汉族志愿者阿米替林代谢与异喹呱羟化代谢的关系

8名男性健康志愿者po阿米替林100 mg后,以阿米替林及其3种代谢物的血浓度曲线下面积(AUC₀^∞)计算阿米替林的脱甲基化代谢及羟基化代谢能力。结果提示个体间阿米替林及其3种代谢物的AUC差异很大。其中7名志愿者测定异喹呱羟化代谢表型,6例为异喹呱强代谢者,1例为弱代谢者。尿中异喹呱的羟化代谢率与阿米替林的羟基化代谢率、阿米替林和10-羟基阿米替林的AUC₀^∞呈显著相关。阿米替林总血浆清除率与异喹呱羟化代谢率呈弱相关。此结果表明阿米替林和异喹呱的羟化代谢可能由同一酶控制,阿米替林的羟基化代谢和脱甲基化代谢可能为两个独立的代谢途径。     

Failure of ablation of a mediastinal parathyroid adenoma by repeated contrast staining

In a patient with primary hyperparathyroidism an attempt was made to ablate a middle mediastinal parathyroid gland by forceful staining with radiographic contrast material. The gland was stained on two separate occasions, two weeks apart. Both times the serum calcium level temporarily fell to the normal range but reverted to abnormal levels. The patient ultimately required surgery for correction of hypercalcemia. The mechanism of staining and possible reasons for failure as well as potential complications are discussed.     

Emphysema in the renal allograft

Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.     

Relationships between anthropometry, cardiorespiratory fitness indices and physical activity levels in different age and sex groups in rural Senegal (West Africa)

BACKGROUND: A high level of activity is commonplace in traditional subsistence societies. Physiological characteristics of individuals, including body composition and physical fitness, could be limiting factors when performing daily tasks. OBJECTIVES: The study investigated the relationships between cardiorespiratory fitness, nutritional status and physical activity patterns, so as to test the hypothesis that these relationships are less straightforward in children than in adults. STUDY DESIGN: Four different groups of individuals from rural Senegal were investigated: 99 10-13-year-old children of both sexes (11.1 +/- 1.5 years old) from two settings in Senegal (Lambaye and Podor), 43 adolescent girls (15.5 +/- 0.5 years), and 30 adult women (17-40 years). METHODS: Subjects undertook a step test, and anthropometric measurements were collected. Continuous heart rate (HR) monitoring was performed for 8-12 h. The flex-HR method was used to estimate levels of activity (per cent of time spent under or over the flex-HR). RESULTS: Ten to 13-year-old children and adolescent girls presented slight degrees of malnutrition. Adult women were apparently not nutritionally deprived. Differences in cardiorespiratory fitness were found among 10-13-year-old children, while adult women performed better than adolescent girls. Children from Lambaye had a higher level of activity than children from Podor. Similarly, adult women were more active than adolescent girls. No relationships were found between cardiorespiratory or anthropometric measurements and per cent of time spent above the flex-HR (> flex-HR) in 10-13-year-old children. In contrast, in adult women and adolescent girls, body composition and cardiorespiratory indices were significant predictors of activity levels. CONCLUSION: Our data support the hypothesis that activity levels are less dependent upon physiological characteristics in children than in adults in traditional subsistence societies.     

Domestic transmission of Rift Valley Fever virus in Diawara (Senegal) in 1998

In 1998, circulation of the Rift Valley Fever (RVF) virus was revealed in Diawara by detection of IgM antibodies in sheep and isolation of the virus from mosquitoes caught outside a village. A seroprevalence study was carried out. Finger-prick blood samples, individual and collective details were obtained. One thousand five hundred twenty people (6 months - 83 years) were included. Overall prevalence in this group was approximately 5.2%. The prevalence in infants (6 months - 2 years) was 8.5%. Age, gender, contact with a pond, presence of sheep, and abortion among sheep, and individual or collective travel history were not statistically associated with prevalence. Prevalence increased significantly when the distance to a small ravine, located in the middle of the village, decreased. The results suggest a low, recent, not endemic circulation of the virus. Culex quinquefasciatus was captured near the ravine. This mosquito, similar to Culex pipiens, can play a similar role in human-to-human transmission of the RVF virus.     

World health system performance revisited: the impact of varying the relative importance of health system goals

Background

In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries.

Methods

We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives.

Results

By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries.

Conclusions

Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.