Current and future treatments of autoimmune hepatitis

Despite the widespread use of anti-TNF agents for inflammatory bowel disease (IBD), the need for surgical intervention remains high. As a result, many IBD patients undergoing surgery have recently been exposed to biologic agents. There is considerable controversy regarding the potential adverse effects of biologic agents on surgical outcomes in IBD patients undergoing major colorectal surgery with studies showing conflicting results. There appears to be discordance in the systemic bioavailability of anti-TNF-α in patients with Crohn’s disease (CD) versus ulcerative colitis, with greater systemic absorption in CD. In patients with CD, preoperative serum anti-TNF-α levels may help guide timing of surgery as patients with elevated serum anti-TNF-α levels appear to be at higher risk for complications. In patients with ulcerative colitis there is likely no need for stopping biologic agents before surgery as there is poor systemic bioavailability of the drug in a majority of patients.     

Longitudinal effects of weight loss and regain on cytokine concentration of obese adults

Objective

To describe patterns of weight loss and regain and their effect on the pro-inflammatory cytokines IL-6 and TNF-α, and anti-inflammatory cytokines adiponectin and IL-10 during a 24-month weight loss trial.

Materials/Methods

Participants were obese adults (N = 66) who lost and regained ≥ 10 lb during a 24-month clinical trial of behavioral weight loss treatment. Measurements of cytokines and weight were conducted at baseline, 6, 12, 18, and 24 months. Linear mixed modeling was used to determine percent change in weight and cytokines from baseline.

Results

The sample was predominantly female (80.3%) and White (86.4%), with a mean age of 48.4 ± 7.3 years and mean BMI of 34.5 ± 4.4 kg/m². At baseline, men had higher waist circumference, body weight, and energy intake, and lower percent body fat and adiponectin. The largest decrease in weight was observed at 6 months with a mean 11% decrease (p < .0001).A significant gender-by-weight change interaction on percent change in adiponectin was observed [b(se) = 0.9 (0.2), p = .0003], with men having a larger increase in adiponectin with weight loss compared to women. There was a significant effect of weight gain over time with increases in IL-6 [b(se) = 0.9 (0.3), p = .001].

Conclusions

Overall, weight loss was significantly associated with improvements in adiponectin and IL-6. Those improvements remained at 24 months, following weight regain. The association between weight change and adiponectin was different between genders. Implementing strategies that support sustained weight loss can help prevent a state of chronic systemic inflammation and its associated adverse effects.     

家庭诸多因素对育龄妇女碘营养水平影响的研究

目的分析碘缺乏病防治难点地区家庭诸多因素对育龄妇女碘营养水平的影响程度,提出有针对性的防治措施。方法依据《我国碘缺乏病高危地区重点调查方案》要求,在和田地区进行入户调查,调查内容包括：家庭主妇文化程度、碘营养水平、碘缺乏病防治知识知晓率、食盐种类、家庭经济状况、家庭子女数量等。结果（1）碘盐覆盖率与尿碘水平呈现正相关关系（r=0.142,P〈0.05）,碘盐覆盖率越高,尿碘水平也越高（χ^2134.58,P〈0.05）;（2）家庭主妇防治碘缺乏病知识知晓率对碘盐覆盖率（χ^263.069,P〈0.05）和尿碘水平（χ^27.081,P〈0.05）有显著影响;（3）家庭主妇生育子女数量越多,尿碘水平越低（χ^217.43,P〈0.05）;（4）尿碘与文化程度及人均收入水平呈正相关关系（r=0.091,P〈0.05;r=0.078,P〈0.05）;（5）不同生理状况的育龄妇女碘营养水平没有显著差异。结论诸多单因素对尿碘的影响程度由大到小依次为碘盐覆盖率、生育子女数、防治碘缺乏病知识知晓率,而家庭人均收入、文化程度、生理状况等因素没有明显影响。在多个因素对尿碘影响的分析中,只有人均平均收入与盐的种类因素有影响。     

Climate change and the selective signature of the Late Ordovician mass extinction

Selectivity patterns provide insights into the causes of ancient extinction events. The Late Ordovician mass extinction was related to Gondwanan glaciation; however, it is still unclear whether elevated extinction rates were attributable to record failure, habitat loss, or climatic cooling. We examined Middle Ordovician-Early Silurian North American fossil occurrences within a spatiotemporally explicit stratigraphic framework that allowed us to quantify rock record effects on a per-taxon basis and assay the interplay of macrostratigraphic and macroecological variables in determining extinction risk. Genera that had large proportions of their observed geographic ranges affected by stratigraphic truncation or environmental shifts at the end of the Katian stage were particularly hard hit. The duration of the subsequent sampling gaps had little effect on extinction risk, suggesting that this extinction pulse cannot be entirely attributed to rock record failure; rather, it was caused, in part, by habitat loss. Extinction risk at this time was also strongly influenced by the maximum paleolatitude at which a genus had previously been sampled, a macroecological trait linked to thermal tolerance. A model trained on the relationship between 16 explanatory variables and extinction patterns during the early Katian interval substantially underestimates the extinction of exclusively tropical taxa during the late Katian interval. These results indicate that glacioeustatic sea-level fall and tropical ocean cooling played important roles in the first pulse of the Late Ordovician mass extinction in Laurentia.     

Disopyramide Decreases the Fasting Serum Glucose Level in Man

The effect of disopyramide, a class Ia antiarrhythmic drug, on the serum glucose level was evaluated in 6 consecutive in-patients. A 19-hour starvation test was repeated with oral administration of sustained-release disopyramide (150 mg) 0 and 12 hours after starting the test. Serum glucose levels during the starvation test decreased with disopyramide administration from a mean value of 96.5 ± 1.8 to 85.9 ± 1.4 mg/dl (24 samples, p < 0.05). The average reduction of the serum glucose level by disopyramide in each patient was 9.7 ± 2.2 mg/dl. The decrease in the serum glucose level was not related to the serum concentration of disopyramide or serum creatinine levels. The decrease in the serum glucose level was larger in older patients (r = 0.75) and in light patients under 45 kg. These results suggested that disopyramide reduced the fasting serum glucose levels even in normal ranges as a common side effect of the drug, and that not only the occurrence of severe hypoglycemia but also the decrease in glucose levels were influenced by multiple factors including age and body weight.     

三峡建坝后长江江苏段水位变化对血吸虫病流行影响的研究 Ⅲ.不同水深对血吸虫虫卵孵化、毛蚴感染钉螺的影响

为研究三峡建坝后长江江苏段水位春季提早升高对血吸虫及血吸虫病传播的影响,对不同深度水下血吸虫虫卵的孵化率及水下钉螺对毛蚴的易感性进行了观察。结果显示,水淹深度与水下血吸虫虫卵孵化率及水下钉螺对毛蚴的易感性均呈非常显著负相关。研究提示,三峡建坝后４ 月份提早浅水水淹有利于受淹滩上虫卵的孵化及毛蚴感染钉螺。     

三峡建坝后长江安徽段江洲滩变化趋势及其对血吸虫病流行的影响

本文根据长江水利委员会提供的三峡建坝后长江安徽段来水来沙变化和冲淤情况,结合安徽段河道、江洲滩现状和血吸虫病流行的状况调查,分析论证了三峡建坝后长江安徽段河道冲淤变化及其对血吸虫病流行的影响。结果显示,三峡建坝后来水变化对长江安徽段河道影响不大,来沙变化对下游影响较大,水库建成后１～８０年内安徽段河道一直处于淤积势态,支流淤塞,滩地面积可能会有所增加。现况调查结果显示,目前皖江段涨滩明显,６年内涨滩１４７９．８万ｍ２,建坝后水沙变化可能进一步促使滩地增长。据涨滩后生长植被,然后孳生钉螺的规律,预测三峡建坝后长江安徽段江洲滩地区钉螺面积可能会有所增加     

A survey on the diagnostic ability of tuberculosis in the county-level medical institutions in China

目的 调查分析我国县级结核病定点医疗机构结核病诊断能力情况,为制订结核病预防控制策略和措施提供依据。方法 2019年7—12月,课题组进行了全国基层结核病诊断服务能力现况调查,描述2019年我国2316家县级结核病定点医疗机构(不包括我国西藏自治区及港澳台地区)从事结核病临床、影像学、实验室的医生人员数量及其分布情况,以及结核病辅助检查的开展情况。结果 2316家县级结核病定点医疗机构中,从事结核病临床、影像学、实验室的医生学历以本科和大专为主,分别占64.14%(24014/37439)和23.57%(8823/37439),职称以初级以下、中级为主,分别占44.07%(16501/37439)和36.15%(13533/37439)。在2316家县级结核病定点医疗机构中,能开展结核病计算机X线摄影(CR)、数字X线摄影(DR)、CT/MRI检查者分别占29.79%(690/2316)、88.77%(2056/2316)、75.86%(1757/2316);能开展结核菌素试验(PPD试验)、γ干扰素释放试验(IGRA)、抗结核抗体感染检测者分别占70.73%(1638/2316)、23.01%(533/2316)、66.02%(1529/2316);能开展支气管镜、B型超声检查者分别占36.10%(836/2316)、81.26%(1882/2316)。结论 县级结核病定点医疗机构结核病防治专业技术人员不足,缺乏高层次人才,结核病实验室诊断能力及结核病影像学检测能力均有待提高。     

云南克山病病区和非病区儿童头发中微量元素硒的对比分析

本文分析了四组儿童发硒,其含量高低依次为:非病区农户儿童>病区城镇职工户儿童>病区农户儿童>新发克山病的患者,差别均非常显著。病区农户儿童和克山病患者均处于贫硒状态状;学龄前和学龄儿童发硒无差异,而克山病却多发于学龄前儿童。因此认为低硒可能不是引起克山病发病的唯一病因;病区或非病区儿童发硒在性别上无差异,与克山病发病性别无差异相吻合。     

Recombinant interferon-α-2a for treatment of chronic hepatitis C: results of a multicenter randomized controlled dose study

Abstract: To compare the efficacy of low and relatively high dosages of recombinant interferon (IFN)-α-2a in Japanese patients with chronic hepatitis C, as well as to characterize the type of patients who will respond well to a low-dosage treatment, 88 patients with histologically proven chronic hepatitis C were randomly assigned to two treatment groups; one treated with IFN-α-2a 6 MU daily for 2 weeks followed by 6 MU three times weekly for 22 weeks (6-MU group), and another given the same initial treatment followed by 3 MU three times weekly for 22 weeks (3-MU group). The rate of sustained normalization of ALT 6 months after the cessation of treatment was 33% in the 3-MU group and 40% in the 6-MU group (p=0.64). In addition, there was no difference in elimination of serum HCV-RNA 6 months after the cessation of treatment between the 3-MU group (26%) and 6-MU group (29%). Multivariate stepwise regression analysis revealed that serum HCV-RNA level (p=0.0035) and platelet count (p=0.0009) were independent variables useful in predicting a sustained response of ALT. The sustained response rate of ALT in patients with a serum HCV-RNA level less than 10⁵ copies/ml and serum platelet level above 15×10⁴/μl was 71%, whereas that in patients with a serum HCV-RNA level above 10⁵ copies/ml and serum platelet level less than 15×10⁴/μl was 12%. These results indicate that a high rate of sustained response to IFN therapy can be expected in chronic hepatitis C patients with a low serum level of HCV-RNA and a high level of platelets, even if treated with a low dose of IFN.