大学生预防性治疗的结核菌素反应强度标准研究

目的探讨结核菌素反应强度与结核病发病的相关性;提出预防性治疗对象的结核菌素反应标准。方法对不同结核菌素反应强度的新入学大学生进行4年的结核病发病观察,分析结核菌素反应强度与发病危险性、发病时间的关系,比较不同反应强度预防性治疗对象发病率的变化。结果26 543名健康学生进行了结核菌素试验和4年的发病观察,反应强度为04、59、1014、1519和≥20 mm或水泡丘疹者的年均结核病发病率分别为12.97/10万、13.34/10万、50.32/10万、167.56/10万和250.21/10万;04和59 mm反应者头2年发病率很低,第3、4年有所增高,而1519和≥20 mm或水泡丘疹者头2年发病率很高,随着时间推移有下降趋势。当逐个计算反应强度每增加1 mm及以上反应者的发病率时,15 mm以上的各反应强度者中结核病发病率相似,一直维持在较高水平。PPD反应标准15 mm及以上可以覆盖80.8%的病人,而且病人的发现效率也维持在一个高水平。结论结核菌素反应强度与结核病发病存在明显正相关,特别在头2年危险比更大;PPD反应≥15 mm或有水泡丘疹阳性者的发病机会明显升高,PPD反应≥15 mm或有水泡丘疹阳性标准能够覆盖80%以上的病人,病人的发现效率也最高。因此以PPD反应≥15 mm或有水泡丘疹作为预防性治疗对象的结核菌素反应标准更为合理。     

中学生PPD反应强度与结核发病及预防性治疗标准研究

目的探讨PPD反应强度与结核病发病相关性和预防性治疗对象的结核菌素反应标准。方法对不同PPD反应强度的新入学初高中学生进行3年的结核病发病观察,分析PPD反应强度与发病危险性、发病时间的关系,比较不同反应强度预防性治疗对象发病率的变化。结果 7223名健康学生PPD反应强度0～4、5～9、10～14、15～19和≥20 mm或有皮疹水泡者的年均结核病发病率分别为18.2/10万、51.1/10万、115.5/10万、507.0/10万、和709.2/10万;0～4和5～9 mm头2年发病率很低,第3年有所增高,而15～19和≥20 mm或有皮疹水泡者头2年发病率很高,第3年均下降。结论 PPD反应强度与结核病发病存在明显正相关,特别在头2年危险比更大;PPD反应≥15 mm或有皮疹水泡者的发病机会明显升高,以此标准作为当地中学生预防性治疗对象的结核菌素反应标准是比较合理的。     

高中生PPD反应程度与结核病发病危险的队列研究

目的 探讨高中生PPD反应程度与结核病发病危险的关系,为选择合适的预防性治疗对象提供科学依据。方法 对两所高中的1664名学生进行随访。研究开始时采用PPD做皮内试验,开始和结束时作X线胸部透视,对有异常阴影者摄X线胸片。PPD试验阴性反应为对照组, 阳性反应（≥5 mm）为暴露组。按阳性反应强度的不同分为5～、10～、15～、≥20 mm、水泡5个亚组,分别有274、339、108、33、55例。采用Mantel-Haenszel卡方检验(卡方_MH)和Cox回归模型,分析暴露组与对照组人年发病率的差异,以P<0.05为差异有统计学意义。结果 Cox回归多因素分析显示,PPD阳性反应15～mm、≥20 mm、水泡组的人年发病率分别是10.14％（14/138）、21.21％（7/33）、52.00％（26/50）,为结核病发病的危险因素（Wald χ²值分别为53.366、54.851、124.829, P值均为0.000）,RR值分别为35.55、63.43、161.84。结论 高中生PPD反应≥15mm或有水泡者为结核病的高发人群,应作为结核病预防性治疗对象。     

北京大学生结核病控制的研究: (一)结核菌素反应性特点

目的　确定大学生结核菌素的反应性。方法 对北京市20所大学51699名大学新生进行标准化PPD试验调查，并对大学生社会———人口学及结核病流行病学特点进行调查分析。结果79.9%大学新生集中在18～19岁，68%源于北京以外的32个省市和地区，无卡痕15203名大学生PPD硬结横径在≥5mm，≥10mm，≥15mm和≥20mm，分别占38.9%，22.6%，12.4%和6.0%，源于城市大学生结核菌素反应性高于农村。有结核病接触史的大学生≥15mm和20mm≥，比无接触史的高出38.7%和48.5%。结论 把大学生作为北京“目标结核菌素试验”规程的对象，可将≥15mm结核菌素反应者作为预防性治疗的界限。     

肺结核疑似病例诊断的说明

1肺结核疑似病例的诊断凡符合下列项目之一者:1)5岁以下儿童有与痰涂片阳性肺结核患者密切接触史和/或结核菌素(PPD,5TU)、皮肤试验反应≥15mm或有丘疹、水     

北京大学生结核病控制的研究：（一）结核菌素反应性特点

目的：确定大学生结构菌素的反应性。方法：对北京市20所大学51699名大学新生进行标准化PPD试验调查，并对大学生社会－－人口学及结核病流行病学特点进行调查分析。结果：79．9％大学新生集中在18－19岁，68％源于北京以外的32个省市和地区，无卡痕15203名大学生PPD硬结横径在≥5mm,≥10mm,≥15mm和≥20mm，分别占38．9％，22．6％，12．4％和6．0％，源于城市大学生结核菌素反应性高于农村.胃结核病接触史的大学生≥15mm和20mm≥，比无接触史的高出38．7％和48．5％。结论：把大学生作为北京“目标结核菌素试验”规程的对象，可将≥15mm结核菌素反应者作为预防性治疗的界限。     

大中专院校学生结核感染发病情况调查分析

目的 对大中专学生结核感染与发病情况进行总结分析，为进一步加强高校结核病控制提供决策依据。方法 新生入学时做结核菌素（PPD）试验和胸透，PPD强阳性（注射局部硬结直径≤20mm）者枉知情同意基础上开展F胰预防性治疗，并对治疗与未治疗组进行发病情况的追踪观察及对比分析,以了解预防性治疗的实际效果.结果 大中专结核感染情况较严重,结素阳性率平均74.2%,强阳性水平均12.6%,高校学生肺结核平均发病率117.93/10万,结素强阳性未治疗者肺结核年发病率高达614.54/10万,是结素阴性及一般阳性者（67.03/10万）的9.2倍.结论 大中专学生结核感染发病情况较严重,是结核暴发浒的严重隐患之一,加强大中专院校结核病控制乃当务之急;新生入学体验,学生中结核病防治基本知识的宣传普及,结素强阳性者预防性治疗、因症就诊为病人发现方式、肺结核病人定点规范诊治，是控制大中专院校结核病疫情的有效措施。     

四所中学初中生结核菌素反应性调查

目的了解当地初中生结核菌素反应状况。方法选医院驻地怀来县4所中学5153名初一年级学生进行标准化PPD试验调查，并对学生年龄、性别、居住来源及结核病流行特点进行调查分析。结果80.2%的学生集中在13～14岁组，来源于农村者占57.6%，≥5mm总阳性反应率23.1%，≥15mm为7.4%。2219名无卡痕学生PPD反应在≥5mm，≥10mm，≥15mm和≥20mm分别为16.0%、10.9%、5.9%和2.9%，有卡痕学生结素反应性明显高于无卡痕者；有结核接触史和既往史学生的结素反应均高于无结核接触史和既往史者。结论把初中新入学学生作为当地结素试验对象，建议将≥15mm结素反应者列为预防性治疗对象,以减少结核病发生。     

活动性肺结核患者接触者中的结核病发病率

背景:在巴西,对于潜伏结核感染(LTBI)的治疗只应用于那些接触痰菌涂阳患者、年龄小于15岁、结核菌素皮试(TST)结果≥10mm、没有接种过卡介苗(BCG)的人群以及那些无论是否接种过BCG但TST结果≥15mm的接触者。目的:评估2年发病率和不符合巴西LTBI治疗标准的结核病接触者中的一些预测指标。设计:人群回顾性研究。12～15岁接触者以及那些>15岁但不符合巴西LTBI治疗标准者进入研究范围。结果:结核病发病率为3.2%(22/667),估计结核病发病率为1649/10万;349例TST结果≥5mm接触者(5.4%)发病的危险性高于318例TST结果<5mm接触者(0.9%;RR6.04,95%CI1.7～20.6)结论:不符合巴西LTBI治疗标准的接触者中,如此高的发病率强烈建议这些标准应重新考虑。另外,即使接种过BCG的接触者,TST硬结≥5mm是唯一的可以预测在2年内发病的变量。     

无细胞M.Smegmatis 菌苗的研究与应用

结核病是世界卫生组织(WHO)公布的危害人类健康的十大疾病之一.我国目前同样面临结核病的严峻挑战,2000年全国结核病流行病学调查结果表明,我国目前有近半人口(约5.5亿)感染了结核菌,其中有5000多万人为结核菌素实验强反应者(硬结直径≥15m或有水泡、坏死),因其结核发病率极高,被称为结核感染高危人群.如何控制这些人潜在的内源性复发、外源性再感染和发病,是结核病控制的重点.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.