儿童癌症幸存者成年后的慢性疾病

由于治疗方法的进步,近80%的儿童和青少年癌症患者能够长期生存。在美国,约有270000例儿童癌症的幸存者,即每640名20至39岁成年人中就有一名幸存者。大量的幸存者有利于儿童癌症治疗后长期健康结果的研究。现在可以明确的是,化疗和放疗所致的儿童各器官系统损害在临床上可能潜伏多年。为了全面了解治疗儿童癌症而继发的健康问题,重要的是衡量三项长期结果:健康状况、死亡率和患病率。这三项中,关于前两项已有相当好的研究报道。在一项对20227例癌症5年生存者的回顾性分析中,Mertens等发现以下原因导致的超额死亡率具有统计学意义:继发癌症(…     

Mutations in Emery-Dreifuss muscular dystrophy and their effects on emerin protein expression

Seventeen families with Emery-Dreifuss muscular dystrophy (EDMD) have been studied both by DNA sequencing and by emerin protein expression. Fourteen had mutations in the X-linked emerin gene, while three showed evidence of autosomal inheritance. Twelve of the 14 emerin mutations caused early termination of translation. An in-frame deletion of six amino acids from the C-terminal transmembrane helix caused almost complete absence of emerin from muscle with no localization to the nuclear membrane, although mRNA levels were normal. This shows that mutant emerin proteins are unstable if they are unable to integrate into a membrane. A 22 bp deletion in the promoter region was expected to result in reduced emerin production, but normal amounts of emerin of normal size were found in leucocytes and lymphoblastoid cell lines. This shows that DNA analysis is necessary to exclude emerin mutations in suspected X-linked EDMD. Emerin levels in female carriers often deviated from the expected 50% and this was due, in at least two families, to skewed emerin mRNA expression from the normal and mutated alleles. In one family with a novel deletion of the last three exons of the emerin gene, a carrier had a cardiomyopathy and very low emerin levels (<5% of normal) due to skewed X-inactivation. In the three autosomal cases of EDMD, emerin was normal on western blots of blood cells, which suggests that autosomal EDMD is not caused by indirect reduction of emerin levels.      

World health system performance revisited: the impact of varying the relative importance of health system goals

Background

In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries.

Methods

We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives.

Results

By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries.

Conclusions

Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.     

Health care seeking among detained undocumented migrants: a cross-sectional study

Background  

As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care.     

汶川地震后重灾区人群重性抑郁障碍流行病学调查

目的 了解中国汶川5·12地震后重灾区居民的重性抑郁障碍患病率、患者的人口学和社会文化特征及患病相关危险因素.方法 采用分层整群抽样方法随机抽取≥15岁人群14 503人,以一般健康问卷12项(GHQ-12)为筛选工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查版(SCID-Ⅰ/P)为调查诊断工具.结果 重性抑郁障碍现患180例,时点患病率为1.27%,终生患病率为1.36%;女性(OR=1.56,95%CI:1.136～2.143,P＜0.05)、合并躯体疾病(OR=4.02,95%CI:2.75～5.90,P＜0.05)、地震中受伤(OR=3.29,95%CI:1.92～5.65,P＜0.05)、财产损失(其中10万～20万元OR=2.09,95%CI:1.18～3.69,P＜0.05;＞20万元OR=2.54,95%CI:1.38～4.68,P＜0.05)、家人去世或失踪(OR=3.79,95%CI:2.08～6.89,P＜0.05)以及中年人群(OR=2.31,95%CI:1.38～3.86,P＜0.05)为危险因素.有职业为保护性因素(OR=0.60,95%CI:0.43～0.83,P＜0.05).结论 重性抑郁障碍是目前地震灾区较为多发的精神疾病.     

VEGF对缺血/再灌注损伤胰腺细胞凋亡的影响

目的 研究血管内皮生长因子(VEGF)对缺血/再灌注损伤胰腺组织细胞凋亡的影响.方法 将雄性sD大鼠30只随机分为3组(n=10),A组为假手术组,B组为缺血/再灌注损伤组,C组为缺血/再灌注损伤+VEGF反义寡核苷酸组.通过血管夹阻断大鼠腹腔干及肠系膜上动脉30 min,然后去除血管夹再灌注6 h,建立大鼠胰腺缺血/再灌注损伤模型.对各组胰腺组织进行VEGF免疫组化染色及TUNEL法细胞凋亡检测.结果 缺血/再灌注损伤后胰腺组织出现细胞凋亡,同时VEGF蛋白表达上调.缺血/再灌注损伤+VEGF反义寡核苷酸组的胰腺组织VEGF蛋白表达较缺血/再灌注损伤组显著减少(P<0.05),前者细胞凋亡指数较后者明显升高(P<0.05).结论 VEGF能抑制缺血/再灌注损伤胰腺细胞凋亡,可能对胰腺缺血再灌注损伤具有保护作用.     

Pain among drug users completing an inpatient detoxification program

We determined the prevalence of persistent pain among illicit drug users who have completed inpatient clonidine detoxification and are returning to the community. We found that 17% of drug users have substantial unexplained pain at discharge, and that drug injectors have significantly more pain than non‐injectors. Drug users with substantial pain reported worse self‐perceived health, interference with daily activities and sleep than pain‐free drug users. Our findings suggest that assessing pain at the first outpatient primary care appointment after drug treatment may be an important aspect of the longitudinal care of this population.