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    Monographic report (Urinary dysfunction and pelvic reconstruction)
    Mechanism and application of nitric oxide synthase neurochemical plasticity in lower urinary tract dysfunction of rats with spinal cord injury
    ZHANG Fan, LIAO Li-min
    2012, 32 (4):  379. 
    doi: 10.3969/j.issn.1674-8115.2012.04.001

    Abstract ( 1105 )   PDF (711KB) ( 1076 )  

    Objective To investigate the expression of nitric oxide synthase (NOS) in afferent nerve of lower urinary tract and the effect of intrathecal injection of NOS inhibitors on cystometry parameters in rats with complete spinal cord injury (SCI). Methods ①Twenty-four SD rats were randomly divided into normal control group A, SCI 1 week group, SCI 4 weeks group and SCI 8 weeks group, with 6 rats in each group, and complete SCI model was established in SCI 1 week group, SCI 4 weeks group and SCI 8 weeks group by T10 spinal segment resection. The expression of neuronal NOS (nNOS) and inducible NOS (iNOS) in L6 to S1 spinal segment in each group of rats was detected by immunohistochemistry. ②Another 16 SD rats were randomly divided into normal control group B (n=9) and injury group (n=7), and complete SCI model was established in injury group by T10 spinal segment resection. Four weeks after model establishment, intrathecal injections of 0.1 mL normal saline, 1 μmol nNOS inhibitor and 1 μmol iNOS inhibitor were performed in two groups, and the cystometry parameters were measured in two groups before and after treatment. Results ①The numbers of cells with positive expression of nNOS in spinal dorsal horn in SCI 1 week group and SCI 4 weeks group [(5.5±2.7)/visual field and (10.3±7.9)/visual field] were significantly larger than that in normal control group A [(2.0±1.5)/visual field] (P<0.05), and the number of cells with positive expression of nNOS in spinal ventral horn in SCI 8 weeks group [(6.7±1.5)/visual field] was significantly larger than that in normal control group A [(4.3±1.5)/visual field] (P<0.05). ②The maximum bladder capacity after intrathecal injection of nNOS inhibitor was significantly larger than that before treatment in injury group [(1.58±0.94)mL vs (1.06±0.70) mL](P<0.05). Conclusion Nitric oxide in spinal level may not participate in normal micturition reflex. Nitric oxide-related neurochemical changes in lumbosacral neurons participate in the emergence of spinal micturition reflex following SCI. The manipulation of nitric oxide production may help to treat lower urinary tract dysfunction after SCI.

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    Protamine sulfate plus lipopolysaccharide in establishment of animal model of interstitial cystitis
    LV Jian-wei, SHA Jian-jun, ZHANG Lian-hua, et al
    2012, 32 (4):  385. 
    doi: 10.3969/j.issn.1674-8115.2012.04.002

    Abstract ( 1545 )   PDF (595KB) ( 1293 )  

    Objective To investigate the feasibility of establishment of animal model of interstitial cystitis by protamine sulfate plus lipopolysaccharide. Methods Thirty female SD rats were divided into experiment group, cyclophosphamide group and control group, with 10 rats in each group. Transurethral bladder perfusion of 10 mg/mL protamine sulfate plus 750 μg/mL lipopolysaccharide was performed in experiment group, intraperitoneal injection of 100 mg/kg cyclophosphamide was conducted in cyclophosphamide group, and PBS solution perfusion was administered in control group. Mononuclear inflammatory cells in bladder tissues were counted with HE staining, degranulated mast cells were counted with special staining, and the urine mass concentrations of histamine in groups were measured. Results A large number of mononuclear inflammatory cells and degranulated mast cells in bladder tissues were observed in experiment group, a large number of mononuclear inflammatory cells and a small number of degranulated mast cells in bladder tissues were found in cyclophosphamide group, and a small number of mononuclear inflammatory cells and degranulated mast cells in bladder tissues were detected in control group. The numbers of mononuclear inflammatory cells per visual field in experiment group (76.5±9.8) and cyclophosphamide group (69.3±6.9) were significantly larger than that in control group (16.5±9.8)(P<0.05). The number of degranulated mast cells per visual field in experiment group (8.4±3.1) was significantly larger than those in cyclophosphamide group (1.2±1.6) and control group (0.7±0.3)(P<0.05). The urine mass concentration of histamine in experiment group [(58.5±10.3) pg/mL] was significantly higher than those in cyclophosphamide group [(11.9±2.4) pg/mL] and control group [(8.9±3.2) pg/mL](P<0.05). Conclusion The animal model of interstitial cystitis established by 10 mg/mL protamine sulfate plus 750 μg/mL lipopolysaccharide is in line with the pathophysiological characteristics of interstitial cystitis, and the way of establishment is simple and reliable.

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    Effects of different ways of delivery on activity of pelvic floor muscle in postpartum women detected with intravaginal surface electrode
    FENG Jie, WU Qing-kai, CHENG Hui, et al
    2012, 32 (4):  389. 
    doi: 10.3969/j.issn.1674-8115.2012.04.003

    Abstract ( 1610 )   PDF (280KB) ( 1303 )  

    Objective To investigate the effects of vaginal delivery and caesarean sectionon on activity of pelvic floor muscles after delivery. Methods One hundred and eighty-four women were divided into caesarean section group (n=59), vaginal delivery group (n=117) and forceps delivery group (n=8) according to the ways of delivery. Questionnaire survey was conducted 6 to 8 weeks after delivery, and the activity of pelvic floor muscles after delivery was measured by Femiscan feedback instrument. Another 20 age-matched nulliparas were selected as control group. Results The parameters of activity of pelvic floor muscles in control group were significantly higher than those of postpartum women (P<0.05). The activity of pelvic floor muscles in caesarean section group was the highest, that in forceps delivery group was the lowest, and there were significant differences between two groups (P<0.05). There was no significant difference between the activity of left pelvic floor muscles and that of right pelvic floor muscles in caesarean section group and vaginal delivery group (P>0.05). There were significant differences between the activity of left pelvic floor muscles and that of right pelvic floor muscles in forceps delivery group (P<0.05). There was no significant difference in the duration of first stage of labor between vaginal delivery group and forceps delivery group (P>0.05), while there were significant differences in the duration of second stage of labor between two groups (P<0.05). Conclusion The activity of pelvic floor muscles in women with vaginal delivery is similar to that in women with caesarean section. The activity of pelvic floor muscles in women with forceps delivery is the lowest, which may be related to the prolonged duration of second stage of labor.

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    Relationship between serum relaxin levels and female pelvic floor prolapse
    ZHOU Yan-na, WU Qing-kai, CHENG Hui, et al
    2012, 32 (4):  393. 
    doi: 10.3969/j.issn.1674-8115.2012.04.004

    Abstract ( 1326 )   PDF (236KB) ( 1135 )  

    Objective To investigate the correlation of serum relaxin level with female pelvic organ prolapse (POP) and menopause. Methods Thirty-nine patients with POP (POP group) were selected, and another 39 women with normal pelvic floor function were served as control group. The relationship between POP and serum relaxin level was analysed, and the effect of menopause on serum relaxin level was investigated. Results The mass concentrations of serum relaxin in POP group and control group were (406.7±311.2) ng/L and (199.4±208.7) ng/L respectively, and there were significant differences between two groups (P<0.05). The mass concentrations of serum relaxin of menopausal women and non-menopausal women were (172.0±197.5) ng/L and (587.5±716.8) ng/L respectively, and there were significant differences between two groups (P<0.05). The mass concentrations of serum relaxin of menopausal women in POP group and in control group were (226.2±178.8) and (108.4±98.7) ng/L respectively, and there were significant differences between two groups (P<0.05). The mass concentrations of serum relaxin of non-menopausal women in POP group and in control group were (1870.2±264.4) ng/L and (373.7±370.4) ng/L respectively, and there were significant differences between two groups (P<0.001). Conclusion The elevation of serum relaxin level may be the cause of female POP.

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    Test results of sacral neuromodulation in 34 patients with chronic pelvic floor dysfunction
    WEI Zhong-qing, SHEN Bai-xin, DING Liu-cheng, et al
    2012, 32 (4):  396. 
    doi: 10.3969/j.issn.1674-8115.2012.04.005

    Abstract ( 1272 )   PDF (682KB) ( 1243 )  

    Objective To investigate the therapeutic effect and safety of temporary electrode and Tined Lead electrode in sacral neuromodulation evaluation. Methods Thirty-four patients with chronic pelvic floor dysfunction were divided into temporary electrode group (n=16) and Tined Lead electrode group (n=18), and temporary stimulation tests were performed after electrode placement. The conditions of voiding and defecation were recorded every day, and related urodynamic parameters were measured. Results The symptoms improved in 43% patients with urgent incontinence and 35% patients with urinary frequency and urgency, and 10% patients with urgent incontinence or urinary frequency and urgency were cured. There were significant differences in the rates of self-perceived improvement of voiding and defecation between temporary electrode group and Tined Lead electrode group (32.2% vs 38.2%, P<0.05). There was no significant difference in the rates of improvement of pain and voiding volume in patients with pelvic floor pain syndrome and interstitial cystitis between two groups (P>0.05). Electrode shift took place in 4 patients in temporary electrode group and in 1 patient in Tined Lead electrode group. Conclusion Sacral neuromodulation is a safe, minimally invasive and effective method for treatment of chronic pelvic floor dysfunction, and Tined Lead electrode may prevent the electrode shift, increase the rate of success, and improve the therapeutic effect.

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    Adhesion behavior of rabbit adipose-derived stromal cells on chitosan-modified polypropylene mesh
    CHENG Hui, WU Qing-kai, SUN Jun-fen, et al
    2012, 32 (4):  401. 
    doi: 10.3969/j.issn.1674-8115.2012.04.006

    Abstract ( 1184 )   PDF (558KB) ( 1085 )  

    Objective To study the technical parameters of chitosan-modified polypropylene mesh, and observe the adhesion behavior of rabbit adipose-derived stromal cells (ADSCs) on the modified mesh. Methods Chitosan of 1 g, 1.25 g and 1.5 g were respectively dissolved into the mixture of 2% acetic acid solution, 5% glutaraldehyde solution and 50% n-heptane solution, and 2.0%, 2.5%, 3.0% chitosan mould solutions were obtained. Polypropylene meshes were modified by different concentrations of chitosan mould solutions, and then the chitosan-modified polypropylene meshes were obtained. Rabbit ADSCs were cultured with chitosan-modified polypropylene meshes for 24 h, and the adhesion behavior of cells on materials was observed. Results Chitosan-modified polypropylene meshes were harder than non-modified polypropylene meshes, and the plasticity of polypropylene meshes decreased with the concentration increase of chitosan solutions. Polypropylene mesh modified by 3.0% chitosan solution had the phenomenon of uneven coating. After co-culture for 24 h, rabbit ADSCs grew well on modified polypropylene meshes, while there was no rabbit ADSCs growing on the non-modified polypropylene meshes. Conclusion The ideal concentration of the chitosan solution for modified polypropylene mesh is 2.5%, and chitosan-modified polypropylene mesh is suitable for rabbit ADSCs adhesion.

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    Clinical efficacy of bladder irrigation with heparin and alkalinized lidocaine for painful bladder syndrome under different temperatures
    LENG Jing, CHEN Hui-xing, LV Jian-wei, et al
    2012, 32 (4):  405. 
    doi: 10.3969/j.issn.1674-8115.2012.04.007

    Abstract ( 1475 )   PDF (296KB) ( 1144 )  

    Objective To compare the clinical efficacy of bladder irrigation with heparin and alkalinized lidocaine for painful bladder syndrome (PBS) under two different temperature (normal temperature and high temperature). Methods Sixty-two female patients newly-diagnosed with PBS were collected. The Interstitial Cystitis Problem Index (ICPI) and Interstitial Cystitis Symptom Index (ICSI) were obtained with O´Leary-sant questionnaire before treatment. Patients were randomly divided into normal temperature group (bladder irrigation with heparin and alkalinized lidocaine under 20 ℃-24 ℃) and high temperature group (bladder irrigation with heparin and alkalinized lidocaine under 37 ℃-40 ℃). ICPI and ICSI were obtained again with O´Leary-sant questionnaire after 8 weeks and 16 weeks of treatment. Results ICPI and ICSI were significantly improved after treatment in two groups (P<0.05). Compared with normal temperature group, ICPI and ICSI in high temperature group were significantly improved 8 weeks after treatment (P<0.05) and 16 weeks after treatment (P<0.001). Three patients (9.38%) in high temperature group experienced strong burning sensation in bladder after first irrigation, but they tolerated after a few times of irrigation. There was no adverse event in normal temperature group. Conclusion The clinical efficacy of bladder irrigation with heparin and alkalinized lidocaine for PBS under high temperature is better than that under normal temperature, with no short-term adverse event.

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    Treatment of female primary bladder neck obstruction with transurethral resection of bladder neck and pathological analysis
    ZHANG Xiao-peng, HU Hao, ZHANG Guo-xi, et al
    2012, 32 (4):  408. 
    doi: 10.3969/j.issn.1674-8115.2012.04.008

    Abstract ( 7649 )   PDF (294KB) ( 1131 )  

    Objective To investigate the outcomes of female primary bladder neck obstruction (PBNO) treated with transurethral resection of bladder neck (TURBN), and perform the pathological analysis. Methods Twenty-two women with PBNO were recruited, and preoperative examinations were conducted, including physical examination, urine routine, American Urological Association scoring, urodymamics, ultrasonography and cystoscopy. Bladder outlet obstruction was diagnosed according to Blaivas-Groutz nomogram, TURBN was performed with Olympus standard resectoscope, and urinary catheter was retained for 24 to 72 h after operation. Results There were 4 patients with severe obstruction, 10 patients with moderate obstruction and 8 patients with mild obstruction. Elevated posterior lip of bladder neck and trabecula hyperplasia of bladder wall were observed through cystoscopy. Twelve months after operation, all the symptoms and parameters were improved. Pathological examinations revealed glandular cystitis, fibrous tissue hyperplasia and chronic inflammation. Conclusion TURBN is an effective and safe method in treatment of PBNO, especially for patients with unsuccessful pharmacotherapy.

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    Efficacy and complications of TVT procedure and TVT-O procedure in treatment of female stress urinary incontinence
    CHEN Hui-xing, LV Jian-wei, LENG Jing, et al
    2012, 32 (4):  412. 
    doi: 10.3969/j.issn.1674-8115.2012.04.009

    Abstract ( 1408 )   PDF (324KB) ( 1224 )  

    Objective To compare the clinical efficacy and complications of tension-free vaginal tape (TVT) procedure (TVT group) and transobturator vaginal tape inside out (TVT-O) procedure (TVT-O group) in treatment of female stress urinary incontinence (SUI). Methods Two hundred and five female patients with SUI were randomized to receive TVT procedure (n=102) or TVT-O procedure (n=103) from February 2009 to February 2010, and the clinical efficacy and complications were compared. Results The mean time of operation in TVT group was (27.5±13.3) min (25 to 45 min), the mean time of operation in TVT-O group was (18.5±7.4) min (11 to 25 min), and there were significant differences between two groups (P<0.05). There was no significant difference in the volume of blood loss during operation, mean duration of indwelling catheter, average length of hospital stay and volume of postoperative residual urine between two groups (P>0.05). The symptoms of urinary incontinence in 195 patients (95.1%) in two groups were controlled after operation, and no incidence of urinary incontinence occurred during the follow-up for 12 to 24 months. There were 5 patients (4.9%) with intraoperative bladder injury and 2 patients (2.0%) with urinary retention after catheter removal in TVT group. There were 2 patients (2%) with urinary retention after catheter removal, 3 patietns (2.9%) with postoperative thigh pain and no case of bladder injury in TVT-O group. There was no symptom of urinary incontinence within 6 months after operation in 4 patients (3.8%), moderate urinary incontinence emerged 12 months after operation, and the symptoms improved in all the 4 patients. Conclusion TVT procedure and TVT-O procedure are effective and reliable in treatment of female SUI. TVT procedure has better long-term effect and higher possibility of bladder injury than TVT-O procedure. TVT-O procedure is simpler than TVT procedure, with less surgical trauma, less complications and occasionally-occurred thigh pain. The mid-term clinical efficacy of TVT-O procedure is slightly worse than that of TVT procedure.

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    Impact of different ways of first delivery on incidence of stress urinary incontinence during subsequent pregnancy
    JIANG Li, WU Qing-kai, XI Jie
    2012, 32 (4):  416. 
    doi: 10.3969/j.issn.1674-8115.2012.04.010

    Abstract ( 1177 )   PDF (213KB) ( 888 )  

    Objective To evaluate whether Cesarean for the first pregnancy can lower the incidence of stress urinary incontinence (SUI) during the second pregnancy. Methods Two hundred and forty-six pregnant multiparas aged between 20 to 35 years who had one term of delivery were selected. The weight of newborn infants was 2 500 to 4 000 g. The duration between two pregnancy was no more than five years. There was no pregnancy-related complications. These women were divided into vaginal delivery group (gave birth to the first child through vagina, n=128) and cesarean group (terminated the first term of pregnancy by cesarean, n=118). All of them were followed up by telephone two weeks after the second delivery, the incidences of SUI during two terms of pregnancy were obtained, and the incidences of SUI were compared between two groups. Results The incidence of SUI during the second term of pregnancy in cesarean group was 40.7%,  which was higher than that in vaginal delivery group (36.7%), and there was no significant difference between two groups (P>0.05). Multiple Logistic regression analysis of age, body weight, gestation week at delivery, time from the first delivery and way of first delivery indicated that there was no correlation of way of first delivery with incidence of SUI during the second term of pregnancy (P>0.05). Conclusion Cesarean has no protective effect on SUI during the subsequent pregnancy.

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    Epidemiological study on stress urinary incontinence in 2 410 women in Shanghai
    PAN Jia-hua, XU Ling, LV Jian-wei, et al
    2012, 32 (4):  419. 
    doi: 10.3969/j.issn.1674-8115.2012.04.011

    Abstract ( 1328 )   PDF (282KB) ( 1300 )  

    Objective To investigate the epidemiological characteristics of female stress urinary incontinence (SUI) in Shanghai, and explore the risk factors for clinical reference. Methods Two thousand and six hundred women aged between 28 and 89 years from 10 districts in Shanghai were selected with multi-stage sampling method, which included workers, teachers, employees, medical staffs and civil servants. A total of 2 600 questionnaires were distributed, and 2 410 valid questionnaires were recovered, with the response rate of 92.7%. The questionnaire design included age, occupation, height, weight, medical co-mobidities, number of delivery, times of abortion, quality of life scale (QOL) score and International Prostate Symptom Score (IPSS). Results Of the 2 410 women, there were 288 women (11.9%) with urge urinary incontinence, 334 (13.8%) women with mixed urinary incontinence and 699 women (29.0%) with pure SUI, and 1 089 women did not have urinary incontinence. The average age of 699 women with SUI was (54.4±12) years, and that of women without SUI was (48.4±11) years (P=0.000). The average body mass index (BMI) of women with SUI was 23.2±4.0, and that of women without SUI was 22.3±3.1 (P=0.000). Four hundred and three women with SUI had metabolic syndrome, and 352 women without SUI had metabolic syndrome (χ2=111.97, P=0.000). Chronic constipation was found in 491 women with SUI, and 322 women without SUI had chronic constipation (χ2=284.07, P=0.000). Two hundred and thirteen women with SUI had chronic bronchitis, while 174 women without SUI had chronic bronchitis (χ2=52.74, P=0.000). The incidence of SUI was significantly related to the history of delivery (χ2=29.81, P=0.000), and the incidence of SUI in women with multiple delivery was significantly higher than that in women with single delivery (χ2=13.68, P=0.000). The average QOL score was 10.97, and the average IPSS was 3.76 in women with SUI, and there was significant correlation between them (P=0.000). The QOL score was significantly related to age in women with SUI (P=0.000). Conclusion SUI has become an important voiding dysfunction disorder in elder women in China, with increasingly higher incidence over years. Forty to 59 years and over 80 years are two main age periods with higher incidence. The incidence is significantly related to age. Obesity, metabolic syndrome, chronic constipation, chronic bronchitis and multiple delivery are risk factors for SUI. In patients with SUI, symptoms of lower urinary tract are important factors affecting quality of life in addition to urine leakage. Selective M receptor blockers may be useful to improve their quality of life.

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    Impact of tension-free vaginal tape procedure on quality of sexual life of women with stress urinary incontinence
    SONG Hai-bo, CHEN Hui-xing, LENG Jing, et al
    2012, 32 (4):  423. 
    doi: 10.3969/j.issn.1674-8115.2012.04.012

    Abstract ( 1219 )   PDF (275KB) ( 1183 )  

    Objective To investigate the impact of tension-free vaginal tape (TVT) procedure on quality of sexual life of female patients with stress urinary incontinence (SUI), and explore the related factors. Methods Ninety-four female patients with SUI received follow-up 6 months to 3 years after TVT procedure, and were investigated with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), including physiological factor, emotional factor and sexual partner factor. The higher PISQ score indicated better quality of sexual life. Eighty-six questionnaires were recovered, with the recovery rate of 91.5%. Results Among the 86 patients, there was no significant change in the total score of PISQ after surgery (P>0.05), while the emotional factor score significantly decreased, and the physiological factor score significantly increased after surgery (P<0.05). Among the 62 patients followed up within 1 year after surgery, the total score of PISQ, emotional factor score and sexual partner factor score were significantly decreased after surgery (P<0.05), while there was no significant change in the physiological factor score after surgery (P>0.05). Among the 24 patients followed up more than 1 year after surgery, there was no significant change in the total score of PISQ, physiological factor score, emotional factor score and sexual partner factor score after surgery (P>0.05). The total score of PISQ in 25 (64.1%) of the 39 patients with involuntary urine leakage in sexual life before surgery was increased after surgery, that in 10 (21.3%) of the 47 patients without involuntary urine leakage in sexual life before surgery was increased after surgery, and there were significant differences in the rates of improvement in quality of sexual life between them (P<0.01). Conclusion TVT procedure does not have consistent negative effects on sexual life of patients. There may be negative effect on sexual life of patients within one year after surgery, but it may gradually disappear later. The quality of sexual life of patients with involuntary urine leakage during sexual life before surgery may be improved after surgery due to the symptom alleviation.

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    Research progress of tissue engineering scaffold materials in female pelvic floor reconstructive surgery
    XU Pei-rong, WU Qing-kai
    2012, 32 (4):  427. 
    doi: 10.3969/j.issn.1674-8115.2012.04.013

    Abstract ( 1282 )   PDF (379KB) ( 1228 )  

    Tissue engineering is an important field in female pelvic floor reconstructive surgery. The tissue engineering scaffold materials which can be used in female pelvic floor reconstructive surgery include natural acellular matrix material, natural polymers material, synthetic biodegradable polymers material and nanocomposites. Each scaffold material has its pros and cons, and nanocomposites will be one of the most promising materials. This review summarizes the research progress of scaffold materials available for pelvic floor reconstructive surgery.

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    Research progress of mechanism of synthetic material contraction after female pelvic floor reconstructive surgery
    ZHANG Rong, WU Qing-kai
    2012, 32 (4):  432. 
    doi: 10.3969/j.issn.1674-8115.2012.04.014

    Abstract ( 1040 )   PDF (422KB) ( 1034 )  

    The application of synthetic materials in female pelvic floor reconstructive surgery reduces the reoccurrence of pelvic organ prolapse, while the synthetic material contraction may result in pain, discomfort in sexual intercourse and decreased compliance of vigina, which affect the quality of life. The chemical properties and structure of synthetic materials, surgical approach, local infection as well as vaginal environment will affect the mesh contraction after surgery. The research progress of mechanism of synthetic material contraction after female pelvic floor reconstructive surgery is reviewed in this paper.

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    Research progress of etiology of female anorectal dysfunction based on the Integral Theory
    ZHANG Rui, WU Qing-kai
    2012, 32 (4):  437. 
    doi: 10.3969/j.issn.1674-8115.2012.04.015

    Abstract ( 994 )   PDF (398KB) ( 962 )  

    According to the Integral Theory, Peter Petros and Michael Swash from Australia presented the Musculo-Elastic Theory for anorectal function and dysfunction in females in 2008. The theory stated that anorectal dysfunction in females is mainly caused by lax suspensory ligaments that inactivate anorectal muscle forces. Vagina slings have been used to repair the damaged ligaments not only to treat the urinary incontinence and pelvic organ prolapse, but also fecal incontinence caused by delivery injury.

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    Original article (Basic research)
    Analysis of expression of brain-derived neurotrophic factor in rats with chronic unpredictable mild stress
    WANG Jing-hua, XIAO Ze-ping, XIAO Shi-fu, et al
    2012, 32 (4):  440. 
    doi: 10.3969/j.issn.1674-8115.2012.04.016

    Abstract ( 1104 )   PDF (402KB) ( 1061 )  

    Objective To investigate the expression of brain-derived neurotrophic factor (BDNF) in different areas of brain in rats with chronic unpredictable mild stress (CUMS), and explore the effects of antidepressant on expression of BDNF. Methods Twenty-four male SD rats were randomly assighed to control group (group A), CUMS group (group B) and CUMS + citalpram group (intraperitoneal injection of citalpram 2 mL once a day, 10 mg/kg) (group C), with 8 rats in each group. The experiment lasted for 6 weeks. Body weight was measured each week, sugar preference was evaluated every 3 weeks, and behavior of rats was assessed through open field tests before model establishment and 6 weeks after model establishment. Animals were sacrificed after 6 weeks, brain tissues were obtained, and Real-Time PCR was employed to detect the expression of BDNF mRNA in different areas of brain. Results At the end of the sixth week, rats in group B had significantly lower sugar preference than group A and group C (P<0.05), and had more behavior. After the beginning of stress experiment, the body weight of rats in group B and group C was significantly lower than that in group A (P<0.05). The expression of BDNF mRNA in hippocampus of rats in group B was higher than that in group A, while there was no significant difference between them (P=0.07). The expression of BDNF mRNA in striatum of rats in group C was significantly lower than that in group A (P<0.05). Conclusion Chronic stress may increase the expression of BDNF in hippocampus, while antidepressant may decrease the expression of BDNF in striatum.

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    Effects of Tranilast on renal structure and function in mice with ischemic reperfusion injury
    WANG Cheng-he, SHAO Kun, WANG Xiang-hui, et al
    2012, 32 (4):  446. 
    doi: 10.3969/j.issn.1674-8115.2012.04.017

    Abstract ( 1643 )   PDF (677KB) ( 1196 )  

    Objective To investigate the effects of pretreatment with Tranilast, indoleamine 2,3-dioxygenase (IDO) high expression activator on the structure and function of mouse renal tissues with renal ischemic reperfusion injury (RIRI), and explore its possible mechanism. Methods C57BL/6 mice were randomly divided into sham operation group, RIRI group, low dose Tranilast pretreatment+RIRI group (intragastric administration of 300 mg/kg Tranilast for 3 d before model establishment) and high dose Tranilast pretreatment+RIRI group (intragastric administration of 600 mg/kg Tranilast for 3 d before model establishment). Twenty-four hours after operation, blood samples were obtained from the fossa orbitalis vascular plexus in each group, mice were sacrificed, and spleen and kidneys of both sides were obtained. Serum creatinine (SCr) and blood urea nitrogen (BUN) were measured with automatic biochemistry analyzer, the distributions of type 1 helper T lymphocyte and type 2 helper T lymphocyte (Th1/Th2) in spleen tissues of each group were determined by flow cytometry, the pathological changes of renal tissues were observed under light microscope with HE staining, the relative expression of IDO mRNA and protein in renal tissues was detected by Real-Time PCR and Western blotting respectively, serum concentrations of kynurenine and tryphtophan were measured with high performance liquid chromatography, and serum IDO activity was estimated. Results Compared with RIRI group, SCr and BUN levels and Th1/Th2 in spleen tissues in low dose Tranilast pretreatment+RIRI group and high dose Tranilast pretreatment+RIRI group were significantly lower (P<0.01), the pathological damage in renal tissues was more moderate, the expression of IDO mRNA and protein in renal tissues and serum IDO activity were significantly higher (P<0.01), and all the above parameters changed in a dosedependent manner (P<0.05 or P<0.01). Conclusion Pretreatment with Tranilast has protective effects on the structure and function of renal tissues in mice, and the mechanism may be associated with the high expression of IDO and negative immunoregulation.

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    Effects of lipolysaccharide on expression of ACE and ACE2 in rat pulmonary microvascular endothelial cells and intervention effects of angiotensin-converting enzyme inhibitor
    LI Ya-chun, LI Ying-chuan, ZHOU Ming, et al
    2012, 32 (4):  452. 
    doi: 10.3969/j.issn.1674-8115.2012.04.018

    Abstract ( 1251 )   PDF (651KB) ( 1238 )  

    Objective To investigate the effects of lipolysaccharide (LPS) on expression of angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) in rat pulmonary microvascular endothelial cells (PMVECs) and the intervention effects of angiotensin-converting enzyme inhibitor (ACEI) Captopril. Methods Rat PMVECs were cultured in vitro with tissue explants adherant method, the toxic effects of LPS on PMVECs were investigated by treatment of PMVECs with different concentrations of LPS for different time, and the intervention effects of Captopril were observed. PMVECs were randomly divided into control group (without intervention, n=6), Captopril group (treatment with 10-5 mol/L Captopril for 8 h, n=6), LPS group (treatment with 1 mg/mL LPS for 8 h, n=6) and Captoril+LPS group (treatment with 10-5 mol/L Captopril for 30 min and 1 mg/mL LPS for 8 h, n=6). Cell viability was determined by CCK8, and the expression of ACE and ACE2 in each group was detected by Western blotting. Results LPS had significant toxic effect on rat PMECs, increased the expression of ACE, decreased the expression of ACE2. Captopril significantly inhibited the toxic effects of LPS, reversed the expression of ACE and ACE2, and regulated the level  of ACE and ACE2 to the level of control group. Conclusion ACEI could attenuate the toxic effects of LPS on PMVECs, and the expression of ACE and ACE2 may be involved in the mechanism.

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    Effects of recombinant human erythropoietin on expression of erythropoietin receptor and its downstream signaling pathway in 3T3-L1 adipocytes
    SHU Jin-lian, PAN Yu, LIU Xiao-li, et al
    2012, 32 (4):  458. 
    doi: 10.3969/j.issn.1674-8115.2012.04.019

    Abstract ( 1257 )   PDF (857KB) ( 1090 )  

    Objective To investigate the effects of recombinant human erythropoietin (rHuEPO) on the expression of erythropoietin receptor (EPOR) and its downstream signaling pathway in normal and insulin-resistant 3T3-L1 adipocytes. Methods The model of insulin-resistant 3T3-L1 adipocytes were induced by 1 μmol/L dexamethasone (model group), and the welldifferentiated normal 3T3-L1 adipocytes were served as control group. The expression of EPOR protein in cells was detected by immunofluorescence staining and Western blotting, and the expression of EPOR mRNA was determined by Real-Time PCR. Cells in model group and control group were intervened with rHuEPO, phosphatidylinositol-3-kinase (PI3K) inhibitor (LY294002) and signal transducer and activator of transcription 5(STAT5), and the effects of different interventions on the expression of EPOR protein and phosphorylation of downstream molecules of serine/threonine kinase (AKT) and STAT5 (p-Akt and p-STAT5 protein) were examined by Western blotting. Results The expression of EPOR protein and mRNA in model group was significantly lower than that in control group (P<0.05). The intervention experiment revealed that the relative expression of EPOR, p-Akt and p-STAT5 protein in rHuEPO+control group or model group was significantly higher than that in corresponding control group or model group (P<0.05), and the relative expression of p-Akt and p-STAT5 protein in rHuEPO+LY29400 or STAT5 blocker+control group or model group was significantly lower than that in corresponding rHuEPO+control group or model group (P<0.05). Conclusion EPOR exists in normal 3T3-L1 adipocytes, the expression of EPOR protein and mRNA in insulin-resistant 3T3-L1 adipocytes decreases, and rHuEPO can activate PI3K-Akt and JAK2-STAT5 signaling pathway through EPOR mediation.

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    Assessment of insulin resistance in diabetic mice by 13C-glucose breath test
    ZHANG Min, GUAN Liang, ZHU Cheng-mo, et al
    2012, 32 (4):  463. 
    doi: 10.3969/j.issn.1674-8115.2012.04.020

    Abstract ( 1444 )   PDF (303KB) ( 920 )  

    Objective To establish a noninvasive method of 13C-glucose breath test in assessment of insulin resistance (IR) based on the diabetic mice models, and explore its correlation with the other IR indexes. Methods Diabetic mice models were established by intravenous injection of alloxan tetrahydrate. For the 13C-glucose breath test, samples were collected at various time points after ingestion of 5 mg/kg 13C-labelled glucose. The value of 13CO2 at 90 min (C90 min) was calculated as the parameter of IR, and the effect of exogenous insulin (1 U) intervention on diabetic mice was evaluated. Fasting blood glucose and fasting insulin of diabetic mice were measured, and homeostatic model assessment of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were calculated. The correlation of C90 min with HOMAIR or QUICKI was analysed.ResultsC90 min in diabetic mice was significantly lower than that in normal rats [(0.79±0.18)% vs (1.19±0.31)%, t=2.470, P<0.05]. C90 min in diabetic mice increased to (1.17± 0.25)% after exogenous insulin (1 U) intervention (t=-2.522, P<0.05). Correlation analysis revealed that C90 min was well related to HOMA-IR (r=-0.64, P<0.05) or QUICKI (r=0.88, P<0.01). Conclusion 13C-glucose breath test may provide an effective noninvasive method for the assessment of IR in diabetic mice, which is well related to the IR indexes clinically available.

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    Impact of valproic acid on growth and expression of angiogenesis and metastasis-related factors in human ovarian carcinoma A2780 cells
    DU Hua-wen, RONG Feng-nian
    2012, 32 (4):  467. 
    doi: 10.3969/j.issn.1674-8115.2012.04.021

    Abstract ( 1204 )   PDF (731KB) ( 1024 )  

    Objective To investigate the impact of valproic acid (VPA) on growth and expression of angiogenesis and metastasisrelated factors in human ovarian carcinoma A2780 cells. Methods Human ovarian carcinoma A2780 cells cultured in vitro were treated with different concentrations of VPA, and the cell growth, cell apoptosis and expression of vascular endothelial growth factor (VEGF) and martix metalloproteinase-9 (MMP-9) protein were determined with MTT assay, flow cytometry and immunohistochemistry respectively. Results After treatment with VPA, the morphology of A2780 cells significantly changed, the cell growth was suppressed in a concentration- and time-dependent manner, and the expression of VEGF and MMP-9 protein decreased. Conclusion VPA may inhibit the growth, induce the apoptosis, and down-regulate the expression of VEGF and MMP-9 protein in human ovarian cancer A2780 cells, which indicates that VPA may contribute to the inhibition of tumor angiogenesis and metastasis.

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    Original article (Clinical research)
    Linear correlation of C0 with C2 of plasma concentrations of cyclosporin A in prediction of early clinical outcomes of recipients after renal transplantation
    PAN Jun-wei, WANG Xiang-hui, ZHOU Pei-jun, et al
    2012, 32 (4):  473. 
    doi: 10.3969/j.issn.1674-8115.2012.04.022

    Abstract ( 1851 )   PDF (365KB) ( 1222 )  

    Objective To investigate the effects of pharmacokinetic intra-variability of cyclosporin A (CsA) on early clinical outcomes of recipients after renal transplantation. Methods Forty-four recipients undergoing triple immunosuppressive therapy of CsA, mycophenolate mofetil (MMF) and corticosteroid early after allogeneic renal transplantation were selected. The plasma concentration of mycophenolic acid (MPA), which was the active component of CsA and MMF, was measured with enzymemultiplied immunoassay technique (EMIT), including the valley value before medication (C0) and peak value 2 h after medication (C2), and the linear correlation of CsA C0 with CsA C2 was analysed. Correlation group and non-correlation group were divided according to the results of correlation analysis, the prevalences of clinical events (infection, acute rejection, acute rejection combined with infection, dysfunction of transplanted kidney, liver and renal toxic reaction to CsA) and qualification rates of area under the curve of plasma concentration of MPA-time (AUCMPA)early after transplantation were compared between groups. Results There was non-linear correlation of CsA C0 with CsA C2 in 31 patients (70.45%), and there was linear correlation in 13 patients (29.55%). Statistic analysis revealed that there were significant differences in the prevalences of all clinical events 2 to 4 weeks after transplantation, prevalence of acute injection 2 to 4 weeks after transplantation and qualification rate of AUCMPA 2 to 4 weeks after translplantation between correlation group and noncorrelation group (P≤0.05). Conclusion The linear correlation of C0 with C2 of pharmacokinetic parameters of CsA may predict the early clinical outcomes of recipients after renal transplantation.

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    Early prediction of intracranial progressive hemorrhagic injury after traumatic brain injury
    YUAN Fang, DING Jun, GUO Yan, et al
    2012, 32 (4):  478. 
    doi: 10.3969/j.issn.1674-8115.2012.04.023

    Abstract ( 1349 )   PDF (519KB) ( 1237 )  

    Objective To establish a prognostic model for early prediction of intracranial progressive hemorrhagic injury after traumatic brain injury. Methods The clinical data of 396 patients with traumatic brain injury were collected for development of prognostic model. The relationship between admissionrelated risk factors and progressive hemorrhagic injury was systemically analysed, prognostic model was established, and the performance of the model was validated by goodness-of-fit test and calculation of C statistical value. Scoring was performed on risk factors according to Logistic β regression coefficient, and risk factor scoring system was established through linear function transformation. Prognostic model was ascertained after exterior validation. The prediction tool for intracranial progressive hemorrhagic injury after traumatic brain injury for clinical use was developed. Results Logistic regression analysis revealed that age≥57 years, decreased platelet count, prothrombin time>14 s, D-dimer≥5 mg/L, blood glucose≥10 mmol/L, intraparenchymal hemorrhage/brain contusion and midline shift ≥5 mm were independent prognostic factors of intracranial progressive hemorrhagic injury after traumatic brain injury. The performance of prognostic model developed from admission related risk factors was good, with P>0.05 for goodness-of-fit test and 0.864 for C statistical value. Exterior validation demonstrated that the prognostic model had a powerful exterior applicability, with P>0.05 for goodness-of-fit test and 0.862 for C statistical value. Patients were divided into low risk group, intermediate risk group and high risk group with risk factor scoring system. The prevalences of progressive hemorrhagic injury were 10.3%, 47.3% and 85.2% respectively in the development cohort, and those were 10.9%, 47.3% and 86.9% respectively in the validation cohort. Conclusion The established prognostic model may conveniently and accurately predict the occurrence of intracranial progressive hemorrhagic injury after traumatic brain injury in the early stage, and the developed prediction tool may help in the dicision making in clinics.

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    Effects of laser-assisted hatching on clinical outcomes of frozen-thawed embryo transfer
    GU Rui-huan, ZHANG Ai-jun, SUN Yi-juan, et al
    2012, 32 (4):  485. 
    doi: 10.3969/j.issn.1674-8115.2012.04.024

    Abstract ( 1373 )   PDF (444KB) ( 1231 )  

    Objective To investigate the effects of artificial thinning by laser-assisted hatching (AH) on the clinical outcomes of frozenthawed embryo transfer on day 3. Methods One thousand and twenty-four cycles undergoing frozen-thawed embryo transfer on day 3 were selected. Nine hundred and sixty-four cycles underwent thawed embryo transfer on day 3 (non-AH group), and the other 60 cycles underwent transfer after artificial thinning by AH (AH group). The rates of implantation, clinical pregnancy, multiple pregnancy, live birth, abortion and biochemistry pregnancy were statistically analysed in two groups. Results The rates of implantation, clinical pregnancy, multiple pregnancy, live birth, abortion and biochemistry pregnancy in two groups were 43.2% and 24.2%, 58.3% and 43.2%, 45.7% and 26.9%, 78.4% and 77.7%, 21.6% and 22.3%, and 6.7% and 4.4% respectively. There were significant differences in the rates of implantation, clinical pregnancy and multiple pregnancy between two groups (P<0.05). The rates of live birth, abortion and biochemistry pregnancy in AH group were higher than those in non-AH group, while there was no significant difference between two groups (P>0.05). Conclusion Artificial thinning by AH can increase the rates of implantation and clinical pregnancy, while there is no significantly change in the rate of live birth.

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    Clinical analysis of re-transurethral resection in management of non-muscle invasive bladder urothelial cancer
    SHEN Hai-bo, ZENG Yan-kai, GU Zheng-qin, et al
    2012, 32 (4):  491. 
    doi: 10.3969/j.issn.1674-8115.2012.04.025

    Abstract ( 1307 )   PDF (298KB) ( 1188 )  

    Objective To investigate the clinical value of re-transurethral resection (ReTUR) in the management of non-muscle invasive bladder urothelial cancer. Methods Seventy-six patients with non-muscle invasive bladder urothelial cancer received transurethral resection (TUR) combined with intravesical chemotherapy (single TUR group, n=38) or TUR, ReTUR combined with intravesical chemotherapy (ReTUR group, n=38). The rate of tumor residue after first TUR and rate of restaging after ReTUR in ReTUR group were observed. Patients were followed up after first TUR in two groups, and the rates of tumor recurrence were compared between two groups. Results In ReTUR group, the rate of tumor residue after first TUR was 31.6%, and the rate of restaging after ReTUR was 10.5%. The rate of tumor recurrence in ReTUR group was significantly lower than that in single TUR group (2.8% vs 21.1%, P<0.05). Conclusion Non-muscle invasive bladder urothelial cancer managed by ReTUR may discover residual tumors after first TUR, increase the accuracy of tumor staging, and decrease the rate of tumor recurrence.

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    Colposcopic cervical biopsy and pathology after loop electrosurgical excision procedure in diagnosis of cervical diseases
    YANG Feng-yun, YANG Bo, GU Ping, et al
    2012, 32 (4):  495. 
    doi: 10.3969/j.issn.1674-8115.2012.04.026

    Abstract ( 1586 )   PDF (366KB) ( 1219 )  

    Objective To investigate the values of colposcopic cervical biopsy, pathology after loop electrosurgical excision procedure (LEEP) and the combined examinations of colposcopic cervical biopsy and LEEP in the early diagnosis of cervical precancerous lesions and cervical cancer. Methods Five hundred and fifty-four patients with abnormal findings in cervical cytology and/or human papillomavirus (HPV) test or with normal findings in these screening tests while having moderate to severe cervical columnar eversion were subject to colposcopic cervical biopsy and LEEP, and the pathological findings were compared before and after LEEP. Results The total coincidence rate of colposcopic cervical biopsy and pathology after LEEP was 49.82%. In patients diagnosed as cervical intraepithelial neoplasia (CIN) Ⅰ by cervical biopsy, 14.36% were diagnosed as CINⅡ/Ⅲ after LEEP. In patients diagnosed as CIN Ⅱ/Ⅲ (including carcinoma in situ)  by cervical biopsy, 3.89% were diagnosed as invasive carcinoma after LEEP. Kappa coefficient was 0.62 in the consistency of diagnosis of CINⅡ/Ⅲ by two methods. Kappa coefficient was 0.80 in the consistency of diagnosis of CINⅡ/Ⅲ by colposcopic cervical biopsy and combined examinations of colposcopic cervical biopsy and LEEP, and that was 0.84 by pathology after LEEP and combined examinations of colposcopic cervical biopsy and LEEP. The total accuracy of colposcopic cervical biopsy was 81.77%, and the misdiagnosis rate of CINⅡ/Ⅲ was 20.64%. Conclusion Colposcopic cervical biopsy and pathology after LEEP are effective measures for diagnosis of CIN and microinvasive cervical carcinoma. Colposcopic cervical biopsy may misdiagnose high-level CIN and microinvasive cervical carcinoma, and the combined examinations can improve the accuracy of diagnosis.

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    Clinical efficacy of diverse intravertebral infusion with sufentanil and ropivacaine for labor analgesia
    LI Hai-bing, LIU Zhi-qiang, CHEN Xiu-bin, et al
    2012, 32 (4):  499. 
    doi: 10.3969/j.issn.1674-8115.2012.04.027

    Abstract ( 1426 )   PDF (293KB) ( 1246 )  

    Objective To compare the clinical efficacy of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) with sufentanil and ropivacaine for labor. Methods Sixty nulliparous parturients with cervical dilation of 3 cm were randomly assigned to receive CSEA (CSEA group) or EA (EA group) for labor, with 30 parturients in each group. Another 30 nulliparous parturients without labor analgesia were served as control group. Sufentanil 5 μg was intrathecally injected in every parturient of CSEA group, and was followed by administration of patient controlled analgesia (PCA). For EA group, 0.1%ropivacaine 5 mL in combination with 0.5 μg/mL sufentanil was administered, which was followed by injection of additional 10 mL, and PCA was applied. No analgesia was performed to control group. The analgesic onset time, maximum effect time, satisfaction from parturients, side effects, duration of stages of labor, cesarean section rate, and oxytocin and instrumental delivery were observed. Results The scores of visual analogue scale (VAS) in CSEA group and EA group gradually decreased after intravertebral anesthesia. The analgesic onset time and maximum effect time of CSEA group significantly advanced than EA group. The active periods of CSEA group and EA group were significantly shorter than that in control group (P<0.05). The duration of second stage of labor of EA group was longer than those of CSEA group and control group (P<0.05). There was no significant difference in the duration of the third stage of labor among three groups (P>0.05). The prevalence of pruritus of CSEA group was higher than those of EA group and control group. The modified Bromage score of EA group was higher than those of CSEA group and control group. There was no significant difference in the cesarean section rate, oxytocin and instrumental delivery rate among three groups (P>0.05). Conclusion CSEA and EA with sufentanil and ropivacaine are effective and safe for labor. CSEA is more suitable for labor with faster onset, lower consumption of drug and higher rate of satisfaction from parturients.

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    Serum visfatin levels in adult male patients with obstructive sleep apnea-hypopnea syndrome
    WANG Yan, LI Qing-yun, LIN Ying-ni, et al
    2012, 32 (4):  503. 
    doi: 10.3969/j.issn.1674-8115.2012.04.028

    Abstract ( 1331 )   PDF (347KB) ( 1236 )  

    Objective To investigate the levels of serum visfatin in adult male patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Seventy-three adult males with habitual snoring received polysonmographic examinations. Based on apnea hypopnea index (AHI), patients were divided into control group (AHI<5/h, n=13), mild OSAHS group (AHI 5-20/h, n=14), moderate group (AHI 21-40/h, n=15) and severe OSAHS group (AHI>40/h, n=31). The serum visfatin levels were measured by ELISA. Results ①There were significant differences in the serum visfatin levels among groups, and the serum visfatin levels increased with the severity of OSAHS [(0.23±0.11) ng/mL, (0.24±0.19) ng/mL, (0.29±0.24)ng/mL and (0.48±0.32) ng/mL, F=4.704,P=0.005)]. The serum visfatin level in severe OSAHS group was significantly higher than those in control group, mild OSAHS group and moderate group (t=2.751,P=0.009;t=2.563,P=0.014;t=2.014,P=0.05). ②Serum visfatin level was positively correlated with AHI, obstructive sleep apnea-index (OAI), micro-arousal index, duration of lowest oxygen desaturation and percentage of the total recorded time spent below 90% oxygen saturation level (TS90)(P<0.01), but was negatively correlated with lowest pulse oxygen saturation (LSPO2)(r=-0.435, P<0.01). ③Partial correlation analysis revealed that the serum visfatin level was positively correlated with OAI (r=0.253, P=0.033) after adjustment for body mass index (BMI) and neck circumference. ④Analysis of receiver operating characteristic (ROC) curve indicated that the cut-off value of serum visfatin was 0.273 ng/mL, and the sensitivity and specificity for differentiating mild and moderate OSAHS from severe OSAHS were 77% and 64% respectively. The area under the ROC curve was 0.733, and 95%CI was 0.609 to 0.858 (P=0.001). Conclusion Serum visfatin level increases with the severity of OSAHS in adult males, and the elevation of serum visfatin is related to the prevalence of OSAHS.

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    Original article (Preventive medicine)
    Investigation on acceptability of pre-exposure prophylaxis among female sex workers in Sichuan, Xinjiang and Guangxi of China
    QIU Lei, TIAN Kao-cong, ZHONG Xiao-ni, et al
    2012, 32 (4):  508. 
    doi: 10.3969/j.issn.1674-8115.2012.04.029

    Abstract ( 1510 )   PDF (370KB) ( 1075 )  

    Objective To investigate the acceptability and influencing factors of pre-exposure prophylaxis (Pr-EP) for human immunodeficiency virus (HIV) among female sex workers (FSWs) in Sichuan, Xinjiang and Guangxi of China. Methods FSWs selected from Sichuan, Xinjiang and Guangxi were surveyed with questionnaires. A total of 1 478 questionnaires were completed, among which 1 469 (99.39%) were effective. The survey mainly concerned with the awareness and acceptability of FSWs on Pr-EP. Results After introduction to Pr-EP by the investigators, under the precondition that Pr-EP was effective and safe, 997(67.9%) FSWs accepted Pr-EP, and there was no significant difference in the acceptability among FSWs in three regions (P>0.05). Univariate χ2 analysis and Logistic regression analysis revealed that self-evaluation of risks (OR=1.776, P=0.005), regular condom use in sex service (OR=1.346, P=0.000), frequency of condom use during the latest three times of sex service (OR=1.519, P=0.003), drug use to prevent sexually-transmitted disease (OR=1.185, P=0.025), refusal of having sex with those without condom use (OR=1.479, P=0.009) and advising peers to use Pr-EP (OR=5.618, P=0.000) were influencing factors of acceptability of Pr-EP. FSWs mainly concerned of the security, effectiveness and cost of Pr-EP. Conclusion FSWs with regular condom use are more likely to accept Pr-EP. Pr-EP related knowledge should be well exposed among FSWs to increase the awareness and acceptability. Peer education may be a better way to improve the acceptability of Pr-EP.

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    Original article (Public health administration)
    Empirical research on competency of general practitioners in community health service institutions
    MA Zhi-qiang, LIU Min, WANG Hai-rong
    2012, 32 (4):  514. 
    doi: 10.3969/j.issn.1674-8115.2012.04.030

    Abstract ( 1454 )   PDF (607KB) ( 1184 )  

    Objective To establish the model of competency of general practitioners in community health service institutions in China. Methods Through analysis of literatures and in-depth interviews of experts, the model of competency of general practitioners containing 16 factors was initially established, and the questionnaire including 16 items of competency was designed. Questionnaire survey (n=55) and empirical research (n=201) on competency of general practitioners were conducted among medical staffs selected from community health service institutions in 7 districts in Zhenjiang of Jiangsu Province. Five-point Likert scale was adopted, and the respondents were asked to determine the importance of each competency by rating from 5 to 1. The data collected from questionnaire survey were processed with exploratory factor analysis and confirmatory factor analysis by SPSS software and LISREL software. Results Exploratory factor analysis revealed that the load factor of each competency was up to 0.5, Cronbach's alpha was up to 0.9, and the explained variance of three factors of human capital, psychologic capital and relational capital was 84.876%, which demonstrated that the scale had a favorable reliability and validity. Confirmatory factor analysis indicated that human capital was the most important competency of general practitioners, among which non-professional knowledge, integrated management capability and analytical skill were more important. Enterprise was the most important competency of the psychological capital. In terms of relational capital, the relation with the signed community inhabitants had the most significant impact on performance of the general practitioners. Conclusion The established model of competency of general practitioners in community health service institution is verified, which has a high degree of fit and stability.

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    Review
    Anti-inflamation action of aspirin in atherosclerosis
    PAN Li-ting, CHEN Zhen-yue, LU Guo-ping
    2012, 32 (4):  519. 
    doi: 10.3969/j.issn.1674-8115.2012.04.031

    Abstract ( 1595 )   PDF (396KB) ( 1161 )  

    Atherosclerosis is a complex vascular inflammatory disease. It has been demonstrated that inflammatory processes participate in all stages of atherosclerotic development, from the initial stage of vascular endothelial cell perturbations to the ultimate thrombogenesis. Through inhibition of platelet function, aspirin plays an important role in the second level prevention of atherosclerotic diseases. However, aspirin is not only an anti-thrombotic drug but also an anti-inflammatory agent. The anti-inflammatory action of aspirin in atherosclerotic diseases, including inhibition action on nuclear factor-κB, cyclooxygenase, CD40/CD40 ligand and oxidative stress, and its lipoxin pathway in anti-inflammation action are reviewed in this paper.

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    Research progress of intraperitoneal free cancer cells of gastric cancer
    XIA Xiang, ZHU Zheng-lun, ZHU Zheng-gang
    2012, 32 (4):  524. 
    doi: 10.3969/j.issn.1674-8115.2012.04.032

    Abstract ( 1637 )   PDF (309KB) ( 1207 )  

    Peritoneum is a common recurrent and metastatic site of gastric cancer, and peritoneal metastasis and recurrence may have significant impact on the outcomes of patients with gastric cancer. As the early state of peritoneal metastasis, the detection of peritoneal free cancer cells may serve as a reliable way to predict peritoneal recurrence, estimate prognosis and guide treatment. The research progress of intraperitoneal free cancer cells of gastric cancer is reviewed in this paper.

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    Research progress of vascular endothelial function in chronic kidney disease
    ZHANG Xia, JIN Hui-min
    2012, 32 (4):  528. 
    doi: 10.3969/j.issn.1674-8115.2012.04.033

    Abstract ( 1504 )   PDF (407KB) ( 1124 )  

    The changes of vascular endothelial function are closely related to the development of chronic kidney disease (CKD). Cardiovascular diseases caused by vascular endothelial dysfunction are the common complications of CKD, and are important causes of mortality in patients with CKD. Based on the control of primary diseases, antioxidant drugs that ameliorate the vascular endothelial injury are now applied in the treatment of vascular endothelial dysfunction. The improvement of vascular endothelial function brought by dialysis is limited to some extent due to many influencing factors. New strategies such as gene therapy and cell transplantation, together with treatment available, may improve function and regeneration of vascular endothelial cells, reduce cardiovascular events, and decrease the mortality of patients with CKD.

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