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。     

Gene regulation and host adaptation mechanisms in Candida albicans.

The yeast Candida albicans is a harmless member of the normal microflora on the mucosal surfaces of most healthy persons, but it can cause severe opportunistic infections in immunosuppressed patients. To become a successful human commensal and pathogen, C. albicans has evolved host adaptation mechanisms on different levels. The regulated expression of virulence and other genes in response to environmental signals allows an optimal adaptation to new host niches during the course of an infection. In addition, C. albicans is able to switch between different cell types in a reversible and apparently random fashion. Phenotypic switching involves the coordinated regulation of phase-specific genes, and the resulting generation of selected, pre-programmed cell types may represent an additional strategy to adapt to certain host environments. Finally, C. albicans produces genetically altered variants at a high rate. This microevolution ensures survival when the pathogen encounters new adverse conditions, as exemplified by the development of stable drug-resistant variants under the selection pressure caused by antimycotic therapy. Thus, rather than the possession of single dominant virulence factors, it is its remarkable versatility that makes C. albicans the most important fungal pathogen of humans.     

The changing clinical pattern of Reye's syndrome 1982-1990

OBJECTIVE: To describe trends in the clinical pattern of Reye's syndrome in the British Isles between 1982 and 1990; and to determine the relation between any changes and the June 1986 warnings against the use of aspirin in children. DESIGN: Development, and application to reported cases, of a scoring system designed such that patients showing the typical clinical and pathological features of 'classical' Reye's syndrome scored highly. The relations between 'Reye scores' and a number of explanatory variables were explored using multivariable analysis. SETTING: British Isles. SUBJECTS: 445 cases fulfilling the Reye's syndrome case definition reported to the surveillance scheme between January 1982 and December 1990. MAIN OUTCOME MEASURE: Individual 'Reye score'. RESULTS: Cases with high scores were more likely to have occurred in the 4 1/2 year period before June 1986 compared with the subsequent period (p < 0.006). Numbers of cases in the low and intermediate score categories declined by about 50% after June 1986, whereas those in the high category fell by 79%. High scorers were more likely to have received aspirin (p < 0.0001) and were older than intermediate and low scorers (p < 0.008). No relation was identified between score and season of onset. CONCLUSIONS: The decline in Reye's syndrome after the aspirin warnings cannot be explained entirely, as has been proposed, by improved diagnosis of 'Reye-like' inherited metabolic and other disorders: this would not account for the greater decline of the high scoring subgroup which also contained those cases most likely to resemble 'classical' Reye's syndrome and to have received aspirin. This study provides further evidence for the role of aspirin in a subset of cases meeting the standard diagnostic criteria for Reye's syndrome and supports the need to consider this disorder as a heterogeneous group of conditions including Reye-like inherited metabolic disorders.     

筛选心肌缺血再灌注大鼠差异表达基因

目的：利用抑制性消减杂交技术，筛选出大鼠心肌缺血再灌注的差异表达基因，以期通过基因线索探讨其损伤机制。方法：实验于2006—03／10在中山大学中山医学院完成。①实验分组：Sprague-Dawley雄性大鼠40只，随机分为手术组，对照组，每组20只。②实验干预：手术组结扎左冠状动脉，心电图出现急性心肌梗死改变90min后，去除结扎线，再灌注60min，建立心肌缺血再灌注大鼠模型。对照组仅穿线不结扎，余同手术组。③取缺血区心肌，提取Total RNA，构建cDNA文库，利用抑制性消减杂交技术筛选差异表达基因，测序，登录Genbank寻找同源性基因。结果：共获得124个阳性结果，56个为高表达基因，68个为低表达基因，其中发现5个新的cDNA片段。其中能量代谢、物质运输、信号转导相关差异表达基因分别占所有差异表达基因的39．25％，15．89％，15．89％，并且主要变化为下调。结论：抑制性消减杂交技术是一种高效的筛选差异基因的方法。心肌缺血再灌注后基因变化涉及多种功能的基因，以能量代谢、物质运输、信号转导相关基因下调明显。     

Novel PLA/Chitosan Composite Materials Prepared by SCF-CO2 Technique

Because of the incomparable merits （nontoxicity, non-remainder, fast transfer mass） of supercritical carbon dioxide fluid technique（SC-CO2）, it was used to developed a series of novel biodegradable tissue engineering scaffold materials in this research. The novel PLA/chitosan composite materials could be molded to different shapes, and the porosity of the materials were over 200 lam and connected. Chondrocyte cultivation, subcutaneous and intramuscular implantation were mainly discussed this paper. The results showed that the cells could well adhere, grow and multiplicate on the surface of the materials, which indicated good biocompatibility of the composite materials. The plantation test revealed that the PLA materials had already dismissed 2 month late in the body, while the composite materials could still keep certain strength and shape, and the most important things is the response of the tissue toward the implanted PLA/chitosan composite materials was mild and had far less inflammation than PLA materials. 8 to 16 weeks later, fiber membrane was stable; degradation of the materials was seen clear and tissue had already spread into it.     

Bone marrow changes in chronic myelogenous leukaemia after long-term treatment with the tyrosine kinase inhibitor STI571: an immunohistochemical study on 75 patients

AIMS: To carry out an immunohistochemical study on bone marrow (BM) biopsy specimens in 75 patients with chronic myelogenous leukaemia (CML) on long-term STI571 therapy. METHODS AND RESULTS: Sequential BM specimens taken at intervals of 21 +/- 6 months were investigated by enzyme- and immunohistochemistry including proliferating cell nuclear antigen and apoptosis. Evaluation was performed either by semiquantitative scoring or by morphometry (CD61+ megakaryopoiesis). In 41 patients with chronic phase CML, treatment resulted in a significant decrease in cellularity and neutrophil granulopoiesis contrasting with an accumulation of erythroid precursor cells. Morphometry showed a reduction of abnormal micromegakaryocytes consistent with normalization. Regression of myelofibrosis was identified in eight of 15 patients, whereas progression occurred in 17 patients; mostly in those with acceleration and blastic crisis. The increased post-treatment incidence of reactive lymphoid nodules was remarkable. Myeloblasts, CD34+ progenitors and immature myelomonocytic cells initially decreased, but recurred in 14 patients who later developed a relapse. STI571 exerted an inhibitory effect on cell proliferation associated with enhanced apoptosis in responding patients. CONCLUSION: Long-term treatment with STI571 exerts pronounced changes on BM histopathology that not only involve haematopoiesis and stromal constituents, but also proliferation and apoptosis.     

Therapie-bedingte Veränderungen der Angiogenese bei Philadelphia-Chromosom-positiver chronischer myeloischer Leukämie

To elucidate the effect of first-line treatment with interferon (IFN), hydroxyurea (HU) and the tyrosine kinase inhibitor imatinib (STI571) on angiogenesis, we studied bone marrow (BM) biopsies in 104 patients with chronic myelogenous leukemia (CML) and 138 patients before and after allogeneic BM transplantation (BMT). After immunostaining (CD34) and morphometric analysis in comparison with a control group, CML specimens showed an increased vascularity and conspicuous morphological abnormalities of microvessels. A close relationship between microvessels and fiber density was detectable in initial biopsies and also in repeatedly performed examinations following therapy. Monotherapy by imatinib and HU generated a significant reduction of microvessels and reticulin fibers in contrast to changes after IFN administration or combination regimens of IFN and HU. A persistence of numerical and structural anomalies of vasculature was observable even several months after BMT. These anomalies shed some light on disturbances of the stroma compartment after myeloablative therapy. The relationship between BM vascularity and fibers is probably dependent on concomitant changes of megakaryopoiesis as the source of various mediators involved in the development of myelofibrosis and neo-angiogenesis acting within a complex functional network.     

Clinical importance of zona pellucida-induced acrosome reaction and its predictive value for IVF

The study aimed to establish zona pellucida induced acrosome reaction response (ZIAR) among 35 couples with normal and G-pattern sperm morphology and repeated poor fertilization results during assisted reproduction treatment. ZIAR tests were performed using 0.25 zona pellucida/microliter co-incubated with spermatozoa for 60 min. Acrosome reactions were measured with FITC-PSA staining, and expressed as the difference between stimulated and unstimulated (spontaneous) sperm populations. Results were compared with IVF rates of metaphase II oocytes. Interactive dot diagrams divided the patients into two groups, i.e. ZIAR <15% and ZIAR > 15%, with mean fertilization rates of 49 and 79% respectively. The sensitivity and specificity for ZIAR results versus fertilization were 93 and 100% respectively. The area under the curve was 99% and the 95% confidence interval did not include 0.5 which implies that the ZIAR test is able to predict fertilization failure among IVF patients. In conclusion, the ZIAR test has diagnostic potential since it can assist the clinician to identify couples that will benefit from intracytoplasmic sperm injection therapy.