河北省4个地区广泛焦虑症的流行病学调查

目的:了解广泛焦虑症的患病率及人口学特点。方法:于2004-10/2005-03随机抽取河北省邯郸、保定、秦皇岛、承德4个地级市18岁以上人口进行全省精神疾病流行病学现场抽样调查工作,总样本24000人。调查筛选工具采用改编后的一般健康问卷12项,以《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查》病人版为调查的诊断工具。根据被调查者一般健康问卷12项总分,把被调查者分为高危人群、中危人群、低危人群3类。根据预试验调查结果确定三段危险人群的分界分:总分≥4分属于高危人群,高危人群全部进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查;总分为2分或3分即属中危人群,中危人群约40%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查,总分为0分或1分即属低危人群,低危人群中10%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。改编后的一般健康问卷12项分数及内容不变,另外增加8个问题均为高危因素,并进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。结果:①实际完成调查20716人,其中男10343人(49.9%),女10373人(50.1%)。共诊断焦虑症患者127例。②按高中低危因素调整后时点患病率为7.69/1000(95%CI6.50/1000～8.88/1000)。城市患病率4.87/1000,农村患病率8.10/1000,两者差异无显著性意义(u=1.78,P>0.05)。女性患病率明显高于男性,差异有显著性意义(分别为10.42/1000,4.97/1000,u=4.49,P<0.01),男女患病率比例为1:2.10。按不同年龄阶段的人口计算出各年龄段的时点患病率,20～29岁患病率较低(3.17/1000),50～59岁患病率较高(15.56/1000)。③通过12个因素的Logistic回归分析发现,影响广泛焦虑症的危险因素有年龄50～59岁(OR=1.713);保护性因素男性(OR=0.431),年龄20～29岁(OR=0.393),收入10001～20000元(OR=0.568),收入20001～40000元(OR=0.117)。结论:广泛焦虑症的流行病学特征为女性、中老年人患病率较高,男性、青年、收入中等者患病率较低。     

GC正畸玻璃离子粘接剂和3M复合树脂粘接剂抗剪切强度的比较

目的:传统的玻璃离子粘接剂的黏结强度较低,经改良后的正畸玻璃离子粘接剂的黏结强度有了很大的改进,实验比较GC正畸玻璃离子光敏粘接剂和3M正畸复合树脂光敏固化粘接剂的抗剪切强度及牙面粘接剂残留指数。方法:试验于2006-06/11在解放军第四军医大学口腔医学院材料试验室完成。取60颗离体前磨牙随机分成GC组和3M组2组,每组30颗,分别应用GC正畸玻璃离子光敏粘接剂和3M正畸复合树脂光敏固化粘接剂黏结方丝弓托槽,在粘接剂结固后5min,24h时各取15颗牙在拉力机上测试去除托槽时的抗剪强度,同时对每一牙面上的粘接剂残留指数进行观察统计(0￣3分,0分为牙面上无残留粘接剂,3分为所有粘接剂均残留在牙面上),扫描电镜观察两组黏结断面。结果:①抗剪强度:两组在5min,24h时比较差异无显著性意义(P>0.05),组内2个时间点相比差异无显著性意义(P>0.05),且两组抗剪强度均>7MPa。②粘接剂残留指数:GC组在5min,24h时均高于3M组(P<0.05)。③电镜照片显示GC组颗粒较粗糙并有小气泡;3M粘接剂颗粒不均匀但其间结合比较紧密。结论:①GC正畸玻璃离子粘接剂和3M正畸树脂粘接剂的抗剪切强度同样达到临床使用标准要求。②使用GC正畸玻璃离子黏结在去除托槽时更有利于釉质表面的保护。     

壳聚糖抗菌支架的制备及体外释药性能

目的:制备壳聚糖抗菌支架并考察吸收性能和体外释药性能。方法:实验于2005-11/2006-04在中国科学院大连化学物理研究所生物医用材料工程组完成。采用不同相对分子质量(Mr 85 000,20 000,585 000,780 000)壳聚糖,在不同壳聚糖质量浓度(2,5,10,12g/L)和不同冷冻温度(-20,-40,-80℃)条件下,用冷冻干燥法制备一系列载磺胺嘧啶银壳聚糖海绵支架。将干燥到恒质量的海绵支架放入磷酸盐缓冲液中,24h后取出海绵支架采用滤纸吸除表面多余液体,立即称湿质量,计算得到海绵支架的吸收性能,吸收性能(%)=(湿质量-恒质量)/恒质量×100%。将海绵支架置于含50mL磷酸盐缓冲液的三角瓶中,置于35℃恒温水浴振荡。按实验设计时间10,20,30,60,90,120,180,240,300min取出释放液样本,采用紫外可见分光光度计于256nm波长处检测释放液的吸光度值,根据标准曲线计算累积释放量。结果:壳聚糖海绵支架吸收磷酸盐缓冲液的质量可达自身质量的20￣30倍,并且冷冻温度越高,所形成的海绵支架的吸收能力越强。载磺胺嘧啶银壳聚糖支架体外释药受壳聚糖相对分子质量、壳聚糖溶液质量浓度、冷冻温度的影响,但释药规律基本一致,在前30～60min内有一快速释放,随后保持缓慢平稳的释放。结论:冷冻干燥法制备的载磺胺嘧啶银壳聚糖海绵支架用于创面时,壳聚糖海绵支架可以吸收大量渗出的体液,使载药支架处于湿润的环境,同时磺胺嘧啶银快速从支架内释放出来可以达到抑制细菌生长的目的。     

Effects of nandrolone decanoate compared with placebo or testosterone on HIV-associated wasting

Objectives Current research is unclear about the most effective pharmacological agents for managing the loss of weight and fat-free mass common in HIV/AIDS. The aim of this study was to compare nandrolone decanoate with placebo and testosterone. Methods The study was a multicentre randomized double-blind placebo-controlled trial. Three hundred and three adult HIV-positive male patients with a weight loss of 5-15% in the last 12 months, or a body mass index of 17-19 kg/m(2), or a body cell mass/height ratio lower than 13.5 kg/m, were randomly assigned to receive nandrolone decanoate (150 mg), testosterone (250 mg) or placebo intramuscularly every 2 weeks for 12 weeks. Fat-free mass, weight, immune markers and perception of treatment were the main outcome measures. Results Treatment with nandrolone resulted in significantly greater increases in fat-free mass [mean increase 1.34 kg; 95% confidence interval (CI) 0.60; 2.08 kg] and in weight (mean increase 1.48 kg; 95% CI 0.82; 2.14 kg) compared with placebo. The mean increase in weight with nandrolone of 1.00 kg (95% CI 0.27; 1.74 kg) when compared with testosterone was significant, although the difference in fat free mass did not reach significance (mean increase 0.69 kg; 95% CI-0.13; 1.51 kg). Patient perception of benefit was significantly greater in the nandrolone group when compared with both the placebo and the testosterone groups. Conclusions Treatment with nandrolone decanoate increased body weight when compared with placebo and testosterone. Nandrolone decanoate treatment resulted in greater increases in fat-free mass than placebo and demonstrated a trend for a significant increase when compared with testosterone.     

Hypoxic hepatitis in children after cardiac surgery

<正>To the Editor: Hypoxic hepatitis(HH), also known as ischemic hepatitis or shock liver, is a liver injury characterized by necrosis of centrilobular hepatocytes with a rapid increase in serum aminotransferase levels. The incidence rate of HH among patients in the intensive care unit(ICU) was found to be 0.9%-11.9% [1]. Occurrence of HH appears to have a significant impact on the clinical outcome.     

Risk of high‐level viraemia in HIV‐infected patients on successful antiretroviral treatment for more than 6 months

Objectives

According to the Swiss Federal Commission for HIV/AIDS, HIV‐infected patients on successful antiretroviral treatment have a negligible risk of transmitting HIV sexually. We estimated the risk that patients considered to have an undetectable viral load (VL) are actually viraemic.

Methods

A Danish, population‐based nationwide cohort study of HIV‐infected patients with VL <51 HIV‐1 RNA copies/mL for more than 6 months was carried out for the study period 2000–2008. The observation time was calculated from 6 months after the first VL <51 copies/mL to the last measurement of VL or the first VL >50 copies/mL. The time at risk of transmitting HIV sexually was calculated as 50% of the time from the last VL <51 copies/mL to the subsequent VL if it was >1000 copies/mL. The outcome was the time at risk of transmitting HIV sexually divided by the observation time.

Results

We identified 2680 study subjects contributing 9347.7 years of observation time and 56.4 years of risk of transmitting HIV (VL>1000 copies/mL). In 0.6% [95% confidence interval (CI) 0.5–0.8%] of the overall observation time the patients had VL >1000 copies/mL. In the first 6 months this risk was substantially higher (7.9%; 95% CI 4.5–11.0%), but thereafter decreased and was almost negligible after 5 years (0.03%; 95% CI 0.0–0.2%). The risk was higher in injecting drug users, but otherwise did not differ between subgroups of patients.

Conclusion

The risk of viraemia and therefore the risk of transmitting HIV sexually are high in the first 12 months of successful antiretroviral treatment, but thereafter are low.     

脐血干细胞和胎盘间充质干细胞在妇产科应用中的前景

目的:介绍脐血干细胞和胎盘间充质干细胞的研究进展,以及干细胞在妇产科中的应用前景。资料来源:应用计算机检索Medline1996-01/2006-12与脐血干细胞和胎盘间充质干细胞、以及干细胞在妇产科中的应用相关的文章,检索词为“human cord blood,mesenchy malstem cell,placenta,gene therapy in the uterus”,限定文献语种为“English”;同时检索万方数据库2000-01/2006-12相关文章,检索词为“脐血,间充质干细胞,胎盘,宫内治疗,卵巢癌,子宫癌”,限定文献语种为中文。资料选择:共检索到相关文献500余条,进一步查找全文,优先选择与临床应用靠近的文章,无论观察对象是人还是动物均纳入,筛除干细胞的提取、分化或培养等基础类研究,明显重复和综述文献也排除,最后纳入31条文献进行综述。资料提炼:31条文献中论述脐血干细胞和胎盘间充质干细胞的特点及应用文章有26篇,关于宫内移植干细胞治疗的文章有2篇,其他为研究干细胞在妇产科中应用的文章。资料综合:①大量实验证明脐血是骨髓、外周血后的第3种非常有潜力的造血干细胞资源。目前应用脐血移植治疗的疾病有急(慢)性白血病、恶性淋巴瘤、多发性骨髓瘤、再生障碍性贫血、严重免疫缺陷症等,而且已经有一定疗效。②胎盘作为胚胎发育中维系母体和胎儿氧气及营养物质交换的重要暂时性器官,无论从解剖结构还是在发育行为上,都包含了较为幼稚的胚胎及趋于成熟的成体干细胞成分,而且胎盘不会涉及伦理道德问题,目前已成为寻找人类间充质干细胞新来源及提高临床应用效果的研究热点。③干细胞宫内移植为先天性疾病治疗开辟了一条新途径。另外干细胞在器官再造、男性不育治疗和保存生育能力等生殖医学领域的研究也取得了重大进展,在妇科肿瘤方面,如以化疗保护为目标的基因治疗已逐步应用于临床。结论:脐血和胎盘取材方便、安全,还能避免免疫排斥和伦理问题,已成为人类间充质干细胞新来源。干细胞在宫内治疗、生殖疾病和妇科肿瘤方面也有广泛的临床应用前景。     

Characterization of colony-stimulating activity produced by human monocytes and phytohemagglutinin-stimulated lymphocytes

Human colony-stimulating activity (CSA) may support the proliferation of both human and murine granulocyte-macrophage progenitor cells (CFU- C) or, in the case of human urinary CSA, may only stimulate murine bone marrow CFU-C. CSA produced in the culture media of monocytes and macrophages and phytohemagglutinin-stimulated lymphocytes from human peripheral blood was characterized for both human and mouse marrow CFU- C stimulating activities. During the initial phase of a long-term cultures of monocytes, both human- and mouse-active CSA (MnCM-HM) were produced. In later phases of culture, however, only mouse-active CSA (MnCM-M) was produced. Fractionation on Sephadex G-150 revealed two functionally distinct species from MnCM-HM and lymphocytes conditioned medium, a high molecular weight factor (MW greater than 150,000) which stimulated mouse but not human colony formation, and a low molecular weight species (MW 25,000-35,000) which was active against both mouse and human target cells. However, MnCM-M revealed only one high molecular weight species (greater than 150,000), active only on mouse marrow. The possible biologic significance of such an activity is discussed.