某省降低危害干预项目的成本分析

随着降低危害的干预在高危人群中迅速扩展,艾滋病防治资源分配和使用效益问题已越来越受到关注。本研究提示G省干预滞后于疫情发展;不同的干预在成本、产出方面差别很大。G省干预项目的单位成本较国外同类项目低;但是由于收集的资料有限,干预未能体现经济规模效应,研究提示在中国开展成本横向比较、纵向跟踪的必要性、可行性。     

Upregulation of heme oxygenase-1 by degranulation in rat basophilic leukemia cells

Heme oxygenase (HO)-1, which is a rate-limiting enzyme involved in the catabolism of heme, is upregulated by a variety of stresses including oxidative stresses and inflammatory cytokines, in many cell types. Recent studies have suggested that upregulation of HO-1 might provide cytoprotection and immunomodulatory functions in addition to its obvious role in heme metabolism. In this study, we examined whether HO-1 was upregulated following degranulation in mast cells that initiate vigorous immunity reactions. To trigger degranulation, rat basophilic leukemia (RBL)-2H3 cells were passively sensitized using an antiserum collected from ovalbumin (OA) immunized-Brown Norway rats, and the cells were stimulated by treatment with OA. Degranulation was confirmed by measuring the release of beta-hexosaminidase. HO-1 mRNA and presence of HO-1 protein were detected using Northern blot and Western blot analyses, respectively. The effect of the antioxidant N-acetyl-L-cysteine (NAC) on HO-1 expression was also tested. HO-1 mRNA transiently increased at 1--2 h after RBL-2H3 cells were stimulated to degranulate. Its mRNA increases were dependent on the extent of degranulation. Following the upregulation of HO-1 mRNA, HO-1 protein was also increased. We also detected intracellular production of reactive oxygen species following degranulation in RBL-2H3 cells. NAC attenuated the HO-1 expression in a dose-dependent manner. This is the first report to reveal induction of both HO-1 mRNA and protein by degranulation in RBL-2H3 cells. We showed that NAC inhibited HO-1 upregulation. These results suggest that oxidative stress in activated RBL-2H3 cells results in the upregulation of HO-1.     

Efficacy of Tokishakuyakusan on the anemia in the iron-deficient pregnant rats

Iron-deficiency anemia not only causes insufficient oxygen delivery to the body of the mother, but creates serious conditions in the fetus, such as insufficient oxygen delivery and poor development, and its treatment has become an important issue. To elucidate the mechanism of the anemia-ameliorating action of Tokishakuyakusan, we investigated the effect of administration of Tokishakuyakusan on anemia-related parameters and the serum transferrin and erythropoietin levels, erythrocyte morphology, and bone marrow cells in pregnant rats and in pregnant rats with iron-deficiency anemia. The results showed that Tokishakuyakusan significantly improved the low erythrocyte count, hemoglobin, and hematocrit values of the pregnant rats in the iron-deficient state, increased the proportion of normal erythrocytes in terms of erythrocyte morphology, increased the proportion of erythroblasts among bone marrow cells, and also significantly increased the erythropoietin and transferrin levels in the blood. These findings suggested that Tokishakuyakusan promotes erythrocyte differentiation in iron-deficiency anemia, and that it possesses anemia-ameliorating efficacy.     

Repair of the triangular fibrocartilage complex after ulnar-shortening osteotomy: second-look arthroscopy

PURPOSE: Ulnar shortening is a widely used procedure for various conditions associated with ulnar wrist pain, including triangular fibrocartilage complex (TFCC) injury; however, few reports have examined the condition of the TFCC after osteotomy. The central avascular zone of the TFCC generally is considered to have no potential to heal. This study investigated whether the avascular zone of the TFCC has any potential for repair, and whether repair of the torn disc proper correlates with clinical findings. METHODS: Between 1987 and 2005, we performed 75 second-look arthroscopies after an ulnar-shortening osteotomy for ulnar wrist disorders. Of these, 32 wrists with a TFCC (disc proper) tear on first arthroscopy were included in this study. Data from patient charts, radiography, and video images of arthroscopy were reviewed retrospectively. Tears of the disc proper were classified as radial, central, or ulnar tears, and as either linear or round tears. RESULTS: Meticulous second-look arthroscopy showed repair of tears in 50% of studied wrists. Round tears tended to repair better than linear tears. Although the final clinical score was better in repaired wrists than in nonrepaired wrists, no marked differences were noted between groups in terms of age, gender, preoperative ulnar variance, follow-up period, or surgical procedures used. CONCLUSIONS: The avascular zone of the TFCC possesses some potential for repair; however, factors promoting spontaneous repair of this tissue were not identified. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Involvement of kappa opioid receptors in formalin-induced inhibition of analgesic tolerance to morphine in mice

This study examined the role of kappa opioid receptors (KOR) in the mechanism underlying tolerance to the analgesic effects of morphine induced by chronic pain. The analgesic effect of morphine (10 mg kg(-1)), estimated by the tail-flick test in mice, gradually decreased during repeated daily morphine treatment. A significant decrease in the analgesic effect of morphine was seen on the fifth day of repeated morphine treatment compared with the first day. Chronic pain was induced by subcutaneous administration of 2% formalin into the dorsal part of the left hind paw, which significantly inhibited development of tolerance to morphine analgesia. The effect of formalin-induced pain on inhibition of morphine tolerance was reversed by the KOR antagonist nor-binaltorphimine. Furthermore, an antisense oligodeoxynucleotide, but not a missense oligodeoxynucleotide, against KOR completely suppressed the inhibitory effect of formalin-induced pain on morphine tolerance. Naltrindole, an antagonist of delta opioid receptor, did not affect chronic-pain-induced tolerance to morphine. Our findings show that the inhibitory effect of chronic pain on analgesic tolerance to morphine is mediated by KOR rather than delta opioid receptors.     

Statin Attenuates Experimental Anti-Glomerular Basement Membrane Glomerulonephritis Together with the Augmentation of Alternatively Activated Macrophages

Macrophages are heterogeneous and include classically activated M1 and alternatively activated M2 macrophages, characterized by pro- and anti-inflammatory functions, respectively. Macrophages that express heme oxygenase-1 also exhibit anti-inflammatory effects. We assessed the anti-inflammatory effects of statin in experimental anti-glomerular basement membrane glomerulonephritis and in vitro, focusing on the macrophage heterogeneity. Rats were induced anti-glomerular basement membrane glomerulonephritis and treated with atorvastatin (20 mg/kg/day) or vehicle (control). Control rats showed infiltration of macrophages in the glomeruli at day 3 and developed crescentic glomerulonephritis by day 7, together with increased mRNA levels of the M1 macrophage-associated cytokines, interferon-γ, tumor necrosis factor-α, and interleukin-12. In contrast, statin reduced the level of proteinuria, reduced infiltration of macrophages in glomeruli with suppression of monocyte chemotactic protein-1 expression, and inhibited the formation of necrotizing and crescentic lesions. The number of glomerular ED3-positive macrophages decreased with down-regulation of M1 macrophage-associated cytokines. Furthermore, statin augmented ED2-positive M2 macrophages with up-regulation of the M2 macrophage-associated chemokines and cytokines, chemokine (C-C motif) Iigand-17 and interleukin-10. Statin also increased the glomerular interleukin-10-expressing heme oxygenase-1-positive macrophages. Statin inhibited macrophage development, and suppressed ED3-positive macrophages, but augmented ED2-positive macrophages in M2-associated cytokine environment in vitro. We conclude that the anti-inflammatory effects of statin in glomerulonephritis are mediated through inhibition of macrophage infiltration as well as augmentation of anti-inflammatory macrophages.Statins, inhibitors of 3-hydroxy-3-methylglutaryl CoA reductase, are widely used for the treatment of hyperlipidemia through reduction of cholesterol synthesis. In addition to their lipid lowering effect, recent evidence suggests that statins have other important properties, such as anti-atherogenic and tissue-protective functions. These functions of statin are mediated by blocking 3-hydroxy-3-methylglutaryl CoA reductase, and thereby inhibition of cholesterol synthesis, as well as blockade of the mevalonate pathway and the synthesis of isoprenoids (farnesyl pyrophosphate and geranylgeranyl pyrophosphate). Isoprenoids are essential for the post-translational modification of several proteins involved in important signaling pathways, and their inhibition would interfere with numerous important cellular functions, thus adding many additional “pleiotropic” effects for statins, such as protection of endothelial function, antioxidant effects, antithrombotic effects, and anti-inflammatory and immunomodulatory functions.^1,2 Other studies have also demonstrated that statins have beneficial effects in renal diseases and impede the progression of renal injury through their anti-inflammatory and immunomodulatory effects.³In various kidney diseases, infiltrating macrophages are found in renal inflammatory sites, and their presence in the interstitium and glomeruli contributes to the severity of tissue injury and progression of renal diseases.^4,5,6,7,8,9 Indeed, interstitial macrophages are involved in the extension of interstitial inflammation, microvascular injury, and progression of interstitial fibrosis.^{5,6,7,8,9,10,11,12} In addition, macrophages infiltrating the glomeruli enhance glomerular injury in various forms of glomerulonephritis (GN), such as antineutrophil cytoplasmic antibodies-associated GN, anti-glomerular basement membrane (GBM) GN, lupus nephritis, cryoglobulinemia, mesangioproliferative GN, IgA nephropathy, and diabetic nephropathy.^5,7,8,13,14 Furthermore, in experimental anti-GBM GN in Wistar-Kyoto (WKY) rats, activated macrophages are the direct cause of necrotizing and crescentic glomerular lesions.^{15,16,17,18,19}In the macrophage-associated inflammatory process, recent studies have focused on the heterogeneity of macrophage activation and in particular their ability to amplify or curtail inflammation.²⁰ In response to environmental milieu, macrophage changes can give rise to different populations of cells with distinct functions that are categorized as either classically activated (M1) or alternatively activated (M2).²¹ Classically activated M1 macrophages are tissue injury type macrophages involved mainly in the expansion of inflammation.^13,22 On the other hand, the M2 macrophages have immunoregulatory and immunosuppressive functions. In addition, heme oxygenase-1 (HO-1) positive (+) macrophages act as cytoprotective anti-inflammatory macrophages by local delivery of HO-1.²³ Thus, in addition to the numbers of infiltrating macrophages, macrophage phenotype is important in determining the outcome of inflammatory disease.While statins decrease the total number of infiltrating macrophages in renal diseases,^3,24,25,26 it remains uncertain whether statins affect the composition of the macrophage population. In the present study, we investigated the influence of statin on macrophage phenotype, particularly pro-inflammatory and anti-inflammatory macrophages, in a rat model of macrophage-mediated immune glomerular injury induced by injection of anti-GBM antibody in WKY rats.     

Factors Associated With Health Service Utilization in Ulaanbaatar,Mongolia: A Population-Based Survey

Background

Understanding patterns of health service utilization can improve health care and increase use of health services. We examined patterns of health service utilization among residents of Ulaanbaatar, Mongolia.

Methods

A total of 500 adults were surveyed using paper-based questionnaires. The χ² test and multiple logistic regression were used to identify associations between factors.

Results

44.1% of respondents had visited a physician during the previous 12 months. After controlling for determinants, the significant predictors of utilization of health service were attention to health examinations (OR = 3.6, CI: 1.93–6.76), being married (OR = 2.7, CI: 1.50–4.72), being satisfied with the overall cleanliness of the hospital (OR = 2.4, CI: 1.12–5.19), being a nonsmoker (OR = 2.2, CI: 1.21–3.98), having periodic physical examinations (OR = 2.2, CI: 1.25–3.71), not being a hospital patient during the previous 3 years (OR = 2.1, CI: 1.22–3.73), having proper documentation (OR = 1.9, CI: 1.10–3.43), having medical insurance (OR = 1.9, CI: 1.96–3.28), not wanting to receive information on food and nutrition (OR = 0.6, CI: 0.36–0.96), having more than 5 household members (OR = 0.5, CI: 0.50–0.85), low income (OR = 0.5, CI: 0.30–0.85), lack of concern for food and nutrition (OR = 0.5, CI: 0.28–0.84), self-medication during the past 12 months (OR = 0.4, CI: 0.24–0.69), and desire for treatment abroad (OR = 0.4, CI: 0.20–0.60).

Conclusions

A number of health-related behaviors and sociodemographic factors were important predictors of health service utilization.Key words: health service utilization, equity, Mongolia     

Proliferation and differentiation of rat bone marrow stromal cells on poly(glycolic acid)-collagen sponge

We studied the effects of dexamethasone (Dex) and basic fibroblast growth factor (bFGF) on proliferation and differentiation of rat bone marrow stromal cells (RBMSCs), using three scaffolds: collagen sponge, poly(glycolic acid) (PGA)-collagen sponge, and PGA-collagen (UV) sponge. RBMSCs were seeded into the sponges, and cultured in primary medium, primary medium with Dex, and primary medium with bFGF and Dex. Three weeks after cultivation, we examined alkaline phosphatase (ALP) activity and cell number in the sponges, and also performed macroscopic, light microscopic, and scanning electron microscopic (SEM) observations. Collagen sponge shrank considerably, but PGA-collagen and PGA-collagen (UV) sponges maintained most of their original shape. PGA-collagen (UV) sponge supplemented with bFGF and Dex together had the highest ALP activity and cell number, followed by PGA-collagen sponge. Although collagen sponge showed cell proliferation only on the surface, the other two sponges showed cell proliferation in the interior. SEM showed the best cell attachment to PGA-collagen (UV) sponge in the presence of bFGF and Dex, followed by PGA-collagen sponge. In conclusion, PGA-collagen (UV) and PGA-collagen sponges proved to be much more useful as scaffolding for bone regeneration when combined with bFGF and Dex.     

Detection of clarithromycin resistance in Helicobacter pylori following noncryogenic storage of rapid urease tests for 30 days

OBJECTIVE: Traditional Helicobacter pylori (H. pylori) eradication therapy has been undermined by increasing antimicrobial, especially clarithromycin, resistance. Susceptibility testing in some areas is difficult to achieve or unavailable. We aimed to determine whether gastric biopsy specimens stored at room temperature for rapid urease test (RUT) were suitable for clarithromycin susceptibility testing of H. pylori. METHODS: After 30 days of storage at room temperature, DNA was extracted from gastric biopsies present in RUTs (Hpfast). H. pylori status and clarithromycin susceptibility were evaluated using H. pylori‐specific polymerase chain reaction (PCR) for ureA, vacA, and allele‐specific primer‐PCR of the 23S rRNA genes. The PCR results were compared with histology, RUT, and culture results. H. pylori positive was defined as RUT and either culture or histology positive; H. pylori negative as RUT, culture and histology negative. RESULTS: Samples from 31 patients were evaluated; 11 were H. pylori positive including 9 by culture; seven of which had allele‐specific primer‐PCR results from the RUT specimen for the detection of mutations of the 23S rRNA gene. When both tests were available, culture and PCR results were concordant in 7 cases. In 15 of the 20 histology, RUT and culture negative patients, three PCR were negative. In one patient, all of the three tests were positive; and in three only the 23S rRNA was positive and in one only ureA was positive. CONCLUSION: Gastric biopsy specimens stored in the gel of RUT for 30 days can be used for molecular testing to confirm the diagnosis of H. pylori infection and test for clarithromycin susceptibility.