丙型肝炎病毒感染所致肝硬化可被一项标准血清生化学指标排除

Objective. Assessment of liver histology is pivotal in prognostication and decision- making regarding therapeutic intervention in patients with chronic hepatitis C virus (HCV). Being an invasive procedure, the liver biopsy is associated with complications, and a non- invasive alternative would be preferable. Material and methods. Sera samples from 179 patients with chronic HCV infection collected at the time of liver biopsy were analyzed using routinely available biochemical markers of liver disease, and liver histology was evaluated using the Ishak protocol. The relationship between the serum biochemical markers and cirrhosis (Ishak stage ≥ 5) as well as bridging fibrosis (Ishak stage ≥ 3) was examined. Results. A strong association was found in the multivariate logistic regression analysis between fibrosis stage and aspartate aminotransferase (AST), platelet count and prothrombin- INR (inte- rnational normalized ratio). An index (the G teborg University Cirrhosis Index (GUCI)) was calculated using these variables: normalized AST × prothrombin- INR × 100/ platelet count ( × 109/l). Using a cut- off value of 1.0, the sensitivity was 80% and the specificity 78% for diagnosis of cirrhosis, and the negative predictive values (NPV) and positive predictive values (PPV)- were 97% and 31% , respectively. The GUCI score proved slightly superior for sensitivity, specificity, NPV, PPV, and the area under the receiver operating characteristic (ROC) curve for prediction of cirrhosis and bridging fibrosis compared with the AST to platelet ratio index (APRI), which has been reported as a predictor of significant fibrosis and cirrhosis. Conclusions. An index using routinely available biochemical markers can with a high degree of accuracy discriminate patients with from those without hepatitis C- related cirrhosis.

婴儿肠道内肠杆菌定殖减少而葡萄球菌定殖增多:卫生生活方式的作用?

The modern Western lifestyle may have altered the composition of the commensal microflora. Here,we investigated the first year’s intestinal colonization pattern in 99 vaginally delivered Swedish infants and 17 delivered by cesarean section. Rectal swabs obtained at 3 d of age were cultured for aerobic bacteria and fecal samples obtained at 1,2,4,and 8 wk and at 6 and 12 mo of age were cultivated quantitatively for aerobic and anaerobic bacteria. Vaginally delivered infants more often had Escherichia coli compared with cesarean section-delivered infants,whereas the latter more frequently earned other enterobacteria,such as Klebsiella and Enterobacter. Independent of delivery mode,it took 2 mo until most infants were colonized by enterobacteria,traditionally the first colonizers. In contrast,coagulase-negative staphylococci colonized 99%of the infants from d 3 onwards. The poor adaptation of staphylococci to the gut was shown by declining population sizes after some weeks. Dominating anaerobes were initially bifidobacteria and clostridia,whereas Bacteroides initially colonized only 30%of vaginally delivered infants and increased very slowly in prevalence. Bacteroides colonization was delayed up to 1 y in cesarean section-delivered compared with vaginally delivered infants. Our results show that some “traditional”fecal bacteria are acquired late today especially in cesarean section-delivered infants,probably due to limited environmental circulation. In their absence,skin bacteria like staphylococci have become the first gut colonizers.

1989～1998年出生儿童的脑积水患病率和临床预后的群体性列队研究

Aim: To determine the prevalence, aetiology and clinical outcome in children w ith surgically treated hydrocephalus. Methods: A population-based study of all 208 liveborn children with hydrocephalus, 124 with infantile hydrocephalus and 8 4 with hydrocephalus associated with myelomeningocoele, born during 1989-1998 i n western Sweden. Aetiological and clinical information was collected from recor ds. Results: The prevalence of hydrocephalus was 0.82 per 1000 live births, 0.49 for children with infantile hydrocephalus and 0.33 for children with myelomenin gocoele. The prevalence of infantile hydrocephalus decreased during the period f rom 0.55 to 0.43 per 1000. In this group, the aetiology was prenatal in 55%and peripostnatal in 44%of the children. The origin was perinatal haemorrhage in al l cases born very preterm. The mortality rate was 5%for children with either in fantile hydrocephalus or myelomeningocoele. Mental retardation, cerebral palsy a nd epilepsy were significantly more frequent in the group with infantile hydroce phalus: 46%vs 16%, 31%vs 4%and 31%vs 10%, respectively. All children with infantile hydrocephalus born very preterm had at least one of these impairments, as did 80%of those with overt hydrocephalus at birth. Conclusion: A slightly d ecreasing trend for infantile hydrocephalus was observed during the 10-y period . Children with infantile hydrocephalus had a worse outcome than those with myel omeningocoele. The need for neurosurgical revisions for two-thirds of the child ren indicates the need for further development of prevention and treatment strat egies.

55例非交通性和交通性脑积水患者的B波客观分析

Background: B waves, slow and rhythmic oscillations in intracranial pressure (ICP), are claimed to be one of the best predictors of outcome after surgery for normal pressure hydrocephalus (NPH). Object: To determine the relation between the percentage of B waves and outcome in patients with hydrocephalus, and also t he diurnal variation of B waves. Methods: ICP and patient behaviour were recorde d overnight (17 to 26 hours) in 29 patients with non- communicating hydrocephal us and 26 with NPH. The B wave activity, measured with an amplitude threshold of 0.5, 0.75, 1.0, 1.5, 2.0, 3.0, and 5.0 mm Hg, was estimated as the percentage o f total monitoring time (% B waves) using a computer algorithm, and correlated with postoperative outcome, defined as changes in 12 standardised symptoms and signs. Results: There was no linear correlation between improvement after surger y in the 55 patients and total % B waves, but a correlation was found between improvement and % B waves during sleep (r=0.39, p=0.04). The percentage of B w aves was the same during sleep and wakefulness, and patients with NPH had the sa me proportion of B waves as the non- communicating patients. Conclusions: B wav es are commonly observed in patients with both communicating and non- communica ting hydrocephalus, but are only weakly related to the degree of postsurgical im provement.

选择性氧化芳香族萜烯是普遍存在的接触性变应原

Terpenes are widely used fragrance compounds in fine fragrances, but also in domestic and occupational products. Terpenes oxidize easily due to autoxidation on air exposure. Previous studies have shown that limonene, linalool and caryophyllene are not allergenic themselves but readily form allergenic products on air-exposure. This study aimed to determine the frequency and characteristics of allergic reactions to selected oxidized fragrance terpenes other than limonene. In total 1511 consecutive dermatitis patients in 6 European dermatology centres were patch tested with oxidized fragrance terpenes and some oxidation fractions and compounds. Oxidized linalool and its hydroperoxide fraction were found to be common contact allergens. Of the patients tested, 1.3%showed a positive reaction to oxidized linalool and 1.1%to the hydroperoxide fraction. About 0.5%of the patients reacted to oxidized caryophyllene whereas 1 patient reacted to oxidized myrcene. Of the patients reacting to the oxidized terpenes, 58%had fragrance-related contact allergy and/or a positive history for adverse reaction to fragrances. Autoxidation of fragrance terpenes contributes greatly to fragrance allergy, which emphasizes the need of testing with compounds that patients are actually exposed to and not only with the ingredients originally applied in commercial formulations.

19例持续瘙痒性小结节及在注射铝吸附的疫苗之后出现对于铝接触性过敏反应

Rare cases of persistent pruritic nodules, sometimes associated with aluminium (Al) allergy, have been reported after the use of several Al adsorbed vaccines. During vaccine trials in the 1990s a high incidence of pruritic nodules (645 cases/76,000 recipients), in 77% associated with Al allergy, was observed after the administration of diphtheria-tetanus / acellular pertussis (DT/aP) vaccines from a single producer. In the present report 19 children with pruritic nodules after vaccination with Al hydroxide-adsorbed DTaP/polio+ Hib (Infanrix, Pentavac) are described. The children had intensely itching nodules at the injection site, often aggravated during upper respiratory tract infections, and local skin alterations. So far, the symptoms have persisted for up to 7 years. The median time between vaccination and onset of symptoms was 1 month. 16 children were epicutaneously tested for Al, all with positive reactions indicating delayed hypersensitivity to Al. The condition is not commonly known but is important to recognise, as the child and the family may suffer considerably. Future vaccinations with Al-adsorbed vaccines may cause aggravation of the symptoms and the Al allergy. Al-containing skin products, such as antiperspirants, may cause contact dermatitis. Nodules may be mistaken for tumours. Even though the incidence of itching nodules and Al allergy after administration of Infanrix, Pentavac and other Al-adsorbed vaccines is probably low, research to replace Al adjuvants seems appropriate. We conclude that intensely itching subcutaneous nodules, lasting for many years, and hypersensitivity to aluminium may occur after DTaP/polio+ Hib vaccination of infants.

对2.5岁时语言能力发展迟缓的瑞典儿童在6岁时语言技能的研究

This study concerns language outcome in 6-y-old children who participated in a longitudinal community-based study of 105 children screened for language delay (LD) at 2 12 y of age. The purpose was to investigate (1) whether results from the 2 12-y screening were persistent at 6 y of age, and (2) what language domains at age 6 were difficult for (a) children with LD at age 2 12 y and (b) children with normal language (LN) at the same age. Significant differences between LD and LN at age 2 12 y were persistent at age 6. The vulnerability that was identified at 2 12 y of age, such as problems with going from single-word utterances to multiword utterances, seems to persist as delayed development at different language levels and across language domains. Conclusion: This study has shown that children who failed the 2 12-y screening are at high risk of having persistent language problems at age 6 y.

儿童期急性淋巴细胞性白血病治疗之后破伤风和Hib抗体亲合力的变化对于疫苗接种措施的影响

Aim: To investigate the possible relationship between serumlevels and avidities of antibodies against tetanus toxoid (TT)-and Haemophilus influenzae type b (Hib) in children that were vaccinated after treatment for childhood acute lymphoblastic leukaemia (ALL). Methods: The study groups were 31 paediatric patients with ALL and 18 healthy controls. All subjects were vaccinated with TT and a protein conjugated Hib vaccine.Antibody levels were analysed at three time points: At diagnosis of ALL, after cessation of treatment before vaccination and three weeks after vaccination. Avidity was measured twice,with a thiocyanate elution assay, at diagnosis of ALL and three weeks after vaccination. Results: There was a correlation between level and avidity of tetanus antibodies after vaccination(r s =0.59)Conclusion: The vaccination strategy after childhood ALL must be different for low-risk and high-risk ALL groups, since the high-risk group fail to elicit a recall response to tetanus.

儿童期早期哮喘症状与预后

Aim: To study the outcome in early adulthood for children with early asthma symptoms and to analyse the factors associated with current asthma. Methods: In a prospective study, we have re- investigated 89/101 children who were hospitalized before the age of two years due to wheezing. The children were investigated using a questionnaire and allergy and bronchial hyperresponsiveness tests at the age of 17- 20 years and compared with age- matched controls. Results: In the cohort, 43% had had asthma symptoms in the preceding 12 months compared with 15% in the control group. The strongest risk factors for asthma were current allergy, bronchial hyper- responsiveness and female gender. Female gender and passive smoking in infancy were independent infantile risk factors. In addition to female gender, two pathways led to current asthma: an allergic pathway from family atopy via the development of allergy and another pathway from early passive smoking via hyperresponsiveness and active smoking. Conclusion: In children with early wheezing disorder, current allergy, bronchial hyper- responsiveness and female gender were the strongest risk factors for asthma in early adulthood, while female gender and passive smoking in infancy were independent infantile risk factors. The effects of early passive smoking persist longer than previously reported.

应用多重取样法评估波罗的海近海风力发电场建设区域中鱼类群落构成的重要性

大型建筑物在施工前需要进行环境影响评估（EIA），这是标准化程序。为了充分描述其所造成的影响，用于EIA的方法必须谨慎采纳，既要考虑到待施工设施的特征，又要考虑受到影响的环境。

有或无宫内生长受限的巴基斯坦新生儿胎盘中的细胞因子

Although intrauterine growth retardation (IUGR) is a ma jor risk factor for increased neonatal mortality and morbidity,the mechanisms behind it are not clear. We analyzed cytokine gene expression and gene polymorphisms in infants with and without IUGR in Pakistan,where IUGR is very common. 45 IUGR and 55 control mother/infant pairs were studied. mRNA for IL-10,IL-8,TNF-α,TGF-β,IL-6,IL-4,IL-1β,IL-12,IFN-γand GAPDH was quantified with RT-PCR from placenta. Cytokine and cytokine receptor gene polymorphisms for -1087IL10,-308TNFA,-174IL6,+915TGFB1,intron 2 IL1RN,+36TNFR1,150V IL4RA and -159CD14 were determined from genomic DNA. The serum levels of IL-1β,IL-6,IL-8,IL-10,IL-12,TNF-αand TGF-βwere measured. There was a significant decrease of IL-10 and IL-12,but increase of TGF-βin the decidua and similarly decrease of IL-10,but increase of TGF-βin the trophoblasts of the IUGR placentas compared with the non-IUGR placentas. We found significantly lower levels of IL-1βin serum from the mothers of the IUGR infants and of TGF-βin serum of the infants with IUGR compared with the non-IUGR infants. We note that the IL-10 mRNA expression in the decidua was down-regulated,but the TGF-βmRNA upregulated in IUGR placentas of mothers from a population with multiple risk factors for IUGR.We propose that the low IL-10 in the placenta may be involved in the pathogenesis of IUGR and might possibly be treatable.

癌症患儿中γ干扰素和肿瘤坏死因子α与贫血和预后的关系

This study examined whether the initial plasma levels of tumour necrosis factor α (TNFα ) and interferon γ (IFNγ ) in 131 children with newly diagnosed cancer were associated with haematopoietic suppression, and whether plasma levels of TNFα or haemoglobin at diagnosis affects long-term prognosis in childhood acute lymphoblastic leukaemia (ALL). Conclusions: IFNγ , and possibly also TNFα , were related to anaemia in children with solid tumours. Neither TNFα levels nor Hb levels were associated with increased risk of ALL relapse.

越南公立—私立结合项目中私人肺病专家的结核病人治疗转归报告

地点:越南胡志明市目的:确定促进结核病控制公立 — 私立结合项目 (PPM)中私人肺病专家的病人治疗转归情况。方法:对由 PPM 项目中私人肺病专家治疗,和在国家结核病规划(NTP)机构中治疗的病人队列进行 12 个月的随访。以治疗卡中的信息为基础,确定病人管理质量和治疗转归。作为补充措施,还开展了小组访谈。种不同的治疗方案,根本就没有采用直接观察下的治疗,利用痰涂片镜检进行治疗效果评价以及健康教育都不够。总治疗成功率为60%,丢失率为37%,比 NTP 机构明显为差。结论:PPM 项目采用了培训、督导、标准化转诊和信息系统以及经济激励机制的综合措施,但私人医生仍然不能获得良好的治疗转归。其原因可能包括对私人医生(PPs)和病人的问卷调查以及私人医生未进行药物成本补偿以及缺乏实施细则。