Cooling dialysate during in-center hemodialysis:Beneficial and deleterious effects

The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.

Effect of lifestyle modification on hepatocellular carcinoma incidence and mortality among patients with chronic hepatitis B

BACKGROUND Research exploring the influence of healthier lifestyle modification(LSM)on the risk of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B(CHB)is limited.AIM To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.METHODS Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1,2009,and December 31,2017,those aged≥20 years who drank alcohol,smoked cigarettes,and were sedentary were analyzed.Exposure included at least one LSM,including alcohol abstinence,smoking cessation,and regular exercise.The primary outcome was HCC development,and the secondary outcome was liver-related mortality.We used 2:1 propensity score matching to account for covariates.RESULTS With 48766 patients in the LSM group and 103560 in the control group,the adjusted hazard ratio(HR)for incident HCC and liver-related mortality was 0.92[95%confidence interval(CI):0.87-0.96]and 0.92(95%CI:0.86-0.99)in the LSM group,respectively,compared with the control group.Among the LSM group,the adjusted HR(95%CI)for incident HCC was 0.84(0.76-0.94),0.87(0.81-0.94),and 1.08(1.00-1.16)for alcohol abstinence,smoking cessation,and regular exercise,respectively.The adjusted HR(95%CI)for liver-related mortality was 0.92(0.80-1.06),0.81(0.72-0.91),and 1.15(1.04-1.27)for alcohol abstinence,smoking cessation,and regular exercise,respectively.CONCLUSION LSM lowered the risk of HCC and mortality in patients with CHB.Thus,active LSM,particularly alcohol abstinence and smoking cessation,should be encouraged in patients with CHB.

Research Protocol： Cross-sectional Study （Survey）--The Fate of Moroccan Childhood Cancer Survivors

Background： Malignant tumors of the child represent one of the major causes of mortality in children between 1 and 14 years in the West. Young people recovering from childhood cancer may have complications related to the disease itself or treatment. Complications can be somatic, psychic or socio-occupational and familial. The current study aims to know the current status of young children treated in the oncology unit of PHOU （Pediatric Hemato-Oncology Unit）, Rabat Children Hospital is exclusively or jointly between 1978 and 2004. Material and methods： It will be a cross-sectional study conducted among childhood cancer survivors treated between 1978 and 2004 at the Pediatric Oncology Unit of Children＇s Hospital of Rabat. Medical and demographic data will be collected through questionnaires completed by phone or intemet, by the survivor, his parent or his physician. Discussion： To our knowledge, there is no previous study about the fate of Moroccan childhood cancer survivors before our study. Hence, it will be a cross-sectional study to have a quick picture on the situation in Morocco. It would be necessary to establish a follow-up strategy in Morocco.

Knowledge, Attitudes and Perception of Moroccan Women about Breast Cancer

Breast cancer appears to be a disease of both the developing and developed worlds. Among Moroccan women, breast cancer represents 34.4% of all cancers seen in women. This study aimed to give an overview of the knowledge, attitudes and perceptions related to breast cancer among Moroccan women. To our knowledge there is no previous study in Morocco to assess Moroccan women awareness of breast cancer. A national Cross-sectional study started in July 2011 based on eligible women for early detection programs in basal health centers from five Moroccan regions. A self-filled questionnaire was used to collect data outside working time. Knowledge was assessed using 24 true-false items. The questions were asked about symptoms and risk factors of breast cancer. A score ranging from 0 to 24 was calculated by weighting each item 1 point. Then the score was dichotomized according to the threshold 12 （50% correct answers）. The study included 1,444 women from the regions of Rabat, Casablanca, Marrakech, Fez and Meknes. The average age was 40.6 ~ 10 years, 2 women with a minimum age of 17 years and a 1 with a maximum age of 86 years. At the bivariate analysis using chi-square test we found that Marital Status, Social Security, Education, Origin, Sport, Personal History of Cancer, Medical and Surgical personal History were associated with knowledge score. At the multivariate analysis （Logistic regression）, we found that Social Security, Education, Origin, Sport were associated to knowledge score at the final model. This study has important implications for health care providers. The poor knowledge of risk factors and practice of breast screening leads to late stage presentation at diagnosis of breast cancer.

Performance evaluation of NeuMoDx 96 system for hepatitis B and C viral load

BACKGROUND Hepatitis B virus(HBV)and hepatitis C virus(HCV)viral load(VL)estimation is essential for the management of both HBV and HCV infections.Due to a longer turnaround time for VL estimation,many patients drop out from the cascade of care.To achieve the global goals of reducing morbidity and mortality due to HBV/HCV and moving towards their elimination by 2030,molecular diagnostic platforms with faster and random(i.e.single sample)access are needed.AIM To evaluate the performance of the recently launched NeuMoDx 96 random access system with the conventional COBAS^(■)AmpliPrep/COBAS TaqMan system for HBV and HCV VL estimation.METHODS Archived once-thawed plasma samples were retrieved and tested on both platforms.Correlation between the assays was determined by linear regression and Bland-Altman analysis.The study included samples from 186 patients,99 for HBV of which 49 were true infected HBV cases(hepatitis B surface antigen,antihepatitis B core antibody,and HBV DNA-positive)and 87 for HCV assay in which 39 were true positives for HCV infection(anti-HCV and HCV RNA-positive).RESULTS The median VL detected by NeuMoDx for HBV was 2.9(interquartile range[IQR]:2.0-4.3)log_(10)IU/mL and by COBAS it was 3.70(IQR:2.28-4.56)log_(10)IU/mL,with excellent correlation(R2=0.98).In HCV,the median VL detected by NeuMoDx was 4.9(IQR:4.2-5.4)log_(10)IU/mL and by COBAS it was 5.10(IQR:4.07-5.80)log_(10)IU/mL with good correlation(R2=0.96).CONCLUSION The overall concordance between both the systems was 100%for both HBV and HCV VL estimation.Moreover,no genotype-specific bias for HBV/HCV VL quantification was seen in both the systems.Our findings reveal that NeuMoDx HBV and HCV quantitative assays have shown overall good clinical performance and provide faster results with 100%sensitivity and specificity compared to the COBAS AmpliPrep/COBAS TaqMan system.

Bilharzia Appendicitis: Incidence in a Commune in Mali, about 3CAS

Appendicitis bilharzia is a very rare condition and we report 3 cases of this pathology that sense clinical and biological similarities with bacterial appendicitis. The etiological diagnosis was exclusively histopathological, this allowed to highlight eggs of Schistosome in the appendicular wall in the three patients. The surgical treatment was supplemented by a specific medical treatment based on praziquantel. The surgical suites were simple for 2 patients, complicated by superficial parietal suppuration in a patient.

重庆市主城区男男同性恋人群艾滋病防治工作现状及需求分析

目的调查重庆主城项目区男男同性恋人群(MSM)对于艾滋病的防治知识、态度和行为情况,以分析该地区艾滋病防治工作的现状及需求。方法对MSM进行问卷调查,并定性访谈MSM、疾病预防控制中心工作人员、志愿者工作组、酒吧及浴室场所经营者。结果约80%MSM为30岁以下及未婚,一半以上为大专及以上文化,以学生、公司职员、娱乐场所服务人员为主,近1/4为双性恋。获取艾滋病防治知识的途径以电视、报刊为主,但经朋友、免费的宣传资料、网络及咨询服务获取亦占较高比例。最近6个月购买和提供男性性服务的分别占3.9%(30/772)、6.5%(50/772),17.1%(132/772)与女性发生过性行为,与男性、女性性行为每次都用安全套的分别为41.9%(271/647)、29.5%(39/132),82.0%(633/772)接受干预服务。MSM建议干预应充分尊重其隐私,要提供有吸引力的宣传材料,增加其他性病的防治知识,形式需多样生动,希望得到专业人士的宣传。志愿者要求获得更多培训和稳定的工作场所。场所经营者建议充分调动场所内干预人员积极性。结论该区MSM存在较多感染艾滋病的高危因素。目前已采取多项干预活动并取得一定效果,但需要更多尊重目标人群的隐私,改进宣传内容和形式,并充分发挥志愿者、场所经营者及场所内工作人员的积极性。

关于空腹血糖、空腹胰岛素乘积的倒数在流行病学研究中应用的补充说明

高胰岛素正糖钳夹技术可以测定活体的胰岛素敏感性,但它并不适用于大规模流行病学研究。流行病学研究需要简单的胰岛素抵抗测定法。本文补充报告在空腹血糖(FPG)(75～306mg/dl或4.2～17.1mmol/L)及空腹胰岛素(FIns)(9.7～120mU/L)范围很宽的Pima印第安人群中,正糖钳夹技术测定的胰岛素介导的葡萄糖代谢率(M)与涉及FPG、FIns的多种复合的胰岛素敏感指数的相关性:胰岛素作用指数(IAI)=1/(FPG×FIns)在非糖尿病人群及2型糖尿病人群都与M显著正相关(r>0.7,P=0.0001),而且这两者的相关性强于M与其他指数如FIns或FPG/FIns比值的相关性,也不弱于M与糖负荷后3～5个时间点的血糖、胰岛素曲线下面积乘积的相关性。IAI的五分变量分布情况表明有90.4%的IAI落在所预测的M值五分变量区域或与之相邻的一个五分变量区域之内。1/FPG×FIns虽相对简单但确实与机体的胰岛素敏感性密切相关,它可以做为胰岛素敏感指数在流行病学研究中应用。

Quality of life in gastric cancer

AIM: To summarize the empirical research on assessing quality of life (QOL) in patients with gastric carcinoma. METHODS: Literature searches were conducted in MedLine from 1966 to February 2004. RESULTS: Twenty-six studies were identified. QOL was used as an outcome measure in virtually all identified studies, such as those examining the effects of gastric cancer and various medical or surgical treatments in the patients. QOL was assessed mainly with generic measures; the social dimensions of QOL were largely neglected. The lack of gastric cancer-specific QOL measures hampers QOL research up to now. The gastric cancer-specific EORTCQLQ-STO22 and the FACT-Ga are important additions to the arsenal of disease-specific QOL measures. In most of the studies, the label QOL is used for questionnaires, which only assess symptoms or performance status, or are physician-reported rather than patient-reported outcomes. CONCLUSION: QOL in patients with gastric cancer deserves more systematic studies, especially as one of the outcome measures in randomized clinical trials. Results of studies that include QOL in patients with gastric cancer should be applied in clinical care, which aims at improving QOL of these patients.

在高收入国家的γ干扰素释放试验与结核病筛查:成本-效益分析

目的:结核菌素皮肤试验(TST)是发现潜伏性结核感染(LTBI)的经典方法,目前γ干扰素试验(IGRA)也是可供选择的技术。我们比较了不同人群、不同临床状态下TST及IGRA的成本效益。方法:20年来加拿大对入境的外国移民或结核病接触者采用了不同的筛查策略,我们采用Markov模式比较了预期发现的病例数与成本的分析。并对比较便宜的商品试剂盒IGRA:γ干扰素定量测定(QFT)进行了调查。模型(model)输入数据均源于已发表的文献。结果:对入境移民,采用胸部X线拍片(CXR)是符合成本-效益原则的,而QFT是最不符合成本- 效益原则者。序贯进行TST及QFT比任何情况下单一行QFT更符合成本-效益。在特定的(选择的)亚群中,也比单一进行TST更符合成本-效益原则。在密切接触者及不定期接触者中,采用TST或QFT筛查是节约成本的(cost saving):除在婴儿期后接种BCG的接触者外,采用TST的收益(savings)大于QFT。结论:只有在结核病高危人群中,以TST或QFT筛查LTBI是符合成本-效益的。TST阳性者再行QFT是最符合成本-效益原则的。

Human immunodeficiency virus-related primary central nervous system lymphoma: factors influencing survival in 111 patients

BACKGROUND: The current study evaluated factors influencing survival in patients diagnosed with human immunodeficiency virus (HIV)-related primary central nervous system lymphoma (PCNSL), with a focus on the effects of therapeutic radiotherapy (RT) and highly active antiretroviral therapy (HAART). METHODS: A retrospective chart review of patients with a diagnosis of HIV-related PCNSL at one of five university hospitals between 1987 and 1998 was performed. Clinical details including antiretroviral agent use, brain imaging scan results, RT use, and survival outcomes were recorded. RESULTS: One hundred eleven patients with HIV-related PCNSL were identified. The annual incidence decreased significantly between 1992 and 1995 and between 1996 and 1998 (P=0.04).

肾功能和贫血是冠心病及其死亡率的危险因素:社区动脉粥样硬化风险(ARIC)研究

Background: Kidney failure causes anemia and is associated with a very high risk of coronary heart disease(CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both conditions are present. Methods: We investigated the association of kidney dysfunction and anemia with CHD events(fatal or nonfatal CHD or coronary revascularization procedures) and CHD and all- cause mortality over 12 years of follow- up in 14 971 adults aged 45 to 64 years in the ARIC Study. Glomerular filtration rate(GFR) was estimated from calibrated serum creatinine using the MDRD Study equation(< 30 mL/min per 1.73 m2 excluded, n=32). Anemia was defined as hemoglobin level<13.5 g/dL in men(648/6746, 9.6% ) and< 12 g/dL in women(1049/8225, 12.8% ). Results: The prevalence of anemia was progressively higher at lower estimated GFR< 75 mL/min per 1.73 m2(both P< .001) for both men and women. A total of 1635(10.9% ) participants had a CHD event, 360(2.4% ) died of CHD, and 1722(11.5% ) died of any cause during follow- up. After adjustment for known risk factors, including diabetes, lipid levels, blood pressure, and use of antihypertensive medication, decreased kidney function was associated with a higher risk of recurrent CHD events and mortality from CHD and all causes. These associations were significantly stronger among participants with anemia. The adjusted relative hazards of all- cause mortality associated with moderately decreased versus normal kidney function(GFR 30- 59 vs ≥ 90 mL/min per 1.73 m2) were 1.7(95% CI 1.3- 2.2) in the absence of anemia and 3.5(95% CI 2.4- 5.1) in the presence of anemia(P interaction=.001) . Conclusions: The combination of moderately decreased kidney function and anemia is associated with an increased risk of CHD events and mortality, emphasizing the need to identify individuals with these conditions and evaluate interventions to treat anemia and slow the progression of chronic kidney disease.

美国视力下降的患病率

Context:The prevalence of visual impairment in the US public has not been surveyed nationally in several decades.Objective:To estimate the number of US individuals aged 12 years or older who have impaired distance vision due to uncorrected refractive error.Design,Setting,and Participants:The National Health and Nutrition Examination Survey(NHANES),using a multistage probability sampling design,included a vision evaluation in a mobile examination center.Visual acuity data were obtained from 13 265 of 14 203 participants(93.4%)-who visited the mobile examination center in 1999-2002.Visual impairment was defined as presenting distance visual acuity of 20/50 or worse in the better-seeing eye.Visual impairment due to uncorrected refractive error was defined as(presenting)visual impairment that improved,aided by automated refraction results,to 20/40 or better in the better-seeing eye.Main Outcome Measures:Presenting distance visual acuity(measured with usual corrective lenses,if any)and distance visual acuity after automated refraction.Results:Overall,1190 study participants had visual impairment(weighted prevalence,6.4% ;95% confidence interval CI,6.0%-6.8%),and of these,83.3% could achieve good visual acuity with correction(95% CI,80.9%-85.8%).Extrapolating these findings to the general US population,approximately 14 million individuals aged 12 years or older have visual impairment(defined as distance visual acuity of 20/50 or worse),and of these,more than 11 million individuals could have their vision improved to 20/40 or better with refractive correction.Conclusions:Visual impairment due to uncorrected refractive error is a common condition in the United States.Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.

乙型或丙型肝炎病毒感染者的癌症发生率:一项基于社区的大型连锁研究

Background/Aims:Risks of hepatocellular carcinoma(HCC) following hepatitis B and/or hepatitis C virus(HBV/HCV) infection are well known,those for other cancers are less well understood.The aim was to quantify the risk of cancers among persons diagnosed with HBV/HCV infections.Methods:The data from a cohort of 39109 HBV,75834 HCV,and 2604 HBV/HCV co-infected persons notified to the State health department,1990-2002,were probabilistically linked to the Cancer Registry and standardised incidence ratios(SIRs) for cancer were calculated.Results:The match rate for any cancer was 2.7%,2.3% and 3.3% for HBV,HCV and HBV/HCV co-infected notifications.SIRs for HCC were 30.6(95% CI 25.7-36.5) ,22.7(95% CI 19.1-26.5) and 30.3(95% CI 13.6-67.5) ,respectively.Increased risk was detected for Burkitt’s lymphoma and HBV(SIR 12.9,95% CI 5.4-30.9) and immunoproliferative malignancies following HCV(SIR 5.6,95% CI 1.8-17.5) .Conclusions:The risk of HCC in the infected cohort was 20-30 times greater than in the uninfected population with SIRs two to three times greater than those for the other HBV/HCV infection associated cancers.The modest though significant risk of immunoproliferative malignancies associated with HCV infection is consistent with recent findings.

年轻发病2型糖尿病对中青年比马印第安人终末期肾病发病率和死亡率的影响

背景：年轻发病2型糖尿病患者的长期结局尚未被阐明。目的：在年轻与年长发生糖尿病的比马印第安人中比较糖尿病性终末期肾病（end-stagerenal disease，ESRD）的发病率和死亡率。设计、地点及参试者：于1965～2002年在Arizona比马印第安人中进行人群纵向研究。参试者分为两组：年轻发病2型糖尿病（发病年龄〈20岁）和年长发病2型糖尿病（发病年龄20～55岁）。随访事件和人年按时间依赖方式以每10岁进行分层。终末期肾病的定义为因糖尿病肾病而接受透析治疗或者死于糖尿病肾病。主要观测指标：根据2型糖尿病的发病年龄，计算25至55岁之间糖尿病ESRD的发病率和死亡率。结果：在1856例糖尿病参试者中，96例为年轻发病。校正年龄及性别后，年轻发病2型糖尿病者ESRD的发生率为每1000人年25．0例（95％可信区间[confidence interval，CI]，6．7～43．1），年长发病者ESRD的发病率为每10130人年5．4例（95％CI，4．4～6．4）（发病率比，4．6；95％CI，2．2～9．8）。在所有年龄段中，年轻发病参试者的年龄别ESRD发生率均较高。在校正年龄及性别后，年轻发病2型糖尿病参试者的自然原因死亡率为每10130人年15．4例（95％CI，0．2～30．5），年长发病2型糖尿病个体为每10130人年7．3例（95％CI，5．9～8．7）（死亡率比，2．1；95％CI，0．8～5．7）。与无糖尿病的参试者相比，年轻发病2型糖尿病个体的死亡率为前者的3倍（95％CI，1．1～1．8），年长发病2型糖尿病个体的死亡率是其1．4倍（95％CI，1．1～1．8）。在1386例具有所有协变量完整数据的亚组中（从糖尿病发病开始即进行观察），在校正性别、平均动脉压、体重指数（kg／m^2）、血浆葡萄糖浓度、吸烟、降糖药以及降压药后，Cox比例风险模型显示糖尿病发病年龄与ESRD发病率并不相关（风险比，1．0；95％CI，0．9～1．2）。结论：2型糖尿病较早发病与中年时ESRD发病率和死亡率显著升高相关。其主要原因是20岁以下诊断糖尿病的个体在中年时已有较长的糖尿病病程。

厄瓜多尔患者及其家庭有关结核病(包括耐多药肺结核)的费用

背景:在中低收入国家中,患者及其家庭有关耐多药肺结核(MDR-TB)费用的公开信息非常少。方法:在2007年2月到7月期间,对细菌学检查确诊并已接受2个月治疗的活动性结核病患者,完成一份有关直接现金支出和工资损失间接费用的面谈问卷。临床信息摘自于医疗记录。结果:104例非MDR-TB患者中,结核病相关的患者总费用平均为960美元/例,相应地,14例参与的MDR-TB患者总费用平均为6880美元,分别占厄瓜多尔年人均收入的31%和223%。MDR-TB相关的高额费用主要是由于较长的病程所致,到访谈时为止,病程平均为22个月。这也导致一段长时间的失业。大多数患者都经历了收入的大幅下降,尤其是MDR-TB患者,在访谈期间,这些人每个月的收入低于100美元。结论:在厄瓜多尔,活动性肺结核患者及其家庭所承受的直接与间接费用是非常高的,其中MDR-TB患者所承受的费用最高。这些费用也是完成治疗的重要障碍。

Marital Status in Moroccan Long-term Childhood Cancer Survivors

In developed countries, currently, more than 80% of children with cancer survive and they are considered as cured. However, the survivors are at high risk of medical and social late effects. In Morocco, childhood cancer accounts for 3% of all cancers. The purpose of this study was to look for factors related to marital status in Moroccan childhood cancer survivors. This was a cross-sectional study conducted among childhood cancer survivors treated between 1978 and 2004 at the Pediatric Oncology Unit of Children＇s Hospital of Rabat. Medical and demographic data were collected through questionnaires completed by phone or internet, by the survivor, his parent or his physician. Among 995 patients considered cured; only 195 were found. The decline from the initial diagnosis varies from 10 years to 36 years, with a mean of 16.2 years and a standard deviation of 6.3 years. In our study, we found that 31 survivoi＇s （22.3%） of adult participants were married. They were aged between 23 and 43 （the mean was 31.8 and the SD was 5.9）. Men, aged more than 35 years old and unemployed are less likely to be married. To our knowledge, there is no previous study about the fate of Moroccan childhood cancer survivors before our study. Hence, it was a cross-sectional study to have a quick picture on the situation in Morocco. It would be necessary to establish a follow-up strategy in Morocco.

A Study on Pre-Induction Cervical Ripening with PGE2 Vaginal Tablet One (3 mg) vs. Half (1.5 mg) in Low Risk Multi Parous Mothers at 40 Weeks of Gestation

Backgrounds: Induction of labor is a common practice. In women with immature cervix, PGE2 is commonly used for pre-induction. We hypothesized that PGE2 1.5 mg may be equally effective to PGE2 3 mg in multiparous women for labor induction. The present effort was an attempt to compare the efficacy and effects of pre-induction cervical ripening with PGE2 3 mg vs. 1.5 mg in multi-parous mothers (2nd and 3rd Pregnancy) at 40 weeks. Methods: A double-blind randomized controlled trial was carried out at Castle Street Hospital for Women, Colombo, Sri Lanka. Study subjects consisted of women with singleton pregnancy (no cesarean history) admitted for delivery at 40 weeks of their 2nd or 3rd pregnancy. PGE2 1.5 mg vs. 3 mg PGE2 vaginal tablet were used for treatment (n = 173) and control (n = 170) groups, respectively. Cervical ripening and maternal, fetal complications were observed. Unfavorable cervices were induced with the same PGE2 dose in the following day. Results: Study group, compared with the control group, achieved the same rate of favorable cervices in 1st and 2nd cycles (63.5% vs. 64%, respectively). Both groups showed the same rate of cervical dilatation achievement, and admissions to Special Care Baby Unit. Study group showed significantly less maternal complications (4% and 11%, respectively: p = 0.01). Conclusion: PGE2 of 1.5 mg is equally effective in achieving favorable cervices, adequate cervical dilatation with minimum maternal complications compared to the usual 3 mg dose in multiparous low-risk women.

QuantiFERON~-TB Gold试验在结核病接触者筛查和活动性结核病预测中的应用

目的:评估QuantiFERON-TBGold(QFT-G)试验在筛查结核病(TB)接触者、以及评估其发展为活动性结核病的风险方面的效果。方法:收集公共卫生中心结核病密切接触者接受QFT-G试验2年后,临床进展为活动性结核病的资料。结果:3102例观察的接触者中,有419例QFT-G阳性,其中323例开始异烟肼(INH)治疗。419例中的20例(4.8%)发展为结核病。在平均随访的1.6年时间里,2683例QFT-G-阴性人群中,19例被诊断为结核病(0.7%)。QFT-G对于检测可能发展为活动性结核病的接触者的敏感性估计为51%,对于进行异烟肼治疗估计的敏感性为64%。在QFT-G阴性接触者中,所有发展为结核病的都是高度传染病例的接触者。没有进行大规模的结核分枝杆菌素皮肤试验。结论:QFT-G阳性接触者中结核病发病率比QFT-G阴性接触者要高,但是QFT-G阴性接触者中的结核病病例数也是不可忽视的,尤其是具有高传染性结核病例的接触者。

糖尿病流行病学研究中应用OGTT资料评估胰岛β细胞功能的可能性——468例非糖尿病Pima印第安人葡萄糖钳研究资料分析

目的 探讨以口服葡萄糖耐量试验 (OGTT)的简单参数在糖尿病流行病研究中评估胰岛 β细胞功能的可能性。方法 美国Pima印第安人糖耐量正常者 332例、糖耐量低减者 1 36例参与本试验。各例均做静脉葡萄糖耐量试验 (IVGTT) ,OGTT及正葡萄糖钳试验。计算Homa IR ,Homa β ,第一时相胰岛素分泌量 (AIR) ,胰岛素曲线下面积 ,ΔI30 /ΔG30 ,胰岛素介导的葡萄糖代谢率 (M ,mg·kg- 1 ·min- 1 )。从基本病理生理学概念推导新 β细胞功能指数MBCI=(FINS×FPG) / (PG2h +PG1h- 2×FPG) (FINS :空腹胰岛素 ;FPG :空腹血糖 ;PG1h和PG2h分别为OGTT 1h和 2h的血糖 )。以线性回归分析正葡萄糖钳技术测定的胰岛素敏感性与不同的β细胞功能指数的组合对血糖水平的贡献 ,探讨以OGTT的简单参数评估β细胞功能的可能性。 结果 (1 )调整M后 ,IGT组AIR、ΔI30 /ΔG30 、Homa β和MBCI与OGTT 2h血糖水平的偏相关系数分别为 - 0 .30、- 0 .30、- 0 .2 9及 - 0 .37(P均 <0 .0 0 1 ) ,但在NGT组则分别为 - 0 .0 6(P >0 .0 5)、0 .0 1 (P >0 .0 5)、- 0 .30 (P <0 .0 0 1 )及 - 0 .43(P <0 .0 0 1 )。 (2 )以OGTT 2h血糖为因变量 ,分别以M +AIR ,M +ΔI30 /ΔG30 ,M +Homa β,M +MBCI为自变量做线性回归分析 ,显示M