安徽省阜阳市HIV/AIDS患者人芽囊原虫感染 流行特征及危险因素

目的　调查安徽省阜阳市HIV/AIDS患者人芽囊原虫感染情况及其危险因素。方法　2016年采用横断面调查方法对安徽省阜阳市HIV/AIDS感染者进行问卷调查，收集调查对象一般人口学信息、社会经济状况、生产生活方式信息。采集调查对象粪便，通过PCR方法检测粪便基因组中人芽囊原虫DNA以判定感染状况；同时采集调查对象血液，检测其中CD4+T淋巴细胞数量和HIV病毒载量。采用单因素分析和多因素logistic回归分析对HIV/AIDS患者人芽囊原虫感染的危险因素进行分析。结果　本研究共招募398名HIV/AIDS病例，平均年龄为49.3岁、平均体重为55.9 kg、平均身高为164.4 cm。人芽囊原虫感染率为6.78%，不同性别（[χ2] = 1.589，P = 0.207）、受教育程度（[χ2] = 0.508，P = 0.776）、婚姻（[χ2] = 0.419，P = 0.811）和职业（[χ2] = 2.744，P = 0.615）患者感染率差异均无统计学意义。人芽囊原虫感染者和非感染者年龄（t = 0.370，P = 0.712）、身高（t = 1.587，P = 0.113）、体重（t = 0.516，P = 0.606）、CD4+ T淋巴细胞数量（t = 1.187，P = 0.230）和HIV病毒载量（t = 0.193，P = 0.496）差异均无统计学意义。饮用非自来水[OR = 6.554， 95% CI：（1.876，22.903）]和养狗[OR = 5.895，95% CI：（2.017，17.225）]是HIV/AIDS患者感染人芽囊原虫的危险因素。结论　安徽省阜阳市HIV/AIDS患者人芽囊原虫感染率较高，饮用非自来水和养狗是该人群人芽囊原虫感染的危险因素。     

菲立磁增强磁共振对局灶性肝病的定性价值及病理基础的研究

菲立磁是一种超顺磁氧化铁（SPIO）磁共振造影剂。目前文献针对局灶性肝病的定性价值研究较少，国内鲜邮与螺旋CT增强扫描对比研究的相关报道。为此，本文前瞻性对比评价螺旋CT增强扫描与菲立磁增强磁共振（MRI）对局灶性肝病的定性诊断价值。并对其成像的病理基础进行分析。     

Targeting mycobacterium protein tyrosine phosphatase B for antituberculosis agents

Protein tyrosine phosphatases are often exploited and subverted by pathogenic bacteria to cause human diseases. The tyrosine phosphatase mPTPB from Mycobacterium tuberculosis is an essential virulence factor that is secreted by the bacterium into the cytoplasm of macrophages, where it mediates mycobacterial survival in the host. Consequently, there is considerable interest in understanding the mechanism by which mPTPB evades the host immune responses, and in developing potent and selective mPTPB inhibitors as unique antituberculosis (antiTB) agents. We uncovered that mPTPB subverts the innate immune responses by blocking the ERK1/2 and p38 mediated IL-6 production and promoting host cell survival by activating the Akt pathway. We identified a potent and selective mPTPB inhibitor I-A09 with highly efficacious cellular activity, from a combinatorial library of bidentate benzofuran salicylic acid derivatives assembled by click chemistry. We demonstrated that inhibition of mPTPB with I-A09 in macrophages reverses the altered host immune responses induced by the bacterial phosphatase and prevents TB growth in host cells. The results provide the necessary proof-of-principle data to support the notion that specific inhibitors of the mPTPB may serve as effective antiTB therapeutics.     

Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn��s disease

AIM: To compare the histopathologic features of intestinal tuberculosis (ITB) and Crohn’s disease (CD) and to identify whether polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) would be helpful for differential diagnosis between ITB and CD.METHODS: We selected 97 patients with established diagnoses (55 cases of ITB and 42 cases of CD) who underwent colonoscopic biopsies. Microscopic features of ITB and CD were reviewed, and eight pathologic parameters were evaluated. Nine cases of acid fast bacilli culture-positive specimens and 10 normal colonic tissue specimens were evaluated as the positive and negative control of the TB-PCR test, respectively. PCR assays were done using two commercial kits: kit detected IS6110 and MPB64, and kit detected IS6110 only; a manual in-house PCR method was also performed on formalin-fixed, paraffin-embedded colonoscopic biopsy specimens.RESULTS: Statistically significant differences were noted between ITB and CD with regard histopathologic criteria: size of granulomas (P = 0.000), giant cells (P = 0.015), caseation necrosis (P = 0.003), confluent granulomas (P = 0.001), discrete granulomas (P = 0.000), and granulomas with lymphoid cuffs (P = 0.037). However, 29 cases (52.7%) of ITB showed less than five kinds of pathologic parameters, resulting in confusion with CD. The sensitivities and specificities of the TB-PCR test by kit , kit , and the in-house PCR method were 88.9% and 100%, 88.9% and 100%, and 66.7% and 100% in positive and negative controls, respectively. The PCR test done on endoscopic biopsy specimens of ITB and CD were significantly different with kit (P = 0.000) and kit (P = 0.000). The sensitivities and specificities of TB-PCR were 45.5% and 88.1%, 36.4% and 100%, and 5.8% and 100%, for kit and kit and in-house PCR method on endoscopic biopsy specimens. Among the 29 cases of histopathologically confusing CD, 10 cases assayed using kit and 6 cases assayed using kit were TB-PCR positive. A combination of histologic findings and TB-PCR testing led to an increase of diagnostic sensitivity and the increase (from 47.3% to 58.2) was statistically significant with kit (P = 0.000).CONCLUSION: The TB-PCR test combined with histopathologic factors appears to be a helpful technique in formulating the differential diagnosis of ITB and CD in endoscopic biopsy samples.     

老年男性卒中危险因素的研究

目的评估老年男性卒中常见危险因素的相对危险度和独立的危险因素。方法以2002年1月至2007年6月中国人民解放军323医院门诊和住院的≥65岁的男性患者为研究对象,明确诊断为卒中的患者为病例组(326例),年龄相当的非卒中患者为对照组(358例),以统一的调查表格进行人口学特征和卒中的常见危险因素调查,以病例-对照研究设计分析各危险因素的卒中优势比,并以Logistic回归分析独立危险因素。结果单因素分析显示,病例组的收缩压、舒张压、平均血压水平、体重、体重指数均显著高于对照组;高血压、心脏病、糖尿病、肥胖、吸烟和饮酒等因素具有统计学显著意义,其OR值分别为2.26、1.57、2.57、1.96、1.49、1.54。多因素Lgistic回归显示,被筛选进入方程的变量分别为吸烟史、糖尿病病史、肥胖和高血压病史。结论老年男性卒中的独立危险因素分别是高血压、糖尿病、吸烟、肥胖。     

Fibroblast growth factor 19 increases metabolic rate and reverses dietary and leptin-deficient diabetes

Hormonal control of metabolic rate can be important in regulating the imbalance between energy intake and expenditure that underlies the development of obesity. In mice fed a high-fat diet, human fibroblast growth factor 19 (FGF19) increased metabolic rate [1.53 +/- 0.06 liters O(2)/h.kg(0.75) (vehicle) vs. 1.93 +/- 0.05 liters O(2)/h.kg(0.75) (FGF19); P < 0.001] and decreased respiratory quotient [0.82 +/- 0.01 (vehicle) vs. 0.80 +/- 0.01 (FGF19); P < 0.05]. In contrast to the vehicle-treated mice that gained weight (0.14 +/- 0.05 g/mouse.d), FGF19-treated mice lost weight (-0.13 +/- 0.03 g/mouse.d; P < 0.001) without a significant change in food intake. Furthermore, in addition to a reduction in weight gain, treatment with FGF19 prevented or reversed the diabetes that develops in mice made obese by genetic ablation of brown adipose tissue or genetic absence of leptin. To explore the mechanisms underlying the FGF19-mediated increase in metabolic rate, we profiled the FGF19-induced gene expression changes in the liver and brown fat. In brown adipose tissue, chronic exposure to FGF19 led to a gene expression profile that is consistent with activation of this tissue. We also found that FGF19 acutely increased liver expression of the leptin receptor (1.8-fold; P < 0.05) and decreased the expression of acetyl coenzyme A carboxylase 2 (0.6-fold; P < 0.05). The gene expression changes were consistent with the experimentally determined increase in fat oxidation and decrease in liver triglycerides. Thus, FGF19 is able to increase metabolic rate concurrently with an increase in fatty acid oxidation.     

Motilin in human milk and its elevated plasma concentration in lactating women

BACKGROUND AND AIMS: The aims of this study were to investigate whether: (i) lactating women had an elevated plasma level of motilin; (ii) there was a correlation between the plasma motilin level and the motilin level in breast milk in lactating women; and (iii) there was a difference in motilin levels between the colostrum and mature human milk in a controlled postprandial state. METHODS: Twenty control women and 18 lactating women were enrolled in this study. All samples were drawn in a controlled postprandial state. The concentration of motilin was measured using radioimmunoassay. RESULTS: The plasma motilin level in lactating women was 434 +/- 180 pmol/L on the fifth day after delivery and 450 +/- 204 pmol/L on the 42nd day after delivery (P > 0.05). Both of these values were significantly higher than those in the control women (231 +/- 48 pmol/L, P < 0.05). The motilin level in human milk in the controlled postprandial state was 161 +/- 56 pmol/L on the fifth day and 154 +/- 60 pmol/L on the 42nd day after parturition (P = 0.7). Although there was motilin in the breast milk and an elevated plasma level of motilin in the lactating women, there was no correlation in motilin level between the blood and the breast milk. CONCLUSIONS: Motilin is elevated in the blood of lactating women and human milk contains motilin. These elevated levels of motilin sustain for a period of at least 6 weeks. Further studies are necessary to assess whether motilin is involved in the development of gastrointestinal motility in the early stage of life in infancy.     

纳洛酮治疗双硫醒反应病人的护理

双硫醒（disulfiram）又称双硫仑，是乙醇增敏剂，在饮酒后被人体微量吸收可引起面色潮红、恶心呕吐、心悸、呼吸困难、视物模糊、低血压等症状，严重者可致昏迷。头孢菌素类药物与乙醇联合应用时可产生双硫醒样反应（disulfiram like reaction，DLR）]。为探讨DLR的有效治疗方法，笔者用纳洛酮（naloxone，NLX）治疗伴有明显低血压的DLR，现将结果报道如下。     

改良插管清洁灌肠法在妇科阴式手术中的应用研究

目的：减轻清洁灌肠时灌肠管插入过程对患者肛门黏膜的刺激程度,提高患者清洁灌肠时的安全性及舒适度。方法：将120例阴式手术患者随机分为实验组和对照组各60例。两组患者灌肠液、灌肠用具、灌肠方法（除外润滑及插管方法）相同。实验组先用无菌棉签蘸取适量液态石蜡油润滑灌肠管前端7～10cm,再用蘸有液态石蜡油的棉签轻轻涂抹患者肛门口及内壁约2～3cm,左手示指轻轻按摩肛缘约2s,待肛门括约肌松弛,排气后将灌肠管轻轻插入肛门7～10cm,按常规完成操作;对照组按常规润滑灌肠管前端7～10cm,排气后将灌肠管插入肛门7～10cm后灌入液体。结果：实验组灌肠时患者对护士满意度高于对照组（P〈0.05）;灌肠后肛门损伤发生率低于对照组（P〈0.05）。结论：改进后的润滑方法及插管前按摩肛缘的方法可有效减轻灌肠管对肛门的刺激,增加患者的舒适度。