ABO Blood Groups in Patients with Congenital and Rheumatic Valvular Heart Disease

ABO blood groups were determined in 404 patients who had cardiac surgery for heart disease; 136 of these patients had rheumatic valvular heart disease and 268 had congenital heart disease. The incidence of each ABO blood group was compared to a control series of 2171 patients by means of the ϰ² test. There was no statistical difference in the incidence of ABO blood group when patients with congenital and rheumatic valvular heart disease were compared with the control group.     

Rheumatic Fever and Rheumatic Heart Disease in Barbados: Detection and Prophylaxis

The objectives of this study were to improve our methods of secondary prophylaxis of rheumatic fever and rheumatic heart disease in Barbados, to estimate the overall prevalence of these diseases and the relative load imposed by them on available health services, and to measure the yield, feasibility, and effectiveness of mass programmes for the detection and prophylactic management of rheumatic heart disease in schoolchildren.Improved methods of surveillance and follow-up resulted in 97% adherence to therapy by patients on prophylactic penicillin. Thirty-four children, 27 with a first attack, were admitted with acute rheumatic fever, representing a 7% occupancy of children''s medical beds during the 12-month period of the study. Out of a possible 3,942 schoolchildren aged 5-11 years, 3,882 (98%) were screened for rheumatic heart disease. Four cases (about 1 per 1,000) were discovered.     

中国14个民族红细胞血型座位的遗传分化

根据中国13个人口逾百万的民族及台湾高山族的红细胞血型座位的基因频率,分析了各血型系统的分化程度。结果表明,中国人群在MNSs系统上的分化十分显著。对各民族间的亲缘关系分析表明,汉族、朝鲜族、蒙古族、回族,满族和藏族等北方民族首先聚集在一起,侗族、高山族、壮族和彝族等聚集在一起,然后白族与南北两大人集聚集在一起,最后才是维吾尔族与其它人群相聚。本文以华北汉族作为蒙古人种的代表,探讨了世界上三大人种间的遗传关系,结果表明,黄种人与黑种人之间的遗传差异最小,而黑种人与白种人之间的遗传差异最大。根据基因分化系数(G_(ST))和Shannon信息测度(H),中国民族间的遗传差异均仅占中国人总遗传变异量的2％左右,这说明,绝大部分遗传变异存在于各民族之内。     

A Cost-Effectiveness Analysis of a Program to Control Rheumatic Fever and Rheumatic Heart Disease in Pinar del Rio,Cuba

Background

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986 – 1996. The present study analyzes the cost-effectiveness of this Cuban program.

Methods and Findings

We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a “do nothing” approach. Our population of interest was the cohort of children aged 5 – 24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program’s effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children) and saved $7,848,590 (2010 USD) despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving.

Conclusions

A 10-year program to control ARF/RHD in Pinar del Rio, Cuba dramatically reduced morbidity and premature mortality in children and young adults and was cost saving. The results of our analysis were robust to higher program costs and more conservative assumptions about the program’s effectiveness. It is possible that the program’s effectiveness resulted from synergies between primary and secondary prevention strategies. The findings of this study have implications for non-communicable disease policymaking in other resource-limited settings.     

EuroSCORE Models in a Cohort of Patients with Valvular Heart Disease and a High Prevalence of Rheumatic Fever Submitted to Surgical Procedures

ObjectivesEpidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery.MethodsBetween 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC) curve analysis.ResultsThe mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery). Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70–0.81) for the additive EuroSCORE, 0.76 (95% CI 0.70–0.81) for the logistic EuroSCORE and 0.81 (95% CI 0.76–0.86) for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II.ConclusionsIn this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.     

修饰血红蛋白作为红细胞代用品的研究进展和挑战

血源紧缺和病毒污染问题推动了血液代用品的研究,以血红蛋白为代表的红细胞代用品成为研究的重点。为克服血红蛋白直接使用的毒副作用,各种修饰技术得到了迅速发展,其中包括双阿司匹林交联、戊二醛交联、棉子糖交联、聚乙二醇偶联、脂质体包埋、生物可降解高分子包埋等。其中一些技术已经形成规模化制备工艺,产品进入临床试验,有的已在个别国家上市。鉴于这项研究意义重大,我国有关研究已经起步并正在迅速发展,各国同行的研究有重要的参考价值,因此有必要对近年来血红蛋白作为红细胞的代用品研究状况进行分析,明确面临的挑战,这将有利于发展更全面和有效的研究方案,以期取得突破性进展。     

安徽省宁国县畲族红细胞血型分布

调查１６０名安徽省宁国县畲族村民的ＡＢＯ、Ｒｈ、Ｐ、ＭＮ系统红细胞血型,结果显示ＡＢＯ血型表型频率分布为Ｏ（０．４６８７）〉Ｂ（０．２３７５）〉Ａ（０．２２５０）〉ＡＢ（０．０６８８）,基因频率ｐ＝０．１５００,ｑ＝０．１５７５,ｒ＝０．６９２５;Ｒｈ血型表型频率分布为ＣＣｄｅｅ（０．５３８５）〉ＣＣＤＥ（０．１６６７）〉ＣｃＤＥ（０．１４７４）〉ＣｃＤｅｅ（０．０９６１）〉ｃｃＤＥ（０．０３２１     

Fluorescence Studies of Red Blood Cell Membranes from Individuals with Huntington''s Disease

Fluorescence spectroscopic methods were used to investigate and compare the properties of erythrocyte membranes from individuals with Huntington's Disease (HD) and from normal individuals. Erythrocyte ghosts were labeled with four different fluorescent probes: 1,6-diphenylhexatriene (DPH); 6-lauroyl-2-(dimethylamino)-naphthalene (Laurdan); 2-(4-maleimide anilino)-naphthalene-6-sulfonic acid (MIANS) and 5-(iodoacetamidoethyl)aminoaphthalene-1-sulfonic acid (IAEDANS). DPH is sensitive to the microviscosity of the membranes. Laurdan is highly sensitive to the polarity and relaxation time of its environment. MIANS and IAEDANS both react covalently with sulfhydryl groups in membrane proteins. Erythrocyte membranes were labeled separately with each of these four probes, and we measured the centers of gravity of the fluorescence emission, the fluorescence anisotropies, and the fluorescence lifetimes. In 10 separate experiments, including a total of 24 patients and 14 control individuals, we found no significant differences between the two groups for any of the probes or spectral parameters. These results do not support the existence of a "generalized membrane defect" in individuals with HD.     

纳西族和普米族的红细胞血型分布

调查了云南纳西族和普米族各１０４人的ＡＢＯ、ＮＭＳｓ、Ｒｈ和Ｐ血型系统。结果表明,ＡＢＯ血型系统中,纳西族和普米族有较高的基因频率ｒ,分别为０．６０８２和０．６８８２,且基因频率ｐ＝ｑ,纳西族均为０．１９５９,普米族均为０．１５５９。ＭＮＳｗ系统中两个民族都表现ｍ〉ｎ、ｓ〉ｓ,Ｍｓ〉Ｎｓ、ＭＳ〉ＮＳ,其中纳西族的基因频率在国内报道的相应值中是比较高的,且ＮＳ为零。