皮质抑素对脓毒症大鼠心肌凋亡的影响

目的:探讨皮质抑素对脓毒症大鼠心肌凋亡的影响。方法:SD雄性大鼠随机分为假手术对照组、脓毒症组、皮质抑素+脓毒症组。分别在盲肠结扎穿孔手术后18 h监测平均动脉压及心脏功能,腹主动脉取血处死大鼠,留取血清检测乳酸,留取心肌组织检测丙二醛(MDA)含量、caspase-3活性及p-JAK2、p-STAT3蛋白表达情况,病理切片进行TUNEL染色。结果:脓毒症大鼠表现出平均动脉压降低,心脏功能抑制和高乳酸特征,且心肌caspase-3活性升高,凋亡细胞数目增多及p-JAK2、p-STAT3蛋白表达水平升高。而预先给予皮质抑素可以改善脓毒症大鼠血流动力学及代谢特点,减轻心肌凋亡。结论:皮质抑素可以改善脓毒症介导的心肌凋亡,且这一作用与JAK2/STAT3信号通路相关。     

抑制JAK/STAT信号通路对缺血再灌注大鼠心肌的影响

目的探讨抑制JAK/STAT信号通路对缺血再灌注大鼠心肌的影响。方法以穿线法结扎左冠状动脉制备心肌缺血再灌注模型。健康Wistar大鼠24只随机分为4组,假手术组(C)、缺血再灌注组(I/R)、AG490组(I/R+AG490)、RMP组(I/R+RMP),每组6只。以Western印迹法检测大鼠心肌JAK2、STAT1、STAT3的表达。以原位末端标记法(TUNEL)检测心肌细胞的凋亡。结果缺血再灌注后p-JAK2、p-STAT1、p-STAT3的表达明显增加,且p-STAT1的表达较p-STAT3多,凋亡心肌细胞数增多,应用抑制剂AG490后p-JAK2、p-STAT1、p-STAT3的表达减少,凋亡的心肌细胞数也明显减少,应用雷帕霉素后p-JAK2、p-STAT1的表达无改变,p-STAT3的表达减少,凋亡细胞数较再灌注组略有增多,但无统计学意义。结论 JAK/STAT信号通路参与了心肌缺血再灌注损伤,应用AG490可减轻心肌细胞损伤,减少心肌细胞凋亡。     

硫化氢对大鼠糖尿病心肌病心肌间质纤维化及JAK2/STAT3通路的影响

目的:观察硫化氢(H_2S)对糖尿病心肌病(DCM)大鼠心肌组织纤维化、JAK2/STAT3通路及炎性因子表达的影响,探讨H_2S对DCM的作用及其机制。方法:运用糖尿病饮食联合链脲佐菌素(STZ)腹腔注射法建立SD大鼠2型糖尿病模型,选取随机血糖16.7 mmol/L的大鼠20只随机分成DCM+0.9%氯化钠组(DCM+saline)、DCM+硫化氢组(DCM+NaHS),每组10只。另选20只正常大鼠随机分成正常对照组(Con trol+saline)、正常对照+硫化氢组(Control+NaHs),每组10只。从造模成功后第8周起,DCM+NaHS组和Control+NaHS组大鼠腹腔注射NaHS溶液100μmol·kg~(-1)·d~(-1),Control+saline组和DCM+saline组腹腔注射等量0.9%氯化钠。第12周未处死大鼠,取左心室心肌组织提取蛋白和制作常规石蜡切片。运用Masson染色观察大鼠心肌间质纤维化并计算心肌间质胶原容积分数(CVF);运用Western blot技术检测大鼠心肌组织Ⅰ型、Ⅲ型胶原;磷酸化JAK2(p-JAK2)、磷酸化STAT3(p-STAT3)蛋白表达水平;运用酶联免疫吸附试验(ELISA)方法检测炎性因子白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)表达水平。结果:与Control+Saline组相比,DCM+Saline组大鼠CVF明显增加,同时心肌组织中Ⅰ型、Ⅲ型胶原蛋白表达水平明显升高,pJAK2、p-STAT3蛋白的表达水平明显升高,IL-1β、IL-6、TNF-α的表达水平也明显升高(均P0.05)。与DCM+Saline组相比,DCM+NAHS组大鼠CVF明显降低,心肌组织Ⅰ型、Ⅲ型胶原蛋白、p-JAK2、p-STAT3和IL-1β、IL-6、TNF-α的表达水平明显降低(均P0.05)。与Control+Saline组相比,Control+NaHS组各检测指标无明显差异。结论:H_2S对正常大鼠心肌间质纤维化无明显影响,但给予外源性H_2S干预可改善DCM大鼠心肌间质纤维化程度,其机制可能与下调JAK2/STAT3通路的活化有关。     

IL-27调控JAK/STAT通路在博来霉素诱导肺纤维化中的作用

目的探讨白细胞介素(IL)-27是否通过酪氨酸激酶(JAK)/信号转导与转录激活子(STAT)信号通路抑制肺纤维化。方法将40只雄性C57/BL6小鼠随机分为空白对照组(A组)、博来霉素(BLM)组(B组)、BLM+IL-27组(C组)和BLM+IL-27抗体组(D组),每组10只。于造模后第7、28天每组各处死5只小鼠,取右肺组织用Western印迹方法检测JAK2、STAT1、STAT3、STAT5及SOCS3蛋白的表达。结果 BLM诱导肺纤维化模型中,7、28 d肺组织均有p-JAK2、p-STAT1、p-STAT3、p-STAT5表达量升高,IL-27治疗后降低SOCS3的表达;D组p-JAK2、p-STAT1、p-STAT3、p-STAT5表达量在造模后7、28 d均最高,C组在造模后7 d表达量少于B组。结论外源性IL-27可能通过抑制JAK/STAT通路相关蛋白的磷酸化减轻肺纤维化。     

温阳通脉方通过JAK2/STAT3信号通路保护大鼠心肌缺血再灌注损伤

目的探讨温阳通脉方是否通过Janus蛋白酪氨酸激酶2(JAK2)/信号转导和转录激活因子3(STAT3)信号转导通路,调节水通道蛋白(AQP)的表达,发挥对缺血再灌注心肌组织的保护作用。方法将30只雄性SD大鼠随机分为5组,每组6只:假手术组、模型组及温阳通脉方低剂量治疗组、中剂量治疗组和高剂量治疗组。将大鼠灌胃给药14天后,结扎心脏左冠状动脉前降支,按缺血30 min再灌注120 min的方法建立心肌缺血再灌注损伤模型。全自动生化分析仪检测各组大鼠的血清肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH);心电图检测大鼠ST段抬高情况;HE染色观察心脏组织病理形态学变化;免疫组织化学染色检测心肌组织中AQP1、AQP4蛋白的表达;Western blot检测JAK2、p-JAK2、STAT3、p-STAT3、AQP1、AQP4的蛋白表达。结果与假手术组比较,模型组大鼠血清中的CK-MB、LDH含量显著上升(P0.01),缺血30 min与再灌注120 min后心电图的ST段显著抬高(P0.01),HE染色显示模型组的心肌细胞损伤严重,AQP1、AQP4免疫组织化学表达明显增多(P0.01),JAK2、p-JAK2、STAT3、p-STAT3、AQP1、AQP4的蛋白表达均明显升高(P0.01)。与模型组相比,给药大鼠CK-MB、LDH水平明显降低(P0.01),缺血30 min与再灌注120 min后的ST段均降低(P0.01),心肌细胞损伤均可见不同程度减轻,AQP1、AQP4免疫组织化学表达明显减少,JAK2、p-JAK2、STAT3、p-STAT3整体的表达呈升高趋势,尤其是p-JAK2和p-STAT3的表达(P0.01),AQP1、AQP4的水平均有不同程度降低(P0.01)。结论温阳通脉方的心肌保护作用可能与激活JAK2/STAT3信号通路,下调AQP1和AQP4的表达有关。     

姜黄素对大鼠脑缺血后Janus蛋白酪氨酸激酶2信号转导和转录激活子3信号通路的影响

目的探讨姜黄素对大鼠脑缺血损伤后Janus蛋白酪氨酸激酶2(JAK2)/信号转导和转录激活子3(STAT3)信号通路的影响。方法将68只SD大鼠随机分为假手术组、脑缺血组、姜黄素组(尾静脉注射姜黄素40mg/kg)和对照组(注射等量生理盐水),每组17只,后3组建立大鼠局灶性脑缺血模型,观察各组大鼠神经行为学变化,ELISA检测大鼠脑组织TNF-α、白细胞介素(IL)-1β、IL-6表达,Western blot检测大鼠脑组织JAK2、磷酸化JAK2(p-JAK2)、STAT3、磷酸化STAT3(p-STAT3)、高迁移率族蛋白1(HMGB1)表达。结果与脑缺血组比较,姜黄素组大鼠神经行为学评分减低[(1.53±0.62)分vs(2.94±0.87)分,P0.05];与脑缺血组比较,对照组TNF-α、IL-1β和IL-6无明显变化(P0.05),姜黄素组大鼠TNF-α[(57.63±10.27)ng/L vs(99.35±8.97)ng/L]、IL-1β[(33.67±9.10)ng/L vs(58.43±7.22)ng/L]和IL-6[(31.97±6.91)ng/L vs(49.23±6.28)ng/L]表达降低(P0.01),p-JAK2/JAK2、p-STAT3/STAT3相对含量及HMGB1表达降低(P0.05,P0.01)。结论姜黄素可保护大鼠缺血后脑损伤,其机制可能是通过抑制JAK2/STAT3信号通路,减少HMGB1表达,减轻炎性反应。     

川芎嗪对刀豆蛋白A诱导的小鼠肝纤维化JAK2/STAT3信号通路的影响

目的为探究JAK2/STAT3信号通路与炎性因子白细胞介素6、1β、10(interleukin-6、1β、10)的关系,IL-6、IL-1β、IL-10是否参与刀豆蛋白A(ConA)诱导的小鼠肝纤维化过程以及川芎嗪对其的影响。方法 BALB/C小鼠随机分为5组,正常对照组(A组)10只;ConA模型(B组)15只;川芎嗪低剂量(100 mg/kg)组(C组)15只;川芎嗪中剂量(200 mg/kg)组(D组)15只,川芎嗪高剂量(800 mg/kg)组(E组)15只。通过实时荧光定量PCR检测IL-6mRNA、IL-1βmRNA和IL-10mRNA的表达水平;Western-blot检测JAK2、STAT3和p-JAK2、p-STAT3的表达情况。结果与模型组相比,小鼠经不同剂量川芎嗪干预8周后,IL-6mRNA和IL-1βmRNA表达水平均降低,且与给药剂量呈相关性;IL-10mRNA表达水平升高,且与给药剂量呈相关性;p-JAK2、p-STAT3蛋白表达均降低,且下降程度与给药呈剂量相关性;JAK2和STAT3蛋白表达变化不明显。结论川芎嗪可能通过JAK2/STAT3信号通路及炎性因子IL-6、IL-1β、IL-10对ConA诱导的小鼠肝纤维化产生保护作用。     

雷公藤多苷通过JAK2/STAT3信号通路减轻溃疡性结肠炎大鼠肠黏膜细胞凋亡及炎症的实验研究

目的研究雷公藤多苷(TG)通过Janus激酶2(JAK2)/信号转导与转录激活子3(STAT3)信号通路对溃疡性结肠炎(UC)大鼠肠黏膜细胞凋亡及炎症的调节作用。方法将SD大鼠分为对照组、UC组、TG组、AG490组,UC组、TG组、AG490组采用三硝基苯磺酸/乙醇灌肠的方式建立UC模型,TG组给予TG灌胃干预,AG490组给予JAK2/STAT3抑制剂AG490干预。检测肠黏膜细胞凋亡率、凋亡基因及JAK2/STAT3表达、炎症细胞因子含量。结果 UC大鼠肠黏膜细胞凋亡率、Caspase-9、Caspase-3、p-JAK2、p-STAT3的表达水平及TNF-α、IL-1β、IL-6的含量均明显高于对照组,Bcl-2、Bcl-xL的表达水平明显低于对照组(P 0. 05); TG组大鼠肠黏膜细胞凋亡率、Caspase-9、Caspase-3、p-JAK2、p-STAT3的表达水平及TNF-α、IL-1β、IL-6的含量均明显低于UC组,Bcl-2、Bcl-xL的表达水平明显高于UC组(P 0. 05)。AG490组大鼠肠黏膜细胞凋亡率、Caspase-9及Caspase-3的表达水平、TNF-α、IL-1β、IL-6的含量均明显低于UC组,Bcl-2、Bcl-xL的表达水平明显高于UC组(P 0. 05)。结论 TG能够通过JAK2/STAT3信号通路减轻UC大鼠肠黏膜细胞的凋亡及炎症。     

姜黄素后处理通过JAK2/STAT3信号通路拮抗心肌缺血/再灌注损伤

目的:观察姜黄素（curcumin,Cur）后处理对离体心肌缺血/再灌注损伤(ischemia and reperfusion injury,I/RI)的拮抗作用及其可能的机制。方法: 40只SD大鼠随机分为5组(n=8),即空白对照(Ctl组)、缺血/再灌注组(I/R组)、I/R+姜黄素后处理组(I/R+Cur组)、I/R+姜黄素后处理+AG490组(I/R+Cur+AG组)及AG490组（AG组）,AG490为JAK2/STAT3信号通路特异性阻断剂。采用离体大鼠心脏Langendoff逆行灌注模型,缺血60 min,再灌注60 min。分别于缺血前及再灌注后15 min、30 min、45 min和60 min,测定血流动力学各项指标,包括:心率（HR）、左心室发展压（LVDP）、左心室内压力上升的最大速率(+dp/dtmax)、冠脉流量（CF）、计算出心率压力指数（DP,LVDP×HR/1000）。用氯化三苯基四氮唑(TTC)染色法测定各组心肌梗死(MI)的面积,用Western blot检测各组JAK2、磷酸化JAK2(p-JAK2)、STAT3以及磷酸化STAT3(p-STAT3)的表达。结果: 与Ctl组比较,I/R组各时间点的收缩及舒张功能均显著降低(P<0.01),MI面积显著增加(P<0.01),磷酸化JAK2和STAT3的表达明显升高(P<0.01)。与I/R组比较,I/R+Cur组各时间点的心肌收缩及舒张功能下降程度明显减轻(P<0.01),MI的面积明显减少(P<0.01),p-JAK2和STAT3的表达更高(P<0.01)。与I/R+Cur组相比,I/R+Cur+AG组各时间点的收缩及舒张功能显著降低(P<0.01),MI的面积显著增加(P<0.01),p-JAK2和STAT3的表达显著下降(P<0.01);和Ctl组相比,AG组血流动力学和MI的面积无统计学差异。结论: Cur后处理对I/R大鼠心肌具有保护作用,其作用机制与JAK2/STAT3信号通路的活化有关。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.