吐鲁番地区农村碘缺乏病危害及防治措施探讨

吐鲁番地区自然环境严重缺碘，土碘约２０μｇ／ｋｇ，水碘仅３～４μｇ／Ｌ。这里岩盐、湖盐、滩盐等土盐资源丰富，分布广，多数农村居民食用土盐或以食用土盐为主。食用土盐的８～１０岁儿童，平均尿碘为４５．６μｇ／Ｌ，平均吸碘率为６３％，触诊法检查甲状腺肿大率为７１．７％，Ｂ超法检查甲状腺体积平均为１０．２ｍｌ；食用土盐为主，仅部分或少量食用加碘盐的８～１０岁儿童，触诊法检查甲状腺肿大率为３６．６％；试用加碘器土盐水加碘防治碘缺乏病，试验区农村居民正确使用率高达９０％，推广难度不大，试用３个月后，食用土盐的儿童的平均尿碘上升到１９４．７μｇ／Ｌ，甲状腺体积平均缩小了１．６ｍｌ，防治效果良好。建议在继续推广加碘盐的同时，尽快实施土盐水加碘防治ＩＤＤ，加强组织领导，健全推广措施，充分调动各有关单位和人员的积极性，实现消除ＩＤＤ的目标     

吐鲁番地区碘缺乏病防治现状调查

新疆吐鲁番地区为典型干旱荒漠大陆性气候,环境缺碘,水碘仅２￣５μｇ／Ｌ,土盐储量大,分布广。维吾尔族农村居民自古以来就自采自食土盐,开展以加碘盐为主防治碘缺乏病（ＩＤＤ）３０多年,放弃土盐吃加碘盐的公有１７．４％,８￣１０岁儿童尿碘中位数３４．８￣７３．６μｇ／Ｌ,Ｂ超法检测甲状腺肿大率７１．１％￣８８．６％。在增大加碘盐推广力度的同时推广土盐水加碘,将有利于持续消除ＩＤＤ目标的尽快实现。     

全民食盐加碘前后不同地区儿童碘营养状况分析

目的　了解不同地区儿童碘营养状况在全民食盐加碘前后有何变化。方法　对安徽省大别山、巢湖缺碘地区及合肥市学龄儿童在全民食盐加碘前及全民食盐加碘一年后进行碘营养状况调查。结果　全民食盐加碘前已进行了长期碘盐防治碘缺乏病工作的大别山区儿童尿碘中位数由２６９．１μｇ／ Ｌ 升至全民食盐加碘后的３９２０μｇ／ Ｌ，甲肿率由２４％ 下降至１４４％ 。巢湖组儿童尿碘中位数由全民食盐加碘前１９２μｇ／ Ｌ 升至全民食盐加碘后的３８４０μｇ／ Ｌ，甲肿率由５４１％ 降至２０６％ 。合肥市儿童尿碘中位数由全民食盐加碘前７９２μｇ／ Ｌ 升至全民食盐加碘后的２６８８μｇ／ Ｌ，甲肿率由４０％ 升至７５％ 。全民食盐加碘一年后３个地区儿童尿碘超过１００μｇ／ Ｌ 者均占９５％ 以上。结论　全民食盐加碘后不同碘营养地区儿童均在一个碘充足的状态，补碘效果明显。     

碘茶防治碘缺乏病后学生尿碘变化分析

吐鲁番市艾丁湖乡岩木石村为碘缺乏病重病区，采用加碘茶为居民补碘。经过一年的加碘茶防治，小学生甲状腺肿大率由９３．９％下降到５７．９％，患病率由６５．３％下降到１５．８％。尿碘几何均值由２１．９４μｇ／Ｌ逐渐上升到１３２．５９θｇ／Ｌ。尿碘的频数分布分析显示防治前以〈２５μｇ／Ｌ为主，占６８．０８％，防治过程中，最高频数分布段逐渐左移。防治一年时，７９．６６％的尿碘含量超过１００μｇ／Ｌ，尿碘变化与     

青海省牧业区碘缺乏病监测结果分析

对青海省牧业区的１１个监测点的４４０名８－１０岁儿童ＩＤＤ病必监测结果进行分析。结果显示，该地区甲状腺触诊法和Ｂ超法的肿大率分别为９．８％和２０．６％，尿碘中位数１１５．３８μｇ／Ｌ、而小于２０μｇ／Ｌ的占１１．００％，大于１００μｇ／Ｌ的仅占５５．３，盐碘中位数为２７．７ｍｇ／ｋｇ，合格率为６６．７０％。此结果说明，牧业区因其特有的自然环境和丰富的盐业资源，造成原盐大量流入市场，碘盐普及较为困难     

延安市285名小学生尿碘检测结果分析

人体的碘营养状况和尿碘含量高度相关，群体的尿碘水平完全可以反映该地区人群的碘营养水平。本文对延安市８～１０岁２８５名小学生尿碘进行了检测，旨在描述我市的人群碘营养状况，为我市碘缺乏病（ＩＤＤ）防治工作措施的制订提供依据。 结果表明，尿碘在 １００－４００μｇ／Ｌ之间的比重较大，５００μｇ／Ｌ以上者只占１０．２％。按ＩＤＤ防治要求，＞１００μｇ／Ｌ者为正常值，仅占总体的８６．７％，也就是说，还有１３．３％没有达到ＩＤＤ防治标准，说明我市儿童碘营养状况不容乐观。 从不同县区尿碘统计结果看，各县区儿童尿…     

碘控释器用于食用盐水加碘的实验报告

有关食用盐水加碘防治ＩＤＤ的效果，初步展现了良好的应用前景。本文报告碘控释器用于盐水加碘的实验研究。碘控释器由漂浮器、碘源室和滤板组成，在盐水中处于悬浮状态，以防止被泥沙埋没而影响其释碘速度。连续检测了１７个月，日均释碘量２．４８２ｍｇ（ｓ＝０．６２７，Ｆ＝１．４１４，Ｐ＞０．０５），符合长效、稳定的要求，改变滤板型号即可满足不同的补碘量。通过透明的碘源室观察碘源的消耗状况，便于群众自检并及时更换     

上海市区学龄儿童尿碘水平调查

应用温和酸消化法对上海市区１４２７名五年级学生进行了尿碘测定。结果显示，尿碘中位数为７１．２７μｇ／Ｌ尿碘值〉１００μｇ／Ｌ者所占比例为３１．８９％。男女学生的尿碘中位数分别为７８．４１μｇ／Ｌ和６３．８７Ｌ，有非常的差异。１０个市区学龄儿童尿碘中位数范围为６０．８９－１０．１５μｇ／Ｌ；按ＷＨＯ／ＵＮＩＣＥＦ／ＩＣＣＩＤＤ的判别标准评估本市有９／１０的区为轻度缺碘地区。此外，午后收集尿样的碘浓度     

常州市已实现消除碘缺乏病阶段目标

江苏省常州市实施以食盐加碘为主的控制碘缺乏病防治措施多年,目前已实现了消除碘缺乏病的阶段性目标。居民食用合格碘盐比例达９９．４％,尿碘中位数３７３．９μｇ／Ｌ,悄样碘含量大于１００μｇ／Ｌ的比例占９５．６％,大于５０μｇ／Ｌ的比例占９９％,８－１０岁学龄儿童甲状腺肿大率,触诊为５．９％,Ｂ超法为３．５％。根据本地区的实际情况,食盐加碘量应当依据社区居民盐的食用量或其它来源碘量的变化面加以调整。     

Tg与TSH检测在碘缺乏病监测中的比较研究

通过对新生儿及孕妇Ｔｇ和ＴＳＨ的分析比较，以初步了解它们在碘缺乏疾病（ＩＤＤ）监测中的价值。结果表明：１．新生儿及孕妇Ｔｇ值均＜２０ｎｇ／ｍｌ，无向高值偏移现象，而２９．５％的新生儿和４．３％的孕妇其ＴＳＨ值向＞５ｍＩＵ／Ｌ的高值偏移；２．孕妇尿碘中位数为１２９μｇ／Ｌ，２３％的孕妇其尿碘值＜１００μｇ／Ｌ、作者认为采用新生儿脐血ＴＳＨ测定监测ＩＤＤ似较Ｔｇ更敏感。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。