体表高频超声技术评价家兔血管成形术后再狭窄模型与病理学结果的相关性

目的:分析体表高频超声检测家兔血管内球囊成形术后再狭窄程度与组织病理学分析的相关性。评估体表超声检测的可行性、可靠性及应用价值。方法:实验于2002-03/2003-12在北京中医药大学中医内科学重点学科实验室完成。①日本大耳白兔26只,随机分为正常组10只、假手术组6只、模型组10只。②模型组电刺激兔颈总动脉,电流1.2mA,刺激12～15min,术后第2天喂饲高脂饲料共8周,假手术组仅剥离颈总动脉,不做电刺激,喂高脂饲料,正常组不施加任何干预因素。③模型组和假手术组根据B超选择颈总动脉有斑块或血流明显改变者行球囊血管内成形术。分别于电刺激后8周、血管成形术后4周行超声检查动脉内径和动脉内膜厚度。④所有动物于血管成形术后4周处死取材,进行病理学半定量分析,并与超声测量结果进行相关分析。结果:进入结果分析数量24只,正常组中途死亡1只,原因为牙齿畸型影响进食。模型组1只因电刺激8周时超声评价颈动脉未形成斑块及血流无明显改变而剔出实验。①超声检测电刺激8周时正常组内膜厚为(0.028±0.004)cm,模型组管壁明显增厚(0.043±0.014)cm,差异有显著性(P<0.05),至血管成形术后膜厚增加更明显(0.064±0.002)cm,内径稍有扩大,但差异不显著。②超声检测模型组颈动脉内径与膜厚的测量结果与病理学测量结果呈正相关关系(OR=0.361,P<0.05;OR=0.526,P<0.01),病理狭窄率与超声是否检测到斑块呈正相关关系(OR=0.796,P<0.01)。结论:体表高频超声在评价家兔颈动脉狭窄诊断中有一定应用价值,与病理学半定量分析结果相关性良好。     

Spatio-temporal heterogeneity in hippocampal metabolism in control and epilepsy conditions

The hippocampus’s dorsal and ventral parts are involved in different operative circuits, the functions of which vary in time during the night and day cycle. These functions are altered in epilepsy. Since energy production is tailored to function, we hypothesized that energy production would be space- and time-dependent in the hippocampus and that such an organizing principle would be modified in epilepsy. Using metabolic imaging and metabolite sensing ex vivo, we show that the ventral hippocampus favors aerobic glycolysis over oxidative phosphorylation as compared to the dorsal part in the morning in control mice. In the afternoon, aerobic glycolysis is decreased and oxidative phosphorylation increased. In the dorsal hippocampus, the metabolic activity varies less between these two times but is weaker than in the ventral. Thus, the energy metabolism is different along the dorsoventral axis and changes as a function of time in control mice. In an experimental model of epilepsy, we find a large alteration of such spatiotemporal organization. In addition to a general hypometabolic state, the dorsoventral difference disappears in the morning, when seizure probability is low. In the afternoon, when seizure probability is high, the aerobic glycolysis is enhanced in both parts, the increase being stronger in the ventral area. We suggest that energy metabolism is tailored to the functions performed by brain networks, which vary over time. In pathological conditions, the alterations of these general rules may contribute to network dysfunctions.

Energy production in brain cells is assumed to be optimized to perform tasks or activities in a brain region–specific manner (1–3). Simultaneously, neuronal activity should be adapted to minimize the energy expenditure required for its fueling (4, 5). Several metabolic pathways are available for energy production, in particular glycolysis and oxidative phosphorylation (1). Whether specific metabolic pathways are preferably recruited in different brain areas in a task-dependent manner is not known. The hippocampus is an ideal region to test this hypothesis. The dorsal hippocampus (DH) is involved in learning and memory associated with navigation, exploration, and locomotion, whereas the ventral hippocampus (VH) is involved in motivational and emotional behavior (6–8). These functions are supported by very distinct anatomical (9, 10), morphological (11–13), molecular (14–19), and electrophysiological (12, 13, 20–23) properties of hippocampal cells. The hippocampus structure is also highly heterogeneous at the gene level, from its dorsal to its ventral tip (24, 25), which may serve as a substrate for different functional networks related to cognition and emotion to emerge (7, 26, 27). Given the hippocampus’s heterogeneity, from structure to function, along its dorsoventral axis, our first hypothesis is that energy production is different between the VH and the DH.If energy production is tailored to a given structure–function relationship, we predicted that a change in energy production should accompany a change in the hippocampus’s functional state. Epilepsy is a particularly relevant situation to test this hypothesis. The different types of epilepsies are associated with numerous metabolic and bioenergetic alterations (28). Hypometabolism of epileptic regions is a common signature of mesial temporal lobe epilepsy (TLE) in humans and animal models, such as the pilocarpine model (29, 30). Importantly, in patients with TLE, only the temporal part (including the hippocampus) is epileptogenic. The temporal part corresponds to the ventral part in rodents, which has been identified as the epileptogenic region in the pilocarpine mode (31). Our second hypothesis is that any dorsoventral organization of energy metabolism found in control condition is altered in epilepsy.Finally, hippocampal functions demonstrate circadian regulation (32), in particular place cell properties (33) and long-term synaptic plasticity (34) as well as memory and learning processes (35, 36). Our third hypothesis is that energy production, specifically the respective contributions of oxidative phosphorylation and aerobic glycolysis (3), vary as a function of the time of the day in control and epilepsy.To test these three hypotheses, we used an ex vivo approach to evoke an energy-demanding electrophysiological activity standardized for the three independent variables considered here: time, region (DH/VH), and perturbation (control/epilepsy). As a first step toward a better understanding of the time regulation of hippocampal metabolism, we considered two time points during the night/day cycle: Zeitgeber 3 (ZT3) and Zeitgeber 8 (ZT8), as they correspond to low and high seizure probability in the TLE model used (37). We found that the control DH and VH have distinct time-dependent metabolic signatures regarding glycolysis and oxidative phosphorylation. In experimental epilepsy, there is no more dissociation between DH and VH at ZT3, but the regional difference reappears at ZT8.     

慢性乙型肝炎患者及其配偶心理状况

目的:认识慢性乙型肝炎患者及其配偶心理健康、生活质量及心理治疗的相关研究现状。资料来源:检索维普期刊全文数据库和中国医院知识仓库(CHKD期刊全文库)1985-01/2006-01有关乙型肝炎与心理方面的文献,检索词为"生活质量,乙型肝炎,心理健康,心理干预,配偶",并限定语言种类为中文;检索Pubmed数据库同期相关文献检索词为"CHB,quality of life,psychology health",并限定语言种类为英语。其他文章查找具体书籍或杂志获得原文。资料选择:对资料进行初审,选择与乙型肝炎患者及配偶心理健康、生活质量及心理治疗等相关的文章。纳入标准:阐述详细,文章内容较新,有助于说明问题的文章。排除标准:去除重复性研究和一般了解性的文章。资料提炼:共收集到204篇文章及2本相关书籍,符合纳入标准的文章48篇,排除158篇。资料综合:慢性乙型肝炎是一种身心疾病,其发病机制复杂,除与病原和免疫因素有关外,心理社会因素起重要作用。同时,与之共同生活的慢性乙型肝炎患者配偶承受了巨大的心理压力,存在许多心理障碍,即夫妇的心理症状可交互影响。心理治疗对于乙型肝炎患者是必要的。结论:慢性乙型肝炎患者及其配偶存在严重的心理问题,心理治疗能取得一定的疗效。     

Genetic variation of <Emphasis Type="Italic">Glucose Transporter-1</Emphasis> (<Emphasis Type="Italic">GLUT1</Emphasis>) and albuminuria in 10,278 European Americans and African Americans: a case-control study in the Atherosclerosis Risk in Communities (ARIC) Study

Background  

Evidence suggests glucose transporter-1(GLUT1) genetic variation affects diabetic nephropathy and albuminuria. Our aim was to evaluate associations with albuminuria of six GLUT1 single nucleotide polymorphisms(SNPs), particularly XbaI and the previously associated Enhancer-2(Enh2) SNP.     

Can mupirocin prevent methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> infections?

In a retrospective study, Dr Muller and colleagues have assessed the efficacy of mupirocin nasal ointment alongside hygienic measures in methicillin-resistant Staphylococcus aureus (MRSA)-positive patients admitted to the intensive care unit (ICU). Their findings, which suggest that intranasal mupirocin can prevent ICU-related MRSA infections, need confirmation in a well-designed clinical trial. In general: early identification, isolation and treatment of all MRSA carriers, including health care workers, and disinfection of contaminated environments, are the main 'ingredients' of an effective MRSA 'search and destroy' program.     

A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes

The objective of the study was to determine the effectiveness and cost-effectiveness of primary care and community-oriented interventions in managing HbA1c, blood pressure, and lipids, and reducing hospitalizations and emergency room visits over 2 years. We describe an ongoing, randomized controlled trial of 542 urban African-Americans with type 2 diabetes ages 25 years and older who are members of a university-affiliated managed-care organization in Baltimore, MD. The participants are 74% female, have a mean age of 58 years, and 35% have yearly incomes greater than 7500 US dollars. Participants were randomized to one of two intervention groups for a period of 2 years: (1) usual medical care plus minimal telephone intervention implemented by a trained lay health educator (control group) or (2) usual medical care plus intensive intervention implemented by a nurse case manager (NCM)/community health worker (CHW) team. The intensive NCM/CHW team executes individual plans of care using evidence-based algorithms that focus on traditional diabetes self-management, screening and management of diabetes-related complications, and social issues surrounding diabetes care. Face-to-face NCM visits are conducted in the clinic once per year and CHW visits are conducted in the participant's home one to three times per year, both with additional follow-up contacts as needed. Written and verbal feedback (when necessary) is provided to the participant's primary care physician. All participants are expected to attend a 24-month follow-up visit where data are collected by interviewers blinded to intervention assignment. As of May 1, 2003, recruitment is complete, interventions are being fully implemented, and 24-month follow-up visits are beginning. Baseline sociodemographic characteristics, health-care utilization, health behaviors, and clinical characteristics of the study population are reported. This study is designed to test the hypothesis that a primary-care-based NCM plus CHW team approach is an effective, practical, and economically feasible strategy for translating current knowledge about type 2 diabetes into high-quality health care for urban African-Americans.     

Postchallenge hyperglycemia and mortality in a national sample of U.S. adults

OBJECTIVE: Although postchallenge hyperglycemia is a well-established feature of type 2 diabetes, its association with risk of mortality is uncertain. Therefore, the aim of this study was to assess the independent association of fasting and 2-h glucose levels with all-cause and cardiovascular disease (CVD) mortality. RESEARCH DESIGN AND METHODS: We analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study, a prospective cohort study of U.S. adults examined in the NHANES II, and focused on the 3,092 adults aged 30-74 years who underwent an oral glucose tolerance test at baseline (1976-1980). Deaths were identified from U.S. national mortality files from 1976 to 1992. To account for the complex survey design, we used SUDAAN statistical software for weighted analysis. RESULTS: Compared with their normoglycemic counterparts (fasting glucose [FG] < 7.0 and 2-h glucose < 7.8 mmol/l), adults with fasting and postchallenge hyperglycemia (FG > or =7.0 and 2-h glucose > or =11.1 mmol/l) had a twofold higher risk of death after 16 years of follow-up (age- and sex-adjusted relative hazard [RH] 2.1, 95% CI 1.4-3.2). However, adults with isolated postchallenge hyperglycemia (FG < 7.0 and 2-h glucose > or =11.1 mmol/l) were also at higher risk of death (1.6, 1.0-2.6). In proportional hazards analysis, FG (fully adjusted RH 1.10 per 1 SD; 95% CI 1.01, 1.22) and 2-h glucose (1.14, 1.00-1.29) showed nearly identical predictive value for mortality. Similar trends were observed for CVD mortality. CONCLUSIONS: These results suggest that postchallenge hyperglycemia is associated with increased risk of all-cause and CVD mortality independently of other CVD risk factors.     

Delta +-thalassemia in Sardinia

We have defined a new type of delta-thalassemia in which beta-globin chain synthesis is incompletely suppressed. Homozygotes have unusually low HbA2 levels, and double heterozygosity for this delta-thalassemia gene and beta-thalassemia normalizes the HbA2 level. The delta- thalassemia occurs on a chromosome that is identifiable using polymorphic restriction endonuclease sites. We call this condition delta +-thalassemia, to distinguish it from the previously described delta 0-thalassemia syndromes in which no delta-globin chain synthesis occurs.     

Effect of an internet-based curriculum on postgraduate education

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum.     

Effect of an Internet-based Curriculum on Postgraduate Education

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum.