宫内暴露于选择性5-羟色胺再摄取抑制剂后足月新生儿的戒断综合征

目的:比较宫内暴露或未暴露于选择性5-羟色胺再摄取抑制剂(SSRI)的新生儿的戒断综合征的发生率和临床特征。设计:队列研究。机构:三级保健中心。受试者:120名足月新生儿,其中60名较长期宫内暴露于SSRI,包括盐酸帕罗西汀、氟西汀、氢溴酸西酞普兰、盐酸舍曲林和盐酸万拉法新。主     

Long term effects of exposure to viral infections in utero

An analysis was conducted of the major findings of a long term follow up study of 3076 subjects who were exposed to viral infections in utero and who at the time of analysis were up to 40 years of age. Mortality and morbidity were compared with those in a control population matched for sex and date and area of birth. An excess of cancers (16 cases against seven) appeared to be clustered among those exposed to herpes viruses (varicella or cytomegalovirus). There was evidence of an increased risk of diabetes among those exposed to mumps during the first trimester (four cases among 128 subjects against none in 148 controls). The most surprising finding was a decrease of diseases of the skin and subcutaneous tissue and of the nervous system among subjects exposed to antenatal varicella zoster infection. The mechanism for the association may include production of fetal anti-idiotype antibodies in response to transplacentally acquired maternal autoantibodies.     

Diethylstilboestrol (DES) exposure in utero

A clinical review of the first 200 patients who attended the DES Referral Clinic at The Royal Women's Hospital, Melbourne, has been undertaken. To date, clear-cell adenocarcinoma has not been detected in patients attending the Clinic. Fifteen per cent of patients who allegedly were exposed in utero to diethylstilboestrol (DES) showed no clinical stigmata. Vaginal adenosis was found in 41% of patients. On its own, cytological examination of vaginal smears was found to be unreliable as routine screening for detection of adenosis. Painting of the cervix and vagina with Lugol's iodine proved to be a more reliable screening test. Colposcopy is recommended in all patients who are suspected of having been exposed in utero to DES.     

Abnormalities in pulmonary function after brief exposure to toxic metal fumes.

A 26-year-old welder became ill after exposure to zinc and cadmium fumes at work. His initial clinical course was consistent with that of metal fume fever, but persistence of symptoms and signs beyond the usual duration in this condition led to suspicion of a toxic pulmonary reaction to cadmium. The finding of high percentages of both metals in the urine confirmed this diagnosis. Pulmonary function tests showed restriction of lung volumes, with increased elastic recoil and reduced diffusion, but no evidence of airways obstruction. Chest roentgenograms indicated central pulmonary edema, which cleared in 6 days. Follow-up assessment 2 years later showed incomplete improvement of the restrictive ventilatory defect.     

Toxic encephalopathy in a child after brief exposure to insect repellents.

Seizures and acute behaviour change developed in an 8-year-old girl following exposure to Muskol and Off insect repellents. She recovered within 3 days with supportive treatment, including anticonvulsant medication. The assumed toxic agent was N,N-diethyltoluamide.     

Neurodevelopment of adopted children exposed in utero to cocaine.

OBJECTIVE: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. DESIGN: A case-control observational study. PARTICIPANTS: Twenty-three children aged 14 months to 6.5 years exposed in utero to cocaine and their adoptive mothers, and 23 age-matched control children not exposed to cocaine and their mothers, matched with the adoptive mothers for IQ and socioeconomic status. SETTING: The Motherisk Programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. MAIN OUTCOME MEASURES: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. RESULTS: Compared with the control group, children exposed in utero to cocaine had an 8-fold increased risk for microcephaly (95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow-up the cocaine-exposed children caught up with the control subjects in weight and stature but not in head circumference (mean 31st percentile v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on the Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). CONCLUSIONS: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, independent of postnatal home and environmental confounders. Because women who use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic effects to cocaine alone.     

邻苯二甲酸二丁酯孕期暴露仔鼠阴茎3-磷酸甘油醛脱氢酶表达差异的研究

目的探讨3-磷酸甘油醛脱氢酶（GAPDH）在SD大鼠尿道下裂发生中的作用机制。方法SD大鼠妊娠14~18天,邻苯二甲酸二丁酯（DBP）按800 mg/（kg.d）染毒孕鼠,妊娠19天取出胚胎大鼠取阴茎,提取蛋白,比较尿道下裂仔鼠与正常仔鼠阴茎组织中GAPDH的差异。结果GAPDH在尿道下裂仔鼠阴茎中的表达量明显高于正常仔鼠,GAPDH主要在阴茎上皮细胞中表达。结论GAPDH可能通过抑制DNA合成和细胞增生发挥生长抑制功能,可能在尿道沟融合障碍过程中起关键作用。     

邻苯二甲酸二丁酯干预Fgfs信号通路致雄性仔鼠尿道下裂发生的分子机制研究

目的:通过验证邻苯二甲酸二丁酯(DBP)孕期染毒所致尿道下裂雄性仔鼠生殖结节内成纤维细胞生长因子(Fgfs)及其受体(Fgfr)信号通路中关键基因的表达异常,探讨其在DBP生殖毒性过程中的作用机制.方法:孕鼠20只,随机分2组,在怀孕(GD)14～18天期间,每天分别灌胃给予大豆油、DBP 750 mg/kg,出生后第1天(PND1),统计仔鼠出生数、尿道下裂发生率,称量雄性仔鼠体重,肛门至生殖器距离(AGD);PND7,取尿道下裂雄性仔鼠生殖结节,用实时定量(real-time quantitative)RT-PCR方法检测生殖结节中Fgf8、Fgf10、Fgfr2的mRNA表达水平.结果:DBP染毒后导致新生仔鼠与正常组相比数量明显减少,雄性仔鼠体重明显下降、AGD明显缩短,雄性仔鼠尿道下裂的发生率为48.83%.同时,与对照组相比,DBP致尿道下裂雄性仔鼠生殖结节中Fgf8、Fgf10、Fgfr2的mRNA的表达水平明显下降.结论:DBP对母体有着明显的毒性作用,DBP干预了Fgfs信号通路中关键基因的表达,这可能是DBP导致生殖结节发育异常,引起尿道下裂的重要原因.     

Unexplained febrile illnesses after exposure to ticks. Infection with an Ehrlichia?

The Ehrlichia are tick-borne rickettsial organisms that cause disease in animals throughout the world but that have been previously recognized as human pathogens only in Asia. We have identified six patients with serological evidence of recent infection with an Ehrlichia: a fourfold or greater rise or fall in titer to Ehrlichia canis. All of the patients reported recent tick bites. Rigors, myalgia, headache, nausea, and anorexia were each reported by five patients. Fever was present in all patients and was accompanied by relative bradycardia and leukopenia in five patients, thrombocytopenia and abnormal liver function test results in four, and anemia in three. Five of the six patients were treated with tetracycline hydrochloride, and all recovered. Infection with Ehrlichia should be considered in patients with unexplained febrile illnesses after tick exposure.     

狂犬病暴露及伤口处理效果研究

目的探讨可疑狂犬病暴露后的有效处理方式,并对其效果进行评价,为更好地防治狂犬病提供科学依据。方法通过对浙江省2005至2006年的所有狂犬病病例和与其有同源暴露的狂犬病暴露者的调查,利用病例对照研究方法,采用非条件Lo-gistic回归方法,分析有效的伤口处理方式并评价其效果。结果本次共调查了132例病例和73例对照。病例组和对照组ll度及以上暴露分别占97.7％和91．8％,相对Ⅰ度暴露,OR值为3．73（090～15．40）及以上。病例组和对照组各有8．5％和1．4％暴露部位在头面部,57．4％在躯干,31．0％在上肢;相对下肢,OR值分别为3．67（1．96～6．87）、12．00（1．49-9679）,存在剂量反应关系（趋势X^2=20．88,P=0．000）。22．6％的病例和11．8％的对照暴露部位数≥2处,OR值为2．19（0．88～5．58）;84．8％的病例和712％的对照伤口有出血,OR值为226（107～4．80）;伤口在医疗机构处理为保护因素,相对伤口未处理者,OR值为047（0．25～088）;8018％的病例和97．4％的对照伤口在当日处理,OR值为0．11（001～0．90）;消毒或冲洗后再消毒为有效的伤口处理方式,相对伤口未处理者,OR值分别为0128（0．10～0．76）和0．33（013～0．80）。结论暴露程度、暴露部位和暴露部位数、伤口有无出血、伤口处理和处理方式、伤口处理时间对狂犬病暴露者的发病有影响,狂犬病暴露后应在医疗机构当天及时对伤口进行消毒处理。