肾间质微血管病变对肾疾病进展的影响

肾间质微血管病变在肾疾病进展中的作用尚不清楚。作者综述了支持肾间质微血管的丢失是肾疾病进展特征的有关证据，指出影响肾间质微血管病变的因素，试图探索肾病变进展的干预措施。     

Periodontal disease and coronary heart disease risk

CONTEXT: Research has suggested a relationship between periodontal disease and coronary heart disease (CHD), but data on the association between these 2 common conditions are inconclusive due to the possibility of confounding. OBJECTIVE: To evaluate the risk of CHD in persons with periodontitis, gingivitis, or no periodontal disease. DESIGN: Prospective cohort study. SETTING: The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: A total of 8032 dentate adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1859 individuals with periodontitis, 2421 with gingivitis, and 3752 with healthy periodontal tissues. MAIN OUTCOME MEASURE: First occurrence of death from CHD or hospitalization due to CHD, or revascularization procedures, obtained from death certificates and medical records, by baseline periodontal status. RESULTS: During follow-up, 1265 individuals had at least 1 CHD event, including CHD fatality (n = 468) or at least 1 hospitalization with a diagnosis of CHD (n = 1022), including coronary revascularization procedures (n = 155). After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD (hazard ratio, 1.05; 95% confidence interval, 0.88-1.26), while periodontitis was associated with a nonsignificant increased risk for CHD event (hazard ratio, 1. 14; 95% confidence interval, 0.96-1.36). CONCLUSION: This study did not find convincing evidence of a causal association between periodontal disease and CHD risk. JAMA. 2000;284:1406-1410.     

肠吸收不良

肠吸收不良是小肠上段的一种炎症病变 ,其发病原因是具有遗传易感性的个体摄入麸质1,2 。炎症可导致几种重要的营养物质吸收不良3 。采用无麸质饮食后 ,临床和粘膜恢复正常 ,证明此病是由麸质诱导的4 。 195 0年Ｄｉｃｋｅ观察到麸质在肠吸收不良发病机理中起核心作用。肠吸收不良与疱疹样皮炎有密切的相关性。在疱疹样皮炎中 ,存在有典型的皮疹和与肠吸收不良相似的小肠病变 ,当除去麸质后两种病损均消失。　　 方法　　本综述是根据定期的国际专题研讨会资料5 7和肠吸收不良会议论文集8、教课书、综述文章和检索Ｍｅｄｌｉｎｅ资料 (1997…     

Meningococcal disease

Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with significant morbidity and mortality. Among the different serogroups of Neisseria meningitidis, serogroups A, B, C account for 90% of the disease. In the last few years there has been a change in the epidemiology of the disease with an increase in the prevalence of serogroup C in Europe and North America, serogroup Y in the United States of America and Sweden, and W135 in the Kingdom of Saudi Arabia. The emergence of Neisseria meningitidis serogroup W135 in the Kingdom of Saudi Arabia has lead to 2 major outbreaks mainly among Pilgrims during the Hajj season of 2000 and 2001. This has lead the health officials in the Kingdom of Saudi Arabia to change their vaccine requirements for the Umra and Hajj to include the quadrivalent meningococcal vaccine (A, C, Y, W135) instead of the bivalent one (A, C). Despite all the advances in prevention, diagnosis and treatment, the disease continues to have high mortality (5-10%). Prompt empirical treatment for suspected cases should include penicillin or a 3rd generation cephalosporin. A new conjugate vaccine against Neisseria meningitidis serogroup C has been recently licensed, while quadrivalent conjugate vaccine against serogroup A, C, Y and W135 is in early development. Meanwhile targeted vaccination with the available vaccines according to the epidemiology of the disease and rapid chemoprophylaxis for the close contacts of active cases are the most effective preventive strategies.