Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis / 中华医学杂志(英文版)

<p><b>Background</b>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.</p><p><b>Methods</b>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.</p><p><b>Results</b>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 (χ = 40.34, P < 0.001; OR = 39.87).</p><p><b>Conclusions</b>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.</p>

Recurrence and surgical salvage of sinonasal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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%.</p><p><b>CONCLUSIONS</b>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.</p>

Multi-modalities for reconstruction of circumferential defects in the pharyngoesophageal region / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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%.</p><p><b>CONCLUSIONS</b>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.</p>

Analysis of under 5 years old children mortality and the leading death cause in China from 1996 to 2000 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the trend of under 5 years old children mortality and the leading cause of the deaths in China from 1996 to 2000.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

Impacts of birth defects on perinatal deaths in Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>Birth defects were accounted for an increasing proportion of perinatal deaths in China, and had become one of the major causes of perinatal deaths.</p>

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 / 中华流行病学杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

Epidemiological investigation of perinatals affected by transverse facial cleft in China / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the epidemiological features of transverse cleft and its multiple congenital anomaly (MCA) patterns in China.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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%).</p><p><b>CONCLUSIONS</b>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.</p>