Li Zhenzhen

Inappropriate use of antibiotics in children in China

www.thelancet.com Vol 387 March 26, 2016 1273 drawn national attention and caused fierce controversy in the scientific community in mainland China. Tu has only a bachelor’s degree from Beijing Medical University School of Pharmacy, China. To many Chinese people, a doctorate and an overseas education are the primary requirements of successful principal investigators, and Tu’s success without having either of these seems to challenge medical education in China. At present, t h e B a c h e l o r– M a s t e r– D o c t o r path is necessary for clinicians or medical researchers to succeed in large hospitals or institutes in mainland China. Because of the rigid examination system during graduate school, publications in journals with Science Citation Index are regarded as a prerequisite or priority for individuals who are applying for master and doctoral degrees, promotion, and funding, or who wish to be awarded bonuses. As a result, the attitudes of many medical students deviate from the Hippocratic Oath, and some individuals even compromise on medical professionalism to pursue fame and wealth rather than to prioritise the health and wellbeing of patients. Most postgraduate medical students spend a lot of time in the laboratory doing experi ments—abandoning opportunities to acquire professional knowledge and improve clinical skills— so as to have articles published in high impact factor journals. Moreover, some third-party agencies make a profi t from editing article s for authors and helping them with the journal submission process, often doing so by proposing fabricated peer reviewers. Despite substantial efforts to retract some fake peer-reviewed articles, the scientific integrity of manuscripts from China is still affected by such retractions. Therefore, neglecting clinical competence and scientific integrity in the pursuit of journal publication seems to be putting the cart before the horse, and the mismatch between doctors’ self-perceived role and patients’ expectations could deteriorate doctor–patient relations. Undeniably, each coin has two sides. Basic scientific research promotes not only medical advances but also critical thinking and analytical skills to researchers. Thus, such research and scientific publication should be encouraged, rather than enforced, depending on individual doctors’ interests after they have shown clinical competence. The correct views on medical learning and scientific integrity should be emphasised during medical school.

Current evidence on the relationship between three polymorphisms in the cyp1a2 gene and the risk of cancer

CYP1A2 is an important cytochrome P450 enzyme that is involved in the metabolism of many clinical drugs and activation of some precarcinogens. Functional CYP1A2 polymorphisms are considered to exert significant effects on the risk of cancer, but the conclusions are inconsistent. Three commonly studied CYP1A2 polymorphisms, namely rs762551 (A>C), rs2069514 (G>A), and rs3569413 (T>delT), were selected to explore their association with the risk of development of cancer by meta-analysis of published case–control studies. Two investigators independently searched the PubMed, Embase, China National Knowledge Infrastructure, and the Chinese Biomedicine Database. Summary odds ratios (ORs) and 95% confidence intervals (95% CIs) for CYP1A2 polymorphisms and the risk of cancer were calculated in a fixed-effects model (the Mantel–Haenszel method) and a random-effects model (the DerSimonian and Laird method) when appropriate. For rs762551, 37 studies were eligible (16 825 cases and 21 513 controls); for rs2069514, 15 studies were eligible (3677 cases and 5127 controls); and for rs3569413, eight studies were eligible (1607 cases and 2043 controls). The results showed that no significant associations with the risk of cancer were found in any model (allele contrast, codominant, dominant, or recessive model) in terms of rs2069514 and rs3569413 when all studies were pooled into a meta-analysis. However, when stratified by cancer type, a statistically significantly elevated risk of cancer was only found in lung cancer for rs3569413 (delT-allele vs. T-allele: OR=1.50, 95% CI=1.16–1.95). In the subgroup analysis by ethnicity, a significantly increased risk of cancer was found in the Caucasian population for rs3569413 (delT-allele vs. T-allele: OR=1.63, 95% CI=1.01–2.63). With respect to rs762551, we found that carriers of the C-allele showed an increased overall risk of developing cancer compared with A-allele carriers (C-allele vs. A-allele: OR=1.08, 95% CI=1.01–1.16). Further subgroup analyses showed that the rs762551 polymorphism was associated with an increased risk of cancer in the subgroup of Caucasians (C-allele vs. A-allele: OR=1.14, 95% CI=1.00–1.28; dominant model: OR=1.19, 95% CI=1.02–1.37). These results suggest that the rs3569413 polymorphism of the CYP1A2 gene is associated with an increased risk of lung cancer and the rs762551 polymorphism of the CYP1A2 gene might be a potential biomarker for the risk of cancer among Caucasians. Further large and well-designed studies are required to confirm this conclusion.

Serum and urinary procollagen III aminoterminal propeptide as a biomarker of obstructive nephropathy in children.

BACKGROUND Ureteropelvic junction obstruction (UPJO) is the most common cause of chronic renal failure in children. Rapid diagnosis is important to preserve function and/or to slow down renal injury. This study was to examine serum and urinary procollagen III aminoterminal propeptide (sPIIINP/uPIIINP) protein as potential biomarkers of obstruction in hydronephrosis. METHODS The study included 29 children with unilateral UPJO who underwent pyeloplasty (Group 1), 30 children with mild, nonobstructive hydronephrosis (Group 2), and 30 healthy children. In Group 1, serum and voided urine samples were obtained at preoperative, 3 days, and 3, 6 and 12 months after pyeloplasty, respectively. Meanwhile, additional urine from the affected pelvis was collected at surgery. Serum and voided urine were evaluated for PIIINP in each group using immunoenzymatic enzyme-linked immunosorbent assay (ELISA) commercial kits and were expressed in picograms per milligram creatine (cr.). RESULTS The preoperative sPIIINP and uPIIINP levels were significantly greater in Group 1 than in other 2 groups. Three months after pyeloplasty, sPIIINP and uPIIINP levels had decreased significantly in Group 1 together with significant improvement of split renal function. Receiver operator characteristic (ROC) analyses revealed a good diagnostic profile for uPIIINP/cr. in identifying children with abnormal split renal function (<40%) [area under the curve (AUC) 0.789]. CONCLUSIONS Increasing uPIIINP levels are associated with worsening obstruction. Additional studies are required to confirm a potential application uPIIINP as a useful biomarker for the diagnosis and progression of congenital obstructive nephropathy.