[A model analysis on the knowledge-attitude-practice of children guardians in Jiangxi, Shanghai and Qinghai].

Objective: To understand the knowledge attitude and practice (KAP) on vaccination among children's parents in Jiangxi, Shanghai, and Qinghai and explore the factors influencing KAP. Methods: The study selected two counties/districts in Jiangxi, Shanghai, and Qinghai, respectively, by stratified sampling and used a unified questionnaire to investigate the parental KAP of vaccination. A structural equation model (SEM) was used to explore factors influencing parental KAP, as well as the relationship between knowledge and behavior. Results: Of the 760 valid questionnaires, the knowledge of vaccination among children's parents was better, and the vaccination knowledge of parents in Qinghai and Shanghai were slightly better than those in Jiangxi. Parents mainly obtained vaccination knowledge through medical staff and vaccination manuals. The fitting degree of SEM was relatively good; the root mean square error of approximation of the model is 0.033. The higher the parents' education level, the better their knowledge of vaccination (ß̂=0.082). Parental vaccination knowledge could influence whether the vaccinated children stay for half an hour in the clinics (ß̂=0.541). It could also impact whether parents giving up vaccinating their children in the face of media reports about the adverse effects of vaccinations (ß̂=0.515). Conclusions: The knowledge of vaccination among the parents in Jiangxi, Shanghai, and Qinghai was quite good. Moreover, we should pay more attention to the mass media programs and vaccination knowledge among parents with low or middle education backgrounds. Vaccination knowledge can be disseminated through medical staff, vaccination manuals, or mobile applications.

Appropriateness of deep vein thrombosis (DVT) prophylaxis use among medical inpatients: a DVT risk alert tool (DRAT) study.

INTRODUCTION: Increasing incidence of Venous Thromboembolism (VTE) has complicated treatment courses for hospitalised patients. Despite recommendation to support deep vein thrombosis (DVT) risk assessment and appropriate use of prophylaxis in medical inpatients, it is either neglected or prescribed unnecessarily by the clinicians. This study aimed to assess and compare the appropriateness of DVT prophylaxis prescribing between usual care versus a pharmacist-driven DVT Risk Alert Tool (DRAT) intervention among hospitalised medical patients. METHODS: A prospective pre- and post-intervention study was conducted among medical inpatients in a Malaysian secondary care hospital. DVT and bleeding risks were stratified using validated Padua Risk Assessment Model (RAM) and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Assessment Model. Pharmacist-driven DRAT was developed and implemented post-interventional phase. DVT prophylaxis use was determined and its appropriateness was compared between pre and post study using multivariate logistic regression with IBM SPSS software version 21.0. RESULTS: Overall, 286 patients (n=142 pre-intervention versus n=144 post-intervention) were conveniently recruited. The prevalence of DVT prophylaxis use was 10.8%. Appropriate thromboprophylaxis prescribing increased from 64.8% to 68.1% post-DRAT implementation. Of note, among high DVT risk patients, DRAT intervention was observed to be a significant predictor of appropriate thromboprophylaxis use (14.3% versus 31.3%; adjusted odds ratio=2.80; 95% CI 1.01 to 7.80; p<0.05). CONCLUSION: The appropriateness of DVT prophylaxis use was suboptimal but doubled after implementation of DRAT intervention. Thus, an integrated risk stratification checklist is an effective approach for the improvement of rational DVT prophylaxis use.

Effects of guanidinoacetic acid on growth performance, creatine and energy metabolism, and carcass characteristics in growing-finishing pigs.

The aim of this study was to investigate the effects of dietary supplementation with guanidinoacetic acid (GAA) on the growth performance, creatine and energy metabolism, and carcass characteristics in growing-finishing pigs. In Exp. 1, Duroc × Landrace × Yorkshire pigs (n = 180, 33.61 ± 3.91 kg average BW) were blocked by weight and sex, and allotted to 5 treatments with 6 replicates (3 gilts and 3 barrows per replicate pen). Diets were corn-soybean meal-basal diets supplemented with 0, 300, 600, 900, and 1,200 mg/kg of GAA and fed to the pigs for 98 d. From days 1 to 98, G:F increased (linear, P < 0.05) with increasing addition of dietary GAA. Using a broken-line model, the optimum level of dietary GAA was 300 mg/kg during the overall experimental period (days 1 to 98) to maximize G:F. Hot carcass weight, carcass length, and lean percentage showed a tendency to increase (quadratic, 0.05 < P < 0.10) with increasing addition of dietary GAA. On day 98, serum GAA and liver creatine tended to increase (linear, P = 0.10, 0.07) as dietary GAA increased. In addition, serum ATP on day 98 increased linearly (linear, P < 0.01), and muscle ATP and adenosine monophosphate increased quadratically (quadratic, P = 0.05) with incremental GAA supplementation. In Exp. 2, Duroc × Landrace × Yorkshire pigs (n = 180, 53.19 ± 5.63 kg average BW) were blocked by weight and sex, and allotted to 5 treatments with 6 replicates (3 gilts and 3 barrows per replicate pen). Diets were corn-soybean meal-basal diets supplemented with 0, 150, 300, 600, and 1,200 mg/kg of GAA for 35 d. As dietary GAA increased, final BW, ADG, and G:F increased quadratically (quadratic, P < 0.01), and 300 mg/kg of GAA maximized ADG and final BW (P < 0.05).The results indicate that dietary GAA could increase the creatine and ATP load in the tissues of pigs and accordingly improve growth performance. Dietary supplementation with 300 mg/kg of GAA was suitable to maximize the growth performance of growing-finishing pigs.

[Ki-67 expression and its effect on response to neo-adjuvant chemotherapy in invasive breast cancer].

Objective: To investigate the response to neoadjuvant chemotherapy (NAC) among different molecular subtypes of breast cancers using molecular classification with Ki-67 (ER+ PR+ HER2+ Ki-67) or without Ki-67 (ER+ PR+ HER2). Methods: One hundred and twenty-seven cases of invasive breast cancer confirmed by core needle biopsy before NAC were collected from January 2007 to December 2009 and diagnosed at West China Hospital, Sichuan University. The cases were classified into different molecular subtypes using molecular classifications with or without Ki-67. Their clinical and pathological response to NAC was evaluated and compared. Results: The different subtypes using both molecular classifications showed significant difference in clinical response(with Ki-67: χ(2)=22.40, P<0.01; without Ki-67: χ(2)=9.202, P=0.027)but not pathological(P>0.05) response to NAC. By multivariate analysis, Ki-67 was predictive for a clinical complete response (P=0.041) and clinical overall response (P<0.01); also Ki-67 was the only clinicopathological factor predictive of pathological response(P=0.041). Conclusion: The molecular classification with Ki-67 is better to predict breast cancers responsiveness to NAC than the molecular classification without Ki-67.

Synthesis and Characterization of SiO2@Y2MoO6:Eu3+ Core-Shell Structured Spherical Phosphors by Sol-Gel Process.

SiO2@Y2MoO6:Eu3+ core-shell phosphors were prepared by the sol-gel process. X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM), energy-dispersive X-ray spectra (EDS), transmission electron microscopy (TEM), photoluminescence (PL) spectra as well as kinetic decays were used to characterize the resulting SiO2@Y2MoO6:Eu3+ core-shell phosphors. The XRD results demonstrated that the Y2MoO6:Eu3+ layers on the SiO2 spheres crystallized after being annealed at 700 °C and the crystallinity increased with raising the annealing temperature. The obtained core-shell phosphors have spherical shape with narrow size distribution (average size ca. 640 nm), non-agglomeration, and smooth surface. The thickness of the Y2MoO6:Eu3+ shells on the SiO2 cores could be easily tailored by varying the number of deposition cycles (70 nm for four deposition cycles). The Eul+ shows a strong PL emission (dominated by 5D0-7F2 red emission at 614 nm) under the excitation of 347 nm UV light. The PL intensity of Eu3+ increases with increasing the annealing temperature and the number of coating cycles.

[The curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleep apnea hypopnea syndrome and its influencing factors].

Objective:To observe the clinical curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleepapnea hypopnea syndrome (OSAHS) and to explore the related influencing factors. Method:The cross-sectional area of the narrowest plane in the nasopharyngeal region, velopharyngealregion, glossopharyngeal region, and hypopharynx region were measured using Spiral CT combined with Müller's experiment and computer processing system. All the elderly patients were administered with proton pump inhibitors (rabeprazole sodium, 20 mg/d) and domperidone tablets (10 mg×3/d) for 3 months. After treatment, repeat tests were performed to evaluate the therapeutic effects. Result:Before and after 3 months of treatment, significant difference was found in the total number of reflux, total reflux time, reflux symptom index and reflux symptoms scale (P<0.05), however, there's no significant difference in respiratory disorder index (P>0.05). After 3 months treatment, the cross-sectional area of those four structural regions was increased in different degrees in the patients with reduced OSAHS. However, no significant changes in the cross sectional area was observed in the patients with unchanged OSAHS. Conclusion:Anti-reflux therapy has curative effect in only 60% of the elderly patients with laryngopharyngeal reflux and OSAHS. In addition to the laryngopharyngeal reflux disease, age, BMI and medical history might be the reasons that lead to the failure of the improvement in the other 40% of the elderly patients.

Observation of the clinical effects of iontophoresis of a chinese drug in the treatment of degenerative osteoarthropathy.

Degenerative osteoarthropathy, a kind of arthrosis induced by various factors, mainly affects articular cartilage and causes syndesmophyte formation. Its morbidity increases year by year, tending to occur more among young people than previously. This paper mainly discusses the clinical effects of iontophoresis of the Chinese drug in treating degenerative osteoarthropathy. A total of 296 cases of degenerative osteoarthropathy were randomly divided into two groups (of both genders): the iontophoresis group: the joint was treated with iontophoresis of the Chinese drug and a medium frequency electrotherapy instrument; the frequency electrotherapy group: the joint was treated only by medium frequency electrotherapy. The two groups were both treated for 30 min once a day, for a total of 4 weeks. The results of the study showed that, the total effective rate in the medium frequency electrotherapy group was 74.3%, the iontophoresis group was 93.2%, indicating the curative effect of iontophoresis of the Chinese medicine. The above finding indicates that, iontophoresis has a good clinical effect in the treatment of osteoarthropathy and deserves to be promoted and applied.

Inflammatory repertoire of Alzheimer's disease and nondemented elderly microglia in vitro.

We have previously developed and characterized isolated microglia and astrocyte cultures from rapid (<4 h) brain autopsies of Alzheimer's disease (AD) and nondemented elderly control (ND) patients. In the present study, we evaluate the inflammatory repertoire of AD and ND microglia cultured from white matter (corpus callosum) and gray matter (superior frontal gyrus) with respect to three major proinflammatory cytokines, three chemokines, a classical pathway complement component, a scavenger cell growth factor, and a reactive nitrogen intermediate. Significant, dose-dependent increases in the production of pro-interleukin-1beta (pro-IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory peptide-1alpha (MIP-1alpha), IL-8, and macrophage colony-stimulating factor (M-CSF) were observed after exposure to pre-aggregated amyloid beta peptide (1-42) (Abeta1-42). Across constitutive and Abeta-stimulated conditions, secretion of complement component C1q, a reactive nitrogen intermediate, and M-CSF was significantly higher in AD compared with ND microglia. Taken together with previous in situ hybridization findings, these results demonstrate unequivocally that elderly human microglia provide a brain endogenous source for a wide range of inflammatory mediators.

Deficiency of complement defense protein CD59 may contribute to neurodegeneration in Alzheimer's disease.

Complement defense 59 (CD59) is a cell surface glycophosphoinositol (GPI)-anchored protein that prevents complement membrane attack complex (MAC) assembly. Here, we present evidence from ELISA assays that CD59 protein levels are significantly decreased in the frontal cortex and hippocampus of Alzheimer's disease (AD) compared with nondemented elderly (ND) patients, whereas complement component 9, a final component to form MAC, is significantly increased. To further confirm the CD59 deficit, PI-specific phospholipase C (PIPLC) was used to cleave the CD59 GPI anchor at the cell surface in intact slices from AD and ND cortex. CD59 released by PIPLC cleavage was significantly reduced in AD compared with ND samples. By the use of a ribonuclease protection technique, amyloid beta-peptide was found to downregulate CD59 expression at the mRNA level, suggesting a partial explanation of CD59 deficits in the AD brain. To evaluate the pathophysiological significance of CD59 alterations in neurons, we exposed cultured NT2 cells, which normally underexpress CD59, and NT2 cells transfected to overexpress CD59 to homologous human serum. Lactic acid dehydrogenase assays revealed significant complement-induced cell lysis in CD59-underexpressing NT2 cells and significant protection from such lysis in CD59-overexpressing NT2 cells. Moreover, cells expressing normal levels of CD59 showed no evidence of MAC assembly or damage after exposure to homologous serum, whereas pretreatment of these cells with a CD59-neutralizing antibody resulted in MAC assembly at the cell surface and morphological damage. Taken together, these data suggest that CD59 deficits may play a role in the neuritic losses characteristic of AD.

Estrogen enhances uptake of amyloid beta-protein by microglia derived from the human cortex.

In recent years, inflammatory mechanisms have been increasingly appreciated as important steps in the pathology of Alzheimer's disease (AD). There are two pathological defects in AD: chronic inflammation and impaired clearance of amyloid beta-peptide (Abeta). In the periphery, estrogen both increases macrophage phagocytosis and has antiinflammatory effects. If estrogen had a similar effect in the CNS, it could reverse inflammatory defects in AD. Although microglia are a key component of the immune system and help clear Abeta deposits in the AD brain, little is known about the effects of estrogen on CNS microglia. Therefore, we sought to determine the relationship between estrogen treatment and internalization of Abeta by microglia by quantifying the internalization of aggregated Abeta by human cortical microglia. Abeta uptake was found to be dose- and time-dependent in cultured microglia. Increased Abeta uptake was observed at 1.5 and 24 h after addition of aggregated Abeta (50, 100, or 1,000 nM: Abeta), and this uptake was enhanced by pretreatment with estrogen. The expression of estrogen receptor (ER) beta (ER-beta) was also up-regulated by estrogen treatment. Cells cotreated with ICI 182,780, an ER antagonist, showed significantly reduced internalization of Abeta in cultured microglia. These results indicate that microglia express an ER-beta but that the effect of estrogen on enhancing clearance of Abeta may be related to the receptor-independent action of estrogen or to nonclassical ER effects of estrogen. Thus, stimulation of the ER might contribute to the therapeutic action of estrogen in the treatment of AD.

Intracellular levels of cyclic AMP and cyclic GMP differentially modify platelet aggregate size in human platelets activated with epinephrine or ADP.

We investigated the effects on human platelet aggregation of several agents that increase either intracellular cyclic AMP or cyclic GMP, using a platelet aggregometer that allows quantification of the size and number of platelet aggregates. During the initial phase of aggregation induced by epinephrine and ADP, small aggregates consisting of < 100 cells predominated; large aggregates formed later. Prostaglandin I2 (PGI2), which increases intracellular cyclic AMP, suppressed the formation of small as well as large aggregates induced by epinephrine, with ID50 values of 10.7 +/- 2.8 and 3.8 +/- 0.5 nM, respectively. ADP-induced formation of small and large aggregates was also inhibited by PGI2, with similar ID50 values. Dibutyryl cyclic AMP (db cyclic AMP), a cell-permeant form of cyclic AMP, also inhibited small and large aggregate formation induced by epinephrine or ADP, with ID50 values of 420-560 microM for small aggregates and 139-166 microM for large aggregates, respectively. On the other hand, nitroprusside, which increases intracellular cyclic GMP, inhibited only the formation of large aggregates, with an ID50 value of 454 +/- 191 nM for epinephrine-induced activation and of 2.1 +/- 0.6 microM for ADP-induced activation. Nitroprusside at 1 mM did not affect the formation of small aggregates induced by epinephrine, whereas that of large aggregates was completely blocked at 10 microM. 8-Bromo cyclic GMP (8-br cyclic GMP) also inhibited only the formation of large aggregates, with ID50 values of 140-170 microM, but not that of small aggregates induced by epinephrine and ADP. Milrinone, which increases the intracellular level of both cyclic AMP and cyclic GMP, suppressed the formation of small and large aggregates induced by epinephrine and ADP. These findings suggest that cyclic AMP and cyclic GMP differentially modify the size of aggregates formed during epinephrine or ADP activation.