消除碘缺乏病评估指标相关性的研究

目的研究碘营养充足状态下新生儿脐带血与足跟血TSH水平间及其同母体孕期尿碘的关系。方法选取河南省碘营养良好地区(居民户盐碘>20 mg／kg,8～10岁儿童尿碘中位数≥100 mg/L,8～10岁儿童B超法甲状腺肿大率<5％)作为调查点,收集孕妇妊娠各个不同时期的尿样测定尿碘。采集新生儿脐带血和足跟血,采用酶免疫分析和放射免疫分析方法测定TSH水平。结果采集不同时期孕妇尿样956份,尿碘中位数255．4μg/L,最小值为32．6μg／L,最大值为2 153．0μg／L。采集新生儿脐带血合格样品289人份,TSH均值为2-32 mU／L;采集新生儿足跟血合格样品246人份,TSH均值为1．22 mU／L,脐带血与足跟血TSH相比差异有统计学意义(t=2．645,P<0．01)。在孕期尿碘≥100μg／L的母亲中,其新生儿脐带血TSH>5mU／L所占比例<3％,新生儿足跟血TSH也显示同样结果。结论孕期碘营养良好是保证新生儿脐带血TSH达标的前提条件,在孕期碘营养良好状态下,盐碘、尿碘、甲状腺肿大率和新生儿脐带血TSH各项指标间将会保持良好的相关关系,以新生儿脐带血TSH作为监测指标可以更灵敏的反映人群的碘营养状态。     

上海市浦东新区周浦和康桥地区孕妇碘营养状况及新生儿足跟血促甲状腺激素水平分析

目的 调查上海市浦东新区周浦和康桥地区(简称周康地区)孕妇的碘营养状况,新生儿足跟血促甲状腺激素(TSH)水平及其与母体孕期尿碘水平之间的关系.方法 于2009年4月至2010年11月,选择上海市周康地区孕早、中、晚期妇女各200例,哺乳期妇女193例,生育期非孕妇女(简称育龄期妇女)200例,同期新生儿200例作为观察对象.采集各期妇女随意1次尿样,用砷铈催化法检测尿碘,同时采集新生儿出生后72 h的足跟血,用时间分辨荧光免疫法(TRFIA)测定TSH.结果 600例孕妇的尿碘中位数为161.35 μg/L,其中孕晚期妇女尿碘中位数(126.35 μg/L)明显低于孕早、中期,哺乳期及育龄期妇女(178.80、180.50、167.90、163.40μg/L,P均＜0.05);孕晚期妇女尿碘＜150 μg/L的比例[57.5％(115/200)]明显高于孕早、中期,哺乳期,育龄期妇女[39.0％(78/200)、39.5％(79/200)、16.6％(32/193)、23.0％(46/200),P均＜0.05].孕早、中、晚期妇女尿碘≥300 μg/L的比例[9.0％(18/200)、8.0％(16/200)、5.0％ (10/200)]明显低于哺乳期、育龄期妇女[20.2％(39/193)、20.5％(41/200),P均＜0.05].200例新生儿足跟血TSH水平为(2.92±1.83)mU/L,范围为0.01～9.76 mU/L,TSH＞5 mU/L的比例为11.0％(22/200),超过世界卫生组织(WHO)碘营养适宜标准(＜3％).结论 上海市浦东新区周康地区孕妇总体碘营养水平处在适宜范围,但孕晚期妇女存在轻度碘营养不足,而该区新生儿有碘营养缺乏的可能.应加强对孕妇碘营养的监测,科学补碘.     

2018-2020年惠州市惠阳区孕妇尿碘监测分析

目的 了解2018-2020年广东省惠州市惠阳区孕妇尿碘变化,为科学制定碘缺乏病防控措施提供依据.方法 从全区各乡(镇、街道)中抽取5个乡(镇、街道)作为监测点,每个监测点抽取20名孕妇,3年5个监测点共采集300份孕妇尿液,测定孕妇尿液中碘含量.结果 2018-2020年孕妇尿碘中位数分别为126.5 μg/L,125.3 μg/L和183.1 μg/L,2018年和2019年孕妇碘营养水平处于碘不足状态,2020年孕妇碘营养水平处于碘适宜状态.300份样本中,孕早期61份、尿碘中位数124.0 μg/L;孕中期114份、尿碘中位数176.0 μg/L;孕晚期125份、尿碘中位数136.0 μg/L.结论 惠阳区加强碘缺乏病防治措施的贯彻落实,但孕妇碘营养水平仍存有不足的风险;应继续加大防控力度.     

哈尔滨市新生儿脐带血TSH切点值的建立

目的　尽快建立适合我国实际情况的新生儿脐带血促甲状腺激素（TSH）切点值。方法　在指定地区对孕妇的碘营养状况进行横断面调查,在证实该地区碘营养状况正常后,于分娩前采集孕妇尿样和盐样,分娩时采集其新生儿脐带血血样,TSH测定采用ELISA方法。结果　哈尔滨市孕妇尿碘中位数为284μg/L,新生儿脐带血TSH>5mU/L的比率为34.1％,TSH>10mU/L的比率为8.8％;新生儿脐带血TSH第95％和97％的分位值是13.37mU/L和15.39mU/L。在正常碘营养条件下,新生儿脐带血TSH值仅受出生方式的影响,孕妇的尿碘水平、年龄、职业、文化程度、家庭收入对2种出生方式新生儿脐带血TSH均无影响。结论　通过哈尔滨市新生儿脐带血TSH研究,为建立适合我国实际情况的新生儿脐带血TSH切点值提供了科学依据。     

2011年张掖市重点人群碘营养状况调查分析

目的了解甘肃省张掖市居民碘营养状况,为调整防治策略提供科学依据。方法在选中的项目县按东、西、南、北、中5个方位随机抽取5个乡;每个乡随机抽取1所小学8~10岁儿童尿样20份;每个乡随机抽取孕妇、哺乳期妇女尿样各5份测定尿碘。结果共检测8~10岁儿童尿样399份,尿碘中位数为239.91μg/L,<100μg/L的占4.26%,>200μg/L占65.91%;检测孕妇和哺乳期妇女尿样198份,尿碘中位数246.58μg/L,<150μg/L占14.65%,>300μg/L占37.88%。结论甘肃省张掖市居民碘营养充足,重点人群尿碘过量比例较高,希望通过适当调整盐碘浓度,提高居民碘营养适宜水平。     

2017-2019年泰兴市重点人群碘营养监测分析

目的 了解并掌握江苏省泰兴市重点人群碘营养状况,为确定该人群碘营养摄入量范围提供科学依据.方法 依据《江苏省碘缺乏病监测方案》,共随机抽取泰兴市600名8～10岁儿童和300名孕妇作为监测对象,测定尿碘浓度和家中食盐含碘量.结果 2017-2019年全市共检测碘盐样900份,盐碘中位数24.72 mg/kg,碘盐合格率98.99％,合格碘盐食用率98.11％,碘盐覆盖率99.11％;共检测儿童尿样600份,尿碘中位数223.60μg/L,各年度尿碘中位数分别为216.90μg/L,248.00 μg/L,204.71 μg/L,尿碘中位数均处于充足状态;共检测孕妇尿样300份,尿碘中位数164.86μg/L,各年度尿碘中位数分别为166.35 μg/L,173.50 μg/L,159.96 μg/L,尿碘中位数均处于适宜状态.结论 泰兴市重点人群碘营养水平整体处于适宜水平,各项指标均达到消除碘缺乏病的标准;但也有不同程度的碘缺乏和碘过量现象,仍需加强监测和积极干预.     

乐昌市学龄儿童、孕妇的尿碘和盐碘水平分析

目的统计乐昌市2016年五所小学8~10岁儿童、县城和乡(镇)两区孕妇尿碘及盐碘水平及其分布。方法采用分阶整群抽样方法选定乐昌市的乐城二小、梅花小学、金鸡小学、廊田小学、九峰小学的8~10岁学生共计207人;乐城孕妇、乡镇孕妇共计110人,采集尿样检测尿碘、收集家中食用盐检测碘含量。结果检测学龄儿童207份尿样及食盐(男生118份,女生89份),调查对象尿碘中位数316.1μg/L(男生为311.6μg/L,女生为320.4μg/L),盐碘平均含量为27.4mg/kg;孕妇110份尿样及食盐(县城为57人,乡(镇)为53人),尿碘中位数为262.5μg/L(县城为219.3μg/L,乡镇为281.4μg/L),盐碘平均含量为25.4 mg/kg。结论学龄儿童的尿碘中位数值偏高,为316.1μg/L,大大超过儿童适宜尿碘中位数100~199μg/L,为过量碘摄入;尿碘中位数乡(镇)孕妇为281.4μg/L,大于县城孕妇的219.3μg/L,均为超足量碘摄入。     

沧州市碘盐覆盖率较低地区儿童及孕妇碘营养调查

目的了解沧州市碘盐覆盖率较低地区的儿童和孕妇碘营养水平,为制定科学预防措施提供依据。方法选择碘盐覆盖率较低的4个县和1个碘盐覆盖率较高的县作为调查点,在每个调查点按方位在5个乡(镇)中共抽取8-10岁学生(男、女各半)200人,检测儿童尿碘、甲状腺、家庭食用盐。同时抽取100名孕妇,采集并检测其尿样和家庭食用盐。采集学校所在村的饮用水水样检测水碘。结果共检测水样25份,水碘范围为2.5μg/L-96.6μg/L;对1103名儿童进行了甲状腺检测,甲肿率1.5%;采集儿童家庭食用盐1022份,盐碘中位数0mg/kg,碘盐覆盖率35.6%;采集儿童尿1022份,尿碘中位数158.9μg/L。采集孕妇家庭食用盐503份,盐碘中位数13.7mg/kg,碘盐覆盖率50.3%;采集孕妇尿503份,尿碘中位数125.7μg/L。碘盐覆盖率较低的4个县儿童尿碘中位数、孕妇尿碘中位数明显著低于碘盐覆盖率较高的对照县。碘盐覆盖率与儿童尿碘成正相关关系。结论在碘盐覆盖率较低的地区,水碘在40μg/L-99μg/L范围的儿童碘营养处于适宜水平,孕妇可能会出现碘营养不足;水碘40μg/L地区的儿童、孕妇都有存在碘营养不足的可能。     

湖北省新生儿脐带血TSH水平及其相关因素研究

目的探讨碘营养状况正常情况下的新生儿脐带血TSH水平及其相关因素的影响,为建立适合我国国情的新生儿TSH正常值范围提供依据.方法在湖北省选取普及碘盐且碘营养状况良好的4个市区,采集孕妇尿样及其新生儿脐带血血样,测定孕妇尿碘和新生儿脐带血TSH水平,TSH值测定采用ELISA法.结果共采集新生儿脐带血879份,测定TSH中位数为3.425 mU/L,P97为10.461 mU/L,＞5 mU/L的为27.0%,且TSH水平受新生儿出生方式和出生时间的影响.结论在碘营养状况良好的环境下,新生儿脐带血TSH水平呈不稳定性,充分说明使用TSH＞5mU/L的比率＜3%的标准来评判新生儿脐带血TSH结果需要修改.     

盐碘含量调整后郑州市人群碘营养动态监测结果与分析

目的了解盐碘含量调整后郑州市重点人群的碘营养水平,为科学补碘提供依据。方法 2012年3月至2015年12月,每年采用分层随机抽样方法,采集居民户食用盐样3300份并按照《制盐工业通用试验方法碘的测定》(GB/T13025.7-2012)测定碘含量。在郑州市所辖11个县(市、区)的医院、妇幼保健院、计生部门的门诊收集新婚育龄妇女、孕妇、哺乳期妇女、0-2岁婴幼儿,在学校收集8-10岁儿童的尿样测定尿碘含量,分析不同人群的碘营养情况。结果2012-2015年盐碘中位数分别为28.20、28.20、27.32、27.50mg/kg。2012-2015年新婚育龄妇女尿碘中位数分别为190.00、205.80、196.00、203.40μg/L,孕妇尿碘中位数分别为190.80、207.30、204.18、193.57μg/L,哺乳期妇女尿碘中位数分别为161.06、163.77、167.88、164.37μg/L,0-2岁婴幼儿尿碘中位数分别为188.51、197.37、217.95、215.56μg/L,8-10岁儿童尿碘中位数分别为217.39、207.86、216.06、221.11μg/L。结论盐碘含量调整后,新婚育龄妇女、孕妇、哺乳期妇女和0-2岁婴幼儿碘营养水平处于适宜范围,8-10岁儿童略高于适宜标准。说明本次调整后的食盐碘含量是适宜的,既能满足儿童,又能满足孕妇和哺乳期妇女的碘营养要求。     

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.     

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.     

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.     

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.