腹腔囊型包虫病在保加利亚、罗马尼亚和土耳其农村地区的发病率

正囊型包虫病是一种人畜共患疾病,分布于世界各地,被世界卫生组织(WHO)列为重点防控疾病。在该疾病流行的大部分地区,包括东欧在内,人们对囊型包虫病造成的医疗负担了解甚少。2018年7月的《The Lancet. Infectious diseases》刊载了一项研究,旨在评估保加利亚、罗马尼亚和土耳其农村地区腹腔囊型包虫病的发病率情况。研究者们进行了一项基于超声检查的横断面调查,从保加利亚、罗马尼亚和土耳其的50个村庄中招募志愿者。这些村庄所在省份的医院每年囊     

Hepatic inflammation and fibrosis biomarkers are associated with cardiovascular risk factors but not cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

BackgroundBoth cardiovascular disease and liver disease are particularly common in people with type 2 diabetes and it is possible that the two conditions are inter-related. Non-invasive biomarkers are increasingly used to estimate liver inflammation and fibrosis. In this study the association of these biomarkers with cardiovascular risk factors and disease was explored in a large, representative population of people with type 2 diabetes mellitus.MethodsCytokeratin 18 (CK18, biomarker of hepatic inflammation) and the European Liver Fibrosis panel (ELF, biomarker of hepatic fibrosis) were measured in a random subgroup of 564 adults, aged 60–75 years at recruitment, participating in the Edinburgh Type 2 Diabetes Study (ET2DS). Data on conventional CV risk factors (body-mass index [BMI], waist circumference, blood pressure, total cholesterol, triglycerides, smoking status) and prevalent cardiovascular disease (validated myocardial infarction, angina, stroke and transient ischaemic attack events) were also available.FindingsMedian CK18 was 102 U/L [IQR 76–137, range 29–993] and mean ELF was 8·9 U/L [SD 0·8, range 6·9–11·6]. After adjustment for age and sex, increased CK18 was significantly associated with higher triglyceride levels (r=0·157, p=0·002). Increased ELF score was associated with higher BMI (r=0·202, p<0·001), waist circumference (r=0·139, p=0·008), and diastolic blood pressure (r=–0·045, p=0·025). Despite these associations, neither biomarker was significantly associated with prevalent cardiovascular disease (prevalent cardiovascular disease vs no cardiovascular disease, mean CK18 108·1 U/L [SD 26·2] vs 105·5 [22·6], p=0·473 and mean ELF 8·94 [0·77] vs 8·89 [0·76], p=0·442).InterpretationIn people with type 2 diabetes, non-invasive biomarkers of hepatic inflammation and fibrosis are associated with a number of cardiovascular risk factors but do not appear to associate with pre-existing vascular disease. Further investigation is required to determine whether liver biomarkers predict incident cardiovascular disease in this high risk group.FundingDiabetes UK.     

Approaches for the development of cell-based in vitro methods for contact sensitization.

Allergic contact dermatitis (ACD) is a cell-mediated immune response to small molecular weight chemicals that contact and penetrate the skin. There are a variety of characteristics that determine whether a chemical can function as a contact sensitizer (or allergen) including the ability to penetrate into the skin, react with protein and be recognized as antigenic by immune cells. The ultimate challenge for developing non-animal test methods for skin sensitization testing will be applying our mechanistic understanding of ACD to the design of predictive in vitro alternative test methods. Specifically, the in vitro approach should be designed so that a chemical's potential to penetrate the skin, react with protein/peptide (biotransformation may be required) and initiate an antigen-specific immune response is incorporated in the test methods developed. In this review, we have focused on cellular-based assays that have been developed or proposed for assessing a chemical's skin sensitization potential in vitro. All of the promising leads to date are based on observations made from in vivo studies conducted in animals and humans, and therefore have a strong mechanistic foundation. However, it remains to be demonstrated whether a single in vitro test, or several in vitro tests in combination, which model the critical steps in sensitization, can replace animal experiments for predicting contact allergic reactions in humans. Regardless, the future looks promising with continued development of our understanding of the chemical and biological aspects of allergic contact dermatitis, and most importantly, with the application of genomics/proteomics to this field on the immediate horizon.     

贫困县小学生睡眠状况调查

目的:了解贫困地区小学生睡眠状况,探讨提高农村儿童睡眠质量的有效措施。方法:于2005-10在吉林省的国家级贫困县应用澳大利亚悉尼大学儿童睡眠中心临床问卷的中国修订版(内容涉及儿童个人情况、睡眠状况、家庭居住环境,父母睡眠状况、吸烟状况,以及父母职业及受教育程度、家庭成员之间的关系等),采用二阶段整群随机抽样法,对750名小学生的睡眠状况进行调查分析,统计分析近1年内儿童在未患重大疾病时的睡眠状况,包括全天睡眠时间分布状况、睡眠障碍发病率及其相关影响因素,根据美国精神障碍诊断统计手册中儿童睡眠障碍的诊断标准,将每周出现1～3次单一或几种睡眠障碍相关症状,定为存在睡眠问题。结果:共发放问卷750份,回收有效问卷691份,回收率为92.1%。6岁和13岁组人数较少予以去除,实际纳入分析者669名。其中男生300名,女生369名;汉族361名,朝鲜族288名,其他民族20名;7岁组96名,8岁组93名,9岁组94名,10岁组122名,11岁组128名,12岁组136名。①贫困县小学生全天睡眠时间均值为(9.62±1.12)h,汉族小学生全天平均睡眠时间比朝鲜族学生长[(9.75±1.23),(9.48±0.90)h,P<0.01]。各年龄组学生全天睡眠时间差异无统计学意义(F=0.169,P>0.05)。②睡眠障碍总时点发病率为27.40%。低年级组小学生(一～四年级)睡眠障碍发病率高于高年级组(五～六年级)(31.80%,24.15%,P<0.05),男生睡眠障碍发病率高于女生(35.35%,20.95%,P<0.01)。③睡眠障碍症状发病率前5位依次为:睡眠不安(8.4%),睡眠姿势异常(8.3%)、张口呼吸(6.1%),梦呓(5.2%);打鼾(4.3%)。④调查结果经单因素相关分析及多重逐步回归分析显示抚养人睡眠习惯、儿童睡眠姿势异常、母亲管教孩子态度和父亲学历等是影响睡眠时间的主要因素。⑤Logistic回归分析显示,孩子患呼吸系统疾病、父母教育孩子方法、母亲有无睡眠障碍、父母之间关系、儿童体弱多病等是睡眠障碍的主要危险因素。结论:贫困地区儿童睡眠障碍是多因素共同作用的结果;孩子的抚养人应改掉不良的睡眠习惯,为儿童提供良好的生活、睡眠环境;增强儿童身体素质,积极防治呼吸系统疾病,应作为近期降低贫困县小学生睡眠障碍的有效措施。     

Glucagon‐Like Peptide 2 Improves Cholestasis in Parenteral Nutrition–Associated Liver Disease

Background: Parenteral nutrition‐associated liver disease (PNALD) remains a significant cause of morbidity and mortality in neonates with intestinal failure. Although glucagon‐like peptide‐2 (GLP‐2) is being advanced as therapy, the effect of GLP‐2 treatment on PNALD is unknown. We aim to investigate the effect of exogenous GLP‐2 administration on hepatic function in a neonatal piglet model of PNALD. Methods: Neonatal piglets (aged 2–6 days) underwent jugular venous catheterization to receive isonitrogenous, isocaloric parenteral nutrition (PN). Piglets were allocated to 2 groups: group 1 (n = 8) received saline while group 2 (n = 7) received GLP‐2 (at 11 nmol/kg/d). After 17 days, piglets underwent terminal laparotomy, and bile flow was measured. Liver specimens were analyzed histologically and with immunoperoxidase staining. Age‐matched sow‐reared control piglets (group 3, n = 8) were used for comparison. Results: Both groups 1 and 2 receiving PN developed cholestasis relative to sow‐reared controls, as evidenced by a decrease in bile flow and increase in serum total bilirubin. However, group 2 had improved bile flow (1.35 vs 0.73 µL/g; P = .02) and diminished bilirubin (38.0 vs 78.5 µmol/L; P = .008) compared with group 1. Group 2 also had lower serum alanine aminotransferase levels, a marker of liver injury. Histologically, the liver specimens in group 1 had marked hepatocyte pigmentation, which was decreased in group 2 specimens. Conclusions: The exogenous administration of GLP‐2 is associated with the improvement of cholestasis and liver injury. This study introduces a novel role for GLP‐2 in improving PNALD in the setting of prolonged PN duration.     

The Impact of Using Different Methods to Assess Completeness of 24‐Hour Urine Collection on Estimating Dietary Sodium

The standard for population‐based surveillance of dietary sodium intake is 24‐hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24‐hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para‐aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted.     

Chronic myelodysplastic syndrome (preleukemia) with the Philadelphia chromosome

A patient with severe anemia, reticulocytopenia, and erythroid hyperplasia of the bone marrow developed fatal acute nonlymphocytic leukemia after 3 yr. A Philadelphia chromosome with the typical 9/22 translocation t(9q +;22q-) was identified by banding techniques in a small number of bone marrow cells throughout the preleukemic phase of the illness (14%--38% of metaphases) and during the acute transformation (50%). Granulocytic colony formation in vitro was abnormal in the preleukemic phase. The diagnosis of chronic granulocytic leukemia was excluded on the basis of clinical and laboratory findings. The identification of the Ph1 chromosome in this form of chronic myelodysplastic syndrome (preleukemia) provides a new example of a hematologic disorder predisposing to acute leukemia in which this chromosomal abnormality occurs.     

Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives

In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.