陕西省HIV/AIDS患者接受抗病毒治疗后病毒载量结果及其影响因素分析

目的 分析陕西省艾滋病病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immune deficiency syndrome,AIDS)患者(以下简称为HIV/AIDS患者)接受抗病毒治疗后病毒载量结果及相关影响因素。 方法 对接受抗病毒治疗六个月以上的1 046例HIV/AIDS患者进行病毒载量检测,结合病例流行病学资料分析病毒载量结果及其影响因素。 结果 1 046例HIV/AIDS患者中,≥1 000 copies/ml占9.6%(100/1 046),50~999 copies/ml占9.1%(95/1 046),＜50 copies/ml占25.4%(266/1 046),TND(未检出病毒)占55.9%(585/1 046)。单因素分析显示病毒载量结果＜1 000 copies/ml与≥1 000 copies/ml HIV/AIDS患者在民族(P＜0.05)、教育程度(χ²=10.901,P＜0.05)、感染途径(χ²=14.286, P＜0.05)变量上差异有统计学意义。多因素分析显示教育程度大专及以上是病毒载量≥1 000 copies/ml的保护因素(OR=0.344,95%CI:0.121~0.979),HIV感染途径中注射吸毒是病毒载量≥1 000 copies/ml的危险因素(OR=5.237,95%CI:1.272~21.556)。 结论 陕西省HIV/AIDS患者抗病毒治疗效果较好,但需要提高患者治疗依从性,减少病毒抑制失败。     

求和自回归移动平均模型在陕西省细菌性痢疾发病预测中的应用

目的探讨时间序列模型预测传染性疾病发病率的可行性,应用自回归移动平均(autoregressive integrated moving average,ARIMA)模型对陕西省细菌性痢疾进行预测,为制定细菌性痢疾防治策略提供依据。方法根据2004-2012年陕西省细菌性痢疾月报告发病率的时间序列,以2013年1-12月的月发病率作为验证数据,建立ARIMA模型,并对预测效果进行评价。结果陕西省2004-2012年细菌性痢疾月发病率即含有长期递减趋势又含有以年为周期的季节效应,拟合的相对最佳模型为ARIMA(0,1,1)×(1,1,0)12。残差分析统计量经检验差异无统计学意义(Ljung-Box Q=21.994,P=0.143),提示残差为白噪声。2013年1-12月实际值与预测值的相对误差平均值为20.75%,最大40.37%,最小4.94%。结论 ARIMA模型可以较好地预测陕西省细菌性痢疾的发病趋势,模型预测效果的优化有待原始数据的进一步积累。     

Validation of Two Clinical Prognostic Models in Patients With Acute Symptomatic Pulmonary Embolism

ObjectiveThe aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE).MethodsWe performed a retrospective analysis of a cohort composed of 1447 patients with acute symptomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using C statistic, which was obtained by means of logistic regression and ROC curves.ResultsOverall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (C statistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (C statistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P<.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the Spanish score (1.1% versus 4.2%), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% versus 2.3%).ConclusionsBoth scores provide excellent information to stratify the risk of mortality in patients treated of PE. The usefulness of these models for nonfatal adverse events is questionable. The sPESI identified low-risk patients with PE better than the Spanish score.     

Noninvasive methods to assess liver disease in patients with hepatitis B or C

The prognosis and management of patients with chronic viral hepatitis B and C depend on the amount and progression of liver fibrosis and the risk for cirrhosis. Liver biopsy, traditionally considered to be the reference standard for staging of fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. These methods rely on distinct but complementary approaches: a biologic approach, which quantifies serum levels of biomarkers of fibrosis, and a physical approach, which measures liver stiffness by ultrasound or magnetic resonance elastography. Noninvasive methods were initially studied and validated in patients with chronic hepatitis C but are now used increasingly for patients with hepatitis B, reducing the need for liver biopsy analysis. We review the advantages and limitations of the noninvasive methods used to manage patients with chronic viral hepatitis B or C infection.     

DNA条形码技术在陕西省鼠形动物鉴定中的应用

目的 探究应用DNA条形码技术进行分子生物学鉴定的可行性,弥补形态学鉴定缺陷。方法 结合鼠疫监测工作,使用样方法、5 m夹笼法、夹夜法采集鼠形动物标本,所有标本形态学初步鉴定后基于线粒体细胞色素C氧化酶I亚基基因(COI基因)进行分子鉴定,计算遗传距离,构建系统发育树。结果 获得709只鼠形动物的COI基因序列,隶属于3目10科24属38种。COI基因序列显示种内遗传距离在3.6%以内, 平均为1.4%,种间遗传距离大于5.6%, 种间遗传距离显著大于种内遗传距离,属间、科间遗传距离界限不明显,对多只鼠形动物形态学鉴定结果进行了纠正。系统发育树显示同种个体聚为高支持度的单一分支,发现索氏仓鼠和中国仓鼠2个隐存种。结论 DNA条形码技术可对鼠形动物进行有效的鉴定,但因数据库的不完善,仍需将传统的分类学鉴定方法和现代分子生物学鉴定方法结合,以保证鉴定结果的准确性。     

2019－2020年陕西省布鲁氏菌病流行病学特征

  目的  了解2019 — 2020年陕西省布鲁氏菌病（布病）疫情流行特征趋势,为制订针对性的布病防控措施提供依据。  方法  收集整理2019 — 2020年陕西省布病病例报告和暴发疫情资料,运用SPSS 25.0、ArcGIS 10.8软件对布病病例三间分布特征进行描述性分析和χ2检验,并对暴发疫情特征和不同感染途径风险进行分析。  结果  2019 — 2020年陕西省累计报告病例2 254例,年均发病率为2.92/10万,发病以4 — 9月为主,病例分布在关中和陕北地区,陕北、关中、陕南地区年均发病率比较,差异有统计学有意义（χ2=1 338.771,P<0.001）;以男性为主,性别年均发病率比较,差异有统计学意义（χ2=440.140,P<0.001）;以40～69岁人群为主（71.25%）,职业以农民为主。 累计报告暴发疫情27起,共发现血清抗体阳性者218例（其中确诊病例175例,隐性感染者43例）,疫情主要是3～5例的小规模暴发（51.85%）,发生场所以家庭散养为主（48.15%）,感染途径以经皮肤黏膜直接接触为主（44.44%）。 对病例经皮肤黏膜直接接触、呼吸道、消化道途径感染布病的感染率比较,差异均有统计学意义（P<0.001）,且经皮肤黏膜直接接触、呼吸道和消化道途径感染布病风险的相对危险度（95% CI）分别为21.257（95% CI: 13.621～33.183）、15.408（95% CI: 8.927～26.600）和15.895（95% CI: 10.117～24.957）。 检测牲畜10 273只,扑杀病畜349只。 累计分离鉴定布鲁氏菌株69株,均为羊种菌,以羊3型为主。  结论  陕西省应继续坚持和完善联防联控机制,加大病畜检疫力度,提高养殖户布病防控知-信-行模式形成率。     

Clinical and familial characteristics of eight Chinese patients with T188K genetic Creutzfeldt–Jakob disease

Eight cases of rare genetic Creutzfeldt–Jakob disease (gCJD) with a mutation T188K in PRNP have been identified and diagnosed genetically in China since 2006. Among the eight cases, the median age of disease onset was 58 years old (ranging from 39 to 76 years old). Progressive dementia and pyramidal or extrapyramidal dysfunction appeared in all cases and lasted during the entire clinical course. Myoclonus and visual or cerebellar disturbances were also frequently observed. The median duration of disease was 3 months. Cerebral MRI findings revealed high caudate and putamen signals in four out of eight cases. CSF in six out of eight patients tested positive for the 14-3-3 protein. Only one case showed periodic sharp-waves (PSW) in EEG. Most cases lacked a family history of associated diseases, though one patient’s mother died of a neurologic disorder without a definite diagnosis. Our data reveal that Chinese T188K gCJD cases have clinical characteristics similar to that of sporadic CJD (sCJD). Compared with other inherited prion disease-associated mutations in China, the genetic frequencies of T188K in PRNP of Han-Chinese are relatively high.     

A study on the clinical characteristics of treating nevus of Ota by Q-switched Nd:YAG laser

The purpose of this study was to retrospectively analyze the clinical characteristics of treating nevus of Ota by Q-switched Nd:YAG laser in Laser Cosmetology Center of Department of Dermatology, the Second Hospital, Xi’an Jiaotong University. The data of 1168 patients of nevus of Ota were analyzed retrospectively, which included the correlation among lesion color, treatment sessions, sex, age, lesion types, and effect. The Q-switched (QS) Nd:YAG laser system had a higher number of treatment sessions which were positively associated with a better response to treatment. Other variables, including gender, age, the categorization of the lesion according to Tanino’s classification, and the color of the lesion, were not associated with the response to treatment. The treatment of nevus of Ota with QS Nd:YAG laser is safe and effective, with rare complications.     

丁桂儿脐贴辅助治疗对泄泻小儿肠道菌群的影响及其作用特征

贴敷治疗是传统中医药治疗小儿泄泻较为独特的一种治疗方法,在临床实践中应用广泛。目前已有众多研究者从中医机制和临床实践中阐释了该治疗途径的合理性,但其作用机制如何,目前并不明确。该研究即在中医临床医师参与下,以不同泄泻证患儿粪便样本为研究材料,在对证口服中药的基础上,辅以丁桂儿脐贴敷脐治疗,采用自动核糖体内转录间隔序列分析法（automated ribosomal intergenic-spacer analysis,ARISA）,研究丁桂儿脐贴辅助治疗对泄泻患儿肠道菌群的影响。结果表明敷脐辅助治疗显著影响着肠道菌群的迁移行为,具体表现在与正常对照间菌群相似性差异程度减少和核心OTUs（operational taxonomic units）及与正常对照共享OTUs数量的增加。此外,丁桂儿脐贴辅助治疗还具有作用持续时间长、缓慢增加菌群OTUs数量等特点。提示丁桂儿脐贴具有促进失衡肠道微生态系统恢复的作用,肠道菌群可能是贴敷治疗小儿泄泻的主要靶点之一,而单纯对证口服中药的主要作用靶点可能不完全是肠道菌群。     

1992 - 2010年陕西省HIV/AIDS报告病例分析

目的 描述1992 - 2010年陕西省HIV/AIDS流行特征和发展趋势。 方法 对陕西省1992 - 2010年艾滋病疫情报告资料进行流行病学分析。 结果 陕西省1992 - 2010年累计报告HIV/AIDS病例1913例;感染途径前期以既往有偿供血和静脉注射吸毒传播为主,后期以性传播和静脉注射吸毒传播为主;病例以中青年为主,主要集中在16~50岁,约占90%;男性占总数的78.36%;女性占总数的21.64%;文化程度以初中及以下为主;职业以农民及家政待业人员为主。 结论 陕西省HIV/AIDS报告病例呈逐年增长的趋势;感染者以年轻人为主,感染途径多样化;美沙酮维持治疗、健康的性观念和安全套普及是针对有高危险行为人群的主要干预手段。