RESUMO Introdução: Há um aumento anual na incidência de diabetes tipo 2 (T2DM) nas pessoas de meia idade. O exercício aeróbico é conhecido por influenciar positivamente as vias metabólicas da glicose. Porém há poucos estudos sobre o exercício aeróbico calistênico e sua influência em pacientes entre 40 a 60 anos com T2DM. Objetivo: Medir o efeito terapêutico do exercício calistênico em pacientes de meia idade com obesidade e T2DM. Métodos: Um total de 86 pacientes com T2DM foram selecionados a partir do exame físico dos funcionários da mesma unidade. Eles foram divididos aleatoriamente entre o grupo de exercícios e o grupo de controle. A intervenção do exercício durou 16 semanas, com sessões realizadas de 3 a 5 vezes por semana, variando de 60 a 90 minutos por sessão. Os marcadores avaliados foram definidos de acordo com a literatura e verificados estatisticamente. Resultados: Após 16 semanas de intervenção de exercício aeróbico calistênico, em comparação ao grupo controle ou antes do experimento, observamos reduções significativas nas variáveis VFA (área de gordura visceral), FPG (glicose de jejum), Fins (insulina em jejum), HOMA-IR (avaliação do modelo de homeostase de resistência à insulina), 2hPBG (glicose pós-prandial de duas horas) e HbAlc (hemoglobina Alc) do grupo exercício foram significativamente reduzidas (P<0,01). Conclusão: A intervenção de exercício aeróbico calistênico pode reduzir os níveis de VFA, FPG. FIns, HOMA-HR, 2hPBG e HbAlc em pacientes com T2DM. Também foi constatado que reduz o conteúdo de gordura visceral de pacientes idosos obesos com T2DM, reduzindo os riscos de obesidade. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

ABSTRACT Introduction: There is an annual increase in type 2 diabetes (T2DM) incidence in middle-aged people. Aerobic exercise is known to influence glucose metabolic pathways positively. Few studies concerning calisthenic aerobic exercise and its influence on elderly patients with T2DM. Objective: To measure the therapeutic effect of calisthenic exercise in obese Middle-aged people with T2DM. Methods: A total of 86 patients with T2DM were selected from the physical examination of employees of the same unit. They were randomly divided into the exercise group and the control group. The exercise intervention lasted for 16 weeks, with sessions held 3-5 times per week, varying from 60 to 90 minutes per session. The markers evaluated were defined according to the literature and statistically verified. Results: After 16 weeks of calisthenic exercise intervention, compared to the control group or before the experiment, we observed significant reductions in variables VFA (visceral fat area), FPG (fasting glucose), Fins (fasting insulin), HOMA-IR (homeostasis model evaluation of insulin resistance), 2hPBG (postprandial two hours glucose) and HbAlc (hemoglobin Alc) of the exercise group were significantly reduced (P<0.01). Conclusion: Calisthenic exercise intervention can reduce the levels of VFA, FPG. FIns, HOMA-HR, 2hPBG and HbAlc in patients with T2DM. It was also found to reduce the visceral fat content of obese elderly patients with T2DM, reducing obesity risks. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMEN Introducción: Cada año aumenta la incidencia de la diabetes tipo 2 (T2DM) en personas de mediana edad. Se sabe que el ejercicio aeróbico influye positivamente en las vías metabólicas de la glucosa. Pero hay pocos estudios sobre el ejercicio aeróbico calisténico y su influencia en pacientes de 40-60 años con T2DM. Objetivo: Medir el efecto terapéutico del ejercicio calisténico en pacientes de mediana edad con obesidad y T2DM. Métodos: Se seleccionó un total de 86 pacientes con T2DM a partir de la exploración física de los empleados de la misma unidad. Se dividieron aleatoriamente entre el grupo de ejercicio y el grupo de control. La intervención de ejercicios duró 16 semanas, con sesiones realizadas de 3 a 5 veces por semana, de 60 a 90 minutos por sesión. Los marcadores evaluados se definieron según la literatura y se verificaron estadísticamente. Resultados: Después de 16 semanas de intervención de ejercicio aeróbico calisténico, en comparación con el grupo de control o antes del experimento, observamos reducciones significativas en las variables VFA (área de grasa visceral), FPG (glucosa en ayunas), Fins (insulina en ayunas), HOMA-IR (evaluación del modelo de homeostasis de resistencia a la insulina), 2hPBG (glucosa postprandial de dos horas) y HbAlc (hemoglobina Alc) del grupo de ejercicio se redujeron significativamente (P<0,01). Conclusión: La intervención de ejercicio aeróbico calisténico puede reducir los niveles de AGV, FPG. FIns, HOMA-HR, 2hPBG y HbAlc en pacientes con T2DM. También se ha comprobado que reduce el contenido de grasa visceral en pacientes ancianos obesos con T2DM, reduciendo el riesgo de obesidad. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Abstract Spices have long been used in many countries to enhance or modify the flavor of meat and meat products. In general, different cooking treatments of spices can produce significantly different flavor. Jiao-ma chicken (JMC), as a traditional and characteristic cuisine in China, is prepared by boiled chicken seasoned with its exquisite flavor sauce. The delicious flavor of its sauce has won great popularity, and fried chili pepper (Capsicum annuum L.) oil (CPO) and pricklyash peel (Zanthoxylum bungeanum M.) oil (PPO) are its essential ingredients. To investigate the effects of CPO and PPO on the formation of aroma characteristics of JMC, the volatiles of CPO and PPO with and without chicken soup (CS) were analyzed by SPME/GC-MS. A total of 69 and 64 volatiles were identified in semi-finished JMC sauce (CS, CPO, and PPO) and final JMC sauce, respectively. GC-MS results showed that the composition and proportions of volatiles were significantly changed. Adding CPO and PPO to the basic CS generated several terpenes, and caused significant decreases in alcohols, aldehydes, and ketones, resulting in an exquisite spicy flavor of JMC sauce. Combined with GC-O and principal component analysis (PCA) results, it was found that 23 volatiles positively involved in the aroma formation, and might be significantly contributed to the unique flavor of JMC sauces.

Abstract Since the grape skin and seed contain different phenolic substances, the proportion of the skin and seed will affect the wine mouthfeel during the wine making process. During the wine ageing, the interaction between flavanols with anthocyanins is an important reaction and considered linked to astringency. Hence, a major question is whether changing the skin-seed ratio will affect the polymerization of phenolic substances in wine, thus affecting the astringency of wine. To answer this, astringency of wine was studied by changing the content of grape skins and seeds by SDS-PAGE, fluorescence quenching and sensory taste. Besides, acetaldehyde-mediated condensation reaction between different flavan-3-ols and malvidin-3-glucoside were studied in model solution. The result showed that grape skins and seeds contribute differently to astringency sensation, mainly because of the difference in the type and content of flavanols and anthocyanins contained in them. In addition, acetaldehyde-induced flavan-3-ols: anthocyanin mixture presents a strong effect toward the interaction with BSA when compared to other phenolic combinations. Furthermore, it was observed that the protein-binding ability of the polyphenols in red wine has a strong correlation with the wine astringency intensity.

ABSTRACT Background: Dragon′s blood is a well-known traditional Chinese medicine, isolated mainly from the trunks of Dracaena trees. Overexploitation of the Dracaena resource has resulted in this plant becoming endangered. This work aimed to assess the potential to use various tissues of the Dracaena cochinchinensis tree, such as leaves and roots, to produce dragon′s blood. Results: We found that many dragon′s blood components accumulated in the bark of trunk and roots of D. cochinchinensis under natural conditions. In addition, small amounts of loureirin A were detected in leaves, suggesting that the leaves could be a potential source of dragon′s blood. Real-time quantitative PCR analysis showed that most of the genes tested in this study, which encoded enzymes involved in the biosynthesis of dragon′s blood flavonoids, were highly expressed in the bark of roots and trunk. Conclusion: We confirmed that the bark of roots and trunk of D. cochinchinensis tree were the main tissues for the synthesis and storage of dragon′s blood under natural conditions. This study demonstrated the potential to extract dragon′s blood from the roots that have been abandoned due to mining difficulties without destroying the tree, a process which would be beneficial to the protection of the endangered wild D. cochinchinensis tree populations.

OBJECTIVE: The occurrence of cryptic Philadelphia (Ph) chromosome translocation is rare in BCR-ABL1-positive acute lymphoblastic leukemia (BCR-ABL1+ ALL) and is of unknown significance in the tyrosine kinase inhibitor (TKI) era. METHODS: We retrospectively studied a series of adult patients receiving TKI-based therapy to evaluate the prognostic impact of the normal karyotype (NK) (n=22) in BCR-ABL1+ ALL by comparison with the isolated Ph+ karyotype (n=54). RESULTS: There were no statistically significant differences in clinical characteristics and complete remission rate between the two groups. Compared with the isolated Ph+ group, the NK/BCR-ABL1+ group had a higher relapse rate (55.0% versus 29.4%, p=0.044). Overall survival (OS) and disease-free survival (DFS) were significantly shorter in the NK/BCR-ABL1+ group than in the isolated Ph+ group [median OS: 24.5 versus 48.6 (months), p=0.013; median DFS: 11.0 (months) versus undefined, p=0.008]. The five-year OS and DFS for patients with NK/BCR-ABL1+ were 19.2% and 14.5%, respectively; those for patients with isolated Ph+ were 49.5% and 55.7%, respectively. Thirty-four (44.7%) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in this study. Among the patients who received allo-HSCT, the median OS and DFS in the NK/BCR-ABL+ group (n=9) were 35.5 and 27.5 months, respectively, while those in the isolated Ph+ group (n=25) were undefined. There was a trend of significant statistical difference in the OS between the two subgroups (p=0.066), but no significant difference in the DFS. Multivariate analysis revealed that NK was independently associated with worse OS and DFS in BCR-ABL1+ ALL patients [Hazard ratio (HR) 2.256 (95% confidence interval (CI), 1.005-5.066), p=0.049; HR 2.711 (95% CI, 1.319-5.573), p=0.007]. CONCLUSION: Our results suggest that the sub-classification of an NK could be applied in the prognostic assessments of BCR-ABL1+ ALL. In addition, allo-HSCT should be actively performed to improve prognosis in these patients.

This aim of this study was to assess the molecular mechanism of osteoporosis in schizophrenia patients with risperidone use. Here, we investigated the effects of risperidone on cellular proliferation and apoptosis of a preosteoblast cell line, MC3T3-E1. Cell viability and apoptotic rate of MC3T3-E1 were detected by cell counting kit-8 and flow cytometry at a serial dose of risperidone and at different time points, respectively. Bone transformation relevant gene serum osteocalcin (BGP), collagen 1, tumor necrosis factor-α (TNF-α), osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL) mRNA levels were determined by real-time PCR (qPCR). Their protein expression patterns were evaluated using western blot. The results revealed that risperidone dramatically inhibited MC3T3-E1 cell proliferation in a dose-dependent manner. It also significantly induced MC3T3-E1 cell apoptosis. TNF-α gene and protein levels were greatly enhanced after risperidone treatment. In contrast, BGP, collagen 1, OPG, and RANKL gene and protein levels were markedly downregulated. Our study indicated that risperidone suppressed MC3T3-E1 cell proliferation and induced apoptosis. It also regulated BGP gene and protein expression.

Non-alcoholic fatty liver disease (NAFLD) is a common disease associated with metabolic syndrome and can lead to life-threatening complications like hepatic carcinoma and cirrhosis. Exenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist antidiabetic drug, has the capacity to overcome insulin resistance and attenuate hepatic steatosis but the specific underlying mechanism is unclear. This study was designed to investigate the underlying molecular mechanisms of exenatide therapy on NAFLD. We used in vivo and in vitro techniques to investigate the protective effects of exenatide on fatty liver via fat mass and obesity associated gene (FTO) in a high-fat (HF) diet-induced NAFLD animal model and related cell culture model. Exenatide significantly decreased body weight, serum glucose, insulin, insulin resistance, serum free fatty acid, triglyceride, total cholesterol, low-density lipoprotein, aspartate aminotransferase, and alanine aminotransferase levels in HF-induced obese rabbits. Histological analysis showed that exenatide significantly reversed HF-induced lipid accumulation and inflammatory changes accompanied by decreased FTO mRNA and protein expression, which were abrogated by PI3K inhibitor LY294002. This study indicated that pharmacological interventions with GLP-1 may represent a promising therapeutic strategy for NAFLD.

Abstract Heparanase activity is involved in cancer growth and development in humans and single nucleotide polymorphisms (SNPs) in the heparanase gene (HPSE) have been shown to be associated with tumors. In this study, we investigated whether SNPs in HPSE were a risk factor for hepatocellular carcinoma (HCC) by undertaking a comprehensive haplotype-tagging, case-control study. For this, six haplotype-tagging SNPs (htSNPs) in HPSE were genotyped in 400 HCC patients and 480 controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. A log-additive model revealed significant correlations between the HPSE polymorphisms rs12331678 and rs12503843 and the risk of HCC in the overall samples (p = 0.0046 and p = 0.0055). When the analysis was stratified based on hepatitis B virus (HBV) carrier status, significant interactions between rs12331678 and rs12503843 and HBV were observed. Conditional logistic regression analysis for the independent effect of one significant SNP suggested that rs12331678 or rs12503843 contributed an independent effect to the significant association with the risk of HCC, respectively. Our findings suggest that the SNPs rs12331678 and rs12503843 are HCC risk factors, although the potential functional roles of these two SNPs remain to be fully elucidated.

Abstract Background: Von Zumbusch type of generalized pustular psoriasis is a rare variant of psoriasis in children. It can occur in patients with or without psoriasis vulgaris. Objective: The aim of the study was to discuss the precipitating factors, clinical manifestations, laboratory data and therapy of von Zumbusch type of generalized pustular psoriasis in children from southwestern China and to improve the diagnosis and treatment level. Methods: A retrospective analysis was conducted for inpatients aged 14 years old or less with von Zumbusch type of generalized pustular psoriasis in our department from 2005 to 2014. Results: A total of 26 patients were included, of whom four (15.38%) had previous history of psoriasis vulgaris and one (3.85%) had previous history of psoriasis arthropathica. Mean onset age was 6.90 years. Gender distribution was equivalent. Incidence of the disease in summer and autumn was higher than that in winter and spring. Nineteen (73.08%) cases were triggered by infection, two (7.69%) cases were caused by sudden discontinuation of systemic use of corticosteroid. Twenty-four (92.31%) cases had concomitant fever. The initial lesion manifested as non-follicular sterile pustules on erythema. Sixteen patients responded well to acitretin, 11 to Tripterygium wilfordii Hook F (TwHF), two to cyclosporine, and one to methotrexate. Study limitations: This study is a retrospective one and the number of cases is small. CONCLUSION: Von Zumbusch type of generalized pustular psoriasis is a rare disease in children, infection is the most common precipitating factor, acitretin is the first-line therapy, traditional Chinese medicine TwHF also can be used.

Abstract Purpose: To evaluate the effects of HBO (Hyperbaric oxygen) and NGF (Nerve growth factor) on the long-term neural behavior of neonatal rats with HIBD (Neonatal hypoxic ischemic brain damage). Methods: The HIBD model was produced by ligating the right common carotid artery of 7 days old SD (Sprague-Dawley) rats followed by 8% O2 + 92% N2 for 2h. Totally 40 rats were randomly divided into 5 groups including sham-operated group, HIBD control group, HBO treated group, NGF treated group and NGF + HBO treated group. The learning and memory ability of these rats was evaluated by Morris water maze at 30 days after birth, and sensory motor function was assessed by experiments of foot error and limb placement at 42 days after birth. Results: The escape latency of HBO treated group, NGF treated group and NGF + HBO treated group was shorter than that of HIBD control group (p<0.01) and longer than that of sham-operated group. The piercing indexes of 3 treated groups were higher than that of HIBD control group (p<0.01). Conclusion: Hyperbaric oxygen and nerve growth factor treatments may improve learning and memory ability and sensory motor function in neonatal rats after hypoxic ischemic brain damage.

ABSTRACT This study highlights the prevalence of aminoglycoside-modifying enzyme genes and virulence determinants among clinical enterococci with high-level aminoglycoside resistance in Inner Mongolia, China. Screening for high-level aminoglycoside resistance against 117 enterococcal clinical isolates was performed using the agar-screening method. Out of the 117 enterococcal isolates, 46 were selected for further detection and determination of the distribution of aminoglycoside-modifying enzyme-encoding genes and virulence determinants using polymerase chain reaction -based methods. Enterococcus faecium and Enterococcus faecalis were identified as the species of greatest clinical importance. The aac(6')-Ie-aph(2")-Ia and ant(6')-Ia genes were found to be the most common aminoglycoside-modifying enzyme genes among high-level gentamicin resistance and high-level streptomycin resistance isolates, respectively. Moreover, gelE was the most common virulence gene among high-level aminoglycoside resistance isolates. Compared to Enterococcus faecium, Enterococcus faecalis harbored multiple virulence determinants. The results further indicated no correlation between aminoglycoside-modifying enzyme gene profiles and the distribution of virulence genes among the enterococcal isolates with high-level gentamicin resistance or high-level streptomycin resistance evaluated in our study.

我们尚不清楚中国目前的方案是否可以实现 2015 年后的全球结核病目标--到 2025 年前将发病率降低 50％ 并将死亡率降低 75％。中国的政策制定者需要保持结核病患病率近期的下降幅度，同时修订调控政策以应对耐药结核病的广泛传播以及对持续进行的医疗改革的影响。 医疗改革有望将患者从结核病防治所转移到指定医院。 我们开发了中国控制结核病的数学模型，以帮助设定适当的目标和优先考虑干预措施，这些都可能会在未来 10 年内实现。 此模型表明，即使在最乐观的情况下--改善结核病防治所中的治疗，引进能够有效治疗药物敏感结核病的新方案和耐多药结核病病例的最佳护理--仍不可能实现目前的全球结核病目标。 然而，降低耐多药结核病的发病率应该是可行的。 我们得出的结论是，如果指定医院中治愈率不能保持在较高的水平，将患者从结核病防治所转移到指定医院有可能会妨碍结核病控制工作。 我们的研究结果可以告知中国的结核病防治规划。

Il est difficile de savoir si les programmes actuellement menés en Chine permettront d'atteindre les objectifs mondiaux pour l'après-2015 concernant la tuberculose, qui consistent à réduire l'incidence de 50% et la mortalité de 75% d'ici à 2025. Les dirigeants chinois doivent confirmer le récent déclin de la prévalence de la tuberculose, mais aussi revoir les politiques de lutte pour faire face à une épidémie de tuberculose pharmacorésistante et les effets de l'actuelle réforme de la santé. La réforme de la santé est censée prévoir le transfert des patients traités dans des dispensaires antituberculeux vers des hôpitaux expressément désignés. Nous avons élaboré un modèle mathématique de lutte contre la tuberculose en Chine qui aide à définir les objectifs appropriés et à hiérarchiser les interventions qui pourraient être réalisées au cours des dix prochaines années. Ce modèle indique que même dans le scénario le plus optimiste - amélioration du traitement dans les dispensaires antituberculeux, introduction d'un nouveau schéma thérapeutique efficace pour le traitement de la tuberculose sensible et traitement optimal des cas de tuberculose multirésistante -, il paraît difficile d'atteindre les objectifs mondiaux actuels pour la tuberculose. Néanmoins, il devrait être possible de réduire l'incidence de la tuberculose multirésistante. Nous en concluons que le transfert des patients traités dans des dispensaires antituberculeux vers des hôpitaux expressément désignés est susceptible d'entraver les efforts de lutte contre la tuberculose s'il est impossible de maintenir des taux de guérison élevés dans ces hôpitaux. Nos résultats peuvent servir de base à la planification de la lutte contre la tuberculose en Chine.

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It is unclear if current programmes in China can achieve the post-2015 global targets for tuberculosis - 50% reduction in incidence and a 75% reduction in mortality by 2025. Chinese policy-makers need to maintain the recent decline in the prevalence of tuberculosis, while revising control policies to cope with an epidemic of drug-resistant tuberculosis and the effects of ongoing health reform. Health reforms are expected to shift patients from tuberculosis dispensaries to designated hospitals. We developed a mathematical model of tuberculosis control in China to help set appropriate targets and prioritize interventions that might be implemented in the next 10 years. This model indicates that, even under the most optimistic scenario - improved treatment in tuberculosis dispensaries, introduction of a new effective regimen for the treatment of drug-susceptible tuberculosis and optimal care of cases of multidrug-resistant tuberculosis - the current global targets for tuberculosis are unlikely to be reached. However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible. We conclude that a shift of patients from tuberculosis dispensaries to designated hospitals is likely to hamper efforts at tuberculosis control if cure rates in the designated hospitals cannot be maintained at a high level. Our results can inform the planning of tuberculosis control in China.

من غير الواضح ما إذا ما كان تحقيق الأهداف العالمية المنشودة لما بعد 2015 ممكنًا فيما يتعلق بمرض السل في الصين من خلال البرامج الحالية، حيث تتمثل هذه الأهداف في تقليل حالات الإصابة بالمرض بنسبة 50% وتقليل حالات الوفاة الناتجة عنه بنسبة 75% مع حلول عام 2025. وإن صناع القرار الصينيين بحاجة إلى الحفاظ على مستوى انخفاض انتشار مرض السل، في الوقت الذي يراجعون فيه سياسات السيطرة على المرض للتعامل بفعالية مع وباء مرض السل المقاوم للأدوية وآثار الإصلاح المستمر في مجال الخدمات الصحية، ومن المتوقع أن تؤدي الإصلاحات في الخدمات الصحية إلى نقل المرضى من مستوصفات علاج السل إلى مستشفيات محددة. وقد وضعنا نموذجًا حسابيًا للسيطرة على مرض السل في الصين للمساعدة في تحديد الأهداف المناسبة وترتيب أولويات التدخلات التي يمكن تنفيذها على مدى العشر سنوات القادمة. ويشير هذا النموذج إلى أنه حتى في حالة حدوث أكثر السيناريوهات تفاؤلًا - ألا وهي تحسين سبل العلاج في مستوصفات علاج مرض السل، وتوفير نظم جديدة فعالة لعلاج السل المستجيب للأدوية، وتوفير الرعاية الصحية المثلى لحالات الإصابة بالسل المقاوم للأدوية المتعددة - من المستبعد الوصول إلى الأهداف العالمية الحالية المتعلقة بمرض السل. وعلى الرغم من ذلك، يجب أن يكون الحد من حالات الإصابة بمرض السل المقاوم للأدوية المتعددة ممكنًا. ونخلص من ذلك بأن نقل المرضى من مستوصفات علاج السل إلى مستشفيات محددة من المرجح أن يعيق الجهود الرامية إلى السيطرة على مرض السل في حالة تعذر الحفاظ على ارتفاع مستوى معدلات التعافي في المستشفيات المحددة. ويمكن الاستفادة من النتائج التي توصلنا إليها في توفير المعلومات اللازمة للتخطيط للسيطرة على مرض السل في الصين.

No está claro si los programas actuales en China pueden alcanzar los objetivos globales para la tuberculosis después de 2015, una reducción del 50% de la incidencia y una reducción del 75% de la mortalidad de aquí a 2025. Los responsables políticos de China necesitan mantener el reciente descenso en la prevalencia de la tuberculosis, al mismo tiempo que revisan las políticas de control para hacer frente a una epidemia de tuberculosis farmacorresistente y los efectos en la reforma sanitaria en curso. Se espera que las reformas sanitarias trasladen los pacientes de los dispensarios para tuberculosis a los hospitales designados. Se ha desarrollado un modelo matemático de control de la tuberculosis en China para ayudar a establecer los objetivos apropiados y priorizar las intervenciones que podrían implementarse en los próximos diez años. Este modelo indica que, incluso en el escenario más optimista (una mejora del tratamiento en los dispensarios para tuberculosis, la introducción de un nuevo y efectivo régimen para el tratamiento de la tuberculosis farmacosensible y la atención óptima en casos de la tuberculosis farmacorresistente), es muy poco probable que se cumplan los objetivos actuales globales para la tuberculosis. Sin embargo, las reducciones en la incidencia de la tuberculosis farmacorresistente deberían ser factibles. Se concluye que es posible que un cambio de los pacientes de los dispensarios para tuberculosis a los hospitales designados obstaculice los esfuerzos de un control para la tuberculosis si las tasas de cura en los hospitales designados no pueden mantenerse en un nivel alto. Nuestros resultados pueden dar información sobre la planificación del control de la tuberculosis en China.

Tuberculosis (TB) services in China are provided through a large network of TB dispensaries. Even though hospitals are not as well placed to follow recommended standards of TB care, a significant proportion of people with TB symptoms seek care from hospitals. In spite of having a policy and mandate in place, the Ministry of Health had little success in encouraging hospitals to refer suspected TB cases to dispensaries. Following the epidemic of severe acute respiratory syndrome in 2003, the government set up a nationwide Internet-based communicable diseases reporting system. This achieved productive collaboration between hospitals and TB dispensaries. From 2004 to 2007, the percentage of TB suspects and patients needing referral from hospitals who arrived in TB dispensaries increased substantially from 58.7% to 77.8% and the contribution of hospitals to diagnosing sputum smear-positive TB cases doubled from 16.3% to 32.9%. Using the Internet-based reporting system, hospitals in China contributed to finding about one third of all sputu m smear-positive TB cases and helped meet the global TB control target of detecting 70% of such cases. Based on the data available from routine surveillance facilitated by this Internet-based system, this paper details the process and outcomes of strengthening collaboration between hospitals and TB dispensaries using the Internet as a tool and its potential application to other country settings.

Los servicios de atención sanitaria de la tuberculosis (TB) en China se proporcionan a través de una amplia red de dispensarios especializados. Aunque los hospitales no están incluidos en las normas asistenciales recomendadas para la tuberculosis, una proporción considerable de personas con síntomas de tuberculosis acuden a ellos. A pesar de haber dispuesto una normativa y una orden al respecto, el Ministerio de Sanidad no había conseguido que los hospitales remitieran los casos sospechosos de tuberculosis a los dispensarios. A raíz de la epidemia de síndrome respiratorio agudo y grave de 2003, el gobierno creó un sistema nacional de notificación de enfermedades transmisibles a través de Internet, que consiguió que los hospitales y los dispensarios de atención de la tuberculosis desarrollaran una colaboración fructífera. Entre 2004 y 2007, el porcentaje de casos posibles o confirmados de tuberculosis derivados de los hospitales que accedieron a los dispensarios de tuberculosis aumentó considerablemente, del 58,7% al 77,8%, y la contribución de los hospitales para el diagnóstico de los casos de TB con baciloscopias positivas se duplicó del 16,3% al 32,9%. Gracias a la utilización del sistema de notificación a través de Internet, los hospitales de China han contribuido en la detección de aproximadamente un tercio de todos los casos de TB con baciloscopias positivas y han ayudado a cumplir el objetivo mundial de control de la tuberculosis, esto es, detectar el 70% de los casos. Basándose en los datos disponibles de vigilancia sistemática facilitados por este sistema basado en Internet, este artículo detalla el proceso y los resultados de la consolidación de la colaboración entre los hospitales y los dispensarios de tuberculosis que utilizan Internet como herramienta fundamental, así como su posible aplicación a otros países.

En Chine, les services de traitement de la tuberculose (TB) sont fournis par un large réseau de dispensaires de TB. Même si les hôpitaux ne sont pas bien placés pour suivre les normes recommandées en matière de soins de la TB, une part importante de personnes présentant les symptômes de la TB cherche à se faire soigner dans les hôpitaux. Bien que le ministère de la Santé dispose d'une politique et d'un mandat, il n'a que très peu réussi à encourager les hôpitaux à signaler les suspicions de TB aux dispensaires. Suite à l'épidémie du syndrome respiratoire aigu sévère (SRAS) en 2003, le gouvernement a mis en place un système de notification des maladies par Internet à l'échelle nationale. Ce système a permis d'obtenir une collaboration productive entre les hôpitaux et les dispensaires de TB. De 2004 à 2007, le pourcentage de suspicions et de cas avérés de TB nécessitant une orientation des patients des hôpitaux vers les dispensaires de TB a considérablement augmenté de 58,7 à 77,8%. De plus, la contribution des hôpitaux dans le diagnostic des cas de TB à frottis d'expectoration positifs a doublé, passant de 16,3 à 32,9%. En utilisant un système de notification par Internet, les hôpitaux chinois ont contribué à détecter environ un tiers de tous les cas de TB à frottis d'expectoration positifs et ont permis de répondre à l'objectif de contrôle de la TB global, qui est d'identifier 70% de ces cas. Reposant sur les données disponibles de la surveillance continue facilitée par ce système Internet, cet article décrit en détail le processus et les résultats d'une collaboration renforcée entre les hôpitaux et les dispensaires de TB qui utilisent Internet comme un outil ainsi que son application potentielle aux situations des autres pays.

OBJECTIVE: To prevent perinatal transmission of hepatitis B virus (HBV), WHO recommends that the first dose of hepatitis B (HepB) vaccine be given within 24 hours after birth. This presents a challenge in remote areas with limited cold-chain infrastructure and where many children are born at home. METHODS: Rural townships in three counties in China's Hunan Province were randomized into three groups with different strategies for delivery of the first dose of HepB vaccine. In group 1, vaccine was stored within the cold chain and administered in township hospitals. In group 2, vaccine was stored out of the cold chain in villages and administered by village-based health workers to infants at home. Group 3 used the same strategy as group 2, but vaccine was packaged in a prefilled injection device. Training of immunization providers and public communication conveying the importance of the birth dose was performed for all groups. FINDINGS: Among children born at home, timely administration (within 24 hours after birth) of the first dose of HepB vaccine increased in all groups after the study: group 1, from 2.4% to 25.2%; group 2, from 2.6% to 51.8%; and group 3, from 0.6% to 66.7%; P < 0.001 in each case. No significant difference in antibody response to vaccine was observed between the groups. CONCLUSION: Timely administration of the first dose of HepB vaccine was improved by communication and training activities, and by out-of-cold-chain storage of vaccine and administration at the village level, especially among children born at home.

OBJETIVO: A fin de prevenir la transmisión perinatal del virus de la hepatitis B, la OMS recomienda que la primera dosis de la vacuna contra esa enfermedad (HepB) se administre en un plazo de 24 horas después del nacimiento. Eso entraña serias dificultades en las zonas remotas, donde falta infraestructura de cadena de frío y donde muchos niños nacen en el hogar. MÉTODOS: Se procedió a asignar aleatoriamente diversos municipios rurales de tres cantones de la provincia china de Hunan a tres estrategias diferentes de implementación de la primera dosis de vacuna HepB. En el grupo 1 la vacuna se conservó en la cadena de frío y se administró en los hospitales del municipio. En el grupo 2 la vacuna se conservó fuera de la cadena de frío en las aldeas y fue administrada por los agentes de salud de aldea a los lactantes en su hogar. Con el grupo 3 se usó la misma estrategia que con el grupo 2, pero envasando la vacuna en un dispositivo de inyección precargado. En todos los grupos se adiestró oportunamente a los vacunadores y se hizo llegar a la población el mensaje de que la dosis de nacimiento era muy importante. RESULTADOS: Entre los niños nacidos en el hogar, la administración puntual (en las 24 horas siguientes al nacimiento) de la primera dosis de vacuna HepB aumentó en todos los grupos después del estudio: del 2,4% al 25,2% en el grupo 1; del 2,6% al 51,8% en el grupo 2; y del 0,6% al 66,7% en el grupo 3 (P < 0,001 en todos los casos). No se observó ninguna diferencia importante en la respuesta de anticuerpos inducida por la vacuna entre los tres grupos. CONCLUSIÓN: La administración puntual de la primera dosis de la vacuna HepB mejoró de resultas de las actividades de comunicación y capacitación, así como del procedimiento de conservar la vacuna fuera de la cadena de frío y administrarla en las aldeas, especialmente entre los niños nacidos en el hogar.

OBJECTIF: Pour prévenir la transmission périnatale du virus de l'hépatite B (VHB), l'OMS recommande que la première dose de vaccin contre l'hépatite B (HepB) soit administrée dans les 24 h suivant la naissance. Cela représente un défi pour les zones reculées et peu équipées en infrastructures de maintien de la chaîne du froid, dans lesquelles de nombreux enfants naissent à la maison. MÉTHODES: Des localités rurales appartenant à trois comtés de la province chinoise du Hunan ont été réparties au hasard entre trois groupes bénéficiant de stratégies différentes pour la délivrance de la première dose de vaccin anti-HepB. Dans le cas du groupe 1, le vaccin a été stocké dans le cadre de la chaîne du froid et administré dans des hôpitaux relevant des localités. Dans celui du groupe 2, le vaccin a été stocké en dehors de la chaine du froid dans des villages et administré à domicile aux nourrissons par des agents de santé basés dans ces villages. Pour le groupe 3, la même stratégie a été appliquée que pour le groupe 2, sauf que le vaccin a été conditionné dans un dispositif pour injection pré-rempli. Pour tous les groupes, une formation a été apportée aux vaccinateurs et une opération de communication en direction du public a été menée pour faire connaître l'importance de la vaccination à la naissance. RÉSULTATS: A l'issue de l'étude, l'administration dans les délais (dans les 24 h suivant la naissance) de la première dose de vaccin anti-HepB a augmenté chez les enfants nés à domicile de tous les groupes. Groupe 1 : 2,4 % à 25,2 % ; groupe 2 : 2,6 % à 51,8 % et groupe 3 : 0,6 % à 66,7 % ; (p < 0,001 dans tous les cas). Aucune différence notable n'a été relevée entre les groupes concernant la réponse en anticorps au vaccin. CONCLUSION: Les opérations de communication et de formation, ainsi que le stockage hors de la chaîne du froid du vaccin et son administration au niveau des villages, ont entraîné des améliorations en termes d'administration dans les délais de la première dose de vaccin anti-HepB, en particulier chez les enfants nés à domicile.