经口内镜下肌切开术治疗7例食管中段憩室的临床观察

探究经口内镜下肌切开术治疗食管中段憩室的有效性与安全性。从前瞻性数据库中回顾性纳入2014年4月—2019年9月在四川大学华西医院接受食管憩室经口内镜下肌切开术（diverticular peroral endoscopic myotomy, D?POEM）治疗食管中段憩室的患者,使用适用于食管中段憩室的改良Eckardt评分系统评估憩室症状的严重程度,从临床成功情况、技术成功情况、并发症及复发情况等方面评价其有效性及安全性。 共纳入7例食管中段憩室患者,D?POEM治疗临床成功7例,技术成功7例,手术用时为16~70 min;2例发生轻微并发症,无严重并发症,无复发;随访时间为2~16个月,改良Eckardt评分患者中位得分由术前3分降至术后0分。初步认为D?POEM确保了正常食管腔与食管憩室之间间隔肌的完全切开,是一种安全有效的治疗食管中段憩室的技术;改良Eckardt评分系统适用于食管中段憩室治疗前后的症状评价。     

高分辨率食管测压评估经口内镜下肌切开术治疗儿童贲门失弛缓症的临床研究

目的 探讨高分辨率食管测压（high resolution esophageal manometry,HREM）评估贲门失弛缓症（achalasia of cardia, AC）儿童经口内镜下肌切开术（peroral endoscopic myotomy, POEM）效果的作用。方法 收集2013年1月—2019年9月于西安市儿童医院行POEM治疗的30例AC患儿资料。患儿分别于POEM治疗前及治疗后6个月行HREM。比较术前与术后患儿食管下括约肌静息压（lower esophageal sphincter pressure, LESP）、4 s完整松弛压（4-second integrated relaxation pressure, 4sIRP）、Eckardt症状评分及营养状况。结果 行POEM治疗的AC患儿年龄4~14岁。LESP术后为(5.50±1.13)mmHg（1 mmHg=0.133 kPa）,较术前的（26.23±4.47）mmHg明显降低,差异有统计学意义（t=-24.623,P<0.001）;术后中位4sIRP为5 mmHg,较术前的25 mmHg降低20 mmHg,差异有统计学意义（Z=-4.786,P<0.001）。术后中位Eckardt症状评分为1分,较术前的8分显著下降,差异有统计学意义（Z=-4.796,P<0.001）;患儿的营养状况由术前的重度营养不良明显改善至正常（Z=-5.166,P<0.001）。结论 POEM治疗能显著改善AC患儿的食管动力学特征,HREM可作为AC患儿POEM术后随访评估的重要客观指标。     

经口内镜全层肌切开术治疗重症贲门失弛缓症的临床应用

目的探讨经口内镜全层肌切开术治疗重症贲门失弛缓症的疗效与安全性。方法经口内镜全层肌切开术治疗64例重症（至少满足以下条件之一：Eckardt评分≥6分;食管直径≥6cm或S形食管）贲门失弛缓症患者,术后定期随访和复查,收集患者一般情况、症状评分、并发症、复发、内镜及X线钡餐检查结果等资料。结果64例患者均成功完成手术,平均操作时间55min,隧道长度平均14．1cm,肌切开长度平均10．6cm,全层肌切开范围为食管胃接合部上下6．0cm。术后患者症状均得到缓解;并发症发生率为9．4％（6／64）,其中气肿发生率为6．3％（4／64）。术后6个月,Eckardt评分较术前明显改善[（7．4±1．5）分比（0．6±0．8）分,P〈0．001],食管直径较术前明显减小[（59．7±13．0）mm比（31．4±3．3）mm,P〈0．001],贲门口直径较术前明显扩大[（15．6±10．1）mm比（33．4±8．9）mm,P〈0．01]。平均随访12．3个月,98．4％（63／64）有效;随访期内无复发病例。结论经口内镜下全层肌切开术可作为重症贲门失弛缓症患者的有效治疗手段,但临床应用时间尚短,其长期疗效及远期并发症仍有待于进一步随访评估。     

经口内镜下肌切开术治疗贲门失弛缓症63例临床分析

为评价经口内镜下肌切开术(peroral endoscopic myotomy, POEM)对贲门失弛缓症患者的疗效, 纳入2017—2021年于吉林大学中日联谊医院行POEM治疗的63例贲门失弛缓症患者资料进行回顾性分析, 收集患者手术情况, 术后Eckardt评分、食管高分辨率测压及上消化道造影等数据, 与术前对比分析。63例患者平均年龄49.0岁, 其中31例女性。术前Eckardt评分为9(3)分, 术后为2(2)分, 术前和术后Eckardt评分差异有统计学意义(V=1 953, P<0.001), 术后食管下括约肌压力与术前比较显著降低[9.90(3.35)mmHg比26.80(13.85)mmHg, V=2 016, P<0.001]。53例(84.1%)患者POEM术后临床缓解, 不良事件发生率为3.2%(2/63), 疗效满意。POEM治疗贲门失弛缓症患者安全、有效、微创, 近期疗效满意。     

经口内镜下肌切开术联合部分食管下段肌层“V”型切除术治疗贲门失弛缓症的方法学、短期疗效及组织标本评估（含视频）

目的 评估经口内镜下肌切开术（peroral endoscopic myotomy,POEM）联合部分食管下段肌层“V”型切除术治疗贲门失弛缓症（achalasia,AC）的短期疗效、安全性及建立食管下括约肌全肌层标本取材的方法。 方法 纳入2018年2月—2019年2月在天津医科大学总医院接受内镜治疗的AC患者,利用随机数字表将其按1∶3的比例随机分为POEM联合部分食管下段肌层“V”型切除术组和POEM组。评估2组患者手术时长、术中出血量和并发症发生情况;比较2组患者治疗后1个月和3个月Eckardt评分、反流症状评分、高分辨率食管测压和食管排空参数;比较2组术中获取组织标本的大小、质量和显微结构。 结果 本研究最终纳入57例患者,其中POEM联合部分食管下段肌层“V”型切除术组16例、POEM组41例。2组患者均成功完成手术,手术时长[（87.81±13.03）min比（82.20±18.10）min,t=1.302,P=0.201]和术中出血量[（6.75±1.44）mL比7.00(2.00)mL,U=-0.903,P=0.348]比较差异无统计学意义;术中和术后均未发生严重并发症。术后1个月和3个月时分别进行随访,2组患者Eckardt评分[0.00（1.00）分比0.00（1.00）分,U=-0.156,P=0.876;0.00（1.00）分比0.00（1.00）分,U=-0.337,P=0.736]、反流症状评分[0.00（0.00）分比0.00（0.00）分,U=-0.207,P=0.836;0.00（0.00）分比0.00（0.00）分,U=-0.207,P=0.836]、食管下括约肌压力[（16.00±7.00）mmHg比（13.76±6.21）mmHg,t=1.183,P=0.242;（15.06±4.14）mmHg比11.00(7.00) mmHg,U=-1.852,P=0.064](1 mmHg=0.133 kPa)、4 s完整松弛压[（6.57±2.69）mmHg比（6.82±2.22）mmHg,t=-0.364,P=0.717;（5.96±1.84）mmHg比（6.46±1.43）mmHg,t=-1.095,P=0.278]及食管排空检查5 min钡剂高度[（2.16±0.91） cm比（2.13±0.87） cm,t=0.127,P=0.899;（2.22±0.51） cm比（2.10±0.87） cm,t=0.657,P=0.514]等指标相比差异均无统计学意义,2组患者上述各指标均较术前明显降低（P均<0.05）,且同组术后两次随访结果相比,上述各指标差异未见统计学意义（P均>0.05）。术后短期随访期间2组分别有1例和2例患者诉偶尔出现反流症状,无需药物干预。POEM联合部分食管下段肌层“V”型切除术组患者术中获取的标本体积大于POEM组术中活检获取的标本[(1.32±0.55) cm×(0.58±0.17) cm×(0.18±0.02) cm比(0.28±0.05) cm×(0.13±0.03) cm×(0.10±0.03) cm,t=5.244,P<0.001],标本质量也较POEM组更重[（0.22±0.09）g比（0.03±0.01）g,t=7.192,P<0.001],且前者可于显微镜下完整观察到环行肌、肌间神经丛和纵行肌结构,而后者仅可观察到环形肌。 结论 POEM联合部分食管下段肌层“V”型切除术治疗AC的安全性及短期疗效与POEM术式相当,并为AC病理学研究提供了良好的组织标本。     

经内镜黏膜下隧道憩室间脊切开术治疗食管憩室的临床初探

背景经内镜黏膜下隧道憩室间脊切开术(submucosal tunneling endoscopic septum division,STESD)为治疗食管憩室的新型内镜技术,但目前国内外对于该技术应用的研究开展得尚不多,其安全性及有效性需进一步评估.目的探讨STESD治疗食管憩室的可行性及安全性.方法回顾性分析我院2017-11/2019-01的3例STESD患者的临床资料、手术经过及手术疗效评估(使用改良Eckardt评分系统,包括吞咽困难、烧心、反流、体重减轻和胸骨后疼痛5项症状,每项评分0-3分,最高15分,最低0分,评分越高,症状越严重).结果全组2例Zenker憩室, 1例膈上憩室;全组3例患者均顺利完成STESD,无术中及术后穿孔、出血等严重并发症的发生.3例患者术前症状评分分别为4分、7分和8分;术后评分为分别为0分、0分和2分.至随访截止日(随访时间9 mo)症状未见加重及复发.结论STESD治疗食管憩室短期疗效好,安全性高.     

经口内镜下肌切开术对贲门失弛缓症患者生活质量的影响

[目的]探讨经口内镜下肌切开术(POEM)对贲门失弛缓症患者(AC)生活质量的影响。[方法]选取47例接受POEM的AC患者作为研究对象,于术前以及术后1个月、6个月和12个月使用AC疾病特异性生活质量问卷、Eckardt评分系统和食管测压对患者进行评估。[结果]AC患者POEM后疾病特异性生活质量、Eckardt评分均较术前显著改善(P0.01),食管下括约肌静息压力显著下降(P0.05)。术前和术后疾病特异性生活质量均与Eckardt评分呈正相关。[结论]POEM能有效改善AC患者生活质量,控制症状对提高患者生活质量具有积极意义。     

改良经口内镜下肌切开术在治疗贲门失弛缓症中的应用研究（含视频）

目的 比较改良经口内镜下肌切开术（Liu-POEM）与传统POEM在治疗贲门失弛缓症中的差异。 方法 采用回顾性研究方法，选择30例完成Liu-POEM的患者和应用Liu-POEM之前近期完成传统POEM的30例患者为研究对象，通过对比两种术式的总手术时间、术后并发症及症状评分（Eckardt评分）来评价Liu-POEM的安全性和有效性。 结果 Liu-POEM平均总手术时间为（27.13±11.42）min，平均肌切开时间为（13.20±5.09）min；术后无患者出现纵隔及皮下气肿，无发热。传统POEM平均总手术时间为 （51.22±25.63）min，平均肌切开时间为 （11.18±7.61）min；术后有3例（10％）患者出现皮下气肿，未经特殊治疗，术后2 d自行吸收；1例患者术后发热1 d，最高体温37.6 ℃，物理降温后体温恢复正常。所有患者术后Eckardt评分＜3分。术后随访3～12个月，均无远期并发症发生。 结论 Liu-POEM具有操作技术简单，手术时间短，手术创伤小的优点。     

环形肌切开和全层肌切开治疗贲门失弛缓症长期随访研究

目的：对比内镜下全层肌切开与环形肌切开治疗贲门失弛缓症的长期临床疗效及远期并发症。方法：回顾性分析2012年6月至2014年12月于郑州大学第一附属医院消化内科行经口内镜下肌切开术治疗并定期随访的53例贲门失弛缓症患者资料,其中21例行环形肌切开,32例行全层肌切开,比较两种术式的长期临床疗效及远期并发症。 结果：环形肌切开组和全层肌切开组治疗有效率分别为90.5%（19/21）和100%（32/32）。两组术后Eckardt评分、食管下括约肌压力和4 s完整松弛压比较差异无统计学意义（P>0.05）。全层肌切开组临床相关胃食管反流发生率高于环形肌切开组（40.6％比14.3%,χ2=4.174,P=0.041）。 结论：经口内镜下环形肌切开术与全层肌切开术治疗贲门失弛缓症长期疗效相当,但全层肌切开术后临床相关胃食管反流发生率更高。     

经口内镜下环形肌切开术治疗老年贲门失弛缓症的疗效

目的 探索经口内镜下环形肌切开术（POEM）治疗老年贲门失弛缓症（AC）的安全性、可行性、围手术期及远期疗效。 方法 回顾性分析2010年8月至2014年12月期间在复旦大学附属中山医院确诊为AC并接受POEM治疗、可获得完整随访资料的老年（≥65岁）患者共41例,观察手术相关并发症、治疗前后Eckardt评分及食管下段括约肌压力变化,并分析远期食管反流及治疗失败的发生情况。 结果 41例患者均成功完成POEM手术,中位手术时间42 min,中位住院天数为3 d,共4例（975%）患者出现主要围手术期不良事件,均为因围手术期不良事件导致住院时间长于5 d。中位随访时间40个月（四分位数区间 24~57个月）,Eckardt评分中位数从术前8分下降为术后1分（P<0001）,食管下段括约肌压力中位数从术前2385 mmHg (1 mmHg=0133 kPa) 下降为术后905 mmHg (P=0005)。术后随访12例（2927%）患者出现临床反流,5年临床治疗成功率8780%(36/41)。 结论 POEM治疗老年AC患者安全可靠,近期和远期疗效均较好。     

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.