云南省龙陵县消除碘缺乏病阶段目标评估分析

目的了解和掌握碘缺乏病（IDD）在云南省龙陵县的防治状况及影响因素,为进一步防治碘缺乏病策略的制订提供科学依据。方法按《全国碘缺乏病防治监测方案》和国家《实现消除IDD阶段目标评估方案》要求,对龙陵县8-10岁儿童的甲状腺肿大率、尿碘中位数、碘盐合格率、碘盐覆盖率、五年级学生和农村家庭主妇碘缺乏病知识知晓率等进行监测评估。结果8-10岁甲状腺肿大率由2006年的3.75%下降到2008年的2.50%,平均尿碘中位数在297.8μg/L,并连续维持在较理想的水平,尿碘含量小于50μg/L以下者占3.3%,碘盐合格率、覆盖率分别达到97.63%,99.6%,五年级学生组和农村家庭主妇组碘缺乏病防治知识知晓率分别为90.1%和91.6%。结论龙陵县已达到了国家消除碘缺乏病标准。     

1983-2002年宁武县碘缺乏病防治效果分析

目的分析宁武县1983-2002年食盐加碘防治碘缺乏病(IDD)的效果,掌握IDD流行状况.方法将有关宁武县1983-2002年间IDD防治和碘盐监测资料分类汇总进行分析.结果儿童甲状腺肿大率由1983年16.2%,下降到2002年6.6%;儿童尿碘中位数1983年后均＞100μg/L,而且＜100μg/L的样本比例由1983年的44%下降到2002年的8.3%;居民食用碘盐覆盖率1983年为63.6%,合格碘盐食用率为58.5%,到2002年覆盖率上升为98.3%,合格率也上升为93.2%.非碘盐率也由1983年的36.4%,下降到2002年的1.7%.结论 20多年的食盐加碘防治IDD取得了显著的防治效果.通过食盐加碘,宁武县儿童甲状腺肿大率、尿碘水平和居民户碘盐合格率等3项指标达到了国家消除IDD阶段目标的标准指标.     

忻州市儿童碘营养现状及干预措施调查分析

目的分析2002年山西省忻州市碘缺乏病防治现状,为当地政府制定可持续性消除碘缺乏病防治措施提供科学依据.方法在全市190个乡(镇、办事处)中,按原碘缺乏病病区分布和人口比例采用概率抽样方法(PPS法)进行抽样,对当地居民用户盐碘含量,8～10岁儿童甲状腺肿大率,儿童尿碘水平,居民饮水含碘水平,5年级学生和家庭主妇防治碘缺乏病知识掌握情况进行现状调查.结果 1 200份居民户盐碘盐合格率为90.25%,含碘量均值为30.6mg/kg,中位数为31.3mg/kg;5 602名儿童甲状腺肿大率为7.33%;375名儿童尿碘中位数为292.28μg/L,均值为288.28μg/L;64户居民饮用水碘含量范围值为1.90～77.61μg/L;5年级学生和家庭主妇防治碘缺乏病知识知晓率分别为87.75%,86.8%.结论 2002年度监测结果表明忻州市儿童尿碘水平、居民食用盐的含碘合格率达到国家消除标准,儿童甲状腺肿大率未达到国家碘缺乏病消除标准,对此应予以重视,并进一步探讨其原因.     

1995～2011年广东省碘缺乏病防治效果分析

目的通过对广东省碘缺乏病防治效果的分析,为制定"因地制宜、分类指导、科学补碘"防治措施提供依据。方法按卫生部统一要求,分别于1995、1997、1999、2002、2005和2011年开展了6次碘缺乏病抽样监测,监测点采用"人口比例概率抽样方法"抽取,监测内容包括盐碘、尿碘、儿童甲状腺肿大率、儿童智商和人均摄盐量等。结果广东省的居民合格碘盐食用率从56.4%提高到96.1%,儿童尿碘水平从91.6μg/L提高到186.5μg/L,儿童甲状腺肿大率从11.1%降至3.5%,儿童智商水平比2002年提高了3.7%,但孕妇和哺乳期妇女尿碘中位数为147.8μg/L,低于世界卫生组织推荐碘供给量。结论广东省碘缺乏病防治措施落实较好,已取得明显的防治效果;但需特别关注孕妇和哺乳妇女碘营养并采取综合措施提高其碘营养水平。     

金昌市1996～2003年碘缺乏病防治效果分析

目的为及时了解和掌握我市碘缺乏病(IDD)病情和防治措施落实情况,评价防治效果及人群碘营养状况,实现消除IDD目标,确保防治措施得到长期有效落实,为完善可持续消除IDD工作机制提供科学依据。方法采用“全国IDD防治监测方案”和国家“实现消除IDD阶段目标评估方案”对金昌地区8~10岁儿童尿碘值、甲状腺肿大率等进行调查、监测。结果经各级政府多年采取干预措施,金昌地区8~10岁儿童甲状腺肿大率由1996年的13.58%下降到2003年的4.92%,尿碘中位数达到186.84μg/L,其中<20μg/L,仅占1.43%,城市儿童的尿碘中位数明显高于农村(P<0.01),有高度显著性差异;金川区儿童的尿碘中位数高于永昌县(P<0.01),有高度显著性差异。结论政府干预是消除IDD可靠的保证。     

贵州省未达到消除碘缺乏病目标地区的流行现状调查

目的了解贵州省碘缺乏病(IDD)防治现状。方法按国家IDD监测方案,抽取贵州省5个地区11个县对学校儿童甲状腺肿大率、尿碘及碘盐等进行横断面调查。结果8～10岁学生平均甲状腺肿大率9.66%,最低2.8%,最高15.78%,年龄组间差异有显著意义,居民户盐碘中位数32mg/kg,碘盐覆盖率99.47%,合格率92.11%,儿童尿碘中位数263.9μg/L,其中<100μg/L占6.1%,<300μg/L占52.5%,≥300μg/L占41.31%。结论贵州省碘盐覆盖率、合格率较往年明显上升,儿童尿碘水平趋于更为合理,但8～10岁学生甲状腺肿大率仍处于较高水平。     

2018年甘南藏族自治州碘缺乏病监测分析

目的了解2018年甘南藏族自治州(简称甘南州)碘缺乏病病情和防治措施落实情况、评价防治效果,为进一步完善消除碘缺乏病防治策略提供依据。方法按照《甘肃省碘缺乏病监测方案》要求,在甘南州八县(市)采集学生和孕妇家庭盐样检测盐碘含量,采用整群抽样法在8个县(市)以B超检查8～10岁学生甲状腺容积,计算甲状腺肿大率;采集8～10岁学生和孕妇尿样检测尿碘;在8个县(市)采集生活饮用水水样检测水碘。结果学生家庭碘盐中位数为25.10 mg/kg,碘盐覆盖率为99.81%,合格碘盐食用率为92.38%;孕妇家庭碘盐中位数为24.53 mg/kg,碘盐覆盖率为100.00%,合格碘盐食用率为90.63%;8～10岁儿童甲状腺肿大率为0.31%,8～10岁儿童和孕妇尿碘中位数分别为145.37μg/L和175.64μg/L;水碘中位数1.10μg/L,水碘范围0.20～15.90μg/L。结论学生和孕妇的碘营养水平处于适宜状态,全州合格碘盐食用率降至碘缺乏病消除标准的临界值;政府应加强盐业监管,以消除碘缺乏病防治风险。     

1995-2004年浙江省碘缺乏病监测10年结果分析

目的了解和掌握浙江省自1995年底实行全民食盐加碘10年来碘缺乏病病情和碘盐干预措施落实状况。方法按照《全国碘缺乏病监测方案》的要求,采用8～10岁儿童甲状腺肿大率、居民用户碘盐合格率和人群尿碘水平等指标对浙江省10年监测结果进行综合评价。结果 8-10岁儿童甲状腺肿大率由1995年的 13．92％下降至2004年的3．08％;碘盐合格率由1995年的25．00％上升至2000年的96.27％,再下降至2004年的89．67％;尿碘中位数由1995年的127．64μg／L上升至2004年的290．73μg／L。结论浙江省碘缺乏病防治工作通过采取以食盐加碘为主导的综合性防治措施正逐步取得显著效果,但非碘盐冲击市场的现象依然存在。     

全民食盐加碘对甲状腺肿大率影响的动态分析

目的对1995～2002年5次IDD监测结果进行报告,以评价食盐加碘对甲状腺肿大率的影响.方法在全省13个市按PPS法抽取30个学校,每个学校随机抽取8～10岁学生40名共1200名,进行甲状腺肿大率、尿碘、盐碘测定,结果甲肿率由23.5%降至1.6%,尿碘水平由85.0μg/L上升到262.2μg/L,盐碘合格率由48.1%升高至96.1%.结论全民食盐加碘促进了甲状腺肿大率的下降,碘盐浓度的调整使加碘量过高可能带来的负面效应正在被改善.     

2018—2022年湖北省荆州市碘缺乏病监测及碘营养水平评价

目的 监测荆州市8～10岁儿童及孕妇食用盐碘含量和碘营养水平,为持续消除碘缺乏病和科学补碘提供依据。方法 2018—2022年每年在荆州市8个县(市、区)抽取200名儿童和100名孕妇,采集其家中食用盐盐样和调查对象尿液样本,检测盐碘含量和尿碘含量。对儿童进行甲状腺B超检查,测定其甲状腺容积。结果 2018—2022年荆州市共监测儿童和孕妇食用盐样12 000份,盐碘中位数为24.51 mg/kg,碘盐覆盖率为99.59%,合格碘盐食用率为93.92%。儿童尿样8 000份,尿碘中位数为272.14μg/L,处于碘超适宜量水平。儿童尿碘低于100μg/L比例为6.78%,尿碘高于300μg/L的比例为41.25%,儿童甲状腺肿大率为0.85%。孕妇尿样4 000份,尿碘中位数为169.78μg/L,处于碘适宜量水平,但尿碘低于150μg/L比例占45.10%。结论 荆州市儿童甲状腺肿大率,儿童和孕妇合格碘盐食用率、尿碘中位数均持续符合国家碘缺乏病消除标准,需持续开展碘盐监测和重点人群健康教育。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.