119例肺结核患者痰涂阳与胸部X线表现的对比研究

目的 探讨肺结核患者痰涂阳与胸部X线表现之间的关联性,为有关科室及时采取措施防治结核病提供参考。方法 对119例肺结核患者痰涂阳与胸部X线表现进行回顾性分析,按痰涂阳1+～2+和3+～4+将其分为痰涂阳程度低和程度高的两组作对比研究,对结果采用SPSS 13.0统计软件进行处理;采用χ²检验及多因素非条件logistic回归分析进行统计学处理,以P<0.05为有统计学意义。结果 肺结核患者是否具有传染性（即痰涂阳）与肺结核病灶分布部位（涂阳1+～2+组与3+～4+组在左右肺病灶分布分别为90个和88个,经比较：χ²=0.208,P=0.649）、范围（本组涂阳1+～2+组其病灶范围为2.37个肺野/例：180个/76例;3+～4+组为2.33个肺野/例：100个/43例,χ²=0.006,P=0.936）、空洞大小(χ²=3.300,P=0.069,OR=2.028, 95% CI：1.012～4.350)、有无引流支气管（χ²=0.092,P=0.761,OR=0.889,95% CI：0.418～1.894）的差异无统计学意义;与其分型（本组Ⅲ型110例,占92.4%）、分期（本组进展期79例,占66.4%;好转期33例,占27.7%;稳定期7例,占5.9%）、X线表现中空洞分布范围（χ²=13.553,P=0.000, OR=2.283,95% CI：1.471～3.543）、数目（χ²=15.427,P=0.000, OR=2.474,95% CI：1.574～3.887）、洞壁情况（χ²=11.166,P=0.001, OR=2.691,95% CI：1.506～4.808）等差异有统计学意义。结论 肺结核患者痰涂阳及菌量与胸部X线表现之间有明显的关联性。     

结核性毁损肺发生的相关因素分析

目的 分析结核性毁损肺发生的相关因素,为避免毁损肺发生提供依据。 方法 对2005年5月至2010年5月住院的结核性毁损肺患者100例和同期非毁损肺的肺结核患者100例进行比较。对患者的一般资料、病程、用药是否规律、耐药情况、肺内感染情况、肺病变数量、合并症、咯血、脓胸及是否有呼吸衰竭等相关因素做统计分析。结果 在单因素中,结核病病程（χ²=84.040,P<0.001）、耐药(χ²=53.107,P<0.001)、是否发生呼吸衰竭(χ²=11.753,P=0.001)、血红蛋白计数（Hg）(χ²=12.106,P=0.001)、是否有肺内感染(χ²=8.036,P=0.005)、咯血(χ²=11.293,P=0.001)、是否排菌(χ²=8.413, P=0.035)、有无脓胸发生(χ²=13.211,P<0.001),以及病变数量(χ²=22.917,P<0.001)是结核性毁损肺发生的危险因素,两组患者相比差异有统计学意义。 不规律治疗(χ²=25.149,P<0.001)、有无慢性阻塞性肺疾病(COPD)(χ²=5.647, P=0.017)、血清白蛋白（ALB）(χ²=6.650,P=0.010)亦是结核性损毁肺的危险因素,两组患者相比差异有统计学意义。在多因素分析中：病程长短［Wald χ²=24.47,P<0.01,OR=3.81(95%CI：2.24～6.64)］、耐药［Waldχ²=20.09,P<0.01,OR=27.11 (95%CI：6.40～114.79)］、合并症［Wald χ²=9.76,P<0.01, OR=4.88 (95%CI：1.81～13.20)］是结核性毁损肺发生的危险因素,两组患者相比差异有统计学意义;Hg［Wald χ²=3.95,P=0.050,OR=0.38(95%CI：0.14～0.99)］、是否排菌［Wald χ²=4.68,P=0.030,OR=0.61(95%CI：0.39～0.95)］、肺病变数量［Wald χ²=5.08,P=0.020,OR=26.53 (95%CI：1.54～458.52)］也是结核性毁损肺的危险因素,两组患者相比差异有统计学意义（P≤005）。结论 结核性毁损肺发生的原因是多方面的,为避免结核性毁损肺的发生要进行早期整体综合治疗。     

湖南省湘潭县农村地区肺结核发病情况及影响因素分析

目的 了解农村地区肺结核发病情况及危险因素。 方法 采用巢式病例对照研究方法，对湖南省湘潭县农村地区人群72859名随访观察1年，队列中80例新发肺结核患者作为病例组；从该队列中采用简单随机抽样的方法抽取400名健康人作为对照。对有关暴露因素进行单因素和多因素非条件logistic回归分析。 结果 农村地区肺结核发病率为109.80/10万（80/72 859），男性、女性发病率分别为168.11/10万（63/37 476）、48.05/10万（17/35 383）。单因素分析显示不同年龄（Wald χ²=22251，P<0.001，OR=1.759）、性别（Wald χ²=16.145，P<0.001，OR=0.310）、文化程度（Wald χ²=21.937，P<0.001，OR=0.468）、婚姻状况（Wald χ²=8.320，P=0.004，OR=0.358）、职业（Wald χ²=10.297，P=0.001，OR=0.377）、结核病患者接触史（Wald χ²=7.535，P=0.006，OR=4.166）、结核病病史（Wald χ²=14.637，P<0.001，OR=57.000）、吸烟史（Wald χ²=4.525，P=0.033，OR=1.730）、可疑症状（Wald χ²=46.630，P<0.001，OR=12.758）人群的肺结核发病情况差异均有统计学意义；多因素分析有统计学意义的变量有性别（β=-1.142，Wald χ²=12.904，OR=0.319、95%CI=0.171～0.595）、文化程度（β=-0.743，Wald χ²=14.355，OR=0.476、95%CI=0.324～0.699）、婚姻状况（β=-1.138，Wald χ²=7.537，OR=0.320、95%CI=0.142～0.722）、结核病病史（β=2.852，Wald χ²=5.563，OR=17.329、95%CI=1.619～185.441）、可疑症状（β=1.728，Wald χ²=16.333，OR=5.630、95%CI=2.435～13.016）。 结论 女性、文化程度高和无配偶是肺结核发病的保护因素，有结核病病史和可疑症状是肺结核发病的危险因素。     

武汉市首次复治涂阳肺结核治疗结局及影响因素分析

目的 探讨武汉市首次复治涂阳肺结核患者疗效影响因素,以便有针对性地采取措施提高复治肺结核疗效。 方法 采用整群抽样法,抽取武汉市2011年7月至2012年3月登记的全部首次复治涂阳患者（共232例）作为研究对象。面访式问卷调查,随访治疗结局。232份调查问卷中,219份合格,合格率94.4%。进行χ²检验及多因素逐步logistic回归分析疗效影响因素。 结果219例首次复治涂阳肺结核患者中,治疗成功156例,成功率为71.2%。伴发糖尿病患者治疗成功率为51.2%（21/41）,不伴发糖尿病患者治疗成功率为75.8%(135/178),差异有统计学意义(χ²=9.860, P=0.002);耐药者治疗成功率为55.0%(33/60),不耐药者治疗成功率为73.7%(87/118),差异有统计学意义(χ²=6.351, P=0.012);耐多药者治疗成功率为26.1%(6/23),非耐多药患者治疗成功率为73.5%(114/155),差异有统计学意义(χ²=20.538, P=0.000)。多因素逐步logistic回归分析显示,耐多药(OR=10.758, 95%CI=3.481～33.247)是治疗不成功的危险因素,差异有统计学意义(P<0.01);伴发糖尿病(OR=2.838, 95%CI=1.187～6.788)及未采用医生督导式管理(OR=1.678, 95%CI=1.087～2.588)是治疗不成功的危险因素,差异有统计学意义（P值均<0.05)。 结论 武汉市首次复治涂阳肺结核患者治疗成功率不高,耐多药、伴发糖尿病及未采用医生督导模式管理是影响复治涂阳肺结核疗效的主要因素。     

中国全球基金项目结核病定点医院模式实施评价

目的评价中国全球基金项目结核病定点医院模式的实施情况。方法采用定量研究方法,通过调查问卷和结核病信息管理系统收集中国全球基金项目结核病定点医院实施前1年和实施2年期间（2008年10月1日至2011年9月30日）16个省（市、自治区）中40个县的实施基本情况、患者发现和治疗管理情况,并与40个非项目对照县（区）和全国同期水平比较分析。使用SPSS 17.0进行统计分析,采用卡方检验分析比较项目地区实施前后,以及与全国和对照县（区）情况的差异,P＜0.05认为差异有统计学意义。结果项目实施前后3年活动性患者登记率分别为74.5/10万（16242/21800000）、69.4/10万(15106/21770000)和70.0/10万(15421/22040000),涂阳患者登记率分别为30.2/10万(6572/21800000)、31.2/10万(6787/21770000)和29.4/10万（6469/22040000）,登记率变化差异有统计学意义（χ²=48.3,P<0.01;χ²=12.0,P<0.05）,与全国同期登记水平（2008年、2009年和2010年活动性肺结核患者登记率分别为76.2/10万、71.9/10万和67.9/10万,χ²=6297.5,P<0.01;涂阳肺结核患者登记率分别为40.3/10万、38.6/10万和36.3/10万,χ²=2790.0,P<0.01）比较均呈现下降趋势。项目地区实施前后3年非结核病防治机构疑似患者总体到位率分别为88.2%（9339/10589）、95.9%（10069/10496）和96.9%（10547/10881）,有较大幅度的提高（χ²=825.6,P<0.01）,增幅略高于对照县（区）（实施前后3年分别为92.9%、93.8%和94.6%,χ²=20.6,P<0.01）。项目地区实施前后3年涂阳患者完成治疗率分别为94.0%（6817/7252）、95.0%（6241/6572）和94.2%（3082/3272）,初治涂阴患者完成治疗率分别为91.8%（6011/6547）、94.0%（6114/6502）和92.8%（3087/3328）,均有明显提高（χ²=6.4,P<0.05;χ²=24.4,P<0.01）,与对照县(区)完成治疗率比较差异均无统计学意义（实施前后3年涂阳患者完成治疗率分别为95.0%、95.3%和94.2%,χ²=4.9,P>0.05;初治涂阴患者完成治疗率分别为95.5%、95.2%和96.4%,χ²=5.8,P>0.05）。结论中国全球基金项目结核病定点医院模式实施取得显著成绩,患者发现和治疗管理水平得到提高,为新形势下完善结核病防治服务体系提供经验借鉴。     

河北省任丘市老年居民颈动脉粥样硬化危险因素分析

目的调查任丘市老年城乡居民颈动脉粥样硬化(CAS)患病情况,分析其危险因素。方法随机整群抽样法选择任丘市常住居民5010例,男性2163例,女性2847例,进行面对面健康问卷调查、体格检查、实验室检测和颈部血管超声检查。CAS包括颈动脉狭窄和斑块形成。分析CAS的危险因素。结果 5010例调查者中,颈动脉正常567例,内膜中层厚度增厚1671例,颈动脉斑块形成2490例,颈动脉狭窄282例。CAS多因素logistic回归分析提示:校正混杂因素后,男性(OR=3.405,95%CI:2.704⁴.289,P<0.01)、年龄(OR=1.142,95%CI:1.1034.289,P<0.01)、年龄(OR=1.142,95%CI:1.103¹.181,P<0.01)、脑卒中或短暂性脑缺血发作(OR=1.910,95%CI:1.3421.181,P<0.01)、脑卒中或短暂性脑缺血发作(OR=1.910,95%CI:1.342².718,P<0.01)、吸烟(OR=1.799;95%CI:1.4292.718,P<0.01)、吸烟(OR=1.799;95%CI:1.429².264;P<0.01)、使用抗血小板药物(OR=1.313,95%CI:1.0682.264;P<0.01)、使用抗血小板药物(OR=1.313,95%CI:1.068¹.615,P<0.05)、收缩压(OR=1.011,95%CI:1.0071.615,P<0.05)、收缩压(OR=1.011,95%CI:1.007¹.015,P<0.01)、空腹血糖(OR=1.151,95%CI:1.0621.015,P<0.01)、空腹血糖(OR=1.151,95%CI:1.062¹.248,P<0.01)、LDL-C(OR=2.038,95%CI:1.7641.248,P<0.01)、LDL-C(OR=2.038,95%CI:1.764².354,P<0.01)、HDL-C(OR=0.787,95%CI:0.6382.354,P<0.01)、HDL-C(OR=0.787,95%CI:0.638⁰.971,P<0.05)为CAS的独立危险因素。结论任丘市600.971,P<0.05)为CAS的独立危险因素。结论任丘市60⁷0岁人群CAS的患病率高,收缩压、血糖、LDL-C、吸烟是CAS重要的可干预的危险因素,有效控制血压、血糖、血脂,积极推进戒烟运动,延缓CAS病变,可进一步减少心脑血管病的发生。     

广西壮族自治区肺结核耐药性调查及复治患者耐药相关因素分析

目的 了解广西壮族自治区（简称“广西”）肺结核耐药现状,探讨影响复治患者耐药产生的因素。 方法2010年8月至2011年7月在广西开展结核病耐药性监测,对14个市采取整群分层抽样方法随机抽取30个结核病防治（简称“结防”）机构门诊为监测点,每个监测点纳入新发涂阳肺结核患者41例、复治涂阳肺结核患者22例。收集复治患者社会和既往临床诊疗信息。收集痰标本培养,培养阳性菌株采用比例法进行异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星药敏试验。对硝基苯甲酸(PNB)培养法鉴定结核分枝杆菌复合群。对复治患者社会经济以及既往诊疗因素对耐药的影响进行单因素统计分析。 结果 监测收集到1545例结核分枝杆菌复合群阳性患者,总耐药率17.22%（266/1545）;其中新发涂阳患者耐药率为11.97%（142/1186）,复治涂阳患者耐药率为34.54%（124/359）,复治患者总耐药率高于新发患者（χ²=98.473,P=0.000）。耐多药率为6.28%(97/1545);其中新发涂阳患者耐多药率为2.45%（29/1186）,复治患者耐多药率为18.94%（68/359）,复治患者耐多药率高于新发患者（χ²=127.450,P=0.000）;广泛耐多药率为0.19%（3/1545）,全部为复治患者,复治患者广泛耐多药率0.84%（3/359）。复治患者耐药单因素分析表明,女性患者耐药率高于男性（OR=2.009,95%CI:1.145～3.523, χ²=6.062,P=0.014）;壮族患者耐药率高于汉族（OR=1.609,95%CI:1.024～2.529,χ²=4.289, P=0.038）;首次诊疗机构为综合医院的患者耐药率高于到结防机构或专科医院诊疗的患者（OR=1.967,95%CI:1.210～3.198,χ²=7.565, P=0.006）;既往治疗次数2次及以上的患者耐药率高于仅接受过1次治疗的患者（OR=4.128,95%CI:2.506～6.801,χ²=33.160, P=0.000）;非联合用药患者耐药率高于联合用药者（OR=3.419,95%CI:1.952～5.988,χ²=19.775, P=0.000）;低收入家庭患者耐多药率高于高收入患者（OR=4.777,95%CI: 1.117～20.435,χ²=5.336, P=0.021）。 结论 当前广西耐药肺结核疫情仍处于全国较低水平。女性、壮族、低收入、不到定点结防机构诊治、反复多次治疗、不联合用药等可能是导致复治患者耐药的危险因素。     

武汉市社区肺结核可疑症状者求医行为及其影响因素分析

目的 了解武汉市社区肺结核可疑症状者的求医行为及其影响因素,为提高肺结核患者发现率提供依据。 方法 采用整群等比例随机抽样方法,抽取4个调查点,每个调查点15岁以上常住人口共5878名。2010年5-7月,筛选出调查前6个月内连续咳嗽、咯痰2周以上或咯血、痰中带血者作为调查对象（共270名）,进行面访式问卷调查。270份调查问卷中,259份合格,合格率95.9%。对270名调查对象进行X线胸片检查、3次痰涂片和2次痰培养检查。用卡方检验及logistic回归对肺结核可疑症状者求医行为的影响因素进行分析。 结果 259例中,79例（30.5%）没有任何求医行为,86例（33.2%）曾去社区及以上医疗机构正式就诊,89例（34.4%）曾自我药疗,5例（1.9%）曾去私人诊所就诊。多因素logistic回归分析显示,有无医疗保障与可疑症状者是否正式就诊相关,差异有统计学意义（β=1.225,Wald χ²=3.955,OR=3.405, 95%CI＝1.018~11.392,P<0.05）;有无严重或慢性呼吸道症状与可疑症状者是否正式就诊高度相关,差异有统计学意义（β=1.601,Wald χ²=22.210,OR=4.959, 95%CI＝2.548~9.652,P<0.01）;是否感到羞耻与可疑症状者是否正式就诊高度相关,差异有统计学意义（β=0.927,Wald χ²=7.767,OR=2.528, 95%CI＝1.317~4.853,P<0.01）。 结论 武汉市社区肺结核可疑症状者主动就诊率不高,有无医疗保障、有无严重或慢性呼吸道症状及是否感到羞耻是影响肺结核可疑症状者求医行为的主要因素。     

深圳市宝安区流动人口涂阳肺结核患者治疗失败影响因素分析

目的 探讨流动人口中涂阳肺结核患者治疗失败的影响因素,为制定干预措施、改善治疗效果提供理论依据。方法 以深圳市宝安区2008年1月1日至2012年12月31日完成治疗疗程且转归为失败或治愈的流动涂阳肺结核患者为研究对象。纳入的研究对象4398例,治愈患者4007例,治疗失败者391例。运用χ²检验、Kruskal-Wallis 检验或Fisher 精确检验比较治疗失败与治愈患者在人口学特征、临床特征、检验结果、管理方式等方面的差异,检验水准为0.05,同时采用非条件logistic回归分析探讨治疗失败的影响因素。结果 治疗失败患者中男性占72.63%（284/391）,明显高于治愈患者的比率［62.27%（2495/4007）］,两组间差异有统计学意义（χ²=16.4636,P<0.0001）;治疗失败患者中30岁以下人群占40.66%（159/391）,明显低于治愈患者的比率［56.68%（2271/4007）］,两组间差异有统计学意义（χ²=36.9359,P<0.0001）;治疗失败患者中2个月末痰检结果阳性者占48.69%(186/382）,明显高于治愈患者的比率［14.08%（562/3992）］,两组间差异有统计学意义（χ²=294.6323,P<0.0001）;治疗失败患者中,实行系统管理的比例为94.37%（369/391）,低于治愈患者的比例98.65%（3953/4007）,两组间差异有统计学意义（χ²=38.4086,P<0.0001）;治疗失败患者中有空洞者占48.59%（190/391）明显高于治愈患者（36.41%,1459/4007）,两组间差异有统计学意义（χ²=22.5579,P<0.0001）。多因素非条件logistic回归结果显示,女性、30岁及以上、2个月末痰检阳性、实行系统管理和有空洞与治疗失败显著相关,OR值（95%CI值）分别为0.76（0.60~0.97）、1.59（1.27~1.99）、5.13（4.10~6.43）、0.37（0.19~0.72）和1.36（1.09~1.70）。结论 女性、实行系统管理是治疗失败的保护因素, 30岁及以上、2个月末痰检阳性和有空洞是治疗失败的危险因素。关注导致治疗失败的危险因素,探索有效的流动人口结核病患者管理方式,有利于降低治疗失败率。     

终末期肾病维持性血液透析患者生存率和死亡的影响因素

目的研究终末期肾病(ESRD)维持性血液透析(MHD)患者生存率情况及有关死亡的影响因素。方法从2007年1月至2012年12月于该院120例ESRD病患接受MHD疗法治疗。依据原发病分为慢性型肾小球肾炎组60例,糖尿病肾病(DN)组42例,高血压肾病组8例,多囊肾组5例,慢性间质型肾炎5例。按年龄分成<50岁组53例,≥50岁组67例。按是否死亡分成死亡组55例和生存组65例。对比各组病患原发病及生存率,不同年龄组病患的生存率,ESRD病患接受MHD疗法的死亡因素,并观察体质量指数(BMI)及血清清蛋白(Alb)与病患死亡率的相关性等。结果 DN组的3年生存率为59.52%(25/42),显著低于慢性型肾小球肾炎组的86.67%(52/60),差异有统计学意义(χ2=9.837,P<0.05),与其他各组相比,差异虽不显著,但3年生存率最低。糖尿病肾病组的5年生存率为35.71%(15/42),均显著低于慢性型肾小球肾炎组的60.00%(36/60)、高血压肾病组的35.71%(15/42)、多囊肾组的60.00%(3/5)、慢性间质型肾炎组的60.00%(3/5)(χ2=5.829,3.009,3.275,3.183,均P<0.05)。年龄<50岁组的3年生存率为96.23%(51/53),5年生存率为84.91%(45/53),均显著高于对照组的59.70%(40/67)及25.37%(17/67)(χ2=21.541,41.997,均P<0.05)。收缩压(95%CI为1.021¹.059,OR=1.044,P<0.01)和年龄(95%CI为1.0141.059,OR=1.044,P<0.01)和年龄(95%CI为1.014¹.066,OR=1.039,P<0.01),血糖(Glu)(95%CI为1.1171.066,OR=1.039,P<0.01),血糖(Glu)(95%CI为1.117¹.737,OR=1.399,P<0.01)及Alb(95%CI为0.7991.737,OR=1.399,P<0.01)及Alb(95%CI为0.799⁰.885,OR=0.828,P<0.01)均为ESRD病患死亡的独立性危险因素。BMI及Alb与病患死亡率均呈负相关(r=-0.352,-0.397,均P<0.05)。结论 ESRD病患行MHD后生存率伴随年龄增长而下降,DN以及营养不良可能是影响生存率的主要因素,而心血管病以及脑血管意外可能为死亡原因,应予以重视。     

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.