Recruitment of general practitioners in China: a scoping review of strategies and challenges

Background

China is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.

Methods

We searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O’Malley’s framework and the PRISMA ScR reporting guidelines.

Results

A total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual’s background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years’ working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.

Conclusions

Long-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives.

Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01854-0.

Yak milk-derived exosomes alleviate lipopolysaccharide-induced intestinal inflammation by inhibiting PI3K/AKT/C3 pathway activation

Intestinal epithelial cells (IEC) are important parts of the mucosal barrier, whose function can be impaired upon various injury factors such as lipopolysaccharide. Although food-derived exosomes are preventable against intestinal barrier injuries, there have been few studies on the effect of yak milk-derived exosomes and the underlying mechanism that remains poorly understood. This study aimed to characterize the effect of exosomal proteins derived from yak and cow milk on the barrier function of IEC-6 treated with lipopolysaccharide and the relevant mechanism involved. Proteomics study revealed 392 differentially expressed proteins, with 58 higher expressed and 334 lower expressed in yak milk-derived exosomes than those in cow exosomes. Additionally, the top 20 proteins with a relatively consistent higher expression in yak milk exosomes than cow milk exosomes were identified. Protein CD46 was found to be a regulator for alleviating inflammatory injury of IEC-6. In vitro assay of the role of yak milk exosomes on survival of IEC-6 in inflammation by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay confirmed the effectiveness of yak milk exosomes to increase IEC-6 survival up to 18% for 12 h compared with cow milk exosomes (up to 12%), indicating a therapeutic effect of yak milk exosomes in the prevention of intestinal inflammation. Furthermore, yak and cow milk exosomes were shown to activate the PI3K/AKT/C3 signaling pathway, thus promoting IEC-6 survival. Our findings demonstrated an important relationship between yak and cow milk exosomes and intestinal inflammation, facilitating further understanding of the mechanisms of inflammation-driven epithelial homeostasis. Interestingly, compared with cow milk exosomes, yak milk exosomes activated the PI3K/AKT/C3 signaling pathway more to lower the incidence and severity of intestine inflammation, which might represent a potential innovative therapeutic option for intestinal inflammation.

Pyridoxine for prevention of hand-foot syndrome caused by chemotherapy agents: a meta-analysis

BACKGROUND

Hand-foot syndrome (HFS) is a common systemic skin toxicity syndrome caused by chemotherapy agents. However, there is no uniform clinical treatment for HFS. It is reported that pyridoxine (vitamin B6) can be used to prevent HFS, but the evidence is insufficient.

AIM

To determine whether pyridoxine can be used to prevent HFS caused by chemotherapy agents.

METHODS

Literature database searches were performed on PubMed, Web of Science, Embase, Cochrane Library and China National Knowledge Infrastructure. The efficacy of pyridoxine was evaluated by the incidence of HFS (any grade) or severe HFS (grade ≥ 2).

RESULTS

Fourteen studies involving 1570 patients were included in this meta-analysis. There were no significant differences between the pyridoxine and control groups in the prevention of HFS (OR = 0.84, 95% CI 0.67-1.05, P = 0.09) or in the incidence of grade ≥ 2 HFS (OR = 0.87, 95% CI 0.70-1.09, P = 0.39, respectively). The subgroup analysis of pyridoxine dose also showed no significant difference between the two groups in preventing HFS grade ≥ 2 (OR = 0.79, 95% CI 0.62-0.99, P = 0.30).

CONCLUSIONS

We did not find adequate evidence to support the idea that the use of pyridoxine can prevent HFS and reduce the incidence of HFS grade ≥ 2. However, the preventive use of pyridoxine might have a tendency to reduce the incidence of HFS.

Prevalence and Risk Factors of White Matter Lesions in Tibetan Patients Without Acute Stroke

Background and Purpose—

Studies on the prevalence and risk factors of white matter lesions (WMLs) in Tibetans living at high altitudes are scarce. We conducted this study to determine the prevalence and risks of WMLs in Tibetan patients without or with nonacute stroke.

Methods—

We undertook a retrospective analysis of medical records of patients treated at the People’s Hospital of Tibetan Autonomous Region and identified a total of 301 Tibetan patients without acute stroke. WML severity was graded by the Fazekas Scale. We assessed the overall and age-specific prevalence of WMLs and analyzed associations between WMLs and related factors with univariate and multivariate methods.

Results—

Of the 301 patients, 87 (28.9%) had peripheral vertigo, 83 (27.3%) had primary headache, 52 (17.3%) had a history of stroke, 36 (12.0%) had an anxiety disorder, 29 (9.6%) had epilepsy, 12 (4.0%) had infections of the central nervous system, and 3 (1.0%) had undetermined diseases. WMLs were present in 245 (81.4%) patients, and 54 (17.9%) were younger than 40 years. Univariate analysis showed that age, history of cerebral infarction, hypertension, the thickness of the common carotid artery intima, and plaque within the intracarotid artery were related risks for WMLs. Ordered logistic analysis showed that age, history of cerebral ischemic stroke, hypertension, male sex, and atrial fibrillation were associated with WML severity.

Conclusions—

Risk factors for WMLs appear similar for Tibetans residing at high altitudes and individuals living in the plains. Further investigations are needed to determine whether Tibetans residing at high altitudes have a higher burden of WMLs than inhabitants of the plains.

Comparison of general practice residents' attitudes and perceptions about training in two programmes in China: a mixed methods survey

Objective

To understand general practice (GP) residents’ attitudes about their residency training in China.

Design

Mixed methods survey administered cross-sectionally.

Setting

Two GP training programmes similar in most regards according to current GP training policy of 5 years’ undergraduate degree in medicine and 3 years of postgraduate GP residency training—but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme.

Participants

105 (85%) of eligible GP trainees, 35 (90%) in the innovative Beijing programme and 70 (83%) in the standard training Shenzhen programme.

Results

Overall, residents felt discrimination because of specialty choice, and that they lacked competency as a general practitioner. Many residents commented faculty had negative teaching attitudes. Beijing residents were more satisfied than Shenzhen residents with their training (p=0.001), and felt teaching faculty had sufficient knowledge (p<0.001), and appropriate attitudes towards teaching (p=0.004). Beijing residents more strongly agreed on five items about good future job prospects (all p<0.05).

Conclusion

These Chinese GP residents identify areas for improvement in their training as well as strengths. Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty, and can earn special certification, suggest that the educational innovations enhance training and promote positivity about job prospects. These findings imply that GP residents in China face many training challenges that are similar to other international reports, while also implicating benefits of using an innovative curricular approach.

First-year medical student attitudes about general practice in China: a comparison between Chinese and international students

INTRODUCTION

Chinese policy increasingly emphasizes growth of general practice (GP). The purpose of this research was to understand attitudes toward GP among first-year Chinese and international medical students studying in China.

METHODS

Based on a cross-sectional survey using a 5-point Likert scale of medical students at Peking University Health Science Center regarding attitudes toward specialty choice, practice setting, care of patient age groups, care types, and GP, we compared responses of Chinese and international medical students.

RESULTS

In total, 258 national and 77 international students participated. International students ranked equally or more highly as favorable practice settings associated with GP, eg, outpatient (P=0.05) and home care (P<0), types of care associated with GP, eg, preventive services (P<0) and palliative care (P=0.01), and age-groups of interest, eg, care for babies (P<0), children (P<0), and adult women (P=0.03). Chinese students more strongly endorsed beliefs that GP physicians are needed in rural Chinese areas (P<0), supported by the government (P=0.02), and respected by society (P<0).

DISCUSSION

Chinese students' attitudes about the social desirability of GP are consistent with Chinese policy, but international students more strongly endorsed desirable work characteristics of actual GP. These differences accentuate the need for more attention in the medical curriculum to educate Chinese students about why GP can be a personally rewarding career.

Training Pathways to Working as a General Practitioner in China

BACKGROUND AND OBJECTIVES

To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways.

METHODS

We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians.

RESULTS

The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited.

CONCLUSIONS

These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

The Expression of PRL-3 Correlates With Chromosomal Instability in Colon Cancer and Thyroid Cancer

Background: Phosphatase of regenerating liver (PRL-3) promotes cell invasiveness, but its role in genomic integrity remains unknown. We have reported that PRL-3 recruits to telomeric DNA by RAP1/TRF2 protein. Overexpression of PRL-3 in colon cancer cells and primary fibroblasts promotes structural abnormalities of telomere, telomere deprotection, DNA damage response, chromosomal instability. Aim: To substantiate the previous results and further assess the physiologic relevance of PRL-3 in tumorigenesis, also to explore the prediction role PRL-3 in clinical patients. We detected the expression of PRL-3, telomere length, H3K9me and p-H2AX in the colon cancer and thyroid cancer samples. Methods: We collected 273 colorectal cancer patients and stained with PRL-3 antibody and counterstained with HE. Semiquantitative scoring was performed. Microscopic analysis was done by 2 of the authors. Tissues-chips were obtained from Alenabio (Th802a, thyroid). Results: We retrospectively analyzed a cohort of colorectal cancer tissues (n = 269) stained with anti-PRL-3 (clone 3B6). Although the majority of mitotic cells were bipolar, more multipolar mitoses, an indicator of chromosomal missegregation and chromosomal instability, was observed in PRL-3 positive tissues than in negative tissues (Fig 1A). Also in the PRL-3 positive tissues, more anaphase bridges were detected ( Fig 1A ). These results suggest that PRL-3 levels positively correlate with chromosomal instability in colon cancer tissues. Next, we analyzed 12 freshly dissected colon cancer tissues, with WI38 control and PRL-3-overexpressing cells as reference samples. We detected varying levels of PRL-3 proteins in these tissues, and the level of stably overexpressed PRL-3 in WI38 cells was comparable to some of these tissues. An inverse correlation between PRL-3 and telomere length was revealed, while PRL-3 showed positive correlations with gamma-H2AX and H3K9me3 ( Fig 1B ). We also performed quantitative FISH (qFISH) analysis of telomere length and immunohistochemical staining of PRL-3 with thyroid tissue chips containing 80 samples. We found decreased telomere staining in adenocarcinoma tissues (n = 40) with positive PRL-3 expression, particularly in those of stage I (n = 23) ( Fig 1C ). No correlation was observed in thyroid adenoma (n = 40) or stage II/III/IV adenocarcinoma (n = 17) ( Fig 1C ). With the same thyroid tissue-chip, we evaluated association between PRL-3 and senescence. In stage I thyroid adenocarcinoma tissues, positive staining of PRL-3 correlated with positive H3K9me3 staining, but such correlation was not observed in thyroid adenoma or Stage II/III/IV adenocarcinoma ( Fig 1D ). Conclusion: These results raise the possibility that PRL-3-promoted telomere deprotection and senescence are early events during the development and progression of cancer. Our results uncover a novel role of PRL-3 in tumor development through its adverse impact on telomere homeostasis.[Figure: see text]

A note on cloning and analysis of the osteopontin gene with egg quality traits in two Chinese domestic ducks

1. Osteopontin (OPN) is a highly phosphorylated acidic glycoprotein that plays a crucial role in eggshell formation. In this study, an 893-bp cDNA sequence of the OPN gene, which encodes 180 amino acids, was obtained. 2. Polymorphisms of the OPN gene were analysed with DNA sequencing and polymerase chain reaction-single-strand conformation polymorphism methods in two Chinese domestic laying ducks (Jingding n = 100, Youxian n = 478, respectively). 3. One polymorphism was identified in exon 7 (NM_ 004676534.1:c.267T>C) of the OPN gene, with three genotypes: TT (both T allels weren't mutated (wild type)), TC (one T allel was mutated to C (heterozygote genotype)) and CC. (both T allels were mutated to C (homozygote 20 genotype)) Association analysis with egg quality traits in the two Chinese domestic laying ducks showed that the ducks with the CC genotype had significantly greater eggshell strength and eggshell thickness (p < 0.05). Hence, the exon 7 267T>C polymorphism of the OPN gene is a potentially valuable genetic marker for laying duck breeding programmes.

Effect of feeding Rumen-protected capsule containing niacin, K2SO4, vitamin C, and gamma-aminobutyric acid on heat stress and performance of dairy cows

This study was conducted to evaluate the effects of supplemental rumen-protected capsule (RPC) on animal performance, serological indicators, and serum heat shock protein 70 (HSP70) of lactating Holstein cows under heat stress (HS). During summer months, 30 healthy multiparous lactating Holstein cows with a parity number of 3.1 ± 0.44, 70 ± 15 d in milk, an average body weight of 622 ± 62kg, and an average milk yield of 32.28 ± 0.96kg/d, were used. The cows were randomly allocated to two groups: a control group and an RPC-supplemented group (0.13373kg K₂SO₄, 0.02488kg vitamin C, 0.021148kg niacin, and 0.044784kggamma-aminobutyric acid per cow). During the 42-d experiment, ambient air temperature and relative humidity inside and outside the barn were recorded hourly every day for the determination of temperature-humidity index (THI). Milk and blood samples were collected every week, and body weight and body condition scoring were measured on day 0. Based on the THI values, the animals had moderate HS. On day 42, the RPC group had lower HSP70, adrenocorticotropic hormone (P = 0.0001), lactate dehydrogenase (P = 0.0338), and IL-6 (P = 0.0724) levels than the control group, with no significant differences in creatine kinase, glucocorticoid, or IL-2 levels. Milk yield, energy-corrected milk, and dry matter intake were higher in RPC than in the control group (P = 0.0196). There were no significant differences in milk fat or daily protein levels between the two groups; however, daily protein and milk fat levels were higher in the RPC group than in the control group (P = 0.0114 and P = 0.0665, respectively). Somatic cell counts were no different between the two groups. In conclusion, RPC may alleviate HS and improve dairy cow performance.

A repetitive sequence assembler based on next-generation sequencing

Repetitive sequences of variable length are common in almost all eukaryotic genomes, and most of them are presumed to have important biomedical functions and can cause genomic instability. Next-generation sequencing (NGS) technologies provide the possibility of identifying capturing these repetitive sequences directly from the NGS data. In this study, we assessed the performances in identifying capturing repeats of leading assemblers, such as Velvet, SOAPdenovo, SGA, MSR-CA, Bambus2, ALLPATHS-LG, and AByss using three real NGS datasets. Our results indicated that most of them performed poorly in capturing the repeats. Consequently, we proposed a repetitive sequence assembler, named NGSReper, for capturing repeats from NGS data. Simulated datasets were used to validate the feasibility of NGSReper. The results indicate that the completeness of capturing repeat is up to 99%. Cross validation was performed in three real NGS datasets, and extensive comparisons indicate that NGSReper performed best in terms of completeness and accuracy in capturing repeats. In conclusion, NGSReper is an appropriate and suitable tool for capturing repeats directly from NGS data.

MicroRNA Bta-miR-181a regulates the biosynthesis of bovine milk fat by targeting ACSL1

MicroRNA (miRNA) are a class of small noncoding RNA that function as important posttranscriptional regulators of gene expression. The acyl-CoA synthetase long-chain family member 1 (ACSL1) is an important enzyme in the process of milk lipid synthesis. In a previous study dealing with incubations of stearic acid in bovine mammary epithelial cells, an opposite expression pattern was observed between ACSL1 and miR-181a. Bioinformatics analysis with TargetScan and PicTar revealed ACSL1 as a potential target gene of miR-181a. The objective of this work was to determine the potential function of miR-181a on milk fat synthesis by defining the regulatory relationship between miR-181a and ACSL1. Primary bovine mammary epithelial cells were harvested from mid-lactation cows and cultured in Dulbecco's modified Eagle's medium/F-12 medium with 10% fetal bovine serum, 0.5μg/mL of insulin, 10 ng/mL of epidermal growth factor, 5μg/mL of transferrin, 1μg/mL of hydrocortisone, 1μg/mL of progesterone, 5μg/mL of estradiol, and 5μg/mL of prolactin. Cells were transfected with an miR-181a mimic to increase its expression and an miR-181a inhibitor to decrease its expression before culturing for 48 h. The results revealed that the overexpression of miR-181a inhibited the expression of ACSL1, whereas the downregulation of miR-181a increased ACSL1 expression. Western blot analysis of ACSL1 revealed similar effects. Oil-red-O staining indicated that cellular lipid droplet synthesis was decreased with the overexpression of bta-miR-181a, and treatment with the bta-miR-181a inhibitor increased concentration of lipid droplets. Furthermore, overexpression of bta-miR-181a resulted in a decrease in concentration of triacylglycerol in the cells, whereas inhibition of bta-miR-181a increased concentration of triacylglycerol. Therefore, the results indicated that bta-miR-181a may contribute to negative regulation of lipid synthesis in mammary cells via targeting ACSL1.

Early development of gonads in Muscovy duck embryos

Characteristics of gonadal development were investigated in Muscovy duck embryos at various embryonic ages. Hematoxylin-Eosin and periodic acid-Schiff staining were used to identify primordial germ cells, oogonia and sustentacular cells. Gene specific primers were designed based on conserved regions of duck antimullerian hormone (AMH), oestrogen receptor-α (ESR-α), doublesex and Mab-3 related transcription factor-1(DMRT1) and W chromosome protein kinase C inhibitor/interacting gene (WPKCI). Quantitative real-time polymerase chain reaction was used to characterise gene expression during gonad development in Muscovy duck embryos. Histology indicated that ovarian and testicular cells of Muscovy duck embryos developed on d 9 and 10. Immunohistochemistry showed that mouse vasa homologue-positive cells as well as Glial cell line-derived neurotrophic factor-positive cells increased significantly more in females than in males between d 9 and 10. AMH and ESR-α expression increased significantly during early development. DMRT1 acts prior to and during testis differentiation whereas WPKCI was expressed actively in the female Muscovy duck embryo before the onset of gonadal differentiation. Gonad development in Muscovy duck embryo was associated with several genes that were expressed before morphological features appear and were gender specific.

An improved phase shift reconstruction algorithm of fringe scanning technique for X-ray microscopy

The X-ray phase imaging method has been applied to observe soft biological tissues, and it is possible to image the soft tissues by using the benefit of the so-called "Talbot effect" by an X-ray grating. One type of the X-ray phase imaging method was reported by combining an X-ray imaging microscope equipped by a Fresnel zone plate with a phase grating. Using the fringe scanning technique, a high-precision phase shift image could be obtained by displacing the grating step by step and measuring dozens of sample images. The number of the images was selected to reduce the error caused by the non-sinusoidal component of the Talbot self-image at the imaging plane. A larger number suppressed the error more but increased radiation exposure and required higher mechanical stability of equipment. In this paper, we analyze the approximation error of fringe scanning technique for the X-ray microscopy which uses just one grating and proposes an improved algorithm. We compute the approximation error by iteration and substitute that into the process of reconstruction of phase shift. This procedure will suppress the error even with few sample images. The results of simulation experiments show that the precision of phase shift image reconstructed by the proposed algorithm with 4 sample images is almost the same as that reconstructed by the conventional algorithm with 40 sample images. We also have succeeded in the experiment with real data.

First Report of Tomato yellow leaf curl virus in Acalypha australis in China

Whitefly-transmitted geminiviruses (WTGs) can cause serious damage to many crops in China, so an investigation of weed hosts of WTGs was carried out in Jiangsu Province, China, in 2012. Fifty-seven symptomless samples of Acalypha australis L., a common weed known as Asian copperleaf, were randomly collected from seven tomato fields in Nanjing and Lianyungang, Jiangsu Province, from July to September. Total DNA of each sample was extracted and PCR was performed using degenerate primers PA and PB to amplify a specific region covering the AV2 gene of DNA-A and part of the adjacent intergenic region (1). DNA fragments were successfully amplified from 27 out of 57 samples and PCR amplicons of 16 samples were sequenced. Alignment results showed that the nucleotide sequence identities ranged from 98 to 100% with Tomato yellow leaf curl virus (TYLCV) accessions. The full-length viral circular DNA genome was amplified using primer pair 1AbF (ATGTGGGATCCACTTCTAAATGAATTTCC) and 1AsR (GCGTCGACAGTGCAAGACAAACTACTTGGGGACC) which were designed based on the known sequences amplified by PA and PB. The complete genome sequence (GenBank Accession No. JX910534) was 2,781 nucleotides in length and had 99 to 100% sequence identity with TYLCV accessions (GU434142, GU111505). The dot immunobinding assay using monoclonal antibody against TYLCV confirmed the 27 weed samples positive by PCR were infected by TYLCV. These results demonstrated that A. australis is a host of TYLCV that might play an important role in viral epidemics in tomato fields in China. TYLCV-infected A. australis did not show typical symptoms like leaf curl, chlorosis, and stunting and thus appears to be a symptomless host. In our investigation, the infection rate ranged from 14 to 79% depending on the field sampled, suggesting that the weed may be an important reservoir of TYLCV, especially during the non-tomato planting period. To our knowledge, this is the first report of A. australis as a host of TYLCV in China. Reference: (1) D. Deng et al. Ann. Appl. Biol. 125:327, 1994.

A novel missense mutation of the ECM1 gene in a Chinese patient with lipoid proteinosis

Lipoid proteinosis (LP), is caused by loss-of-function mutations in the gene for extracellular matrix protein 1 (ECM1), and has been mapped to chromosome 1q21. We report the case of a 49-year-old Chinese woman with LP, who presented with a hoarse voice, easily damaged skin with poor wound healing, lesions and scarring on the skin, and bead-like papules around the eyelids. On physical examination, yellowish deposits were seen on the soft palate, with thickening of the vocal cords. The coding region of ECM1 was amplified and sequenced, and a novel homozygous single-nucleotide substitution, c.1429T>C, was found in exon 9, which converts cysteine to arginine, designated p.C477R. This mutation was not founded in 100 unrelated normal genomic DNA sequences. In conclusion, this is a novel mutation in the ECM1 gene, which is the underlying cause of LP in this patient.

Aberrant expression of Fas and FasL pro-apoptotic proteins in basal cell and squamous cell carcinomas

BACKGROUND

Fas and FasL are cell-surface receptors involved in apoptosis. Aim.  To investigate Fas and FasL expression levels in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) to gain an insight into the mechanisms of Fas/FasL apoptosis and immune evasion in epidermal tumours.

METHODS

Real-time PCR and streptavidin-biotin immunohistochemistry techniques were used to detect Fas and FasL expression in BCC, SCC and normal skin specimens.

RESULTS

Fas and FasL mRNA expression and immunostaining levels were lower in the 21 BCC specimens than in normal skin, whereas they were higher in the 15 SCC specimens than in normal skin.

CONCLUSION

FasL immunostaining correlated with the capability of the tumour to invade and metastasize; the absent or weak immunostaining in the BCC specimens correlated with low capability, and the strong staining in the SCC specimens correlated with high capability.

Identification of a novel mutation in a Chinese family with X-linked ocular albinism

PURPOSE

The purpose of the study was to evaluate the GPR143 gene (G-protein coupled receptor 143) in a Chinese three-generation family with OA1, including four carriers and a proband with clinical features of X-linked ocular albinism.

METHODS

The proband underwent a detailed ophthalmologic evaluation. Blood samples of family members were obtained and genomic DNA isolated. Mutational analysis by SSCP and direct sequencing of the GPR143 gene was used to screen all nine exons including the intron/exon junctions. The novel mutation c.943G>T (p.G315X) found in the study was confirmed by DHPLC to exclude the possibility of polymorphism.

RESULTS

Ophthalmic features of the proband were characteristic of X-linked ocular albinism. The authors identified a novel nonsense mutation p.G315X on exon 8 that was not found in 100 non-albinism subjects by DHPLC. This novel mutation in the GPR143 gene is predicted to subject to nonsense mediated decay.

CONCLUSIONS

The novel mutation p.G315X in the OA1 gene was identified in a Chinese family with ocular albinism, which is predicted to generate a premature stop codon. These findings extend the mutational spectrum of GPR143 gene and will be useful for gene diagnosis and genetic counseling in Chinese OA1 patients.

Oily skin: specific features in Chinese women

BACKGROUND/PURPOSE

Inconsistent data are available on the various types of skin, their prevalence and characterization, particularly regarding Asian skins. This observation prompted to conduct a large study in China to assess the prevalence of oily skin and identify the specific factors related to that type of skin.

METHODS

The multicentre trial involved 1787 Chinese women in Shenyang, Harbin, Beijing, Chengdu and Suzhou, between 18 and 65 years of age. Data on history of acne, the presence of environmental factors and a detailed self-evaluation of the skin were collected using a standardized questionnaire. A clinical evaluation of facial skin oiliness was carried-out by a dermatologist at each centre. Sebum secretion was measured on the forehead using Sebumeter SM810. Statistical analysis (multiple correspondence analysis) of typology was conducted based on self-evaluation data.

RESULTS

According to self-evaluation data, oily skin prevalence in the overall Chinese population of the study was 25.6%. Self-evaluation results were quite consistent with sebum measurements and with clinical assessment by dermatologist. Parameters associated with oily skin were (i) shiny skin and a past history of acne, (ii) irregular menstruation, and (iii) highly reactive or sensitive skin. Moreover, a clear and significant link was noted between oily skin and the ingestion of spicy or sweet food. Lastly, sebum levels were found to be twice as high in Beijing as in the other cities and were correlated to higher oily skin prevalence.

CONCLUSION

The study demonstrated the capacity of women for proper self-evaluation of their skin type. It also suggests a potential link between nutritional factors such as spicy and/or sweet diets and oily skin as well as between sensitive and oily skin in this population.

[A case-control study on the risk factors of esophageal cancer in Linzhou]

OBJECTIVE

To explore the characteristics of prevalence and influencing factors on the genesis of esophageal cancer.

METHODS

A population-based 1:1 matched case-control study was conducted in Linzhou. A total number of 352 pairs of cases and controls matched on sex, age and neighborhoods. Data was analysed by SAS software to calculate the odds ratio of and to evaluate the relative risks.

RESULTS

It was found that lower socio-economic status, environmental pollution around the residential areas, lampblack in room, lower body mass index (BMI), more pickled food intake, cigarette smoking, alcoholic drinking, vigor mental-trauma and depression were risk factors of esophageal cancer. It also showed that the subjects having had history of upper digestive tract operation, dysplasia of esophagus and family history of carcinoma markedly increased the risks of developing esophageal cancer.

CONCLUSION

Esophageal cancer seemed to be resulted from the combination of genetic and environmental factor, hence called for of medical surveillance and comprehensive prevention.

The effect of a levonorgestrel-releasing intrauterine device on human endometrial oestrogen and progesterone receptors after one year of use

Thirty-four women bearing a levonorgestrel-releasing intrauterine device, 20 micrograms/day (LNG-IUD-20), for 12-15 months were recruited. Endometrial biopsies were collected during the late proliferative phase of the cycle (on cycle days 10-12) before (control) and after the use of the IUD for 12 months, and assayed for oestrogen receptors (ER) and progesterone receptors (PR). An immunohistochemical technique with the peroxidase-antiperoxidase detection system (PAP method) was employed. D75 and JZB39 were the primary antibodies for ER and PR respectively. The immunostaining semiquantitative analysis was performed with a computerized microscope image processor, and expressed as 'grey value'. Both endometrial ER and PR populations were significantly lower after insertion of the IUD (P < 0.01) than in control biopsies. The intensity of nuclear staining and the percentage of positively stained cells for ER and PR in women with LNG-IUD were each about 50% of those in control biopsies. The results suggested that LNG released locally from the IUD has a depressive action on the ER and PR, which may contribute to the contraceptive effectiveness of this type of IUD and also to the possible causes of LNG-IUD-induced irregular bleeding and amenorrhoea.

The effect of levonorgestrel-releasing intrauterine device (20 micrograms/day) (LNG-IUD-20) on the morphological structure of human endometrium: a study of the endometrial factor VIII activity in the women before and after insertion of LNG-IUD-20 by the digital image analysis

The specimens of endometria were obtained from 18 women using an intrauterine device releasing levonorgestrel at 20 micrograms/day (LNG-IUD-20). An immunoperoxidase reaction, PAP method, with the antiserum of Factor VIII as the primary antibody, was carried out in the endometrial biopsies to detect the Factor VIII activity in the endometrial endothelium before and after insertion of LNG-IUD-20. The immunoperoxidase activity was quantitatively assessed by a computer digital image analyser. The results revealed that there were a lower Factor VIII activity in the endometrial endothelial cells after insertion of LNG-IUD-20 (p < 0.001) when compared with the control. From the results of the present study, it is suggested that the synthesis and release of endometrial endothelial Factor VIII might be inhibited by the insertion of LNG-IUD20.

A small scale field trial with expanded polystyrene beads for mosquito control in septic tanks

A field trial of the use of expanded polystyrene beads (EPSB) to control the breeding of mosquito larvae in household septic tanks was conducted in Sarawak. One week after treatment, the breeding of Culex quinquefasciatus and Aedes albopictus was reduced by 100% and 68.7% respectively. For both species combined, a 57.25% reduction in the adult emergence rate was achieved. No adult was caught in the emergence trap one month after treatment. A reduction in mosquito biting rates was reported by 87.3% of respondents. All households regarded the EPSB treatment as effective. This study has reduced the relatively high infestation rate of A. albopictus in the septic tanks to 16-20%. The EPSB treatment is feasible and practical. Post-treatment assessment using adult emergence traps and the implications for the vector control programme of the local authority are discussed.

An epidemiological study on the relationship of ectopic pregnancy and the use of contraceptives in Beijing--the incidence of ectopic pregnancy in the Beijing area. Beijing Collaborating Study Group for Ectopic Pregnancy

The incidence of ectopic pregnancy (EP) was studied through a 3-level monitoring network of maternal and child health care (MCH) in the entire Beijing area, including 82 hospitals, 19 MCH centers and 2 institutes for family planning. A total of 1,420 cases of EP were collected in a sample of 2.7 million women of reproductive age (15-49) during a one-year period from January 1 to December 31, 1990. The cases were confirmed by pathological examination or laparoscopy. In addition, epidemiological surveillance method was used. The results showed that the overall incidence of EP was 0.52 per thousand women of reproductive age (W = Women of reproductive age (15-49)) in the Beijing area, 0.6/1000W in the urban districts and 0.41/1000 in the rural area; 0.67/1000W married women, and 0.05/1000W in the unmarried. For married women, 0.54/1000W for those women using various contraceptive measures and 1.80/1000W for women using no contraceptives. The incidence of EP varies with different contraceptive methods. Female sterilization had the lowest incidence (0.18/1000W) and natural contraceptive measures (rhythm or withdrawal method) had the highest (2.43/1000W). It was 0.65/1000W in IUD users, 0.21/1000W in OC users and 0.57/1000W in couples using condoms or spermicides.

[Changes in TXB2/6-keto-PGF1 alpha ratio and their relation to blood lipids of Type A behavioral patterns]

To study the pathophysiological relation between Type A behavioral pattern and coronary artery disease, we analyzed the Type A behavioral pattern, serum triglycerides (TG), cholesterol (TC), high density lipoprotein cholesterol (HDLc), and TXB2, 6-keto-PGF1 alpha in 60 patients with coronary artery disease and 60 age-sex-matched healthy subjects. All of them had normal blood pressure. The results showed Type A behavioral pattern was more prevalent than Type B behavioral pattern in coronary artery diseased patients and the reverse was true in the controlled subjects (P < 0.025); TG, TC and TXB2/6-keto-PGF1 alpha ratio increased significantly in Type A behavioral pattern compared with Type B behavioral patients, but HDLc/(TC+TG) and the level of HDLc decreased significantly in the Type A behavioral pattern than in the Type B behavioral pattern (P < 0.05). The TG, TC increased significantly and 6-keto-PGF1 alpha HDLc decreased significantly in the coronary artery diseased patients (P < 0.05). However, the ratio of TXB2/6-keto-PGF1 alpha was inversely related to HDLc/(TC+TG) among the coronary artery diseased patients. The results of this cross-sectional study suggest that coronary artery disease is associated with Type A behavioral pattern through the metabolism of lipids and prostaglandins in various ways.

Ga-67 scan in patients with intrathoracic esophageal carcinoma planned for surgery

The authors evaluated Ga-67 scan in 68 patients with intrathoracic esophageal carcinoma initially planned for surgery. Of these, 59 patients were staged pathologically or surgically; their Ga-67 scan results correctly predicted the presence of extraesophageal spread and lymph node metastases. Of 38 clinical Stage II patients, 15 (39%) could be Stage III by the results of Ga-67 scan. However, two of four clinical Stage I patients (50%) and 35 of 38 clinical Stage II patients (92%) were eventually pathologic or surgical Stage III. This high conversion rate and the high incidence of Stage III in esophageal carcinoma patients may not justify routine use of Ga-67 scan only for staging. Ga-67 scan, however, was useful for planning radiotherapy, because missing extraesophageal extension or gross metastases from the radiation fields were detected in six patients of 51 so treated. Ga-67 scan has its value in some patients with intrathoracic esophageal carcinoma.

Adenocystic carcinoma in computed tomography

Computed tomography was introduced in 1972 by Ambrose and Hounsified in England. At first it was designed for diagnostic radiology and neurosurgery of the brain and skull. Soon, in 1974, whole-body computerized tomography scanners went into operation in the United States and then came into worldwide use. The use of computed tomography in maxillofacial regions is rare. In the report two adenocystic carcinomas in the maxilla are described by computed tomography, and the images thus produced are compared to those obtained by ordinary tomography and isotope scintigraphy.