山阴县饮水砷含量及砷中毒病情调查

目的：搞清山阴县高砷水和砷中毒病情的分布及危害程度。方法：水砷检测用快速试剂盒法，采用统一调查表对高砷暴露人群进行流行病学调查。结果：共调查3个乡(镇)36个自然村，测定井水样3083份，水砷超标率为54．40％；砷中毒患病率为16．85％，患病存在年龄和性别差异。结论：山阴县水砷浓度高、病情重，砷中毒病区的形成与该地区地质环境及居民饮水方式有关。     

2017年天水市居民死因监测分析

目的 了解2017年甘肃省天水市居民死亡原因及死因分布特征，为制定卫生事业发展规划和卫生政策提供参考依据。方法 从中国疾病预防控制信息系统的人口死亡信息登记管理系统中导出2017天水市户籍居民死亡报告卡基本信息，使用EXCEL 2017和SPSS 17.0软件分析死亡率、构成比、死因顺位、减寿顺位等指标。结果 2017年天水市居民粗死亡率276.38/10万（标化死亡率281.50/10万），男性粗死亡率317.80/10万（标化死亡率327.54/10万），女性粗死亡率233.21/10万（标化死亡率234.66/10万）；死因顺位前五位的疾病依次为循环系统疾病（151.94/10万）、肿瘤（44.90/10万）、呼吸系统疾病（27.75/10万）、损伤中毒（21.07/10万）和消化系统疾病（6.53/10万）；减寿率顺位前五位疾病依次为循环系统疾病、损伤中毒、呼吸系统疾病、肿瘤和消化系统疾病。结论 慢性非传染性疾病和损伤中毒是该市居民的最主要死亡原因。     

富砷饮水暴露剂量与反应关系

为了解饮水型砷中毒皮肤损害与饮水砷含量、砷暴露剂量的关系,调查了砷中毒病区常住居民７９３人,分析了饮水砷含量、总砷摄入量与患病率的关系。结果表明：皮损患病率与水砷含量、总砷摄入量与患病率的关系。结果表明：皮损患病率与水砷含量、总砷摄入量呈正的直线相关关系（ｒ＝０．９６０、ｒ＝０．６８３）并得出该关系的方程表达。总砷摄入量与患病率呈一定的剂量反应关系。     

饮水型砷暴露人群p16基因甲基化的研究

目的研究砷暴露人群p16基因甲基化发生情况。方法分别在饮水型砷中毒病区选取40例典型确诊地砷病患者、40名病区非患者及40名非病区的正常人（2个对照组），并进行年龄、性别匹配，采用甲基化特异性PCR技术测定人群血标本p16基因甲基化水平。结果地砷病患者及对照人群p16基因的甲基化率分别为65．0％、47，5％和20．0％；随着饮水砷浓度的增高，p16基因甲基化率也是逐渐增高。结论饮水砷暴露可引起人群p16基因甲基化发生率升高。     

贵州燃煤型砷中毒患者患恶性肿瘤死亡观察

目的 探讨贵州燃煤型砷中毒病区病人恶性肿瘤死亡情况，了解燃煤型砷中毒与癌症死亡之间的流行病学关系。方法 采用前瞻性研究方法，观察了病区砷中毒病人从1991～2001年11年来的癌症死亡情况。结果 砷中毒病人癌症年死亡率（204．07／10万）显著高于非砷中毒组（22．36／10万），其相对危险度（RR）为9．13，归因危险度（PAR）为89．04％。男性相对危险度（RR）为10．61，归因危险度（PAR）为90．57％，女性相对危险度（RR）为6．53，归因危险度（PAR）为84．69％。男女之间死亡率（危险度）差别有显著意义。总砷摄入量与癌症死亡率之间呈明显的剂量反应关系。癌症构成中依次为肺癌09．02％）、肝癌（30．89％）、皮肤癌（25．20％）、胃癌（1．63％）、膀胱癌（1．63％）和直肠癌（0．81％）。女性尿中排泄的形态砷中3价砷（Asm）明显较男性少，而二甲基胂酸（DMA）显著较多。结论 长期摄入高砷煤污染的室内空气和粮食（玉米和辣椒）导致砷中毒，对癌症的发生具有直接作用，从而确立了燃煤型砷中毒与癌症的关系。女性砷中毒癌症死亡率显著低于男性，可能与女性无机砷甲基化能力高于男性有关。     

山西省地方性砷中毒流行现状

目的探讨山西省地方性砷中毒病区暴露人群的病情程度和发病特点以及高砷水的分布规律，为科研防治工作提供科学依据。方法根据《中国地方性砷中毒分布调查实施方案》的要求，重点调查和抽样调查相结合，采用统一调查表对居民饮水砷和暴露人群进行流行病学调查。水砷检测用半定量快速试剂盒法，水氟检测用氟离子选择电极法。结果结合既往调查结果，目前山西省包括病区在内的高砷区共分布在8个市(地)、18个县(市、区)、44个乡(镇)、116个村，病人临床表现主要以色素脱失或色素脱失并角化为主。发病率随年龄增大而增加，男女患病率差异显著，男性高于女性，高砷水与当地地质结构和水文地质条件有着密切关系。结论山西省高砷暴露区域广、人数多、病情重，氟砷中毒并存。     

湖北南洪村饮水砷含量及砷中毒调查

目的确定湖北江汉平原南洪村是否为高砷地区。方法采用统一调查表对该村可能高砷暴露人群进行初步流行病学调查,用氢化物发生-原子吸收光谱法测定饮水、尿样和头发中砷含量。结果该村有6人存在典型慢性砷中毒症状,该村村民的尿砷、发砷平均水平显著高于对照组（P〈0.05）;4眼井水砷含量〉0.05mg/L。结论该村可能为饮水型慢性砷中毒地区。     

一本人与自然和谐相处的宝贵教科书——评《燃煤污染型砷中毒环境与疾病图谱》

据世界卫生组织2006年报道,全球接近1／4的疾病由可以避免的环境暴露引起,每年超过1300万人的超额死亡归因于可预防的环境因素。砷是一种严重危害人类健康的环境毒物和已知的人类强致癌物。地方性砷中毒的主要发病原因是自然环境高砷所致的饮水型砷中毒以及燃烧高砷煤所引起的燃煤污染型砷中毒。我国燃煤污染型砷中毒病区仅限于贵州和陕西两省。其中,贵州兴仁县是在上个世纪80年代末期卫生部首个确定的燃煤型砷中毒病区（也是世界上最早被确认的燃煤型砷中毒病区）,当地的煤砷含量均值417．7～2166．7mg／kg,     

甘肃省合作市地方性砷中毒流行病学调查

目的了解甘肃省合作市饮水高砷水源的分布和地方性砷中毒（地砷病）的流行情况，为进一步开展防治工作提供科学依据。方法对全市不同类型的饮水水源进行采样检测，同时进行地方性砷中毒病情调查。结果合作市的砷超标水样分布在4个乡19个自然村，呈点状分布，覆盖范围约700km^2，受威胁人群约1万人。在调查的987人中，检出地砷病可疑病例61例．检出率6．18％；高砷水源区人群尿砷平均值为0．0834mg／L，低砷水源区人群尿砷均值为0．0396mg／L，二者间差异有统计学意义（P〈0．05）。结论甘肃省合作市部分地区饮水含砷量超标．并存在地方性砷中毒的流行。     

饮水型砷中毒病区居民血清尿素氮浓度检测分析

目的探讨饮用高砷水对机体尿素氮水平的影响。方法以2个地区（高砷区和对照区）的常住成年居民为调查对象,采集晨尿及空腹静脉血,同时采集受访者家中饮用水水样。用原子吸收法测水总砷,用苦味酸比色法检测尿肌酐,采用酶偶联速率法测尿素氮。结果饮水型砷中毒病区居民血清尿素氮平均水平（5.08 mmol/L）高于非高砷区居民（3.60 mmol/L）,二者差异显著（P=0.0239）;饮水型砷中毒病区居民饮用水总砷浓度与血清尿素氮水平呈正相关关系（r=0.293,P=0.023）。结论饮用高砷水对居民肾脏存在潜在危害。     

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.