Integrative review of international nursing research in Mainland China

BACKGROUND

Nursing research in Mainland China is divided into two parts: domestic nursing research, comprising all publications in Chinese; and international nursing research, comprising all publications in English. Domestic nursing research has been developing rapidly, demonstrated by the increase in new national or regional journals and publications. However, little is known about the extent of international research.

AIMS

To outline the development of international nursing research publications in Mainland China and to provide suggestions for future development.

METHOD

All of the papers were retrieved from PubMed. The key search phase was 'China or P.R.China NOT Hong Kong NOT Taiwan NOT Macao [AD]', with the limits of 'English', 'nursing journals' as well as the published date up to '2007/09/30'.

FINDINGS

PubMed recorded 57 English papers that were originally conducted in Mainland China during the search period from 1989 to 30 September 2007. Thirty-seven of the total 57 (65%) publications were contributed by Beijing, Shanghai and Hubei. Forty-four of the 57 publications were conducted with collaborators from Hong Kong, the USA, the UK and Canada. Thirteen publications were funded by international societies, while only three were funded by the Chinese government. The research topics mainly focused on clinical research, nursing education and nursing management.

CONCLUSIONS AND IMPLICATIONS

This study indicates that international nursing research has been growing slowly in Mainland China along with provincial variations. The suggestions to improve nursing research include the reform of nursing education, the enhancement of the collaboration with the international societies and the establishment of research priorities.

Clinical characteristic analysis of 32 patients with abdominal incision endometriosis

Medical records of 32 women with abdominal incision endometriosis who underwent surgical treatment in the Obstetrics and Gynaecology Hospital at Fudan University between September 1999 and March 2006 were reviewed retrospectively. All cases concerning the diagnosis of endometriosis were confirmed by two gynaecological pathologists. The median age was 32 years (range from 25 to 45). A total of 31 patients had a history of caesarean section, and one case underwent ovarian endometrioid cystectomy. All abdominal incision endometriosis presented with a mass in the abdominal scar. Among them, there were 30 patients who complained of cyclical pain during menses. All of the 32 cases underwent surgical treatment and had follow-up from 10 months to 6 years; there was no recurrence of endometriosis in 31 cases. Abdominal incision endometriosis is rare in women and most cases present following caesarean section. It is suggested that during caesarean section, precautions need to be taken to avoid transplantation of endometrium into the abdominal incision. Surgical treatment is recommended to excise the lesion completely. The frozen section is performed during the operation due to the possibility of malignancy in abdomen incision endometriosis.

NovaSil clay intervention in Ghanaians at high risk for aflatoxicosis: II. Reduction in biomarkers of aflatoxin exposure in blood and urine

The efficacy of NovaSil clay (NS) to reduce aflatoxin (AF) biomarkers of exposure was evaluated in 656 blood samples and 624 urine samples collected from study participants during a 3-month phase IIa clinical intervention trial in Ghana. NS was delivered before meals via capsules. Serum AFB (1)-albumin adduct was measured by radioimmunoassay and urinary AFM (1) metabolites were quantified by immunoaffinity-high-performance liquid chromatography (HPLC)-fluorescence methods. Levels of AFB (1) -albumin adduct in serum samples collected at baseline and at 1 month were similar (p = 0.2354 and p = 0.3645, respectively) among the placebo (PL), low dose (LD, 1.5 g NS day (-1)), and high dose (HD, 3.0 g NS day (-1)) groups. However, the levels of AFB (1)-albumin adduct at 3 months were significantly decreased in both the LD group (p < 0.0001) and the HD group (p < 0.0001) compared with levels in the PL group. Levels of AFM(1) in urine samples collected at baseline and at 1 month were not statistically different among the three study groups. However, a significant decrease (up to 58%) in the median level of AFM (1) in samples collected at 3 months was found in the HD group when compared with the median level in the PL group (p < 0.0391). In addition, significant effects were found for dose, time, and dose-time interaction with serum AFB(1)-albumin adduct and dose-time interaction with urinary AFM (1) metabolites. The results suggest that capsules containing NS clay can be used to reduce effectively the bioavailability of dietary AF based on a reduction of AF-specific biomarkers.

Polymorphism of HLA-DRB1, -DQB1 and -DPB1 genes in Bai ethnic group in southwestern China

In this work, polymorphism of human leukocyte antigen (HLA)-DRB1, -DQB1 and -DPB1 genes was detected using polymerase chain reaction-sequence-based typing method in 128 healthy unrelated volunteers from the Bai ethnic group of Yunnan province of southwest China. Among all the 28 alleles detected for the DRB1 gene, the most common allele was DRB1*120201 with a frequency of 16.41%, followed by DRB1*090102, DRB1*080302, DRB1*1404, DRB1*150101, DRB1*140101 and DRB1*160201, with frequencies of 10.16%, 9.77%, 9.38%, 8.98%, 8.59% and 8.21%, respectively. Among 19 DQB1 alleles detected, the most frequent allele was DQB1*030101/0309 (35.94%), followed by DQB1*050201 (11.33%), DQB1*060101/060103 (10.54%) and DQB1*0401 (10.16%). For the DPB1 locus, the most common alleles were DPB1*0501 (42.19%), DPB1*1301 (13.28%), DPB1*020102 (10.93%) and DPB1*040101 (9.77%). The comparison of HLA class II allele frequencies of Bais with those of other Chinese populations suggested that the Bai ethnic group belonged to the southern group of Chinese.

Reducing human exposure to aflatoxin through the use of clay: a review

Innovative sorption strategies for the detoxification of aflatoxins have been developed. NovaSil clay (NS) has been shown to prevent aflatoxicosis in a variety of animals when included in their diet. Results have shown that NS clay binds aflatoxins with high affinity and high capacity in the gastrointestinal tract, resulting in a notable reduction in the bioavailability of these toxins without interfering with the utilization of vitamins and other micronutrients. This strategy is being evaluated as a potential remedy for acute aflatoxicosis, and as a sustainable human intervention for aflatoxins via the diet. Phase I and II clinical trials confirmed the apparent safety of NS for further study in humans. A recent study in Ghanaians at high risk for aflatoxicosis has indicated that NS (at a dose level of 0.25%) is effective in decreasing biomarkers of aflatoxin exposure and does not interfere with the levels of serum vitamins A and E, and iron and zinc. In summary, enterosorption strategies/therapies based on NS clay are promising for the management of aflatoxins and as a sustainable public health intervention. The NS clay remedy is novel, inexpensive and easily disseminated. Based on the present research, aflatoxin sequestering clays should be rigorously evaluated in vitro and in vivo, and should meet the following criteria: (1) favourable thermodynamic characteristics of mycotoxin sorption, (2) tolerable levels of priority metals, dioxins/furans and other hazardous contaminants, (3) safety and efficacy in multiple animal species, (4) safety and efficacy in long-term studies, and (5) negligible interactions with vitamins, iron and zinc and other micronutrients.

Workshop on the production, application and clinical translation of ''non-standard'' PET nuclides: a meeting report

A one-day satellite workshop was organized to coincide with the 17(th) International Symposium on Radiopharmaceutical Sciences held in Aachen, Germany, April 30-May 4, 2007. The workshop, ''Production and application of non-standard' PET nuclides'', was held on Sunday April 29, 2007 at the Eurogress Aachen and was organized by J. Lewis, PhD, L. Tang, and M. Welch, PhD. The workshop was designed for the radiopharmaceutical community discussing the production, use and dissemination of the ''non-standard'' PET nuclides. The definition of ''non-standard'' positron emission tomography (PET) nuclides included (45)Ti, (60)Cu, (61)Cu, (64)Cu, (66)Ga, (72)As, (74)As, (76)Br, (86)Y, (89)Zr, (94)mTc and (124)I. The workshop was supported by the grant Research Resource for Cancer Applications (R24 CA86307) funded by the National Cancer Institute at the National Institutes of Health. The workshop was attended by over 110 scientists and engineers from over 20 countries from all over the world and was designed with an open forum style to allow for discussions and interactions by all participants. All of the invited speakers were asked to make a contribution to this edition of the Quarterly Journal of Nuclear Medicine. The individual articles following this introduction are reviews of their area of expertise and the current state-of-the-art. This introduction briefly describes the role of the workshop, the aims and the general outcome. Also, the translation of these nuclides to the clinic, perhaps the most important goal of this work is discussed in this introductory article.

Radionuclide production and yields at Washington University School of Medicine

Washington University School of Medicine has carried out the production of ''non-standard'' nuclides for the positron emission tomography (PET) community since 1999 under the Radionuclide Resource for Cancer Applications grant R24 CA 86307 funded by the National Cancer Institute. With the support from the grant, we have successfully developed procedures for the high yield production of a wide range of radionuclides and made them available to the research community. The following non-standard PET nuclides, (60)Cu, (61)Cu, (64)Cu, (76)Br, (77)Br, (124)I, (94m)Tc, and (86)Y are routinely produced on Washington University on-site Cyclotron Corporation CS-15 or Japan Steel Works 16/8 cyclotrons. Additionally, a technique to produce (45)Ti has been developed and lately, (89)Zr is being investigated. This paper describes the production techniques and presents the performance results in terms of yields and radionuclidic purity. Sufficient yields for distribution are achieved and high radionuclide purity is also achieved yielding high quality product for medical research.

Measurement of nuclear transparency for the A(e,e'pi+) reaction

We have measured the nuclear transparency of the A(e,e'pi+) process in 2H, 12C, 27Al, 63Cu, and 197Au targets. These measurements were performed at the Jefferson Laboratory over a four momentum transfer squared range Q2=1.1 to 4.7 (GeV/c)2. The nuclear transparency was extracted as the super-ratio of (sigmaA/sigmaH) from data to a model of pion-electroproduction from nuclei without pi-N final-state interactions. The Q2 and atomic number dependence of the nuclear transparency both show deviations from traditional nuclear physics expectations and are consistent with calculations that include the quantum chromodynamical phenomenon of color transparency.

Increasing risk for negative ozone impacts on vegetation in northern Sweden

Trends were found for increasing surface ozone concentrations during April-September in northern Sweden over the period 1990-2006 as well as for an earlier onset of vegetation growing season. The highest ozone concentrations in northern Sweden occurred in April and the ozone concentrations in April showed a strong increasing trend. A model simulation of ozone flux for Norway spruce indicated that the provisional ozone flux based critical level for forests in Europe is exceeded in northern Sweden. Future climate change would have counteracting effects on the stomatal conductance and needle ozone uptake, mediated on the one hand by direct effect of increasing air temperatures and on the other through increasing water vapour pressure difference between the needles and air. Thus, there is a substantial and increasing risk for negative impacts of ozone on vegetation in northern Sweden, related mainly to increasing ozone concentrations and an earlier onset of the growing season.

Biomass production and carbon sequestration potential in poplar plantations with different management patterns

Biomass production and carbon storage in short-rotation poplar plantations over 10 years were evaluated at the Hanyuan Forestry Farm, Baoying County, China. Experimental treatments applied in a split-plot design included four planting densities (1111, 833, 625 and 500 stems ha(-1)) and three poplar clones (NL-80351, I-69 and I-72). Based on the model of total biomass production developed, total plantation biomass production was significantly different in the plantations. The ranking of the plantation biomass production by planting density was 1111>833 more more than 625>500 stems ha(-1), and by components was stem>root>or=branch>leaf for all plantations. At 10 years, the highest total biomass in the plantation of 1111 stems ha(-1) reached about 146 t ha(-1), which was 5.3%, 11.6% and 24.2% higher than the plantations of 833, 625 and 500 stems ha(-1), respectively. The annual increment of biomass production over 10 years differed significantly among initial planting densities and stand ages (p<0.01), but no significant difference was observed from age 7 to 10. Mean carbon concentration among all biomass components ranged from 42-50%, with the highest carbon concentrations in stems and the lowest in leaves. Over the study period, the dynamic pattern of total plantation carbon storage by planting density was similar to that of total biomass production. At age 10, the highest total plantation carbon storage in the plantation of 1111 stems ha(-1) reached about 72.0 t ha(-1), which was 5.4%, 11.9% and 24.8% higher than in the plantations of 833, 625 and 500 stems ha(-1), respectively. The annual carbon storage increment over 10 years differed significantly among initial planting densities and stand ages (p<0.01), and it showed a pattern similar to the annual biomass production increment of the plantations. The results suggest that biomass production and carbon storage potential were highest for planting densities of 1111 and 833 stems ha(-1) grown over 5- and 6-year cutting cycles, respectively. If 3- or 4-year cutting cycles are used, the planting density should be higher than 1111 stems ha(-1) (e.g., 1667 or 2500 stems ha(-1)). Based on the mean annual carbon storage for the plantation of 625 stems ha(-1), as an estimation, the mean carbon storage in the biomass of poplar plantations (excluding leaves) amounts to 3.75x10(7) t ha(-1)yr(-1) in China.

NovaSil clay intervention in Ghanaians at high risk for aflatoxicosis. I. Study design and clinical outcomes

A 3-month double-blind and placebo-controlled, phase IIa clinical trial was conducted in Ghana to investigate the safety, tolerance and aflatoxin-sorption efficacy of dietary NovaSil (NS). Volunteers (507 subjects) were clinically screened to evaluate their general health, pregnancy status and blood AFB(1)-albumin adduct levels. Of these subjects, 177 were randomly assigned to three groups: high-dose (HD), low-dose (LD) and placebo-control (PL) groups receiving 3.0, 1.5 and 0 g NS day(-1) in capsules. Trained study-monitors supervised NS capsule administration to participants and recorded side-effects daily. Physical examinations were performed monthly. Blood and urine samples were collected for laboratory analysis. Approximately 92% of the participants (162 of 177) completed the study and compliance rate was over 97%. Overall, 99.5% of person x time reported no side-effects throughout the study. Mild to moderate health events ( approximately 0.5% of person x time) were recorded in some participants. Symptoms included nausea, diarrhea, heartburn and dizziness. These side-effects were statistically similar among all three groups. No significant differences were shown in hematology, liver and kidney function or electrolytes in the three groups. These findings demonstrate that NS clay is apparently safe and practical for the protection of humans against aflatoxins in populations at high risk for aflatoxicosis.

Selective hepatic vascular exclusion and Pringle maneuver: a comparative study in liver resection

OBJECTIVE

Most liver resections require champing of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver cannot control backflow bleeding of the hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from injuries of the hepatic vein. Although total hepatic vascular exclusion (THVE) can prevent bleeding of the hepatic vein effectively, it also may result in systemic hemodynamic disturbance because of the clamped inferior vena cava (IVC). SHVE, a new technique, can control the inflow and outflow of the liver without clamping the vena cava. We compared the effects of selective hepatic vascular exclusion (SHVE) and Pringle maneuver in resection of liver tumors involving the junction of the hepatic vein.

METHODS

From January 2000 to October 2005, 2100 patients with liver tumors had undergone liver resections in our department. Among them, tumors of 235 cases adhered to or were close to the junction of one or more hepatic veins. Both SHVE and Pringle maneuver were used to control blood loss during hepatectomy. These 235 cases were divided into two groups: Pringle maneuver group (110) from January 2000 to December 2002 and SHVE group (125) from January 2003 to October 2005. Data were analyzed regarding the intraoperative and postoperative courses of the patients. In the SHVE group, total SHVE (clamping the porta hepatis and all major hepatic veins) was used in 69 cases and partial SHVE (clamping the porta hepatic and one or two hepatic veins) in 56 cases. There were three methods in hepatic veins occlusion: ligating with suture, encircling and occluding with tourniquets and clamping with Satinsky clamps.

RESULTS

There was no difference between the two groups regarding the age, gender, tumor size, cirrhosis and HBsAg rate, ischemia time and operating time. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group. Hepatic veins rupture with massive blood loss occurred in 14 and air embolism in three during the tumor resection, but there was no massive blood loss and air embolism in the SHVE group due to hepatic vein occlusion. Postoperative bleeding, reoperation, liver failure and mortality rate were higher, and ICU stay and hospital stay were longer in the Pringle group than those in the SHVE group.

CONCLUSION

SHVE is much more effective than Pringle maneuver in controlling intraoperative bleeding. It can prevent massive blood loss and air embolism from hepatic veins rupture and can reduce the postoperative complication rate and mortality rate. Clamping the hepatic veins with Satinsky clamps is much safer and easier than ligating with suture and occluding with tourniquets.

Gene therapy with CX3CL1/Fractalkine induces antitumor immunity to regress effectively mouse hepatocellular carcinoma

CX3CL1/Fractalkine(FK), a chemokine existing in both secreted and membrane anchored form, was reported to induce suppressive activities in tumor models. Here, we demonstrate for the first time the antitumor effects of FK in murine hepatocellular carcinoma (HCC) by constructing a FK eukaryotic expression vector (pIRES-FK) and transferring it into such tumor cells. Tumor rejection experiments were performed by injecting FK gene-modified murine HCC cell line (MM45T.Li) into immunocompetent mice, which significantly inhibited tumorigenicity or growth of MM45T.Li-FK cells. Immunohistochemistry examination and fluorescence-activated cell sorting analyses revealed both CD4+ and CD8+ T cells infiltration within the tumor together with a marked increase of these cells in the peripheral blood. Splenic lymphocyte from mice treated with MM45T.Li-FK were effective in the induction of tumor-specific cytotoxic T cells. We also observed an increased production of IL-2 and IFN-gamma in MM45T.Li-FK tumor tissue. Our results suggest that transfer of the FK gene into tumor cells could elicit a specific antitumor immunity capable of inhibiting tumor growth which lead to increased survival of tumor-bearing hosts. FK should be considered as a chemokine suitable for cancer immunoprevention or gene therapy.

Minimal residual local disease predicts improved survival after chemoradiotherapy in patients with squamous cell carcinoma of the esophagus

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Background: Our recent analyses (JCO, in press) showed that residual nodal disease but not T-stage predicted survival after chemo-radiotherapy (CRT) and surgery for esophageal adenocarcinoma (AC). In this study, we investigated prognostic factors for esophageal squamous cell carcinoma (SCC) after CRT. Methods: Retrospective review of patients with esophageal SCC who had CRT and esophagectomy. Data collected: demographics, CRT details, pathologic findings, and survival. Statistical methods included recursive partitioning (RP) and Kaplan-Meier (KM) analyses. Results: Patients included in the study were treated between 1/1996 and 2/2006. Follow up was thru 5/06. 91 patients were appropriate for analysis. There were 56 men (61.5%) and 35 women (38.5%). 72 (79.1%) patients had clinical regional disease prior to treatment, while the rest had locally advanced disease. Median radiation dose was 5040 cGy, and 78 (85.7%) patients received cisplatin based chemotherapy. 49 (53.8%) patients had a complete local pathologic response (pCR), including 10/91 (10.9%) who had a pCR with residual nodal disease. 42 (46.2%) patients had residual local disease. RP analysis identified 3 prognostic groups: a) Group 1 (n=52), patients with minimal residual local disease (pCR & T1- regardless of nodal status), b) Group 2 (n=28), patients with residual T2 disease (N0 and N1) as well as patients with T3–4N0 disease, and c) Group 3 (n=11), patients with residual T3–4N1 disease. 3-year survival by KM analysis was 68.4% in group 1, 45.6% in group 2, and 0 % in group 3 (p<0.001). Conclusions: Unlike adenocarcinoma of the esophagus where residual nodal disease after CRT is the most significant predictor of survival, in SCC of the esophagus, the presence of minimal residual local disease after CRT, regardless of nodal status, predicts the best survival. The implications of these findings might include establishing different endpoints to assess response to treatment and prognostic criteria.

No significant financial relationships to disclose.