Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study

Background Studies of Australian infants have reported that more than 80% of those with moderate atopic eczema (AE) have high levels of IgE food sensitization (IgE‐FS) that are commonly associated with IgE food allergy. Objectives To explore the relationship between high levels of IgE‐FS and AE in a large cohort of young children with eczema participating in a multi‐centre, international study. Methods Two thousand one hundred and eighty‐four subjects (mean age 17.6 months, range 11.8–25.4; 1246 males) with active eczema from atopic families from 94 centres in 12 countries were studied. Clinical history, Scoring Atopic Dermatitis index as a measure of eczema severity and CAP‐FEIA measurements for total IgE and IgE antibody levels to cow milk, egg and peanut were entered into a database. If CAP‐FEIA levels exceeded previously reported age‐specific cut‐off levels for 95% positive predictive values (PPVs) for food allergy, subjects were defined as having high‐risk IgE‐FS (HR‐IgE‐FS). Results Serum was available from 2048 patients; 55.5% were atopic. The frequency of HR‐IgE‐FS to milk, egg and/or peanut was the greatest in patients whose eczema developed in the first 3 months of life and the least in those whose eczema developed after 12 months (P<0.0001). In a regression analysis to allow for potential confounding factors, children with HR‐IgE‐FS had the most severe eczema and the youngest age of onset (P<0.001); 64% of infants with severe eczema of onset‐age <3 months had HR‐IgE‐FS. Conclusion Early‐onset severe eczema in infancy was associated with HR‐IgE‐FS. Clinical implications Food allergies should be routinely assessed in infants with moderate or severe eczema. Capsule summary In eczematous infants, the earlier the age of onset, and the greater the severity of eczema, the greater the frequency of associated high levels of IgE‐FS.     

HIV-1准种的变化与疾病进展关系的研究

目的　研究HIV 1准种的变化对疾病进展的影响。方法　PCR方法扩增HIV 1V3～V5区片段 ,采用HMA(异源双链泳动分析 )的方法分析 4 8例HIV/AIDS准种的变化 ,并结合HIV/AIDSCD4 T淋巴细胞计数及病毒载量的结果分析HIV 1准种的变化对疾病进程的影响。结果　在不同的疾病状态下 ,体内病毒变异是不相同的 ,在体内CD4 T淋巴细胞计数较高 ,血浆病毒载量低的个体内 ,病毒毒株有很强的变异特征 ,体内具有很高的准种复杂度 ;而在CD4 细胞数很低 ,病毒载量较高的个体 ,病毒基因变异较少 ,病毒准种较为单一。结论　HIV 1准种的变化与疾病进展相关。     

卵巢女性化性索间质性肿瘤39例临床病理分析

重新复查我院1960～1980年收治原诊为卵巢女性化性索间质性肿瘤39例的病理切片,可疑者再切片作特殊染色,复查后纠正了11例误诊病例,对确诊的28例的临床表现、病理特征、随访结果及预后等进行了分析。讨论了误诊病例的病理后,建议此类肿瘤中的粒层细胞瘤命名为“恶性粒层细胞瘤”,其恶性度与细胞分级密切相关,预后与卵巢外扩散及治疗是否彻底相关。     

Involvement of doctors in torture: conclusions and recommendations

In 1984 the Council of the British Medical Association set up a working party, chaired by J.P. Quillam, to investigate claims that doctors in some countries were cooperating with the use of torture as a routine instrument of repression. The conclusions and recommendations of the working party's recently published report are reproduced here, along with a list of the members of the working party. Among the report's conclusions [which are reproduced also in the British Medical Journal 1986 Mar 15; 292(6522): 781-782] are that doctors have a responsibility to support any practitioner who refuses to keep silent about abuses of human rights, to check for signs of physical abuse of prisoners, and to publicize any violations of the Declaration of Tokyo. Physicians are also encouraged to offer their services to organizations such as the Medical Foundation for the Care of Victims of Torture.     

The role of surgery in transmitting ≪ post-transfusion hepatitis ≫

The role of surgery as an additional risk in transmitting post-transfusion hepatitis was investigated in a retrospective study on acute hepatitis occurring in 77 transfused patients, 293 transfused and operated patients and 243 hepatitis cases with history of surgery without transfusion.Hepatitis A patients admitted to the same centres in the same period were utilized as controls. In transfused patients the percentage of NANB hepatitis was higher than that of type B (61.0% vs. 36.4%), while in the operated not transfused group the percentage of type B was twice that of type NANB (63.4% vs. 32.5%).In transfused and operated cases intermediate values were observed. The age-adjusted measures of association between exposures and the different hepatitis types showed a lack of effect of transfusion and a dominant role of surgery in transmitting type B hepatitis. In contrast, NANB post-transfusional cases were actually a mixture of post-transfusional and post-surgical cases, since both these exposures were found to be significantly associated with the disease.Our results suggest that studies on the incidence and the etiology of post-transfusion hepatitis should take into account the risk of surgical exposure which might have occurred.Corresponding author.     

The POSCH data processing experience

Metadata, the term, may be new but metadata, the concept, is not new. For purposes of this paper, the term metadata is defined as the data used to define, store, retrieve, combine, analyze, and present the data values (the “real” data, so to speak). As clinical research studies get larger, it becomes desirable to use automated managers of the metadata. The Program on the Surgical Control of the Hyperlipidemias (POSCH), a national multiclinic clinical trial, manages most of its metadata manually but has been experimenting with ways to more fully automate them. Its Information Management System (IMS) is described with special emphasis on how it manages the metadata. The case is presented for further automation and standardization of metadata in large clinical research studies so that costs can be contained and smaller increments of “progress” can be measured. The concept of a Metadatabase Management System (MDBMS) is developed and illustrated using POSCH.     

中国幼儿睡眠状况评估量表的编制与评价研究

目的 编制适用于我国12～35月龄幼儿的睡眠状况评估量表,评价其信度、效度和可行性,为评估中国幼儿睡眠情况提供适宜的评估工具。 方法 建立条目池,通过头脑风暴法、德尔菲法和预调查对条目进行初筛和修改。采用抽样调查方法,2019年7-11月从全国6个社区、6个乡镇和两家睡眠门诊选择12～35月龄幼儿看护人进行现场调查,共收回有效问卷551份。采用项目分析、效度分析、信度分析、可行性和验证性因子分析对量表进行评价。 结果 幼儿睡眠状况评估量表(12～35个月)包含睡眠节律、夜醒情况、入睡行为、日间嗜睡,睡眠呼吸和异态睡眠6个因子20个条目,累积解释变异量为55.55%。所有条目的内容效度指数介于0.83～1.00。量表入睡潜伏期、夜醒次数、睡眠时间3个条目与简明婴儿睡眠问卷呈正相关(r=0.41、0.69、0.42,P＜0.001)。除日间嗜睡外,社区幼儿量表总分以及其他5个因子得分均低于门诊幼儿(P＜0.05)。量表总Cronbach's α系数为0.72,两周重测信度为0.84,完成率为92.6%。验证性因子分析结果显示,量表的因子结构模型较为合理、稳定。 结论 量表具有较好的信度效度,可以区分不同幼儿的睡眠状况,有助于及早发现幼儿的睡眠问题。     

梗阻性黄疸大鼠血清内毒素水平与生长激素／生长激素结合蛋白的关系

目的：探讨梗阻性黄疸大鼠血清内毒素水平与生长激素／生长激素结合蛋白的关系。方法：复制大鼠胆道梗阻－再通模型,对胆道再通前1d、术后1,3,7d的浆生长激素、生长激素结合蛋白、胰岛素样生长因子－I、内毒素、肝功能及前白蛋白水平进行检测,并与假手术组（对照组）进行对照。结果：生长激素、生长激素结合蛋白、胰岛素样生长因子－I在胆道梗阻组较对照组显著降低（P＜0．01） ,并与黄疸程度、内毒素水平、前白蛋白相关（P＜0．01）。结论：梗阻性黄疸大鼠生长激素／生长激素结合蛋白存在明显下降,其原因可能与营养障碍、内毒素血症引起的生长激素受体表达受抑有关,并可进一步加重营养障碍和内毒素血症,是介导梗阻性黄疸病理生理改变的重要因素。     

心房颤动者并发脑梗死相关因素分析

目的 心房颤动是一种常见的心律失常,其并发症包括脑梗死等。国外 对此已经进行了广泛的研究。国内关于此方面的研究较少。本研究分析了心房颤动患者脑梗死发生的危险因素,筛选高危患者,指导临床干预。方法 结合186例慢性心房颤动患者的临床特点,分析不同性别、年龄、病因、并发高血压、糖尿病、心脏瓣膜钙化以及心房大小对房颤并发梗死的影响。结果本研究分析表明：风湿性心脏病（二尖瓣狭窄）、高血压、糖尿病、心脏瓣膜钙化是房颤并发脑梗死的高危因素,性别、年龄对房颤并发脑梗死无显著影响。结论 对于心房颤动并发风湿性心脏病（二尖瓣狭窄）、高血压、糖尿病、心脏瓣膜钙化的患者容易发生脑梗死,可能需要进行抗血栓治疗,预防脑梗死的发生。     

止血汤治疗血友病甲后凝血指标的变化

目的：探讨中药止血汤治疗血友病患后血浆凝血酶原时间／国际标准化比率（PT／INR）、部分凝血活酶时间（APTT）、简易凝血活酶生成时间（STGT）、凝血酶时间（TT）、凝血因子Ⅷ活性（FⅧ：C）等凝血指标的变化及其临床意义。方法：用中药止血汤治疗13例血友病甲患,治疗前、后分别用凝血一期法测定PT、APTT、FⅧ：C、STGT等指标。结果;治疗后病人的临床症状明显好转,PT、APTT、STGT较治疗前缩短,FⅧ：C增高,但治疗后与正常组相比较,APTT、STGT显延长,FⅧ：C处低水平。结论：止血汤治疗血友病有效的机理可能为：通过低调TFPI水平增强外源性凝血途径,补偿内源性凝血途径功能的缺陷。