镇江市先天性甲状腺机能低下症筛查

用滤纸片脐带全血斑测ＴＳＨ作新生儿筛查。ＴＳＨ〈２０ｍＵ／Ｌ者进行复查，以血清ＴＳＨ和Ｔ４确诊。１９９３年７月－１９９６年６月筛查１４４１６例，复查１１４例，复查率０．８％。确诊先天性甲状腺机能低下症患儿３例，检出率为１／４８００。血清ＴＳＨ３例均〉８１ｍＵ／Ｌ。血清Ｔ４分别为３１．４、６８．５和１１．７ｎｍｏｌ／Ｌ。ＦＴ４分别为０．８、６．５和４．６ｐｍｏｌ／Ｌ。新生儿甲状腺低下指数分别为８、３     

镇江市先天甲状腺机能低下症筛查

用滤纸片脐带全血斑测ＴＳＨ作新生儿筛查。ＴＳＨ＜２０ｍＵ／Ｌ者进行复查，以血清ＴＳＨ和Ｔ４确诊。１９９３年７月～１９９６年６月筛直１４４１６例，复查１１４例，复查率０．８％。确诊先天性甲状腺机能低下症患儿３例，检出率为１／４８００。血清ＴＳＨ３例均＞８１ｍＵ／Ｌ。血清Ｔ４分别为３１．４、６８．５和１１．７ｎｍｏｌ／Ｌ。ＦＴ４分别为０．８、６．５和４．６ｐｍｏｌ／Ｌ。新生儿甲状腺低下指数分别为８、３和８分。ＤＤＳＴ２例迟长，１例可疑。Ｘ线骨龄落后１～２个月。     

克拉玛依市特殊人群碘缺乏病监测结果分析

采用放射免疫法对克拉玛依市区５１０例新生儿脐带血ＴＳＨ和１２２例２～４岁儿童的ＴＳＨ及１２７例８～１０岁儿童尿碘进行测定,市区新生儿ＴＳＨ值〉５μＩＵ／ｍｌ 占２２．９％;２～４岁儿童ＴＳＨ值大〉５μＩＵ／ｍｌ占１．７％,８～１０岁儿童尿碘〉１００μｇ／Ｌ占９８．４％,〈１００μｇ／Ｌ 占１．６％。甲状腺肿大率为１６．６７％（触诊法）。调查结果表明克拉玛依市还存在着碘缺乏。     

江苏省新生儿脐带血TSH抽样调查结果分析

目的 了解江苏省新生儿碘营养状况。方法 于１９９７年３～５月在全省范围按ＰＰＳ法抽取３０个点,检测新生儿脐带全血促有朱激素（ＴＳＨ）水平。结果 检测新生儿脐带血８６２份,ＴＳＨ中位数为３．５３５ｍＵ／Ｌ,〉５ｍＵ／Ｌ的脐血样品数占总样品数的３１．７％,与１９９５年（４１．４％）相比有所下降（Ｐ〈０．０５）,但仍远高于“新生儿ＴＳＨ〉５ｍＵ／Ｌ的比例〈３％”的碘缺乏病消除标准。同时发现新生儿ＴＳＨ水     

湖北省新生儿脐带血TSH水平评价

目的了解湖北省特需人群（育龄及孕产妇女）的碘营养水平。方法采用免疫放射（ＩＲＭＡ）法。共测定湖北省４７个市（县）正常产新生儿脐带血５３３５例。结果湖北省新生儿ＴＳＨ＞５ｍＵ／Ｌ者占４９．７％。其中１９９８年新生儿ＴＳＨ值＞５ｍＵ／Ｌ者占４４．８％,比１９９７年的５４．９％明显下降（Ｐ＜０．０１）。结论特需人群（育龄及孕产妇女）的碘营养状有所改善,但距碘缺乏病消除标准仍有一定差距     

孕妇碘负荷对新生儿甲状腺功能及行为神经发育的影响

目的　探讨孕妇高碘负荷 对新生儿甲状腺功能及行为神经发育的影响。方法　生活在地方性高碘地区的孕妇２９１名,收集临产前尿样及出生后１５分钟内的脐带血样,并采集不同乡地下水样５份。酸式消化砷铈接触法测定微量碘, Ｅ Ｌ Ｉ Ｓ Ａ 测定脐血 Ｔ Ｓ Ｈ 和 Ｆ Ｔ４,新生儿２０项行为神经测定方法检查行为神经发育。结果　水碘浓度为４９５１±３３．７μｇ／ Ｌ;孕妇尿碘浓度中位数为８５３２μｇ／ Ｌ;脐血 Ｔ Ｓ Ｈ 中位数５００ｍ Ｕ／ Ｌ,其中, Ｔ Ｓ Ｈ＞ ５．００ｍ Ｕ／ Ｌ 的占５０８％ , Ｔ Ｓ Ｈ≥１０．００ｍ Ｕ／ Ｌ的占１３９％ ; Ｆ Ｔ４为１．４４±０．５１μｇ／ｄ Ｌ,其中 Ｆ Ｔ４＜ ０．８０μｇ／ｄ Ｌ 的为２７％ ;新生儿行为神经发育测定得分为３９０±１１。相关分析显示,孕妇尿碘水平与脐血 Ｔ Ｓ Ｈ 和 Ｆ Ｔ４水平无显著相关关系。新生儿行为神经发育正常。结论　孕妇高碘负荷对新生儿甲状腺功能及行为神经发育未见产生明显影响。     

缺碘地区母婴分娩状态性别体重对新生儿TSH水平的影响

为探讨缺碘地区母婴不同分娩状态及各种生理因素对新生儿促甲状腺激素（ＴＳＨ）水平分布的影响，应用免疫放射分析（ＩＲＭＡ）测定了１５７９名新生儿脐带血ＴＳＨ水平。结果发现，ＴＳＨ值＞５ｍＵ／Ｌ者所占百分数，城镇新生儿的为１９．７％，农村的为２５．９％（Ｐ＜０．０５），女婴的为２８．１％，男婴的为２１．４％（Ｐ＜０．０１），难产的为３１．８％，足月顺产的为２３．３％（Ｐ＜０．０５）；ＴＳＨ值≥２０ｍＵ／Ｌ者所占百分数，早产的为５．３％，足月顺产的为０．４％（Ｐ＜０．０１），重度缺氧的为１２．５％，正常的为０．４％（Ｐ＜０．０１）。提示不同地区、新生儿性别、母亲分娩状态及新生儿缺氧程度对新生儿ＴＳＨ水平分布有一定影响。因此应用新生儿ＴＳＨ评价人群中碘缺乏病流行状况时应当考虑这些因素     

以新生儿TSH水平评价人群碘营养状况

在不同年龄人群中,胎儿对碘缺乏最为敏感,在轻度缺碘尚未影响到甲状腺功能时,ＴＳＨ即可轻度升高。在非缺碘地区,９７％以上的新生儿ＴＳＨ值＜５ｍＵ／Ｌ,随着一个地区缺碘程度的加重,新生儿ＴＳＨ的分布向高值方向偏移。因而测定新生儿脐带血ＴＳＨ水平,按每５ｍＵ／Ｌ为组距分组,计算各组的频数分布,即可可靠地反映该地区碘缺乏的程度［１］。我们测定了天津市３００例新生儿的ＴＳＨ水平,并对其中１５４例同时进行了甲状腺素（Ｔ４）测定,结合天津市区居民饮水中碘含量及儿童尿碘和甲状腺肿大率等指标,对我市总体碘营养状况…     

边缘性碘缺乏地区孕妇及新生儿垂体─甲状腺轴功能研究

边缘性碘缺乏地区孕妇及新生儿垂体─甲状腺轴功能研究贵阳医学院附属医院内分泌科时立新，马启玲，张家秀等在中国边缘性碘缺乏地区─上海市探讨孕妇及新生儿垂体─甲状腺轴功能。结果表明：（１）新生儿促甲状腺激素（ＴＳＨ）水平＞５ｍＩＵ／Ｌ者占６１．０％，＞１０...     

新生儿出生方式对脐带血TSH的影响分析

目的　为进一步认识新生儿出生方式是脐带血 Ｔ Ｓ Ｈ 向高值偏移的重要影响因素。方法　调查沿海城市出生的新生儿 １ ０１４ 例，其中阴道产 ７６３ 例，剖宫产 ２５１ 例，采脐带血，使用免放分析（ Ｉ Ｒ Ｍ Ａ）检测 Ｔ Ｓ Ｈ。同期检测孕妇尿碘。结果　在孕妇尿碘中位数 ２１６．６４μｇ／ Ｌ 状况下，脐带血 Ｔ Ｓ Ｈ＞ ５ｍ Ｕ／ Ｌ 的频率，阴道产与剖宫产组分别为 ５６７％ 与 ２０３％ ，差异非常显著（χ２＝ １００．３８）。结论　首次揭示在孕妇碘营养明显改善后，新生儿在娩出过程中 Ｔ Ｓ Ｈ 的升高是一种普遍现象，以阴道娩出者最明显，是导致脐带血 Ｔ Ｓ Ｈ 向高值偏移的重要因素之一，并建议用剖宫产脐带血 Ｔ Ｓ Ｈ 值或足跟血 Ｔ Ｓ Ｈ 值校正阴道产脐带血 Ｔ Ｓ Ｈ 值。     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.