Viewpoint: Scientific dogmas, paradoxes and mysteries of latent Mycobacterium tuberculosis infection

Worldwide, there are nearly 10 million new cases of active TB and 1.8 million associated deaths every year. WHO estimates that one-third of the world's population is infected with Mycobacterium tuberculosis (Mtb), forming a huge latent Mtb global reservoir. This renders the prospect of ever eliminating Mtb from the human race almost impossible. Several controversial issues regarding host-pathogen interactions and existing prevention and eradication strategies for latent Mtb infections need to be critically re-examined. In this viewpoint, widely held assumptions on Mtb latency and isoniazid monotherapy and chemoprophylaxis are challenged. We highlight the need for future research to resolve these issues and to develop evidence-based strategies for better understanding of equilibrium and escape of Mtb in the human body, eventually leading to global recommendations for elimination of the latent Mtb state through informed policy and practice. Until such strategies and policies are realized, WHO and TB experts will have to settle for global TB control rather than eradication.     

Clinical evaluation of insulin resistance and β-cell function by the homeostasis model assessment in patients with systemic lupus erythematosus

The aim of this preliminary study was to evaluate insulin resistance and secretion using homeostasis model assessment (HOMA) in patients with systemic lupus erythematosus (SLE). The fasting glucose and insulin concentrations, HOMA insulin resistance (IR), HOMA -cell, antidouble-stranded DNA antibodies (anti-dsDNA), C3, C4, and SLE disease activity index (SLEDAI) were determined in a total of 58 female SLE patients. All patients were classified into subgroups according to the presence of anticardiolipin antibodies (aCL+ vs. aCL-) and SLEDAI scores (SLEDAI <3 vs. SLEDAI >3). Results showed that SLE patients with and without aCL had significantly higher fasting insulin levels, HOMA IR, and HOMA -cells than controls. Similar results were also found in SLE patients with different disease activities. Pearsons correlation analysis showed that there was a highly significant correlation of HOMA IR with fasting insulin concentration in the SLE patients and SLE subgroups overall. However, HOMA -cells were positively correlated with HOMA IR and fasting insulin level, but negatively correlated with fasting glucose concentration in SLE patients overall. In conclusion, SLE patients, regardless of the presence of aCL and different disease activities, had a higher risk of insulin resistance and abnormal insulin secretion than age-matched healthy controls, based on fasting insulin concentration, HOMA IR, and HOMA -cells.Abbreviations HOMA Homeostasis model assessment - IGT Impaired glucose tolerance - IR Insulin resistance - NGT Normal glucose tolerance - SLE Systemic lupus erythematosus - SLEDAI SLE disease activity index     

Levels of soluble E-selectin in patients with active Behçet’s disease

Behçets disease is a systemic vasculitis of unknown aetiology. Endothelial cell injury plays an important role in the pathogenesis and immunopathology of Behçets disease. E-selectin is expressed by activated endothelial cells. Because the selectin adhesion molecules are shed from activated cells, soluble forms of these proteins can be used as activation markers of endothelium (E-selectin). The pathogenesis of Behçets disease (BD) is closely related to endothelial cells, leucocyte functions and immunity. The aim of this study was to investigate circulating E-selectin adhesion molecules, which are known to play a significant part in the immune response especially by regulating interaction of the leucocytes with endothelium in BD. Plasma E-selectin concentrations were evaluated in 23 patients with BD and 20 healthy control subjects. The disease activity was evaluated by clinical manifestations (oral aphthous ulcer, genital ulceration, positive pathergy test, skin lesions, eye involvement, thrombophlebitis and arthritis) and by laboratory investigations [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]. The patients were newly or previously diagnosed cases not taking any drug for BD. Levels of E-selectin were measured with commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kits using human sE-selectin (cat. no: BMS 205). Plasma E-selectin concentrations of patients and controls were compared with the Mann-Whitney U test. Statistical significance was assigned to p values lower than 0.05. Serum levels (mean±SD) of soluble E-selectin (sE-selectin) were significantly higher in 23 patients with BD than in 20 healthy controls (53.2±18.2 ng/ml vs 33.8±7.5 ng/ml, p<0.0001). A statistically significant positive correlation was observed between sE-selectin levels and CRP and ESR in patients with BD (r=0.78, p<0.001 and r=0.56, p<0.01, respectively). Increases in the E-selectin in BD may be a direct consequence of the leucocyte and endothelium activations observed during the disease process. The noninvasive investigations can be used as biochemical markers for inflammation. This may provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.     

Individual, household and community factors associated with HIV test refusal in rural Malawi

Objective To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi. Methods HIV counselling and testing was offered to individuals aged 18–59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables. Results Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think. Conclusion Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.     

完全腹膜外腹腔镜疝修补术的护理配合

目的：总结经腹腔镜完全腹膜外疝修补术的配合方法。方法回顾性分析20例腹股沟疝患者经腹腔镜完全腹膜外疝修补的临床资料,术前准备充分,术中护士与医生密切配合。结果20例患者均顺利完成手术,无1例发生并发症。结论加强经腹腔镜完全腹膜外疝修补术的手术配合是手术成功的关键,术前充分准备、术中严格遵守操作规程、熟练的配合技术是手术成功的重要保证。     

C5a/C5aR通路对约氏疟原虫增殖和小鼠生存的影响

目的观察C5a/C5aR通路对约氏疟原虫17XL（P.y17XL）的增殖及其对BALB/c小鼠致死率的影响。结论将实验小鼠分为正常BALB/c组和C5aR-/-BALB/c组,每组5只,相同剂量的P.y17XL（2×105）分别感染正常BALB/c组小鼠和C5aR-/-BALB/c组小鼠,于感染后0、2、4和6d观察两组小鼠原虫血症和存活率的变化,并且采用ELISA检测感染P.y17XLBALB/c小鼠血清中C5a的水平。结果与正常组小鼠相比,C5aR-/-组小鼠生存期缩短,P.y17XL在C5aR-/-组小鼠的原虫血症较野生株小鼠高（P〈0.05）,而P.y17XL感染小鼠的血清中C5a含量低于未感染的小鼠。结论 C5a/C5aR能够抑制P.y17XL的增殖,并能延长感染小鼠的生存期。     

冠状动脉旁路手术中动脉材料的选择与应用

目的 在冠状动脉旁路手术(CABG)中寻求动脉材料作旁路移植，减少因大隐静脉桥(SVG)阻塞对远期通畅率的影响。方法 34例冠心病患者以乳内动脉(IMA)和桡动脉(RA)作为血管桥行CABG，采用不接触血管技术制备动脉桥，应用药物防止动脉痉挛。结果 取乳内动脉35根，桡动脉20根，大隐静脉11根，平均移植血管1．94支，死亡1例，手术死亡率2．9％。结论 使用动脉材料行旁路移植术安全有效，预计能保持移植血管长期通畅。     

Serotoninergic activation and inhibition: effects on carbohydrate tolerance and plasma insulin and glucagon.

Glucose and arginine infusion tests were performed on 12 healthy volunteers (8 males, 4 females) before and after serotoninergic activation [oral administration of L-5-hydroxytryptophan (5-HTP-) for 6 days] and serotoninergic inhibition (oral treatment with D,L-p-chloropenylalanine for 6 days). 5-HTP treatment markedly increased urinary 5-hydroxyindoleacetic acid excretion, increased the mild hyperglycemic effect of arginine infusion, and lowered the glucose disposal rate constant. The adverse effect of serotoninergic activation on glucose tolerance is not sufficiently explained by the observed changes in insulin and glucagon secretion during the fasting state and after intravenous glucose and arginine infusions. Serotoninergic inhibition did not affect the carbohydrate tolerance of normal individuals. The results of this work supports the idea that excessive indoleamine production is probably the main cause for carbohydrate intolerance in carcinoid tumors.     

药物洗脱支架的临床研究

目的:观察药物洗脱支架治疗冠状动脉(冠脉)病变的可行性和安全性.方法:对我院78例冠心病患者,置入药物洗脱支架(Cypher支架),治疗病变84处,A型病变4处,B型病变38处,C型病变42处.靶病变长度(19.89±10.61)mn,术前靶病变狭窄程度(86.00±10.01)%;目标血管直径(2.95±0.11)mm.其中长度＞20 mm的病变26处.68例支架在行球囊预扩张后置入,10例为支架直接置入.术前、术后常规使用抗血小板药物及治疗冠心病药物.观察药物洗脱支架置入的手术成功率、术中并发症、住院期间及短期临床随访期间的心脏事件.随访术后6个月时的再狭窄发生率.结果:78例患者84处病变共置入Cypher支架100枚,手术即刻成功率100%,术后冠脉造影提示病变残余狭窄(5.0±6.8)%.1例术后38小时因胸痛冠脉造影证实为支架内血栓形成.临床随访16～188天,平均(94.0±10.9)天,无一例心肌梗死或猝死发生.25例(32.05%)患者术后6个月随访冠脉造影未发现支架再狭窄.结论:药物洗脱支架置入时手术成功率高,未见术中并发症,部分病例短期随访效果令人鼓舞.