Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout.Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed.Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Urate-lowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03).ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout. Gout is characterised by deposition of monosodium urate (MSU) crystals in the joints and other tissues. The central strategy for management of gout is long term serum urate (SU) lowering, which leads to dissolution of MSU crystals, prevention of acute gout flares, and regression of tophi . A numbeBased on these studies, a ‘treat to serum urate target’ approach has been recommended in a number of gout treatment guidelines ,7. HowevPatients with gout for less than 10 years were recruited by community advertising and through primary and secondary care clinics in Auckland and Wellington, New Zealand. As in other regions of the world, gout management is frequently suboptimal in New Zealand ,15. The Participants attended a study visit which included a comprehensive clinical assessment. The following data were recorded: demographic data , gout history , medical history, examination, questionnaires -II, Brief Illness Perception Questionnaire (B-IPQ) , confidePatient self-reported confidence in gout treatment was assessed using 0 -10 (very confident) Likert scales, which covered aspects of gout management including confidence to follow recommended diet, take ULT regularly, have blood tests and keep blood urate level under control. These items were adapted from a diabetes-specific Multidimensional Diabetes Questionnaire .Data were analysed using SPSS . Means with standard deviations (SD) and percentages were used to describe the clinical characteristics of participants. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. T-tests and Chi square analysis was used to compare the group of patients at SU target with those who were not. Forward stepwise logistic regression analysis was used to determine the independent variables associated with SU target in those prescribed ULT, with factors included in the model with p < 0.15 in the univariate analysis. The measures of gout activity were pre-specified as flare frequency, presence of tophi, work absences, and activity limitation as assessed by the HAQ-II. All tests were two tailed and P < 0.05 was considered statistically significant.A total of 273 patients attended the study visit. There were 89 (32.6%) patients with serum urate level <0.36 mmol/L (‘at SU target’ group). The clinical characteristics are shown for all patients in Table Although there was no difference between groups in confidence to follow dietary advice, patients at SU target reported greater confidence to take gout medications regularly and to keep SU concentrations under control Table . The perThe factors independently associated with SU target were determined using logistic regression analysis. All factors with p < 0.15 in the univariate analysis were included in the models. In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target Table . AdherenPatients at SU target reported lower gout flare frequency (p = 0.03), compared with those who were not at target Table . There wDespite widespread recognition that long term SU lowering to target is required for good clinical outcomes in gout, this study has confirmed that the majority of patients with gout are not at SU target. This work has highlighted ULT prescription and allopurinol dosing as central modifiable factors associated with SU target. The data emphasize the important role of the health care professional to ensure ULT prescription at sufficient doses to reduce SU to target.The finding that prescription and dose of allopurinol are key variables associated with SU target is consistent with previous reports from our group (in a different study population of patients with longstanding gout) and from others, showing a close relationship between allopurinol doses and SU concentrations ,9. ColleMany recent studies and commentaries have focused on the need to address patient factors such as adherence and health related behaviours for optimal treatment of gout ,22-24. HThe cross-sectional design of this study does not allow conclusions to be made about the direction of the relationship between SU target and confidence to keep SU under control; that is, whether high confidence to keep SU under control reflects the patient’s experience of good control, or influences the ability to achieve target. It is possible that feedback from clinic visits in patients achieving SU target increases confidence and reinforces behaviour. Longitudinal analysis of this group is underway to further address this issue.This study has also identified several independent non-modifiable variables associated with SU target. Women were more likely to be at target. It is possible that allopurinol doses relative to creatinine clearance may have been higher in women. However, we did not observe a relationship between creatinine clearance and SU targets in this study. Patients of Māori or Pacific ethnicity were less likely to be at target. Population based studies have demonstrated that men and those of Polynesian ancestry have higher mean SU concentrations ,26, and We acknowledge the potential limitations of this study. Long-term SU lowering is recommended for optimal gout management, and this study has addressed SU target at a single timepoint. Furthermore, the cross-sectional nature of this study does not allow analysis of the direction of the relationship between SU target and other variables. However, many of the variables included in the analysis are modifiable and dynamic, and this approach allowed for direct analysis of these variables at the time that the SU was obtained. Although patients were recruited from a wide range of clinical settings, adherence and health-related behaviours may be different in those willing to participate in a research study, compared with those who are not. The study design is not able to capture an individual physician’s reasons for not escalating doses of ULT, emphasizing the importance of future studies examining why physicians do not initiate ULT or titrate appropriately. Consistent with other studies in gout, flare frequency was self-reported, and not verified by a health care professional. However, this definition is consistent with that used in other long term studies of gout ,3.In summary, SU target is frequently not achieved in patients with gout. Greater ULT use and higher doses of allopurinol, rather than patient behaviours, are the key modifiable variables associated with suppression of SU to target. These data support interventions focusing on prescription and dosing of ULT to improve outcomes in patients with gout.The authors have no conflict of interest to declare.ND (the guarantor) accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. ND conceived the study, participated in data analysis, and drafted the manuscript, MEH and AH recruited the patients, collected data, and assisted with the analysis, KJP assisted with study design, data analysis, and drafting the manuscript, FMM assisted with study design and drafting the manuscript, WJT assisted in study design, data analysis, and drafting the manuscript. All authors read and approved the final manuscript.This work was funded by the Arthritis New Zealand, the University of Auckland and the Henry Cotton Charitable Trust.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/13/174/prepub


The transmission of schistosomiasis japonica in a local setting is still poorly understood in the lake regions of the People's Republic of China (P. R. China), and its transmission patterns are closely related to human, social and economic factors.Schistosoma japonicum with epidemiological data collected from 2339 villagers from 1247 households in six villages of Jiangling County, P.R. China. By using the back-propagation (BP) of the ANN model, 16 factors out of 27 factors were screened, and the top five factors ranked by the absolute value of mean impact value (MIV) were mainly related to human behavior, i.e. integration of water contact history and infection history, family with past infection, history of water contact, infection history, and infection times. The top five factors screened by the logistic regression model were mainly related to the social economics, i.e. village level, economic conditions of family, age group, education level, and infection times. The risk of human infection with S. japonicum is higher in the population who are at age 15 or younger, or with lower education, or with the higher infection rate of the village, or with poor family, and in the population with more than one time to be infected.We aimed to apply the integrated approach of artificial neural network (ANN) and logistic regression model in assessment of transmission risks of Both BP artificial neural network and logistic regression model established in a small scale suggested that individual behavior and socioeconomic status are the most important risk factors in the transmission of schistosomiasis japonica. It was reviewed that the young population (≤15) in higher-risk areas was the main target to be intervened for the disease transmission control. Schistosomiasis japonica is one of the serious infectious diseases causing problems in public health in People's Republic of China (P.R. China). The prevalence of schistosomiasis japonica is easily rebounding in the lake regions due to unique environmental settings. By considering the importance in assessing the risk factors for transmission of schistosomiasis, we conducted an epidemiologic investigation of schistosomiasis in Jiangling County, a lake region of P.R. China. Results showed that the top risk factors included integration of water contact history and infection history, infection times, main lifestyle of water contact, main recreation of water contact, etc., illustrated by both back-propagation artificial neural network and multivariable logistic regression approaches. It was found that the population at age 15 or younger having one or two times of infections was the high-risk group in the study settings. We concluded that socioeconomic factors are far more important than environmental factors in the transmission of schistosomiasis at local settings or in a small scale in Jiangling County, P.R. China. Schistosoma japonicum is the most severe pathologically in infected humans S. japonicum affected by following facts S. japonicum is still a key issue for the disease transmission in those regions, and closely related to human social and economic status, consequently the epidemical extent of schistosomiasis varies from region to region S. japonicum transmission in different local settings.In spite of schistosomiasis has been considered as one of neglected tropical diseases distributed in tropical and subtropical areas of the world, schistosomiasis ranks higher priority among four infectious diseases in alliance with HIV/AIDS, tuberculosis and hepatitis B in the People's Republic of China (P.R. China) It is well known that the complex relationship between risk factors and schistosomiasis transmission is existed, and is quite difficultly to be assessed by conventional statistical methods. Artificial neural network (ANN) can provide an encouraging computer-based method for recognition of transmission pattern due to its special features of nonlinearity, self-adaptation, and parallel processing S. japonicum which varied to the socioeconomic and ecological factors, such as health-economic condition of family, human behaviors and habit of individual at a small scale, supported by integrated approach with BP artificial neural network and multivariate logistic regression model in order to offer guidelines for controlling the transmission of schistosomiasis japonica tailored to the local settings.Therefore, our study aimed to identify risk factors for human infection with i.e. ground of courtyard and family latrines), and economic conditions of family, the results of IHA and Kato-Katz examination. The primary data of economic condition for each household were collected including following 3 aspects, including (i) electric appliance, e.g. electric rice-cooker, electric fan, TV set, refrigerator, etc., (ii) agricultural machine, e.g. tractor, cultivator, etc., and (iii) vehicles, e.g. bicycle, motorcycle, automobile, etc.. The economic status of each household was analyzed by principal component analysis and divided into 3 grades, i.e. good, general, and poor, according to the interquartile of principal component score. The specification of each variable in the study is listed in the Six villages in Jiangling County, Hubei Province, P.R. China were sampled in random by the stratified clustered sampling, in which the prevalence and village was viewed as stratum and clustering, respectively. The study was performed from August to September in 2010 among local villagers with a range of age 6–60 from six villages as targeted population for the study. All of targeted villagers were screened by serum examination with indirect hemagglutination assay , then the positive individual with the titers of ≥20 in IHA was reconfirmed by stool Kato-Katz examination with three slides from a single stool specimen Crude associations between infection and each of the variables considered for the analysis were analyzed by chi-square test. The important risk-factors were selected through fitting multivariate logistic regression model in three steps 2) presents the interpretation of the model for independent variable, when R2 is close to zero it is indicated that there is no relationship between the dependent and the independent variables in the models. A model was considered relatively parsimonious when the fitting indices changed little The significance of risk factors was estimated by standard partial regression coefficients and odds ratios. The logistic regression model was established employing seropositive rate that is a result of human exposure to the risks as the dependent variable with 26 independent variables, such as prevalence level , village level (village), ground of courtyard (courtyard), source of drink water (drink water), family latrines (latrines), distance to site of positive snail (distance), the family with past infection (past-infection), economic conditions of family (economic conditions), age group (age), gender, education level (education), marriage, occupation, infection history, time interval from the first infection to now , category of the diseases (category), treatment history (treatment), medicine varieties (medicine), infection times, history of water contact (infested water), main agricultural activity of water contact (agriculture activity), main lifestyle of water contact (main lifestyle), main recreation of water contact (main recreation), frequency of water contact (frequency), months to contact with water (months), protective measures (measure), and possible interaction between independent variables. The fitness of the logistic regression models were tested by the summary measures based on the likelihood chi-square statistics. Akaike's information criterion (AIC) and Schwartz criterion (SC) were used to define the optimal models. The smaller the values of both AIC and SC were, the better the model is. The determination of coefficient  that measures the performance of network. The most appropriate network was determined empirically during the training process that is a black box process. After a large number of applications of input neurons, the network converged to a solution that minimized the least square difference between the expected and measured outputs. With the magnitude of the gradient became very small, the training reached a minimum of the performance. In the third step, when the multilayer network was trained, data were automatically divided into training (70%), validation (15%) and test (15%) sets, in order to perform the cross-validation of the network and to evaluate the ability of a trained network. The error on the validation set was monitored during training until the training stopped when the validation increased over a given iterations. The test errors that used in the comparison of different models were set and plotted during the training process. If the test error reached a minimum at a significantly different iteration number than the validation set error, it might hint a poor division of the data set. The correlation coefficient (R) was used to assess the relationship between the outputs of network and the targets. In the forth step, the salient variables were selected according to mean impact value (MIV) which was an index reflecting changes of weights matrix in neural networks after the construction of the most appropriate ANN All of the data collected from the field were employed into the BP artificial neural network We repeated the above four-step process until the optimal network could be found. BP artificial neural network was developed in the Matlab .Ethical clearance had been granted by the Ethics Committee of the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention in Shanghai, P.R. China (Ref No: 20100802-1). The objectives, procedures and potential risks were orally explained and informed to all participants through village head. All adult participants gave written, informed consent, and child participants provided written informed consent signed by their parents or guardians before participating in this study, of which the research protocol was also approved by Institutional Review Board.The study was conducted among 2339 villagers from 1247 families in the six villages, namely Sanzha, Qinggang, Zhongqiao, Luyangtai, Liugang, and Qingan of Jiangling County. Among which 448, 411, 377, 311, 248 and 544 villagers were from above 6 villages, respectively, including 1155 (49.38%) women and 1184 (50.62%) men. The median of age was 47 years, and interquartile range was from 38 to 55 years. The population was composed of 6 age-groups, such as ≤15 years old (8.25%), 15–25 (6.11%), 25–35 (6.15%), 35–45 (25.14%), 45–55 (30.10%), >55 (24.24%). Their occupation consisted of 1843 (78.79%) from farmers, 253 (10.82%) from children and students, and 243 (10.39%) individuals in other occupation. The positive rate of IHA was 15.09% (353/2339), varied from 5.88% to 27.32% at village level .The results from crude association analysis showed that the variables to associate with infection, or the results of serum examination, were in turn into 20 risk factors investigated as follows: prevalence, village, courtyard, latrines, past-infection, economic conditions, education, infection history, category, treatment, medicine, infection times, infested water, agriculture activity, main lifestyle, main recreation, frequency, measure, months, and integration .infection history = 0 was 1.0426 (95%CI 1.0019–1.0850), OR infection history = 1 was 0.7198 (95%CI 0.7198–0.5051), and the ORs in the two strata was significant difference justified by the Breslow-Day test, with its total odds ratio of the two strata (ORCMH) was 1.4510 (95%CI 1.1809–2.365) and common odds ratio (ORcommon) was 1.8969 (95%CI 1.3189–2.7283).The stratified analysis, namely Cochran Mantel Haenszel (CMH), was used to determine the correlation between infection history, infested water and IHA positive rate, in which infection history was viewed as stratification factor. The results of CMH showed that ORi.e. the AIC was 1793.805, R2 was 0.5984, and test of Likelihood ratio (χ2) was 1358.1638 (P<0.0001). There were six independent variables in the logistic regression, which were in turn village, economic conditions, age, education, infection times, infested water Click here for additional data file.Dataset S1The specification of variable assignment.(DOC)Click here for additional data file.Dataset S2The variable assignment of household economic conditions.(DOC)Click here for additional data file.Figure S1The initial BP ANN includes an input layer, one hidden layer, and an output layer. In the form of ‘neural activity’, the first hidden layer is fed forward from the input layer; then its resulting outputs are in turn applied to the second hidden layer; and so on for the rest of the network, and the error is back-propagated (layer by layer) to modify the weights of the connections.(TIF)Click here for additional data file.Figure S2The flowchart to select variables on the basis of MIV.(TIF)Click here for additional data file.Figure S3The plot showing the performance of network which containing different number of risk factors.(TIF)Click here for additional data file.Text S1The procedure of screening risk factors.(DOC)Click here for additional data file.


After eight weeks of nutritional rehabilitation, a normal WHZ of −1.41 was obtained. These children recovered more than those in a similar study performed in 2006 with the old formula of Misola. This study shows that malnutrition remains a public health problem in Burkina Faso. It should be necessary that public health services and the epidemiologists work in synergy with nutritionists and “nutrigenetics” in order to combat malnutrition efficiently.The New Misola consists of millet soybean, peanut, vitamins, minerals, and industrial amylase. Our objective is to demonstrate that porridge made from local grains and legumes restores the nutritional balance of malnourished children. The study was carried on 304 malnourished children aged 6–48 months including 172 girls and 132 boys from Saint Camille Medical Centre. At the beginning, these malnourished children had a WHZ  Malnutrition is a major public health problem. Indeed, undernutrition affects several millions of people worldwide, mainly children under five years. FAO estimates that a total of 925 million people are undernourished in 2010 compared with 1.023 billion in 2009; that is higher than before the food and economic crises of 2008-2009 and higher than the level that existed when world leaders agreed to reduce the number of hungry by half at the World Food Summit in 1996 [Malnutrition is a condition resulting from deficiency or excess of one or more essential nutrients. Undernutrition that occurs most often in developing countries leads in children under 5 years to stunting or delayed growth, emaciation, and underweight. It mainly causes diseases such as marasmus and kwashiorkor . OvernouLike other Sahelian countries, Burkina Faso is confronted each year with significant risks for food security and nutritional deficiencies. Malnutrition represents 1/3 of the direct and indirect causes of child mortality at pediatric age. In Burkina Faso, prevalence of acute diseases linked to nutritional deficiencies was 21.2% in 2003 , while iFor many children, lack of access to enough food is not the only cause of malnutrition. The lack of nutritional quality, poor feeding practices, and parasitic, bacterial, and viral infections act synergistically in the worsening and aggravation of the nutritional problems , 9. HowePennisetum glaucum (millet), Soja hispida (soja), Arachis hypogaea (peanut). This porridge is prepared from a flour called “Misola” whose production, in Burkina Faso, is supported by a nonprofit organization: the Burkinabe Association of Misola Units.The management of cases of severe malnutrition in developing countries through the use of porridges composed of flour of local grain and legumes in order to restore nutritional balance for the infant is today a priority target for developing countries. In this purpose, for over 15 years, in the Center for Recovery and Nutritional Education (CREN) of the Saint Camille Medical Centre (CMSC), each year, almost 800 malnourished children with marasmus (M), kwashiorkor (K), or both  have been nutritionally recovered thanks to a porridge prepared from local grains and legumes:  Phytochemical and biochemical studies of Misola flour show that it contains different types of proteins, glucoses, and carbohydrate elements that promote nutrition and human health . From 20The main objective of this study was to demonstrate that the porridge made from local grains and legumes can help to restore nutritional balance. It is in this purpose that the New Misola was used in the CMSC to save malnourished children suffering from marasmus or kwashiorkor, or both. z-scores calculations, (iii) use the New Misola to recover nutritionally malnourished children, and, finally, (iv) compare the results of this study that used the New Misola (NM) with those of the study carried out in 2006 on the old formula of Misola.The specific objectives of this research were to (i) search for causes of malnutrition in the city of Ouagadougou, (ii) estimate, from the anthropometric parameters of malnourished children, the degrees of severity through The study was conducted in the CREN  of Saint Camille Medical Centre (CMSC), where about 800 malnourished children are followed every year. The study recruited all the 310 malnourished children attending this CREN from November 2010 to April 2011. Among them, 304 children, aged 6 to 48 months (average age 13.84 ± 6.68 months) including 172 girls and 132 boys, have followed the protocol of nutritional rehabilitation for 8 weeks. For 6/310 children, we stopped the research protocol because their health status required a reference to the national pediatric hospital. Among the 304 children no death was observed during the eight weeks of nutritional rehabilitation. z-score criteria, recommended by WHO and UNICEF: (i) z-score inferior or equal to −3 standard difference corresponds to severe malnutrition; (ii) z-score between −3 standard difference and −2 standard difference corresponds to moderate malnutrition; (iii) z-score greater than −2 standard difference corresponds to a normal nutritional status. The ages of undernourished children were confirmed by their birth notebooks.At the beginning of this study, undernourished children were anorexic and many of them had diarrhea and were treated with nose-gastric (NG) rehydration according to the CMSC protocol . They weWeight, height, brachial perimeters (BPs), and head perimeters (HPs) of the children were recorded. The weight of the children was recorded once a week from the day of admission to the CREN with a 10-gram sensitivity balance. The brachial perimeter (BP) is the mid-upper-arm circumference (MUAC). It is measured at the midpoint between the tips of the shoulder and elbow using an MUAC tape. The MUAC of children aged 6–59 months shows the degree of malnutrition: BP < 11.0 cm indicates severe acute malnutrition; 11.0 cm < BP < 12.5 cm corresponds to a moderate malnutrition; 12.5 cm < BP < 13.5 cm corresponds to a risk of malnutrition; 13.5 < BP corresponds to a satisfactory nutritional status [z-score), WHZ (weight for height z-score), and WAZ (weight for age z-score) parameters were calculated according to the references of the National Center for Health Statistics (NCHS) [The measure of head circumference (head perimeter); in children, head growth has been used by healthcare providers as a marker of brain well-being, because an abnormal rate of growth could suggest a pathological disorder requiring diagnosis and possible treatment, for example, hydrocephalus, psychosocial problems, and craniosynostosis. Measure Head Circumference as the name implies, occipital frontal circumference (OFC) is a measurement of the circumference of the head around the occiput, or posterior aspect, of the skull, to the most anterior portion of the frontal bone. An accurate head circumference measure is obtained with a flexible nonstretchable measuring tape . The heis (NCHS) . At the s (NCHS)  are usedz-score (WAZ) or weight insufficiency indicates a global malnutrition affecting both the linear growth and the weight increment. The height for age index expressed in z-score (HAZ) or growth delay is an index indicating chronic malnutrition provoked by an extended reduction of food consumption and by repeated pathologic episodes. Emaciation or weight loss expressed by the weight for height index (WHZ) indicates a slightly less malnutrition status or weight deficit due to a decrease or slowdown of regular growth.The evaluation of the nutritional status of the children has been made according to the nutritional indices . The wehttp://www.misola.org), which is responsible for the quality control of the product every year. The flour is produced by the handicraft production unit  of the CMSC, which has been operating since 1998 and is part of the network of UPAs acknowledged by the Misola Association (P + 250)/4, where “P” is the weight in decagrams. This formula is done by the Misola Association. We specify that the Misola is a dietary supplement it is not a substitute for breastfeeding which is highly recommended for malnourished young children. The NM flour is a mixture of millet, soya, peanut kernel, sugar, salt, vitamins and industrial amylase. In 100 g of NM used, we have 405 kcal of energy, 16.8 g of proteins, 10.1 g of lipids, and 63 g of carbohydrates, minerals, and vitamins. The preparation of the NM was carried out according to traditional customs, namely, 60 grams of flour and 200 mL of water were mixed and boiled over a low fire, mixing for 5-6 minutes. Each mother has to cook it, 4 times a day , in order to feed her child. After this preliminary phase they continued to administer the mixture at home. Each day they accompanied their children to the CREN to monitor weight and other anthropometric parameters and deliver the 24-hours diet recall sheet to CREN  were given weekly rations of 1500 grams, three bags, each containing 500 grams of flour. The daily quantity in grams of MN porridge to provide to children with malnutrition is obtained by the following formula: , P = 0.002, P < 0.001, P < 0.001, and P = 0.061 (NS) , and brachial perimeter (BP) were greater than females with respective significance: (NS) see .P = 0.004), weight (P = 0.013), height (P = 0.004) and BP (P < 0.001). z-scores identified at the beginning of the study and those of the end have statistic difference significance: WHZ1 versus WHZ2 (P < 0.001) and WAZ1 versus WAZ2 (P < 0.001). It was also found statistic difference significance when comparing z-scores from this study and those of Simpore et al., [P < 0.001); WAZ2 versus WAZ2 (P = 0.033). We do not consider the parameters size and age (HAZ) because the study lasted two months and the sizes of the children have not increased significantly.  et al., : WHZ1 veThe New Misola (NM) we have used for the nutritional rehabilitation of the children was composed of 60% of small millet, 20% of soya beans, and 10% of groundnuts which contain proteins, glucose, and lipids. Moreover, it had been enriched with vitamins, carbohydrates, minerals, and industrial amylase. Treatment compliance was excellent, and none of the children dropped out. The mothers reported that the children accepted the meal of NM. They attended weekly appointments, but only the first and the last visit (8 weeks) were considered in the final evaluation. After eight weeks of study, children treated with NM, appeared clinically improved; their weight increased. This study enabled us to show that the malnutrition of pediatric aged children is directly related to the level of their parents' level of education and their occupation. In fact, most of their mothers were illiterate (93.42%) and housewives (86.84%) while only 14.14% of their fathers were literate and 3.95% had a monthly salary. Moreover, their parents had several other children (41.4% of mothers had more than 3 living children), and some of them were even deceased. Emphasize that 20.4% of parents had at least one child died and 7.2% had more than 3 children died. These elements could reveal family penury and poverty which would partly account for such malnutrition of the living children when they are less than 5 years old . But we z-score of weight and height WHZ = −3.10 and a z-score of weight and age WAZ = −3.85 which meant, according to the WHO criteria, a severe malnutrition . Other studies carried out on malnourished children with other foods, such as that [P = 0.067). Nevertheless, the children in this study had recovered more than those of Simpore et al. [P = 0.033). That could be caused by the addition of vitamins, minerals, and industrial amylase in the Misola flour. However, eight weeks after their nutrition with New Misola, we score a normal WHZ of −1.41 which is similar to the results obtained by Simpore et al. [ as that , and Kwe as that . With thThe flour of the New Misola is basically composed of millet, soya beans, and groundnuts as detailed previously. Apart from the proteins, glucose, and lipids, millet is a grain that contains microelement such as magnesium, calcium, iron zinc, copper, and manganese. Groundnuts contain glucose, protides, lipids, sodium, potassium, manganese, calcium, iron, zinc, and so forth, while soya beans contains calcium, iron, magnesium, phosphorus, potassium, sodium, vitamins , folic acid, linoleic acid, alpha-linolenic acid, isoflavone, and so forth. The inflationary trend, “the cost of living” in Burkina Faso, makes it almost impossible for many poor families to afford animal protein from meat, fish, and egg for their children. This has led us to the search for an alternative (vegetable protein) to animal protein in human diets. The use of plant protein can serve as a complement to animal protein in human diets so as to increase the total protein intake . Among tTherefore, we understand the reason why the New Misola porridge can nutritionally rehabilitate undernourished children. The Misola, through its elements of composition , could reestablish also in the malnourished children the depressed immune system , 27.This study shows that malnutrition remains a public health problem in Burkina Faso and over the world. The consequences of malnutrition represent a global problem, which affects morbidity as well as mortality. Awaiting the enrolment of these undernourished children in rehabilitation protocols, those in charge of public health services and epidemiologists should work in synergy with nutritionists and nutria-genetics in order to combat malnutrition efficiently . AccordiIndeed, whole grains and legumes bring to the human being energy and the needed micronutrients for his or her metabolic homeostasis. Without the external contribution of these fundamental elements produced by these vegetables, the human being would be unable to synthesize them for his or her own metabolic processes. At the present time of globalization, the world seems to have become a big village. The kitchens of the international community must review their diet by basing them upon grains and legumes that are sources of a sound nutrition. Moreover, it would be very important to promote the science of nutrition and to develop the nutria-genetics science in order to cast new foundations of nutrition for the future, taking into account the requirements of population's genetics.The Ethics Committee of the Saint Camille Medical Centre approved this protocol of study and authorized each person, after oral consent, to accept this study.


Although aberrant foot movement during gait has been associated with adverse outcomes in the lower extremities in clinical patients, few studies have analyzed population differences in foot function. The purpose of this study was to assess demographic differences in foot function in a large population-based study of community-dwelling adults.Participants in this study were from the Framingham Foot Study. Walking data were collected from both feet using a Tekscan Matscan pressure mat. Foot function was characterized using the center of pressure excursion index (CPEI). T-tests were used to assess differences between population subsets based on sex, and in men and women separately, age, body mass index (BMI), physical activity and in women, past high heel use.There were 2111 participants included in this analysis. Significant differences in CPEI were noted by sex (p< 0.0001), by age in women (p = 0.04), and by past high heel use in women (p = 0.04).Foot function during gait was affected by sex, as well as by age and shoe-wear in women, but not by BMI or physical activity. Future work will evaluate possible relations between CPEI and outcomes such as falls, sarcopenia, and lower extremity function. Foot function affects overall foot and lower extremity health. Prior research has linked abnormal foot function to adverse outcomes, such as lower extremity joint injuries ,2 and foData were obtained from the Framingham Foot Study , a populBetween 2002 and 2008, Framingham Foot Study participants were seen for a data collection protocol that included a walking plantar pressure assessment, a validated foot examination, assessments of clinical variables , and questionnaire-based assessments of activities and shoe-wear. Analysis inclusion criteria for this study required availability of foot function (center of pressure excursion index (CPEI)) data for at least one foot and valid data on age, BMI and physical activity  . As the Plantar pressure data were collected from a Tekscan Matscan  at 40 Hz. Participants walked at a self-selected pace and scans were collected using the two-step method  . One triFoot function was characterized using the CPEI, a measure of dynamic foot function. CPEI has previously been shown to discriminate between feet clinically determined to have planus versus rectus and planus versus cavus foot types ,19, wher2 or < 30 kg/m2. PASE scores were dichotomized at the sex-specific median, with the median being 134.5 for men and 115.5 for women.Age groups were dichotomized as ≥ 65 years or < 65 years to provide information on older adults at a common population cut-point. BMI groups were dichotomized by obesity using the cut-off ≥ 30 kg/mWomen were grouped into those who had always worn , sometimes , and never worn high heels (referent). Sex-specific t-tests were used to compare CPEI distributions between age, BMI, and PASE groups. A t-test was used to compare CPEI between sexes. Linear regression was used to compare high heel groups using those who had never worn high heels as the referent, and to model the relation between CPEI and continuous age, BMI, and PASE measurements. To further examine the effect of age on CPEI, we categorized age as <55 years, 55–65 years, 65–75 years and 75+ years. Linear regression was used to compare CPEI among these age groups, using those <55 years of age as the referent. Alpha was set to 0.05.2. Mean CPEI was smaller (p <0.0001) among women compared to men  were women .Given the link between foot deformities and muscle weakness in diabetic patients  and fallBoth finite element modeling  and a st2), in addition to including both men and women.This study has several strengths and limitations worth noting. Because the study design was cross-sectional, causal relations between foot function and the factors under study cannot be inferred. Due to examination time constraints, only one plantar pressure scan per foot was obtained from each participant and thus, there is likely a larger degree of measurement error. This limitation is mitigated by the large sample size of the study, but if this error had an effect on the results, it would act to bias towards a null effect between variables rather than create a false positive . There wThis study showed that there are sex, age, and high heel use-related differences in foot function (as measured by CPEI) in a large population-based sample of men and women. These results should be helpful in informing future research and analysis of foot biomechanics. Future work will evaluate the relation between CPEI and outcomes such as falls, as well as lower extremity function, injury, musculoskeletal disorders, and disease.The authors have no competing interests to report.TJH contributed to the analysis and interpretation of data and drafted the original manuscript. ABD carried out the statistical analyses, contributed to the interpretation of data and the revision of the manuscript. YMG made substantial contributions to the drafting and revision of the manuscript. JLR participated in the interpretation of data and the drafting and revision of the manuscript. HJH participated in the study conception and design and provided critical revision of the manuscript for intellectual content. VAC made substantial contributions to the drafting and revision of the manuscript. MTH conceived of the study, was responsible for the acquisition of data, contributed to the analysis and interpretation of data, and provided critical revision of the manuscript for intellectual content. All authors read and approved the final manuscript.


The aim of this research is to search for the distribution of blood groups in all the regions of Morocco. This study, done for the first time, aimed to provide the frequency of the Rhesus system and Kell (K) in more than 55000 blood donors from nine different regions around the country. In addition, the frequency of the Cellano, Duffy, Kidd, and MNS blood antigens was searched for 500 blood donors from the Rabat's region. Frequency of blood donors with rare blood groups was characterized for the first time in the country and compared to results found from other populations. Blood group phenotypes have been used for several applications as for blood transfusion practices and population genetic studies –3.In Morocco, no study has identified yet the distribution and frequency of different blood groups. In this perspective we tried to identify the Rhesus phenotypes in nine different regions spanning the whole country. We have also conducted a study to determine the frequencies of the k (cellano), Fya, Fyb, Jka, Jkb, S, and s antigens in blood donors (BD) from the Rabat region.N = 55630) BD who gave blood in nine different regions were phenotyped for the following Rhesus blood antigen D, C, E, c, and e. In addition, from the CRTS Rabat, we phenotyped 513 BD in the S and s antigens from the MNS system, Fya and Fyb antigens from the Duffy system, Jka and Jkb antigens from the Kidd system, and k (cellano) antigen from the Kell system.Fifty-five thousand six hundred and thirty . All samples that showed negative agglutination with monoclonal/polyclonal IgM/IgG anti-D and the Fy  phenotype were confirmed using Coombs' test. Fya, Fyb, Jka, Jkb, S, s, and k (cellano) antigens were typed by commercially prepared polyclonal antisera (Seraclone) with microplates methods for S antigen and by hemagglutination in gel cards  for other antigens.Positive and negative control cells and Coombs' control cells were used for quality controls.The allele frequencies were calculated using the gene counting method, which was described by Mourant et al. in 1976 .Statistical analysis was carried out using Microsoft Excel and the program PASTE .We characterized the Rhesus antigens distribution in 55630 randomly chosen BD from 9 regions, representing different ethnic groups of Morocco.The Rhesus antigens frequencies found were as follows: e (89.45%), D (70.65%), c (60.58%), C (38.54%), and E (9.59%). The observed phenotypes distributions are summarized in N = 55630). The D antigen is present in 70% of the BD population, thus showing an intermediate prevalence between those found in the African and European continents [Little data are available regarding the frequencies of the blood group antigens other than ABO and RhD in the Moroccan population. In this study, we examined the composition of RBC antigens in Moroccan BD. It is the first study in Morocco that involved such large number of BD N = 5530. The Dntinents . The e antinents .The most common Rhesus haplotypes in Morocco are DCe, followed by Dce and then by dce, respectively, found at 0.38, 0.34, and 0.28. This prevalence is similar to our neighbor Algerians  and TuniIn addition, Principal Component Analysis showed a clear evidence of a north-to-south gradient for some Rhesus phenotypes. In fact the DCcEe, CCDee, and ccDEe are linked to the north regions  while the Dccee is associated with the south provinces (Laayoune and Ouarzazate). This gradient was also found in a previous study by our group for the D antigen .Other system  phenotype frequencies showed that out of 513 Rabat's blood donors, only one donor (0.19%) was homozygote for the K. Cellano represented 99.80%. A north-to-south gradient was observed for the Kell antigen.The S and s antigens were positive in 43.1% and 91.2%, respectively. Fy (a− b+) was the most common phenotype seen in about 42% of the studied subjects. The Duffy null or Fy (a− b−) phenotype was observed in 11.11%. This latter phenotype is referred to in the African population as discussed by different authors , 13, 14.For the Kidd system, about half (49.5%) of our BD have the Jk (a+ b+), as found in the European population . The Jk Since the current practice of providing compatible blood to patients in Morocco is still relaying on blind cross-matching of available red blood cell units, we initiated this study to map the distribution of the blood groups around Morocco, especially for better management of red cell unit delivery to highly alloimmunized patients.The main result found here illustrated that the Moroccan population shares phenotypes with Sub-Saharan Africa and European populations, and a clear evidence of a north-to-south gradient for some Rhesus phenotypes.Some particularities were also found as the higher frequency of “e” antigen blood group and the Fy (a− b−) which was represented at a significant frequency (11.1%).


Celiac disease and cystic fibrosis have many common manifestations, such as malabsorption, steatorrhea and growth failure, and were for many years recognized as one clinical entity. Since their recognition as two separate diseases, their co-existence in a patient has been described sporadically; around 20 cases have been described in the literature. Taking into consideration the incidences of the two diseases, the chance of them occurring together is one in 2,000,000 in the general population.We describe the case of a five-year-old boy of Turkish ethnicity with both celiac disease and cystic fibrosis, who presented initially with a skin hemorrhage. The diagnosis of celiac disease was made with a positive serum anti-tissue transglutaminase antibody test and the presence of HLA-DQ2 heterodimer, and confirmed on histology with small intestinal villous atrophy. A positive sweat test confirmed the diagnosis of associated cystic fibrosis.To the best of our knowledge there has been no previous report of this rare presentation of associated celiac disease and cystic fibrosis.The clinical significance of this case is the consideration of malabsorption with both celiac disease and cystic fibrosis in patients who present with unexplained coagulopathy. Celiac disease (CD) is a multi-factorial, autoimmune disorder that occurs in genetically susceptible individuals, triggered by a well-identified environmental factor--gluten. Originally considered to be a rare malabsorption syndrome of childhood, CD is now recognized as a common condition that may be diagnosed at any age and that affects many organ systems. The interplay between genes and the environment leads to the onset of intestinal and/or extraintestinal symptoms.Cystic fibrosis (CF) is the most common genetically inherited disease in Caucasian populations. Understanding of the disease has progressed rapidly the past 20 years. CF used to be predominantly a lung disease of young children but more recently it has become a complex multi-system disease extending into adulthood. The co-existence of CD and CF was first described, in a child, by Hide and Burman in 1969 [We present the case of a boy with concomitant CD and CF, initially manifesting with a skin hemorrhage. To the best of our knowledge there has been no previous report of this rare hemorrhagic presentation of concomitant CD and CF.A five-year-old boy of Turkish ethnicity was referred to our hospital because of the spontaneous appearance of hematomas on both his upper and lower limbs and on his back over the preceding few weeks. His parents were healthy, unrelated, and he had no siblings. No family history for genetic diseases was reported. He was born out of normal pregnancy and delivery, with a birth weight of 4.1 kg; had normal peri-natal course and regular weight gain. He was barely breastfed and cow's milk was introduced from his first month. There were no previous hospital admissions. He did not have any major illnesses except for a few upper respiratory infections which were successfully treated with medication. In addition to these, he had experienced occasional, mild, non-troublesome cough that had never required treatment. His abdomen was always distended and his mother reported three to four loose stools per day in the last five months.th percentile for his age. His body mass index was 16.5 (within the 50th percentile for his age).A general physical examination on admission revealed skin paleness, but no jaundice, and remarkable multiple bruises on both his legs and right arm and a single large hematoma in the lumbar region of his back. An examination of his abdomen showed marked abdominal distension, with no hepatosplenomegaly and no palpable mass or ascites. His height was on the third percentile, his weight was within the 25DQB1*02 homozygous). A sweat test was preformed on two separate occasions and came back positive, with chloride concentration measuring 118 mmol/L and 67 mmol/L. A chest radiography showed hyperinflation with increased retrosternal air space and reduced transparency in his lower lung lobes, especially expressed on the right side. The molecular work up was negative for the most frequent mutations of cystic fibrosis transmembrane conductance regulator (CFTR) (only 11 are available in our center). Our patient was diagnosed to have both CD and CF. Treatment with ursodeoxycholic acid and pancreatic enzymes, antibiotics and oral iron supplementation was initiated and a gluten-free diet was recommended.A laboratory analysis was suggestive of iron deficiency anemia, with hemoglobin level 97 g/L, serum iron 2.8 μmol/L, hypoproteinemia (50 g/L protein), hypoalbuminemia , elevated serum aspartate transaminase (AST) (129 U/L), and elevated alanine transaminase (ALT) (159 U/L). A coagulation screening profile showed normal platelets number and bleeding time, but a prolonged prothrombin time (PT) of 63s , and prolonged activated partial thromboplastin time (aPTT) of 105s . Possible primary liver disease was excluded, with negative antibodies for viral hepatitis A, B and C, as well as negative antibodies for autoimmune hepatitis type I and II. Ceruloplasmin and α1-antitrypsin were within normal limits for his age. A liver biopsy was not performed because of the severe coagulation impairment. A rapid screening test for tissue transglutaminase IgA antibodies was positive, with quantitative measurements of 903.3IU/mL . Antigliadin IgA was 1822IU/mL  and antigliadin IgG was 922.6IU/mL . Histologic assessment of the intestine revealed villous atrophy, cryptal elongation and hyperplasia plus increased intra-epithelial lymphocytes and mononuclear cells infiltration into the lamina propria. HLA typing was positive for HLA-DQ2  of 24 patients with CF, mean age 17 years. In three cases this was suggestive of liver disease, and in 14, of vitamin K deficiency [Unlike pulmonary and pancreatic manifestations that are present in 80-90% of CF patients, liver involvement is much less frequent, affecting only one third of CF patients . Corrigaficiency . In 1994ficiency . Factorset al. described a patient suffering from CD and CF and reviewed the available literature, summarizing 16 documented cases of CD co-existing with CF [et al. in 2009 performed a systematic screening for CD in a large Scandinavian cohort of 790 CF patients, and detected 10 patents with CD (1.2%) [CD and CF share a number of clinical manifestations and were for many years recognized as one clinical entity . Co-exis with CF . VallettD (1.2%) . A recenD (1.2%) .Taking into consideration the incidences of these two diseases, the chance of their occurring together in the general population is one in 2,000,000 .In the literature there are some hypotheses to explain the co-existence of CD and CF. Due to pancreatic insufficiency in patients with CF, the mucosa of the bowel may have more contact with the complete gluten protein. In addition, malnutrition might contribute to some additional mucosal damage . Some stIn our case, the first challenge was to identify the etiology of the bleeding diathesis. The abnormality of both the PT and PTT, as seen in our patient, led to the consideration of a multiple coagulation factors abnormality. In such abnormalities the hepatic synthesis of factors II, VII, IX, and X from vitamin K is impaired. The most common manifestations, bleeding from hypoprothrombinemia, are ecchymosis and hematomas, as seen in our patient. Vitamin K malabsorption leading to hemorrhage is an unusual presentation of both CD and CF. The chronic diarrhea, that had not been diagnosed until this episode, assisted in narrowing the diagnosis. The positive serologic test in correlation with HLA-DQ2 presence was strongly suggestive for CD. Intestinal histology and marked clinical improvement after gluten withdrawal confirmed the diagnosis. Our patient also fulfilled the diagnostic criteria for CF because of the manifested pancreatic insufficiency and a chest radiography, with the initial diagnosis confirmed with the positive sweat test.The clinical significance of this case is in the consideration CD and CF in patients who present with unexplained coagulopathy. The presence of abnormal tests of coagulation should prompt the clinician to consider any signs of malabsorption. The co-existence of CD and CF in this case was also a motive to systematically screen for CD among other CF-diagnosed patients in our center.Written informed consent was obtained from the patient's father for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.AK analyzed and interpreted the patient data and performed the GI endoscopy. NZ analyzed and compiled all the data and laboratory analysis and was the major contributor in writing the manuscript. All authors read and approved the final manuscript.


Introduction. The effect of Qigong on psychological well-being is relatively unknown. This study systematically reviewed the effects of Qigong on anxiety, depression, and psychological well-being. Methods. Using fifteen studies published between 2001 and 2011, a systematic review was carried out and meta-analyses were performed on studies with appropriate homogeneity. The quality of the outcome measures was also assessed. Results. We categorized these studies into three groups based on the type of subjects involved as follows: (1) healthy subjects, (2) subjects with chronic illnesses, and (3) subjects with depression. Based on the heterogeneity assessment of available studies, meta-analyses were conducted in three studies of patients with type II diabetes in the second group, which suggested that Qigong was effective in reducing depression  and anxiety , as measured by Symptom Checklist 90, and in improving psychological well-being  as measured by Diabetes Specific Quality of Life Scale. Overall, the quality of research methodology of existing studies was poor. Conclusions. Preliminary evidence suggests that Gigong may have positive effects on psychological well-being among patients with chronic illnesses. However the published studies generally had significant methodological limitations. More high-quality studies are needed. Together, Qigong (or Chi Kung) means cultivating energy . Qigong  (waiqi) .Qigong exercises consist of a series of orchestrated practices including body posture, movement, breathing, and meditation, all of which have been designed to enhance Qi function—that is, to draw upon natural forces to optimize and balance energy within, through the attainment of deeply focused and relaxed states . An overalternative medicine, Qigong has been used to treat medical conditions such as high blood pressure [As a form of complementary and pressure , 10, bonpressure , and weipressure . Short-tpressure  and immupressure . Variouspressure –17, Parkpressure , Type IIpressure , cancer pressure , cardiacpressure , pain repressure , 22. Several Qigong review articles have been published, which mainly focus on the effects of Qigong on specific medical conditions such as hypertension , cancer Since many Qigong studies were conducted in China and published only in Chinese language journals, the authors included three researchers from China and five researchers from the U.S. Electronic relevant publications from both Chinese and English databases were reviewed. Two reviewers searched and screened the titles and abstracts of the studies identified by the search against the eligibility criteria for English databases independently. One reviewer searched and screened the studies in Chinese. For potentially eligible studies, the full text publications were obtained and criteria reapplied. Disagreement was resolved by discussion. A professional librarian was consulted in our search process.Research articles published in English on the effects of Qigong on mood and depression were identified from the following databases: from the inception to 2011 on Medline, PubMed, PsycINFO, Cochrane Reviews, Ovid, EBSCOhost, and all of the journals in the Harvard Countway Library of Medicine. Research articles published in Chinese on the effects of Qigong on mood and depression were identified from the following Chinese databases: from the inception to 2011 on CNKI, Wan Fang Med Online, and VMIS. For English databases, the key words used included a combination of MeSH and free text terms: “Qigong/Qi Gong/Gong, Qi/Ch'i Kung/Kung, Ch'i”, “mood,” “depression,” “anxiety,” “emotional well-being,” and “psychological well-being” as main subject headings, text words in titles, and abstracts. For Chinese databases, the key words used included equivalent Chinese terms as main subject headings, text words in titles, and abstracts. According to the selection criteria, interventions were restricted to Qigong. Other psychological interventions such as yoga and meditation were excluded; mixed interventions  were excluded  or quasi-experimental (Q-E) design. The process of study selection was described in We assessed the characteristics of the original research and extracted data accordingly. Some basic information was collected based on date of publication, study sites, language of study, and clinical domains see . The metk coefficient [Findings of 15 studies were tabulated regarding sample characteristics , duration, intervention style, design of control measures being used, and main outcomes . Two revfficient . Disagreχ2-test with a significance level of α = 0.1, given the low power of such tests. Statistical heterogeneity was specifically examined with I2 [I2 values of 50% or more indicate a substantial level of heterogeneity [If substantial clinical, methodological, or statistical heterogeneity existed, study results were not combined by means of meta-analysis. Clinical heterogeneity usually came from patients' characteristics . Methodological heterogeneity refers to differences between studies in terms of methodological factors, such as sequence generation and concealment of allocation . If the with I2 , where Iogeneity . When heBecause all 15 studies we reviewed had small samples, funnel plots were used in an exploratory analysis to assess the potential existence of small study bias if 9 or more studies were included in one meta-analysis. If less than 9 studies were included in the meta-analysis, we considered that a potential risk of selective reporting existed . Since all outcomes were continuous variables, if the same measurement was used across studies, effect size (ES) was determined by calculating the mean difference between groups. If the same underlying concept was measured but different outcome measurements were used, ES was determined by calculating the standardized mean difference between groups. Because of the different trials implemented various styles of Qigong, if any trials with three or more treatment arms were identified, we made two assumptions for the analysis. Firstly, if the trial was comparing two or more styles of Qigong versus control, then the data for those Qigong arms were combined to give one comparison of Qigong intervention versus control for that trial.Secondly, if the trial was comparing Qigong versus two or more controls, then the data for those control arms were kept separate, and the data for that trial were included in the appropriate control categories. Overall outcome was assessed by pooling the ES of each study. In view of the heterogeneity, random-effects model was used for pooling. All analyses were conducted using Review Manager 5 . We assessed the quality of the outcome of measures using GRADE profiler version 3.Fifteen studies published between 2001 and 2011 were included in this systematic review. Of these, 6 were published in Chinese and identified from Chinese databases –33 and 9n = 9) of the remaining studies were conducted in China, including Hong Kong. In six studies, effects of Qigong interventions were examined in healthy adults without any specific medical conditions. The majority of the studies, however, targeted individuals with a variety of chronic conditions, including diabetes (n = 4), depression (n = 1), cancer (n = 1), and hypertension (n = 2)  .κ) was 0.901 (P < 0.0005). Seven studies described the randomization process. One study reported that the randomization was performed by a statistician who had prepared a randomization list before the study started . Four stBlinding was described in only three studies. One study adopted a single blind run-in period . AnotherFive studies described the methods to evaluate the adherence of patients to intervention , 38, 39.The durations of the interventions ranged from 70 minutes to 4 months. Interventions of 3-4 months' duration appeared to be the norm for demonstrating changes while maximizing study enrollment and adherence. Among the Qigong intervention studies, the most popular form was the “Eight Section Brocade Exercise.” During and outside of group practice sessions, peer learning and discussions to facilitate social interaction and mutual support were encouraged since these may be important therapeutic ingredients. In most of the studies, control groups received treatment as usual and routine medical check-up. Three studies utilized a waitlist as the control group , 35, 39.While all included studies reported on psychological outcomes, only the study by Tsang et al. targeted participants with a psychiatric disorder . The remThe most frequently reported psychological benefits were decreased depressive symptoms and improved mood, reported in seven studies , 36–38, Participants in the intervention groups also demonstrated reduced anxiety , 37, 41,Three studies reported statistically significant improvements in somatic symptoms among the intervention group as evidenced by scales such as the Symptom Checklist-90 and Somatization Scale . In thesSome studies employed measures of physical health and biomarkers, including blood pressure , cholestImprovement of overall quality of life (QOL) was the second most frequently mentioned benefit reported in six studies , 40, 41.Self-efficacy was generally assessed in the RCTs as a secondary outcome related to the problem area under investigation . The perceived ability to handle stress or novel experiences , 40 and We categorized the studies into three groups based on the type of subjects for further analysis as follows: (1) healthy subjects, (2) subjects with chronic illnesses, and (3) subjects with depression. Only one RCT recruited subjects with depression  and therEight RCTs were included in the group of studies of patients with chronic illnesses , 38, 41.P < 0.05). Results of the individual trials for SCL-90 are presented in After assessment of heterogeneity and consideration of the choices of varying control groups used in different studies, meta-analysis of outcomes related to depression measured by Symptom Checklist 90 (SCL-90) were performed on the remaining three RCTs of patients with type II diabetes –32. BaseI2 = 0% , with I2 = 0% . Meta-anI2 = 0% . I2 = 0% , somatization , obsessive-compulsive , interpersonal sensitivity , anger-hostility , phobic anxiety , psychotism  and paranoid ideation . All the above outcomes were with  Figures . P < 0.05). Results of the individual trials for DSQL are presented in Two RCTs were included in the meta-analysis of psychological health measured by Diabetes Specific Quality of Life Scale (DSQL) , 36. BasI2 = 0% , with I2 = 0% . Data syI2 = 0% .The studies in this paper demonstrated that Qigong may have beneficial effects for a variety of populations on a range of psychological well-being measures, including mood, anxiety, depression, general stress management, quality of life, and exercise self-efficacy. The movements of Qigong is relatively easy to learn, when compared to other mind body traditions , 4. HencThis systematic review highlights the mood and psychological effects of Qigong in addition to its physical effects. The outcomes of the three selected studies showed improvements in psychological well-being, especially when the control intervention does not include active interventions such as exercise. These studies used SCL-90 to measure the pre- and post-outcomes related to Qigong intervention. While SCL-90 is a widely used and well validated measure for psychological outcomes, it is important to point out that it does not provide information on clinical diagnoses of anxiety of depressive disorders. Due to the small number of studies available in this area, and the diverse outcomes used, we limited meta-analysis on patients with diabetes. With more relevant studies in the future, it will be informative to review separately, the anxiety and depressive outcomes among healthy subjects, patients with specific chronic illness , and for patients with specific psychiatric disorders . Qigong practice usually involves doing Qigong , plus peer learning, social support, and positive expectation. All these could have beneficial effects to psychological well being and so all these are encouraged in Qigong practice. We have acknowledged that the outcomes of studying such Qigong practices will not provide us with the information on the question whether Qigong  alone is beneficial to psychological well being. Positive expectations or social interactions may add to effects related to the Qigong intervention, to form a multi-component mind-body practices instead of a single (Qigong) intervention.In this paper, we included studies both from the Chinese and in English databases. We consider this approach a strength as many Qigong studies continue to be originated in China and published in Chinese language. While only one researcher performed literature search in Chinese which may lead to some biases, early Qigong research findings published before 2003 (in English), respectively, 2000 (in Chinese) have not been considered. This approach has substantially limited the literature base for the present review and consequently also its findings. The findings of this study should be interpreted in light of the methodological limitations of the studies reviewed. In both of the English and Chinese studies included in the review, most of them used treatment as usual (and one used a waitlist) for the control group. This may lead to bias since positive outcomes from the study could be due to positive expectations or social interactions rather than to the Qigong intervention. A sham treatment which offers social interaction and positive expectations from receiving an intervention could be a better control for these studies. It will also be important in future studies to control for what has been called the frustrebo effect  .The majority of these RCTs were pilot studies on patients with chronic illnesses conducted to collect preliminary data on the efficacy of a group intervention to estimate the effect size needed for a larger, more definitive study. While the studies provided valuable data regarding feasibility and clinical efficacy, the use of a small sample could lead to instability of the outcomes, making it harder to generalize to other populations. In addition, many studies used inadequate blinding of the intervention, which could lead to more favorable responses among the Qigong intervention groups. Most of the cited studies did not provide data on whether participants continued to practice Qigong after the intervention period. Subsequently, long-term psychological effects of Qigong are unclear. Generally, Qigong practices are considered safe, and there have been few published adverse events , 4. Whil


Background. Circulation system, immunity system, and nervous system have a close relationship with meridian phenomen. However, there is still lack of the results of dynamic changes of these structures in acupoint. The aim of this study is to explore the interrelationship by composite staining techniques. Methodology/Principal Findings. Twenty rats were separated into electroacupuncture group (EA) and control group (Con) randomly. In EA group, the Zusanli and Weishu were stimulated with the 0.1 mA for 25 min. The tissue of these acupoints was double-stained with acetylcholinesterase and Toluidine blue. The compound structure of mast cells, nervous fibers, and mast cells in the acupoint was observed. Conclusions/Significance. The blood vessels, mast cells and acetylcholinesterase responded nerves were clearly observed in acupoint tissues. EA can result in the mast cell recruitment and migration along the blood vessels and nervous bundle, which conformed the dynamic compound structure and played important roles in acupuncture. Previous study has proved the evidence that nervous system , 2, blooTwenty male Wistar rats were kept in an animal house maintained with a 12-hour light-dark cycle and were given free access to food and water. The weight of the rats was 120–150 g. The other instrument and materials are as follows: the vulcanization acetylcholine iodized salt , Toluidine Blue O , constant cold box slicer .μm thickness section was prepared for double staining with Copper ferrocyanide method and acetylcholinesterase stain method. Finally, the section was dyed in 1% Toluidine blue solution for 15 second. The tissue section was observed with microscope.The rats were separated into control group (Con) and electroacupuncture group (EA) randomly, in EA group, left Zusanli (ST36) and Weishu (BL21) were stimulated with electroacupuncture machine, and the parameters are 0.1 mA, 2/15 Hz, for 25 min every day, and the duration is 2 days. In Con group, there have been no interventions. The tissue samples including skin, subcutaneous tissue, and muscle tissue were collected from Zusanli and Weishu acupoint (size: 1 cm × 1 cm × 0.4 cm) in both EA and Con groups. Then the 15 μm) and the capillary tortuosity into the group. Cholinesterase-positive nerve fibers (Acher) with different thickness were clearly visible, surrounding the blood vessels in the arterial wall, which has the close relationship with the vascular smooth muscle (Figures Under the microscope, the small and medium-sized artery in Zusanli acupoint area was longitudinal distribution along the limb long axis; the medium-sized artery in the Weishu acupoints was longitudinal distribution, too. However, the small artery and vein in the Weishu area were mutual anastomosis with each other and form the trunk long axis blood network. The blood vessel layers can be identified, with the smooth muscle distributed in the wall of the small arteries (diameter, 20–200  Figures . There a Figures . Finally Figures . In the  Figures . In the  Figures . In addi Figures . Previous research suggested that acupoint is relatively dense structures such as nerves , blood vUnder the action of acupuncture, MC was migrated and recruited in the acupoint and meridians. As a result, the active components which come from vessels, nervous fibers, immunity system, and endocrine system interacted with each other to form a functional coupling structure. According to the properties of this composite structure and correlation with the acupuncture meridians effect, we defined this special structure as mobile cell communication web system.Mobile cell communication web system mainly consists of the vascular network subsystem, neural network subsystem, the immune network subsystem, and the channel network subsystem. The vascular network subsystem is the source of human activity which collected the materials, energy, information, and also the orignal ditch of mobile cells. It is also the metabolism foundation of tissues and cells and stable physiological functions. Neural network subsystem is an important information control system, linked to various organs through different nerve endings. For example, different caliber blood vessels closely related to the different types of neural endings which had different neurotransmitters and peptides regulated the flow of the peripheral blood circulation precisely  then infMobile cell subsystem is an active subsystem, which plays an important role in cell-cell or tissue-tissue communication through cell migration. In particular, the increased number of mobile cells or particle matters released from the mobile cell reflected the correlation and dynamic function of these subsystems.Therefore, the mobile cell subsystem is an important order parameter in switching and regulating the acupuncture effect. The mobile cells take part in the cascade reaction of acupuncture through multi-channel and multi-target.After acupuncture, the MC number increased in the fascial spaces or channel spaces around the blood vessels. The volume of MC was enlarged, and the large amount active compound was released; as a positive feedback reaction, the channel spaces gradually enlarged. The enlarged tissue space is a special functional pathway which will be beneficial for MCs migration in a special order, and finally, these special spaces formed the tissue channel as an important exchange pathway for material, information, and energy , 13.


Early aggressive parenteral nutrition (PN), consisting of caloric and nitrogen intake soon after birth, is currently proposed for the premature baby. Some electrolyte disturbances, such as hypophosphatemia and hypercalcemia, considered unusual in early life, were recently described while using this PN approach. We hypothesize that, due to its impact on cell metabolism, the initial amino acid (AA) amount may specifically influence the metabolism of phosphorus, and consequently of calcium. We aim to evaluate the influence of AA intake on calcium-phosphorus metabolism, and to create a calculation tool to estimate phosphorus needs.Prospective observational study. Phosphate and calcium plasma concentrations and calcium balance were evaluated daily during the first week of life in very preterm infants, and their relationship with nutrition was studied. For this purpose, infants were divided into three groups: high, medium and low AA intake . A calculation formula to assess phosphorus needs was elaborated, with a theoretical model based on AA and calcium intake, and the cumulative deficit of phosphate intake was estimated.154 infants were included. Hypophosphatemia (12.5%) and hypercalcemia (9.8%) were more frequent in the HAA than in the MAA (4.6% and 4.8%) and in the LAA group (0% and 1.9%); both p<0.001.Calcium-phosphorus homeostasis was influenced by the early AA intake. We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome).We provide a simple tool to calculate the optimal phosphate intake. The early introduction of AA in the PN soon after birth might be completed by an early intake of phosphorus, since AA and phosphorus are  the main determinants of cellular growth. Recent nutrition guidelines recommend early introduction of “aggressive” parenteral nutrition (PN) for the preterm baby, in order to avoid cellular catabolism and to promote extra-uterine growth -4]..4].There is some current evidence that water and electrolyte balance, along with micronutrient homeostasis, may be influenced by early aggressive PN ,6. In prThe metabolism of phosphorus and its plasma concentration may also be influenced by this new nutritional approach. Phosphate content is very abundant in the cell, as it represents the main anion in the intracellular space and it enters into the composition of the nucleic acids, the ATP and the cell membrane. The phosphate role in bone development and mineralization, but also in cellular growth, may cause dramatic variations in its serum concentration during early aggressive PN.Recent clinical observations support this hypothesis. Mizumoto et al.  have obsIndeed, phosphate concentration disturbances will also induce variations in calcium plasma levels and urinary excretion, due to the metabolic interactions of these two micronutrients during the bone resorption and formation process.The present study is part of a prospective investigation carried out with the aim of assessing the relationship between the fluid and electrolyte homeostasis and the nutritional intake in a cohort of premature infants, as already described . Some inThe aims of this study are the following:Firstly, to evaluate the influence of early nutrition on calcium and phosphate homeostasis in preterm infants;Secondly, to create a simple calculation tool, in order to estimate the optimal amount of phosphorus to be added in the PN bags, according to the administered AA intake.This was a prospective study was conducted from June 1, 2006 to September 30, 2007. All the infants born below 33 weeks of gestational age (GA) and hospitalized within 6 hours of life in the Neonatal Intensive Care Unit of the Dijon University Hospital were eligible. Infants with major congenital anomalies were excluded from the study.The study was conducted according to the principles of the declaration of Helsinki, and the study protocol was approved by the regional Ethics Committee . Informed, signed parental consent was obtained. The study was entirely supported by the institution.PN on central venous line or on peripheral venous line was administered according to clinical decision. In both cases, PN was administered by individualized formulations prepared into the unit or by standardized batch-produced bags, as already shown in a previous report . In caseMinimal enteral feeding by human milk was started on day one of life, and continued for at least 4 days in babies having total PN. When partial PN was given, enteral nutrition was started on day one at 20 ml/kg/day and daily increased over the week.AA intake  was started on day one and incremented daily up to 3.5 g/kg at the end of the first week in the standardized procedure. When PN was individualized, the initial amount and the rate of AA increase were decided by the prescribing physician, based on a written protocol available in the unit which suggested the day of life for initiation of each nutrient and energy intakes.st day of life at 40-50 mg/kg/d. P infusion  was started on the 2nd or the 3rd day, with wide variations among the infants, depending on the prescribing physician.Ca infusion  was started on the 1Plasma sodium, potassium, Ca, P, total carbon dioxide, urea and creatinine were determined daily for 7 days. The first blood sample was obtained at around 12 hours of life. Daily diuresis was calculated and a consecutive 8-hour urine collection, starting 4 hours before the blood sampling, was performed using a plastic bag. Urine was analysed for sodium, potassium, Ca, urea and creatinine concentrations. Urine escaping the bag was quantified by weighing nappies. Fluid, energy and nutrient intakes were recorded daily. Oral human milk intakes were considered in fluid and nutrient intake calculations. Plasma and urine electrolytes were measured by an Ortho Clinical Diagnostic analyser , which uses direct potentiometry. Ca balance was expressed in mg/kg/day and calculated as the difference between daily intake and daily urinary excretion.First, the association of calcemia, phosphatemia and Ca balance with perinatal variables and energy, AA, Ca and P intake, was explored using one-factor analysis of variance. The perinatal variables entered into the model were: birth weight, gestational age, gender, small for gestational age, antenatal corticosteroids, caesarean section, postnatal age and respiratory distress syndrome. Variables significant at a P-value 0.10 at the univariate analysis were entered into a backward selection analysis of variance. Then, the infants were divided into three groups, according to the mean level of AA intake during the week: low AA intake: <1.5 g/kg/day (LAA); medium AA intake: 1.5-2 g/kg/d (MAA); high AA intake: >2 g/kg/day (HAA). Calcemia, phosphatemia and Ca balance were compared within the three groups. The crude risk for Ca and P perturbation was also evaluated. Data from continuous variables were expressed as mean ± SD. Differences among groups were studied using analysis of variance test, and results were adjusted for GA with analysis of covariance test. Linear regression procedures were used to correlate the cumulative calculated deficit in P intake with Ca and P plasma levels. Statistical tests were performed by SAS software 8.2 , results were considered significant at a 5% level.A theoretical model for P need was elaborated as follows.1. Estimated Ratio of Ca and P mass in bone, based on hydroxyapatite composition: P (mg) = Ca (mg) / 2.15  2. Estimated Ratio of Nitrogen (AA) and P in the rapid growing cell: P (mg) = AA (g) * 12.3 -16]  16] 3. Estimated minimal AA intake to obtain a positive nitrogen balance: AA = 1.3 g/kg/d ,114. Estimated AA retention: AA = 80% of AA intake P need = Ca intake/2.15 + (AA intake -1.3) * 0.8 * 12.3Calculation Formula: P need is expressed in mg/kg/d; Ca intake is expressed in mg/kg/d; AA intake is expressed in g/kg/d.The formula was based on total intakes. It does not take in account the enteral absorption rate of nutrients.The estimated P need was calculated for each day of the first week. Then we evaluated the daily P deficit by subtracting the real intake of P from the theoretical need. The cumulative deficit of P intake from birth was then calculated, and correlated to the Ca and P plasma levels. A second linear regression analysis was performed adjusting the daily plasma levels of Ca and P for their level on the first day of life in each infant.One hundred and fifty-four infants were included. A total of 813 Ca and 436 P plasma determinations were performed. In total, 465 Ca urine collections were obtained.Antenatal, postnatal characteristics and nutritional intake for the three groups are summarized in The group analysis confirmed the influence of the AA intake on the homeostasis of Ca. Calcemia was significantly higher in the HAA group as was the incidence of severe hypercalcemia (Ca > 2.8 mmol/L). Calcium urine output was very important in the HAA group by the end of the week. Despite these high levels of calciuria, the Ca balance remained positive at any time for all the groups. Phosphatemia was strongly influenced by early nutrition, with very low plasma levels in the HAA group and a significant risk of hypophosphatemia (P < 1 mmol/L) .The modern approach to nutrition of the premature infant is based on starting feeding as soon as possible after birth, supplying a parenteral continuous flow of AA and energy . According to some of the latest studies it appears clear, however, that this new approach can be associated with some important metabolic disturbances in the first days of life .In particular, the early feeding strongly influences the metabolism of potassium, phosphorus and calcium, defining a syndrome that somehow simulates what happens in re-feeding conditions after intense nutritional deprivations, such as in Kwashiorkor, and in extreme bodybuilding ,19.For this reason, Mizumoto also used the definition of re-feeding syndrome for this condition of the premature infant .The disturbances that we observe are no real surprise for the researcher. In fact, potassium and phosphorus are the main ions present in the cytoplasm, respectively with positive and negative charge. In addition, the phosphorus is a significant component of nucleic acids, ATP and membrane phospholipids. The provision of adequate amounts of nitrogen, potassium and phosphorus is the condition required to obtain a rapid cell growth whether in bacteria or in eukaryotic cells of both plants and animals. In addition, the variability of the ratios among these nutrients will be able to modulate the quality of growth .In the human newborn, as in animals, rapidly growing cells will need large amounts of AA and potassium, so we can estimate that the needs of this cation are closely linked to the AA supply. In a previous report we showed that the balance of potassium closely parallels that of nitrogen .When considering the metabolism of phosphorus, it is important to consider that it enters into the constitution of the soft tissues. The phosphorus to nitrogen ratio in the cells is not stable and it is increased in the rapidly growing tissues ,15. A laTherefore, the association of hypokalemia, hypercalcemia and hypophosphatemia may effectively describe a new syndrome in premature infants, linked to early aggressive parenteral nutrition. However it cannot properly be considered a “re-feeding” syndrome.PI-Feeding syndrome)  .PI-ReFeeding syndrome)  .The attempt to calculate the ideal requirement of phosphorus in the premature infant is perhaps mission impossible. In fact, our data on specific tissue needs, on optimal bone phosphorus content, and on ideal growth pattern are incomplete; wide variations can be hypothesized according to gestational age, post-natal age, and depending on the individual variations. Furthermore, the tolerance and stability of the phosphorus in the parenteral nutrition bags limit our possibilities.However, the phosphorus is present in tissues with somewhat fixed ratios compared to other essential constituents, allowing a correct calculation of predictable imbalances.Our goal was therefore to estimate on the basis of defined AA and calcium intakes, whenever arbitrarily decided, the optimal supply of phosphorus, in order to minimize the risk of acute metabolic disturbances. Caution has to be exercised concerning the stability of PN solution. In our population the enteral feeding was limited during the first week of life. For this reason we elaborated the formula without considering the intestinal absorption rate of nutrients that may widely vary in the preterm infant. This has to be considered as a limitation of this study. The proposed algorithm needs to be validated in a prospective study.The present study adds more evidence to current knowledge, underlining the risk of electrolyte disturbances during early ‘aggressive’ parenteral nutrition in the preterm infant. As already observed by us and other authors, this risk of systematic perturbations may describe a syndrome due to incomplete feeding after the placenta nutrient flow disruption, the PI-ReFeeding syndrome. The effort to improve nutrition of premature infants has led many of us to focus primarily on the amount of AA and energy intake, thus in part underestimating the fundamental role of phosphorus and potassium for growth. This paper attempts a pragmatic approach to calculate the amount of phosphorus to be added in the PN bag, whilst not trying to provide the ideal intake, but rather aiming to avoid serious disturbances in the plasma concentrations of calcium and phosphate.