TRENDS OF CASE DETECTION AND OTHER INDICATORS OF LEPROSY IN CHINA DURING 1985-2002

Objective To analyze the trends of case detection and other indicators of leprosy in China during 1985-2002. Methods Data reported by each province were collected by China National Leprosy Database in Nanjing P.R.China. All data about registered cases were put into computer for analysis. Results From 1985 to 2002, a total of 49 477 leprosy new cases had been detected. Among them, 69.5% were multi- bacillary cases and 25.4% had grade 2 disability. The child cases aged below 15 years accounted for 3.74% of total cases. Totally, 5824 cases and 303 cases relapsed after dapsone (DDS) mono-therapy and multidrug therapy (MDT), respectively. Case detection showed a marked reduction from 0.47/100 000 in 1985 to 0.18/100 000 in 1993 although there were several spurts due to operational factors. From 1994, case detection showed no significant decline. The grade 2 disability among new patients decreased from 31.4% in 1985 to 23.4% in 2002. The child case detection rate among new cases fluctuated between 2.70%-3.56% from 1999 to 2002. The incidence of relapse declined after the introduction of DDS mono-therapy. However, it increased after the introduction of MDT. Conclusion China experiences in leprosy control show that it will take a long time with continuing present leprosy control activities to bring down the case detection and other indicators to a very low level even after reaching the elimina- tion goal of leprosy.

The association of various social capital indicators and physical activity participation among Turkish adolescents

Background: Physical activity participation(PAP) has been proven to improve health and promote optimal growth among adolescents. However,most adolescents do not meet the current physical activity(PA) recommendations in Turkey. The role of the social environment and social factors on PAP is being increasingly recognized. Although social capital(SC) indicators have been examined in high-income countries, there are few studies on developing countries. The aim of this study was to examine the relationship between SC indicators and PAP among Turkish adolescents.Methods: A survey was conducted among 19 high schools in 4 different cities in Turkey in 2016. A total of 506 female and 729 male high school students participated in this study. The dependent variable was overall PAP, which was measured using the short form of the International Physical Activity Questionnaire. The independent variables included self-perceived family, neighborhood, and school SC. Self-rated health and obesity status, measured by body mass index, were other study covariates in multiple binary logistic regression models. Chi-square tests were used to assess the differences between genders.Results: PAP levels were significantly different between males and females. A higher percentage of males reported PAP(77.4%) compared to females(51.0%). Among males, teacher–student interpersonal trust and informal social control were inversely associated with PAP, while high students interpersonal trust was positively associated with increased odds of PAP. For females, students interpersonal trust was inversely associated with PAP.Conclusion: Various SC indicators are associated with PAP for males and females. These associations are different from findings of studies conducted in developed countries. Therefore, health-promotion interventions and policies should consider gender and different social agents on the social and cultural background to improve PAP among Turkish adolescents.

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively).CONCLUSIONPPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.

Growth of the tropical Pinus kesiya as influenced by climate and nutrient availability along an elevational gradient

Aims In contrast to temperate regions,the reasons for growth reductions of individual tree species along elevational gradients in tropical mountain ranges are poorly known,especially for tropical conifers.We aimed at testing whether climatic or edaphic conditions are responsible for the reduced growth of Pinus kesiya,a widely distributed pine species of southern and south-eastern Asia,at higher elevations.Methods We analysed the stem diameter increment and the isotope discrimination against ^(13)C(△^(13)C)in tree rings of P.kesiya along an elevational gradient of~900 to~2000 m a.s.l.in the mountain ranges of South-Central Vietnam,and related growth to△^(13)C and to climatic and edaphic variables.Important findings We found no consistent correlation patterns between the basal area increment(BAI)of the trees and temperature or precipitation.In contrast,across the elevational gradient,we obtained significantly negative correlations of BAI with△^(13)C and with the C/N ratios and theδ^(15)N signature of the upper mineral soil.BAI was positively correlated with the concentrations of plant-available phosphorus(P_(a))and of“base”cations(calcium,magnesium,potassium)in the soil.We conclude that lower temperatures at higher elevations exert an indirect effect on tree growth by inducing higher C/N ratios and by reducing the rate of nitrogen(N)and P mineralization,which may be further hampered by lower concentrations of“base”cations(upon enhanced leaching by precipitation)and a negative feedback from low availability of mineralized N and P at higher elevations.Our results may be transferable to the uppermost growth limit of P.kesiya and to other montane regions of the species’occurrence.

Should few retrieved oocytes be as an indication for intracytoplasmic sperm injection?

Objective:To reevaluate whether relatively few oocytes obtained in one cycle are an indication for intracytoplasmic sperm injection(ICSI).Methods:A total of 406 cycles with three or fewer retrieved oocytes performed in 396 non-male infertile couples were retrospectively reviewed.Cycles were classified into three groups by different fertilization techniques:the in vitro fertilization(IVF) group,insemination with conventional IVF;the ICSI group,insemination with ICSI though semen parameters were normal;and the rescue ICSI group,re-insemination with ICSI after conventional IVF failure.Results:The ICSI group resulted in higher normal fertilization compared with the conventional IVF group.Correspondingly,the cycle cancellation rate was decreased in the ICSI group,though it was not statistically significant.The clinical pregnancy rate and implantation rate were lower in the ICSI group compared with the conventional IVF group.Rescue ICSI was a method to avert total fertilization failure in conventional IVF,increasing fertilization and ensuring embryo availability for transfer,but the normal fertilization was the lowest due to delayed insemination and the chance of pregnancy was very little.Conclusions:Obtaining only few oocytes in one cycle is not considered as an indication for ICSI when the sperm sample is apparently normal.Rescue ICSI is either not recommended if conventional insemination fails.Such patients should not be subjected to the unnecessary costs and potential risks of ICSI.