Influence of puberty on muscle area and cortical bone area of the forearm in boys and girls

The aim of the current study is to analyze the interaction of the muscle and bone system (muscle-bone unit) during puberty in males and females by computed tomography of the nondominant forearm. The data presented here are the first results from 318 healthy children (159 boys and 159 girls), aged 6-22 yr, and 336 adults (parents) participating in the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study). Cortical area (CA) of the radius representing bone strength and muscle area (MA) representing muscle strength were measured with peripheral quantitative computed tomography (XCT 2000; Stratec, Pforzheim, Germany). A single slice measurement at a site corresponding to 65% of the ulnar length proximal to the radial endplate was used. MA and CA of the radius have been determined by a built-in software algorithm using density differences. There was a strong correlation between MA (x) and CA (y) in all children, adolescents, and adults (y = 0.019x + 10.93; r2 = 0.77). Before puberty, boys and girls displayed a similar relation between MA and CA. CA in relation to MA was greater in girls than in boys during puberty. Analysis of covariance was performed investigating the dependency of CA on MA, five pubertal stages, sex, and interaction of sex and pubertal stages. MA representing muscle strength was the strongest predictor of CA (P < 0.001) representing bone mass. Pubertal stage (P < 0.001) and interaction of pubertal stage*sex (P = 0.002) also had a significant influence on CA. r2 of the model was 0.85. These data suggest that in pubertal girls and women rather than in pubertal boys and men an additional factor shifts the relationship between MA and CA to higher values of cortical area. The present data confirm previous studies of the influence of puberty and estrogens or related factors on the muscle-bone interaction.     

克山病病区与非病区营养膳食调查及微量元素对比分析

本文对克山病病区丰田村２４户居民及非病区群发村２４户居民进行了膳食调查、并对病区居民２５例及非病区居民３０例检测了血液中微量元素Ｃｕ、Ｚｎ、Ｓｅ的含量。结果表明，病区居民与非病区居民主要营养素摄入量无明显差异，其蛋白质、脂肪及能量的摄入量基本达到中国人平均供给量。两组人群血液微量元素含量也无显著差异。提示，近年克山病发病率明显减少与克山病病区农民膳食改善有关。     

城区与偏远山区复治耐多药肺结核的临床疗效比较

目的比较重庆市城区和偏远山区复治耐多药肺结核接受以KPO1321为主的抗痨方案疗效的差异。方法回顾性总结91例复治耐多药患者接受该方案试疗3～6月的痰菌阴转率,比较两者的差异。结果城区50例,3月痰菌阴转率为44%,6月为66%;偏远山区41例,3月痰菌阴转率为73.17%,6月为85.36%,二者比较有显著性差异。结论偏远山区复治耐多药肺结核对该方案的疗效明显优于城区。     

西藏高原地区与山东菏泽平原地区脑出血临床特点的比较

目的探讨西藏高原地区与山东菏泽平原地区脑出血患者的临床特点的差异。方法选择2017年1月～2018年6月西藏自治区人民医院神经科收治的脑出血患者100例为高原组,同期于菏泽医学专科学校附属医院神经内科治疗的脑出血患者100例对照组,回顾性分析2组危险因素、临床特点、相关血液指标。结果与对照组比较,高原组脑出血患者发病年龄、HDL-C水平和入院时格拉斯哥昏迷量表评分明显降低(P 0.01),高血压(71.0%vs 51.0%,P=0.004)、脑出血伴发破入脑室比例(29.0%vs 9.0%,P=0.000)和血红蛋白水平[(167.00±32.00)g/L vs (148.00±21.00)g/L,P=0.000]以及病死率明显升高(26.0%vs 10.0%,P=0.003)。发病年龄、饮酒、高血压、HDL-C是2组发病的独立危险因素,高血红蛋白是高原组发病的独立危险因素。结论西藏高原地区脑出血发病的危险因素与平原地区有所不同,并且病情重,预后差。     

哈尔滨地区儿童甲状腺肿发病情况及病因学调查

目的调查哈尔滨市儿童甲状腺肿大的发病情况,分析病因。方法采用PPS抽样法选取3 243名11～13岁的学龄儿童,进行甲状腺触诊检查,对疑诊甲状腺肿大者进行甲状腺超声检查,其中354人进行尿碘测定;对发现的甲状腺肿大者进行甲状腺功能、甲状腺自身抗体和尿碘测定;随机选取30名无甲状腺肿大儿童作为对照。结果哈尔滨市学龄儿童尿碘中位数为241.81μg/L,甲状腺肿大率为2.43%。31名采血化验的甲状腺肿大儿童中,发现临床甲状腺功能减退(甲减)1人,亚临床甲减3人,亚临床甲状腺功能亢进(甲亢)2人,临床甲亢1人,这些儿童甲状腺自身抗体均为阳性。抗甲状腺过氧化物酶抗体(TPOAb)与抗甲状腺球蛋白抗体(TGAb)在甲状腺肿大儿童中阳性率分别为45.2%、38.7%,阳性率与抗体浓度均较对照组明显增高(P< 0.01)。尿碘在甲状腺肿大组与对照组之间以及自身抗体阳性组与阴性组之间差异无统计学意义(P> 0.05)。结论目前哈尔滨市学龄儿童碘营养状况处于超足量水平,儿童中有较高的甲状腺自身抗体表达。     

Concurrent dengue and malaria in an area in Kolkata

ObjectiveTo establish the nature and extent of dual dengue and malaria infections in an endemic area through a longitudinal study.MethodsA prospective study was conducted from August 2005 to December 2010 to document the nature and extent of concurrent dengue and malaria infections in an area in central Kolkata, endemic both for dengue and malaria.ResultsOf 2 971 suspected cases of dengue fever, in 605 (20.36%) persons dengue infection was detected, of whom 46 (7.60%, 46/605) patients (40 and 6 suffered from secondary and primary dengue fever respectively) were simultaneously suffering from malaria (28 and 18 were infected with Plasmodium vivax (P.vivax) and Plasmodium falciparum (P. falciparum) respectively, such dual infections of dengue and malaria were detected in all the years of the study period, except 2007, indicating intense transmission of both dengue and malaria in the study area, and the phenomenon was not an isolated one, the rate of concomitant infections ranged from 25% in 2009 to 4.9% in 2005. Out of total population surveyed, 1.54% (46/2 971) had concurrent dengue and malaria infection.ConclusionsThese findings added a new dimension in diagnosis, treatment, epidemiology and control of dengue and malaria. The possible risk of concurrent dengue and malaria infections should always be kept in mind in endemic areas for early diagnosis employing modern technology and prompt and effective treatment to avoid serious complications.     

肝门区域微波凝固消融的可靠性与安全性探讨

目的探讨经皮微波凝固消融（PMCT）治疗肝门区域肝癌的可靠性与安全性。方法将12只健康狗随机分为A、B组，各6只，经皮穿刺，于肝门区行PMCT，之后3d（A组）和4周（B组）处死、取肝，观察消融靶区和Ghsson管道系统一级分支的病理变化。结果术后Glisson管道系统一级分支周围的肝组织均坏死；门静脉血管壁在肉眼及镜下观察可见轻度损伤，但恢复良好；胆管结构未见不可恢复的破坏；肝脏功能的损伤表现为可逆性。结论PMCT可完全灭活肝门区域大血管周围的肝组织，Glisson管道系统及肝脏功能未出现严重不可逆的损伤，是一种疗效可靠且安全的治疗肝门区域肿瘤的方法。     

高原地区结肠镜检查质量临床观察及干预对策分析

目的分析高原环境对结肠镜检查质量的影响。方法收集2016年1月—2018年5月在青海省人民医院完成结肠镜检查且结果无异常的450例健康体检者资料。根据患者居住地区海拔高度,分为对照组（海拔>1 500~<2 500 m,120例）、高海拔组（海拔2 500~<3 500 m,170例）、超高海拔组（海拔3 500~<5 500 m,160例）,分析进镜时间、退镜时间、结肠清洁率、盲肠达镜率、镜检过程中腹痛腹胀症状等指标与海拔的关系。结果对照组、高海拔组和超高海拔组平均进镜时间为9.23 min、17.69 min和24.51 min,多元回归分析发现,高海拔组比对照组平均延长8.20 min,超高海拔组比对照组平均延长15.11 min（P<0.001）。对照组、高海拔组和超高海拔组平均退镜时间为7.17 min、7.28 min和7.93 min,多元回归分析发现,高海拔组与对照组比较差异无统计学意义（P>0.05）,但超高海拔组相比对照组延长了0.76 min（P<0.001）。对照组、高海拔组和超高海拔组的肠道清洁优良率分别为41.7%（50/120）、17.6%（30/170）和12.5%（20/160）,Logistic回归分析发现,高海拔组比对照组肠道清洁程度下降一个等级的可能性增加1.96倍,超高海拔组比对照组肠道清洁程度下降一个等级的可能性增加8.76倍（P<0.001）。对照组、高海拔组和超高海拔组盲肠达镜率分别为91.7%（110/120）、85.9%（146/170）和81.2%（130/160）,高海拔组与对照组比较差异无统计学意义（P>0.05）,超高海拔组与对照组比较差异有统计学意义（OR=0.38,95%CI：0.17~0.82,P=0.015）。随着患者居住地海拔升高,结肠镜检查中患者腹痛、腹胀等症状逐渐加重,3组间差异有统计学意义（P<0.05）。结论高原地区结肠镜检查质量低,检查前选择性干预可提高高原地区结肠镜检查质量。     

DOTS in Japan--Tokyo area]

The resurgence of tuberculosis has required a successful strategy to control TB in Japan. The World Health Organization has recommended the so-called DOTS (Directly Observed Therapy, Short-Course) strategy since 1995 and DOTS has been used with great success not only in many developing countries, but also in many developed countries. In Tokyo, especially in urban areas with a high prevalence of TB, DOT has been started. Using DOT, Sanya in Taito-ku (ward) and Arakawa-ku (ward), have shown high treatment completion--more than 90% since 1997. In 2000, other health care offices in Shinjuku-ku (ward), Yokohama city, Kawasaki city and Nagoya city started DOT for groups of homeless with TB. Presently, DOT is applied only to homeless people. However, the number of people who need DOT is much higher, due to poor adherence. It is also important to reconsider cost-efficiency for TB control in Japan.     

Molecular area effects in Cepaea

Enzyme polymorphisms in the land snail Cepaea nemoralis in the central Pyrenees show concordant geographic patterns of strong differentiation that are not correlated with the distributions of characters of shell color and banding or with the major pattern of variation in climate and vegetation type. Three regions of relative genetic uniformity separated by steep clines in allele frequencies are designated as “molecular area effects.” A model of allopatric differentiation of populations in temporary geographic isolation during the last period of Pleistocene glaciation, followed by invasion of the Pyrenees and hybridization in secondary contact, is proposed to account for the present-day pattern of genetic differentiation. The genetic structure of the Pyrenean populations of C. nemoralis is not interpretable in terms of stasipatric or parapatric models of speciation.     

希氏束区起搏的研究进展

传统的右心室心尖部起搏,其电激动顺序与正常生理起搏顺序相反,经临床试验证实会导致心室重构、影响心脏功能,增加二尖瓣反流、心律失常发生和死亡[1-6].而希氏束区起搏的电激动沿心脏正常传导系统下传,保持了相对正常的心室电激动顺序和心室收缩同步性,能获得较好的血流动力学效果,是目前起搏治疗领域研究的热点之一.     

Leishmaniasis in the genital area

Two patients from the gold mines of Bolivar State, Venezuela, presenting cutaneous leishmaniasis in the genital region, an unusual location, are described. The first patient showed an ulcerated lesion of the glans penis. Leishmanin skin test was positive. A biopsy specimen revealed a granulomatous infiltrate containing Leishmania parasites. In the second patient, Leishmanin skin test was positive, HIV and VDRL were negative. Leishmania parasites were present in a biopsy of an ulcerated lesion in the scrotum, with an indurated base, infiltrative borders with an yellowish exudate. Patients were treated with meglumine antimoniate and the lesions healed.     

上海部分城乡地区血管性痴呆的发病率及危险因素研究

目的　调查上海部分城乡地区血管性痴呆 (VaD)的发病率及相关危险因素。方法　在上海地区基线患病率调查的基础上选择 5个居委会和 4个村委会的居民作为研究对象。通过简易精神状态量表 (MMSE) ,根据文化程度划分的分界值进行初筛 ,在分界值以下的对象和正常人群中随机选择 4 %进入细查。细查项目有体格检查、详细病史记录以及成套的神经心理学测试 ,包括 :Pfeffer功能活动、Fuld物体记忆、快速物体回忆、韦氏儿童智力量表积木测验和韦氏成人智力量表数字广度、日常生活功能量表 (ADL)、HachisKi缺血量表、汉密顿抑郁量表 (HAMD)等。以精神障碍诊断和统计手册作为痴呆的诊断标准。 6个月后对所有进入细查的对象进行复查 ,根据美国神经病学、语言障碍和卒中 老年性痴呆和相关疾病学会的标准诊断阿尔茨海默病 (AD) ;根据美国国立神经病卒中研究所和瑞士神经科学研究国际协会的标准诊断VaD。结果　在实际完成初筛的 35 4 5例中 ,确诊新发痴呆病例 112例 ,其中VaD 2 8例 ,发病率是 2 .5 4 3 千人年 (标化率为 2 .4 0 3 千人年 )。VaD与年龄呈正相关 ,其OR =1.12 7(95 %CI :1.0 76～ 1.179,P =0 .0 0 0 ) ,与教育呈负相关 ,其OR =0 .6 5 4 (95 %CI:0 .4 5 1～ 0 .94 3,P =0 .0 2 3)。结论　上海部分城乡地区