Medical comic strips | Anti-smoking laws weakened | No support for Orphan Diseases

A female doctor in Shanghai draws weekly comic strips and posts them on WeChat to try demystify medical jargon and improve doctor-patient relations
Dr Chen Haiyan, a cardiac ultrasonographer at the Shanghai Zhongshan Hospital has used the comic strips to explain conditions such as heart defects and high blood pressure in easy-to-understand ways. She also tries to explain the daily life of medical staff and show they are human in an effort to defuse the major tensions that have triggered many recent violent attacks against hospital staff.

Health experts have expressed disappointment that Beijing's proposed anti-smoking regulations have been watered down. The latest draft legislation only bans smoking in "shared indoor public places," compared to a previous draft that banned smoking in all indoor public areas, said Professor
Wang Qingbin, a legal expert at the China University of Political Science and Law,
"By banning smoking only in 'shared' indoor public areas, the legislators are giving officials with their own offices a chance to smoke, which is against the spirit of equality," Wang said, adding that it will only make law enforcement all the more difficult.

China lacks adequate health systems to deal with rare 'orphan' diseases such as Duchenne Muscular Dystrophy, medical experts say. At a recent conference on rare diseases at the Children's Hospital of Fudan University experts called for legislation and policies on the prevention and treatment of rare diseases that affect more than 10 million people in China."Related regulations should be created to help provide better support to patients with rare diseases and their families," said Li Dingguo, chairman of the rare disease branch of the Shanghai Medical Association.

Resisting the Japanese invader: the China success story against Japanese encephalitis

by Michael Woodhead
 As China cranks up its media hate campaign against its former enemy Japan, the country can actually celebrate victory in its war against another 'Japanese' invader from the 1940s: Japanese encephalitis. 

This mosquito borne viral disease used to cause about 200,000 cases of severe neurological illness in China every year at its peak in the 1960s and 70s - with about 30% patients dying and many of the survivors  left with lasting neurological disability as a result of the infection.

The name is misleading - the disease did not originate in Japan, but was first identified there in the 19th century. The infection was first recorded in China in the 1940s and became widespread in the 1960s - partly because of the breakdown in public health preventive activities during the chaos of Mao Zedong's Cultural Revolution.

A vaccine against the virus was developed in Japan in 1965, and China started manufacturing its own vaccine a few years later.  Writing in the journal PLOS Neglected Tropical Diseases, Dr Gao Xiaoyan and colleagues at the Chinese Centre for Disease Control and Prevention, Beijing, describe how Japanese encephalitis was brought under control in China.

The initial Chinese vaccine was only available in limited quantities and required many doses. It was expensive and was only available to privileged cadres and Party members, not to the peasants who were most at risk of the disease. With more than half the cases of Japanese encephalitis in the world, China continued to work on improving the vaccine and eventually developed one in 1988 that was more convenient and could be mass produced at relatively low cost, to make it affordable for public health use.

This vaccine was gradually made available at a cost of 1 yuan to rural residents, and was fully subsidised as a free vaccine after the year 2005. Since it was included in the "Expanded Program of Immunisation" this cheap and effective vaccine had reduced the incidence of Japanese encephalitis in China from 21/100,000 people to just a fraction of 1 per 100,000 - a remarkable achievement.

But the vaccine is not the only reason for the drastic reduction in Japanese encephalitis in China. Other public health measures were implemented by local health authorities to reduce mosquito breeding and transmission:  pig farms were moved away from villages,  sewage disposal was improved to reduce mosquito breeding, and mosquito breeding grounds in areas of static water were eliminated.

The threat from Japanese encephalitis has now been markedly reduced in the more prosperous eastern provinces of China but it remains a problem in the poorer parts of southwest China. Nevertheless, Chinese researchers say other developing countries can copy the Chinese model for eliminating Japanese encephalitis: low cost programs using inexpensive vaccine and anti-mosquito measures.

Seven China medical news snippets for Thursday 13 March

1. Antivirals at kindergarten
Children at a kindergarten in Xian have been treated with an antiviral without the knowledge of their parents. Parents were furious to discover their children were dosed with moroxydine thee days a week supposedly as prophylaxis to prevent viral infections, at the direction of a doctor who was only licensed to practice in Guangdong.

2. Private health eyes China profits
Private healthcare operator Concord Medical says it sees huge potential in the Chinese health system reforms. The group already owns 144 medical centres and the Chang'an Hospital in Xi'an, and is now building three high-end specialty cancer hospitals in Guangzhou, Beijing and Shanghai.

3. Stroke risk with high normal BP
Cardiologists in Guangzhou have shown that pre-hypertension (systolic BP of 120-140mmHg) is a risk factor for stroke. Their research showed that low range hypertension increased stroke risk by 44%, according to the meta-analysis published in the journal Neurology this week.

4. Needlestick risks in Chinese hospitals
Doctors and nurses in Chinese hospitals face high risks of blood-borne infections because of poor needlestick injury prevention practices, a study has found. Doctors faced a high risk of infections from suturing needle accidents while nurses often had needlestick injuries with syringes and IV infusion sets,w ith an average of two injuries per year, a study in the American Journal of Infection Control showed.

5. Medical article fraud
A doctor in Hainan has been jailed for eight years for fraud after it was discovered he wrote 11 medical articles and dissertations for others. The doctor charged about 12,000 yuan for each article.

6. Knee OA undiagnosed
Knee osteoarthritis is common among elderly people in Guangzhou but often goes undiagnosed and untreated. A study of elderly inpatients at a city hospital found the prevalence rate of knee arthritis was 10% in males and 38% in females. Only about half of patients were aware they had arthritis, and among these only 77% had adequate treatment.

7. Dust full of carcinogens
Inhabitants of Guangzhou are exposed to toxic levels of arsenic and chromium in PM2.5 particle in dust, a study has found. Using hair analysis, researchers from Sun Yat-sen University, Guangzhou found that Guangzhou residents had high and carcinogenic levels of accumulated metals and other toxic elements.

Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

TCM fails for migraine | Quit advice ineffective | Rural migrants need HIV help

Chinese herbal medicines ineffective in migraine
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine.  The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
 
Quit advice not working
 Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.

Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and  6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should  also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.

China medical news for Sunday 2 February

Cosmetic procedures a high risk for hepatitis C
Chinese people are more likely to contract hepatitis C from a cosmetic and beauty treatments than from medical procedures or blood transfusion, a study from Jilin shows.
Researchers found that hepatitis C rates had increased rapidly in Yanbian, Jilin, more than doubling from  2007 to 2011. Unexpectedly, they found that cosmetic treatments conferred the higest risk - almost five fold higher than control groups. Having someone esle in the family with HCV was also a high risk for infection, presumably through sexual transmission between spouses, the researchers said. Writing in PLOS One, the researchers for the Capital Medical University, Beijing, said cosmetic treatments had become popular in recent years and there was a risk of viral infection with procedures that broke the skin such as shaving and ear piercing.

Atherosclerosis defined in stroke
Intracranial atherosclerosis (ICAS) is the most common vascular lesion in patients with cerebrovascular disease in China, a study  has shown. Researchers at the Tiantan Hospital in Beijing assessed 2864 consecutive patients who experienced an acute cerebral ischemia and found the prevalence of ICAS was 47%. Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis. According to the study in Stroke, after 12 months, recurrent stroke occurred in 3.3% of patients with no stenosis, in 3.8% for those with 50% to 69% stenosis, in 5.2% for those with 70% to 99% stenosis, and in 7.3% for those with total occlusion.

STI risk high for men who visit prostitutes
Men who have unprotected sex with prostitutes are at high risk of HIV and syphilis, Guangxi research has shown. A study of more than 100 men who visited prostitutes found a high rate of unprotected sex (84%). The overall prevalence of HIV, hepatitis C and syphilis was 1.9%, 1.0% and 18.4%, respectively, according to the study published in Sexually Transmitted Infections.

Parasite problems on the Tibetan plateau
Worm parasites are an endemic problem for Tibetans, especially nomadic herders, a study has found.
Echinococcosis affects more than 380,000 people on the Tibet-Qinghai plateua, is spread by dogs and cattle, and is often picked up from drinking groundwater, according to a study by Chinese researchers. Those most at risk include the old and female in particular. Writing in Infectious Diseases of Poverty, the researchers said control of the parasites should focus on deworming both owned and stray dogs and health education activities n Tibetan language.

China medical news headlines for Wednesday 29th January

Tuberculosis rates fall by 80%
Rates of tuberculosis in Shandong have fallen by 80% in the last decade, a study of 55,000 adults has shown.The prevalence rate of bacteriologically confirmed TB ases was 34 per 100,000 for adults in 2010. However, diagnosis of TB is now more difficult as half of bacteriologically confirmed cases did not present persistent cough, researchers said in BMC Infectious Diseases.

Man arrested for spreading H7N9 rumours
China's internet is full of stories of doctors and medical staff who have died of H7N9 influenza. Social networks such as Sina Weibo, QQ and WeChat have stories circulated by netizens of deaths of medical staff in Shanghai, Tianjing, Shenzhen and Nantong, according to CRI. However, health authorities have branded the stories as rumours and have arrested one man for spreading false information. In one case, a doctor who was named as having died of H7N9 influenza has startled patients by being on duty at hospital.

Shanghai life expectancy is 82
Life expectancy in Shangahi is 82 and a half years old, the Shanghai Health and Family Planning Commission has said. Women have a life expectancy four and a half years longer than, a report in ECMS said. LIfe expectancy in the city is on a par with developed countries but infant mortality including migrant families, rose from 5.04 per 1,000 in 2013 to 5.73 per 1,000.

High alert as H7N9 cases increase
China has gone on to high alert for H7N9 influenza as the number of cases continues to increase. Bird markets have been shut down in Shanghai and quarantine authorities have stepped up monitoring at airports. However, health authorities have played down the risk of a pandemic, saying the infection is not spread by human-to-human transmission. A vaccine against the H7N9 virus is being developed but is not ready for use in humans yet, authorities have reported.

China's can't cope with dementia
People in China are ill prepared to cope with the huge number of elderly people with dementia and Alzheimers disease, according to an article in SCMP. China has almost six million patients with Alzheimer's, 50% higher than a decade ago and twice as many as earlier estimated by the international health community. However, caring for dementia sufferers in China is left to family members with limited or no training and no support from the state.

Red Cross resuscitation ads are wrong
An advertising campaign by the Red Cross that urges Chinese to help those who have collapsed and need resuscitation is technically inaccurate, according to emergency specialists The picture on the ad shows a woman pressing the soft tissue of the patient's neck, which will lead to obstruction of the airway. First-aid practitioners should place their index finger and middle finger on the patient's chin bone, a doctor has pointed out.

Tianjin to implement autism early diagnosis program

Tianjin is to implement an autism early diagnosis program in collaboration with Australian researchers.
The program is based on a set of markers that can help diagnose the condition in children below the age of two. Dr Josephine Barbaro from La Trobe University has developed a new screening tool that uses recognised early markers of autism spectrum disorder to identify the condition.
"We designed a program called the social attention and communication surveillence study and we trained maternal and child health nurses to monitor these very early markers in very young children, from one to two years of age."
The government of Tianjin has agreed to use the program over the next seven years for every child born in the city.
"These sample sizes that we can have for research are huge so it's fantastic for research," Dr Barbaro said, adding that there are about 100,000 babies born every year.
"It's also fantastic... for family so that we can actually work together with families and try and identify children early. And so we can begin early intervention."
Source: ABC Asia Pacific

Chinese Alzheimers research may be example of academic 'black market'

by Margaret Munro
Some of Canada’s top brain specialists have apparently been duped by shady operators in China.
The Canadian doctors approved and recently published a scientific report on Alzheimer’s disease that came from a “flourishing” academic black market in China, according to a report released Thursday.
“China’s publication bazaar,” as it is described, allows unscrupulous scientists to pay big money — up to  $26,300 — to become authors of scientific papers they didn’t write.
They don’t do any experiments or research either, according to the report in the U.S. journal Science that adds a creative, if disturbing, twist to research misconduct.
“It’s new to me,” says Dr. Robert Chen, at the University of Toronto, who is now investigating the origins of the suspect Alzheimer’s report.
It surfaced last year in China’s “flourishing academic black market involving shady agencies, corrupt scientists and compromised editors — many of them operating in plain view,” according to Science. It says that several scientific papers advertised under “authorship for sale” by Chinese brokers and editing shops have later appeared in established journals — including the Alzheimer’s report published this year in the Canadian Journal of Neurological Sciences.

China medical research in the journals

No increase in obesity among rural children

There are no signs of an obesity epidemic among rural Chinese children, a study from has shown

Researchers from the Capital Institute of Paediatrics, Beijing, monitored overweight and obesity rates in more than 280,000 children from eight counties in Jiangsu and Zhejiang between 1998 and 2005. They found that the prevalence of overweight was barely changed from 3.7% in 1998 to 3.9% in 2005 and there was no increase in the 0.5% prevalence of obesity.  An increase in overweight/obesity was more likely in boys than girls, especially among those aged over three years. The study also found that the prevalence of stunting decreased dramatically.

Full study: Public Health

IVF conception for 1% of Chinese babies

About one in a hundred Chinese babies is born to women undergoing IVF or other assisted reproductive technology, Beijing researchers have shown. Dr Yang Xiaokui and co-researchers from the Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital analysed rates of ART among 112,403 deliveries from 14 provinces and 39 hospitals. They found the proportion of infants born as a result of ART in China was about 1.013% in 2011, compared to 4% in developed countries. Their study also found an increased maternal complications such as multiple gestation, higher cesarean section rate, low birth weight infants, higher infant mortality in women who conceived with the help of ART, compared with spontaneously pregnant women.
Full study: Fertility and Sterility

Urgent action needed on liver fluke infections in Heilongjiang

Liver fluke infestations are a common and increasing problem in China’s north east province of Heilonjiang, a study from Harbin Medical University has shown.

The infections, which are caused by eating undercooked fish,  were  seen commonly throughout Heilongjiang Province and mainly along the Songhua River, according to Dr Han Su and colleagues from the university. In a review of 4951 outpatients with suspected liver fluke infections the overall prevalence of clonorchiasis was 26%.  Rates of infection increased from 22.5% in 2009 to 34% in 2012. Farm labourers accounted for two thirds of cases and consumption of freshwater fish was the strongest risk factor. Cases of re-infection were common.

“The present study revealed that clonorchiasis remains widespread and prevalent in Heilongjiang Province. An integrated control programme is urgently needed to reduce the public health impact of clonorchiasis in this endemic area.”

Full study: PLOS One

Benzodiazepine use linked to benign brain tumours

Benzodiazepines may increase the risk of benign brain tumours, according to Taiwanese researchers. In a review of  62,186 patients who had been prescribed benzodiazepines, they found that rates of benign brain tumours were more than three times higher in patients using benzodiazepines. The risk of benign brain tumours was dose dependent and increased over time with increasing exposure to benzodiazepines. There was no increase seen in risk of malignant brain tumours, but this may have been due to the low number of such tumours in the study group.

Full study: Journal ofthe Neurological Sciences

SMS reminders improve allergy medication compliance

For patients with allergic rhinitis, a daily SMS reminder is an effective way to improve adherence with intranasal corticosteroid treatment medication and treatment outcomes, according to researchers from the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital.

In a study of 50 patients with allergic rhinitis they showed that adherence to medication was 60% in the SMS group and 28% in the control group. Clinic attendance and allergy symptoms scores were also better for patients who received SMS reminders.

Full study: International Archives of Allergy and Immunology

Statins may replace surgery for chronic subdural haematoma

by Michael Woodhead

Doctors in Tianjin have shown that atorvastatin may be an alternative to surgery for patients with chronic subdural haematoma.

In a study involving 23 patients with chronic subdural haematoma they showed that statin treatment improved symptoms and reduced haematoma volume.

The patients were treated with oral atorvastatin 20 mg/day for one to six months, and haematoma was completely resolved in 77% of patients and showed major shrinkage in the other pateints within three months of starting treatment.

After six months, 18 patients showed no haematoma by CT or MRI scan and none of the 22 patients relapsed during the follow-up period of up to 36 months. All patients had improved symptoms scored.

Dr Wang Dong and colleagues from the Department of Neurosurgery at Tianjin Medical University said chronic subdural haematoma  was common and more prevalent in the aged population.

They noted that surgical intervention was the treatment of choice, but its outcomes may not be satisfactory because of recurrence and physical infirmity associated with aging.

They said aberrant angiogenesis and localised inflammation contribute to the formation of chronic subdural haematoma, and atorvastatin had significant effects on  angiogenesis and inflammation.

“Results of this preliminary prospective study show that the oral administration of atorvastatin is safe and effective in treating chronic subdural haematoma, offering a cost–effective alternative to surgery,” they concluded.

Read the full study at Journal of the Neurological Sciences

China medical news roundup for Monday 18 November

Thousands of fake rabies vaccine doses may still be on the market

Almost 11,000 fake rabies vaccines brought into the eastern Shandong Province have yet to be found, some 10 days after the case was busted, Qilu Evening News reported yesterday.

According to the Ministry of Public Security, the suspect bought 12,000 fake rabies vaccines in the central Henan Province, and since 2009 has sold 10,800 in Shandong.

The fake shots are made from distilled water and vitamin K1.

Police say the suspect, surnamed Liu, bought vaccines at 0.8 yuan (13 US cents) each and resold them for 1 yuan to vendors in Shandong. In turn, they sold them to patients for 26 yuan each.

Health and drug authorities in Shandong Province started an investigation earlier this month after the suspect was held.

However, they don’t know where the fake rabies vaccines have gone.

Insiders warned they could flood the market as vaccination units are allowed to buy stocks independently.

This increases the risk of buying fake vaccines, compared to unified provincial-level purchases in the past.

As inspectors didn’t find fake rabies vaccines in legal vaccine trade companies, there is speculation that they were bought by unlicensed vaccination units or licensed vaccination units that didn’t check certification, said Zhang Jun, who works in the industry in Jinan, capital of Shandong.

There have been fake rabies vaccine cases across the country since 2005.

In 2009, a five-year-old boy in the Guangxi Zhuang Autonomous Region died 21 days after he was injected with a rabies vaccine which was later discovered to have been a fake.

Source: Shanghai Daily

Adenovirus implicated in severe infant pneumonia

Adenovirus is a critical pathogen that can cause severe respiratory infections even in immunocompetent children, researchers from Hangzhou have found.

In a study of children hospitalised with acute lower respiratory tract infection from 2006 to 2012 they found that infection due to adenovirus infection was infrequent but often caused severe outcome. In an analysis of 479 children with adenovirus infection, the incidence rate of adenovirus-associated acute lower respiratory tract infection peaked in the second six months of life.

Children with pneumonia accounted for 74% of the patients, and more than one-third developed severe pneumonia. Features of severe adenovirus-associated lower respiratory tract infection included persistent high fever with serious infective symptoms, and hepatic dysfunction was one of the most common complications. Mixed infection of atypical pathogens was common (19%).

 The researchers from concluded that “co-infection of adenovirus with atypical pathogens is common and that antibiotic treatment with azithromycin or erythromycin is necessary in patients with mixed infection of atypical pathogens.”

Full study at World Journal of Pediatrics

H6N1 poultry flu reported in humans for first time

The first report of human infection with a wild avian influenza A H6N1 virus has ben published by clinicians from Taipei.

Writing in the Lancet, researchers from the Taiwan Centres for Disease Control say the virus is one of the most common viruses isolated from wild and domestic avian species, but human infection with this virus has not been previously reported.

They publish a case history concerning a 20-year-old woman with an influenza-like illness who presented to a hospital with shortness of breath in May, 2013. An unsubtyped influenza A virus was isolated from her throat-swab specimen and was transferred to the Taiwan Centres for Disease Control (CDC) for identification.  The virus was identified as the H6N1 subtype, but the source of infection was not established. Sequence analyses showed the human case was very similar to chicken H6N1 viruses.

“These viruses continue to evolve and accumulate changes, increasing the potential risk of human-to-human transmission,” they comment.

“Our report highlights the continuous need for preparedness for a pandemic of unpredictable and complex avian influenza.”

Read the full study in The Lancet.

 

Chinese women fare worse after stroke compared to males

Neurologists in north east China have shown that women fare worse than men after a stroke.

Health-related quality of life was significantly worse for  adult females compared to males, according to a study carried out by Dr Wu Xiaoning and colleagues at the First Affiliated Hospital of Liaoning Medical University.

More than 400 stroke survivors were followed up six months after discharge from hospital.

Following stroke, improvements in physical functioning, bodily pain, vitality, social functioning, emotional role, and mental health in the SF-36 survey were significantly higher for men than woman.

Regression analyses confirmed that female sex was adversely associated with overall health status at discharge.

Female stroke patients were older than male stroke patients and were more likely to have transient ischemic attack and hypertension. Male stroke patients were more likely to have a history of smoking, heart disease and dyslipidemia, while female patients were less likely to achieve daily living independence.

“Our results demonstrate that sex has a significant impact on stroke outcome in Chinese individuals, wherein female stroke survivors are more likely to live a life of profound disability with poor self-care ability compared to male survivors,” the researchers concluded.

Read full study at: Journal of Clinical Neuroscience

Lung cancer increase seen in Beijing

Beijing municipal health authorities said on Friday that the number of lung cancer patients in the city has been rising over the last decade, without elaborating on what might have caused the rise.

The number of lung cancer patients per 100,000 people was 63.09 in 2011, compared with 39.56 registered in 2002, according to the Beijing Municipal Health Bureau, citing figures from the city's tumor prevention and treatment office.

In 2011, Beijing reported a total of 7,999 new lung cancer cases, accounting for 20.8 percent of the malignant tumor cases that year.

The bureau said lung cancer is the most common disease among male malignant tumor patients.

The statistics also showed that the lung cancer incidence rises as people age, and male patients outnumber female patients after the age of 35.

Health experts with the Beijing Cancer hospital said lung cancer is highly linked to lifestyle, noting that smoking is the top reason for the disease, followed by passive smoking and environmental pollution, such as air pollution.

People with respiratory diseases are more likely to contract lung cancer, the experts added.

Source: Xinhua

Chinese medical news from the journals

Almost one in three Staphylococcus aureus strains found in humans by Yangzhou researchers were methicillin-resistant S. aureus (MRSA), with most being hospital-acquired MRSA. The superbugs were also found in food and animal samples. Writing in the journal Foodborne Pathogens and Diseases, the researchers say infection with multidrug-resistant MRSA strains acquired from food, animal, and human sources might also become a significant problem for human medicine.

One in four Chinese people with epilepsy has poor adherence to their anti-epilepsy medication and 70% have only moderate compliance, a new study shows. The reasons for nonadherence included forgetfulness (54%), being seizure-free for a period (49%), and fear of adverse drug effects (28%).
Epilepsy and Behavior.

Rotovirus and norovirus are the two most common causative agents for diarrhoea and vomiting in Chinese infants, a study from southeastren China has found. Rotovirus tended to cause more prolonged, frequent and severe illness and the viruses were seasonal, the study published in Pediatrics Infectious Diseases journal showed.

Smoking is a major risk factor for nonalcoholic fatty liver disease, especially in obese people, a Shanghai study has found. People who smoked and had a high BMI had a nine-fold higher risk of nonalcoholic fatty liver disease, their study in the Journal of Epidemiology showed. Passive smoking was also associated with a  25% increased risk of the disease, say researchers from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine.

China has made progress in the prevention and control of major non-communicable diseases but there are still large action gaps in the fight against epidemic non-communicable diseases according to members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China’s Ministry of Health.
Global Health Action.

Chinese people who have a more varied diet and especially a diet rich in fruit have a much reduced risk of bladder cancer, a study in Cancer Causes and Control shows

Type 2 diabetes is associated with the increased risk of  liver cancer within five years after diagnosis in Chinese population, researchers at the State Key Laboratory of Oncogene and Related Genes and the Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine have shown.  Writing in Annals of Oncology, they say the finding suggests that hyperinsulinaemia rather than hyperglycaemia is more likely to be a primary mediator for this association.

Chinese trial shows clopidogrel better than aspirin for preventing recurrence of stroke or TIA

A relatively short course of aspirin plus clopidogrel immediately after sustaining a transient ischemic attack (TIA) or minor stroke outperforms aspirin alone in cutting the risk for a subsequent stroke, and it does this without a significant increased risk of major bleeding complications, results of a large Chinese trial show.
Results of the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial were presented here at the International Stroke Conference (ISC) 2013 in Honolulu on Feb 8
The CHANCE trial, carried out exclusively in China, is a few steps ahead of a similar trial, the Platelet Oriented Inhibition in New TIA and stroke (POINT) trial, now enrolling mostly in the United States.
However, although CHANCE was a "well done" trial and its results showed "a larger treatment effect," it's important to note that healthcare in China is different from that in the United States, said CHANCE co–principal investigator, S. Claiborne Johnston, MD, PhD, professor, neurology, and director, Stroke Service, University of California, San Francisco.
"Secondary prevention practices are not as robust there as they are in Europe and in North America, and that could have impacted the trial," he said. "Also, usually genetic differences don't matter, but in this case, they might because there are differences in polymorphisms that affect clopidogrel metabolism in Asian populations."
For these reasons, although American neurologists might see the CHANCE trial as a signal to go ahead and use combined therapy, "I think it's wise for us to wait for a confirmatory trial outside of China, said Dr. Johnston, who is also co–principal investigator of the POINT trial.
CHANCE co–principal investigator was Yongjun Wang, MD, professor of neurology and vice-president of Beijing TianTan Hospital, Capital Medical University, who presented the full results here.
The study enrolled 5170 patients at least 40 years of age who had sustained a TIA or minor stroke. Within 24 hours of their symptom onset, they were randomly assigned to 1 of 2 groups: aspirin (1 day loading dose of 75 to 300 mg, followed by 75 mg/day) plus placebo, or the same aspirin regimen plus clopidogrel (loading dose of 300 mg followed by 75 mg/day).
Patients in the combination group were taken off aspirin at 21 days because of the concern that Chinese patients, as with other Asian populations, are at relatively high risk for hemorrhage. "Frankly, that belief comes from epidemiological studies, but the epidemiology may just reflect underlying risk factors and not a true propensity for it," said Dr. Johnston. He pointed out that the studies testing this have not been in the acute period.
The study showed that stroke occurred less frequently in those receiving both aspirin and clopidogrel. At 90 days, the hazard ratio (HR) for survival free of stroke — either ischemic or hemorrhagic — in the combination group was 0.68 (95% confidence interval [CI], 0.57 - 0.81; P < .001).
For the secondary outcome of combined events (stroke, myocardial infarction, vascular death), the HR was 0.69 (95% CI, 0.58 - 0.82; P < .001). The risk for hemorrhagic stroke was the same in the 2 groups (0.3%).
Notably, severe bleeding events occurred at a similar rate in the 2 groups (0.2% in each). Although mild bleeding occurred more often in the combination group (1.2% versus 0.7%), Dr. Johnston noted that these events included nose bleeds. "We did not see a signal that the combination was unsafe."
Both aspirin and clopidogrel affect platelets, but through different pathways. "Together, the 2 are much more powerful than either one alone," said Dr. Johnston.
CHANCE was the first trial to focus on the acute period in TIA and minor stroke, which Dr. Johnston emphasized is not being seen nearly enough in the emergency department. "People with TIA and minor stroke are not coming in acutely or they're calling the office and being seen in clinic," he said. "We need to remind people that this really is an emergency and it should be treated right away."
Asked whether the combination therapy would be an acceptable approach for more severe strokes, Dr. Johnston said it's impossible to know "where to draw the line." The researchers will do more subgroup analyses looking at stroke severity, but Dr. Johnston pointed out that "there was no difference between the TIA and stroke in terms of rates of hemorrhagic stroke or in the efficacy of the combination."
Compared with elsewhere in the world, the risk for stroke is very high in China. "There are a whole lot more strokes in China than there are in the US and even if you add Europe, you still have more strokes in China," said Dr. Johnston.
Because the trial was so large and because standards for clinical research have improved dramatically in China, the CHANCE results are "incredibly important" and should have a major effect on public health around the world, said Dr. Johnston. However, there are important differences between healthcare in China and that in the United States.
For example, Dr. Johnston noted that about two thirds of the Chinese patients in the study had hypertension and less than half were receiving any drug for hypertension during follow-up. Undertreatment, he said, could "certainly" affect the absolute effect size that's seen in the trial.
It's probably wise to await what happens with the POINT trial before changing treatment approaches here in North America, said Dr. Johnston, who is that study's principal investigator. Interim POINT results will be available in May, he said. "That will provide an opportunity to say it's very important to continue POINT or it's not important to continue POINT."
The POINT trial, which is about a third of the way through recruitment, differs slightly from CHANCE, said Dr. Johnston. For example, it includes a higher loading dose of clopidogrel and requires enrollment within 12 hours instead of 24 hours. As well, patients in the combination group continue with aspirin for 90 days instead of stopping at 21 days as in the CHANCE study.
Dr. Johnston pointed out a graph showing times for survival free of stroke for the treatment groups. "Most of the separation in the 2 curves occurs just in the first couple of days, so certainly by 21 days, the curves are almost parallel."
POINT includes mainly centers in the United States, although some sites have been added internationally.
The idea of comparing aspirin plus clopidogrel in a North American trial dates back more than a decade, but the researchers ran into funding difficulties when the drug manufacturer pulled its backing. This, said Dr. Johnston, substantially delayed the start of the trial.
When asked about next steps for CHANCE, Dr. Johnston said the Chinese researchers will look at ancillary studies of biomarkers and subtyping based on vascular imaging. As well, they plan to provide outcomes at 1 year that will include results related to cognition.
Source: Medscape

China medical news in brief

Headache and migraine a problem for one in ten Chinese children

A study of 4812 children and adolescents in Shanghai, China has found that 10% experienced a headache in the past three months. Of those who had headache, 45% were classified as having migraine. with the highest rates of migraine found at ages 14 years and 15 years. Tension-type headache accounted for 29% of headaches, while  cluster and other headache were responsible for 6.2% and 20%, respectively.
Source: Clinical Journal of Neuroscience 

Zhejiang prostitutes have high HPV rates and cervical cancer risk

Two out of three sex workers are infected with high risk subtypes of HPV putting them at increased risk of cervical cancer, a Zhejiang study has found.
Cervical samples from almost 300 female sex workers  in Huzhou, Zhejiang, showed that the prevalence of HPV was 67%, compared to 19% in the general population. Among the different types of HPV found,  HPV-16 (29%) was the most prevalent, followed by HPV-58 (24%) and HPV-52 (21%), and these were significantly associated with abnormal cervical cytology. The rate of cervical abnormalities was also higher among female sex workers (21%) than among the general population (5%). Researchers from the Huzhou Central Hospital conclude that female sex workers in the city have a greater probability of being infected with high-risk HPV, and novel vaccines against HPV-58 and HPV-52 should be developed. Using condoms could reduce the risk of infection.
Source: International Journal of Gynecology & Obstetrics 

Jiangsu simplifies medical insurance claims

Medical insurance claims can now be settled on the spot for outpatients in  Jiangsu. Outpatients from 13 cities including Changzhou, Nantong, and Wuxi can immediately settle their medical insurance if they go to see a doctor with their medical insurance cards, according to Jiangsu provincial Human Resources and Social Security Bureau.
Source: Jiangsu China.


Gay men in Yunnan have high HIV risk

More intensive HIV and STD screening and prevention campaigns are needed for gay men in Yunnan, say researchers who found a high incidence of new infections. In an 18 month study of 378 seronegative gay men in Yunnan they found that 11 became infected with HIV and 15 were infected with syphilis. Subgroups at high risk included students, retirees and minority ethnic groups, say the researchers from the No.1 Hospital of China Medical University, Nanjing.
Source: BMC Infectious Diseases.

Recurrent stroke risk with metabolic syndrome

Chinese patients who have a stroke are at increased risk of a recurrent stroke if they have metabolic syndrome, Beijing researchers have shown.
In a study of more than 700 patients with ischaemic stroke, researchers from the Department of Neurology at Beijing's Tiantan Hospital, followed patients up at 3-month intervals for one year to monitor development of recurrent stroke or death. Metabolic syndrome was identified in 26% of the stroke patients and these patients had a higher rate of stroke recurrence (7%) than patients without metabolic syndrome (4%).
However, there was no difference in mortality (3.3% versus 3.5%, respectively).
Source: PLOS One

Headache in China more likely to be migraine

Migraine accounts for almost 40% of headaches treated in specialist clinics in Beijing

by Michael Woodhead
In contrast to other counties, migraine seems to be the most common form of headache seen in specialist headache clinics, Beijing researchers report.
In a review of 1843 headache patients treated at the headache clinic of the General Hospital for PLA in Beijing, researchers found that migraine and tension-type headache are the two most common presentations, accounting for 39% and 33% of the total patients, respectively.
These findings are in contrast to international studies in which the proportion of headaches is found to be 11% for migraine, and 42% for tension-type headache.
Dr Zhao Dong and colleagues at the International Headache Center, Department of Neurology, Chinese PLA General Hospital, Beijing, say that  there may be racial or social factors that determine the character of headache treated at specialist clinics in China.
Their study also found that  cluster headache and other trigeminal autonomic headaches were much less common than other severe headaches such as migraine but nevertheless more than 5% of patients had these kinds of headache.
"The reasonable explanation may be the fact that cluster headache is an excruciating headache syndrome and patients often responded poor to nonspecific treatment such as analgesics and the low recognition rate by many physicians and even neurologist. As a result, these patients are willing to go to headache clinic for specific treatment," they suggest.
The peak ages of tension type headache at onset for males and females were both in the 30–39 years age group, but the most likely period of migraine seems to be earlier, at 20–29 years of age for females and 10–19 years of age for males.
Almost 15% of headache patients were given an additional diagnosis of chronic daily headache, of which half were defined as medication-overuse headaches.
The researchers say their study gives a more accurate picture of headache in Chinese specialist clinics as they used the criteria define by the International Classification of Headache Disorders, 2nd Edition.
Source: PLOS One

Stroke likely to recur in Chinese patients as 1 in 4 have aspirin resistance

One in four patients is aspirin resistant and this increases their risk of recurrent stroke

by Michael Woodhead
Aspirin resistance is present in one in four Chinese patients who have a stroke and may explain why there is a high rate of recurrent events, researches from Zhejiang say.
In a study of 634 Chinese stroke patients, Dr Yi Xingyang and other researchers from the Department of Neurology at the 3rd Affiliated Hospital of Wenzhou Medical College, found that 20% had aspirin resistance and a further 5% had partial aspirin resistance.
Patients who had diabetes or high levels of LDL  cholesterol were especially likely to have aspirin resistance, perhaps due to platelet activation and thrombosis, they found.
Rates of recurrent cardiovascular events such as stroke and heart attack were more than 30% in patients with aspirin resistance compared to only12% in the aspirin sensitive patients.
The researchers say resistance to the antiplatelet effects of aspirin is one explanation as to why aspirin may not be absolutely effective in preventing recurrent vascular events, and it is not uncommon for patients to experience a recurrent atherothrombotic vascular event in the subsequent years after their first stroke, despite taking aspirin.The finding that rates of recurrent stroke, heart attack and death and all vascular events were higher in patients with aspirin resistance shows that aspirin resistance seems to be a new predictor of vascular events, they say.
"To reduce the risk of thrombotic complications in patients detected to be aspirin resistant, increasing the dose of aspirin might be beneficial," they suggest.
"In conclusion, aspirin resistance is common in Chinese patients who receive antiplatelet medications. Diabetes and high LDL levels may increase the occurrence of AR due to platelet activation and thrombosis. Patients with AR may have a greater risk of suffering clinically important vascular events. To provide stroke prevention in patients with AR, other medications (e.g., statins, ACE inhibitors) should be considered to prevent the sequelae of vascular disease."
Source: International Journal of Stroke

Sub-optimal diagnosis and management of Parkinsons disease in China

Treatment of Parkinsons is often by general physicians with little training in how to best manage the disease

by Michael Woodhead
The diagnosis and management of Parkinsons disease in China is often sub-optimal and not done in accordance with best practice guidelines, Shanghai researchers say.
   Writing in the journal BMC Neurology, they say there are at least two million patients with Parkinson’s disease in China, accounting for two-fifths of all Parkinson's patients in the world.
In a study of how the disease is diagnosed and treated, they found that the lack of movement disorder specialists and clinics in China meant that the condition was often treated by general physicians or neurologists with limited expertise in Parkinsons disease.
   The findings come from a survey of Parkinson's disease diagnostic methods and management carried out by Dr Chen Wei and colleagues from the Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
   Their survey showed that most doctors involved in treating patient with Parkinsons disease were aware of the Chinese Parkinson's disease guidelines; however CME activity in the area was very low and few of the doctors surveyed had published Parkinson's disease-related articles.
   With respect to diagnostic methods for Parkinson's disease, the standard oral levodopa test and conventional MRI were commonly considered for suspected patients in routine practice, whereas other recommended diagnostic tests such as susceptibility weighed imaging, transcranial sonography and functional neuroimaging were less used.
   The researchers say that in China, relative expensive functional neuroimaging methods, such as PET scans are not covered by Chinese medical insurances, and few patients would like to choose them. Additionally, because of lack of knowledge and shortage of transcranial sonography experts in many hospitals, transcranial sonography is rarely accepted as a regular method.
   There was a relatively high level of knowledge on therapeutic strategies for Parkinson's disease  among movement disorders specialists and those from tertiary hospitals. However, a discrepancy between best practice guidelines and clinical practice still exists in management of non-motor symptoms among all of the clinicians surveyed. Up to 46% of doctors selected olanzapine to treat Parkinsons patients with psychosis, only 23% of those prescribed clozapine. For treating Parkinsons with dementia, the most often prescribed treatment was donepezil, not rivastigmine, as recommended in guidelines.
   "Based on these observations, great efforts should be made on CME programs for physicians and general neurologists," the study authors conclude.
Source: BMC Neurology

China clinical news in brief

* IV alteplase improves stroke outcomes in Chinese patients if given within the 'golden window' of four hours.   
Read more: CNS Neuroscience and Therapeutics

* Eradication of schistosomiasis in China may not be as straightforward as expected.  
Read more: Parasites and Vectors

* Emotionally abused Chinese children more likely to have ADHD.  
Read more: PLOS One

* Oral Supplementation with vitamin D (cholecalciferol) ameliorates albuminuria in Chinese Type 2 diabetes patients .  
Read more:PLOS One