Bactericidal and anti-adhesive properties of culinary and medicinal plants against Helicobacter pylori

AIM： To investigate the bactericidal and anti-adhesive properties of 25 plants against Helicobacter pylori （H pylon）. METHODS： Twenty-five plants were boiled in water to produce aqueous extracts that simulate the effect of cooking. The bactericidal activity of the extracts was assessed by a standard kill-curve with seven strains of H pylori. The anti-adhesive property was assessed by the inhibition of binding of four strains of FITC-labeled Hpylori to stomach sections. RESULTS： Of all the plants tested, eight plants, including Bengal quince, nightshade, garlic, dill, black pepper, coriander, fenugreek and black tea, were found to have no bactericidal effect on any of the isolates. Columbo weed, long pepper, parsley, tarragon, nutmeg, yellow-berried nightshade, threadstem carpetweed, sage and cinnamon had bactericidal activities against Hpylori, but total inhibition of growth was not achieved in this study. Among the plants that killed H pylori, turmeric was the most efficient, followed by cumin, ginger, chilli, borage, black caraway, oregano and liquorice. Moreover, extracts of turmeric, borage and parsley were able to inhibit the adhesion of H pylori strains to the stomach sections. CONCLUSION： Several plants that were tested in our study had bactericidal and/or anti-adhesive effects on Hpylori. Ingestion of the plants with anti-adhesive properties could therefore provide a potent alternative therapy for H pylori infection, which overcomes the problem of resistance associated with current antibiotic treatment.

Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

AIM:To investigate the effects of percutaneous endoscopic gastrostomy(PEG) feeding on gastro-oesophageal reflux(GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance(pH/MII) . METHODS:Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS:Prior to PEG placement(pre-PEG) a total of 183 GOR episodes were detected,156(85.2%) were non-acidic.After PEG placement(post-PEG) a total of 355 episodes were detected,182(51.3%) were nonacidic.The total number of distal acid reflux events statistically significantly increased post-PEG placement(prePEG total 27,post-PEG total 173,P=0.028) and themean distal pH decreased by 1.1 units.The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25(0-2) ,post-PEG 2.95(0-40) ].Average proximal pH was lower post-PEG but the within subject difference was not statistically significant(P=0.058) . Median number of non-acid GOR,average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG,but not statistically significant. CONCLUSION:PEG placement increases GOR episodes in neurologically impaired children.

Gene therapy and erectile dysfunction： the current status

Current available treatment options for erectile dysfunction （ED） are effective but not without failure and/or side effects. Although the development of phosphodiesterase type 5 （PDE5） inhibitors （i.e. sildenafil, tadalafil and vardenafil） has revolutionized the treatment of ED, these oral medications require on-demand access and are not as effective in treating ED related to diabetic, post-prostatectomy and severe veno-occlusive disease states. Improvement in the treatment of ED is dependent on understanding the regulation of human corporal smooth muscle tone and on the identification of relevant molecular targets. Future ED therapies might consider the application of molecular technologies such as gene therapy. As a potential therapeutic tool, gene therapy might provide an effective and specific means for altering intracavernous pressure ＂on demand＂ without affecting resting penile function. However, the safety of gene therapy remains a major hurdle to overcome before being accepted as a mainstream treatment for ED. Gene therapy aims to cure the underlying conditions in ED, including fibrosis. Furthermore, gene therapy might help prolong the efficacy of the PDE5 inhibitors by improving penile nitric oxide bioactivity. It is feasible to apply gene therapy to the penis because of its location and accessibility, low penile circulatory flow in the flaccid state and the presence of endothelial lined （lacunar） spaces. This review provides a brief insight of the current role of gene therapy in the management of ED.

Electrophysiological evidence of P2X2 receptor expression in the neurons of intracardiac and paratracheal ganglia

Objective： To investigate the expression of P2X receptors on rat intracardiac and paratracheal ganglion neurons. Methods： For preparation of intracardiac neurons, hearts were excised, the atria were separated and the medial region containing intracardiac ganglia was isolated and cut into pieces. For preparation of paratracheal neurons, the tracheas were removed and the superficial membranous layer containing paratracheal ganglia was rapidly isolated. Intracardiac and paratracheal ganglion neurons were dissociated after digestion by collagenase and trypsin. Whole-cell patch clamp recording was used to identify the pharmacological properties of P2X receptors in cultured neurons. Results：Neurons from these two ganglia responded to ATP with a rapidly activating, sustained inward current, αβ-meATP failed to evoke any re- sponses in paratracheal ganglion neurons while a few of intracardiac ganglion neurons responded to αβ- meATP with a tiny sustained inward current. ADP and UTP had no effect on intracardiac neurons. Lowering pH potentiated ATP responses in neurons from these two ganglia whereas increasing pH inhibited ATP responses. Co-application of Zn^2＋ potentiated ATP responses in intracardiac and paratracheal ganglion neurons. Conclusion： The receptor subtypes involved in intracardiac and paratracheal ganglia appear to be homomeric P2X2, while heteromeric P2X2/3 could not be completely excluded from intracardiac neurons.

Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

Non-pharmacological treatments in the irritable bowel syndrome

INTRODUCTIONThe irritable bowel syndrome (IBS) is a gastrointestinal disorder characteried by chronic lower abdominal pain and disordered defaecation associated with bloating ,tenesmus and extra-intestinal symptoms including and functional upper gastrointestinal symptoms .Currently there is nounifying hypothesis which adepuately explains the pathogenesis of the disorder although a number of physiological and psychological abmormalites have been described.

Post-gastrectomy patients need to be followed up for 20-30 years

AIM:To investigate the incidence and management of nutritional deficiencies following a gastrectomy.METHODS:A gastrectomy population of 227 patients in London was followed up for 30 years after operation to detect and treat nutritional deficiencies.RESULTS:By the end of the first decade iron deficiency was the commonest problem. Vitamin B(12) deficiency became more important in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency was a lesser problem, reaching its climax in the second decade. Overall, all women fared worse than men.CONCLUSION:The importance of long-term follow-up of gastrectomy patients for iron, Vitamin B(12) and Vitamin D deficiencies is emphasised.

Pyrrolidine dithiocarbamate reduces ischemia-reperfusion injury of the small intestine

AIM： To evaluate whether pyrrolidine dithiocarbamate （PDTC）, an enhancer of HO production, attenuates intestinal IR injury. METHODS： Eighteen male rats were randomly allocated into three groups： （a） sham; （b） IR, consisting of 30 min of intestinal ischemia, followed by 2-h period of reperfusion; and （c） PDTC treatment before IR. Intestinal microvascular perfusion （IMP） was monitored continuously by laser Doppler flowmetry. At the end of the reperfusion, serum samples for lactate dehydrogenase （LDH） levels and biopsies of ileum were obtained. HO activity in the ileum was assessed at the end of the reperfusion period. RESULTS： At the end of the reperfusion in the IR group, IMP recovered partially to 42.5% of baseline （P〈0.05 vs sham）, whereas PDTC improved IMP to 67.3% of baseline （P〈0.01 vs IR）. There was a twofold increase in HO activity in PDTC group （2 062.66±106.11） as compared to IR （842.3±85.12） （P〈0.001）. LDH was significantly reduced （P〈0.001） in PDTC group （585.6±102.4） as compared to IR group （1 973.8±306.5）. Histological examination showed that the ileal mucosa was significantly less injured in PDTC group as compared with IR group. CONCLUSION： Our study demonstrates that PDTC improves the IMP and attenuates IR injury of the intestine possibly via HO production. Additional studies are warranted to evaluate the clinical efficacy of PDTC in the prevention of IR injury of the small intestine.

Precise role of H pylori in duodenal ulceration

The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn’s disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.

How labile is gastric infection with Hpylori?

It is known that patients infected with H pylori can spontaneously become free from infection, and that the reverse change can occur. The time-scale of these conversions is expressed as percentages per year. Since they have been investigated in terms of serology, the changes are called sero-reversion and sero-conversion respectively. Using serological evidence to investigate these phenomena is open to the criticisms that positive serology can be present in the absence of all other evidence of infection, and that a time-lag of 6-12 mo or longer can occur between eradication of the infection and sero-reversion. Investigations using direct evidence of current infection are sparse. The few that exist suggest that some individuals can seroconvert or sero- revert within six to twelve weeks. If these findings are confirmed, it means that some patients have an ability that is variable in time to resist, or spontaneously recover from, H pylori infection. Evidence suggests that the deciding factor of susceptibility is the level of gastric secretion of acid.

比较急性症状性和无症状性重度颈动脉狭窄患者的血小板数目增多和白细胞-血小板复合体形成

Objective: The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference. Methods: A full blood count was done and whole blood flow cytometry used to measure platelet surface expression of CD62P, CD63, and PAC1 binding and the percentage of leucocyte-platelet complexes in patients with acute (0-21 days, n = 19) and convalescent (79-365 days) symptomatic (n = 16) and asymptomatic (n = 16) severe (≥70%) carotid stenosis. Most patients were treated with aspirin (37.5-300 mg daily) although alternative antithrombotic regimens were more commonly used in the symptomatic group. Results: The mean platelet count was higher in patients with acute and convalescent symptomatic compared with asymptomatic carotid stenosis. There were no significant differences in the median percentage expression of CD62P and CD63, or PAC1 binding between the acute or convalescent symptomatic and asymptomatic patients. The median percentages of neutrophil-platelet (p = 0.004), monocyte-platelet (p = 0.046), and lymphocyte-platelet complexes (p = 0.02) were higher in acute symptomatic than in asymptomatic patients. In patients on aspirin monotherapy, the percentages of neutrophil-platelet and monocyte-platelet complexes (p=0.03) were higher in acute symptomatic (n=11) than asymptomatic patients (n = 14). In the convalescent phase, the median percentages of all leucocyte-platelet complexes in the symptomatic group dropped to levels similar to those found in the asymptomatic group. Conclusion: Increased platelet count and leucocyte-platelet complex formation may contribute to the early excess risk of stroke in patients with recently symptomatic carotid stenosis.

建立国家服务框架后老年患者的冠心病二级预防:基于人群的研究

Objective: To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before(1998- 2001) and after(2003) the implementation of the national service framework. Design: Two population based, longitudinal studies of men and women aged 60- 79 in 1998- 2001, based in one general practice in each of 24 British towns. Participants: Men and women with established coronary heart disease at the two time points(respectively 817 and 465 in 1998- 2001, 857 and 548 in 2003), aged 60- 79 in 1998- 2001. Main outcome measures : Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme(ACE) inhibitors, and other blood pressure lowering treatments(individually and in combination) assessed in 1998- 2001 and 2003. Results: Between 1998- 2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins(from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. Conclusions: Between 1998- 2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment(particularly with β blockers and ACE inhibitors).

Purinergic contraction of the rat vas deferens in L-NAME-induced hypertension：effect of sildenafil

Hypertension （HTN） is a risk factor for erectile dysfunction, but its effect on vas deferens （VD） contractility and the ejaculatory response has not been delineated. NG-nitro-L-arginine methyl ester （L-NAME）, a nitric oxide synthase inhibitor, was used for induction of nitric oxide （NO）-deficient HTN. Our aim was to evaluate the effects of L-NAME-induced HTN on rat VD contractility and to determine whether sildenafil affects VD contractility. A total of 36 male rats were divided into （1） control, （2）L-NAME-HTN, （3） sildenafil treated L-NAME-HTN groups. Group 2 was treated with L-NAME （40 mg kgI per day） in drinking water for 4 weeks. Group 3 received sildenafil （1.5 mg kg^-1 per day, by oral gavage） concomitantly with L-NAME. The prostatic portion of the VD was subjected to electrical field stimulation （EFS, 1-20 Hz）, and the P2X1 agonist α,β-methylene ATP （α,β meATP, 100 μmol L^-1-1 μmol L-1） and the al-adrenoceptor agonist phenylephrine （Phe, 100 μmol L^-1-1 mmol L^-1） were used to construct concentration-response curves. These experiments were repeated in the presence of P2X receptor antagonist, pyridoxalphosphate-6-azophenyl-2＇,4＇-disulfonic acid （PPADS, 30 μmol L-1）. VD contractions in response to EFS, a,β-meATP and Phe were significantly enhanced by L-NAME. Sildenafil treatment in the L-NAME group improved the contractile response of VD to EFS （20 Hz）. In the presence of PPADS, the enhanced contractile response of VD to EFS and a,β-meATP in hypertensive rats was reversed. In the rat model of chronic NO depletion, the purinergic and adrenergic components and EFS affect VD contractility. The VD contractile response may be mediated more by the purinergic system than the adrenergic system, and sildenafil may alter the ejaculatory response in men with PE.

Fatty liver in H63D homozygotes with hyperferritinemia

To study the clinical correlates of the H63D mu-tation we have analysed the phenotype of H63D homozygotes identified through mutation analysis in a referral laboratory. A total of 366 blood samples referred for lIFE analysis were screened for C282Y and H63D mutations. Four H63D homozygotes were identified. All had raised serum ferritin but normal transferrin saturation. They were negative for hepatitis B and C and only one patient consumed excess alcohol. In all 4 cases ultrasonography revealed fatty liver. In two patients a liver biopsy was done and showed mild siderosis with an unusual distribution and macrovesicular steatosis. These data confirm the association between fatty liver, hyperferritinaemia and increased hepatic iron, but do not clarify whether siderosis was related to steatosis rather than homozygosity for the H63D mutation. Patients with fatty liver may complicate the interpretation of data in population studies of the expression of H63D homozygosity.

细胞浆内精子注射受孕、体外授精受孕、自然受孕出生的儿童5岁时结局的国际合作研究:认知和运动能力评价

Objective. To date, very few studies have been conducted on the neurodevelopmental well-being of children conceived through intracytoplasmic sperm injection (ICSI). The limitations of these studies often include a lack of comparison with a demographically matched, naturally conceived (NC) group and the investigation of only very young children, with relatively small samples sizes. One study showed that there were no differences in IQ scores among ICSI-conceived, in vitro fertilization (IVF)-conceived, and NC children at 5 years of age. Unfortunately, psychomotor development was not assessed in that study. Because findings regarding these children’s cognitive and motor development are inconclusive, the aim of this study was to shed more light on the cognitive and motor development of 5-year-old ICSI-conceived children. Methods. A total of 511 ICSI-conceived children were compared with 424 IVF-conceived children and 488 NC controls. Children were recruited in 5 European countries, ie, Belgium, Denmark, Greece, Sweden, and the United Kingdom. Participation rates ranged from 45%to 96%in the ICSI and IVF groups and from 34%to 78%in the NC group. Cognitive and motor development was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and McCarthy Scales of Children’s Abilities (MSCA) Motor Scale, respectively. The WPPSI-R consists of 2 major scales, ie, Verbal and Performance, each including 6 subtests. The 6 Performance Scale subtests are object assembly, geometric design, block design, mazes, picture completion, and animal pegs. The 6 Verbal Scale subtests are information, comprehension, arithmetic, vocabulary, similarities, and sentences. Scores on the Performance and Verbal Scale subtests are summed to yield the performance IQ (PIQ) and verbal IQ (VIQ), respectively. Scores on both the Performance Scale and the Verbal Scale yield the full scale IQ (FSIQ). IQ scales have a mean score of 100 and a SD of 15. Each subtest has a mean score of 10 and a SD of 3. The MSCA consists of 6 scales, ie, Verbal, Perceptual-Performance, Quantitative, General Cognitive, Memory, and Motor Scale. In this study, only the Motor Scale was administered. This scale assesses the child’s coordination during performance of a variety of gross-and fine-motor tasks. Leg coordination, arm coordination, and imitative action tests provide measures of gross-motor ability. Draw-a-design and draw-a-child assess fine-motor coordination, as revealed by the levels of hand coordination and finger dexterity. The mean score for this test is 50, with a SD of 10. Results. No differences were identified among ICSI, IVF, and NC children with respect to VIQ, PIQ, or FSIQ scores of the WPPSI-R. Furthermore, there were no differences between groups regarding the discrepancy between VIQ and PIQ scores. These results were not influenced by gender, country, or maternal educational level. However, in the subgroup of first born children with mothers who gave birth at an older age (33-45 years), NC children obtained significantly better VIQ and FSIQ scores than did children conceived through assisted reproductive technologies. These differences in VIQ and FSIQ scores between ICSI/IVF and NC children were relative, because NC children scored < 1 IQ point higher than ICSI/IVF children. Therefore, these scores show no clinical relevance. For Verbal Scale subtests, variables such as age of the mother at the time of the birth, educational level of them other, and gender and nationality of the child interacted with mode of conception, resulting in clinically irrelevant differences between scores for the ICSI/IVF and NC groups on the arithmetic, vocabulary, and comprehension subtests. For Performance Scale subtests, these same demographic factors interacted with mode of conception for the block design, object assembly, and animal pegs subtests, again resulting in clinically irrelevant differences among groups. In the 3 groups (ICSI, IVF, and NC), we observed equal numbers of children scoring below 1 SD from the mean on the WPPSI-R and the MSCA. Conclusions. This study includes a substantial number of children from several European countries. Apart from a few interaction effects between mode of conception and demographic variables, no differences were found when ICSI, IVF, and NC scores on the WPPSI-R and MSCA Motor Scale were compared. Nevertheless, the aforementioned interaction effects could indicate that demographic variables such as maternal age at the time of the birth and maternal educational level play different roles in the cognitive development of IVF and ICSI children, compared with NC children. Additional research is needed to explore and verify this finding. Previous studies revealed that ICSI children, in comparison with NC children, more frequently obtained scores below 1 SD from the mean on 3 subtests of the Performance Scale (object assembly, block design, and mazes) or showed a trend of 5.2%of ICSI children, compared with 2.5%of IVF children and 0.9%of NC children, obtaining a score below 1 SD from the mean, but those findings were not confirmed in this study. Here no differences were found among the 3 groups in the numbers of children scoring below 1 SD from the mean on the VIQ, PIQ, and FSIQ tests and the Verbal and Performance Scale subtests. Motor development results were somewhat more conclusive. There were no differences between the scores of ICSI, IVF, and NC children on the MCSA Motor Scale. No interaction effects were found between mode of conception and demographic variables, indicating that these results are not influenced by gender, nationality, maternal educational level, or maternal age at the time of the birth. Furthermore, equal proportions of children in all 3 groups scored below 1 SD from the mean. The results of this study are reassuring for parents who conceived through ICSI (or IVF). The findings indicate that the motor and cognitive development of their offspring is very similar to that of NC children. However, demographic factors such as maternal educational level and maternal age at the time of the birth might play different roles in the cognitive development of ICSI and IVF children, compared with NC children.

1990—2000年综合医疗性传播感染的趋势:应用英国综合医疗研究数据库数据的人群研究

Objective: To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990- 2000, in the context of increasing incidence of infections in genitourinary medicine clinics. Design: Population based study. Setting: UK primary care. Participants: Patients registered in the UK general practice research database. Main outcome measures: Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. Results: An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998- 2000, along with 49.2% cases of non- specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. Conclusions: A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics. Large numbers of men are treated in primary care for presumptive sexually transmitted infections.

吸香烟、烟斗/雪茄烟和戒烟与心血管疾病患者凝血和炎症标记物的关系

Aims: To examine the associations between cigarette smoking, pipe/cigar smoking, and years since quitting smoking, and inflammatory and haemostatic markers. Methods and results: A study in 2920 men aged 60-79 with no history of myocardial infarction, angina, stroke, or diabetes, and who were not on warfarin, from general practices in 24 British towns. After adjustment for other major cardiovascular risk factors, compared with never smokers, current cigarette smokers showed significantly higher levels of C-reactive protein(2.53 vs. 1.35 mg/L), white cell count(7.92 vs. 6.42×109/L), and fibrinogen(3.51 vs. 3.13 g/L). They also showed higher levels of haematocrit, blood and plasma viscosity, tissue plasminogen activator antigen, and fibrin D-dimer, and lower levels of albumin. Primary pipe/cigar smokers showed levels similar to never smokers. Ex-cigarette smokers and secondary pipe/cigar smokers showed intermediate levels although secondary pipe/cigar smokers showed higher odds of having elevated white cell count and fibrinogen than ex-cigarette smokers. Most inflammatory and haemostatic levels improved within 5 years of smoking cessation but took over 20 years to revert to levels of never smokers. Conclusion: These findings suggest that activation of inflammation and haemostasis may be potential mechanisms by which cigarette and pipe/cigar smoking increase cardiovascular risk.

1990—2000年间全科门诊中性传播感染的趋势:基于英国全科门诊研究数据库的人群调查研究

Objective: To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990- 2000, in the context of increasing incidence of infections in genitourinary medicine clinics. Design: Population based study. Setting: UK primary care. Participants: Patients registered in the UK general practice research database. Main outcome measures: Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. Results: An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998- 2000, along with 49.2% cases of non-specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. Conclusions: A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics.Large numbers of men are treated in primary care for presumptive sexually transmitted infections.

结肠直肠癌肝转移灶切除后对分离出的肝细胞功能的前瞻性研究:术前化疗的作用

Background/Aims:Chemotherapy is increasingly used prior to resection of colorectal liver metastases,yet few studies have addressed its effect on the viability and function of hepatocytes.This study evaluated the effect of pre-operative chemotherapy on human hepatocytes.Methods:Studies were carried out on isolated hepatocytes from 47 patients undergoing hepatectomy for colorectal metastases.The function of drug metabolising enzymes in hepatocytes was assessed in vitro,as well as hepatocyte integrity and culture longevity.These results were compared between patients undergoing no pre-operative chemotherapy(N = 8) ,5 fluorouracil(5FU) post-bowel resection(N = 20) ,and neo-adjuvant 5FU alone(N= 7) or in a combination with oxaliplatin(N = 12) .Results:Average cell viability at isolation determined by trypan blue dye exclusion was 71% with no significant difference between the no chemotherapy or pre-resection chemotherapy groups.There was no significant difference in LDH leakage and cellular ATP content over a 96-h time course between the patient treatment groups.The function of cytochromes P450(CYP1A2,CYP2A6,CYP2C9,CYP2D6,CYP2E1,CYP3A4) and phase II enzymes(UDP-glucuronosyltrans-ferase and sulphotransferase) was not adversely affected by pre-operative chemotherapy.Conclusions:Pre-resection chemotherapy does not impair the function or culture integrity of hepatocytes isolated at the time of liver resection.

英国和爱尔兰的人类疱疹病毒-6和-7均可导致神经系统疾病的发病率升高

Background: Primary human herpesvirus-6 and -7 (HHV-6/-7) infections cause febrile illness sometimes complicated by convulsions and rarely encephalopathy. Aims: To explore the extent of such HHV-6 and -7 induced disease in young chi ldren. Methods: In a three year prospective study in Britain and Ireland, 205 ch ildren (2-35 months old) hospitalised with suspected encephalitis and/or severe illness with fever and convulsions were reported via the British Paediatric Sur veillance Unit network. Blood samples were tested for primary HHV-6 and -7 inf ections. Results: 26/156 (17%) of children aged 2-23 months had primary infect ion (11 HHV-6; 13 HHV-7; two with both viruses) coinciding with the acute illness; this was much higher than the about three cases expected by cha nce. All 26 were pyrexial; 25 had convulsions (18 status epilepticus), 11 requir ing ventilation. Median hospital stay was 7.5 days. For HHV-6 primary infection the median age was 53 weeks (range 42-94) and the distribution differed from t hat of uninfected children; for HHV-7, the median was 60 weeks (range 17-102) and the distribution did not differ for the uninfected. Fewer (5/15)-children w ith primary HHV-7 infection had previously been infected with HHV-6 than expec ted. Conclusions: Primary HHV-6 and HHV-7 infections accounted for a significa nt proportion of cases in those< 2 years old of severe illness with fever and co nvulsions requiring hospital admission; each virus contributed equally. Predispo sing factors are age for HHV-6 and no previous infection with HHV-6 for HHV-7 . Children with such neurological disease should be investigated for primary HHV -6/-7 infections, especially in rare cases coinciding by chance with immunisat ion to exclude misdiagnosis as vaccine reactions.