Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study.

OBJECTIVE: To investigate the perceptions of pelvic floor dysfunction (PFD) and rehabilitation care amongst women after radical hysterectomy and to explore ways to improve quality of care. METHODS: Thirty-six women who underwent radical hysterectomy at a hospital in southeast China were enrolled via purposive sampling. Semi-structured in-depth interviews were conducted. The texts were analysed via qualitative content analysis. RESULTS: Four themes were obtained: serious lack of knowledge, heavy psychological burden, different coping strategies and great eagerness to receive multiparty support on PFD rehabilitation care. CONCLUSION: The society and professional staff should strengthen health education on PFD. Professionals should offer education before and after surgery and actively provide rehabilitation consultation to promote the availability of rehabilitation to support women with PFD rehabilitation care. In addition, family-centred care is an important way to support women to return to normal life, and women's need for family support should be more actively expressed. Moreover, knowledge of medical insurance should be popularised, especially in rural areas in China.

[Icodextrin improve angiogenesis of peritoneal membrane in continuous ambulatory peritoneal dialysis patients].

OBJECTIVE: To observe the effect of icodextrin on peritoneal membrane angiogenesis in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: This was a randomized double-blind perspective study of CAPD patients at our center between January 2006 to December 2006. The patients were randomized to receive either 7.5% icodextrin (ICO, n = 27) or glucose (GLU, n = 27) solution at night for 4 weeks. Peritoneal membrane function was defined as dialysate dwell for 4 hours to plasma ratio of creatinine (4 h D/Pcr) at baseline. Ultrafiltration volume, creatinine clearance (Ccr), VEGF and IL-6 in peritoneal effluent during the long night dwell (UF) dialysate were measured at baseline and after 4 weeks. The VEGF appearance was used to adjust the influences of dwell time and ultrafiltration volume. RESULTS: A total of 54 patients were enrolled. The baseline conditions showed no difference between the groups. After 2 and 4 weeks of therapy, both net UF and peritoneal creatinine clearance of long dwell were significantly higher in the ICO group than the GLU group. VEGF in night dwell PD solution was positively correlated with D/PCr (r = 0.68, P < 0.01)and negatively correlated to 4 hour ultrafiltration volume (r = -0.51, P < 0.01). The VEGF appearance was comparable between two groups at baseline. After a follow-up of 4 weeks, the VEGF appearance had an increasing tendency in the GLU group and a decreasing tendency in the ICO group but there was no significant difference. The ΔVEGF appearance (VEGF appearance in 4 week-VEGF appearance at baseline) was different between the GLU and ICO groups (9.5 ± 20.2 vs -13.4 ± 26.1, P < 0.01). IL-6 in night dwell dialysate had no difference between two groups. CONCLUSION: As compared with glucose-based solution, 7.5% icodextrin significantly decreases the local VEGF level in dialysate.

Adiponectin is related to carotid artery plaque and a predictor of cardiovascular outcome in a cohort of non-diabetic peritoneal dialysis patients.

AIMS: Adiponectin is an adipocytokine with antiatherogenic and anti-inflammatory properties. We investigated associations between circulating adiponectin, inflammation and cardiovascular disease in peritoneal dialysis patients. METHODS: A prospective study was performed in 59 non-diabetic patients. The concentrations of serum adiponectin, biochemical data and ultrasound of carotid artery were measured at enrollment. The patients were followed up to 39 months mainly for cardiovascular events. RESULTS: The serum adiponectin concentration was elevated and inversely related to C-reactive protein and interleukin-6 in the patients. The adiponectin level of patients with carotid plaques was significantly lower than in those without plaques (p < 0.01). Kaplan-Meier analysis showed that the cumulative survival without new cardiovascular events was better in patients with higher adiponectin levels than in those with lower adiponectin levels. CONCLUSION: Serum adiponectin levels are inversely related with markers of systemic inflammation and signs of atherosclerosis which may explain why hyperadiponectinemia in this study was associated with better cardiovascular outcome.

Prospective controlled study on mycophenolate mofetil and prednisolone in the treatment of membranous nephropathy with nephrotic syndrome.

BACKGROUND: Retrospective and anecdotal data suggest that mycophenolate mofetil (MMF) might be effective when given as rescue therapy for membranous nephropathy (MN). Prospective controlled data on MMF and prednisolone as primary therapy are lacking. METHODS: A prospective, randomized, controlled, open-label study was performed to investigate the efficacy and tolerability of MMF and prednisolone as primary treatment in MN with nephrotic syndrome. MMF and prednisolone given for 6 months was compared against a modified Ponticelli regimen in 20 patients, with follow up of 15 months. RESULTS: MMF with prednisolone and the comparative immunosuppressive regimen showed similar efficacy in proteinuria reduction, despite a lower cumulative prednisolone dose in the MMF group (3.80 +/- 0.28 vs 9.93 +/- 0.25 g, P < 0.001). Remission (composite of 'complete' and 'partial') rates were 63.6% and 66.7% in the MMF group and control group, respectively (P = 1.000). Serum creatinine and creatinine clearance remained stable during follow up. Cumulative relapse rate was 23.1% at 2 years. Chlorambucil resulted in more leucopenia compared with MMF. CONCLUSION: Data from this pilot study indicate that more than 60% of patients with MN and nephrotic syndrome respond to combined MMF and prednisolone treatment, and suggest potential benefits of MMF as being steroid-sparing and having less adverse effects compared with other commonly used cytotoxic agents.

[Investigation of bromate, haloacetic acids and perchlorate in Beijing's drinking water].

Disinfection by-products and perchlorate in the raw water and finished water of Beijing's a drinking water plants were investigated. The results indicated that there was little bromate in the drinking water. Five haloacetic acids (HAAs) were found in the water. The concentrations of the sum of the five HAAs were ranged from 42.1 micrograms/L to 149.5 micrograms/L. In the HAAs, the chlorine-containing HAAs accounted for more than 90% of the total HAAs. In the five HAAs, the concentration order of the HAAs were trichloroacetic acid > dichloroacetic acid > bromochloroacetic acid > dibromoacetic acid > bromodichloroacetic acid. The HAAs in Beijing's drinking water were much influenced by the variation of season. They had the highest concentrations in September and lowest concentration in April, respectively. For perchlorate in Beijing's drinking water, it was greatly influenced by the groundwater. Its concentrations were between 0.1-6.8 micrograms/L in the finished drinking water. It had peak value in November and minimum value in July, respectively.

Quality of life in elderly continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: In the present study, we determined the characteristic of quality of life (QOL) in elderly peritoneal dialysis (PD) patients by using the Medical Outcomes Study Short Form 36 (SF-36) to compare QOL between two age groups of continuous ambulatory PD patients. PATIENTS AND METHODS: Patients were allocated to one of two groups according to age: patients in group A were >or=65 years of age, and patients in group B were <65 years of age. We compared SF-36 scores, serum albumin, prealbumin, hemoglobin, lipid profile, normalized protein catabolic rate (nPCR), dialysis adequacy (Kt/V), creatinine clearance (CCr), and glomerular filtration rate (GFR) between the two groups. RESULTS: Group A contained 25 patients, and group B, 53 patients. Mean age in the two groups was 68.6 +/- 3.3 years and 47.7 +/- 10.2 years respectively. Elderly patients showed lower QOL scores with regard to physical problems. Quality-of-life scores with regard to psychological problems were similar in the two groups. Duration of PD, body mass index, serum albumin, prealbumin, hemoglobin, and lipid profile were not different between the two groups. However, nPCR, GFR, and total solute clearance were lower in group A than in group B (nPCR: 0.70 +/- 0.13 g/kg daily vs 0.95 +/- 0.21 g/kg daily, p < 0.001; GFR: 1.03 +/- 1.21 mL/min vs 3.19 +/- 2.22 mL/min, p < 0.001). CONCLUSIONS: In elderly patients, QOL scores were lower, mainly because of a perception of being more physically impaired. Nutritional indices and QOL scores reflecting psychological processes were similar between the two groups. These descriptive data show that PD is an ideal choice in elderly patients with end-stage renal disease. More attention needs to be paid to "healthy start" dialysis and maintenance of nutritional status in elderly patients because of lower GFR and nPCR.

[Determination of trace level of bromate and perchlorate in drinking water by ion chromatography with microwave preconcentration].

A simple sample preconcentration technique for the determination of trace level of bromate and perchlorate in drinking water with ion chromatography is presented. With the hydrophobic anion-exchange column and a sodium hydroxide eluent in linear gradient, bromate and perchlorate can be determined in a single injection within 35 min. Prior to ion chromatographic analysis, the drinking water sample was treated with the OnGuard Ag cartridge to remove the superfluous chloride and concentrated in 20-fold with poly(tetrafluoroethylene)(PTFE) beaker in a domestic microwave oven in 15 min. The recoveries of the analytes are better than 90%. The detection limits for bromate, perchlorate, iodate and chlorate were 0.10 microgram/L, 0.20 microgram/L, 0.11 microgram/L and 0.21 microgram/L, respectively. The developed method is applicable for the quantitation of bromate and perchlorate in real drinking water samples.