云南省祥云县不明原因心源性猝死回顾性调查

目的 了解云南省祥云县不明原因心源性猝死的流行特征。方法 对祥云县2004年以前上报的云南不明原因心源性猝死病例和同发病例开展回顾性调查，疑似病例搜索调查，将资料核实整理、讨论归类后，进行统计学分析。结果 共调查到14例云南不明原因心源性猝死病例，3例同发病例，4例野生菌中毒死亡病例和4例未定论病例。不明原因猝死病例村庄、家庭聚集性明显（P〈0．01），时间分布在7、8月份，发病年龄为10—50岁，性别及民族间发病率差异无统计学意义（P〉0．05）。调查中野生菌中毒死亡的流行特征与不明原因心源性猝死极为相似。结论 祥云县不明原因心源性猝死呈现出明显的地区性、季节性、人群选择性、村庄聚集和家庭聚集的流行特点，提示危险因素在特定条件下存在，猝死病例间具有同源暴露史。     

不同类型造血干细胞移植后巨细胞病毒感染的监测

目的观察在不同类型造血干细胞移植中巨细胞病毒感染状况。方法应用半巢式PCR技术定期检测了2001-03～2003-07苏州大学附属第一医院住院病人55例移植病人外周血标本，比较不同类型移植CMV-DNA阳性率的差别。结果在检测的462份标本中，有285份为阳性，33／55（60％）患者CMV-DNA阳性，非清髓性造血干细胞移植（NST）的阳性检出率为15／17（88．2％），亲缘间外周血造血干细胞移植（PBSCT）的阳性检出率为3／7（42．9％），非亲缘性骨髓移植（UR-BMT）的阳性检出率为7／11（63．6％），亲缘性骨髓移植（R-BMT）的阳性检出率为8／20（40．0％）。NST与PBSCT、R-BMT的巨细胞病毒感染率差别显著（χ^2=5．44，P〈0．05；χ^2=9．14，P〈0．05），NST与UR-BMT（χ^2=2．39，P〉0．05）间的差别无统计学意义。结论巨细胞病毒感染在不同的造血干细胞移植方式可能存在差异。     

肝癌特异性AFP亚组分联合AFP-mRNA对肝癌诊断与鉴别价值

目的 探讨甲胎蛋白（AFP）基因及肝癌特异性AFP亚组份（AFP-L3）在肝癌早期诊断和鉴别诊断中的价值。方法 从肝病患者外周血中制备总RNA，以逆转录聚合酶链反应（RT-PCR）扩增AFP基因。用小扁豆凝集素亲和层析法分离血清中AFP-L3，放射免疫法测定AFP及AFP-L3。结果 在肝癌和肝硬化病人中AFP-L3阳性率分别为91．7％（110／120）和18％（9／50），AFP-mRNA阳性率分别为56．7％（68／120）和16％（8／50），两者总阳性率分别为95％（114／120）和26％（13／50）。正常对照组AFP-L3及AFP-mRNA均为阴性。肝癌病人AFP-L3％及AFP-mRNA阳性率明显高于肝硬化及正常对照组（P〈0．01）。AFP-L3及AFP-mRNA与肿瘤大小、数目等无关（P〉0．05），而与肿瘤分化程度、是否转移及有无复发等明显相关（P〈0．05）。结论 外周血AFP-L3及AFP-mRNA检测特异性强、敏感性高，有助于肝癌诊断与鉴别诊断、肝外转移或术后复发监测。     

CD7+CD56+双阳性急性髓系白血病临床生物学特征

目的：探讨CD7^＋CD56^＋急性髓系白血病（AML）的临床生物学意义。方法：对25例初治CD7^＋CD56^＋AML患者进行细胞学形态、免疫表型、多药耐药P糖蛋白（PgP）检测，临床观察、并常规采用HAE方案诱导治疗，判定疗效，并随机选择66例CD7^-CD56^-AML患者进行对照。结果：CD7^＋CD56^＋AML阳性率4．08％（25／612）。CD7^＋CD56^＋AML在FAB分型中以M0、M1、M5、M7多见。与CD7^-CD56^-AML组比较CD7^＋CD56^＋AML具有高血红蛋白含量（89．29：75．62g／L，P〈0．05），高表达PgP（78．26％：34．85％，P〈0．01）和CD34表达（72．00％：45．45％，P〈0．05）等特征；此外，CD7^＋CD56^＋AML患者中枢神经系统浸润现象明显（36．00％：3．27％，P〈0．01），CD7CD56共表达与年龄、性别、白细胞计数、血小板计数、及外周血幼稚细胞数无关，也不影响完全缓解率和无病生存时间（均P〉0．05）。结论：CD7^＋CD56^＋AML具有独特的临床生物学特征，较少贫血，高表达PgP和CD34，常伴有中枢神经系统浸润。     

GSH-Px活性与云南省地方性猝死关系的研究

目的研究云南省地方性猝死病例组与谷胱甘肽过氧化物酶（GSH—Px）活性的关系，为云南省地方性猝死的预防提供依据。方法现场调查病区大姚县、景东县、南涧县、宁蒗县及非病区大理县，采用GSH—Px活力测试盒检测患者25例、对照107例的GSH—Px活性。结果病例组GSH—Px活性高于外对照组（P〈0．05）；大姚县、景东县GSH—Px活性高于外对照大理县（P〈0．05）；宁蒗县低于大理县；宁蒗县补硒前后两次检测结果为补硒后GSH—Px活性较补硒前高（P〈0．05）。结论GSH—Px活性与云南省地方性猝死的发生可能存在一定程度的相关。     

脂联素基因SNP-11377多态性与冠脉病变程度相关性研究

目的探讨在中国上海地区汉族人群中脂联素基因（APM1）启动子序列单核苷酸多态性（SNP）与冠脉病变程度的关系。方法采用聚合酶链反应-限制性片段长度多态性（PCR—RFLP）方法，分析了325例冠脉造影结果和脂联素启动子序列单核苷酸多态性（-11377G／C）的关系．研究设立了冠心病组（CAD）和正常对照组，并根据冠脉造影结果按照不同病变支数及Gensini评分将分成不同病变组，分析-11377位点基因型及基因频率的差异性。结果（1）冠心病组脂联素基因-11377位点多态性GC、GG基因型频率与对照组比较，显著高于对照组，差异有极显著性（χ^2=12．619，P〈0．05）；（2）冠心病患者脂联素-11377位点G等位基因频率显著高于正常人（χ^2=11．291，P〈0．05）；（3）根据冠脉造影结果冠脉不同病变支数各组比较，脂联素-11377位点基因型差异无显著性（χ^2=11．575，P〉0．05），而等位基因频率具有显著差异性（χ^2=11．582，P〈0．05）；（4）按Genisini标准冠状动脉不同积分各组之间比较脂联素基因型间差异无显著性（χ^2=10．983，P〉0．05），但等位基因频率具有显著差异性（χ^2=8．978，P〈0．05）。结论脂联素SNP-11377G／C各种基因型与冠心病有关，与冠状动脉粥样硬化病变程度无关，而等位基因频率不但与冠心病显著相关，并且与冠状动脉病变程度有关。     

支气管哮喘儿童急性发作期诱导痰液T细胞亚群及自然杀伤T细胞的变化

目的分析支气管哮喘（简称哮喘）儿童急性发作期及缓解期诱导痰液T细胞亚群及自然杀伤T细胞（NKT细胞）的变化，探讨T细胞及NKT细胞在儿童哮喘气道炎症中的作用。方法选取18例哮喘急性发作、21例哮喘缓解期及12名正常儿童的痰液，采用流式细胞术比较各组儿童诱导痰液CD3、CD4、CD8、NKT（CD3-CD56^＋）百分比及CD4／CD8比值。结果哮喘急性发作组CD4细胞百分比[（43．75±13．5）%]明显高于缓解期组[（37．04±7．1]）％]和正常对照组[（33．57±7．54）％]（P〈0．05），CD8细胞百分比[（21．10±6．10）%]明显低于缓解期组[（28．67±5．32）%]和正常对照组[（28．31±9．46）％]（P〈0．05），CD4／CD8比值（2．14±0．94）高于缓解期组（1．33±0．35）和正常对照组（1．31±0．42）（P〈0．05），CD4、CD8细胞百分比及CD4／CD8缓解期组和正常对照组差异无统计学意义（P〉0．05），急性发作组CD4／CD8比值与嗜酸粒细胞百分比呈正相关（r＝0．559．P〈0．05）。缓解期组CD4／CD8比值与嗜酸粒细胞无相关性（r＝0．898，P〉0．05）。急性发作组CD3 CD56。细胞百分比[（3．33±1．69）％]略高于缓解组[（3．09±1．23）％]及对照组[（2．94±0．87）％]．但差异无统计学意义（P〉0．05）。CD3^-CD56^＋细胞百分比在三组之间无统计学差异（P〉0．05）。结论儿童哮喘急性发作期，气道内CD4细胞占优势，CD4／CD8细胞比例失衡，CD4细胞可能介导儿童哮喘气道炎症过程。     

利福类联合多种药物长疗程方案治疗耐多药肺结核

目的评价国产利福布汀的治疗方案对耐多药肺结核患者的疗效和安全性。方法对130例耐多药肺结核患者，采用1：1随机、平行对照的方法，分为试验组和对照组，两组患者除采用帕司烟肼、左旋氧氟沙星、乙胺丁醇、丙硫异烟胺和阿米卡星治疗外，试验组患者加用利福布汀，对照组患者加用利福喷汀，疗程共18个月。结果强化期结束时，试验组和对照组的痰涂片和痰结核分枝杆菌培养阴转率分别为41．54％（27／65）和35．94％（23／65），差异无统计学意义（X^2：2．42，P〉0．05）。X线影像学结果表明，两组的病灶显效率均为10．77％（7／65），差异无统计学意义（X^2=0．01，P〉0．05）；有效率分别为67．69％（44／65）和56．92％（37／65），差异无统计学意义（X^2=1．44，P〉0．05）。疗程结束时，试验组和对照组的痰涂片和痰结核分枝杆菌培养阴转率分别为75．00％（48／65）和65．08％（41／65），差异无统计学意义（X^2=1．88，P〉0．05）。X线影像学结果表明，两组的病灶显效率分别为46．15％（30／65）和44．62％（29／65），差异无统计学意义（X^2=0．02，P〉0．05）；有效率分别为76．92％（50／65）和73．85％（48／65），差异无统计学意义（X^2=0．19，P〉0．05）；空洞闭合率分别为23．64％（13／55）和33．33％（17／51）。结论含利福布汀或利福喷汀的多药联合长疗程方案治疗耐多药肺结核，具有促进痰细菌学阴转、病灶吸收和空洞关闭的作用，其安全性和耐受性良好。     

新疆老年人群TTV感染状况的初步研究

目的了解输血传播病毒（TTV）在老年易感人群中的感染情况。方法采用套式PCR方法,对214例老年易感人群血清进行TTV—DNA的检测。结果在214例老年易感人群中共检出71例TTV—DNA阳性血清,总检出率为33．2％,TTV—DNA阳性率与民族、性别无统计学差异（χ^2=1．14,P〉0．05）;其中甲型肝炎老年病人中TTV—DNA阳性率为28．6％,乙型肝炎老年病人中TTV—DNA阳性率为36．0％,HBsAg（＋）携带者的TTV—DNA阳性率为29．1％,各组相比差异无统计学意义（χ^2=0．779,P〉0．05）。结论新疆老年易感人群中存在较高的TTV感染,TTV的感染可能与肝炎有关。     

胆管梗阻患者的磁共振成像与超声影像比较

目的探讨超声和磁共振成像胰胆管水成像（MRCP）诊断梗阻性黄疸的差异。方法选择经过磁共振成像（MRI、MRCP）和超声检查并经过手术证实为梗阻性黄疸患者45例，分析两种影像学判定梗阻部位和疾病定性的准确性。结果对于结石，MRI结合MRCP定位的准确率为95．56％；超声的准确率为77．78％。MRI（MRCP）和超声定性的准确率不具有统计学差异（χ^2=1．083，P〉0．05），但超声准确率（96．15％）大于磁共振。对于恶性梗阻，MRI（MRCP）和超声定位的准确率分别为94．74％和68．42％（χ^2=4．38，P〈0．05）。结论超声对于结白的诊断敏感性高，但对于良恶性病变所致黄疸的定性和定位，磁共振成像（MRI、MRCP）则更具有优势。     

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.     

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.     

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.     

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.     

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。     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.