2002年商洛市碘缺乏病监测结果分析

目的 了解在现行碘盐含量标准条件下碘缺乏病病情势态及重点人群碘营养状态。方法 采用一次性点状调查方式，监测人群为儿童与妇女。结果 8～10岁儿童甲肿率为6．0％；尿碘中位数儿童为287．2μg／L，育龄妇女为278．2μg／L，哺乳妇女为251．3μg／L，孕妇为268．3μg／L；盐碘均数30．5mg／kg，合格率84．25％；饮用水碘中位数3．1μg／L；7～14岁学生智商总体评价为中下水平；健康教育问卷学生组平均61分，家庭主妇组平均68分。结论 商洛市碘缺乏病病情呈稳定下降势态；现行盐碘浓度适合商洛市现状，重点人群碘营养状况良好。     

2002年广东省孕妇碘营养状况调查分析

目的 为了解和评价广东部分地区现行加碘盐浓度是否满足轻、中、重3种不同缺碘程度地区孕妇的碘营养需求。方法 采用一次性点状调查方式，选择了3个基本代表广东轻、中、重缺碘地区的深圳、佛冈、乐昌的城市和农村各2个调查点，调查孕妇的尿碘、盐碘。结果 深圳市、佛冈县和乐昌市孕妇的尿碘中位数分别为223．4、125．6、180．9μg/L，尿碘大于300μg／L的比例分别占37．5％、14．2％和21．0％；尿碘小于100μg／L的比例分别占10．4％、35．9％和23．1％。盐碘中位数分别为32．8、28．6、34．9mg／kg。结论 当前的盐碘浓度完全可满足不同缺碘程度地区孕妇的碘营养需求，但对于部分沿海轻度缺碘地区，孕妇碘营养水平有偏高趋势；而在碘盐问题地区，孕妇的碘营养水平呈偏低趋势。为保护孕妇的身体健康，建议将孕妇纳入到碘营养监测和保健计划中来。     

2005年河南省宝丰县重点人群碘营养调查

目的了解达标后河南省宝丰县重点人群的碘营养状况。方法尿碘测定采用酸消化砷-铈接触法；盐碘测定采用直接滴定法。结果孕妇尿碘中位数为187．7μg／L，低于50μg／L的比率为1．2％，低于100μg／L的比率为13．1％，不同孕期尿碘水平有显著差异；哺乳期妇女尿碘中位数为147．8μg／L，低于50μg／L的比率为1．8％，低于100μg／L的比率为15．9％；婴幼儿尿碘中位数为178．3μg／L，低于50μg／L的比率为0．9％，低于100μg／L的比率为8．0％；共调查家庭食用盐1036份，碘盐覆盖率为100．0％，中位数为28．8mg／kg。结论宝丰县重点人群的碘营养是适宜的，能够满足其生理需要。     

河北省高碘地区8～10岁儿童碘营养状况调查

目的调查河北，肯高碘地区8～10岁儿童碘营养状况.方法采用人口比例概率方法抽样，盐碘测定采用直接滴定法，水碘测定采用砷铈接触法，尿碘测定采用过硫酸铵消化-砷铈催化分光光度方法结果检测居民饮用水样85份．水碘中位数为166．0μg／L；测定居民户盐样301份，盐碘中位数为28．8mg／kg，碘盐覆盖率为70．43％；检测8～10岁儿童一次即时尿样363份，尿碘中位数为418．8μg／L，尿碘〉300μg／L为248份，占总数的68．0％：水碘〉150μg／L调查点的儿童尿碘中位数与水碘中位数相关（r=0．539，P〈0．05），而与盐碘中位数不相关，结论河北省高碘地区8～10岁儿童碘营养过剩，碘盐加重了这种状况，应停止供应碘盐。     

2000～2004年新疆库尔勒市妇尿碘水平观察

目的掌握新疆库尔勒市孕妇群体碘营养状况。方法2000～2004年期间采集库尔勒市各医院实施围产期保健的孕妇尿样，采用国家规定的检测方法测定尿碘。结果孕妇尿碘中位数分别为287．0μg／L，253．9μg／L，234．81μg／L，217．Oμg／L，189．8μg／L，呈逐年回落趋势；结合2000—2004年期间生产企业的碘盐监测结果，其碘盐合格率均在100％以上，2000年碘盐浓度调整前均数为49．1mg／kg，2001—2004年调整后分别为36．5mg／kg，39．0mg／kg，29．1mg／kg，28．3mg／kg，比调整前分别下降了25．7％，20．6％，40．7％，42．4％。结论库尔勒市孕妇群体尿碘水平在国家调整碘盐浓度后仍维持在国家推荐的最佳尿碘值范围内，其整体碘营养状况良好。     

河南省孕妇碘营养水平调查

目的　了解河南省孕妇碘营养状况,评价碘盐防治效果。方法　选择孕妇测定其尿碘含量,同时采用 Ｌ Ｑ Ａ Ｓ法抽取加碘厂、盐库、售盐点和居民家的碘盐进行全定量检测。结果　孕妇尿碘中位数为２９１．０μｇ／ Ｌ,售盐点和居民家碘盐合格率接近或达到了９０％ 以上。结论　孕妇单纯食用合格碘盐可以满足机体对碘的需要量。     

河南省际妇碘营养水平调查

目的 了解河南省孕妇碘营养状况,评价碘盐防治效果。方法 选择孕妇测定其尿碘含量,同时采用ＬＱＡＳ法抽取加碘厂,盐库,售盐点和居民家的碘盐进行全定量检测。结果 孕妇尿碘中位数为２９１．０μｇ／Ｌ,售盐点和居民家碘盐合格率接近或达到了９０％以上。结论孕妇单纯食用合格碘盐可以满足机体对碘的需要量。     

青海省第5次碘缺乏病监测结果分析

目的了解和掌握青海省碘缺乏病防治工作现状，发现存在的问题，为今后制定防治措施提供科学依据。方法采用人口比例概率抽样法（PPS）抽取30个调查点，尿碘采用酸消化砷铈接触法测定、盐碘采用GB／T13025．7-1999直接滴定法，判定标准依据GB5461-2000（食用盐）执行。结果8～10岁儿童甲状腺肿大率触诊迭为5．8％，B超法为2．0％；儿童尿碘中位数为160．2μg／L；碘盐覆盖率为85．5％，碘盐合格率为89．8％，合格碘盐食用率为76．8％；5年级学生健康教育问卷调查，平均为29．6分，及格（1〉60分）率为10．8％。结论青海省人群总体碘营养状况不断得到改善；由于局部地区非碘盐冲击仍然比较严重，局部地区的人群尿碘水平还很低；健康教育宣传环节非常薄弱，应加强宣传力度。     

高碘地区儿童碘营养甲状腺肿影响因素的研究

目的探讨河北省高碘地区儿童碘营养和甲状腺肿的影响因素。方法采用人口比例概率抽样方法（PPS）。结果有碘盐供应的高碘地区8～10岁儿童尿碘中位数为490．0μg／L，明显高于无碘盐供应点的360．9μg／L。儿童的尿碘中位数与水碘中位数相关（Spearman R=0．539，P=0．038〈0．05），而与盐碘中位数不相关。有碘盐供应高碘地区儿童的甲状腺肿大率为12．1％，高于无碘盐供应地区的8．6％。结论高碘地区水碘是影响儿童碘营养状况的主要因素，碘盐加重了高碘地区儿童的碘营养过剩和对儿童甲状腺的危害。     

孕妇、0～2岁婴幼儿及其母亲尿碘调查分析

目的 了解广州市孕妇、0-2岁婴幼儿及其母亲碘营养现状和规律。方法 在所辖12个区、县抽样调查孕妇、0-2岁婴幼儿及其母亲、非妊娠育龄妇女尿碘。结果 非妊娠育龄妇女、孕妇、0-2岁婴幼儿母亲的尿碘中位数分别为250．3μg／L、212．8μg／L和198．3μg／L;尿碘＜100μg／L分别占9．9％、14．9％和16．2％；尿碘≥800μg／L分别占5．8％、3．2％和1．6％。统计检验上述三人群尿碘均值相互间差异有显性。0-2岁婴幼儿的尿碘中位数为260．8μg／L，高于800μg／L占10．1％；其中0-1岁(含1周岁)尿碘中位数为266．2μg／L，其低于50μg／L占1．8％;1-2岁的尿碘中位数为242．8μg／L，其低于100μg／L占13．3％。在0-1岁婴幼儿中，母乳喂养子女尿碘高于非母乳，差异有显性；不管何种喂养方式，母子尿碘相关。孕期尿碘变化呈孕中期略低。结论 广州市孕妇、0-2岁婴幼儿及其母亲碘营养是充足的，但孕妇、母亲尿碘低于非妊娠育龄妇女，其低尿碘比例也高于非妊娠育龄妇女，提示要加强孕妇、母亲的碘营养。特别要关注孕中期碘营养，防止出生前缺碘损伤。     

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.     

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.     

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.     

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。     

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。     

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     

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。