Trends in tuberculosis incidence and their determinants in 134?countries

Objective

To determine whether differences in national trends in tuberculosis incidence are attributable to the variable success of control programmes or to biological, social and economic factors.

Methods

We used trends in case notifications as a measure of trends in incidence in 134 countries, from 1997 to 2006, and used regression analysis to explore the associations between these trends and 32 measures covering various aspects of development (1), the economy (6), the population (3), behavioural and biological risk factors (9), health services (6) and tuberculosis (TB) control (7).

Findings

The TB incidence rate changed annually within a range of ±10% over the study period in the 134 countries examined, and its average value declined in 93 countries. The rate was declining more quickly in countries that had a higher human development index, lower child mortality and access to improved sanitation. General development measures were also dominant explanatory variables within regions, though correlation with TB incidence trends varied geographically. The TB incidence rate was falling more quickly in countries with greater health expenditure (situated in central and eastern Europe and the eastern Mediterranean), high-income countries with lower immigration, and countries with lower child mortality and HIV infection rates (located in Latin America and the Caribbean). The intensity of TB control varied widely, and a possible causal link with TB incidence was found only in Latin America and the Caribbean, where the rate of detection of smear-positive cases showed a negative correlation with national incidence trends.

Conclusion

Although TB control programmes have averted millions of deaths, their effects on transmission and incidence rates are not yet widely detectable.     

Malignant biliary obstruction: intracavitary treatment with a high-dose- rate remote afterloading device

A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized.     

Human myeloma in vitro colony growth: interrelationships between drug sensitivity, cell kinetics, and patient survival duration

Ninety-seven patients with multiple myeloma evaluated serially had both a tritiated thymidine labeling index of bone marrow plasma cells (LI%) and in vitro myeloma stem cell culture performed. Thirty-three patients with myeloma colony growth had in vitro drug sensitivity testing carried out, 18 having in addition in vitro thymidine suicide determinations. The LI% and the likelihood of in vitro myeloma colony growth were highly correlated: the higher the LI%, the more likely was colony or cluster growth (p less than 0.001). The tritiated thymidine suicide of myeloma stem cells was usually very high. There was excellent correlation between in vitro and in vivo drug sensitivity. Both pretreatment drug resistance and selective sensitivity (e.g., interferon, bisantrene, methotrexate, vinblastine) at the time of relapse were accurately detected and correlated well with survival duration (p = 0.01 Wilcoxan). Although LI% and in vitro sensitivity were clearly independent variables, a high LI% (greater than 3%) plus in vitro resistance were associated with a subsequent survival duration of less than 6 mo. The studies allowed dissection of the complex interrelationship between cell kinetics and drug sensitivity.     

Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]

Background  

A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions.     

Early detection of abnormalities in partial epilepsy using magnetic resonance

The incidence of brain abnormalities determined by magnetic resonance in 30 consecutive children presenting with intractable complex partial seizures is reported. Images were optimised to visualise the hippocampus and cortical grey matter. Abnormalities of the hippocampus or temporal lobe were seen in all 19 children with clinical features of temporal lobe epilepsy and in six of the seven children with clinically unlocalised epilepsy. By contrast, in the four children with a clinical diagnosis of extratemporal epilepsy, no temporal or hippocampal abnormalities were seen. Generalised cortical abnormalities of uncertain significance were found in a total of 14 children from all groups. The identification of focal brain abnormalities using optimised magnetic resonance imaging enables early non-invasive assessment of children with intractable seizure disorders and the identification of patients for whom epilepsy surgery may be appropriate. It may also lead to a better understanding of the structural basis of intractable epilepsy, and thereby contribute to early treatment decisions.     

Artificial renal and liver support in a severe hepatorenal syndrome of childhood

This case report describes a special management approach in a child aged 4.5 years with a severe form of hepatorenal syndrome in which the final diagnosis was familial hemophagocytic lymphohistiocytosis (FHL). The patient presented with grade IV hepatic coma and acute renal failure (ARF). While the diagnosis was difficult at the time of admission, as well as during acute treatment, artificial liver support was established for elimination of bilirubin and other metabolic by-products by using charcoal column plasma perfusion (CCPP) and bilirubin-adsorbing resin column plasma perfusion (BRCPP). Serum levels of bilirubin showed a notable decrease after each of the four treatment sessions. Additional artificial renal function replacement by continuous arteriovenous hemofiltration and hemodialysis (CAVH, CAVHD, respectively) had a marked lowering effect on urea and creatinine serum concentrations. Both artificial liver and renal support contributed to the general clinical improvement and survival of the patient. Further experience in these therapies will be needed to establish better prognosis in such fatal or acute similar conditions.     

Twin and singleton growth patterns compared using US

Sonography has been used widely in the evaluation of singleton fetal growth. Twin gestations, however, have received less careful attention. In a statistical study of 103 twin pregnancies, the growth patterns of twin biparietal diameter (BPD), fetal femur length (FFL), and abdominal circumference (AC) were compared with those of singletons. The results of the study revealed a decrease in twin BPD growth after 31 to 32 weeks of gestation relative to singletons. Twin AC growth rate decreases after 32-33 weeks of gestation relative to singletons, but the twin FFL growth pattern does not deviate from that of singletons throughout gestation. Because of the significant difference in growth patterns of BPD and AC between twins and singletons in our population, new growth charts for twin BPD and AC are proposed.     

完全去神经大鼠皮肤愈合过程中神经纤维再生和降钙素基因相关肽的变化

目的:观察完全去神经对大鼠皮肤伤口愈合的影响及愈合过程中神经纤维再生和降钙素基因相关肽的变化情况,探讨神经纤维再生和降钙素基因相关肽与伤口愈合的关系。方法:实验于2006-02在北京大学人民医院中心实验室完成。雌性Wistar大鼠32只,体质量250～300g。切断所有大鼠右下肢的坐骨神经和股神经,然后分别制造1cm的圆形皮肤缺损作为去神经组,在大鼠左下肢相应部位制造同样皮肤缺损作为对照组,于伤后1,3,7,14d每个时间点随机处死8只大鼠,用3M贴膜覆盖于伤口,然后沿切口周围1cm切取伤口组织,观察伤口愈合情况,组织化学染色观察神经丝蛋白和降钙素基因相关肽的变化。结果:纳入大鼠32只,均进入结果分析,伤口无感染。①两组大鼠伤后7d的伤口面积比伤后1d均明显缩小[去神经组:(0.195±0.053),(0.687±0.053)cm2;对照组:(0.131±0.041),(0.562±0.088)cm2]。与对照组相比,去神经组伤后3d大鼠的伤口面积无明显变化[(0.366±0.031),(0.408±0.079)cm2,P>0.05]。②去神经组伤口的神经丝蛋白和降钙素基因相关肽阳性染色在伤后第1,3,7,14天均明显少于对照组。结论:完全去神经后皮肤伤口愈合缓慢,而伤口内的神经纤维再生缓慢和降钙素基因相关肽的减少与皮肤伤口愈合缓慢有着密切关系。