青年人群骨密度及标准差对骨质疏松检出率的影响研究

目的 探讨青年人腰椎BMD和SD正常参考值影响骨质疏松症(OP)检出率的程度.方法 用GE-Lunar 公司的DXA仪测量骨密度,调查全国6个中心11418例腰椎PA和髋部BMD,建立了骨密度参考数据库.6个中心的仪器内部精度0.3%～0.7%,仪器间的精度1.1%.从T-score=(受试者BMD-青年人平均BMD)÷青年人骨密度SD值公式中可知,OP检出率与青年人平均BMD呈正比与SD值呈反比.结果 用6个中心及总体各自的青年人平均BMD和SD值为参考标准.对同一人群计算T-score和获得的OP检出率则不相同;发现青年人平均BMD每变化0.01g/cm2,则OP检出率变化1.6%(呈正相关),其SD值每变化0.01 g/cm2,则OP检出率变化4%(呈负相关).结论 青年人平均BMD和SD值不同引起OP检出率也不相同.为了让不同中心的OP检出率有可比性,建议同一个类型的BMD仪,同一个种族,同一个地区用一个设计较完善大样本的参考数据库,以其青年人正常参考值计算T-score.     

Irritable bowel syndrome:A clinical review

Irritable bowel syndrome(IBS)remains a clinical challenge in the 21st century.It’s the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics.Its can affect up to one in five people at some point in their lives,and has a significantly impact of life quality and health care utilization.The prevalence varies according to country and criteria used to define IBS.Various mechanisms and theories have been proposed about its etiology,but the biopsychosocial model is the most currently accepted for IBS.The complex of symptoms would be the result of the interaction between psychological,behavioral,psychosocial and environmental factors.The diagnosis of IBS is not confirmed by a specific test or structural abnormality.It is made using criteria based on clinical symptoms such as Rome criteria,unless the symptoms are thought to be atypical.Today the Rome CriteriaⅢis the current goldstandard for the diagnoses of IBS.Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis.There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS.However,a number of different changes in IBS patients were demonstrated in recent years,some of which can be used in the future as a diagnostic support.IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs,stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used.However,the cornerstone of its therapy is a solid patient physician relationship.This review will provide a summary of pathophysiology,diagnostic criteria and current and emerging therapies for IBS.     

世界华人消化杂志和World Journal of Gastroenterology2006年工作总结

世界胃肠病学杂志社于2006-12-22在北京鹭鹭酒家东方店举行了第三次工作会议,总结了2006年《世界华人消化杂志》和《World Journal of Gastroenterology》各项编辑出版工作,国家自然科学基金委员会杂志部祖广安主     

Combined tumor genomic profiling and exome sequencing in a breast cancer family implicates ATM in tumorigenesis: A proof of principle study

Familial breast cancers (BCs) account for 10%‐20% of all diagnosed BCs, yet only 20% of such tumors arise in the context of a germline mutation in known tumor suppressor genes such as BRCA1 or BRCA2. The vast genetic heterogeneity which characterizes non BRCA1 and non BRCA2 (or BRCAx) families makes grouped studies impossible to perform. Next generation sequencing techniques, however, allow individual families to be studied to identify rare and or private mutations but the high number of genetic variants identified need to be sorted using pathogenicity or recurrence criteria. An additional sorting criterion may be represented by the identification of candidate regions defined by tumor genomic rearrangements. Indeed, comparative genomic hybridization (CGH) using single nucleotide polymorphism (SNP) arrays allows the detection of conserved ancestral haplotypes within recurrent regions of loss of heterozygosity, common to several familial tumors, which can highlight genomic loci harboring a germline mutation in cancer predisposition genes. The combination of both exome sequencing and SNP array‐CGH for a series of familial BC revealed a germline ATM mutation associated with a loss of the wild‐type allele in two BC from a BRCAx family. The analysis of additional breast tumors from ten BC families in which a germline ATM mutation had been identified revealed a high frequency of wild‐type allele loss. This result argues strongly in favor of the involvement of ATM in these tumors as a tumor suppressor gene and confirms that germline ATM mutations are involved in a subset of familial BC.     

Holter Recordings with Continuous Marker Annotations: A New Tool in Pacemaker Diagnostics

Pacemakers provide marker annotations to facilitate the interpretation of pacemaker electrocardiograms (ECGs) and can be used in cases of suspected pacemaker malfunction or to understand pacemaker behavior. Due to the need for a programmer, only short-term evaluations are possible. We evaluated a prototype Telemetry Data Logger (TDL) designed to continuously transfer markers from the pacemaker to a conventional Holter recorder. A miniaturized telemetry receiving coil was attached to patient's skin above the pacemaker, which was programmed to transmit markers continuously. The TDL, which receives and converts markers into eight positive and eight negative deflections, ranging from -2.5 to +2.5 mV in amplitude, was connected to one channel of a conventional Holter recorder (Tracker 2). We performed 20 Holters in 13 patients who had implanted VDDB or DDDR devices from the same manufacturer and evaluated three versions of software. Marker transmission was possible in all patients, producing Holter ECGs with complete marker annotations. Artifacts occurred < 4 % of the time. A 50-ms rectangular pulse was optimal for marker interpretation. The device, which was easy to use and well accepted by the patients, assisted in the diagnosis of inappropriate pacemaker programming, even when the surface ECG seemed to show regular pacemaker function. In the presence of low quality surface ECGs, marker annotations allowed the assessment of pacemaker function. The capability to annotate the onset of special algorithms, like tachycardia termination algorithms or mode switching, facilitates interpretation of pacemaker behavior, enabling a reliable assessment of the appropriateness of such algorithms. Conclusion: The TDL effectively enables pacemaker markers to be inscribed onto a conventional Holter recording, facilitating the interpretation of pacemaker ECGs and the diagnosis of inappropriate pacemaker programming even when not discernible from the surface ECG alone.     

Heterosexually acquired human immunodeficiency virus infection and the United States blood supply: considerations for screening of potential blood donors. HIV Blood Donor Study Group

The impact of heterosexual transmission of the human immunodeficiency virus (HIV) on the United States blood supply was assessed, and deferral criteria that may exclude potential donors who are at high risk for heterosexually acquired HIV infection were evaluated. Interviews were conducted with 508 HIV-seropositive blood donors from May 1, 1988, to August 31, 1989 (Phase 1), and with 472 donors from January 1, 1990, to May 31, 1991 (Phase 2), at 20 blood centers. From Phase 1 to Phase 2, the overall HIV prevalence decreased from 0.021 to 0.018 percent (p < 0.001). HIV risk factors among HIV-1-seropositive donors were similar during both study phases. Eleven percent of the men and 56 percent of the women reported as their only risk that they had a heterosexual partner who was at increased risk for HIV or was known to have HIV. These percentages were similar during both study periods. During Phase 2, 13 percent of the men and 17 percent of the women with heterosexual transmission risk had a positive serologic test for syphilis, hepatitis B core antibody, or hepatitis C antibody. Among HIV- 1-seropositive donors reporting heterosexual risk, the median numbers of previous-year and lifetime sex partners for men were 2 and 30, respectively; for women, those numbers were 1 and 7, respectively. Thirty-one percent of the men and 6 percent of the women reporting heterosexual transmission risk also reported having had syphilis or gonorrhea within 3 years of donation. It is concluded that the impact of heterosexual transmission of HIV infection on transfusion safety is not worsening at this time.(ABSTRACT TRUNCATED AT 250 WORDS)     

A national study of the availability and use of electrophysical agents by Australian physiotherapists

Electrophysical agents (EPAs) are a core part of physiotherapy practice and entry level education. With the increase in the number of EPAs over time, their availability and use in contemporary physiotherapy practice is an important consideration when determining entry level curricula. Thus, the aim of the study was to ascertain the current availability and usage of EPAs in Australian physiotherapy practice. A purpose-designed questionnaire was mailed to all registered physiotherapists in Australia. A response rate of 27% was obtained (n=3,538). Nonresponder analyses indicated that the results were representative of the total population of Australian physiotherapists. Over 70% of respondents had access to ultrasound, cold packs/ice, heat packs, electrical stimulation for sensory stimulation, and interferential therapy. Two main groups of EPAs were used relatively frequently. The first group was used daily or monthly by 60% of respondents (ultrasound, hot packs, and cold packs/ice), and a second group (electromyographic and pressure biofeedback, interferential therapy, and electrical stimulation for sensory stimulation) was used on a daily or monthly basis by between 30% and 45% of the sample. A group of EPAs, including ultraviolet light, microwave, and shortwave diathermy, was not used by over 90% of the sample. The study has provided contemporary national data on EPA availability and use in Australia.     

Mobile phones,mobile phone base stations and cancer: a review

There have been reports in the media and claims in the courts that radiofrequency (RF) emissions from mobile phones are a cause of cancer, and there have been numerous public objections to the siting of mobile phone base antennas because of a fear of cancer. This review summarizes the current state of evidence concerning whether the RF energy used for wireless communication might be carcinogenic. Relevant studies were identified by searching MedLine with a combination of exposure and endpoint terms. This was supplemented by a review of the over 1700 citations assembled by the Institute of Electrical and Electronics Engineers (IEEE) International Committee on Electromagnetic Safety as part of their updating of the IEEE C95.1 RF energy safety guidelines. Where there were multiple studies, preference was given to recent reports, to positive reports of effects and to attempts to confirm such positive reports. Biophysical considerations indicate that there is little theoretical basis for anticipating that RF energy would have significant biological effects at the power levels used by modern mobile phones and their base station antennas. The epidemiological evidence for a causal association between cancer and RF energy is weak and limited. Animal studies have provided no consistent evidence that exposure to RF energy at non-thermal intensities causes or promotes cancer. Extensive in vitro studies have found no consistent evidence of genotoxic potential, but in vitro studies assessing the epigenetic potential of RF energy are limited. Overall, a weight-of-evidence evaluation shows that the current evidence for a causal association between cancer and exposure to RF energy is weak and unconvincing. However, the existing epidemiology is limited and the possibility of epigenetic effects has not been thoroughly evaluated, so that additional research in those areas will be required for a more thorough assessment of the possibility of a causal connection between cancer and the RF energy from mobile telecommunications.