动脉粥样硬化与12/15-LOX基因启动子区甲基化状态的关系

目的 探讨动脉粥样硬化（AS）与12/15-脂氧合酶（12/15-LOX）基因启动子区甲基化状态的关系。方法 将40只SD大鼠随机分为两组,即模型组和对照组,每组20只。模型组:给予高脂＋维生素D3粉剂饮食;对照组正常饮食。3个月后,处死大鼠,取其主动脉弓至腹主动脉的血管组织,用改进的半定量甲基化特异性PCR法检测血管组织中12/15-LOX基因启动子区甲基化状态。结果 ①经苏木精-伊红染色,显微镜下观察可见模型组大鼠的主动脉有明显的粥样斑块形成,对照组未见明显变化。②按照吸光度(A)比值把全部血管组织分为低甲基化状态和高甲基化状态,模型组大鼠的血管组织的低甲基化率显著高于对照组（P<0.01）。结论 血管斑块处12/15-LOX基因启动子区的甲基化状态与AS的形成相关,在AS发病过程中可能发挥着重要的作用。     

儿童支气管哮喘血清IL-4、IL-10和IFN-γ浓度的测定及其临床意义

目的探讨血清白介素4（IL-4）、IL-10和干扰素γ（IFN-γ）与支气管哮喘（简称哮喘）的关系及其临床意义。方法随机收集于2008年6月至2009年1月期间在山东大学齐鲁儿童医院就诊的哮喘患儿纳入哮喘组,哮喘诊断全部符合2003年中华医学会儿科分会呼吸学组修订的支气管哮喘诊断标准,共计47例。同时选取性别和年龄与哮喘组匹配的51例健康体检儿童作为正常对照组。收集外周静脉血,采用双抗体夹心ELISA方法测定两组血清IL-4、IL-10、IFN-γ浓度,比较两组之间血清IL-4、IL-10、IFN-γ浓度的差异。结果哮喘组血清IL-4浓度[（346.74±82.92）ng/L]显著高于正常对照组[（199.87±59.25）ng/L]（P〈0.01）;哮喘组血清IL-10浓度[（86.38±58.58）ng/L]与正常对照组[（98.77±37.05）ng/L]的差异无统计学意义（P〉0.05）,哮喘组血清IFN-γ浓度[（94.51±22.92）ng/L]低于正常对照组[（110.75±47.11）ng/L]（P〈0.05）。结论 Th2类细胞因子IL-4在哮喘患儿血清中浓度升高,而Th1类细胞因子IFN-γ浓度下降,哮喘患儿存在Th1/Th2细胞免疫失衡;血清IL-4、IFN-γ浓度检测可以作为儿童哮喘的辅助诊断手段,同时本研究为使用抗IL-4制剂、补充IFN-γ等免疫学方法治疗哮喘提供依据。     

γ-促分泌酶抑制剂阻断Notch信号对支气管哮喘模型小鼠气道炎症的影响

目的研究γ-促分泌酶抑制剂阻断Notch信号对支气管哮喘（简称哮喘）模型小鼠气道炎症反应的影响,为哮喘治疗寻找新的药物提供理论基础。方法制作小鼠哮喘模型,在小鼠激发阶段尾静脉注射γ-促分泌酶抑制剂MW167,采用RT-PCR方法检测小鼠肺T细胞IL-4mRNA及IFN-γmRNA的表达,ELISA方法检测外周血清及BALF上清中IL-4及IFN-γ水平。结果 MW167注射组较哮喘组病理学改变减轻,而肝及肾无明显形态学改变,MW167阻断Notch信号后,MW167注射组小鼠肺T细胞IL-4mRNA的表达较哮喘组减弱,而IFN-γmRNA的表达增强（IL-4：0.119±0.045比0.414±0.214,P〈0.01;IFN-γ：0.459±0.205比0.170±0.050,P〈0.01）;MW167注射组外周血清及BALF中IL-4的表达较哮喘组减弱[血清：（19.601±0.870）ng/L比（26.046±2.211）ng/L,P〈0.05;BALF：（75.077±14.438）ng/L比（113.478±8.628）ng/L,P〈0.01）];外周血清中及BALF中IFN-γ的表达较对照组增强[血清：（10.644±3.338）ng/L比（5.119±2.230）ng/L,P〈0.01];BALF：（26.131±3.608）ng/L比（21.299±2.830）ng/L,P〈0.01]。结论静脉注射γ-促分泌酶抑制剂抑制了哮喘模型小鼠气道炎症,对哮喘有潜在的治疗价值。     

急性心肌梗死患者血清炎症因子、尿酸水平的变化

目的：观察急性心肌梗死（AMI）患者血清白细胞介素（IL）-6、IL-10、C反应蛋白（CRP）、血尿酸（SUA）浓度的变化,探讨上述因子对AMI的影响。方法：选择AMI患者（AMI组）30例和正常人30例（正常对照组）做对照研究。正常对照组于清晨空腹抽取静脉血,AMI组分别于发病后24h、2周抽取静脉血6ml。检测所有研究对象血清炎症因子,SUA等水平。结果：与正常对照组比较,AMI组发病24h后血清IL-6[（114.66±25.74）pg/ml比（238.11±102.08）pg/ml]、IL-10[（17.68±3.33）ng/ml比（22.84±12.36）ng/ml]、CRP[（3.27±1.25）mg/L比（24.51±19.46）mg/L]、SUA[（252.76±50.70）μmol/L比（379.50±122.90）μmol/L]、IL-6/IL-10比值[（6.70±1.99）比（13.94±10.03）]水平明显升高（P〈0.05～0.01）。结论：急性心肌梗死时血清白细胞介素6、10,C反应蛋白、血尿酸水平明显升高,它们共同参与了急性心肌梗死的发生和发展。     

高脂饮食对自身免疫性肝炎肝损伤与焦亡的研究CSCD

目的探讨高脂饮食（high-fat diet, HFD）对小鼠自身免疫性肝炎（autoimmune hepatits, AIH）肝脏损伤的影响。方法50只C57BL/6雄性小鼠选取6只为S-100制备组,剩余小鼠用随机数字法随机分成标准饮食组（standard chow, SC）、HFD组、AIH＋SC组及AIH＋HFD组,喂饲1周后进行AIH造模,4周后处死小鼠,收集小鼠肝脏、脾脏、血清,进行HE染色观察肝组织病理学改变;检测小鼠血清中ALT和AST变化;蛋白质印迹法和实时PCR法检检测肝组织中Nod样受体蛋白3（NLR pyrin domain containing 3, NLRP3）和含半胱氨酸的天冬氨酸蛋白水解酶1（cysteinyl aspartate specific proteinase, Caspase-1）的表达;ELISA试剂盒检测血清中TNF-α、IL-6和IL-1β的分泌量;流式细胞仪分析脾脏中Th17细胞的数量。各组间均数比较采用单因素方差分析（one-way ANOVA）,每两组间比较方差齐性采用SNK-q检验,方差不齐采用非参数检验。结果HFD组肝组织可见少许脂肪空泡形成,AIH＋SC组可见血管周围炎性反应,AIH＋HFD组可见炎性反应加重,出现少许空泡样脂肪变性。与SC组小鼠相比,AIH＋SC组和HFD组小鼠的血清ALT和AST水平有所增加,AIH＋HFD组上升最为明显,各组均数相比差异均具有统计学意义（F值分别为57.12和37.58,P均〈0.05）。SC组外周血中Th17占CD4＋T细胞的比例为（2.98±0.90）%,HFD组为（6.89±0.99）%,AIH＋SC组为（6.47±1.08）%,AIH＋HFD组为（9.96±0.83）%,各组之间比较及两两比较差异有统计学意义（F＝54.05,P〈0.05）。SC组各血清细胞因子浓度分别为IL-1β [（7.62±2.81） ng/L]、IL-6 [（106.54±53.08） ng/L]、TNF-α [（107.26±36.20） ng/L];HFD组分别为IL-1β [（25.06±7.09） ng/L]、IL-6 [（220.11±47.41） ng/L]、TNF-α [（273.77±33.62） ng/L];AIH＋SC组分别为IL-1β [（17.49±5.68） ng/L]、IL-6[（260.73±50.29） ng/L]、TNF-α [（250.49±81.63） ng/L];AIH＋HFD分别为IL-1β [（52.04±10.22） ng/L]、IL-6 [ （785.93±70.91） ng/L]、TNF-α [（913.97±64.57） ng/L],各组之间差异均有统计学意义（F值分别为44.66、242.15、233.49,均P〈0.05）。HFD组和SC组相比、AIH＋HFD组与AIH＋SC组相比,NLRP3、Caspase-1表达明显上升,差异均有统计学意义（均P〈0.05）。结论HFD促进AIH,可能是通过促炎因子分泌、促进Th17细胞活化和促进炎症小体NLRP3激活进而促进细胞焦亡。     

同型半胱氨酸对强直性脊柱炎患者MTHFR基因启动子甲基化状态的影响

目的探讨同型半胱氨酸（Hcy）对强直性脊柱炎（AS）患者亚甲基四氢叶酸还原酶（MTHFR）基因启动子甲基化状态的影响。方法运用酶联免疫吸附法测定36例AS患者及30例对照组血浆Hcy水平,采用MS—PCR法分析MTHFR基因启动子甲基化水平。结果AS患者血浆Hcy水平明显高于对照组,两组间比较差异具有统计学意义（P〈0．05）;AS组中有29例患者其MTHFR基因启动子出现非甲基化特异PCR条带,与对照组比较有显著性差异（P〈0．05）;AS组中血浆Hcy〉20μmol／L的患者其MTHFR基因启动子甲基化状态与对照组比较,存在显著性差异（P〈0．05）。结论部分AS患者MTHFR基因启动子区出现去甲基化,高Hcy血症影响了AS患者MTHFR基因启动子区的去甲基化过程。     

不稳定型心绞痛患者血清白细胞介素-18浓度与冠状动脉病变程度的关系

目的探究不稳定型心绞痛(unstable angina,UA)患者血清白细胞介素-18(interleukin-18,IL-18)浓度与冠状动脉病变程度的关系。方法回顾性纳入2017年1月至2019年1月在延安大学附属医院心血管内科治疗的160例UA患者的临床资料,并以同期64例无冠状动脉粥样硬化性心脏病(冠心病)诊断的体检人群为对照组。通过酶联免疫吸附试验(ELISA)法检测入选对象的血清IL-18浓度,并比较冠状动脉病变数目和经血管造影评估的Gensini评分与血清IL-18浓度的相关性。结果 UA患者的血清IL-18浓度显著高于对照组,差异有统计学意义[(162.43±47.35)ng/L vs.(110.23±20.34)ng/L,P<0.05]。冠状动脉三支病变患者的血清IL-18浓度分别高于双支病变组[(207.12±49.83)ng/L vs.(158.67±31.02)ng/L,P<0.05]和单支病变组[(207.12±49.83)ng/L vs.(143.78±33.43)ng/L,P<0.05],差异有统计学意义。冠状动脉极重度病变组患者的血清IL-18浓度显著高于重度病变组[(283.47±103.72)ng/L vs.(179.75±47.38)ng/L,P<0.05]、中度病变组[(283.47±103.72)ng/L vs.(145.53±38.72)ng/L,P<0.05]和轻度病变组[(283.47±103.72)ng/L vs.(123.32±24.74)ng/L,P<0.05],差异有统计学意义。Pearson相关性分析结果显示UA患者的血清IL-18浓度与Gensini评分呈正相关关系(r=0.617,P<0.05)。结论 UA患者的血清IL-18浓度与患者冠状动脉病变程度密切相关。     

冠心病与血浆血栓调节蛋白基因启动子甲基化有关

目的探讨血栓调节蛋白（thrombomodulin,TM）基因启动子甲基化与冠心病（CHD）的关系。方法选择经冠状动脉造影（CAG）证实有狭窄或粥样斑块的CHD患者90例,和经CAG证实无狭窄或粥样斑块的对照组75例,采用甲基化特异性PCR（MS-PCR）检测两组血浆TM基因启动子甲基化状况。结果CHD组TM基因启动子甲基化检出率为41%（37/90）,对照组为20%（15/75）,两组比较差异有统计学意义（P<0.01）;CHD组1支病变组TM基因启动子甲基化检出率为44%（11/25）,2支病变组检出率为39%（9/23）,≥3支病变组检出率为40%（17/42）,3组比较差异无统计学意义。结论CHD患者血浆TM基因启动子甲基化与CHD有关,但其甲基化状态与动脉粥样硬化的病变程度没有相关关系。     

高同型半胱氨酸血症对雌激素受体α基因甲基化修饰的影响及其与脑梗死发病的关系

目的探讨雌激素受体α（ER-α）基因启动子区甲基化状态与脑梗死发病的关系,同时探讨高同型半胱氨酸血症作为脑梗死独立危险因素的致病机制。方法选择106例脑梗死患者作为观察组,47例健康体检者作为正常对照组。检测两组血同型半胱氨酸（tHcy）浓度,并采用巢式甲基化特异性PCR法检测其ER-α基因启动子区甲基化状态。结果观察组tHcy浓度及ER-α基因启动子区甲基化发生率明显高于正常对照组（t=7.019,P=0.00;χ2=22.27,P=0.00）。Spearman秩相关分析结果显示,脑梗死患者ER-α基因启动子区甲基化状态与tHcy浓度呈高度正相关（r=0.733,P=0.00）。结论高同型半胱氨酸血症很可能通过干扰ER-α基因的甲基化状态而成为脑梗死独立危险因素的致病机制。     

同型半胱氨酸对雌激素受体α基因甲基化调控及其与原发性高血压相关性分析

目的观察原发性高血压(EH)患者雌激素受体α(ER-α)基因启动子区域甲基化状态,分析其与血浆同型半胱氨酸(Hcy)水平和颈动脉内膜中层厚度(CIMT)的相关性。方法选择EH患者70例为EH组,其中高血压1级24例、高血压2级23例、高血压3级23例。选同期健康体检者50例为对照组。用直接化学发光法检测血浆Hcy水平,Hcy正常47例(Hcy<15μmol/L)和高同型半胱氨酸血症(HHcy,Hcy≥15μmol/L)23例。用巢式甲基化特异性PCR法检测ER-α基因启动子区甲基化状态,颈部血管超声测CIMT。用Spearman秩相关分析。结果EH组ER-α基因启动子区甲基化比例显著高于对照组(52.9%vs 30.0%,P=0.013),且高血压1级、高血压2级和高血压3级患者ER-α基因启动子区甲基化比例比较,差异有统计学意义(29.2%vs 52.2%vs 78.3%,P=0.003)。EH组血浆Hcy水平明显高于对照组[(13.34±4.22)μmol/L vs (10.34±3.10)μmol/L,P=0.000]。EH组中合并HHcy患者ER-α基因启动子区甲基化比例明显高于Hcy正常者(100.0%vs 29.8%,P=0.00)。EH组ER-α基因启动子区甲基化水平与血浆Hcy水平和CIMT呈正相关(r=0.722,r=0.718,P=0.00)。结论EH患者ER-α基因启动子区呈异常高甲基化,且其甲基化水平与血浆Hcy水平和CIMT具有显著的相关性。     

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.