 servicesPrimary health careComprehensive primary health careSelective primary health care


Drug Resistance of Mycoplasma Pneumoniae:A Study of Current Situation in the World

DONG Yan-qingXIN De-li.Beijing Tropical Medicine Research InstituteBeijing Friendship HospitalCapital Medical UniversityBeijing 100050China

    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 yearsespecially in EuropeUSA and Asia.The point mutation of 23S rRNA domain V is the main mechanism of MP drug resistance.

    Key words  Mycoplasma pneumoniaeMacrolidesDrug resistancemicrobialRNAribosomal23SPoint mutationReview


A Real-Time PCR Approach for Genotype of 2063 in Mycoplasma Pneumoniae

LI Jing-yiSUN LanQIN Xuan-guanget al.Beijing Tropical Medicine Research InstituteBeijing Friendship HospitalCapital Medical UniversityBeijing 100050China

    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 copiesrespectively.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 pneumoniaMacrolidesDrug resistancemicrobialPolymerase chain reactionPoint mutation


Drug Resistance of MP and Its Mechanism:A Study of Children in Beijing District in 2011

JIANG YueLIU Xi-jieQIN Xuan-guanget al.Beijing Tropical Medicine Research InstituteBeijing Friendship HospitalCapital Medical UniversityBeijing 100050China

    Abstract  Backgrounds  MacrolidesMLsare considered as the first choice for the treatment of Mycoplasma pneumoniaeMP-associated respiratory diseases in children and adolescentsbut 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 strainserythromycin 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 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 of 23S rRNA is the main molecular mechanism.But point mutation in ribosomal protein and the change of amino acid remains unclearwhich requires further investigation.

    Key words  Mycoplasma pneumoniaeMacrolidesDrug resistancemicrobialMolecular 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=65form 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(P0.05).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 ClassificationA Comparative Study of TOASTASCO and CISS

FU Na-naSHI Zheng-hong.Department of Neurologythe Second Hospital of Lanzhou UniversityLanzhou 730030China

    Abstract  Objective  To compare the differences in ischemic stroke subtype classification criteria including TOASTASCO 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 TOASTASCO and CISS.The differences were compared among the three approaches.Results  ASCO and CISS assigned fewer patients as cause undeterminedP0.0001P=0.0007),with increased assignment of large artery atherosclerosisP0.0001compared with TOAST.The proportions of small-vessel occlusion and cardioembolism increased using ASCO compared with using TOASTthe relative increase rate28.1%P0.000150.0%P=0.0047.The proportion of penetrating artery disease decreased by 21.9% using CISS,compared to using TOASTP0.0001.Comparison between CISS and ASCO showed that there was significant difference in the proportions of penetrating artery diseasesmall-vessel disease),cardioembilism and stroke of undetermined etiologyP0.05,but no significant difference in large artery atherosclerosis and other etiologyP0.05.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 scientificreasonable 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  StrokeTOASTASCOCISSCausative classification systemOthernessConsistence


Prognostic Values of Serological Index Combined with Marrow Morphology in Myelodysplastic Syndrome

LI Wen-wenLI YanWANG Xiao-min.Department of Hematology,Peoples 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(P0.05).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,P0.001).The patients were divided,based on the scores,into 3 groups(01.5 points2.03.5 points,≥4.0 points),there was significant difference in survival in 3 groups(Log-rank χ2=101.870P0.001).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 syndromesLactate dehydrogenasesbeta 2-microglobulinLactoferrinMorphologyPrognosis


Association between Omentin-1 and Coronary Heart Disease Risk in Men with Type 2 Diabetes Mellitus

TIAN Yan-fengSUN Wen-xiu,BAO Wei-jing.Hospital of Beijing Technology UniversityBeijing 100083China

    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 beginningand then the two-year following up was performed.Agebody mass and smoking history were recorded and BMI was calculated.HbA1cblood lipidfasting blood glucoseinsulinliver function and omentin-1 were detected.According to the quartile of omentin-1the patients were divided into four groupsnamely 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 groupand 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)AgeBMIalcohol consumptionuse of insulinfamily history of myocardial infarctioncourse of T2DMTGHDL-CApoB100CRP and fibrinogen in the four groups all showed statistically significant differences(P0.05).(2)During the two-year following up of the 154 patients17 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(P0.05).(3)After adjustment for alcohol consumptionBMIageexercisemyocardial infarction historyhypertension history and other factorsomentin-1 was associated with a decreased risk for CHD eventsRR=0.7095%CI(0.520.94).After further adjustment for HDL-Comentin-1 level was still related to the risk of CHDRR=0.7795%CI(0.580.97).(4)Compared with group one with low level omentin-1group four with high level omentin-1 had lower risk of CHDRR=0.5195%CI(0.261.00).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-1Diabetes mellitustype 2MenCardiovascular diseaseRisk factorsProportional hazards models


Incidence and Related Influencing Factors of Chronic Kidney Disease among Pregnant Women with Serious Diseases in ICU

ZHAO Yu-hongJI Kai-qiangZANG Binet al.Department of NephrologyShengjing Hospital of China Medical UniversityShenyang 110031China

    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 2010were 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 groupsand 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 patientsand the incidence rate was 15.6%.(2)CKD group were significantly older than non-CKD grouppregnant weeks of CKD group were significantly less than those of non-CKD groupthe level of serum creatinine was significantly higher than that of non-CKD groupand the prevalences of anemiahypertensiondiabeteslower limb vascular diseases and proteinuria in CKD group were significantly higher than those in non-CKD groupthe proportions in history of heart disease or strokecongestive heart failure or heart failure in CKD group were significantly higher than those in non-CKD group(P0.05).(3)Etiology of CKDpreeclampsia(33.9%19/56)pregnancy-induced hypertension(23.2%13/56)placental abruption(12.5%7/56)others(30.4%17/56).(4)CKDs influencing factorsage of pregnant womenpregnant weekspregnancy complicated with AKIpregnancy complicated with heart diseasepregnancy complicated with hypertention and perinatal death entered into regression equation(P0.05).Conclusion  The incidence of CKD among pregnant women with serious diseases can not be ignored.The main causes of CKD are preeclampsiapregnancy-induced hypertension and placental abruption.Advanced ageshorter pregnancy timepregnancy complicated with AKIpregnancy complicated with heart diseasepregnancy complicated with hypertention are the risk factors of CKD among pregnant women with serious diseases.

    Key words  PregnancyCritical illnessIntensive care unitsRenal insufficiencychronicRisk factorsPrognosis


Clinical CharacteristicsTreatmentand Prognosis of ANCA-associated Vasculitis in Patients with Renal Injury

WANG LiZHANG Gai-huaZHAO Yuet al.Department of NephrologyGuanganmen HospitalChina Academy of Chinese Medical SciencesBeijing 100053China

    Abstract  Objective  To analyze the treatment and prognosis of anti-neutrophil cytoplasmic antibodyANCA-associated vasculitisAAVin patients with renal injury.Methods  There were 43 patients of AAV with renal injury diagnosed in Department of Nephrology in Guanganmen Hospital from April 2004 to April 2011 included in our study.The clinical characteristicspathological and laboratory indexesand the treatment


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