上海市7158例寄生虫病住院病例流行病学分析

目的分析上海市寄生虫病住院病例构成特点及其变化态势。方法采用回顾性调查方法，对上海市1991—2001年间各级医疗机构确诊的寄生虫病住院病例资料进行分析。结果共调查寄生虫病住院病例7158例，其中原虫病、土源性线虫病、食源性寄生虫病及“三病”（血吸虫病、疟疾、丝虫病）患者所占病例总数比例依次为5．66％、25．71％、8．96％和59．12％。11年间寄生虫病住院病例数总体呈上升趋势，2001年病例数较1991年上升了112．87％。其中滴虫病、囊虫病和血吸虫病的构成比分别从1991年的0．54％、2．68％和42．63％上升至2001年的6．42％、6．80％和65．62％；而蛔虫病的构成比从1991年的46．92％减少至2001年的11．84％；肺吸虫病的构成比在1998—1999年间达高峰（占4．64％～5．50％）。蛔虫病以〈10岁婴幼儿居高（占25．14％）；阴道滴虫病以21～29岁居高（占48．90％）；肺吸虫病和囊虫病以20～49岁青壮年为多，分别占59．70％和80．95％；血吸虫病则主要集中在50岁以上老年人．占88．34％。结论蛔虫病等土源性寄生虫病的构成比呈下降趋势，滴虫病、囊虫病等食源性寄生虫病的构成比呈上升趋势。     

健康教育对寄生虫病防治的影响

目的 了解医学院校新生对常见寄生虫病预防的知识、态度、信念、行为（knowledge、attitude、belief、practice，KABP）情况，探讨健康教育的重要性，为进一步搞好人体寄生虫学教学提供依据。方法参照有关KABP调查标准，对贵阳医学院2005级新生采取无记名问卷调查。结果大学前开设健康教育课的占80．54％：开设寄生虫病健康教育课的占41．83％；学生的寄生虫病防治知识平均知晓率13项中有8项在50％以下：态度、信念、健康教育开设形成率14项有6项在50％以下；行为形成率13项有2项在50％以下。结论我国许多中小学对寄生虫病防治的健康教育重视程度不够，教学效果不理想。加强学校、家庭、社区、媒体等各层次的健康教育，改进医学院校学生的寄生虫学教学是十分必要的。     

加强健康教育对肠道寄生虫疾病的预防作用分析

目的探讨在肠道寄生虫疾病预防控制工作中加强健康教育的效果,希望能为肠道寄生虫疾病的预防提供有效的帮助遥方 法选取2016 年4 月~2017 年4 月接受肠道寄生虫疾病健康教育的3869 例居民作为研究对象,评估健康教育的效果遥结果 2015 年3 月~2016 年3 月本地居民寄生虫疾病感染率为14.50%,2016 年4 月~2017 年4 月本地居民寄生虫疾病感染率为 2.51%遥结论加强对居民行健康教育,可有效提高居民对肠道寄生虫疾病预防相关知识知晓程度,减少居民感染率遥     

肝寄生虫感染的声像图特征及超声引导下穿刺活检的诊断价值

目的 探讨超声引导下穿刺活检对肝脏结节性寄生虫感染性病变的诊断价值、病变声像图特征及病理组织学基础；方法 分析了经超声引导下穿刺活检病理证实的12例17个直径3cm以下的结节肝脏寄生虫病变的二维及彩色多普勒特征，并与病理结果进行了对照研究；结果 本组12例17个结节，其中单发结节8例，2个结节3例，3个结节1例；病变形态多不规则，5例呈较均匀低回声，7例呈混合性回声，低回声中混有点状高回声，肿块一般边界清楚，但无包膜或包膜不完整，周边无低回声暗环；彩色多普勒血流显像（CDFI）显示病灶内血流，12例中仅1例于病灶内探及低速动脉血流（12cm/s);7例低回声为主的混合性回声在活检标本镜下以嗜酸性白细胞为主的大量炎性细胞浸润，3例伴组织凝固性坏死，3例于坏死组织中找到夏科－莱登结晶，其中1例找到虫卵；5例低回声均为较均匀的组织凝固性坏死；结论 肝脏＜3cm结节性寄生虫感染一般表现为肝内的实性病变，以不均匀低回声或低回声多见，边界多不规则，无完整包膜，CDFI肿块内多无血流信号；上述特征有利于与肝脏恶性病变区别，鉴别诊断困难超声引导下穿刺活检是确诊的必要手段。     

对寄生虫病预防控制方向紧缺人才情况的调查与分析

本文以中国疾病预防控制中心寄生虫病预防控制所为例,在对寄生虫病预防控制方向紧缺人才情况的调查与分析的基础上,针对性地提出了紧缺人才的培养方法及完善配套机制的建议。     

The Concept of Type-1 and Type-2 Helper T Cells and Their Cytokines in Humans

In both mice and humans, functionally distinct helper T (Th)-cell subsets, known as Th1 and Th2 cells, are characterized by the patterns of cytokines they produce. These two polarized forms of the specific cellular immune response provide a useful model for explaining not only the different types of protection, but also the pathogenic mechanisms of several immunopathological disorders. The development of polarized Th1 or Th2 responses depends on either environmental factors, including dose of antigen, nature of immunogen and cytokines (IL-12 and interferons or IL-4) at the time of antigen presentation, or other undefined factors in the individual genetic background, mainly at level of the so-called “natural immunity”. Th1-dominated responses are potentially effective in eradicating infectious agents, including those hidden within the host cells. When the Th1 response is poorly effective or exhaustively prolonged, it may result in host damage. In contrast, Th2 responses are apparently insufficient to protect against the majority of infectious agents, but can provide some protection against parasites. Th2 cells are able to make unpleasant the life of parasites in the host and tend to limit potentially harmful Th1-mediated responses. Thus, Th2 cells may be regarded as a part of down-regulatory (or suppressor) mechanism for exaggerated and/or inappropriate Th1 responses. The Th1/Th2 paradigm applied to the study of chronic inflammatory disorders or autoimmune diseases allowed to understand that a number of diseases are mediated by Th1 cells, the two clearest examples being multiple sclerosis and thyroid autoimmunity. In other disorders, Th1/Th2 polarization is less prominent, or rather Th2 responses tend to predominate, such as in systemic lupus erythematosus, progressive systemic sclerosis or allergic diseases. It is of note that in experimental models in animals, a number of diseases can be prevented by switching immune responses from Th1 to Th2 or from Th2 to Th1. Moreover, the Th1/Th2 concept suggests that modulation of the relative contribution of Th1-or Th2-type cytokines makes possible to regulate the balance between protection and immunopathology, as well as the development and/or the severity of some immunologic disorders.     

Evaluation of rK28 antigen for serodiagnosis of visceral Leishmaniasis in India

Antibody detection is a safely applied method at the wide scale in diagnosis of visceral Leishmaniasis (VL). In order to further advance serodiagnosis, the rK28 antigen has been recently introduced as a candidate for diagnosis of VL. We evaluated the sensitivity and specificity of the rK28 antigen in a micro-ELISA format in comparison to the rk39 antigen. The test was conducted on 252 parasitologically confirmed VL cases, 103 endemic healthy controls, 95 non-endemic healthy controls, 88 other infectious disease and 53 follow-up cases. Of 252 parasitologically confirmed VL cases, 251 cases were reported positive by rK28 antigen, yielding 99.6% sensitivity (95% CI, 0.97–0.99), which was similar to the sensitivity of rK39 ELISA (99.6%) (95% CI, 0.97–0.99). Specificity of the rK28 antigen in non-endemic and endemic healthy controls was 100% (95% CI 0.96–1) and 94.17% (95% CI, 0.88–0.97), respectively. In 88 different diseases, specificity was 95.45% (95% CI, 0.84–0.96). With the rK39 antigen, specificity of non-endemic and endemic controls and different diseases was 100% (95% CI 0.96–1), 92.23% (95% CI 0.85–0.96) and 96.59% (95% CI 0.90–0.98), respectively. Our results show that rK39 and rK28 antigens have similar sensitivity and specificity and rK28 can also be used as a serodiagnostic tool in the endemic population of Bihar.     

In Vivo Efficacy of Oral and Intraperitoneal Administration of Extracts of Warburgia Ugandensis (Canellaceae) in Experimental Treatment of Old World Cutaneous Leishmaniasis Caused by Leishmania Major

The antileishmanial activity of extracts of Warburgia ugandensis Spraque (Canellaceae), a known traditional therapy in Kenya was evaluated in vivo. Treatment of infected BALB/c mice with W. ugandensis extracts orally resulted in a reduction of the size of lesions compared to the untreated control. The lesion sizes differed significantly for the four extracts (p=0.039) compared to the untreated control. For mice treated by intraperitoneal injection, the lesion sizes increased initially for the hexane, dichloromethane and ethyl acetate extracts and healed by day 42. The lesion sizes for mice treated with methanol increased steadily from 2.47mm to 3.57mm. The parasitic burden was significantly higher (p<0.001) in mice treated with methanol extracts and PBS compared to those treated with hexane, dichloromethane and ethyl acetate. This study demonstrated the antileishmanial potential of extracts of W. ugandensis.     

Decrease in the Frequency of Circulating CD56+CD161+ NK Cells in Human Visceral Leishmaniasis

Background: Natural Killer (NK) cell plays an important role in the innate immune system and is known to produce IFN-γ at an early stage of infection that is essential to eliminate intracellular infection like Leishmania spp. It is already established that Leishmania parasite inhibits the activity of NK cells, avoiding the encounter with the early innate immune response. This, in turn, favors establishment and further dissemination of the infection. Methods: In the present study, we have tried to measure the frequency of different phenotypic subsets of NK cells among visceral leishmaniasis (VL) patients. Results: We have phenotyped three distinct three distinct subsets (CD56^–CD161⁺, CD56⁺CD161^–, and CD56⁺CD161⁺) of NK (CD3^–) cell using their specific markers CD161 and CD56. Conclusion: Interestingly, we observed selective loss of CD56⁺CD161⁺ subset of circulating NK (CD3^–) cells. Importantly, the other subsets (i.e., CD56^?CD161⁺ and CD56⁺CD161^–) of circulating NK cells remain unaffected as compared with healthy subjects.     

Cytokines and Chemokines in HIV Infection: Implications for Therapy

HIV infection is associated with both a hyperactivity of the immune system and decreased immune responses against specific antigens. A similar pattern is observed when considering cytokine production in HIV-infected patients. Several cytokines are spontaneously produced at an increased level, whereas other cytokines playing an important role during cell-mediated immune responses are produced at a low level following stimulation. This deregulation of cytokine production may participate to the immune deficiency, both by impairing immune responses and by accelerating CD4+ T lymphocyte destruction. Chemokine receptors have recently been shown to function as coreceptors for the virus, and to govern its cellular tropism. Heterogeneous expression of chemokine receptor may contribute to differences in infectability as well as in rate of progression of the disease between individuals. Better understanding of the role of cytokines and chemokines in HIV infection suggests new therapeutic approaches where administration of cytokines or cytokine antagonists may allow the immune system to function in better conditions, to stimulate antiviral and antiinfectious immune defenses, and to limit viral spread.     

In Situ Characterization of the Cutaneous Immune Response in Ethiopian Cutaneous Leishmaniasis

Cryostat sections from 10 patients with localized cutaneous leishmaniasis (LCL) and eight patients with diffuse cutaneous leishmaniasis (DCL) from Ethiopia were studied with immunofluorescence methods for the phenotypic characterization of cells in the lesions. Higher numbers of Leu 2+ and Leu 3+ cells (P less than 0.005) were found in LCL than in DCL, while the Leu 3a + b/Leu 2a ratios were the same. No differences were found in the numbers of transferrin receptor, HLA-DR, and HLA-DQ expressing cells in the granulomas. Significantly (P less than 0.0001) lower numbers of IL-2 receptors expressing (Tac+) cells were found in DCL than LCL lesions, suggesting interference in the activation of the T cells. IL-2-containing cells were absent in DCL and were found in LCL lesions. Epidermal keratinocytes above the LCL but not the DCL lesions expressed HLA-DR (but not HLA-DQ) antigen, suggesting a lower gamma-interferon production in the DCL granulomas. The number of Langerhans' cells (Leu 6+) was higher in the epidermis of DCL (P less than 0.005) than in LCL, while a lower number of Leu 6+ cells were seen in the dermal lesions (P less than 0.001). These observations could account for some of the mechanisms responsible for the disturbed immunostimulation and immunoregulation observed in the lesions of DCL.     

电磁技术用于骨科治疗的研究进展

近年来,电磁场生物效应的研究已被我国列为生物物理学方面的重大课题。电磁技术用于骨科治疗的研究横跨电工技术、生物技术和医学领域。早期的医学研究表明低频电磁场能加速骨折愈。     

创伤后应激障碍患者血清细胞因子水平初探

目的初步探讨创伤后应激障碍(PTSD)患者血清细胞因子IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α含量及其意义。方法采用酶联免疫吸附法(ELISA)对50例PTSD患者血清IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α进行检测,并与对照组进行比较。结果 PTSD组血清IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α水平显著高于正常对照组(P<0.01)。结论 PTSD患者存在广泛的免疫异常。     

The humoral immune response to the kinetoplastid membrane protein-11 in patients with American Leishmaniasis and Chagas disease: prevalence of IgG subclasses and mapping of epitopes

The kinetoplastid membrane protein-11 (KMP-11) is a major target of the humoral immune response during Leishmania-infections. The majority of sera from visceral leishmaniasis, mucocutaneous leishmaniasis and even some cutaneous leishmaniasis patients contain detectable IgG antibodies against KMP-11. We also provide evidence that this protein may act as a potent antigen in T. cruzi infections, since most Chagas sera show immunological cross-reactivity. Therefore, KMP-11 cannot be used as a specific diagnostical tool for the serodiagnosis of leishmaniasis in those regions where both, Leishmania and T. cruzi infections overlap geographically. When analyzing the subclass specificity of the antibody response to KMP-11 we observed the following order of reactivity: IgG1 >>IgG3 >IgG2 >IgG4, which is similiar to that seen in crude parasite extract. The mapping of antigenic determinants by using synthetic 20-mer peptides revealed the existence of predominantly conformational epitopes in leishmaniasis, while 50% of sera from Chagas patients reacted with a particular KMP-11 peptide. These results therefore suggest the presence of disease-specific B-cell epitopes.     

Cytokines in Autoimmune Disorders

Cytokines are important protein mediators of immunity, inflammation, cell proliferation, differentiation, fibrosis, etc. (Oppenheim and Saklatvala, 1993). As these are the major biological processes underlying autoimmunity, it is not surprising that there is now convincing evidence that cytokines have an important role in the pathogenesis of autoimmunity (Brennan and Feldmann, 1996; Feldmann et al., 1996).

There has been much progress since we first highlighted the role of cytokines such as IFNγ in autoimmunity in the early 1980s (Bottazzo et al., 1983). The number of cytokines molecularly cloned has increased greatly, and the biochemical and structural basis of their actions are partly understood, as cytokine genes and that of their receptors have been cloned. Knowledge of cytokine signalling is rapidly expanding (see Chapter XIII). In medical terms, clear evidence of the importance of cytokines in autoimmunity is demonstrated by therapeutic advances. Thus it is possible to dramatically improve patients with rheumatoid arthritis and Crohn's disease by blocking TNFα, and a new target for therapy, TNFα, has thus been validated for both these diseases.     

Peptide-Mediated Targeting of Cytokines to Tumor Vasculature: The NGR-hTNF Example

A growing body of evidence suggests that the efficacy of cytokines in cancer therapy can be increased by targeting strategies based on conjugation with ligands that recognize receptors expressed by tumor cells or elements of the tumor microenvironment, including the tumor vasculature. The targeting approach is generally conceived to permit administration of low, yet pharmacologically active, doses of drugs, thereby avoiding toxic reactions. However, it is becoming clear that, in the case of cytokines, this strategy has another inherent advantage, i.e. the possibility of administering extremely low doses that do not activate systemic counter-regulatory mechanisms, which may limit their potential therapeutic effects. This review is focused on the use of tumor vasculature-homing peptides as vehicles for targeted delivery of cytokines to tumor blood vessel. In particular, we provide an overview of peptide-cytokine conjugates made with peptides containing the NGR, RGD, isoDGR or RGR sequences and describe, in more details, the biological and pharmacological properties of NGR-hTNF, a peptide-tumor necrosis factor-α conjugate that is currently being tested in phase II and III clinical studies. The results of preclinical and clinical studies performed with these products suggest that peptide-mediated vascular-targeting is indeed a viable strategy for delivering bioactive amounts of cytokines to tumor endothelial cells without causing the activation of counter-regulatory mechanisms and toxic reactions.     

Cytokines in the Neuroendocrine System

Cytokines are important partners in the bidirectional network interrelating the immune and the neuroendocrine systems. These substances and their specific receptors, initially thought to be exclusively present in the immune system, have recently been shown to be also expressed in the neuroendocrine system. Cytokines can modulate the responses of all endocrine axes by acting at both the central and the peripheral levels. To explain how systemic cytokines may gain access to the brain, several mechanisms have been proposed, including an active transport through the blood-brain barrier, a passage at the circumventricular organ level, as well as a neuronal pathway through the vagal nerve. The immune-neuroendocrine interactions are involved in numerous physiological and pathophysiological conditions and seem to play an important role to maintain homeostasis.     

Parasitic conjoined twins: external, internal (fetuses in fetu and teratomas), and detached (acardiacs).

During the course of researching the embryologic etiology of conjoined twins, more than 1260 individual cases were collected from the literature and the reported abnormal anatomy tabulated and evaluated in the light of known embryology. It soon became apparent that the association of conjoined twins and their parasites with fetuses in fetu, acardiacs, and teratomas was more frequent than could be attributed to chance. These anomalous fetuses form a continuum, strongly suggesting that they are all variations of abnormal conjoined twinning, with the site of union and the extent of damage (or defect) of one embryo resulting in (1) an externally attached parasitic twin, (2) an enclosed fetus in fetu, (3) an internal teratoma, or (4) an acardiac connected via the placenta. Common patterns among them are a family history of twinning, the predominance of females, and the frequent presence of a twin or triplet accompanying the malformation. The several reports of chromosomal abnormality suggest that perhaps, at least on occasion, it is a genetically imperfect embryo that develops into a defective fetus. Of singular importance is the fact that rarely, if ever, is either a functional heart or a competent brain found in any of these abnormal fetuses, suggesting that the etiology of all of them is a primary cardiac malformation with secondary disruption in the development of the brain.     

Characterization of the Local and Systemic Immune Responses in Patients with Cutaneous Leishmaniasis Due toLeishmania major

In this study skin biopsies and peripheral blood samples were obtained from patients with cutaneous leishmaniasis caused by Leishmania major. Samples were obtained at diagnosis and during healing when the lesions had regressed to half the original size. At diagnosis most of the cells expressed HLA-DR. The numbers of CD8+ cells in the lesions were higher at diagnosis than during healing. By contrast, a lower percentage of PBMC expressed CD8+ cells at diagnosis probably due to sequestration in the lesion. In the lesion, in situ staining for IFN-gamma, IL-10, and IL-4 showed marked variation between all patients in the number of positive cells for a particular cytokine. The proliferative response of PBMC to leishmanial antigens and IFN-gamma production tended to increase during healing. Cytokine patterns in the PBMC in response to Leishmania antigen was more specific than in the lesion and correlated better with the clinical manifestations. Possible reasons for this are discussed.