亚太地区炎症性肠病处理共识意见(二)

通过Medline检索过去15年内亚太地区发表的IBD治疗文献发现，虽然可检索到该地区有关IBD的先进治疗手段，但缺乏富有实践经验的临床治疗研究文献。在亚太地区IBD工作组（APWP-IBD）会议上就IBD的治疗提出了下列问题，并基于文献回顾和专家经验达成如下共识意见。     

Complete amino acid sequence of a 50,000-dalton fragment of human ceruloplasmin.

The complete amino acid sequence has been determined for a 50,000-dalton fragment that is an internal segment of the single polypeptide chain of human ceruloplasmin [ferroxidase; iron(II):oxygen oxidoreductase, EC 1.16.3.1]. The fragment (designated Cp F4) contains 405 amino acid residues, has one glucosamine-containing carbohydrate unit, and, together with the 19,000-dalton fragment that follows it, accounts for the carboxyl-terminal half of the molecule. Fragment Cp F4 has a very nonuniform distribution of certain amino acid residues, which show a high potential to be adjacent to or one residue separated from a similar amino acid. This is most pronounced for acid and amide residues (65% clustered), aromatic residues (56% clustered), and basic residues (41% clustered). In addition, there is a long-range clustering of proline residues at the amino- and carboxyl-terminal 60 residues (50% clustered). Also, there are a number of short repeated segments of sequence. Calculations based on parameters predictive of secondary structure folding patterns indicate that the 50,000-dalton fragment has a low content of alpha-helix and is predominantly beta-sheet, beta-turn, and random in structure. Limited enzymatic cleavage of human ceruloplasmin to yield 67,000-, 50,000-, and 19,000-dalton fragments occurs at specific exposed sites of random structure in between domain-like regions.     

Complete covalent structure of a human immunoglobulin D: sequence of the lambda light chain.

We have determined the amino acid sequence of the lambda light chain of human IgD WAH. Together with the sequence of the delta heavy chain already reported, this establishes the complete covalent structure of a human immunoglobulin D. The sequence determination was greatly aided by our ability to use high-pressure liquid chromatography to purify large peptides, including one large fragment extending from Ser-81 through the carboxyl terminus. The IgD molecule is a four-chain monomer of Mr approximately equal to 176,000; it consists of two lambda chains (each of 214 residues, Mr = 22,893) and two delta chains (each of 512 residues, Mr approximately equal to 65,000, including carbohydrate), and, unlike murine IgD, it contains two C delta 2 domains. A computer-assisted search using the J (joining) segment of the WAH lambda chain as a test piece showed a close evolutionary relationship of human and mouse J lambda regions and suggested that germ-line J lambda genes in the two species are very similar if not identical. DNA segments encoding J lambda, J kappa, and JH appear to have had a common evolutionary origin, and, surprisingly, JH seems closer to J lambda than does J kappa.     

The spatial distribution of leprosy cases during 15 years of a leprosy control program in Bangladesh: An observational study

Background  

An uneven spatial distribution of leprosy can be caused by the influence of geography on the distribution of risk factors over the area, or by population characteristics that are heterogeneously distributed over the area. We studied the distribution of leprosy cases detected by a control program to identify spatial and spatio-temporal patterns of occurrence and to search for environmental risk factors for leprosy.     

Human Rotavirus Group a Serotypes Causing Gastroenteritis in Children Less Than 5 Years and HIV-Infected Adults in Viwandani Slum,Nairobi

Background

Rotavirus remains a leading cause of acute gastroenteritis in children worldwide with an estimated 2000 deaths each day in developing countries. Due to HIV/AIDS scourge in Kenya, it is possible that rotavirus-related gastroenteritis has been aggravated in adults. The Global Alliance for Immunizations has ranked rotavirus infection a priority for vaccine, and, to ensure its success, there is a need to document the local strain(s) circulating in different regions.

Methods

A cross-sectional study was conducted to document human rotavirus group A serotypes in children below 5 years and HIV-infected adults in Viwandani slum in Nairobi, Kenya. A total of 260 (128 from children and 132 from HIV infected adults) fecal specimen samples were analyzed from August 2012 to July 2013. Screening for rotavirus was done by antigen based enzyme immune-sorbent assay (ELISA), Polyacrylamide gel electrophoresis (PAGE) was used to detect rotavirus electropherotypes and finally genotyping was done by RT-PCR using genotype-specific primer sets targeting VP4 and VP7 genes.

Results

Rotavirus was detected in 23% and 8% of children and adult, respectively. Prevalence was high in children of < 2 years and adults of > 48 years. Long electropherotypes accounted for 80% and 60% while short electropherotypes accounted for 20% and 40% in children and adult, respectively. The common globally distributed strains, G1 and G3, accounted for 60% detections while the unusual G9 strain accounted for 80% infection in adults. G1P[8] was the common genotypic combination in children, accounting for 40% infection, whereas G9 [P8] accounted for 60% of the infections in adults.

Conclusion

This study shows the existence of strain diversity between rotavirus circulating in children and adults within this study group. It further shows that as currently constituted, the 2 vaccines recommended for rotavirus would cover the circulating strain in Viwandani slum. Finally, there is a need for continuous rotavirus strain surveillance in children and a further focus on HIV infected adults.     

Increasing socioeconomic disparities in adolescent obesity

Recent reports suggest that the rapid growth in youth obesity seen in the 1980s and 1990s has plateaued. We examine changes in obesity among US adolescents aged 12–17 y by socioeconomic background using data from two nationally representative health surveys, the 1988–2010 National Health and Nutrition Examination Surveys and the 2003–2011 National Survey of Children’s Health. Although the overall obesity prevalence stabilized, this trend masks a growing socioeconomic gradient: The prevalence of obesity among high-socioeconomic status adolescents has decreased in recent years, whereas the prevalence of obesity among their low-socioeconomic status peers has continued to increase. Additional analyses suggest that socioeconomic differences in the levels of physical activity, as well as differences in calorie intake, may have contributed to the growing obesity gradient.Childhood and adolescent obesity is one of the most important current public health concerns in the United States. The prevalence of obesity among adolescents has more than doubled over the past three decades (1). Recent data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) show that more than one-third of adults and almost 17% of children and adolescents were obese. Obesity in children and adolescents increases the risk for a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, metabolic syndrome, and various psychosocial problems (2–6).Recent research suggests that the tide might be turning, however. After years of steady increase, obesity rates have finally begun to plateau (7). Furthermore, American children consumed fewer calories in 2010 than they did a decade before (8). For boys aged 2–19 y, calorie consumption declined by about 7% to 2,100 calories a day over the period of the analysis, from 1999 through 2010. For girls, it dropped by 4% to 1,755 calories a day. Another recent study found that teenagers are exercising more, consuming less sugar, and eating more fruits and vegetables (9).Some health experts have taken these findings as a sign that the obesity epidemic might finally be abating. According to a recent report released by the Centers for Disease Control and Prevention (CDC), obesity rates among low-income preschoolers modestly declined in 19 US states and territories between 2008 and 2011 (10). However, there are compelling reasons to suspect that this abatement may not be equally distributed across youth from different class backgrounds. Socioeconomic background influences an individual’s food consumption and physical activity patterns. Not only are fresh vegetables and fruits costlier than fast food, but healthy alternatives are sometimes hard to find in poor neighborhoods. According to a recent estimate by the US Department of Agriculture, 9.7% of the US population, or 29.7 million people, live in low-income areas more than one mile from a supermarket, where the only options for grocery shopping are “convenience” stores, liquor stores, gas stations, or fast food restaurants that sell foods high in fat, sugar, and salt (11). Low-income families are less likely to own a car, and may thus opt for diets that are shelf-stable (12). Dry packaged foods have a long shelf life, but they also contain refined grains, added sugars, and added fats. Neighborhoods influence not only food access but opportunities for physical activity. Low-income neighborhoods have fewer playgrounds, sidewalks, and recreational facilities (13). Education is linked to both understanding what healthy diet and healthy lifestyle mean as well as how to implement them (14). Children of more educated parents are more likely to eat breakfast and consume fewer calories from snacks, and they are less likely to eat foods with high-energy content, such as sweetened beverages (15).Although substantial socioeconomic inequalities in childhood and adolescent obesity are well documented, there is no consensus on the extent to which social disparities in obesity have changed over time. Indeed, some studies have suggested that socioeconomic gaps in the prevalence of obesity among youth have increased (16–19), whereas other research has suggested that disparities have not changed (20) or have even decreased (21, 22). To address this question, we examined socioeconomic disparities in the prevalence of obesity among adolescents aged 12–17 y using data from two large, nationally representative federal health surveys, the 1988–2010 NHANES and the 2003–2011 National Survey of Children’s Health (NSCH).     

Complete amino acid sequence of the delta heavy chain of human immunoglobulin D.

We have determined the amino acid sequence of the variable (V) region of the delta heavy (H) chain of human IgD isolated from the plasma of myeloma patient WAH. This V region is unusual in its amino end group (arginine) and in its length (129 residues). The length is due to 10 insertions in the third complementarity-determining region (CDR3). A computer search showed that no reported CDR3-joining region (-JH) sequences are identical and that they appear to be unrelated to the constant (C) region sequences of immunoglobulins. The V region sequence together with our previous results for the C region give the complete sequence of the human delta chain WAH, which has 512 amino acid residues and a Mr congruent to 65,000. The human delta chain has four domains (V, C delta 1, C delta 2, and C delta 3) and a long hinge region; by comparison, the mouse delta chain lacks a continuous segment of 135 residues, including half the hinge region and the entire C delta 2 domain. The human and mouse delta chains also differ in the number, kind, and location of GlcN and GalN glycans and probably in conformation and quaternary structure. These and other considerations suggest that there may be multiple forms of both secreted and membrane-bound IgD that differ in size, structure, and function.