沙格列汀对ox-LDL诱导的血管内皮细胞损伤及miR-590/TLR4/NF-κB表达的影响

目的探讨沙格列汀对ox-LDL诱导的血管内皮细胞损伤及miR-590/TLR4/NF-κB表达的影响。方法培养人脐静脉内皮细胞(HUVEC)并分为对照组、ox-LDL组、沙格列汀组、沙格列汀+miR-590抑制物组、NC模拟物组、miR-590模拟物组、NC抑制物组、miR-590抑制物组。检测细胞的增殖活力、细胞中miR-590/TLR4/NF-κB表达量及培养基中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、细胞间黏附分子1(ICAM-1)、血管细胞黏附分子1(VCAM-1)的含量。结果 ox-LDL组细胞中TLR4、NF-κB p65表达量及培养基中TNF-α、IL-1β、ICAM-1、VCAM-1的含量均明显高于对照组,细胞增殖活性及细胞中miR-590的表达量明显低于对照组;沙格列汀组细胞中TLR4、NF-κB p65表达量及培养基中TNF-α、IL-1β、ICAM-1、VCAM-1的含量均明显低于ox-LDL组,细胞增殖活性及细胞中miR-590的表达量明显高于ox-LDL组;沙格列汀+miR-590抑制物组细胞中TLR4、NF-κB p65表达量及培养基中TNF-α、IL-1β、ICAM-1、VCAM-1的含量均明显高于沙格列汀组,细胞增殖活性及细胞中miR-590的表达量明显低于沙格列汀组;miR-590模拟物组细胞中TLR4、NF-κB p65的表达量及培养基中TNF-α、IL-1β、ICAM-1、VCAM-1的含量均明显低于NC模拟物组,miR-590抑制物组细胞中TLR4、NF-κB p65的表达量及培养基中TNF-α、IL-1β、ICAM-1、VCAM-1的含量均明显高于NC抑制物组。结论沙格列汀能够通过miR-590/TLR4/NF-κB通路减轻ox-LDL诱导的血管内皮细胞损伤。     

miR-497-5p靶向沉默核苷酸结合寡聚化结构域样受体蛋白1促进巨噬细胞源性泡沫细胞胆固醇流出

目的观察miR-497-5p对核苷酸结合寡聚化结构域样受体蛋白1(NLRP1)靶向调控及其对细胞胆固醇流出的影响。方法生物信息学与荧光素酶报告基因验证miR-497-5p与NLRP1靶向结合。人源THP-1单核细胞经佛波酯及氧化低密度脂蛋白处理后成为泡沫细胞。使用miR-497-5p mimic和miR-497-5p inhibitor处理细胞。实时荧光定量PCR和Western blot检测NLRP1、含半胱氨酸的天冬氨酸蛋白酶1(Caspase-1)、凋亡相关斑点样蛋白(ASC)表达情况。酶联免疫吸附法测定细胞培养液白细胞介素1β(IL-1β)和IL-18含量。液体闪烁计数仪检测泡沫细胞胆固醇流出水平。高效液相色谱法检测泡沫细胞内脂质含量。结果 miR-497-5p mimic能够显著性降低野生型NLRP1 3′UTR报告基因的荧光素酶活性。与对照组相比,miR-497-5p mimic组NLRP1、ASC、Caspase-1的mRNA及蛋白表达水平明显下调,IL-1β和IL-18分泌明显减少。miR-497-5p mimic较对照组显著促进细胞胆固醇流出,减少细胞内总胆固醇、游离胆固醇和胆固醇酯的含量。结论 miR-497-5p可能通过靶向调控NLRP1,抑制巨噬细胞源性泡沫细胞炎症反应并促进胆固醇流出。     

NLRP3炎性小体与冠心病的相关性

目的探讨核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体与冠心病(CHD)的临床相关性。方法入选符合纳入标准的冠心病患者60例及对照者30例。收集所有研究对象的性别、年龄、吸烟史、体重指数(BMI)、平均动脉压(MAP)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、血脂等临床资料,采用RT-q PCR、Western blot法分别检测各组外周血单个核细胞(PBMC)中NLRP3、凋亡相关微粒蛋白(ASC)、半胱氨酸蛋白酶1(Caspase-1)的mRNA及蛋白表达水平,ELISA法检测各组血浆中白细胞介素1β(IL-1β)、白细胞介素18(IL-18)水平。应用SPSS20.0软件进行统计分析。结果 PBMC中ASC mRNA、NLRP3、ASC、Caspase-1表达水平及血浆IL-1β、IL-18水平在冠心病组明显高于对照组(P0.05)。NLRP3、ASC、Caspase-1及其mRNA在各组分别进行Spearman相关分析显示,NLRP3 mRNA和Caspase-1 mRNA在冠心病组均与IL-18呈正相关(r分别为0.327和0.274,P0.05);ASC在冠心病组与年龄、IL-1β、IL-18呈正相关(r分别为0.370、0.467、0.403,P0.05);Caspase-1在冠心病组与吸烟、IL-18呈正相关(r分别为0.613和0.414,P0.05)。结论以NLRP3炎性小体为中心的NLRP3-ASC-Caspase-1-IL-1β/IL-18信号通路可能在冠心病的发生发展过程中发挥着重要作用。     

胰升糖素样肽1通过miR-137途径减轻高糖诱导的胎盘滋养细胞HTR8/SVneo炎症及凋亡

目的研究胰升糖素样肽1(GLP-1)减轻高糖诱导的胎盘滋养细胞HTR8/SVneo炎症及凋亡的作用及分子机制。方法收集妊娠期糖尿病(GDM)产妇及健康产妇的胎盘,检测miR-137及白细胞介素6(IL-6)的表达;培养胎盘滋养细胞HTR8/SVneo,分为低糖(5 mmol/L)处理的LG组、高糖(25 mmol/L)处理的HG组、高糖联合GLP-1处理的GLP-1组、转染miR-137模拟物后高糖联合GLP-1处理的miR-137+GLP-1组、转染miR-137模拟物的miR-137模拟物组、转染阴性对照(NC)模拟物的NC模拟物组、转染miR-137抑制物的miR-137抑制物组、转染NC抑制物的NC抑制物组。测定细胞凋亡率、miR-137及IL-6的表达量。结果 HG组的细胞凋亡率及miR-137、IL-6的表达水平均明显高于LG组,GLP-1组的细胞凋亡率及miR-137、IL-6的表达水平均明显低于HG组,miR-137+GLP-1组的细胞凋亡率及miR-137、IL-6的表达水平均明显高于GLP-1组;miR-137模拟物组细胞的凋亡率及IL-6的表达水平均明显高于NC模拟物组,miR-137抑制物组细胞的凋亡率及IL-6的表达水平均明显低于NC抑制物组。结论 GLP-1通过抑制miR-137/IL-6途径减轻高糖诱导的胎盘滋养细胞HTR8/SVneo炎症及凋亡。     

NLRP3炎性体在原发性高尿酸血症患者中的表达

目的研究NOD样受体蛋白(NLRP)3信号通路在原发性高尿酸血症(HUA)患者中的表达情况。方法利用Western印迹检测实验组与对照组NLRP3、凋亡相关斑点样蛋白(ASC)、天冬氨酸特异性半胱氨酸蛋白酶(caspase)-1的蛋白表达水平,应用酶联免疫吸附(ELISA)法检测各组血浆白细胞介素(IL)-1β、IL-18、IL-4、IL-10的表达情况。结果各实验组NLRP3、ASC、caspase-1的蛋白表达水平,血浆IL-1β、IL-18、IL-4、IL-10表达水平均显著高于对照组(P<0.05)。结论原发性HUA患者外周血单个核细胞中炎性体NLRP3各基因蛋白及相关致感染和抗感染因子表达异常,NLRP3参与原发性HUA患者的炎症反应,可能通过调节免疫反应参与病程的发生与发展。     

白果内酯通过NLRP3相关通路发挥对乙醇致大鼠胃溃疡的保护作用

背景白果内酯对胃溃疡胃黏膜损伤有一定的保护作用,但其具体的作用机制尚不清楚.目的探讨白果内脂通过NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)通路改善乙醇诱导胃溃疡的分子机制.方法将60只SD大鼠随机分为空白组(A组,不做处理),模型组(B组,乙醇诱导的急性胃溃疡模型),对照组(C组,20 mg/mL奥美拉唑),低剂量组(D组,1 mg/mL白果内酯)、中剂量组(E组,2.5 mg/mL白果内酯)和高剂量组(F组,5 mg/mL白果内酯),每组10只,比较不同组别大鼠的胃液pH值、胃泌素、胃蛋白酶以及溃疡指数(ulcer index,UI)等,采用Elisa方法检测大鼠腹主动脉血清以及眼眶血清中的NLRP3、半胱氨酸蛋白酶-1(Caspase-1)、IL-18和IL-1β、超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)和还原型谷胱甘肽(reduced glutathione,GSH)含量.采用实时荧光定量PCR、免疫印迹(WB)法以及免疫荧光法检测胃组织中NLRP3相关通路中NLRP3、白介素-18(IL-1β)、IL-1β、Caspase-1和调亡相关斑点样蛋白(apoptosis associated blotch-like protein,ASC)的表达量变化.结果B组UI、胃泌素、总酸度和胃蛋白酶总活性均明显高于A组(P<0.01),C组,E组和F组的UI、总酸度和胃蛋白酶总活性均低于B组(P<0.01).C组,D组,E组和F组大鼠血清中SOD值和GSH值较B组明显升高(P<0.01).B组大鼠MDA值、NLRP3、Caspase-1、IL-18、IL-1β、Caspase-1和ASC蛋白的mRNA水平和蛋白表达量均明显高于A组(P<0.01).C组,D组,E组和F组大鼠胃组织中MDA值、NLRP3、Caspase-1、IL-18、IL-1β、Caspase-1和ASC蛋白的mRNA水平和蛋白表达量均低于B组(P<0.01).结论白果内脂可通过NLRP3通路抗炎机制达到胃溃疡的保护作用.     

利拉鲁肽通过抑制高糖环境下NOD样受体家族核苷酸结合寡聚化结构域样受体3炎性体活化保护人髓核细胞的研究

目的 探讨利拉鲁肽（Lir）通过抑制高糖环境NOD样受体家族核苷酸结合寡聚化结构域样受体3(NLRP3)炎性体活化保护人髓核细胞（NPCs）的作用及机制。方法 培养人髓核细胞株,第三代髓核细胞随机分为对照组（Con组）、高糖组（HG组）、Lir干预组（Lir组）,培养48 h。ELISA法检测IL-1β,流式细胞术检测活性氧簇（ROS）,Western blot法检测NLRP3、半胱天冬氨酸酶-1前体（Pro-caspase-1）、半胱天冬氨酸酶-1(Caspase-1)蛋白表达。结果 与Con组比较,HG、Lir组IL-1β、ROS、NLRP3、Pro-caspase-1、Caspase-1蛋白表达、细胞凋亡率升高（P<0.05）。与HG组比较,Lir组IL-1β、ROS、NLRP3、Pro-caspase-1、Caspase-1蛋白表达、细胞凋亡率降低（P<0.05）。结论 Lir通过抑制NLRP3炎性体活化,降低IL-1β分泌,抑制细胞凋亡,保护人NPCs。     

瓜蒌-薤白对ApoE－/－小鼠动脉粥样硬化过程中NLRP3炎症小体活化的影响

目的通过建立ApoE^-/-小鼠动脉粥样硬化(As)模型,探讨As病程不同时间点NOD样受体热蛋白结构域3(NLRP3)炎症小体表达水平的变化及瓜蒌-薤白的干预作用。方法将高脂饲养6、20、34周的ApoE^-/-小鼠均随机分为模型组(M1、M2、M3)和给药组[6 g/(kg·d)](GX1、GX2、GX3),每组10只;另设C57BL/6J小鼠为空白组(C1、C2、C3)。空白组及模型组小鼠给予生理盐水灌胃,给药组小鼠每日给予相应药物灌胃,共4周。实验结束后处死小鼠,油红O染色评估主动脉斑块面积及形态;HE染色观察主动脉病理形态学变化;免疫组织化学法检测主动脉NLRP3表达;ELISA法检测血清中白细胞介素1β(IL-1β)和白细胞介素18(IL-18)水平;Western blot法检测主动脉组织中NLRP3、凋亡相关斑点样蛋白(ASC)、含半胱氨酸的天冬氨酸蛋白水解酶1(Caspase-1)的蛋白表达;qRT-PCR检测主动脉组织中NLRP3、ASC、Caspase-1的mRNA表达。结果在As病程进展过程中,模型组小鼠主动脉脂质累积和斑块面积显著增加,血清中IL-1β和IL-18的表达不断升高,NLRP3和ASC的蛋白及mRNA的表达均不断上调。Caspase-1的蛋白表达也呈上升趋势,但M2与M3组间的比较无统计学差异。与模型组相比,给药组各时间点小鼠主动脉的脂质累积和斑块面积显著减少,血清中IL-1β和IL-18的水平降低;主动脉组织中N LRP3、ASC、Caspase-1蛋白和mRNA表达显著下调。结论NLRP3炎症小体参与了主动脉As的病变过程,瓜蒌-薤白可能通过调节As模型小鼠主动脉不同阶段NLRP3炎症小体的表达,从而发挥抗As的作用。     

结肠灵通过调节NLRP3炎性小体活化对感染后肠易激综合征大鼠内脏敏感性的机制研究

目的探讨核苷酸结合寡聚化结构域样受体3(NLRP3)炎症小体在结肠灵调节感染后肠易激综合征(PI-IBS)内脏高敏感性中的作用及分子机制。方法选取SPF级雄性SD大鼠40只随机分配到4组:正常对照组、模型组、结肠灵组和阳性对照组。HE染色检测大鼠结肠组织中性粒细胞等炎症细胞浸润情况及黏膜损伤状况;利用腹壁回缩反射(AWR)评分和粪便含水量评估大鼠的内脏敏感性。ELISA检测大鼠血清中IL-18和IL-1β表达;Western blotting检测NLRP3、ASC、Caspase-1、IL-18、IL-1β及NF-κB表达。结果正常对照组大鼠结肠黏膜完整,无炎症细胞浸润;模型组大鼠结肠黏膜受损,有大量炎症细胞(中性粒细胞等)浸润,AWR评分值显著升高(P0.01),粪便含水量也显著增加(P0.01);给予药物干预后黏膜组织完整性恢复,降低了炎症细胞浸润,AWR评分值和大鼠粪便含水量显著降低(P0.05)。结肠灵干预降低了大鼠血清中IL-18和IL-1β含量(P0.05),显著抑制NLRP3、ASC、Caspase-1、IL-18、IL-1β及NF-κB蛋白表达(P0.05)。结论结肠灵可能通过NF-κB通路抑制NLRP3炎症小体活化,降低大鼠结肠黏膜炎症,改善PI-IBS大鼠内脏敏感性。     

京尼平通过miR-499调节缺血缺氧诱导心肌细胞线粒体途径凋亡

目的研究京尼平对缺血缺氧诱导心肌细胞线粒体途径凋亡的调节作用及其分子机制。方法培养H9c2细胞并进行分组处理,对照组用不含药物的DMEM在常氧条件下培养,缺氧组用不含药物的DMEM在缺氧条件下培养,低、中、高剂量京尼平组在缺氧条件下分别用含有2.5μmol/L、5.0μmol/L、10.0μmol/L京尼平的DMEM处理,NC抑制物组在常氧条件下转染NC抑制物,NC抑制物+缺氧组在缺氧条件下转染NC抑制物,NC抑制物+缺氧+京尼平组在缺氧条件下转染NC抑制物并用含有10.0μmol/L京尼平的DMEM处理,miR-499抑制物+缺氧+京尼平组在缺氧条件下转染miR-499抑制物并用含有10.0μmol/L京尼平的DMEM处理。比较组间心肌酶含量、细胞凋亡率、凋亡基因及miR-499表达的差异。结果京尼平组能够以剂量依赖性的方式降低细胞培养基中乳酸脱氢酶(LDH)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)含量及细胞凋亡率和细胞中Bax、Caspase-3表达,增加细胞中Bcl-xL及miR-499的表达;转染miR-499的抑制物能够逆转10.0μmol/L京尼平降低细胞培养基中LDH、CK、CK-MB含量及细胞凋亡率、细胞中Bax、Caspase-3表达和增加细胞中Bcl-xL表达的效应。结论京尼平通过miR-499调节缺血缺氧诱导心肌细胞线粒体途径凋亡。     

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.