The effects of household wealth on HIV prevalence in Manicaland,Zimbabwe – a prospective household census and population-based open cohort study

Introduction

Intensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe.

Objectives

To assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population-based open cohort.

Methods

Household wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011). Temporal trends in summed asset ownership indices for sellable, non-sellable and all assets combined were compared for households in four socio-economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). Multivariate logistic random-effects models were used to measure differences in individual-level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation.

Results

Household mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non-sellable assets continued increasing until 2008. Small-town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better-off locations (small towns) but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.

Conclusions

The economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio-economic locations and sub-groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.     

慢性移植肾失功后的移植肾切除手术分析

目的:分析总结因慢性移植肾失功而行移植肾切除手术患者的临床治疗经过,进一步探讨这类手术的安全性和适应证。方法:以慢性移植肾失功患者76例为研究对象,年龄23~72(36.6±13.5)岁,以上患者发生慢性移植肾失功的时间为术后11~91(35.8±24.6)个月,转入血液透析的时间为3~33(10.4±6.2)个月。76例患者均实施了移植肾切除手术,移植肾切除术后随访时间为6个月~5年。结果:平均手术时间50(35~180)min;术中平均出血量450(200~2 600)ml,平均输血量300(400~2 400)ml,其中67例进行了自体血液回收后输血。术后平均引流量250(20~1 100)ml,平均住院时间11(5~23)d。术后主要并发症:切口血肿8例,切口感染10例,消化道出血7例,心衰7例,肺部感染5例,肾上腺危象2例,下肢跛行2例。死亡4例。多数患者的体重指数、血红蛋白及血清白蛋白含量较术前有所提高。结论:慢性移植肾失功后的移植肾切除手术为高风险手术,应积极做好术前准备,同时加强围手术期护理,以降低手术并发症的发生率;积极适时地切除已经完全失功了的移植肾,有助于改善患者身体素质,避免免疫抑制的不良反应,同时有利于减轻患者本人及社会的经济负担。     

缺陷腺病毒载体表达重复10次的Aβ3-10基因疫苗鼻黏膜免疫APPswe, PSEN1dE9转基因小鼠可诱导出Th2型免疫反应

Immunotherapy for Alzheimer’s disease (AD) is effective in improving cognitive function in transgenic mouse models of AD. Because the AN1792 [beta-amyloid (Aβ) 1-42] vaccine was halted because of T cell mediated meningoencephalitis, many scientists are searching for a novel vaccine to avoid the T cell mediated immune response caused by the Aβ1-42. Importantly, the time when the immunization is begun can influence the immune effect. In this study, an adenovirus vaccine was constructed containing 10 × Aβ3-10 repeats and gene adjuvant CpG DNA. Transgenic AD mice were immunized intranasally for 3 months. After 10 × Aβ3-10 vaccine immunization, high titers of anti-Aβ42 IgG1 predominant antibodies were induced. In spatial learning ability and probe tests, the 10 × Aβ3-10 immunized mice showed significantly improved memories compared to control mice. The 10 × Aβ3-10 vaccine resulted in a robust Th2 dominant humoral immune response and reduced learning deficits in AD mice. In addition, the 10 × Aβ3-10 vaccine might be more efficient if administered before Aβ aggregation at an early stage in the AD mouse brain. Thus, the adenovirus vector encoding 10 × Aβ3-10 is a promising vaccine for AD.     

氟伐他汀对脂多糖和血管紧张素Ⅱ致大鼠主动脉内皮细胞TF和TFPI表达的影响

目的 研究氟伐他汀(fluvastatin)对脂多糖(LPS)和血管紧张素Ⅱ(AngⅡ)诱导的离体大鼠主动脉内皮细胞(RAEC)表达组织因子(TF)和组织因子途径抑制物(TFPI)的影响.方法 体外培养RAEC,分别给予LPS和AngⅡⅡ刺激,采用ELISA法检测氟伐他汀对RAEC TF和TFPI表达的影响.结果 氟伐他汀0.01、O.1、1和10μmol/L组能剂量依赖性抑制LPS和AngⅡ引起的TF表达增强;氟伐他汀0.01、0.1、1和10μmnol/L.组TFPI表达增强,呈剂量依赖性.结论 氟伐他汀能抑制引起血栓形成的TF表达,增加TFPI表达.     

针刺治疗慢性无菌性前列腺炎文献系统评价

目的：系统评价针刺治疗慢性无菌性前列腺炎（CNBP）的有效性。方法：按照循证医学的要求,以针刺、体针、电针、头针、CNBP等为主题词,检索国内相关医学数据库,以随机临床对照试验为纳入标准。治疗组为针刺或针刺加其他疗法,对照组为药物,把CNBP痊愈率为测量指标。共纳入33篇文献,并对其中6篇文献采用RevMan4．2．9进行Meta分析。结果：6篇文献的痊愈率合并OR=3．48,95％CI[2．46,4．92],治疗组对CNBP的疗效优于对照组（P〈0．05）。结论：从纳入的国内文献来看,针刺治疗CNBP有效,且效果优于药物,但是仍需要更多的高质量文章来证实。     

基于1H-NMR代谢组学的阿胶化学成分差异性分析方法初探

目的 采用氢核磁共振(¹H-NMR)代谢组学技术对不同生产厂家的阿胶酸水解成分进行差异性比较。方法 对5个不同生产厂家的阿胶进行酸水解,然后进行¹H-NMR分析。对所得的¹H-NMR图谱进行化学成分归属指认,并结合相关软件进行多元统计分析,找出差异性化学成分。结果 从阿胶¹H-NMR谱中指认出17种化学成分;通过对A、C、D、E厂家生产的阿胶与B厂家生产的阿胶进行比较分析,找出了相应的差异性成分,主要包括异亮氨酸、羟脯氨酸、精氨酸、亮氨酸、苯丙氨酸、缬氨酸、赖氨酸和乙酰丙酸等。结论 ¹H-NMR代谢组学方法可用于不同厂家阿胶化学成分差异性的分析,为阿胶的质量控制提供新方法和新思路。     

Adoptive immunotherapy evaluating escalating doses of donor leukocytes for relapse of chronic myeloid leukemia after bone marrow transplantation: separation of graft-versus-leukemia responses from graft-versus-host disease

Infusions of large numbers (> 10(8)/kg) of donor leukocytes can induce remissions in patients with chronic myeloid leukemia (CML) who relapse after marrow transplantation. We wanted to determine if substantially lower numbers of donor leukocytes could induce remissions and, if so, whether this would reduce the 90% incidence of graft-versus-host disease (GVHD) associated with this therapy. Twenty-two patients with relapsed CML were studied: 2 in molecular relapse, 6 in cytogenetic relapse, 10 in chronic phase, and 4 in accelerated phase. Each patient received escalating doses of donor leukocytes at 4- to 33-week intervals. Leukocyte doses were calculated as T cells per kilogram of recipient weight. There were 8 dose levels between 1 x 10(5) and 5 x 10(8). Lineage-specific chimerism and residual leukemia detection were assessed using sensitive polymerase chain reaction (PCR) methodologies. Nineteen of the 22 patients achieved remission. Remissions were achieved at the following T-cell doses: 1 x 10(7) (n = 8), 5 x 10(7) (n = 4), 1 x 10(8) (n = 3), and 5 x 10(8) (n = 4). To date, 15 of the 17 evaluable patients have become BCR-ABL negative by PCR. The incidence of GVHD was correlated with the dose of T cells administered. Only 1 of the 8 patients who achieved remission at a T-cell dose of 1 x 10(7)/kg developed GVHD, whereas this complication developed in 8 of the 11 responders who received a T-cell dose of > or = 5 x 10(7)/kg. Three patients died in remission, 1 secondary to marrow aplasia, 1 of respiratory failure and 1 of complications of chronic GVHD. Sixteen patients who were mixed T-cell chimeras before treatment became full donor T-cell chimeras at the time of remission. Donor leukocytes with a T-cell content as low as 1 x 10(7)/kg can result in complete donor chimerism together with a potent graft-versus-leukemia (GVL) effect. The dose of donor leukocytes or T cells used may be important in determining both the GVL response and the incidence of GVHD. In many patients, this potent GVL effect can occur in the absence of clinical GVHD.     

Protein Losing Enteropathy in Severe Atopic Dermatitis in an Exclusively Breast-Fed Infant

Abstract:   We first report a case of protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed 5-month-old infant. Protein losing enteropathy was confirmed by fecal α₁-antitrypsin clearance test and imaged successfully by ^99mTc-human serum albumin scintigraphy. The present case highlights that protein losing enteropathy in severe infantile atopic dermatitis is being a topic of concern and also an issue even in exclusive breast feeding patients.     

乌贼墨对小鼠脾细胞和巨噬细胞NO生成及 IFN-γ分泌水平的影响

目的：探讨乌贼墨对脾细胞和巨噬细胞NO生成及IFN-γ分泌的影响。方法：用Griess法和ELISA法分别检测了经乌贼墨灌胃处理后小鼠脾细胞和腹腔巨噬细胞培养上清中NO和IFN-γ的水平的变化。结果：乌贼墨灌胃处理小鼠后的第4、6天脾细胞及腹腔巨噬细胞(Mφ)可产生较高水平的NO；脾细胞可产生较高水平的IFN-γ，并且小鼠脾细胞NO的产生水平与IFN-γ产生水平呈正相关(r=0．98)；用LPS和L-NMMA(NO抑制剂)分别同乌贼墨灌胃第6d小鼠的脾细胞一起培养，结果显示LPS可协同IFN-γ促NO水平升高。L-NMMA可抑制小鼠脾细胞的NO生成。结论：乌贼墨可促进巨噬细胞NO生成；脾细胞NO的产生与IFN-γ分泌水平呈正相关。     

2008年泌尿外科热点问题

随着科学技术的飞速发展,随着世界逐渐进入老龄化社会,泌尿外科疾病发病率日益增高,泌尿外科逐渐发展成为临床医学的一门重要学科.2008年泌尿外科有许多热点问题.