四氢生物喋呤对内皮细胞产生一氧化氮和超氧阴离子的影响

目的探讨四氢生物喋呤(BH4)对人脐静脉内皮细胞产生一氧化氮(NO)和超氧阴离子(O-2)的影响.方法在培养液中分别加入不同浓度的D-葡萄糖、胰岛素和BH4,24 h后取细胞培养液分别测定一氧化氮合酶(NOS)、超氧化物歧化酶(SOD)活性、NO和O-2浓度.结果BH4(10、100、500μmol/L)使内皮细胞NOS活性增高,500 μmol/L BH4使内皮细胞NO产生增加,10或100 μmol/LBH4对内皮细胞产生NO有增加的趋势,但与对照组比较无显著性差异(P＞0.05);25 mmol/L葡萄糖+BH4(10、100、500 μmol/L)对内皮细胞产生NO与对照组比较无显著性差异(P＞0.05);高浓度胰岛素(10、100、1 000 mU/L)+BH 4(10、100、500 μmol/L)使内皮细胞NOS活性增强,NO产生增加.BH4(10、100、500μmol/L)对内皮细胞SOD活性无明显影响,但可以改善25 mmol/L葡萄糖对内皮细胞SOD活性的影响;胰岛素+BH4对内皮细胞SOD活性无明显影响(P＞0.05).BH4(10、100、500 μmol/L)使内皮细胞产生O-2减少,并可以改善25 mmol/L葡萄糖对内皮细胞产生O-2影响;胰岛素+BH4组O-2浓度明显低于对照组和不同浓度胰岛素组(P＜0.01).结论BH4可以增加培养的人脐静脉内皮细胞NOS活性,使NO产生增加而使O-2水平下降.     

血管紧张素Ⅱ对人脐静脉内皮细胞产生一氧化氮和超氧阴离子的影响

目的 研究不同途径生成的血管紧张素(Ang)Ⅱ对人脐静脉内皮细胞产生一氧化氮(NO)和超氧阴离子(O2^-)的影响。方法 应用卡托普利(商品名：开博通)、chymostafin(一种胃促胰酶抑制剂)、抑肽酶(广泛的蛋白酶抑制剂)、氯沙坦[AngⅡ1型受体(AT1受体)拮抗剂]分别阻断体外培养的人脐静脉内皮细胞AngⅡ的生成或阻断其与受体结合，观察细胞培养液中NO和O2^-的变化。结果 高浓度AngⅡ使内皮细胞NOS活性下降，NO产生减少，SOD活性下降，O2^-产生增加；100、1000μmol／L卡托普利使。AngⅡ的生成分别降低了11．15％和17．06％；100、1000μmol／L chymostatin使AngⅡ的生成分别降低了60．23％和68．48％；1μmol／L抑肽酶使AngⅡ的生成降低了13．96％；卡托普利 chymostatin使人脐静脉内皮细胞产生AngⅡ减少85．81％；卡托普利 抑肽酶抑制29．57％。AngⅡ的生成；卡托普利 chymostatin 抑肽酶几乎完全抑制人脐静脉内皮细胞将AngⅠ转变成AngⅡ，与AngⅠ组相比降低97．71％；氯沙坦不能阻断内皮细胞使AngⅠ转变成AngⅡ。阻断AngⅡ的生成或阻断其与受体结合均可以使内皮细胞NOS活性升高，NO产生增加，SOD活性升高，O2^-产生减少。结论 内皮细胞AngⅡ的生成主要是胃促胰酶途径，阻断胃促胰酶途径AngⅡ的生成可以使NO产生增加，O2^-生成减少。AngⅡ引起内皮细胞NO和O2^-的改变是AT1受体介导的。     

L-精氨酸对高糖引起内皮功能失调的保护作用

目的通过研究L-精氨酸和N^G-硝基-L-精氨酸-甲基酯对人脐静脉内皮细胞产生一氧化氮和超氧阴离子的影响以探讨L-精氨酸对高糖引起内皮功能失调的保护作用。方法不同浓度L-精氨酸、N^G-硝基-L精氨酸-甲基酯、葡萄糖和胰岛素加入体外培养的人脐静脉内皮细胞，24h后分别测定细胞培养液中一氧化氮舍酶和超氧化物歧化酶活性及一氧化氮和超氧阴离子浓度。结果25mmol／L葡萄糖使内皮细胞一氧化氮合酶活性增高，一氧化氮产生增加，超氧化物歧化酶活性下降，超氧阴离子产生增加；L-精氨酸对一氧化氮舍酶、一氧化氮、超氧化物歧化酶的影响与对照组相比无显著性差异（P〉0．05）。但可以使超氧阴离子产生减少；25mmol／L葡萄糖＋L-广精氨酸使内皮细胞一氧化氮舍酶活性增强，一氧化氮产生增加，L-精氨酸可以改善高糖引起的超氧阴离子升高。不同浓度的胰岛素使内皮细胞一氧化氮合酶活性增高，一氧化氮产生增加，对超氧化物歧化酶活性和超氧阴离子产生无明显影响；不同浓度胰岛素＋L-精氨酸使内皮细胞一氧化氮合酶活性增强，一氧化氮产生增加，对超氧化物歧化酶活性无明显影响，但可以使超氧阴离子水平降低。100μmol／LN^G-硝基-L-广精氨酸-甲基酯使内皮细胞一氧化氮合酶活性下降，一氧化氮产生减少，对超氧化物歧化酶活性无明显影响，但使超氧阴离子产生增加；25mmol／L葡萄糖＋N^G-硝基-L-精氨酸-甲基酯使内皮细胞一氧化氮合酶活性下降，一氧化氮产生减少，但对高糖引起的超氧化物歧化酶活性下降和超氧阴离子升高无明显影响。10mu胰岛素＋10μmol／L N^G-硝基-L-精氨酸．甲基酯和100mu胰岛素＋100μmol／L N^G-硝基-L-精氨酸-甲基酯使内皮细胞一氧化氮合酶活性下降，一氧化氮产生减少，对超氧化物歧化酶活性无明显影响，但使超氧阴离子升高。结论L-精氨酸对一氧化氮合酶、一氧化氮、超氧化物歧化酶无明显影响，但可以使超氧阴离子产生减少；N^G-硝基-L-精氨酸-甲基酯使内皮细胞一氧化氮合酶活性下降。一氧化氮产生减少，对超氧化物歧化酶活性无明显影响，但使超氧阴离子产生增加。     

体外研究胰岛素及磷脂酰肌醇3-激酶途径对一氧化氮生成的影响

目的探讨胰岛素及磷脂酰肌醇3-激酶(PI3-K)途径对NO生成的影响。方法检测胰岛素、葡萄糖以及PI3-K活性不可逆的抑制剂(Wortmannin)对培养的人脐静脉内皮细胞(HUVECs)PI3-K表达以及NO、超氧阴离子(O_2~-)产生和内皮型一氧化氮合酶(eNOS)活性的影响。实验分为对照组、10 mU/L胰岛素组、100 mU/L胰岛素组、甘露醇组、5 mmol/L葡萄糖+10 mU/L胰岛素组(5 mmol/L G1组)、25 mmol/L葡萄糖+100 mU/L胰岛素组(25 mmol/L G2组)、50 nmol/L Wortmannin组(50 nmol/L W组)、50 nmol/L Wortmannin+10 mU/L胰岛素组(50 nmol/L W1组)和50 nmol/L Wortmannin+100 mU/L胰岛素组(50 nmol/L W2组)。结果与对照组比较,不同浓度胰岛素组eNOS活性及NO水平显著升高(P<0.01);25 mmol/L G2组、50 nmol/L W组、50 nmol/LW1组和50 nmol/L W2组eNOS活性及NO水平均显著降低,O_2~-生成明显增加(P<0.01);与对照组比较,不同浓度胰岛组、50 nmol/L W组、50 nmol/L W1组和50 nmol/L W2组PI3-K蛋白表达显著升高(P<0.05,P<0.01)。结论 PI3-K信号途径对于促进NO产生、维持血管内皮细胞的正常功能具有重要作用,在高糖、高胰岛素状态下该条途径受损并由此引发内皮功能障碍。     

沙格列汀对过氧化氢诱导损伤的血管内皮细胞二甲基精氨酸二甲胺水解酶/非对称性二甲基精氨酸/内源性一氧化氮合酶通路影响的研究

目的观察二肽基肽酶-4(DPP-4)抑制剂沙格列汀对过氧化氢(H2O2)诱导损伤的血管内皮细胞二甲基精氨酸二甲胺水解酶/非对称性二甲基精氨酸/内源性一氧化氮合酶(DDAH/ADMA/eNOS)通路的影响。方法以培养人脐静脉内皮细胞株(HUVEC)作为靶细胞,在内皮细胞培养基中加入100μmol/L的H2O2制备细胞损伤模型,以20μmol/L沙格列汀进行干预,观察24~72h,检测细胞上清一氧化氮(NO)含量、ADMA浓度,检测细胞中NOS活性、DDAH活性及DDAH蛋白表达量。结果H2O2作用HUVEC后,细胞上清中NO含量降低,而ADMA浓度增加(P0.05)。细胞中NOS活性、DDAH活性、DDAH-Ⅱ蛋白表达量降低(P0.05);而加入沙格列汀,细胞上清中NO含量升高,ADMA浓度降低(P0.05)。细胞中NOS活性、DDAH活性、DDAH-Ⅱ蛋白表达量升高(P0.05)。结论沙格列汀通过对DDAH/ADMA/eNOS通路的调节作用改善H2O2诱导的内皮细胞NO生成减少。     

胰岛素对牛主动脉内皮细胞一氧化氮合酶(NOS)活性及诱生型NOS mRNA表达的影响

目的　观察胰岛素对牛主动脉内皮细胞一氧化氮合酶 (NOS)活性及诱生型NOS(iNOS)基因表达的影响。方法　原代培养牛降主动脉内皮细胞 ,在不同浓度胰岛素条件下孵育 2 4h ,用比色法检测NOS活性 ,用半定量RT PCR检测内皮细胞iNOSmRNA表达。结果　药理浓度胰岛素 (10 -7mol/L)比生理浓度胰岛素 (10 -10 mol/L)条件下NOS活性及iNOSmRNA表达均显著增高 (均P <0 .0 5 )。结论　高胰岛素浓度状态下大血管病变可能与内皮细胞iNOS过度表达及合成一氧化氮功能异常有关。     

α-硫辛酸对高糖作用下人脐静脉内皮细胞护骨素表达的影响

目的 观察α-硫辛酸对高糖作用下血管内皮细胞护骨素(OPG)mRNA表达的影响.方法 脐静脉内皮细胞株分别在5.5mmol/L葡萄糖、30mmol/L葡萄糖及30mmol/L葡萄糖+不同浓度α-硫辛酸(50、100、200μmol/L)条件下培养48h.取内皮细胞培养上清液,以黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活性,以硫代巴比妥酸为底物检测丙二醛(MDA)含量;RT-PCR法检测内皮细胞OPG mRNA表达水平的变化.结果 高糖作用下内皮细胞SOD活性降低(P<0.01),MDA水平升高(P<0.01),OPG mRNA表达水平显著上升(P<0.01);以不同浓度α-硫辛酸干预高糖组,SOD活性升高(P<0.01),MDA水平降低(P<0.01),OPG mRNA表达水平显著下降(P<0.05).结论 α-硫辛酸改善高糖环境下血管内皮细胞的氧化应激状态,下调OPG mRNA的表达水平.     

胰岛素介导的内皮依赖性血管舒张功能与高血糖关系的实验研究

目的：研究不同浓度胰岛素，葡萄糖对培养血管内皮细胞一氧化氮（NO）产生的影响，探讨糖尿病时内皮依赖性血管舒张异常的作用机制。方法：用放免法测定内皮细胞cGMP水平来反映NO的量，半定量RT－PCR检测NO合酶（eNOS)mRNA水平。结果：胰岛素（0.18-6.0nmol/L)，葡萄糖（20mmol/L,40mmol/L)能增加内皮细胞cGMP产量，并呈浓度和时间依赖性；高浓度葡萄糖上调eNOS mRNA水平，而胰岛素对其无影响，在高浓度葡萄糖下，胰岛素（6.0nmol/L)刺激NO的生成作用明显降低。结论：胰岛素介导的内皮依赖性血管扩张与胰岛素刺激内皮细胞NO合成有关；血管内皮对胰岛素的敏感性减低是胰岛素抵抗的一部分；高浓度葡萄糖可能会抑制胰岛素介导的内皮依赖性血管舒张。     

缺氧复氧损伤对血管内皮细胞分泌一氧化氮及其合酶活力的影响及辛伐他汀的干预作用

目的:探讨缺氧复氧对血管内皮细胞分泌一氧化氮(NO)及NO合酶(NOS)活力的影响及辛伐他汀的干预作用,并分析其产生作用的可能机制。方法:体外培养人脐静脉内皮细胞株ECV304,使用自制的缺氧小室对ECV304进行缺氧复氧处理。第1实验:仅进行缺氧复氧处理。第2实验:不同浓度的辛伐他汀(0.1、1.0、10.0μmol/L)以及10.0μmol/L辛伐他汀加0.2mmol/L甲羟戊酸预处理ECV30424h后,再行缺氧2h复氧2h处理。硝酸还原酶法及化学比色法分别检测培养液上清中NO的含量及NOS活力。结果:缺氧2h、复氧2、4hECV304分泌NO与对照组相比明显减少,复氧2、4hNOS活力与对照组相比明显下降;经1.0、10.0μmol/L浓度辛伐他汀预处理ECV304后再行缺氧复氧处理则NO含量及NOS活力较对照组明显增加;同时用辛伐他汀和甲羟戊酸预处理后NO含量和NOS较对照组差异无统计学意义。结论:缺氧复氧应激下血管内皮细胞分泌NO功能下降、NOS活力降低;辛伐他汀可以阻止因缺氧复氧刺激导致的NO减少及NOS活力下降,该作用可被甲羟戊酸逆转。     

电压依赖性钾通道在京尼平苷调控大鼠胰岛素分泌中的作用

目的研究电压依赖性钾(Kv)通道在京尼平苷调控大鼠胰岛素分泌机制中的作用。方法采用放免法检测大鼠胰岛组织的胰岛素分泌情况,膜片钳技术记录胰岛β细胞Kv电流和动作电位时程(APD)。结果在8.3 mmol/L葡萄糖条件下,京尼平苷(0~100μmol/L)可剂量依赖性地增加胰岛素分泌含量,在10μmol/L时基本达最大促分泌效应,低糖(2.8 mmol/L)情况下则没有作用。膜片钳实验数据表明,京尼平苷剂量依赖性地(0~100μmol/L)降低Kv通道电流密度,并在10μmol/L的浓度下发挥最大抑制作用,并明显延长了动作电位时程。结论京尼平苷在胰岛β细胞中通过抑制Kv、延长APD发挥促胰岛素分泌作用。     

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.