甲型H1N1流感暴发疫情处置的卫生经济学评价

目的 从卫生经济学角度评价南宁市2009～2011年学校甲型H1N1流感暴发疫情处置的效果和效益,探索传染病暴发疫情处置的卫生经济学评价方法.方法 采用成本-效果和成本-效益分析方法对南宁市2009～2011年学校甲型H1N1流感暴发疫情处置过程中的投人情况及相关资料进行分析.结果 通过采取疫情防控措施减少了41 899人发病,减少了35 882 303.60元的损失,效果-成本比为18.91,效益-成本比为161.93.按照疫情发生时间划分为3个阶段,不同阶段疫情处置措施的经济学效果不同,效果-成本比和效益-成本比均以第三阶段为最高,其次是第二阶段,第一阶段最低.结论 疫情处置措施的实施取得了显著的社会效益和经济效益,但是防控措施的应用应强调以科学为依据.     

上海市某小学一起甲型H1N1流感疫情分析

目的 了解卜海市一起小学甲型H1N1流感疫情的流行病学特征和疫情处置情况,为完善学校甲型H1N1流感防控工作提供依据.方法 采用现场流行病学方法,调查90名发病学生的疫情资料.按照<甲型H1N1流感流行病学调查和暴发疫情处理技术指南(试行)>和<学校甲型H1N1流感防控工作方案>要求进行.结果 本起疫情历时10 d,共计90人出现流感样症状,其中1人被确诊为甲型H1N1流感.临床表现以发热(体温≥38℃),伴咳嗽、咽痛等为主.所有患病学生均未接种过甲型H1N1流感疫苗.学校的甲型H1N1流感疫情以轻症为主.未及时彻底隔离发病学生、流感疫苗接种率低、学生卫生防病意识差是造成甲型H1N1流感疫情的重要原因.结论 加强流感疫苗接种和适时停课足有效的疫情防控措施.     

昆明地区部分中小学暴发甲型H1N1流感的流行病学分析

2009年9月中下旬,昆明市多所中小学暴发甲型H1N1流感疫情,部分学校采取停课等干预措施,疫情于2009年10月中旬得以控制.现将该次甲型H1N1流感的流行情况调查报告如下. 对象与方法 一、数据来源 根据昆明市常规传染病报告系统及昆明市疾病预防控制中心的流行病学调查报告,采用描述流行病学方法进行资料分析.     

西安市某高校一起聚集性甲型H1N1流感暴发的流行病学调查

目的分析西安市某高校一起聚集性甲型H1N1流感暴发的流行病学资料,评价控制效果,为预防控制甲型H1N1流感疫情暴发积累经验。方法采集体温在37℃及以上,或有咳嗽、咽痛等流感样症状之一者的鼻咽拭子,用PCR方法检测流感病毒核酸。并用SPSS17.0分析资料,χ2检验比较不同性别罹患率。结果2009年9月西安市某高校暴发甲型H1N1流感疫情,首发病例已经找到,全校累计发生流感样病例(ILI)337人,确诊甲型H1N1流感病例59人,确诊高峰集中在9月2、3日,呈单峰右偏态分布。确诊病人男生显著高于女生,院系分布和公寓楼分布均具有一定的聚集性。结论2009年9月西安市某高校暴发甲型H1N1流感疫情,经采取停课、封校、隔离治疗现症病人、消毒、健康教育、预防性服药等综合防控措施有效地控制疫情的发展。     

四川省首起学校甲型H1N1流感暴发疫情分析

目的分析评价四川省首起学校甲型H1N1流感暴发疫情处置效果,总结防控经验,为政府和卫生部门科学应对学校甲型H1N1流感暴发疫情提供对策建议。方法收集汇总疫情处置相关信息和各类数据,对防控措施进行分析评价。结果该校师生共1201人,确诊甲型H1N1流感46例,无重症病例,在1个甲型H1N1流感最长潜伏期(7d)内未再有确诊病例;1155名隔离师生自最后1例确诊病例出现后7d内未出现流感样症状。结论该校疫情处置得当,甲型H1N1流感流行及时中止。     

洛阳市某中学甲型H1N1流感暴发疫情调查

目的了解甲型H1N1流感暴发的流行病学特征,为同类疫情的有效控制提供科学依据。方法采用描述性流行病学方法,对洛阳市某中学甲型H1N1流感暴发疫情进行分析。结果本次暴发疫情累计发现甲型H1N1流感患者253例,其中实验室确诊79例,疑似病例174例,罹患率为8.57%,男、女生罹患率差异有统计学意义(P0.05)。结论加强学校晨检,严格隔离传染源,及时报告,是及时发现和预防控制学校甲型H1N1流感暴发疫情的重要措施。     

甲型H1N1流感暴发现场控制策略探讨

甲型H1N1流感在国内许多单位内部暴发,为了快速有效控制单位内甲型H1N1流感暴发疫情,在总结多次甲型H1N1流感暴发疫情现场处置经验的基础上,军事医学科学院疾病预防控制所探索出了一套简单、实用、有效的甲型H1N1流感暴发现场控制策略,并在某大学的疫情处置中得到了应用,取得了较好的控制效果。     

1起小学校内甲型H1N1流感爆发调查

目的通过分析1起学校甲型H1N1流感爆发疫情的发现和处置情况,总结防控经验,为控制学校甲型H1N1流感爆发疫情提供参考。方法通过流行病学调查,对这次甲型H1N1流感暴发学校的所有病例进行调查,并对部分病例采集咽拭子标本,采用RT-PCR检测甲型H1N1流感病毒核酸。结果 2013年12月27至2014年1月26日,该校共累计报告流感样病例24例,罹患率为2.37%。病例全部为学生,病例主要集中在二年级。病例均为轻症表现,未出现大规模暴发。采集8例流感样病例的咽拭子标本进行检测,结果显示,5份标本新甲1型流感病毒核酸呈阳性。结论此次为一起甲型H1N1流感爆发疫情,及早报告疫情、落实隔离、通风、接种流感疫苗等综合防控措施是控制甲流疫情的关键。     

福州市晋安区甲型H1N1流感学校疫情处置效果分析

目的分析和评价甲型H1N1流感（＂甲流＂）学校疫情流行特征及控制措施效果,为应急处理提供依据。方法对2009年福州市晋安区甲流学校聚集性暴发疫情控制措施进行分析评价。结果共报告学校甲流疫情33起,流感样病例1 242例,平均罹患率2.9%。聚集性暴发疫情在学校罹患率〈1%时采取干预措施效果较好;适时班级停课较全校停课效果好。追踪确诊病例密切接触者3 858人,仅1.7%医学观察期间发病。流行后期翌年1月甲型H1N1流感病毒抗体检测,未接种组血清阳性率达76.9%（40/52）。结论在甲流社区广泛传播时,对学校聚集性暴发疫情需采取隔离病例、适时停课、做好健康监测和管理、落实晨检制度、开窗通风等综合措施,是控制疫情的关键。     

山东省2009-2010年学校甲型H1N1流感暴发疫情分析

目的分析山东省学校甲型H1N1流感暴发疫情的流行病学特征,为学校防控甲型H1N1流感提供参考。方法从中国疾病预防控制系统收集山东省各地学校H1N1流感聚集性疫情信息,用Excel建立个案信息库,用SPSS软件进行统计分析。结果山东省2009年共发生学校甲型H1N1流感暴发疫情99起,发生流感样病例2 214人,确诊甲型H1N1流感病例288人,罹患率为1.11%;死亡5人,病死率为0.18%。不同类型学校学生罹患率差异有统计学意义。结论学校是山东省甲型H1N1流感暴发防控的重点场所,需要进一步加强对学校疫情的监测。     

Arsenic methylation, GSTT1, GSTM1, GSTP1 polymorphisms, and skin lesions

OBJECTIVE: We investigated whether primary and secondary arsenic methylation ratios were associated with skin lesions and whether GSTT1, GSTP1, and GSTM1 polymorphisms modify these relationships. METHODS: A case-control study of 600 cases and 600 controls that were frequency matched on age and sex was conducted in Pabna, Bangladesh, in 2001-2002. Individual well water, urine, and blood samples were collected. Water arsenic concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary arsenic speciation was determined using high performance liquid chromatography hydride with generator atomic absorption spectrometry and ICP-MS. Genotyping was conducted using multiplex polymerase chain reaction and TaqMan. RESULTS: A 10-fold increase in primary methylation ratio [monomethylarsonic acid (MMA)/(arsenite + arsenate] was associated with a 1.50-fold increased risk of skin lesions (multivariate odds ratio = 1.50; 95% confidence interval, 1.00-2.26). We observed significant interaction on the multiplicative scale between GSTT1 wildtype and secondary methylation ratio [dimethylarsinic acid/MMA; likelihood ratio test (LRT), p = 0.01]. No significant interactions were observed for GSTM1 or GSTP1 or for primary methylation ratios. CONCLUSION: Our findings suggest that increasing primary methylation ratios are associated with an increase in risk of arsenic-related skin lesions. The interaction between GSTT1 wildtype and secondary methylation ratio modifies risk of skin lesions among arsenic-exposed individuals.     

老年呼吸机相关肺炎患者死亡的危险因素

目的分析老年呼吸机相关肺炎(VAP)患者死亡的危险因素。方法调查2011年4月—2017年2月某院年龄≥60岁且发生VAP的患者,收集患者的临床资料,包括基本情况、感染情况、预后等,并对其死亡的危险因素进行分析。结果共有老年VAP患者682例,198例患者死亡,病死率为29.03%。APACHEⅡ评分15分(OR=2.482,95%CI=1.473~4.183)、机械通气时间15 d(OR=2.526,95%CI=1.661~3.840)、多重耐药菌感染(OR=3.379,95%CI=2.008~5.686)、真菌感染(OR=3.414,95%CI=1.830~6.370)、使用糖皮质激素(OR=2.075,95%CI=1.265~3.403)、血清清蛋白浓度35 g/L(OR=2.129,95%CI=1.386~3.268)、器官损伤数目≥3个(OR=3.438,95%CI=2.165~5.459)、血糖≥10 mmol/L(OR=1.744,95%CI=1.106~2.751)等8个因素均为老年VAP患者死亡的独立危险因素。结论老年VAP患者死亡与多种因素有关,临床应采取以干预主要危险因素为主的综合防控措施,降低其病死率。     

脑循环分析仪的研制

介绍脑循环分析仪的基本结构、工作原理、软件设计和临床应用等内容,该仪器运用超声多普勒、超声脉冲和压力变送器,在心电同步信号监测下检测血液流速、压力波形和血管管径管数据,然后通过分析计算得到脑血管阻力,代偿血流量和血管壁弹性等脑循环血流动力学参数。     

Association of genetic polymorphisms in CYP2E1, MPO,NQO1, GSTM1, and GSTT1 genes with benzene poisoning

Metabolic enzymes involved in benzene activation or detoxification, including NAD(P)H, quinone oxidoreductase 1 (NQO1), cytochrome P450 2E1 (CYP2E1), myeloperoxidase (MPO), glutathione-S-transferase mu-1 (GSTM1), and glutathione-S-transferase theta-1 (GSTT1), were studied for their roles in human susceptibility to benzene poisoning. The potential interactions of these metabolic enzymes with lifestyle factors such as cigarette smoking and alcohol consumption were also explored. We studied 156 benzene-poisoning patients and 152 workers occupationally exposed to benzene in South China. Sequencing, denaturing HPLC, restriction fragment-length polymorphism, and polymerase chain reaction were used to detect polymorphisms on the promoters and complete coding regions of NQO1, CYP2E1, MPO, and the null genotypes of GSTM1 and GSTT1. Seventeen single nucleotide polymorphisms (SNPs) were identified in NQO1, CYP2E1, and MPO genes, including 6 novel SNPs in CYP2E1 and MPO. Of the subjects who smoked and drank alcohol, an 8.15-fold [95% confidence interval (CI), 1.43-46.50] and a 21.50-fold (95% CI, 2.79-165.79) increased risk of benzene poisoning, respectively, were observed among the subjects with two copies of NQO1 with a C-to-T substitution in cDNA at nucleotide 609 (c.609 C>T variation; i.e., NQO1 c.609 T/T) compared to those with the heterozygous or wild (NQO1 c.609 C/T and c.609 C/C) genotypes. Our data also indicated that individuals with CYP2E1 c.-1293 C/C and c.-1293 G/C, and NQO1 c.609 T/T, and GSTT1 null genotypes tended to be more susceptible to benzene toxicity. Our results suggest that the combined effect of polymorphisms in NQO1, CYP2E1, and GSTT1 genes and lifestyle factors might contribute to benzene poisoning.     

GSTM1, GSTT1, GSTP1, and GSTA1 polymorphisms and urinary isothiocyanate metabolites following broccoli consumption in humans

Isothiocyanates (ITC) are potentially anticarcinogenic phytochemicals formed from the metabolism of glucosinolates and are found in cruciferous vegetables as well as a select number of other foods. ITC are both substrates for and inducers of glutathione S-transferase (GST) phase II metabolizing enzymes involved in carcinogen detoxification as well as effectors of phase I pathways. Previous studies report mixed results on the interaction between cruciferous vegetable intake, GST polymorphisms, and risk of cancer. We conducted a study of 114 healthy human subjects between 18 and 50 y of age to examine the biologic mechanism underlying the associations, specifically, to assess whether GST genotype is associated with urinary ITC metabolites following a known dose of broccoli. After 48 h of abstaining from all sources of glucosinolates, participants provided a blood sample, consumed 1 meal containing 2.5 g broccoli/kg body weight, and collected urine for 24 h. ITC metabolites were measured in the urine using a HPLC cyclocondensation assay. DNA was extracted from blood samples, and GSTM1 deletion, GSTT1 deletion, GSTP1 Ile105Val, and GSTA1*A/*B were genotyped by matrix-assisted laser desorption/ionization time-of-flight. A chi-square test was used to compare high and low ITC excretion levels across genotypes. ITC levels were regressed on genotype, adjusting for gender. There were no substantial differences in ITC levels among genotypes, either individually or in combination. Contrary to our hypothesis, a higher proportion of GSTM1 null individuals had high ITC excretion (62%) compared with the proportion of GSTM1 present with high ITC excretion (39%) (P = 0.03). These results are in agreement with another feeding study, and lend support to the idea of alternative routes of ITC metabolism.     

Genetic polymorphisms of MnSOD, GSTM1, GSTT1, and OGG1 in coal workers' pneumoconiosis

Little is known about the genetic susceptibility to coal workers' pneumoconiosis (CWP). We investigated the association between genetic polymorphisms of MnSOD, GSTM1, GSTT1, or OGG1 and susceptibility to CWP. The study population was composed of 259 Chinese retired coal miners who had similar dust exposure histories. Of these, there were 99 cases with International Labor Organization chest radiologic criteria for CWP and 160 controls (with no radiologic criteria for CWP). Individual dust exposure variables were estimated from work histories, and smoking information was obtained from interviews. Polymerase chain reaction-based techniques evaluated the genotypes of all study subjects. There were no differences in genotype frequency of MnSOD, GSTM1, GSTT1, and OGG1 between miners with CWP and miners without CWP, by logistic regression analysis. Cumulative dust exposures, but not genetic polymorphisms, were associated significantly with the presence of CWP. This study illustrates the complexity of factors that may contribute to the development of CWP.     

被动吸烟与cyp1b1、gstp1、sult1a1基因多态性对乳腺癌发病的影响

目的 探讨被动吸烟、cyp1b1、gstp1、sult1a1基因多态性及其联合作用对乳腺癌发病的影响。方法 2014 - 2015年间,采用病例-对照研究方法,收集病例794例,对照805例。问卷调查收集研究对象信息。采用飞行质谱技术,进行cyp1b1、gstp1、sult1a1基因单核苷酸多态性分型检测。采用多因素非条件 logistic 回归,分析环境烟草烟雾暴露及cyp1b1、gstp1、sult1a1基因多态性与乳腺癌发病风险的关系。结果 调整年龄、教育程度、家庭年总收入、职业、婚姻状况后,环境烟草烟雾暴露与gstp1基因多态性未发现协同作用。以环境烟草烟雾低暴露且携带 cyp1b1 rs1056836 C等位基因为参照,环境烟草烟雾高暴露且携带 GG 基因在绝经前女性中乳腺癌风险明显增高（OR = 1.678,95%CI:1.039～2.711）。以环境烟草烟雾组合低暴露且携带sult1a1 rs9282861GG基因型为参照,环境烟草烟雾高暴露且携带A等位基因绝经前乳腺癌风险明显增高（OR = 2.389,95%CI:1.157～4.931）,但交互作用系数无统计学意义。结论 环境烟草烟雾高暴露与cyp1b1 及sult1a1基因对乳腺癌发病风险可能存在协同作用,但尚扩大样本进行验证。