不同补碘时期亚克汀病可疑儿童精神运动功能的变化

目的探讨在碘营养变化过程中精神运动功能障碍对亚克汀病诊断的有效性。方法分别于1996、1999年对宁强试验区7～14岁亚克汀病可疑儿童和正常对照组儿童做精神运动功能检查。结果①无论是在试验区补碘不足时期(1996)还是补碘正常时期(1999),亚克汀病可疑儿童的精神运动功能检查的多数项目得分都显著低于正常对照儿童(P<0.01);②用年龄常模标化后,同一组儿童1996和1999年前、后2次的精神运动功能测验标准分数的差值无显著性差异(P>0.05)。结论精神运动功能障碍与母孕期缺碘所造成的脑与神经损伤有关,这种障碍具有不随出生后碘营养水平的变化而发生变化的相对稳定性或持续性,因而在碘营养不断发生变化的时期或地区,它仍可作为诊断亚克汀病患儿的辅助条件和指标。     

辽宁省地方性亚临床克汀病流行程度调查

目的：了解供应同浓度（1：5万）碘盐后重、中、轻碘缺乏病病区出生儿童的亚克汀病流行程度。方法：用中国联合型瑞文测验图岫和农村儿童智商常模（CRT－C2）测验判定7－14岁儿童智商，用津医精神运动成套测验（JPB）、测听仪、拍X线片、标准度衡器具检出智商值（IQ）50－69儿童的精神运动、听力障碍者和骨龄、体格发育落后者。结果：供应碘盐后重、中、轻病区出生儿童的人群轻度智力落后率分别为6．7％、5．0％、3．5％，轻度智力落后儿童的亚损伤率分别为77．8％、77．0％、40．2％。重、中、轻病区儿童人群亚克汀病患病率分别为5．2％、3．9％、1．4％；评价同浓度碘盐预防后重病区儿童亚克汀病流行程度为重，次之为中度病区，轻病区该病流行程度则轻。结论：居民食用的碘盐合格率低，尤其是孕妇碘不足，致使碘缺乏病病区仍有亚克汀病儿出生。     

碘缺乏病病区轻度智力落后儿童精神运动测验结果评价

目的　验证津医精神运动成套测验（ＪＰＢ）检查轻度智力落后儿童精神运动障碍的灵敏度,评估碘缺乏病（ＩＤＤ）病区亚克汀病患病率。方法　对中国联合型瑞文测验智商常模（ＣＲＴ－Ｃ２）判定的４１５ 名７～１４ 岁轻度智力落后儿童进行ＪＰＢ检查,用Ｔ 分数与损伤指数确定其精神运动功能状况。结果　Ｔ 分数确定的ＪＰＢ检出ＩＤＤ 重、中病区ＩＱ ５０～６９ 儿童精神运动功能异常率为５７．８％ ,其中ＩＱ ５０～５９ 人群异常率达７０．９％ ;损伤指数确定的异常率与Ｔ 分结果差异不显著（ Ｐ＞ ０．０５）。结论　ＪＰＢ是发现和定量描述轻度智力落后儿童精神运动功能障碍的有效实用方法,可用于诊断亚克汀病。     

IL1RAPL1基因多态性与秦巴山区儿童精神运动功能的相关性

目的 探讨精神发育迟滞相关基因(IL1RAPL1)对人类精神运动功能的影响,为精神运动功能障碍对亚克汀病诊断的有效性提供证据.方法 采用传统PCR、单链构象多态PCR(PCR-SSCP)、聚丙烯酰胺凝胶电泳等分子生物学方法,对秦巴山区220名7～14岁儿童IL1RAPL1基因的DXS1218、DXS9896、rs6526806,rs12847959共4个遗传标记位点进行多态性检测,并进行精神运动功能测验,对多态性检测结果与儿童精神运动功能测验成绩进行关联分析.结果 DXS1218、DXS9896、rs12847959 3个遗传标记在受检儿童中均有较高杂合度(Het),分别为0.8941、0.8674、0.4872,rs6526806有较低的Het,为0.1804;4个遗传标记多态性均未显示出与儿童精神运动功能的相关性(F值分别为0.909、0.279、0.725、1.982,P均>0.05).结论 IL1RAPL1基因多态性对人的精神运动控制能力无影响,即精神运动功能可能较少受遗传因素影响,是对亚克汀病诊断更为有效的一个辅助指标.     

长治市农村儿童精神运动功能调查分析

目的了解长治市农村儿童精神运动功能状况,分析儿童亚克汀病患病情况.方法用中国联合型瑞文测验修改版(CRT-C2及CRT-RC),判定在校8～10岁儿童智商;用天津医科大学精神运动功能成套试验(JPB)的T分值,确定368名各智商组儿童的精神运动功能.结果碘缺乏病(IDD)病区轻度智力落后组儿童的精神运动功能异常率为58.3%,智力边缘组儿童异常率为25.7%,智力正常和优秀儿童的精神运动功能均正常.结论 JPB证实轻度智力落后儿童的精神运动功能显著低于同龄者,推算出长期供应碘盐IDD病区儿童的亚克汀病患病率为2.9%左右,表明亚克汀病患者仍然是今后地方病防治的重点.     

陕西省秦巴山区4岁以下可疑亚克汀病婴幼儿诊断标准探讨

目的探讨4岁以下亚克汀病婴幼儿的诊断标准：方法在陕西省秦巴山区选择宁强县、柞水县以及安康市北部山区共7个乡作为试验点，采用丹佛发育筛查量表（DDST）检测4岁以下婴幼儿发育异常率，Gesell智力测验方法检查智能发育迟长率以及精神发育迟滞患病率。结果婴幼儿智能发育迟长率低于DDST异常率（Х^2=86．76，P〈0．01），而精神发育迟滞患病率低于智能发育迟长率（Х^2=9．17，P〈0．01）；与缺碘时期相比，补碘后DDST异常婴幼儿以及智能发育迟长婴幼儿的动作能水平均明显提高（P〈0．01或〈0．05），结论对4岁以下亚克汀病婴幼儿的轻度智力低下诊断．需符合发育商水平异常、社会适应能力评定异常两个标准，对其精神运动功能可用动作能发育商作为初步测量指标：建议4岁以下可疑亚克汀病婴幼儿诊断标准可暂定为：出生于缺碘环境，Gesell测验应物能与动作能轻、中度迟长，社会适应能力异常，且临床检查没有其他病因的婴幼儿：     

JPB诊断亚临床克汀病可行性研究

目的：验证津医精神运动功能成套测验（JPB）对亚临床克汀病的诊断。方法：用中国联合型瑞文测验（CTR－RC2）确定轻度弱智（IQ54－69）,再用JPB测其精神运动功能。结果：轻度弱智儿童中JPB异常率高达30．00％,亚克汀患病率约为3．93％。结论：CRT－RC2／CC2和JPB共同为诊断亚克汀病提供了有效的定量方法。     

地方性亚临床克汀病的定义值得商榷

<WS-104-1999,地方性克汀病和亚临床克汀病诊断>将地方性克汀病(地克病)和地方性亚临床克汀病(亚克汀)其用同一定义,即缺碘所致神经-精神综合征.但诊断条件规定则为精神-神经-甲低综合征.这对地克病适用,对亚克汀则需商榷.①Hetzel所称IDD中有一轻病型,是和地克病并列的一个病型,而不是轻型地克病.还有学者认为缺碘的不良作用主要在大脑;亚克汀的发病机理是轻度脑损伤综合征;缺碘并不是按全或无效应只引起地克病,还可引起不同程度的发育缺陷,而致以大脑为主的轻度损害;缺碘大鼠的海马中一氧化氮有关的代谢异常等.均说明亚克汀为大脑轻微缺碘性损伤所致的轻度精神功能受损.②亚克汀定义与我国病情不符,轻度缺碘所致的亚临床征以轻度低智最多见,且和另6项亚临床征并非完全平行出现,故这类轻度低智中必然有28%～46%因无诊断辅助条件不能诊断为亚克汀而被忽略.③检出IDD轻病型所用方法(智力删验和精神运动删验)部是测试大脑精神功能的,也说明亚克汀的病变主要在大脑并引发精神功能轻度异常.建议将亚克汀定义修订为环境缺碘所致的轻度精神功能损伤综合征.亚克汀诊断条件为,出生和成长于病区并经排陈非缺碘病因后的轻度低智为必备条件,JPB检查异常为辅助条件.有必备和辅助条件者诊断为亚克汀;有必备条件无辅助条件者为缺碘性轻度低智;有辅助条件而无必备条件者作略而不计处理.     

农村非IDD病区智力正常儿童精神运动成套测验的检测结？…

目的：掌握非ＩＤＤ病区智力正常儿童精神运动成套测验的正常值，为制定全国儿童精神运动测验量表提供依据。方法：按“九五”国家医学科技攻关项目的设计，在沿海和内陆平原家村非ＩＤＤ病区对ＩＱ８０￣１１９的无甲肿７￣１４岁儿童进行１０项精神运动测验。结果：选择反应时测验的反应时间（ｍｓ）间隔均值是由于小年龄组向大年龄组逐渐递降，相临两个年龄组差异显（Ｐ〈０．０１或Ｐ〈０．０５）；连续作业、划消数字、目标追     

新疆高氟低碘环境与亚临床型克汀病

本文对和田不同类型的碘缺乏病区,采用瑞文联合型中国农村智力常模表,分别随机抽样检查了7～14岁学生130名,并同步检查了听力、四项精神运动及甲状腺功能。高氟低碘病区儿童平均IQ71.09±6.84,平均听阈24.08±13.18dB,骨龄发育落后检出率28.5％,24小时甲状腺吸I~(131)”率59.87±14.63％,TSH 21.09±9.43μU/ml,亚克汀病患病率15.71％;低碘病区平均IQ 77.32±11.54,平均听阈19.91±7.23 dB,骨龄发育落后检出率13.5％,甲状腺吸I~(131)率50.26±19.25％,TSH 11.05±11.49μU/ml,亚克汀病患病率9.36％。补碘对照区平均IQ 95.76±17.52,平均听阈16.08±3.21 dB,骨龄发育落后检出率3.88％,甲状腺吸I~(131)率23.61±11.71％,TSH6.26±2.88μU/mL,亚克汀病患病率为3.20％。上述各项参数和病区之间,均有显著差异。说明在缺碘病区同时并存高氟摄入时,氟可加剧由缺碘而引起的中枢神经损害和体躯发育障碍。在104例精神轻度发育迟泄的儿童中,亚克汀病的检出率69.23％。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.