Risk factors affecting the mother-to-infant transmission of hepatitis B virus： a meta analysis

Objective：To search for risk factors that affect mother-to-infant transmission of hepatitis B virus（HBV）. Methods：To obtain studies eligible for meta-analysis, China biological medicine discs and MEDLINE citations were surveyed. Mother HBV DNA or HBeAg positivity,neonate HBeAg positivity, mode of delivery, threatened abortion and threatened premature labor were processed with meta analysis. Criteria for selection of published studies for meta analysis were based on principle by Abdolmaleky HM. Odds ratio （OR） was calculated and summarized by fixed effect model or random-effects model using RevMan software. The heterogeneity of the group of ORs was assessed using an X^2 test. The significance of the pooled OR was determined by the u-test. The strength of association was assessed using the OR. An OR〉1. 0 indicated a positive association between the risk factor and neonate HBV infection. Results： After meta analysis of factors concerned, a significant association was found between the positivity of HBeAg in mother and neonate, of HBV DNA in mother peripheral serum, and HBV mother-to-infant transmission, with a pooled OR equal to 19.43 （95% CI=8. 77-43. 06）, 36.5 （95% CI= 19.85-67. 11）, and 36.5 （95 % CI= 19.85-67.11 ） respectively. Mode of delivery, threatened abortion and threatened premature labor proved not to be of risk factors on the mother-to-infant transmission of HBV. Conclusion： Mother HBV DNA or HBeAg positivity and neonate HBeAg positivity were proved to be of risk factors affecting the transmission of HBV from mother to fetal.     

Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history

Harvey J. Murff, MD, MPH; David R. Spigel, MD; Sapna Syngal, MD, MPH

JAMA. 2004;292:1480-1489.

Context  A family history of certain cancers is associated with an increased risk of developing cancer. Both cancer screening and genetic services referral decisions are often based on self-reported pedigree information.

Objective  To determine the accuracy of self-reported family cancer history information.

Data Sources  English-language articles were retrieved by searching MEDLINE (1966-June 2004) using Medical Subject Headings family, genetic predisposition to disease, medical history taking, neoplasm, and reproducibility of results. Additional articles were identified through bibliography searches.

Study Selection  Original studies in which investigators validated self-reported family history by reviewing the identified relatives' medical records, death certificate, or cancer registry information were included, as well as studies that evaluated breast, colon, ovarian, endometrial, and prostate cancers.

Data Extraction  Two of the 3 investigators independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of self-reported family cancer history information. Only data from studies that evaluated both positive and negative family cancer histories were included within the analyses. A total of 14 studies met the search criteria and were included in the review.

Data Synthesis  For patients without a personal history of cancer, the positive and negative LRs of a family history of the following cancers in a first-degree relative were 23.0 (95% confidence interval [CI], 6.4-81.0) and 0.25 (95% CI, 0.10-0.63) for colon cancer; 8.9 (95% CI, 5.4-15.0) and 0.20 (95% CI, 0.08-0.49) for breast cancer; 14.0 (95% CI, 2.2-83.4) and 0.68 (95% CI, 0.31-1.52) for endometrial cancer; 34.0 (95% CI, 5.7-202.0) and 0.51 (95% CI, 0.13-2.10) for ovarian cancer; and 12.3 (95% CI, 6.5-24.0) and 0.32 (95% CI, 0.18-0.55) for prostate cancer, respectively. Positive predictive values tended to be better in articles concerning first-degree relatives compared with second-degree relatives.

Conclusions  Patient-reported family cancer histories for first-degree relatives are accurate and valuable for breast and colon cancer risk assessments. Negative family history reports for ovarian and endometrial cancers are less useful, although the prevalence of these malignancies within families is low.

     

Idiopathic inflammatory demyelinating diseases of the central nervous system in patients following allogeneic hematopoietic stem cell transplantation: a retrospective analysis of incidence， risk factors and survival

Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for many hematological diseases,but there are many complications following allo-HSCT,among which neurolog...     

Juxtaglomerular cell tumor of the kidney: a clinicopathological analysis of five cases

Juxiaglomerular cell tunor (JGCT)is a kind of rare renal neoplasm that was first deseribed by Robertson in     

Does pre-procedure ultrasound increase the success and safety of right internal jugular venous catheterization? An intervention study

BackgroundReal-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, ensuring real-time US into routine practice is impeded by its perceived expense and difficulty. This expertise requires hand–eye coordination and learning curve. Moreover, availability of multiple US machines and probes for multiple operation theatres may not be possible even at the tertiary level care set-up. Currently, pre-procedure US and landmark methods are most widely used. We investigated both the techniques with application of skin markings in the pre-procedure group to ascertain efficacy and safety with a view to incorporate pre-procedure US in our practice.MethodsIn this randomized study, we investigated 66 patients. Thirty-three patients in the pre-procedure ultrasound group and 33 patients in the landmark group were included for right internal jugular vein (RIJV) cannulation. We recorded the first needle pass success rate, cannulation time and complications.ResultsPre-procedure US was associated with more successful attempts, shorter cannulation times and less complications. Under pre-procedure US, 75.76% of first attempts were successful with a cannulation time of 50 (25–180) seconds. Under landmark technique, 27.27% of first attempts were successful with a cannulation time of 85 (20–200) seconds. First puncture success rates were higher in pre-procedure US than landmark technique, 66.67% vs 27.27%, respectively.ConclusionPre-procedure US for RIJV catheterization is safer, quicker and superior to landmark technique.     

Whither Divisions of General Practice? An empirical and policy analysis of the impact of Divisions within the Australian health care system

OBJECTIVE: To examine the effect of Divisions of General Practice on various measures of primary care performance. DESIGN AND SETTING: Regression analysis using longitudinal data across Australia. PARTICIPANTS: All Divisions of General Practice between 2002 and 2004. MAIN OUTCOME MEASURES: Fourteen indicators of primary care performance in the areas of general practice infrastructure, access, multidisciplinary working, chronic disease, and measurable aspects of quality of care. RESULTS: Between 2002 and 2004, Divisions and the activities they performed were associated with a number of measures of primary care performance, particularly measures of general practice infrastructure. Of the total variation in each performance indicator, between 19% and 64% can be attributed to the influence of Divisions while controlling for remoteness, health needs, and general practitioner characteristics. In all regression models, these effects were significant (P < 0.05). Divisions that provided support in electronic communication and electronic transfer of data were associated with: a 0.56 (95% CI, 2 0.04 to 1.2; P = 0.07) percentage point increase in the proportion of Practice Incentives Program (PIP) practices; a 0.73 (95% CI, 2 0.09 to 1.5; P = 0.08) percentage point increase in the proportion of PIP practices with electronic prescribing software; and a 0.66 (95% CI, 0.05 to 1.3; P = 0.03) percentage point increase in the proportion of PIP practices with a modem. Divisions providing activities with an asthma focus were associated with a 0.84 (95% CI, 0.02 to 1.5; P = 0.01) percentage point increase in the proportion of PIP practices receiving the asthma sign-on payment. There were no significant effects of Division activities on clinical aspects of care, such as GP claims for Service Incentive Payments for asthma, diabetes or cervical screening. CONCLUSIONS: Divisions of General Practice had an effect on primary care performance in a difficult health system context.     

Transfer of head-injured patients in Jamaica: is there a problem?

Head-injured patients are often transferred to the University Hospital of the West Indies (UHWI) for tertiary care. There is no standardized, agreed protocol governing their transfer. During the three-year period January 1998 to December 2000, 144 head injured patients were transferred to the UHWI from other institutions. They were 70% male, had a mean age of 34 years and spent a mean of 13 days in hospital. Eighteen per cent were admitted to the Intensive Care Unit, where they spent a mean of nine days. On arrival, mean pulse rate was 92 +/- 22 beats/minute, mean systolic blood pressure was 130 +/- 27 mmHg and mean diastolic was 76 +/- 19mmHg. Twenty-eight per cent of patients had a pulse rate above 100/min on arrival and 13.8% had systolic blood pressure below 60 mmHg. The Glasgow Coma Scale score was unrecorded at the referring institution in 70% of cases and by the receiving officers at the UHWI in 23% of cases. Intubation was done on only half of those who were eligible. Junior staff members initiated and carried out transfers whenever this was documented. The types of vehicles and monitoring equipment used could not be determined in most instances. Fifty-eight per cent of patients had minor head injuries, 12%, severe injury and 33%, associated injuries requiring a variety of surgical procedures by multiple specialties. Most patients (80.6%) were discharged home but 11.8% died in hospital. Transfer of head-injured patients, many with multiple injuries is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardized protocol for the transfer of such patients in Jamaica.     

Effect of polymorphisms in the β2-adrenergic receptor on the susceptibility and pulmonary function of patients with chronic obstructive pulmonary disease: a meta analysis

Background  Chronic obstructive pulmonary disease (COPD) is a heterogeneous and complex disease of which the pathogenesis remains largely unknown. Many factors could influence COPD development and progression. One of them is the genetic risk factor. A severe hereditary deficiency of alpha-1 antitrypsin is the best genetic proof. Four single nucleotide polymorphisms (SNPs) of beta2-adrenergic receptor (β₂AR) result in single amino acid substitution. Two loci had been extensively studied and found that they could change the function of β₂AR. Two SNPs consist of substitutions of glycine for arginine at amino acid position 16, glutamic acid for glutamine at position 27. Many studies proved that polymorphisms at position 16 and 27 altered the lung function of COPD patients or the patient’s susceptibility to the development of COPD. However, there was no exclusive conclusion. Therefore, a meta analysis was done to investigate the effect of polymorphisms in the β2-adrenergic receptor (ADRB2) gene on the risk of COPD and lung function.

Methods  Comprehensive searches of MEDLINE, Embase, Ovid, HighWire, Cochrane Library, and Chinese databases (CBMdisc, VIP, CNKI, and Wanfang data) from January 1980 to September 2011 were performed, using the keywords: COPD OR chronic obstructive pulmonary disease AND adrenoreceptor OR adrenergic receptor AND polymorphism OR mutation OR variation. Case-control research or cross sectional studies in which diagnosis of COPD met the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines; all the studies reported the ADRB2 genotype at position 16 or 27. Outcomes measured were genotype frequency and forced expiratory volume in the first second (FEV₁%) in both the case and control.

Results  Twelve case-control studies and eight cross-sectional studies were included. Compared to the control (n=1225), neither Gly/Gly (n=527) nor Arg/Arg (n=422) homozygotes at position 16 demonstrated increased susceptibility to COPD, with odds ratios (ORs) of 0.95 (95% CI (0.68, 1.31), z=0.33, P=0.740) and 0.82 (95% CI (0.52, 1.28), z=0.88, P=0.381), respectively. Similar results were obtained for position 27, with ORs of 0.97 (95% CI (0.77, 1.23), z=0.21, P=0.833) for Glu/Glu homozygotes (n=357) and 0.82 (95% CI (0.53, 1.29), z=0.85, P=0.393) for Gln/Gln homozygotes (n=704) (control=1183). In patients with COPD, Arg/Arg homozygotes (n=41) had a similar FEV₁% compared with Gly/Gly homozygotes (n=102) (standardized mean difference (SMD)=0.88, 95% CI (–0.85, 2.62), z=1.00, P=0.319). The genotype distribution was different between Caucasian and Asian populations (all P <0.05 except the genotype Arg/Gly) for both position 16 and 27.

Conclusions  Polymorphisms of ADRB2 at positions 16 and 27 did not change the risk of COPD nor affect lung function or disease severity. The genotype distribution for these polymorphisms was different between Caucasian and Asian populations.

     

Nosocomial infection in patients with ventricular hemorrhage cured by lateral ventricle drainage: An analysis of 41 cases

Objective To analyse infection rate of ventricular hemorrhage after lateral ventricle drainage and evaluate the method and measure of precaution. Methods Patients were divided into first and second groups according to the remaining time of drainage tube and into A and B groups according to drainage in one or two sides. After operation the infection condition of insert tube was observed and blood was cultivated regularly. Results The infection rate in the first group was significantly shorter than that in the second one (P < 0. 01), while it was no significantly difference between groups A and B (P > 0. 05). Conclusion To remain drainage tube for one to two weeks is safer than for more than two weeks. The infection rate is higher in group with drainage in two sides than in one. In addition, it is obviously related to the patient's body condition and immunity. 6 refs,2 tabs.     

Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients

Background  The increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae (K.pneumoniae) was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients.
Methods  Microbiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K. pneumoniae were analyzed.
Results  In the 84 patients, 52 men and 32 women aged (58.2±13.3) years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever (98.8%), chills (69.0%) and abdominal pain (58.3%). 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was (17.4±8.7) days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality.
Conclusions  The low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.

     

Is it safe to perform operation for colorectal malignancy in Chinese patients without DVT prophylaxis? : An 8 year experience from a regional hospital in Hong Kong

Background Colorectal surgery was regarded as one of the high risk surgery for post-operative deep vein thrombosis （DVT） and pulmonary embolism. This study aimed at investigating the incidence of venous thromboembolism （VTE） after colorectal surgery for malignancy.Methods Data were collected from the prospective database of colorectal malignancy from 2000 to 2008. A total of 1421 colorectal （open and laparoscopic） operations were performed for the colorectal malignancy without DVT prophylaxis.Results Only seven patients （0.5%） developed symptomatic DVT and one of them had complication of pulmonary embolism without mortality. Open operation for colorectal malignancy was identified as possible risk factor of DVT,however, risk factors like operative time, low anterior resection, sex, age etc. were not identified.Conclusion Risk of venous thromboembolism after colorectal operation is low in Chinese of our locality and it might be safe to perform colorectal operation for malignancy without DVT prophylaxis.