澳门特别行政区初三学生的睡眠质量、睡眠模式与抑郁、焦虑情绪

目的:了解澳门特别行政区初三年级学生的睡眠质量、模式与抑郁、焦虑情绪的关系。方法:抽取澳门535名初中三年级学生,用匹兹堡睡眠质量指数量表(PSQI)评估睡眠质量,爱泼沃斯思睡量表(ESS)以及清晨型和夜晚型量表(MEQ)调查白天思睡与睡眠模式,用贝克抑郁量表(BDI)、状态-特质焦虑量表(STAI)调查抑郁、焦虑状况。结果:PSQI和ESS得分分别为(5.2±2.6)和(8.4±4.7),女生PSQI[(5.5±2.5)vs.(4.8±2.6)]和ESS[(8.9±4.6)vs.(8.0±4.8)]得分高于男生(均P0.05)。MEQ平均得分(13.3±3.1),女生得分低于男生[(12.8±3.0)vs.(13.7±3.2),P0.01]。学生周末和假日的总睡眠时间长于平日总睡眠时间[(608±106)min,(605±109)min vs.(457±75)min],女生周末[(628±110)min vs.(590±97)min]和假期[(631±109)min vs.(581±103)min]平均睡眠时间长于男生(均P0.01)。BDI和STAI得分分别为(13.5±10.3)、(78.9±17)。睡眠质量差和白天思睡者MEQ得分、上学日睡眠时间低于睡眠质量好和无白天思睡者MEQ得分,而睡眠质量差和白天思睡者BDI得分高于睡眠质量好和无白天思睡者BDI得分(均P0.05)。PSQI分别与ESS、BDI,以及STAI中的TAI分呈正相关(r=0.27、0.37、0.12,均P0.05),而与M EQ和上学日总睡眠时间呈负相关(r=-0.30、-0.30,均P0.05)。结论:睡眠质量差和白天思睡在澳门初三学生中较为普遍,他们在上学日的平均睡眠时间不足,但在周末和假日则延长睡眠时间以作补充,其中女生更易出现上述睡眠模式。大部分学生有轻度抑郁,睡眠质量差可能与其抑郁、焦虑状况相关。     

Mutations and impaired function of LKB1 in familial and non-familial Peutz-Jeghers syndrome and a sporadic testicular cancer

Germline mutations in LKB1 have been reported to underlie familial Peutz-Jeghers syndrome (PJS) with intestinal hamartomatous polyps and an elevated risk of various neoplasms. To investigate the prevalence of LKB1 germline mutations in PJS more generally, we studied samples from 33 unrelated PJS patients including eight non-familial sporadic patients, 20 familial patients and five patients with unknown family history. Nineteen germline mutations were identified, 12 (60%) in familial and four (50%) in sporadic cases. LKB1 mutations were not detected in 14 (42%) patients, indicating that the existence of additional minor PJS loci cannot be excluded. LKB1 is predicted to encode a serine/threonine kinase. To demonstrate the putative Lkb1 kinase function and to study the consequences of LKB1 mutations in PJS and sporadic tumors, we have analyzed the kinase activity of wild-type and mutant Lkb1 proteins. Interestingly, while most of the small deletions or missense mutations resulted in loss-of-function alleles, one missense mutation (G163D) previously identified in a sporadic testicular tumor demonstrated severely impaired but detectable kinase activity.      

Comparative Study of Leaf and Stem Bark Extracts of Parkia Biglobosa Against Enterobacteria

Hydroethanolic and aqueous extracts of leaf and stem bark of Parkia biglobosa (Jacq) Benth. (Mimosaceae) were tested against clinical isolates Escherichia coli, Salmonella typhi, Shigella dysenteriae and Enterococcus faecalis, and corresponding collection strains E. coli CIP 105 182, Salmonella enterica CIP 105 150, Shigella dysenteriae CIP 54-51 and Enterococcus faecalis CIP 103 907. Discs of Gentamicin, a broad spectrum antibiotic were used as positive controls. The results showed that all the extracts possess antimicrobial activities. A comparative study of the antibacterial activity of the leaves and that of the bark showed that for all the tested microorganisms, the hydroalcoholic extract of the bark is more active than the aqueous extract of the leaf. The hydroethanolic extract of the leaves is as effective as the aqueous extract of the stem bark prescribed by the traditional healer, suggesting it is possible to use leaves other than the roots and bark. The phytochemical screening showed that sterols and triterpenes, saponosides, tannins, reducing compounds, coumarins, anthocyanosides, flavonosides are present in both bark and leaf but in different concentrations.     

No association between maternal psychological symptoms and infant outcome after pregnancy complicated by early-onset hypertensive disorders

Aim: The aim of this work was to study the effect of maternal psychological symptoms on infant development 1 year after early-onset hypertensive disorders of pregnancy.
Methods: All mothers were enrolled in the Pre-eclampsia, Eclampsia TRial Amsterdam. Mothers were asked to complete the 90-item Symptom Check List (SCL-90) at the corrected ages of their infants of 0, 3 and 12 months. The total sum score of these three checklists was calculated. Infants were examined at the corrected age of 12 months using the Bayley Scales of Infant Development (Mental Developmental Index [MDI] and Psychomotor Developmental Index [PDI] subscales). The Bayley scores were compared between infants of mothers with SCL-90 sum scores in the highest 25% and lowest 75%.
Results: For 141 mother–infant pairs (80%) all three SCL-90 checklists and Bayley scores were available. Mean gestational age was 32 weeks and 90% of the infants were growth restricted. The mean MDI was 87 in the highest 25% and 89 in the lowest 75% group. This was 79 versus 80 for the PDI.
Conclusion: In this population of high-risk growth-restricted infants born after a pregnancy complicated by early-onset hypertensive disorders, there is no additional impact of negative maternal psychological symptoms on infant development after 1 year.     

Effects of an oxalate load on urinary oxalate excretion in calcium stone formers.

OBJECTIVE: To investigate the oxalate intake and the effect of an oxalate load on urinary oxalate excretion in calcium stone-forming (CSF) patients. DESIGN: Prospective study. SETTING: University-affiliated outpatient Renal Lithiasis Unit. Patients and controls: Seventy (70) CSF and 41 healthy subjects (HS) collected a 24-hour urine sample and were submitted to a 3-day dietary record to determine mean oxalate (Ox), calcium (Ca) and vitamin C intake. Fifty-eight (58) CSF patients were randomly selected to receive milk (N = 28) or dark (N = 30) chocolate as an oxalate load. INTERVENTION: Administration of either milk (94 mg Ox + 430 mg Ca) or dark chocolate (94 mg Ox + 26 mg Ca) for 3 days. A 24-hour urine sample was obtained before and after the load to determine calcium, oxalate, sodium, potassium, urea, and creatinine. MAIN OUTCOME MEASURE: Oxalate intake and excretion. RESULTS: CSF patients presented mean Ox intake of 98 +/- 137 mg/d, similar to that of HS (108 +/- 139 mg/d). Mean Ox and vitamin C intake was directly correlated with Ox excretion only in CSF. The consumption of dark chocolate induced a significant increase in mean urinary Ox (36 +/- 14 versus 30 +/- 10 mg/24 hr) not observed in the milk chocolate group. Thus, a 2-fold increase in Ox intake in this population of CSF patients produced a significant 20% increase in oxaluria, not observed when Ca was consumed simultaneously. CONCLUSION: The present study suggests that even small increases in Ox intake affect oxalate excretion and the mitigation of urinary oxalate increase by Ca consumption reinforces that Ca and Ox intakes for CSF patients should be in balance. Further studies are necessary to assess whether or not a 20% increase in oxaluria will lead to a higher risk of stone formation.     

The Role of Parasympathetic Modulation of the Reentrant Arrhythmic Substrate in the Genesis of Sustained Ventricular Tachycardia

The influence of parasympathetic activity on the reentrant arrhythmic substrate in the genesis of sustained ventricular tachycardia remains unclear. To assess this influence, we studied the heart rate variability in 59 patients referred for invasive electrophysiological testing. In addition, the presence of late potentials and high grade ventricular ectopy, and the left ventricular ejection fraction was determined. The 28 patients with inducible sustained ventricular tachycardia were found to have lower heart rate variability by time- and frequency-domain measurements over 24 hours when compared to the 31 subjects who were noninducible. PNN50 was 4% in the inducible patients, whereas it was 9% in the subjects who were noninducible (P = 0.03). Similarly, HFP24H was 9 and 14 msec, respectively (P = 0.02). MAXHFP1H also differed (20 vs 27 msec [P = 0.04]) but not MINHFP1H (5 vs 6 msec). There was no association between heart rate variability and late potentials, degree of ventricular ectopy, or left ventricular ejection fraction. Thus, vagal tone does not appear to correlate with the presence of late potentials, ventricular ectopy, or left ventricular dysfunction. Low mean as well as maximal vagal tone, in contrast to minimal vagal tone, predicts inducibility of sustained ventricular tachycardia. Our data suggest that the inability to modulate parasympathetic tone appears to be an important determinant in the genesis of reentrant sustained ventricular tachycardia.     

Chemotherapy for advanced (stage IIIB and stage IV) non-small cell lung cancer: The Hong Kong perspective

Abstract Non-small cell lung cancer (NSCLC) accounts for about 80% of all primary lung cancers, and 60% of cases present as advanced stages IIIB and IV disease. Traditionally, treatment of stages IIIB and IV disease was only symptomatic (including radiotherapy) and supportive care, and cytotoxic chemotherapy was relatively ineffective. Our initial clinical trials, using MACC, FuAM, FAM, Hi-FAM and cisplatin-VP16, gave response rates of 5–20% and a stabilization rate of 7–25%, with no impact on median survival. Our most recent chemotherapy regimen MIP (mitomycin-C, ifosfamide and cisplatin) proved to be more effective with a 44% response rate and a 28% stabilzation rate, and produced a significantly longer median survival (32 weeks) than best supportive care alone (19.5 weeks, P < 0.05). The response rate further increased to 62.5% with dose intensification and GM-CSF support. Chemotherapy can now be recommended to motivated, well-informed patients with good performance status in institutions with experience in cancer chemotherapy on a protocol basis. The most recent addition of new effective cytotoxic agents such as paclitaxel, docetaxel, gemitabine and vinorelbine gave promising results in NSCLC, and optimal combinations and dose schedules are being defined by multicentred studies.     

Changes in cytokine secretion patterns of CD4+ T-cell clones in human immunodeficiency virus infection

In addition to the loss of CD4+ T cells in later stages of human immunodeficiency virus (HIV) infection, functional defects of Th cells can already be observed in early infection. Decreased interleukin (IL)- 2 and interferon (IFN)-gamma production by CD4+ T cells and diminished delayed type hypersensitivity reactions are indicative for impaired Th1 responses. We studied the cytokine secretion patterns of T-cell clones (TCC) generated by mitogenic stimulation of CD4+ memory T cells. Compared with TCC from HIV-negative controls, TCC isolated from HIV- infected individuals consistently showed increased IL-4 production, often paralleled by increased IL-5 and decreased IFN-gamma production. This resulted in a decreased percentage of Th1 clones with an increase in Th0 clones. To rule out the influence of interindividual differences, we studied two individuals from whom cells were available before and after infection with HIV. Indeed, an increase in Th2 cytokine secretion was observed after HIV-infection. Loss of Th1 and enhanced Th2 responses might further curtail cellular responses resulting in deficiency of cellular immunity in HIV infection.