经颅多普勒超声评估老年颅内外动脉狭窄及相关因素分析

目的利用经颅多普勒超声(TCD)评估老年颅内外动脉狭窄的相关危险因素。方法选择TCD筛查、并经其他影像检查确诊的颅内外动脉狭窄患者299例,分为老年组(≥60岁)200例和非老年组(40~59岁)99例,记录血管疾病相关病史,分析各危险因素的影响特点。结果老年组前循环狭窄发生率低于非老年组(66.5%vs82.8%,P=0.002),前后循环狭窄发生率高于非老年组(14.0%vs 4.0%,P=0.005),颅内外动脉狭窄发生率高于非老年组(9.0%vs 3.0%,P=0.043)。老年组与非老年组大脑中动脉狭窄发生率比较无显著差异(74.0%vs72.7%,P=0.459)。高血压、糖尿病、高脂血症、吸烟、心脑血管危险因素家族史是老年颅内外动脉狭窄的独立危险因素(P=0.000)。结论老年颅内外动脉和前后循环狭窄发生率明显增高,存在长期吸烟、高血压、糖尿病、高脂血症及有心脑血管病危险因素家族史等患者应常规进行TCD检测。     

青年早发冠心病的病变特点和危险因素

目的 分析青年早发冠心病患者的临床特点以及危险因素。方法 按照入选、排除标准,分为青年早发冠心病组(199例年龄≤40岁冠心病患者)、老年冠心病组(1737例年龄≥65岁冠心病患者)和健康对照组(204例年龄≤40岁冠脉造影正常的对照者),对3组患者的相关资料进行回顾性统计分析,比较3组的年龄、体质量指数、血压、心率、吸烟、家族史等基础情况,以及并发的高血压病、糖尿病、高脂血症、脑血管疾病、肾功能不全等,分析两组的差异性。结果 青年冠心病以前降支病变为主,主要为单支病变,且发病较急是其冠脉病变特点。青年早发冠心病组中男性、吸烟史,冠心病家族史并发高血压、糖尿病高于健康对照组,而老年冠心病患者并发高血压、糖尿病、高脂血症、脑血管疾病发病率更高,有统计学差异(P<0.05),多因素logistic回归分析结果显示吸烟、家族史、糖尿病、高脂血症是青年冠心病独立危险因素,饮酒有一定保护作用。结论 吸烟、冠心病阳性家族史,糖尿病、高脂血症是青年早发冠心病主要的危险因素。     

高尿酸血症与脑梗死相关性研究

目的分析高尿酸血症与脑梗死的相关性。方法脑梗死患者1 026例为脑梗组,选同期887例非脑血管病患者为对照组,分别记录年龄、性别、高血压、糖尿病、吸烟、高脂血症、高同型半胱氨酸血症及血尿酸(SUA),采用Logistic多因素回归分析脑梗死的危险因素。结果年龄、性别、高血压、糖尿病、吸烟及高尿酸均可能是脑梗死的独立危险因素,(P=0.000);且影响强度依次为高血压吸烟糖尿病年龄高尿酸血症性别。结论高尿酸血症可能是脑梗死新的独立危险因素。     

心踝血管指数与老年冠心病的相关性研究

目的探讨心踝血管指数(CAVI)与老年冠心病的相关性,并对影响CAVI的因素进行分析。方法对拟诊冠心病或确诊冠心病的住院老年患者364例行冠状动脉造影术,根据冠状动脉造影结果分为非冠心病组(127例)和冠心病组(237例),并对所有患者行CAVI检测、病史采集及常规化验检查,分析CAVI与老年冠心病的关系。结果冠心病组CAVI显著高于非冠心病组(P<0.01),单因素相关分析,年龄、高血压、脉压、糖尿病、吸烟、LDL-C与CAVI呈正相关(P<0.05,P<0.01),多元逐步回归分析,年龄、高血压、糖尿病、吸烟、LDL-C是CAVI的影响因素(R~2=0.430),logistic回归分析,高血压、脉压、糖尿病、吸烟、LDL-C和CAVI是老年冠心痛的独立危险因素。结论 CAVI是老年冠心病的独立危险因素,年龄、高血压、糖尿病、吸烟、LDL-C是CAVI的影响因素。     

伴有高血压的缺血性脑血管病患者肾动脉狭窄的相关性研究

目的通过血管造影评估伴有高血压的缺血性脑血管病患者动脉粥样硬化性肾动脉狭窄(ARAS)患病率及其相关危险因素。方法选择老年高血压患者274例,在实施脑血管造影时,同时行非选择性肾动脉造影以评价肾动脉主干狭窄(数字减影血管造影术测量直径狭窄率≥50%)患病率。根据诊断分为ARAS组51例,无ARAS组223例。采用标准化问卷法收集人口学资料、心脏病、吸烟、糖尿病、高脂血症、脑梗死、心脑血管病家族史等临床资料,通过单因素及多因素分析伴有高血压的老年缺血性脑血管病患者ARAS的相关因素。结果 274例患者中,吸烟87例(31.8%),糖尿病98例(35.8%),高脂血症126例(46.0%),脑梗死122例(44.5%),慢性肾功能不全23例(8.4%),心脑血管病家族史79例(28.8%);单侧ARAS 42例(15.3%)、双侧ARAS 9例(3.3%)。ARAS组吸烟比例明显高于非ARAS组,差异有统计学意义(96.1%vs 17.0%,P=0.001)。结论对拟行脑血管造影的高血压患者建议同时行非选择性肾动脉造影,尤其是吸烟的高血压患者发现肾动脉主干狭窄的可能性更大。     

不同性别冠心病患者主要危险因素的比较

目的 探讨不同性别患者吸烟、高血压、糖尿病、年龄与冠心病发病的关系.方法 2008年2月至6月在河北省唐山工人医院心内科收集病例113例,在河北省人民医院收集病例38例.核实全部病史情况.结果 总计151例患者中(男93女58)吸烟、患有高血压和糖尿病以及年龄在60岁以上的人所占百分比.男性分别为:33%,48%,23%,55%.女性分别为:5%,50%.43%,74%.吸烟比率男性明显高于女性(P<0.05).高血压对不同性别冠心病的作用强度无差别,而糖尿病和年龄对女性冠心病的作用强度明显大于男性(P<0.05).结论 不同性别冠心病主要危险因素存在差异,糖尿病是老年女性冠心病的主要危险因素.     

老年突发性耳聋患者缺血性脑卒中危险因素分析

目的观察老年突发性耳聋患者缺血性脑卒中发生率,并分析老年突发性耳聋患者发生缺血性脑卒中的危险因素。方法收集天津医科大学第二医院耳鼻喉科住院的老年突发性耳聋患者508例,根据是否存在缺血性脑卒中分为缺血性脑卒中组24例和对照组484例。收集研究对象一般临床资料,包括年龄、性别、高血压、高脂血症、糖尿病及血脂、肌酐、尿酸水平等实验室指标,采用logistic回归分析缺血性脑卒中的危险因素。结果老年突发性耳聋合并缺血性脑卒中患者占4.7%。2组年龄、性别、吸烟、饮酒、糖尿病、冠心病、肌酐和尿酸水平比较,无统计学差异(P0.05)。缺血性脑卒中组高血压和高脂血症比例明显高于对照组,差异有统计学意义(66.7%vs 39.5%,P=0.008;29.2%vs 7.4%,P=0.000)。校正其他因素后,多因素logistic回归分析显示,高脂血症是老年突发性耳聋患者缺血性脑卒中发生的独立危险因素(OR=0.222,95%CI:0.069～0.714,P=0.012)。结论老年突发性耳聋患者缺血性脑卒中发生率为4.7%。高脂血症是老年突发性耳聋患者发生缺血性脑卒中的独立危险因素。     

老年心房颤动患者合并脑血管病危险因素研究

目的研究老年心房颤动(房颤)患者合并脑血管病的危险因素。方法选择房颤患者16 885例,根据年龄分为老年组7254例(年龄≥65岁),对照组9631例(年龄<65岁),对比分析老年房颤患者合并脑血管病的危险因素。结果房颤患者合并脑血管病的总患病率为9.4%。老年组脑血管病患病率明显高于对照组(14.4%vs5.6%,P<0.01),老年组合并脑血管病危险因素中,男性比例明显低于对照组,高血压、糖尿病、高同型半胱氨酸血症、冠心病比例明显高于对照组(P<0.05,P<0.01)。logistic回归分析,年龄、高血压、糖尿病、高脂血症、高同型半胱氨酸血症为房颤合并脑血管病的独立危险因素(P<0.01)。结论老年心房颤动患者合并脑血管病患病率明显高于非老年心房颤动患者,年龄、高血压、糖尿病、高脂血症、高同型半胱氨酸血症是心房颤动合并脑血管病的独立危险因素。     

老年高血压患者外周血管动脉粥样硬化相关危险因素分析

目的探讨老年高血压患者外周血管动脉粥样硬化相关危险因素及治疗情况。方法选取我院干部病房212例≥75岁的原发性高血压3级住院患者,依据原始病历记载情况,将212例高血压患者分为外周血管动脉粥样硬化组118例及非外周血管动脉粥样硬化组94例,对两组基线资料及治疗前后动脉参数情况进行χ2或t检验,比较分析两组之间的差异。同时,进一步对两组基线资料进行Logistic回归分析,探讨老年高血压外周血管动脉粥样硬化的高度危险因素。结果外周血管动脉粥样硬化组与非外周血管动脉粥样硬化组年龄、病程、合并高脂血症、糖尿病、IGR及高尿酸血症比例有明显统计学差异(P<0.05),而吸烟、肥胖在两组之间无统计学意义。多因素非条件Logistic回归分析结果显示年龄、高脂血症、糖尿病及IGR是高血压合并外周血管动脉粥样硬化的高度危险因素(P<0.01)。结论积极防治,早期强化降压、降糖、调脂治疗及生活方式的干预对于高血压的治疗尤为必要。     

冠心病发病危险因素研究分析

目的分析冠心病发病的危险因素,为有效防治提供参考依据。方法选取行冠状动脉造影检查的患者100例为研究对象,将经冠状动脉造影确诊的冠心病患者50例作为研究组,将其余50例非冠心病患者作为对照组,比较两组患者在吸烟、家族史、高血压、糖尿病、高脂血症、BMI、性别、年龄、TC、TG、HDL-C及LDL-C方面的差异,同时进行多因素Logistic回归分析。结果两组患者在吸烟、家族史、高血压、糖尿病、高脂血症、BMI方面比较,差异具统计学意义(P0.05),两组的性别构成比、年龄、TC、TG、HDL-C及LDL-C水平方面比较,差异无统计学意义(P0.05)。Logistic多元回归结果显示吸烟(OR=3.342)、高血压(OR=2.578)、糖尿病(OR=2.341)、高脂血症(OR=3.176)是冠心病发病的独立危险因素。结论吸烟、高血压、糖尿病、高脂血症为冠心病发病的独立危险因素,针对上述危险因素进行有效干预,可能有助于降低冠心病患病率。     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Routine diagnosis of intestinal tuberculosis and Crohn’s disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。