Effect of mite-impermeable mattress encasings and an educational package on the development of allergies in a multinational randomized, controlled birth-cohort study – 24 months results of the Study of Prevention of Allergy in Children in Europe

BACKGROUND: Sensitization to house dust mite (HDM) is an important risk factor for the development of asthma and allergic disease in childhood. Higher levels of HDM allergen are linked to increased sensitization to HDM. OBJECTIVE: To study the effect of mite-impermeable mattress encasings and an educational package on the development of allergies in a newborn cohort. METHODS: Six hundred and ninety-six newborns at high risk of developing allergies were enrolled in three European countries (Germany, Austria, UK) in a prospective, randomized, controlled birth-cohort study. Children were randomly assigned to an intervention and control group. Intervention measures included the use of mite-impermeable mattress encasings for the child's bed and a simple educational package on allergen avoidance. The control group received basic information about allergies. Children were followed up at age 6, 12, 18 and 24 months. RESULTS: 80.9% of the children were followed up to the age of 24 months. No difference in the prevalence of sensitization to HDM (control vs. intervention group: 8.4% vs. 6.1%, P=0.33) or the development of symptoms (recurrent wheezing 10.3% vs. 10.7%, nocturnal cough 12.5% vs. 12.5%) or allergic diseases (asthma 3.5% vs. 5.1%, eczema 20.0% vs. 19.6%, rhinitis 28.9% vs. 25.8%) could be found between the control and intervention group. CONCLUSION: In this study, HDM avoidance did not show a protective effect on the development of sensitization to HDM or symptomatic allergy in children at age 24 months.     

Preoperative methicillin‐resistant Staphylococcus aureus (MRSA) screening: An effective method to control MRSA infections on elective orthopaedics wards

Background: Methicillin‐resistant Staphylococcus aureus (MRSA) infections continue to increase in UK hospitals despite the introduction of various control measures. These infections have serious clinical and economic implications, particularly in relation to elective orthopaedic surgery. Methods: A prospective study was performed from August 2003 to July 2004 to assess the effect of preadmission screening and ‘ring fencing’ of beds on the incidence of infection in an elective orthopaedics unit. Results: The preoperative incidence of MRSA colonization was 2.25% and 53% of these patients had at least one risk factor. There were no postoperative MRSA infections in the ring‐fenced orthopaedic unit. Conclusions: Preoperative screening and ring fencing reduced the MRSA incidence to zero in the operated patients. Mechanisms need to be developed where screening and isolation of MRSA cases can be performed in most, if not all, hospital admissions.     

乳腺癌的二级预防

在我国乳腺癌的发病率有逐渐增加的趋势，而且它对我国中年妇女的威胁最大。乳腺癌二级预防已被公认是降低死亡率的有效途径。综合应用宣教、自检、体检、Ｘ线摄影、近红外线摄影、超声检查、针吸活检、手术活检等方法对年龄在３０～６０岁的城市妇女定期进行分层筛检、监检可以使乳腺癌患者早期被发现，降低乳腺癌死亡率。     

Reduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid

Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n=276) and a Treatment group (n=279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p<0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p<0.05). IHD mortality was reduced by 36% (p<0.01)in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level >1.5 mmol/l (n=216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride concentration by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p<0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13 %. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was reponsible for the beneficial effect of the treatment.     

A model for estimating the potential costs and savings of osteoporosis prevention strategies

A model was developed which estimates the costs of osteoporosis risk evaluation and treatment, and the resulting savings in terms of reduced fracture frequency, for the adult female population of the United States. In the absence of treatment, the model predicts 1.44 million fractures will occur annually from non-violent causes. Treatment of all women beginning at age 50 with an agent that slows bone loss by 50% would reduce the number of these fractures by 0.59 million. Selective treatment of the 47% of women at the greatest fracture risk would reduce the number of fractures by 0.45 million, but would only cost 47% as much as treating all women. Additional data are required before the model can be used to evaluate specific treatment regimens. However, it appears that selective treatment of those at highest risk would yield the greatest benefit to cost ratio, if only benefits related to reduced fracture frequency are considered.     

Sulphanilic acid: divergent results in the guinea pig maximization test and the local lymph node assay

The guinea pig maximization test (GPMT) has proven to be a valuable tool for the identification of the skin sensitization potential of chemicals. The method identifies a hazard which can lead in the EC to compulsory labelling of that chemical. In the present study, data on sulphanilic acid derived from the GPMT has been compared with results from a second guinea pig assay (the cumulative contact enhancement test) and the murine local lymph node assay, both of which require only topical application of chemical. Except for the GPMT, no test identified any sensitizing activity associated with exposure to sulphanilic acid. These latter results are consistent with the experience gained from substantial human exposure in an occupational setting and from which no cases of allergic contact dermatitis to sulphanilic acid have arisen over a 20-year period. In consequence, it is questioned which test protocol in practice has given the more accurate identification of sensitization hazard relevant to man.     

大学生预防性治疗的结核菌素反应强度标准研究

目的 探讨结核菌素反应强度与结核病发病的相关性;提出预防性治疗对象的结核菌素反应标准.方法 对不同结核菌素反应强度的新入学大学生进行4年的结核病发病观察,分析结核菌素反应强度与发病危险性、发病时间的关系,比较不同反应强度预防性治疗对象发病率的变化.结果 26 543名健康学生进行了结核菌素试验和4年的发病观察,反应强度为0～4、5～9、10～14、15～19和≥20 mm或水泡丘疹者的年均结核病发病率分别为12.97/10万、13.34/10万、50.32/10万、167.56/10万和250.21/10万;0～4和5～9 mm反应者头2年发病率很低,第3、4年有所增高,而15～19和≥20 mm或水泡丘疹者头2年发病率很高,随着时间推移有下降趋势.当逐个计算反应强度每增加1 mm及以上反应者的发病率时,15 mm以上的各反应强度者中结核病发病率相似,一直维持在较高水平.PPD反应标准15 mm及以上可以覆盖80.8%的病人,而且病人的发现效率也维持在一个高水平.结论 结核菌素反应强度与结核病发病存在明显正相关,特别在头2年危险比更大;PPD反应≥15 mm或有水泡丘疹阳性者的发病机会明显升高,PPD反应≥15 mm或有水泡丘疹阳性标准能够覆盖80%以上的病人,病人的发现效率也最高.因此以PPD反应≥15 mm或有水泡丘疹作为预防性治疗对象的结核菌素反应标准更为合理.     

Molecular Pharmacology of Topiramate: Managing Seizures and Preventing Migraine

Topiramate is a neuromodulatory compound with stabilizing properties that was initially introduced for the management of partial seizures. Topiramate has been demonstrated to modify several receptor-gated and voltage-sensitive ion channels, including voltage-activated Na⁺ and Ca²⁺ channels and non-NMDA receptors. These receptors have been implicated in the pathophysiology of both epilepsy and migraine. The pharmacological mechanisms of action for topiramate that may explain its antiepileptic and migraine preventive activities will be discussed in this review. In addition, the potential relationship between the molecular activities of topiramate and its efficacy in epilepsy and migraine prevention will be emphasized.     

Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy

Polyunsaturated fatty acids (PUFAs) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis (AD). The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants. Based on the parents' decision on their babies' primary feeding, mothers and newborns were randomized to the supplementation with gamma-linolenic acid (GLA) or placebo for up to 6 months. Breastfed infants received GLA by supplementing their mothers. Formula diet was commercial whey hydrolysate unsupplemented with PUFAs. Of 131 eligible infants, 24 developed AD within the first year of life. Of these, nine belonged to the exclusively breastfed group (n = 58), 14 to the combined-fed group (n = 53), and one to the never breastfed group (n = 20). We could not find an influence of GLA on the development of AD. In subjects with AD, at 1 yr of age the serum-immunoglobulin E (IgE) was the lowest in the GLA-supplemented group A-subjects. In the GLA-supplemented group, GLA-levels in breast milk were similar in atopic and non-atopic infants. In the non-supplemented group the GLA-content of breast milk was 0.07% of total fatty acids in atopic infants vs. 0.17% in non-atopic infants (p < 0.01). Dietary GLA-supplementation could not prevent AD. Interestingly, the number of infants developing AD was the lowest in never breastfed children. In infants suffering from AD, GLA-supplementation seemed to reduce total IgE in the first year of life.     

化疗病人的静脉保护

化疗病人因营养失调 ,骨髓抑制、药物反复刺激、损伤等原因造成血管硬化、塌瘪、脆性大 ,给护理工作带来了一定的难度 ,自 2 0 0 0年始 ,我们摸索出一套保护化疗病人静脉的方法 ,延长了静脉使用的次数和时间。1　临床资料自 2 0 0 0年 1月至 2 0 0 3年 1月 ,我科共收住病人 112 0人食道癌 36 0人 ,乳腺癌 2 6 0人 ,肺癌 30 0人 ,直肠癌 10 8人 ,其他癌 82人 ,其中化疗病人占 6 5 % ,我们均采取了从选择静脉到拔针后处理的方法收到了满意的效果。2　静脉保护2 .1　重视选择静脉　人们根据药物的刺激程度选择不同静脉 ,如强刺激化疗药物如 HN…