Epidemiologic background and long-term course of disease in human immunodeficiency virus type 1-infected blood donors identified before routine laboratory screening. Transfusion Safety Study Group

BACKGROUND: The long-term course of human immunodeficiency virus type 1 (HIV-1)-related disease among seropositive blood donors has not been described. The enrollment and epidemiologic background of HIV-1- infected donors in the Transfusion Safety Study and their immunologic and clinical progression are described. STUDY DESIGN AND METHODS: Through the testing of approximately 200,000 sera from donations made in late 1984 and early 1985, 146 anti-HIV-1-positive donors and 151 uninfected matched donors were enrolled. These two cohorts were followed with 6-month interval histories and laboratory testing. RESULTS: Seropositive donors detected before the institution of routine anti-HIV-1 screening disproportionately were first-time donors and men with exclusively male sexual contacts. The actuarial probability of a person's developing AIDS within 7 years after donation was 40 percent; the probability of a person's dying of AIDS was 28 percent. AIDS developed more often when the donor was p24 antigen-positive at donation. Over a 3-year period, significant decreases occurred in CD4+, CD2+CD26+, CD4+CD29+, and CD20+CD21+ counts, but not in CD8+ subsets, CD20+, or CD14+. CONCLUSION: The high proportions of first-time donations and exclusively homosexual men among seropositive donors suggest that test-seeking may have contributed to the high HIV-1 prevalence in the repository. Implementation of alternative test sites when routine donor screening began in 1985 may have averted many high- risk donations. The disease course in HIV-1-infected donors had the same wide spectrum of immunologic and clinical manifestations as were reported for other cohorts.     

常咯啉在实验性心律失常狗的药代动力学－药效动力学分析

用Ｈａｒｒｉｓ冠脉结扎法诱发的心律失常狗研究常咯啉药代动力学－药效动力学。７只狗按８３．３３μｇ·ｋｇ￣（－１）·ｍｉｎ￣（－１）静脉滴注６０ｍｉｎ，在给药期间和停药后不同时间记录ＥＣＧ及测定血药浓度。Ｃ－Ｔ数据用药代程序计算药代参数；药效数据用药代－药效同步分析模型计算药效动力学参数，Ｋ１０，Ｔ１／２，Ｖｄ，Ｃｌ分别为０．００８７ｍｉｎ￣（－１），７８．０３ｍｉｎ，４０．５５ｍｌ·ｋｇ￣（－１）和０．４２１ｍｌ·ｋｇ￣（－１）·ｍｉｎ￣（－１）；Ｋｅ０和Ｃｅ（５０）分别为０．００４８ｍｉｎ￣（－１）和２．０１μｇ·ｍｌ￣（－１）.     

Recurrent hemoptysis with Penicillium marneffei and Stenotrophomonas maltophilia in Job’s syndrome

Pulmonary infection caused by the opportunistic organisms Penicillium marneffei and Stenotrophomonas maltophilia in patients with Job’s syndrome is rare and not well documented. The case of a 30-year-old man with Job’s syndrome who developed recurrent pneumonia and lung abscesses caused by P marneffei and S maltophilia, complicated by massive hemoptysis, is described. Bronchial artery embolization was successful in controlling the hemoptysis; however, the infection proved fatal despite appropriate antimicrobial therapy. A brief review of the literature on Job’s syndrome and its associated infective pulmonary manifestations is also presented.     

干燥综合征神经系统病变的临床及病理分析

目的探讨原发性干燥综合征(Sjogren综合征;pSS)神经系统病变的临床及组织病理特征。方法对18例并发神经系统损伤的pSS患者的临床及病理资料进行回顾性分析。结果周围神经系统病变pSS(PNS-pSS)表现为对称性感觉运动性周围神经病、多发性单神经病、感觉性周围神经病、颅神经损伤。中枢神经系统病变pSS(CNS-pSS)表现为多发性硬化、缓慢进展的认知障碍和共济障碍、脑炎。头颅MRI显示脑白质多发异常信号、脑白质、脑干及小脑多发异常信号、脑脓肿。唇黏膜活检示部分腺体萎缩,腺泡及间质内可见淋巴、单核吞噬细胞浸润。腓肠神经活检既有典型血管炎改变也有非血管炎性改变。脑活检可见白质脱髓鞘及小静脉周围炎性细胞浸润以及典型血管炎改变。结论Sjogren综合征导致的神经系统损伤呈多样性,且常先于Sjogren综合征的诊断之前出现。了解其神经系统损伤的临床表现、影像学特点及组织病理改变对认识本病具有重要的临床意义。     

机械通气患者中心静脉压与上腔静脉横径相关性研究

目的通过监测机械通气患者中心静脉压(CVP)与上腔静脉横径值(SVCD)的动态变化,评价呼气末正压(PEEP)对机械通气患者CVP与SVCD的影响,以及CVP与SVCD相关性研究,为用无创手段测定机械通气患者SVCD值以来指导患者液体治疗提供理论依据。方法选取22例因急性呼吸衰竭行机械通气的患者应用彩色超声诊断仪监测受试者在不同水平PEEP(0～20cmH2O)时的SVCD值与CVP值,同时记录患者心率、平均动脉压与血氧饱和度,分析SVCD、CVP与PEEP相关性分析。结果①机械通气患者SVCD值随PEEP值的增加而递减,SVCD与PEEP值呈显著负相关(r=-0.981,P<0.01);②CVP与PEEP呈显著正相关(r=0.997,P<0.01);③CVP与SVCD值呈显著负相关(r=-0.961,P<0.01)。结论机械通气时患者SVCD值随PEEP值增加而减少,CVP随PEEP值增加而增加,从而可用多普勒超声心动图检查来监测SVCD值,以间接评价患者治疗效果。     

Educational difference in the prevalence of osteoporosis in postmenopausal women: a study in northern Iran

Background

Osteoporosis is the most common metabolic bone disease in the world and it is rapidly increasing in Iran. In this study the relationship between educational levels and osteoporosis was investigated among Iranian postmenopausal women.

Method and subjects

Seven hundred and six women aged 50-75 years old were randomly recruited from urban (n = 440) and rural (n = 266) areas in Guilan. Osteoporosis was diagnosed by quantitative ultrasound technique and dual X-ray absorptiometry. Serum 25(OH) D3, body weight and height were measured in all subjects. Other data including age, educational level, menopause age, medications and history of illness were also collected.

Results

We found that the prevalence of osteoporosis was significantly greater among women with low educational level than women with high educational status (18.0% vs 3.8% P < 0.0001). However, women with low educational level had higher mean serum level of vitamin D than women with high educational level. Osteoporosis was significantly more prevalent among women living in rural areas than women living in urban areas (19.1% v.s 13.3%, P < 0.0001).

Conclusion

This study showed that educational level is associated with bone health in this population of postmenopausal women with significantly higher osteoporosis found in lower social groups. Therefore, we suggest that women with low social level should be carefully evaluated for signs of osteoporosis during routine physical examinations.