抗病毒药物在免疫活性宿主中的应用(二)流感病毒和呼吸道合胞病毒感染的治疗

抗病毒药物在免疫活性宿主中的应用(二) 流感病毒和呼吸道合胞病毒感染的治疗@宝轶$中国医科大学!86期沈阳110001~~     

Dietary Change and Obesity Associated with Glucose Intolerance in Alaska Natives

Objective To investigate frequency of food intake, body weight, and glucose intolerance in Alaska Natives.Design Height, weight, and random blood glucose levels were measured and a frequency-of-food-intake questionnaire was obtained. This questionnaire classified persons as consumers of indigenous foods or nonindigenous foods within three food groups. Those with a random blood glucose measurement ≥6.72 mmol/L received an oral glucose tolerance test.Setting Community screening in 15 villages in Alaska.Subjects Nutrition screenings were done for 1,124 Alaska Native residents aged 20 years or older. An oral glucose tolerance test was done for 202 subjects.Outcomes measured Subjects were classified as consumers of indigenous or nonindigenous foods within three food groups. A diagnosis of non–insulin-dependent diabetes mellitus (NIDDM) was made on the basis of World Health Organization criteria. A determination of overweight was made on the basis of National Center for Health Statistics criteria.Statistical analysis A χ² test with Yates correction, t test, and linear regression, with two-sided P values.Results Athabascan Indians had twice the rate of NIDDM as Yup’ik Eskimos with significantly higher frequency of non-indigenous food intake, plus lower frequency of indigenous carbohydrate and fat intake. Subjects ≤30 years old consumed significantly more nonindigenous protein and fat and low-nutrient-density carbohydrates than those ≥60 years old. Persons who had glucose intolerance reported significantly greater consumption of nonindigenous protein and less seal oil. Incidence of overweight was significantly higher than was found 25 years ago. Participants with glucose intolerance were significantly more overweight than others.Conclusion A pattern of increased frequency of non-indigenous protein, low-nutrient-density carbohydrate, and fat intake with less indigenous carbohydrate and fat consumption was found in subjects ≤30 years old and in association with the higher rate of NIDDM found in the Athabascan Indians. Persons with glucose intolerance were significantly more overweight than others.Applications Although the nutritional value of indigenous foods for reducing disease risk should be promoted, nutrition education, especially among young adults, should also include building skills to select and prepare nonindigenous foods to attain a healthful diet. Although snacking is a concern, dietary fat was the most significant factor in obesity and NIDDM. J Am Diet Assoc. 1995; 95:676-682.     

EFFECTS OF GENERAL ANAESTHETICS ON THE ACTIVITY OF THE Na,K-ATPASE OF CANINE RENAL MEDULLA

Several previous studies have reported inhibition of Na,K-ATPase activity by chlorpromazine, phenobarbital and pentobarbital, thiopental, and monoketones. The purpose of this study is to investigate the influences of other general anaesthetics on Na,K-ATPase activity. The ATPase activity of Na,K-ATPase-enriched membranes from canine renal medulla was determined at 37 degrees C in the absence and in the presence of hexanol, diethylether, halothane, and propofol. The influence of hexanol on stimulation of Na,K-ATPase activity by Na+ and K+ was investigated. Hexanol, diethylether, halothane, and propofol inhibited the activity at 37 degrees C of the Na,K-ATPase of canine renal medulla. The IC50 values at 37 degrees C were: hexanol, 12.3 mM; diethylether, 170 mM; halothane, 7.35 mM; propofol, 0.127 mM. Hexanol increased the K0.5 of the Na,K-ATPase for K+ at 37 degrees C, but did not affect the K0.5 for Na+. At lower [K+] hexanol was a more potent inhibitor than at higher [K+].     

Interventions for replacing missing teeth: treatment of perimplantitis

Background : One of the key factors for the long‐term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. Objectives : To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. Search strategy : We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomized controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 15 March 2006. Selection criteria : All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. Data collection and analysis : Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random‐effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Main results : Seven eligible trials were identified, but two were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening. Follow up ranged from 3 months to 2 years. No meta‐analysis was conducted due to different interventions tested and outcomes used. No side effects occurred in any of the trials. The only significant statistically differences were observed in a 4‐month follow‐up RCT evaluating the use of adjunctive local antibiotics to manual debridement in patients having lost at least 50% of the supporting bone around the implants. There were improved probing attachment levels (PAL) mean differences of 0.61mm (95% CI 0.40 to 0.82), and reduced probing pockets depths (PPD) mean differences of 0.59mm (95% CI 0.39 to 0.79) in those patients receiving adjunctive local antibiotics. This trial was judged to be at high risk of bias. Authors' conclusions : There is no reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. However, the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6mm additional improvement for PAL and PPD over a 4‐month period in patients associated with severe forms of perimplantitis. In three trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Smoothening of rough implant surfaces was not associated with statistically significant improvements of the clinical outcomes. However, sample sizes were small, therefore these conclusions have to be considered with great caution. More well‐designed RCTs are needed. Plain language summary : As with natural teeth, dental implants can be lost due to gum disease (perimplantitis). This review looked at which are the most effective treatments to arrest perimplantitis Five studies were included in the review and evaluated five different treatment modalities. In one small study of short duration (4 months) it was shown that the use of locally applied antibiotics in addition to the deep manual cleaning of the diseased implants decreased the depth of the pockets around the implants of an additional 0.6mm in patients affected by severe forms of perimplantitis. In conclusion, at present, there is no reliable evidence to determine which is the most effective way to treat perimplantitis. This is not to say that currently used interventions are not effective. The majority of trials testing more complex and expensive therapies did not show any statistically or clinically significant advantages over the deep mechanical cleaning around the affected implants.     

A 2-year report on caries prevention by fluoride varnishes in a community with fluoridated water

Abstract – The benefit of semi-annual applications of sodium fluoride varnish (Duraphat®) and silanc fluoride varnish (Fluor Protector®) was studied in 11-13-year-old children with life-long exposure to fluoridated drinking water (1–1.2 parts/ 10⁶). Annual clinical and radiograpic examinations were made on 67 children in the Duraphat group and 71 children in the Fluor Protcctor group. Floride varnish was applied semi-annually using the half-mouth tecnique. At the end of 2 years, the mean overall DMFS- increments on te control side and test side of the Duraphat group were 5.0 and 3.8 ( P 0.01), respectively, and of te Fluor Protector group 3.7 and 3.3 (NS). The caries redutions were 24%and 12%, respectively. Since there were no differences between initial mean DMFS scores of te groups, it was assumed that lower increments in the Fluor Protector group were due to fluoride ions crossing the midline and providing protectioon on the control side as well. When increments in the Duraphat control side and the Fluor Protector test side were compared, the caries reducation of Fluor Protector was 35% ( P <0.01). Fluoride varnishes provide additional benefit even when fluoride intake from drinking water is optimal.     

The effect of breastfeeding on weight gain in infants: results of a birth cohort study

The objective of this study was to examine whether duration of exclusive breastfeeding is associated with elevated weight gain in infants during the first two years of life. In this prospective cohort study 2624 healthy term neonates were followed from birth to age 2 years in 4 German study centres. Data on breastfeeding and potential confounders were gathered by questionnaires. Data on anthropometric measures at birth and age 2 years were obtained from routine standardised medical check up documentation. Odds ratios for the association between breastfeeding and weight gain until age 2 years (> or = 90th sex-specific percentile of the cohort) were calculated by logistic regression, adjusting for age at introduction and composition of solid food, maternal BMI, maternal smoking during pregnancy, socioeconomic status, study centre, birth order and, in unstratified analysis, sex. Children exclusively breastfed for less than 6 months had a greater risk of elevated weight gain at the age of 2 years than children breastfed for 6 months and more (OR (95% CI): 1.65 (1.17, 2.30)). Duration of exclusive breastfeeding was inversely associated with the risk of elevated weight gain in a strongly duration-dependent way. Those infants who were exclusively breastfed 1 month at the most had twice as often elevated weight gain (OR (95% CI): 1.99 (1.34, 2.97)) compared to infants breastfed at least 6 months. Our data show that exclusive breastfeeding protects against elevated weight gain during infancy which may be the first step on the pathway of obesity development.     

Early endotoxin exposure and atopy development in infants: results of a birth cohort study

BACKGROUND: Exposure to endotoxin in childhood is currently discussed to protect from the development of allergic diseases. OBJECTIVE: To study the effect of early endotoxin exposure on incidence of atopic sensitization, atopic dermatitis and wheezing until the age of 2 years in infants with different risk status in terms of parental atopy. METHODS: Data of 1942 infants of an ongoing birth cohort study were analysed by logistic regression. Endotoxin was measured in settled dust of the mothers' mattresses at infants' age of 3 months. Data on allergic symptoms and physicians' diagnoses were gathered by questionnaire. Sensitization to common food and inhalant allergens was assessed by specific serum IgE. RESULTS: High endotoxin levels increased the risk of repeated wheeze [adjusted odds ratio (OR) for 4th exposure quartile (Q4) 1.52, 95% confidence interval (CI) 1.08-2.14], but were associated with neither sensitization to food allergens nor atopic dermatitis. Stratification by parental atopy showed that there was an association of endotoxin exposure with incidence of repeated wheeze as well as with sensitization to inhalant allergens (P for trend = 0.008 and 0.044, respectively) only in infants with parental atopy, with the highest risk in the 4th exposure quartile (repeated wheeze: ORQ4 1.77, 95% CI 1.14-2.73; sensitization to inhalant allergens: ORQ4 1.69, 95% CI 0.70-4.11). CONCLUSION: Early endotoxin exposure in terms of mattress dust endotoxin levels seemed to increase the risk of atopic reactions to inhalant allergens at the age of 2 years, especially in infants at risk due to parental atopy. Our data disagree with an early protective effect of endotoxin on atopy development until the age of 2 years.     

Generation-specific incentives and disincentives for nurses to remain employed in acute care hospitals

Aim This is a report on generation-specific incentives and disincentives selected by acute care nurses that promote and discourage them to remain employed in hospitals. Background Recent literature indicates that nurse preferences for strategies to promote their retention may differ across generational cohorts. However, current literature is primarily anecdotal with few studies focused on evidence-based generation-specific nurse retention-promoting strategies. Methods Data were gathered from a cross-sectional survey administered to a random sample of 9904 registered nurses working in Alberta and Ontario, Canada. Two survey items asking nurses to identify preferences for incentives to remain employed and disincentives that encourage them to leave employment were included. Survey items were based on information gathered from previous focus groups exploring determinants of nurse retention. Results There were statistically significant differences in the rates of selection across generations of nurses for eight of 10 incentives to remain employed and for eight of 15 disincentives. All generational cohorts selected the same two incentives most frequently: reasonable workloads and manageable nurse–patient ratios. Two of the three most frequently selected disincentives were the same across generations: inadequate staffing and unmanageable workloads. Implications for nursing management Leaders should implement and evaluate strategies that ensure workloads are reasonable and nurse–patient ratios are manageable to promote retention among all generations of nurses in the acute care hospital workforce.