不同补碘时期亚克汀病可疑儿童精神运动功能的变化

目的探讨在碘营养变化过程中精神运动功能障碍对亚克汀病诊断的有效性。方法分别于1996、1999年对宁强试验区7～14岁亚克汀病可疑儿童和正常对照组儿童做精神运动功能检查。结果①无论是在试验区补碘不足时期(1996)还是补碘正常时期(1999),亚克汀病可疑儿童的精神运动功能检查的多数项目得分都显著低于正常对照儿童(P<0.01);②用年龄常模标化后,同一组儿童1996和1999年前、后2次的精神运动功能测验标准分数的差值无显著性差异(P>0.05)。结论精神运动功能障碍与母孕期缺碘所造成的脑与神经损伤有关,这种障碍具有不随出生后碘营养水平的变化而发生变化的相对稳定性或持续性,因而在碘营养不断发生变化的时期或地区,它仍可作为诊断亚克汀病患儿的辅助条件和指标。     

碘缺乏病病区轻度智力落后儿童精神运动测验结果评价

目的　验证津医精神运动成套测验（ＪＰＢ）检查轻度智力落后儿童精神运动障碍的灵敏度，评估碘缺乏病（ＩＤＤ）病区亚克汀病患病率。方法　对中国联合型瑞文测验智商常模（ＣＲＴ－Ｃ２）判定的４１５ 名７～１４ 岁轻度智力落后儿童进行ＪＰＢ检查，用Ｔ 分数与损伤指数确定其精神运动功能状况。结果　Ｔ 分数确定的ＪＰＢ检出ＩＤＤ 重、中病区ＩＱ ５０～６９ 儿童精神运动功能异常率为５７．８％ ，其中ＩＱ ５０～５９ 人群异常率达７０．９％ ；损伤指数确定的异常率与Ｔ 分结果差异不显著（ Ｐ＞ ０．０５）。结论　ＪＰＢ是发现和定量描述轻度智力落后儿童精神运动功能障碍的有效实用方法，可用于诊断亚克汀病。     

辽宁省地方性亚临床克汀病流行程度调查

目的：了解供应同浓度（1：5万）碘盐后重、中、轻碘缺乏病病区出生儿童的亚克汀病流行程度。方法：用中国联合型瑞文测验图岫和农村儿童智商常模（CRT－C2）测验判定7－14岁儿童智商，用津医精神运动成套测验（JPB）、测听仪、拍X线片、标准度衡器具检出智商值（IQ）50－69儿童的精神运动、听力障碍者和骨龄、体格发育落后者。结果：供应碘盐后重、中、轻病区出生儿童的人群轻度智力落后率分别为6．7％、5．0％、3．5％，轻度智力落后儿童的亚损伤率分别为77．8％、77．0％、40．2％。重、中、轻病区儿童人群亚克汀病患病率分别为5．2％、3．9％、1．4％；评价同浓度碘盐预防后重病区儿童亚克汀病流行程度为重，次之为中度病区，轻病区该病流行程度则轻。结论：居民食用的碘盐合格率低，尤其是孕妇碘不足，致使碘缺乏病病区仍有亚克汀病儿出生。     

IL1RAPL1基因多态性与秦巴山区儿童精神运动功能的相关性

目的 探讨精神发育迟滞相关基因(IL1RAPL1)对人类精神运动功能的影响,为精神运动功能障碍对亚克汀病诊断的有效性提供证据.方法 采用传统PCR、单链构象多态PCR(PCR-SSCP)、聚丙烯酰胺凝胶电泳等分子生物学方法,对秦巴山区220名7～14岁儿童IL1RAPL1基因的DXS1218、DXS9896、rs6526806,rs12847959共4个遗传标记位点进行多态性检测,并进行精神运动功能测验,对多态性检测结果与儿童精神运动功能测验成绩进行关联分析.结果 DXS1218、DXS9896、rs12847959 3个遗传标记在受检儿童中均有较高杂合度(Het),分别为0.8941、0.8674、0.4872,rs6526806有较低的Het,为0.1804;4个遗传标记多态性均未显示出与儿童精神运动功能的相关性(F值分别为0.909、0.279、0.725、1.982,P均>0.05).结论 IL1RAPL1基因多态性对人的精神运动控制能力无影响,即精神运动功能可能较少受遗传因素影响,是对亚克汀病诊断更为有效的一个辅助指标.     

长治市农村儿童精神运动功能调查分析

目的了解长治市农村儿童精神运动功能状况,分析儿童亚克汀病患病情况.方法用中国联合型瑞文测验修改版(CRT-C2及CRT-RC),判定在校8～10岁儿童智商;用天津医科大学精神运动功能成套试验(JPB)的T分值,确定368名各智商组儿童的精神运动功能.结果碘缺乏病(IDD)病区轻度智力落后组儿童的精神运动功能异常率为58.3%,智力边缘组儿童异常率为25.7%,智力正常和优秀儿童的精神运动功能均正常.结论 JPB证实轻度智力落后儿童的精神运动功能显著低于同龄者,推算出长期供应碘盐IDD病区儿童的亚克汀病患病率为2.9%左右,表明亚克汀病患者仍然是今后地方病防治的重点.     

地方性亚临床克汀病的定义值得商榷

<WS-104-1999,地方性克汀病和亚临床克汀病诊断>将地方性克汀病(地克病)和地方性亚临床克汀病(亚克汀)其用同一定义,即缺碘所致神经-精神综合征.但诊断条件规定则为精神-神经-甲低综合征.这对地克病适用,对亚克汀则需商榷.①Hetzel所称IDD中有一轻病型,是和地克病并列的一个病型,而不是轻型地克病.还有学者认为缺碘的不良作用主要在大脑;亚克汀的发病机理是轻度脑损伤综合征;缺碘并不是按全或无效应只引起地克病,还可引起不同程度的发育缺陷,而致以大脑为主的轻度损害;缺碘大鼠的海马中一氧化氮有关的代谢异常等.均说明亚克汀为大脑轻微缺碘性损伤所致的轻度精神功能受损.②亚克汀定义与我国病情不符,轻度缺碘所致的亚临床征以轻度低智最多见,且和另6项亚临床征并非完全平行出现,故这类轻度低智中必然有28%～46%因无诊断辅助条件不能诊断为亚克汀而被忽略.③检出IDD轻病型所用方法(智力删验和精神运动删验)部是测试大脑精神功能的,也说明亚克汀的病变主要在大脑并引发精神功能轻度异常.建议将亚克汀定义修订为环境缺碘所致的轻度精神功能损伤综合征.亚克汀诊断条件为,出生和成长于病区并经排陈非缺碘病因后的轻度低智为必备条件,JPB检查异常为辅助条件.有必备和辅助条件者诊断为亚克汀;有必备条件无辅助条件者为缺碘性轻度低智;有辅助条件而无必备条件者作略而不计处理.     

陕西省秦巴山区4岁以下可疑亚克汀病婴幼儿诊断标准探讨

目的探讨4岁以下亚克汀病婴幼儿的诊断标准：方法在陕西省秦巴山区选择宁强县、柞水县以及安康市北部山区共7个乡作为试验点，采用丹佛发育筛查量表（DDST）检测4岁以下婴幼儿发育异常率，Gesell智力测验方法检查智能发育迟长率以及精神发育迟滞患病率。结果婴幼儿智能发育迟长率低于DDST异常率（Х^2=86．76，P〈0．01），而精神发育迟滞患病率低于智能发育迟长率（Х^2=9．17，P〈0．01）；与缺碘时期相比，补碘后DDST异常婴幼儿以及智能发育迟长婴幼儿的动作能水平均明显提高（P〈0．01或〈0．05），结论对4岁以下亚克汀病婴幼儿的轻度智力低下诊断．需符合发育商水平异常、社会适应能力评定异常两个标准，对其精神运动功能可用动作能发育商作为初步测量指标：建议4岁以下可疑亚克汀病婴幼儿诊断标准可暂定为：出生于缺碘环境，Gesell测验应物能与动作能轻、中度迟长，社会适应能力异常，且临床检查没有其他病因的婴幼儿：     

JPB诊断亚临床克汀病可行性研究

目的：验证津医精神运动功能成套测验（JPB）对亚临床克汀病的诊断。方法：用中国联合型瑞文测验（CTR－RC2）确定轻度弱智（IQ54－69）,再用JPB测其精神运动功能。结果：轻度弱智儿童中JPB异常率高达30．00％,亚克汀患病率约为3．93％。结论：CRT－RC2／CC2和JPB共同为诊断亚克汀病提供了有效的定量方法。     

农村非IDD病区智力正常儿童精神运动成套测验的检测结？…

目的：掌握非ＩＤＤ病区智力正常儿童精神运动成套测验的正常值，为制定全国儿童精神运动测验量表提供依据。方法：按“九五”国家医学科技攻关项目的设计，在沿海和内陆平原家村非ＩＤＤ病区对ＩＱ８０￣１１９的无甲肿７￣１４岁儿童进行１０项精神运动测验。结果：选择反应时测验的反应时间（ｍｓ）间隔均值是由于小年龄组向大年龄组逐渐递降，相临两个年龄组差异显（Ｐ〈０．０１或Ｐ〈０．０５）；连续作业、划消数字、目标追     

新疆高氟低碘环境与亚临床型克汀病

本文对和田不同类型的碘缺乏病区,采用瑞文联合型中国农村智力常模表,分别随机抽样检查了7～14岁学生130名,并同步检查了听力、四项精神运动及甲状腺功能。高氟低碘病区儿童平均IQ71.09±6.84,平均听阈24.08±13.18dB,骨龄发育落后检出率28.5％,24小时甲状腺吸I~(131)”率59.87±14.63％,TSH 21.09±9.43μU/ml,亚克汀病患病率15.71％;低碘病区平均IQ 77.32±11.54,平均听阈19.91±7.23 dB,骨龄发育落后检出率13.5％,甲状腺吸I~(131)率50.26±19.25％,TSH 11.05±11.49μU/ml,亚克汀病患病率9.36％。补碘对照区平均IQ 95.76±17.52,平均听阈16.08±3.21 dB,骨龄发育落后检出率3.88％,甲状腺吸I~(131)率23.61±11.71％,TSH6.26±2.88μU/mL,亚克汀病患病率为3.20％。上述各项参数和病区之间,均有显著差异。说明在缺碘病区同时并存高氟摄入时,氟可加剧由缺碘而引起的中枢神经损害和体躯发育障碍。在104例精神轻度发育迟泄的儿童中,亚克汀病的检出率69.23％。     

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.