感染与动脉粥样硬化国际研讨会结论

SAPlotkin：AmHeartJ138（Suppl）S560，1999动脉粥样硬化的感染病因假说近年国外报道频频，成为热点。为什么？因为问题涉及一种常见疾病的防、治大计。如果仅说得到证实，控制某些感染可以防止冠心病、脑卒中和其他血管事件的发生，这些造成人类死亡及病残的主要疾病的病因、发病机理、预防、治疗将大为改观。如果假说得到证实，抗生素将与他汀类同列为抗冠心病的常用药物。因此，人们一直认真追踪国外这方面文献的每一重大动态，尤其是1999年。1998年12月在法国的Annecy由法国卫生研究院及Merieux基金联合召开了邀请临床医生、病理学…     

Coronary artery fistula; coronary computed topography – The diagnostic modality of choice

Coronary artery fistulae (CAF) are rare anomalies. They are vascular communications between the coronary arteries and other cardiac structures, either cardiac chambers or great vessels. There can be considerable variation in the course of a coronary artery fistula. We report a case of a coronary artery fistula between the left circumflex coronary artery and the right and left atria. CAF are often diagnosed by coronary angiogram, however with the advent of new technologies such as Coronary Computed Tomography Angiography (Coronary CTA) the course and communications of these fistulae can be delineated non-invasively and with greater accuracy.     

Breast-feeding and a subsequent diagnosis of measles

Background: Breast-feeding protects against many infectious diseases and may also influence immunization outcomes.
Aim: This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization.
Methods: We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1–3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451).
Results: Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60–0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13–0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy.
Conclusion: Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.     

累及距下跟骰关节损伤跟骨骨折术后远期疗效

[目的] 探讨应用跟骨钢板内固定的方法治疗累及距下、跟骰关节损伤的跟骨骨折的远期临床效果.[方法] 采用钢板内固定的方法治疗跟骨关节内骨折61例63足,男58例,女3例;年龄19～68岁,平均42岁.按Sanders分型:Ⅱ型16足,Ⅲ型30足,Ⅳ型17足.其中急诊手术13足,亚急诊手术50足.[结果] 术后随访时间3～5年,平均4年3个月.术中无重要神经、肌腱损伤.术后有2足切口延迟愈合,1足发生切口皮缘坏死感染;无骨折不愈合和内固定松动及再骨折发生;2足于久走后出现距下关节痛,尚能忍受.按张铁良百分评分法进行评定:优36例,良24例,可3例,总优良率为95.2%.[结论] 选择适当的手术时机,并采用钢板内固定治疗距下、跟彀关节损伤的各型跟骨骨折,可有效恢复Bohlers角和Gissane角,具有固定坚强.并有利于早期踝关节功能锻炼.可以取得较好的远期疗效.     

"Ethnic" variation in childhood lung function may relate to preventable nutritional deficiency

This study aimed to define the differences in lung function between British Caucasian and rural eastern Indian children, and to test the hypothesis that nutrition could account for such "ethnic" variation. To exclude confounders, a rural Indian setting was identified and children were screened for respiratory illness before lung function and nutritional characteristics were measured. Regression equations for this population have already been published. In this study, the lung function differences between rural eastern Indian ( n = 391) and mean predicted lung function for Caucasian children were characterized, matched for height and sex. In addition, stepwise multiple regression models were fitted to investigate the relative associations of lung function differences with body mass index (BMI), occipitofrontal circumference and age. Although the largest differences in the forced expiratory volume in 1 s (FEV 1 ) [girls 28.7 (27.3-30.1), boys 23.4 (22.2-24.6)] and forced vital capacity [girls 27.9 (26.4-29.4), boys 30.7 (29.6-31.9)] [values as mean difference in % predicted (95% confidence intervals)] ever reported between two populations were observed, differences in peak expiratory flow rate (PEFR) were small. BMI was strongly associated with inter-racial differences for FEV 1 for both sexes (boys β= -0.227, girls β= -0.353, p ≤0.001) and PEFR for girls ( β= -0.200, p ≤0.05) ( β= standardized coefficient).

Conclusion: Preventable nutritional factors may play a causal role in determining the FEV 1 differences between rural Indian and Caucasian children. As peak FEV 1 in youth influences respiratory morbidity in later life, it is important to define specific nutrient 1 deficiencies that may relate to poor FEV growth in these children.     

脂代谢通路及脂代谢异常在癌症中的研究现状

脂质具有多种重要的生物功能,在生物体内具有复杂的代谢通路及多种脂质间的相互转化。脂质代谢异常可引发诸多人类疾病,包括糖尿病、肥胖症、癌症以及神经退行性疾病等。肿瘤的发生发展是一个多机制多因素的复杂的生物学过程,近年来,能量代谢异常在多种癌症研究中日益受到关注。随着脂质组学技术的发展,越来越多的研究表明脂质谱系变化及脂代谢异常在癌症的发生发展过程中扮演着十分重要的作用。本文从脂代谢通路、不同脂类在癌症中的异常代谢及其研究进展这几个方面对脂代谢在癌症发生发展中的作用与研究现状作一综述。     

18F-FDG PET/CT显像在原发性中枢神经系统淋巴瘤诊断中的应用

目的:探讨¹⁸F-FDG PET/CT在原发性中枢神经系统淋巴瘤(PCNSL)的诊断和鉴别诊断中的价值,阐明其影像学表现特点,为临床选择治疗方法提供参考和依据。方法:回顾性分析经病理证实的8例PCNSL、19例胶质瘤和28例脑转移瘤患者的 ¹⁸F-FDG PET/CT 影像资料及免疫组织化学结果;对3种疾病的半定量最大标准摄取值(SUV_max)进行比较。结果:PCNSL ¹⁸F-FDG PET/CT显像表现为结节状、团块状、束带状异常放射性摄取浓聚,病灶内示踪剂摄取均匀,与周围组织分界不清,但水肿少见。胶质瘤¹⁸F-FDG PET/CT显像的放射性摄取程度取决于其病理类型,一般低级别胶质瘤脱氧葡萄糖(FDG)摄取减低,SUV_max为2.2~4.3;高级别胶质瘤FDG摄取增高,SUV_max为9.3~17.2;病灶内示踪剂摄取欠均匀,且瘤周水肿范围较严重。典型脑转移瘤¹⁸F-FDG PET/CT显像表现为病灶放射性摄取增高,灶周伴大片状水肿。PCNSL患者的SUV_max高于脑转移瘤患者(P<0.05),PCNSL与胶质瘤患者SUV_max比较差异无统计学意义(P>0.05)。结论:PCNSL 患者¹⁸F-FDG PET/CT 显像具有一定的影像学特征,可与其他中枢神经系统肿瘤进行鉴别诊断。     

洋地黄毒苷对肺癌NCI-H446与A549细胞增殖和周期的影响

目的： 探讨洋地黄毒苷对肺癌NCI-H446与A549细胞增殖和细胞周期的影响,并初步探讨其可能的作用机制。方法：体外培养的NCI-H446与A549细胞分别经不同浓度(10、20、40、80、160 nmol/L)的洋地黄毒苷处理24、48和72 h后,采用MTT法检测细胞增殖情况,应用流式细胞术检测洋地黄毒苷处理细胞48 h后各组细胞周期分布,Western blot检测细胞中Cyclin A和P21蛋白表达水平。结果：与未经洋地黄毒苷处理的对照组相比,不同浓度(10、20、40、80和160 nmol/L)的洋地黄毒苷均可抑制 NCI-H446与A549细胞的增殖, 均呈剂量和时间依赖性(P<0.05),作用48 h后,洋地黄毒苷对NCI-H446与A549细胞的IC50值分别为61.26 nmol/L和110.73 nmol/L。流式细胞仪分析结果显示,随药物作用浓度增加,G0/G1细胞比例降低,S期细胞比例显著增加,与对照组相比,差异具有统计学意义(P<0.05)。Western blot分析结果显示,洋地黄毒苷能剂量依赖性的下调Cyclin A1蛋白表达和上调P21 蛋白的表达(P<0.05)。结论：洋地黄毒苷可抑制体外培养的肺癌NCI-H446与A549细胞增殖,诱导细胞发生S期阻滞,其机制可能与细胞周期相关调控蛋白的表达有关。     

血清雄性激素、AMH检测 在女性不孕诊断中的应用价值

目的 探讨雄激素、抗苗勒氏管激素(AMH)对女性不孕诊断中的应用价值。方法 用化学发光法检测258例女性不孕患者雄激素睾酮(To)、雄烯二酮(AND)、硫酸去氢表雄酮(17HS)、性激素结合球蛋白(SHG)和抗苗勒氏管激素(anti-Müllerian hormone,AMH); 女性不孕患者按照不孕原因分观察组(内分泌性不孕158例)和对照组(输卵管因素不孕100例),两组数据采用t检验进行统计学分析; 采用Pearman's 相关法分析女性不孕患者血清AMH水平与AND,SHG间的关系; 采用ROC曲线评估AND和AMH对女性不孕的诊断效能。结果 ①观察组与对照组的各项指标To,AND,AMH,SHG分别为(1.25±0.41 vs 0.25±0.15)nmol/L,(4.9±0.62 vs 1.80±0.51)nmol/L,(13.6±3.5 vs 6.4±1.81)ng/ml和(64.2±32.1 vs 89.3±30.2)nmol/L,与对照组比较,观察组To,AND和AMH显著高于对照组(t=13.02,11.36,9.35,P值均<0.01),SHG则明显低于对照组(t=7.35,P<0.01),差异具有统计学意义; ②以生物学参考区间(AMH:7.63～10.1 ng/ml,AND:0.3～3.3 ng/ml,17HS:18～144 μg/dl,SHG:80～560 nmol/L)为标准,观察组中17HS增高占17.7%,AND增高占72.2%,AMH增高占87.9%,SHG降低51.2%; ③AMH水平与AND存在正相关(r=0.579,P<0.05),与SHG存在负相关(r=0.763,P<0.05); ④AMH,AND和SHG诊断不孕的ROC 曲线下面积(AUC)分别为0.921,0.863,0.736; 最佳cutoff值分别为11.26 ng/ml,4.62 nmol/L和32.62 ng/ml,灵敏度分别为89.7%,72.9%和59.6%,特异度分别为86.2%,98.5%和75.6%,准确度分别为87.1%,81.6%和51.2%。联合检查AND,AMH和SHG诊断不孕的灵敏度、特异度分别为96.3%和90.2%。结论 用ROC曲线分析的结果表明AMH,AND和SHG对内分泌性不孕具有诊断价值; 联合检测AMH和AND,SHG对不孕症的早期诊断和治疗更有意义。