Characteristic and prognosis of acute large vessel occlusion in anterior and posterior circulation after endovascular treatment: the ANGEL registry real world experience

There were limited studies comparing the anterior (AC) and posterior (PC) circulation acute ischemic strokes (AIS). Our study aimed to evaluate distinct features of AC and PC strokes regarding clinical, vascular risk, pathogenesis and outcome factors after endovascular procedures. This multicenter prospective study registered 873 patients with acute large occlusion of anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Patients who underwent endovascular procedures were included in this study. The differences in ACS and PCS regarding baseline characteristics, post-operative intracranial hemorrhage and outcomes were evaluated. A total of 741 patients were included in the data analysis. Intravenous thrombolysis (31.5%), atrial fibrillation (22.7%) and stent thrombectomy (82.4%) were more frequently observed in ACS patients. While higher NIHSS score, hypertension (67.6%) and balloon angioplasty (20.7%) were more prevalent in PCS patients. Symptomatic intracranial hemorrhage was more common in ACS (7.4% vs 2.8%). However, a 3-month follow-up outcomes were better in ACS with higher functional independence and low mortality rate than PCS (46.8% vs 30.3% and 16.4% vs 33.8%, respectively, P?<?0.01). In this large prospective study, there were significant differences in the pathogenesis of stroke and treatment procedure between ACS and PCS which influence the clinical outcome. These findings could lead to a tailored clinical procedures and treatment strategies to improve the prognosis in both groups.

     

Corrigendum

Introduction

In the mid-1990s, Cambodia faced one of the fastest growing HIV epidemics in Asia. For its achievement in reversing this trend, and achieving universal access to HIV treatment, the country received a United Nations millennium development goal award in 2010. This article reviews Cambodia’s response to HIV over the past two decades and discusses its current efforts towards elimination of new HIV infections.

Methods

A literature review of published and unpublished documents, including programme data and presentations, was conducted.

Results and discussion

Cambodia classifies its response to one of the most serious HIV epidemics in Asia into three phases. In Phase I (1991–2000), when adult HIV prevalence peaked at 1.7% and incidence exceeded 20,000 cases, a nationwide HIV prevention programme targeted brothel-based sex work. Voluntary confidential counselling and testing and home-based care were introduced, and peer support groups of people living with HIV emerged. Phase II (2001–2011) observed a steady decline in adult prevalence to 0.8% and incidence to 1600 cases by 2011, and was characterized by: expanding antiretroviral treatment (coverage reaching more than 80%) and continuum of care; linking with tuberculosis and maternal and child health services; accelerated prevention among key populations, including entertainment establishment-based sex workers, men having sex with men, transgender persons, and people who inject drugs; engagement of health workers to deliver quality services; and strengthening health service delivery systems. The third phase (2012–2020) aims to attain zero new infections by 2020 through: sharpening responses to key populations at higher risk; maximizing access to community and facility-based testing and retention in prevention and care; and accelerating the transition from vertical approaches to linked/integrated approaches.

Conclusions

Cambodia has tailored its prevention strategy to its own epidemic, established systematic linkages across different services and communities, and achieved nearly universal coverage of HIV services nationwide. Still, the programme must continually (re)prioritize the most effective and efficient interventions, strengthen synergies between programmes, contribute to health system strengthening, and increase domestic funding so that the gains of the previous two decades are sustained, and the goal of zero new infections is reached.     

Hand,foot and mouth disease in China: evaluating an automated system for the detection of outbreaks

Objective

To evaluate the performance of China’s infectious disease automated alert and response system in the detection of outbreaks of hand, foot and mouth (HFM) disease.

Methods

We estimated size, duration and delay in reporting HFM disease outbreaks from cases notified between 1 May 2008 and 30 April 2010 and between 1 May 2010 and 30 April 2012, before and after automatic alert and response included HFM disease. Sensitivity, specificity and timeliness of detection of aberrations in the incidence of HFM disease outbreaks were estimated by comparing automated detections to observations of public health staff.

Findings

The alert and response system recorded 106 005 aberrations in the incidence of HFM disease between 1 May 2010 and 30 April 2012 – a mean of 5.6 aberrations per 100 days in each county that reported HFM disease. The response system had a sensitivity of 92.7% and a specificity of 95.0%. The mean delay between the reporting of the first case of an outbreak and detection of that outbreak by the response system was 2.1 days. Between the first and second study periods, the mean size of an HFM disease outbreak decreased from 19.4 to 15.8 cases and the mean interval between the onset and initial reporting of such an outbreak to the public health emergency reporting system decreased from 10.0 to 9.1 days.

Conclusion

The automated alert and response system shows good sensitivity in the detection of HFM disease outbreaks and appears to be relatively rapid. Continued use of this system should allow more effective prevention and limitation of such outbreaks in China.     

Increased fasting glucose and the prevalence of arterial stiffness: a cross-sectional study in Chinese adults

Abstract

Objective:

Previous studies have shown that diabetes increases the prevalence of arterial stiffness. However, it remains controversial whether impaired fasting glucose (IFG), a key pre-diabetes condition, is associated with increased risk of arterial stiffness. This study aimed to investigate the relationship between increased fasting plasma glucose (FPG) and the prevalence of arterial stiffness in a Chinese adult population.

Methods:

A random sample of 5039 participants aged 40 years or older (40·0% female) were enrolled in this study. Information on potential risk factors for cardiovascular disease was collected, and the presence of arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). Participants were stratified into three groups: normal fasting glucose (NFG), IFG, and diabetes mellitus (DM). The IFG group was further stratified by quartiles based on the level of FPG into Q1, Q2, Q3, and Q4.

Results:

Fasting plasma glucose level was found to be independently and positively associated with baPWV. The adjusted odds ratios (ORs) (95% confidence interval (CI)) for arterial stiffness were 1·09 (0·80–1·48), 1·33 (0·98–1·81), 1·27 (0·93–1·73), 1·82 (1·31–2·53), and 2·15 (1·66–2·79) for those in IFG Q1, Q2, Q3, Q4, and DM groups compared with NFG group (P < 0·001), respectively, after adjusting for age, sex, and other potential confounders. Moreover, male participants and participants younger than 60 years were closely associated with the presence and severity of arterial stiffness (P < 0·001).

Conclusion:

Our study reports a previously unidentified positive association between increased FPG and the prevalence of arterial stiffness, suggesting the importance of FPG control in the prevention of arterial stiffness.     

19种粉剂抗生素溶解后体积的研究

目的观察粉剂抗生素溶解后体积的变化,提高给药剂量的准确性。方法收集19种常用粉剂抗生素,溶入10mL相应溶媒,充分溶解后记录体积的变化情况。结果18种抗生素溶解后体积增加,其中11种增量5%以上,5种增量10%以上,最多增量达3mL。结论临床护士应注意粉剂抗生素溶解后体积变化对注射剂量准确性的影响,加强给药护理的环节管理,确保给药剂量的准确性。     

精子形态对宫腔内人工授精妊娠率的影响

目的探讨正常形态精子比率对宫腔内人工授精（IUI）临床妊娠率的影响。方法回顾分析328个周期宫腔内人工授精临床资料,根据男方精子形态学检查结果分为三组：正常形态精子百分率≥4%、2%～〈4%、〈2%,比较各组间精液处理前后精子浓度、活力、前向运动精子总数以及IUI临床妊娠率。结果处理前精子浓度、活力及前向运动精子总数各组间比较无显著性差异（P〉0.05）,处理后精子浓度、活力、前向运动精子总数各组间比较有显著性差异（P〈0.05）,≥4%、2%～〈4%、〈2%各组临床妊娠率分别为19.5%、17.9%、2.6%,有显著性差异（P〈0.05）。结论正常形态精子比率影响IUI临床妊娠率,正常形态精子百分率≥2%可获得较满意的临床妊娠率。     

腹腔镜手术联合米非司酮/孕三烯酮治疗子宫内膜异位症临床观察

目的：探讨腹腔镜手术联合米非司酮或孕三烯酮治疗子宫内膜异位症的临床疗效。方法选取我院2011年6月～2013年6月149例子宫内膜异位症确诊患者,随机分为3组,治疗组为腹腔镜联合米非司酮组（n=60）和腹腔镜联合孕三烯酮组（n=60）,对照组为单独腹腔镜治疗组（n=29）。比较各组临床治疗效果、术后复发、内分泌变化及副作用发生率等指标。结果与对照组相比,治疗组患者的有效率明显提高,差异均具有统计学意义（P＜0.05）。治疗组间治疗效果、内分泌指标（FSH、LH、P、E2等）及副作用发生率均无明显差异。结论腹腔镜手术联合米非司酮或孕三烯酮治疗子宫内膜异位症安全可靠、临床疗效好,适合临床推广。     

云南省曲靖市护理人力资源配置现状调查

目的：通过调查,分析曲靖市各级医疗机构护理人力资源配置情况,为卫生行政管理部门为医疗机构合理配置护理人力,保障护理工作质量及医疗安全提供依据。方法通过调查问卷,对全市有法人代表的23个市、县（区）、乡镇、企业、民营医院、社区卫生服务中心等医疗机构的护理管理部门及4382名护士进行调查,应用SPSS17.0统计软件进行统计分析。结果虽然床护比基本达标,临床护理岗位人员人力资源缺乏依然存在,人力资源不足依然是困扰护理管理的首要因素,护理队伍结构不合理,护理人员身份多元化,编制内护士比例逐渐降低,对护理职业的认同感及薪酬的满意度不容乐观。结论多途径、多渠道增加护理人员,尤其是编制内护士。有计划的重点培养一批护理骨干,在护理队伍中起好承上启下的引领、带动作用。尽快建立编制外护士管理标准,稳定护理队伍。改善护理人员待遇,尤其是技术职称的评定和聘任,不能与医疗机构其它卫生专业技术岗位形成巨大差距。     

Analysis of αSMA‐Labeled Progenitor Cell Commitment Identifies Notch Signaling as an Important Pathway in Fracture Healing

Fracture healing is a regenerative process that involves coordinated responses of many cell types, but characterization of the roles of specific cell populations in this process has been limited. We have identified alpha smooth muscle actin (αSMA) as a marker of a population of mesenchymal progenitor cells in the periosteum that contributes to osteochondral elements during fracture healing. Using a lineage tracing approach, we labeled αSMA‐expressing cells, and characterized changes in the periosteal population during the early stages of fracture healing by histology, flow cytometry, and gene expression profiling. In response to fracture, the αSMA‐labeled population expanded and began to differentiate toward the osteogenic and chondrogenic lineages. The frequency of mesenchymal progenitor cell markers such as Sca1 and PDGFRα increased after fracture. By 6 days after fracture, genes involved in matrix production and remodeling were elevated. In contrast, genes associated with muscle contraction and Notch signaling were downregulated after fracture. We confirmed that activating Notch signaling in αSMA‐labeled cells inhibited differentiation into osteogenic and adipogenic lineages in vitro and ectopic bone formation in vivo. By characterizing changes in a selected αSMA‐labeled progenitor cell population during fracture callus formation, we have shown that modulation of Notch signaling may determine osteogenic potential of αSMA‐expressing progenitor cells during bone healing. © 2014 American Society for Bone and Mineral Research.     

Comparative pharmacokinetics of zolpidem tartrate in five ethnic populations of China

The objective of this study was to evaluate the difference in the pharmacokinetics of zolpidem tatrate in subjects from five Chinese ethnicities (Han, Mongolian, Uigur, Korean and Hui). Healthy subjects (10 Hans, 10 Mongolians, 10 Uigurs, 10 Koreans and 9 Huis) were recruited and each received a 10 mg tablet-dose of zolpidem tatrate. A total of 12 plasma samples were collected over a 12 h period after administration. The concentrations of zolpidem in plasma were determined by an HPLC-FLU method, after which the pharmacokinetic parameters were determined using DAS 2.0 software and analyzed by SPSS 16.0 software. After normalization by weight, no differences were noted in the pharmacokinetic parameters of zolpidem tatrate among the five ethnic groups (P>0.05). However, there were statistically significant differences between males and females for the pharmacokinetic parameters (P<0.05). The metabolism of zolpidem tatrate in males was faster than in females. Results indicate that ethnicity has no significant impact on the pharmacokinetics of zolpidem tatrate after a single oral dose in healthy Chinese subjects. However, an effect of gender on the pharmacokinetics of zolpidem tatrate can be noted.KEY WORDS: Zolpidem tartrate, Pharmacokinetics, Chinese population, Gender, Ethnicity