青年冠心病患者危险因素与冠状动脉病变程度的关系

目的 :探讨国人 40岁以下冠心病患者危险因素与其冠状动脉 (冠脉 )病变程度之间的关系。方法 :根据冠状动脉造影结果将 10 8例 40岁以下 (含 40岁 )行冠脉造影者分为冠心病组 (6 2例 )和非冠心病组 (4 6例 ) ,进行危险因素调查并加以分析。结果 :男性患者多支病变多于女性 (5 8%vs 2 9% ,P <0 .0 5 ) ,冠脉病变积分高于女性 (12 .84± 5 .47vs 17.5 3± 3.16 ,P <0 .0 5 ) ,Logistic回归分析显著冠心病家族史、血浆总胆固醇水平及男性性别为冠心病的独立危险因素 ,其比值比 (OR)分别为 3.99(95 %CI 1.39～ 11.5 2 ) ,2 .0 9(95CI 1.30～3.48)和 2 .15 (95 %CI 1.16～ 3.86 ) (P =0 .0 11～ 0 .0 0 4) ;冠脉病变积分与冠心病家族史、血总胆固醇水平及男性性别呈正相关 ,r分别为 0 .36 7,0 .416和 0 .391,P均 <0 .0 5。结论 :冠心病家族史、血浆总胆固醇水平及男性性别对青年人冠心病的发生、发展有着重要促进作用。     

Incidence of Interpersonal Violence among Individuals with Drug Addiction Receiving Compulsory Treatment: A Survey at Two Drug Detention Centers in Hunan,China

正Drug dependence is a serious global health problem.To assist individuals with drug addiction,China alone has established 678 Compulsory Detoxification Detention Centers (CDDCs) that treat over300,000i ndividuals who are required by national law to receive compulsory treatment~([1])because community-based outpatient treatment failed.     

郭勇教授中西医配合辨治肠癌经验

目的：近年来,肠癌的发病率逐年上升,严重影响患者生活质量,笔者有幸跟随郭勇教授,将其诊治肠癌经验与临床文献研究进展结合作一个总结探讨。方法：将郭勇教授多年来诊治的肠癌患者病例收集、整理,剖析并归纳其遣方用药特点,并与郭师探讨交流其辨病辨证思想,将其首创的肿瘤中医治疗应遵循“四阶段、一盲区、二弱点”理念深入解析并与肠癌的治疗融合。将中医与西医在肠癌治疗过程中的角色比重与转变作一个深入且系统的归纳。结果：肿瘤从发生、发展、演变直至归宿存在围手术期、辅助治疗期、随访期和姑息治疗期4个不同的阶段。通过对四个阶段疾病侧重的把握,灵活转换中西医治疗的角色比重,从而使肠癌患者阴平阳秘,达到延长生存时间,提高生活质量的最终目的。结论：中医与西医绝不是一个相互对立的关系,而是应该相互配合,相辅相成。在肠癌的治疗中,郭师中西医配合四阶段治疗肠癌的观点取得了显著疗效。     

Development of an Easy-to-Use Visual Aid for the Prediction of Body Fat Based on Waist Circumference and Height in Asian Chinese Adults

BackgroundAdiposity is a major risk factor for metabolic and cardiovascular diseases. Initial prediction equations to estimate adiposity are complex, requiring skinfold measurements that cannot be obtained conveniently by the general population.ObjectiveTo develop simplified prediction equations to estimate body fat percentage (%BF) in Asian Chinese adults, evaluate the validity of the simplified %BF prediction equations, compare the simplified %BF prediction equations with an existing equation, and create visual charts to enable easy assessment of adiposity by the general public.DesignSimplified prediction equations were developed and evaluated for validity using anthropometric measurements obtained from a cross-sectional study.Participants and settingHealthy participants with no major diseases and not taking long-term medications were recruited in a cross-sectional study conducted at Clinical Nutrition Research Centre, Singapore, between June 2014 and October 2017. A total of 439 participants were used for model building (269 women and 170 men) and another 107 participants were used for evaluating validity (62 women and 45 men).Main outcome measuresSimplified but acceptable prediction models and generation of user-friendly charts.Statistical analyses performedSimplified sex-specific %BF prediction equations were developed using stepwise regression and the model-building dataset. The best models were selected using the Akaike information criterion. The models were further simplified and their performance was compared using the validation dataset before choosing the final prediction equations.ResultsThe final selected models for women and men included waist circumference and height with nonsignificant prediction bias in %BF of 0.84%±3.94% (P=0.098, Cohen’s d_z=0.21) and –0.98%±3.65% (P=0.079, Cohen’s d_z=0.27), respectively. The final equations were split into three height categories from which the sex-specific prediction charts were generated.ConclusionsThe sex-specific prediction charts provide a good visual guide for estimating %BF using height and waist circumference values that are easy to obtain by the general public.     

Evaluation of ompK36 allele groups on clinical characteristics and virulence features of Klebsiella pneumoniae from bacteremia

Background/purposeThis study investigated the implications of ompK36 allele groups on clinical and microbiological features of patients with Klebsiella pneumoniae bacteremia.MethodsA total of 80 K. pneumoniae bloodstream isolates were collected and then divided into four ompK36 allele groups. Clinical characteristics, bacterial antibiotic resistance and virulence determinants were analyzed, including resistance and virulence genes, hypermucoviscosity phenotype, K capsule serotypes, biofilm formation, serum killing, neutrophil phagocytosis, and mouse lethality studies.Results78 isolates were classified into four ompK36 variants, designated groups A (34), B (6), C (26), and D (12), respectively; 2 isolate was untypeable. OmpK36 group C isolates carried higher frequencies of K1/K2 capsule serotypes, hypermucoviscosity phenotype, rmpA gene, allS gene, iroB gene, aerobactin gene, or rmpA2 gene than non-C group isolates. OmpK36 group C isolates were significantly more virulent, as higher serum resistance, higher anti-phagocytosis and higher mouse lethality, than OmpK36 non-C group isolates, except for similar biofilm formation capability. The K20 isolates probably has low expression rates of rmpA and rmpA2 for hypermucoviscosity phenotype. The biofilm formation was significantly associated with ESBL production. OmpK36 group C isolates were more frequently detected in patients with community-acquired bloodstream infection. However, significant underlying diseases and prior use of carbapenem were highly prevalent in patients with OmpK36 non-C group isolates infection. ESBL production was apparently higher in non-C group but did not reach statistical significance.ConclusionOur results suggest that the OmpK36 group C K.pneumoniae is more associated with community-acquired infection with a lower frequency of underlying illness, but with significantly more virulence in bloodstream infection. This would give a remind that clinicians should be aware of such clinical impacts of the ompK36 allele group.     

Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke

The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Mild hypoesthesia was observed on his left limbs. No speech disturbance, facial palsy, or neck or shoulder pain was observed. Intravenous thrombolytic treatment was given 238 min after symptom onset. Brown–Sequard syndrome subsequently developed 6 h after thrombolysis with a hypoesthetic sensory level below the right C5 dermatome. An emergent brain magnetic resonance angiography did not reveal an acute cerebral infarct but rather an atlantoaxial dislocation causing upper cervical spinal cord compression. Clinical symptoms did not deteriorate after thrombolysis. He received successful decompressive surgery 1 week later, and his muscle power gradually improved, with partial dependency when performing daily living activities 2 months later. A literature review revealed that only 15 patients (including the patient mentioned here) with spinal disorder mimicking acute stroke who received thrombolytic therapy have been reported. Atlantoaxial dislocation may present as acute hemiplegia mimicking acute stroke, followed by Brown–Sequard syndrome. Inadvertent thrombolytic therapy is likely not harmful for patients with atlantoaxial dislocation-induced cervical myelopathy. The neurological deficits of patients should be carefully and continuously evaluated to differentiate between stroke and myelopathy.     

中国被毛孢发酵物对 NOD 小鼠1型糖尿病的预防作用

目的 观察中国被毛孢发酵物对自发性1型糖尿病 NOD 小鼠的预防作用。方法 利用 NOD 小鼠1型自发性糖尿病模型,连续 10 周 ig 给予 1 g/kg中国被毛孢发酵物后,观察 NOD 小鼠的体质量、血糖、发病率、谷氨酸脱羧酶 (GAD) 抗体水平、胰岛病变和胰腺纤维化的变化。结果 NOD 小鼠给予 1 g/kg 中国被毛孢发酵物后,第6～10周时血糖和发病率明显降低 (P＜0.05、0.01),小鼠血清中 GAD 抗体明显降低 (P＜0.01),小鼠胰岛病变和胰腺纤维化评分值显著降低 (P＜0.05、0.01),胰腺结构较为清晰,胰岛有少量炎症细胞浸润,胰岛β细胞未见异常。结论 中国被毛孢发酵物有较好的预防 NOD 小鼠1型糖尿病发生的作用。     

四川省双流县永安中心卫生院基本情况现状调查

目的调查四川省双流县永安中心卫生院服务与经营现状,为乡镇卫生院卫生技术人员配置和国家基本药物目录实施提供基线数据。方法采用问卷调查加专题访谈的方式调查该中心卫生院基本情况,内容包括一般情况、人员、经营及业务状况、基本药物目录实施情况等。结果该中心乡镇卫生院硬件条件良好,服务人群的经济水平和健康状况较好。卫生院医护比、医药比高于全国平均水平。医院员工大专以上学历占61.6%,88%的员工为初级及以下职称,人员流失与流入基本持平。2009年药品收入占业务收入的53.6%,医药费用比2008年增加。医院于2010年4月1日起实行基本药物目录,尚无相关配套技术文件。结论四川省双流县永安中心卫生院基础条件较好,但作为西部小康型乡镇卫生院,存在卫生技术人员结构不合理、学历和资质不高及员工流动性大等问题,需制定相应政策和不断完善相应措施。完全实行基本药物零差价销售可能对医院经营造成较大影响,需及时足额补贴及政策配套才能维持现有卫生服务水平。     

Acute effects of hourly particulate-matter air pollution on 24 h ambulatory blood pressure in Chinese elderly individuals: a prospective panel study

Background

The association between hourly exposure to air pollution and blood pressure, and its threshold effects, are unclear. We aimed to examine the association between hourly PM_2·5 and PM₁₀ exposure and 24 h ambulatory blood pressure among a panel of Chinese elderly individuals.