永嘉县2004～2008年艾滋病流行病学分析

目的了解永嘉县艾滋病流行现状,为制定防制措施提供科学依据。方法利用传染病网报系统导出永嘉县2004～2008年HIV/AIDS数据库,核对流行病学调查表,使用Excel和SPSS软件进行数据整理及统计分析。结果艾滋病疫情逐年上升,以外地流动人口为主,男女比为1.41：1,年龄集中在20～44岁人群,文化程度低,传播途径以性接触（75.38%）传播为主。结论艾滋病流行速度加快,应加强艾滋病预防知识宣传,尤其是对流动人口的宣传,同时要加大干预力度,以遏制艾滋病上升趋势。     

葡萄球菌属临床分布及耐药性监测

目的了解医院的耐甲氧西林金黄色葡萄球菌(MRSA)感染的临床分布及耐药性,为临床合理使用抗菌药物提供依据。方法菌种鉴定采用常规方法涂片、革兰染色镜检、触酶试验、血浆凝固酶试验确认及ATB细菌鉴定系统对标本进行细菌鉴定,药物敏感试验采用纸片扩散(K-B)法。结果 2008年1月-2010年12月共分离金黄色葡萄球菌144株占70.9%,凝固酶阴性葡萄球菌(CNS)59株占29.1%;临床科室分布,ICU金黄色葡萄球菌71株占35.0%,CNS 30株占14.8%,呼吸内科金黄色葡萄球菌52株占25.6%,CNS 23株占11.3%,皮肤科金黄色葡萄球菌21株占10.3%,CNS 6株占3.0%等。结论监测葡萄球菌属的耐药状况,准确检出耐甲氧西林葡萄球菌(MRS),尤其是MRSA,在指导临床合理用药,隔离治疗感染者,预防MRS医院传播等方面具有重要作用。     

以临床前期糖尿病视网膜病变为例分析医学图像人工智能系统在自发荧光图像识别中的应用

目的：以临床前期糖尿病视网膜病变为例分析医学图像人工智能系统对于自发荧光图像识别的能力，为早期诊断治疗提供技术支持。方法：连续收集2017年8月至2018年5月在温州医科大学附属第三医院眼科门诊就诊患者的眼底自发荧光图像，按是否患有糖尿病标准，纳入正常组102例（200 眼），糖尿病组105例（200眼）。受检者均行裂隙灯显微镜、前置镜、裸眼视力或矫正视力、眼底自发荧光影像等检查。采用基于二维格子复杂性度量的医学图像特征提取和识别系统对糖尿病组及正常组图像进行分析。结果：该系统分析临床前期糖尿病视网膜病变眼底自发荧光图像与正常视网膜自发荧光图像具有可识别差异，提取出具有比较意义的25个特征。针对25个特征进行单个特征及多个特征的10折交叉检验以及5折交叉检验，准确率为82.47%。结论：复杂性分析医学图像人工智能系统可用于识别临床前期糖尿病视网膜病变的眼底自发荧光改变，准确率高。     

浙江省永嘉县某鞋厂暴发隐翅虫皮炎

浙江省永嘉县一鞋厂2009年发生一起隐翅虫叮咬引起的隐翅虫皮炎暴发流行,595名女性员工中,患病23例,罹患率为3.87%。     

浙江省某农村社区糖尿病病人综合干预效果分析

目的：探讨农村糖尿病综合干预措施效果。方法：制定随访调查表,由医务人员对糖尿病患者进行健康教育、药物治疗和非药物干预,2年后开展中期评估,4年末期评估。资料使用Epidata3.0建立数据库,用SPSS13.0进行统计分析,显著性检验采用χ2检验。结果：农民糖尿病患病率为5.62%;糖尿病患者经过干预,规律药物治疗率由20.45%提高到79.07%;不服药者由37.50%下降到5.81%;不规律服药由42.05%下降到15.12%;吸烟、饮酒、常吃肉类、常吃腌制品等饮食习惯分别由28.41%、59.09%、40.91%、21.59%下降9.30%、26.74%、17.44%、8.14%;认为吸烟、饮酒、高脂饮食等是糖尿病危险因素的知晓率,分别由26.14%、35.23%、31.82%上升到90.70%、73.26%、82.56%;认为导致糖尿病是多因素的知晓率由29.55%上升到77.91%;认为老年人才会得糖尿病、只有胖子才得糖尿病,分别由21.59%、13.64%下降到2.33%、3.49%,以上各项指标干预前后的变化均有统计学意义。结论：对糖尿病患者进行以健康教育为主的综合防治干预,可以改善糖尿病患者治疗依从性,提高慢性病相关知识知晓率,有效改善不良生活习惯,是一项可推广的防控策略。     

手法复位石膏夹板固定治疗踝关节骨折脱位57例

踝关节骨折脱位为临床上常见疾病,属关节内骨折。自2003年7月至2007年12月运用手法复位石膏夹板固定治疗踝部骨折脱位57例,收到良好疗效,现报告如下。     

替吉奥联合奥沙利铂治疗晚期胃癌临床研究

目的对替吉奥联合奥沙利铂治疗晚期胃癌的有效性及安全性进行观察。方法选取2009年1月至2011年12月治疗的晚期胃癌116例患者,经随机简单抽样方法分为A、B两组,每组58例,A组患者给予替吉奥联合奥沙利铂治疗,B组患者给予奥沙利铂、氟尿嘧啶联合亚叶酸钙治疗。观察两组给药前后血常规、肝肾功能、胸腹部CT扫描及胃镜等检查的变化,分析近期疗效及化疗的不良反应;比较三组患者的生存期及疾病进展时间。结果116例患者均可评价疗效,A、B两组患者的有效率分别为48．3％（28／58）和29．3％（17／58）,临床获益率分别为74．1％（43,58）和55．2％（32／58）,差异均有统计学意义（P〈0．05）。两组在不同时间点的生存率比较差异无统计学意义（P〉0．05）。A、B两组恶心发生率分别为34．5％（20／58）、67．2％（39／58）;呕吐发生率分别为37．9％（22／58）、62．1％（36／58）;两组比较差异均有统计学意义（P〈0．05）。药物对血液系统的影响、常见的末梢神经毒性、手足综合征及口腔黏膜炎,两组比较差异无统计学意义（P〉0．05）。结论替吉奥联合奥沙利铂治疗晚期胃癌患者临床效果好,不良反应轻,值得临床推广。     

Chronic obstructive pulmonary disease patients increase medio-lateral stability and limit changes in antero-posterior stability to curb energy expenditure

BackgroundA relationship exists between step width and energy expenditure, yet the contribution of dynamic stability to energy expenditure is not completely understood. Chronic obstructive pulmonary disease (COPD) patients’ energy expenditure is increased due to airway obstruction. Further, they have a higher prevalence of falls and balance deficits compared to controls.Research questionIs dynamic stability different between COPD patients and controls; and is the association between dynamic stability and energy expenditure different between groups?MethodsSeventeen COPD patients (64.3 ± 7.6years) and 23 controls (59.9 ± 6.6years) walked on a treadmill at three speeds: self-selected walking speed (SSWS), −20%SSWS, and +20%SSWS. Mean and variability (standard deviation) of the anterior-posterior (AP) and medio-lateral (ML) margins of stability (MOS) were compared between groups and speed conditions, while controlling for covariates. Additionally, their association to metabolic power was examined.ResultsThe association between stability and power did not significantly differ between groups. However, increased metabolic power was associated with decreased MOS AP mean (p < 0.0001), independent of speed. Increased MOS AP variability (p = 0.01) and increased SSWS (p’s < 0.05) were associated with increased metabolic power.The MOS ML mean for COPD patients was greater than that of healthy patients (p = 0.02). MOS AP mean decreased as speed increased and differed by group (p = 0.048). For COPD patients, a plateau was observed at SSWS and did not decrease further at +20%SSWS compared to controls. MOS AP variability (p < 0.0001), MOS ML mean (p < 0.0001), and MOS ML variability (p = 0.003) decreased as speed increased and did not differ by group.SignificancePatients with COPD operate at the upper limit of their metabolic reserve due to an increased cost of breathing. To compensate for their lack of stability, they walked with larger margins of stability in the ML direction, instead of changing the stability margins in the AP direction, due to its association with energy expenditure.     

Differential deficits in spatial and temporal interlimb coordination during walking in persons with incomplete spinal cord injury

BackgroundReturning to community walking remains a major challenge for persons with incomplete spinal cord injury (iSCI) due, in part, to impaired interlimb coordination. Here, we examined spatial and temporal features of interlimb coordination during walking and their associations to gait deficits in persons with chronic iSCI.Research QuestionDo deficits in spatial and temporal interlimb coordination correspond differentially to clinical indicators of walking performance in persons with iSCI?MethodsSixteen persons with chronic iSCI and eleven able-bodied individuals participated in this study. Participants walked at self-selected gait speeds along an instrumented walkway that recorded left and right step lengths and times. We quantified interlimb coordination in terms of normalized differences between left and right step lengths (spatial asymmetry index) and step times (temporal asymmetry index), as well as, gap and phase coordination indices. We then assessed the extent to which these indices independently associated with clinical measures of walking performance.ResultsParticipants with iSCI demonstrated greater spatial and temporal asymmetry, as well as, reduced gap and phase interlimb coordination as compared to age-matched controls (p < 0.001). We found no linear relationships between spatial and temporal asymmetry indices (p > 0.05) or between gap and phase coordination indices (p > 0.05). Spatial and temporal asymmetry indices weakly correlated with SCI-FAI composite scores (r² = 0.26; p = 0.04). However, only spatial asymmetry indices strongly correlated with slower walking speed (r² = 0.51; p < 0.002). We also found participants who used a hand-held assistive device (walker) demonstrated great spatial asymmetry as compared to those who did not (p < 0.03).SignificanceDifferential impairments in spatial and temporal interlimb coordination correspond to overground walking deficits in persons with chronic iSCI. Spatial asymmetry associated with decreased walking speed and increased reliance on hand-held assistive devices. Gait training methods that target well-defined space and time domains of interlimb coordination may enhance overground gait training in persons with iSCI.