贵州省第4次碘缺乏病监测分析

目的了解贵州省碘缺乏病防治现状,为制定贵州省可持续消除碘缺乏病的防治策略提供依据。方法采用多级随机抽样法。结果居民户盐碘中位数为34.9mg/kg,食用碘盐合格率87.2%,变异系数26.8%,高碘盐比例(>60mg/kg或>50mg/kg)较第3次监测时明显降低;8～10岁儿童尿碘中位数340.4μg/L,<50μg/L的比例为0;甲状腺肿大率触诊法为10.5%,B超法为14.2%。水碘均值<10μg/L;10岁儿童智商(IQ)均值为93.9±19.6,智力低下占9.9%。结论随着盐碘、尿碘中位数水平的降低和碘盐合格率提高,甲肿率明显降低。碘盐浓度还有下调空间。     

2017年上海市松江区8～10岁儿童及孕妇碘营养水平分析

目的通过监测2017年上海市松江区8~10岁儿童与孕妇的盐碘和尿碘水平,了解该人群的碘营养状况,为科学制定预防措施提供依据。方法按照《2017年上海市人群碘营养状况监测方案》要求,对上海市松江区进行片区划分,对5个街道(镇)的210名8~10岁儿童和15个街道(镇)的100名孕妇进行盐碘、尿碘和甲状腺肿大率的检测。结果检测8~10岁儿童家庭食用盐210份,碘盐覆盖率为80.5%,合格碘盐食用率为67.6%,碘盐合格率为84.0%,非碘食盐率为19.5%;检测孕妇家庭食用盐100份,碘盐覆盖率为82.0%,合格碘盐食用率为68.0%,碘盐合格率为82.9%,非碘食盐率为18.0%。检测8~10岁儿童尿样210份,尿碘中位数为263.5μg/L,尿碘含量<50μg/L的占1.90%,<100μg/L的占10.00%,达到国家碘缺乏病消除标准,同时40.00%的儿童尿碘含量 >300μg/L;检测孕妇尿样100份,尿碘中位数为142.0μg/L。8~10岁儿童甲状腺肿大率为0。结论儿童和孕妇的盐碘盐覆盖率和合格碘盐食用率都处于偏低水平,均未达到碘缺乏病消除标准,8~10岁儿童尿碘中位数超过适宜量,但孕妇尿碘水平略低于适宜水平,应继续加强健康教育工作,合理科学食用碘盐。     

呼和浩特地区碘缺乏病20年监测结果分析

目的评估20年来本地区碘缺乏病防治效果。方法收集近20年8～10岁儿童甲状腺肿大率、尿碘含量、居民户盐碘含量等监测数据整理分析。结果经食盐加碘干预,8～10岁儿童甲状腺肿大率显著下降,近7年已控制在4%以下,尿碘中位数近8年波动在199.4μg/L～305.8μg/L之间,居民户盐含碘量中位数在22.9～42.0mg/kg之间,碘盐覆盖率已连续12年稳定在98%以上,碘盐的合格率连续4年稳定在96%以上。结论本地区加碘食盐供应系统正常,质量稳定,防治效果显著。2000年达到国家消除IDD阶段目标。现各项技术指标达到消除IDD的目标已连续5年。     

兰州市碘缺乏病碘盐干预效果评价

目的评价碘盐干预,为进一步加强和完善消除碘缺乏病的长效工作机制提供科学依据。方法采用PPS抽样法,1995～2009年在兰州市8个县区随机抽取8～10岁儿童进行甲状腺肿大率、尿碘、盐碘监测。结果经食盐加碘干预,8～10岁儿童甲状腺肿大率呈下降趋势,近4年达到国家碘缺乏病消除标准;尿碘中位数波动在100～300μg/L,均满足国家学龄儿童碘营养评价标准（尿碘中位数〉100μg/L）,尿碘合格率波动在67.01%～97.22%;碘盐合格率连续7年稳定在90%以上,各年碘盐中位数均达到国家标准（碘盐20～50mg/kg）。结论普及碘盐是改善人群碘营养状况、防治碘缺乏病的有效措施。     

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。     

北京市外来务工人员子女碘缺乏病调查

目的了解北京市外来务工人员子女的碘营养状况,以便提出相应的防治措施。方法选择朝阳区和昌平区的4所外来务工子弟小学,每所学校随机抽取7～12岁儿童100名,采集学生家中食盐、学生随机尿样以及进行甲状腺触诊。结果碘盐覆盖率65.9%,碘盐合格率95.2%,合格碘盐食用率62.7%;学生尿碘中位数233.8μg/L,〈100μg/L的学生占11.2%,〉300μg/L的学生占27.8%;甲肿率为10.1%。结论碘盐覆盖率、合格碘盐食用率都低于2008年碘盐监测结果中北京的水平,儿童甲状腺肿大率明显高于2005年北京市监测结果的水平,尿碘中位数与2005年全国学龄儿童尿碘水平监测结果中北京市学龄儿童的尿碘平均水平基本一致。现阶段该人群碘摄入量处于基本适宜水平。     

1998～2006年张掖市碘缺乏病监测结果分析

目的了解张掖市碘缺乏病发展动态、防治现状、病情消长趋势,探索碘缺乏病消长趋势,变化规律及其影响因素,为防治提供依据。方法采取按人口容量比例概率抽样方法对8~10岁儿童甲状腺肿大率、尿碘水平、碘盐合格率、覆盖率等指标进行流行病学调查。结果1998~2006年8~10岁儿童甲状腺肿大率分别为11.09%、9.61%、7.75%、5.70%、4.49%、4.23%、3.66%、2.94%;尿碘中位数分别为164.6μg/L、284.9μg/L、199.46μg/L、164.93μg/L、138.65μg/L、153.54μg/L、168.79μg/L、154.26μg/L;碘盐合格率分别为88.42%、86.85%、91.50%、94.17%、95.87%、96.70%、97.94%、99.20%;覆盖率分别为82.95%、86.50%、88.63%、92.23%、93.98%、96.1%、98.13%、98.60%。结论碘盐合格率、覆盖率逐年升高,甲状腺肿大率逐年下降,尿碘水平趋于理想,人群碘营养状况逐步改善。但还存在部分非碘盐和不合格碘盐,应加强监管。     

2018年临夏州碘缺乏病病情监测分析

目的了解甘肃省临夏回族自治州(简称临夏州)碘缺乏病病情变化及居民碘营养水平,评估持续消除碘缺乏病进展情况。方法采取随机抽样方法从每个抽样单位中抽取5所小学,在抽取的小学随机抽取40名8～10岁儿童,B超检查甲状腺并检测尿碘;在每所抽中的小学附近村庄抽取100名孕妇检测尿碘,并检测其家中碘盐。结果居民户盐碘中位数25.55 mg/kg,碘盐覆盖率90.63%,碘盐合格率90.48%,合格碘盐食用率82.00%;8～10岁儿童甲状腺肿大率0.12%,尿碘中位数185.93μg/L,其中50μg/L以下占2.5%;孕妇尿碘中位数174.6μg/L,50μg/L以下占2.5%。结论临夏州8～10岁儿童碘摄入量适宜,碘营养状况理想;除康乐县、广河县和积石山县以外,其他地区的孕妇碘营养适宜。     

2008年宁夏西吉县碘缺乏病监测报告

目的了解西吉县碘缺乏病病情,评价防治效果。对2008年西吉县碘缺乏病监测结果进行分析,为制定碘缺乏病防治措施提供科学依据。方法碘盐检测采用GB/T13025-1999直接滴定法;尿碘测定采用砷铈分光光度法;甲状腺肿大率检查采用触诊法。结果全县测定盐样288份,碘盐中位数27.36 mg/kg,碘盐覆盖率91.67%,合格碘盐食用率为90.97%,〈20 mg/kg碘盐有26份,占9.03%;8-10岁学生甲状腺肿大率为5.2%;特需人群（妇女）尿碘中位数148.76μg/L,尿碘〈100μg/L,占81.95%;〈50μg/L占11.11%;（20μg/L占6.94%。结论西吉县各项监测指标达到基本消除碘缺乏病标准,但儿童甲状腺肿大率、特需人群尿碘等指标仍然存在一些问题。     

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.     

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.