中国神经外科的领航者——2008年度国家最高科学技术奖获得者王忠诚院士介绍

2009年1月9日上午10时,在中国北京人民大会堂,由中共中央总书记、国家主席、中央军委主席胡锦涛将2008年度国家最高科学技术奖之一授予首都医科大学神经外科学院院长、附属北京天坛医院名誉院长、北京市神经外科研究所所长王忠诚院士,以表彰他在神经外科领域所做出的杰出贡献。本文简要介绍王忠诚院士的经历、主要贡献及其意义。     

以中国内蒙古及蒙古国聚居区调查数据分析包虫病相关危险因素

目的 本研究通过在内蒙古和蒙古国两个地区大量的流行病学调查,分析肝包虫患病危险因素,为政府相关部门制定相应预防措施提供依据。方法 在内蒙古地区选择8个肝包虫高发区及蒙古国扎门乌德地区作为流调现场,通过发放流行病学调查表,血清学检查及腹部超声检查,收集并分析数据结果得出患病危险因素。结果 本研究内蒙古地区7 373例有效数据,蒙古国地区1 500例, 整个调查样本平均年龄为52.86±13.90岁,女性比例(58.35%)高于男性比例(41.65%).单因素及多因素分析均显示女性(14.7%)患肝包虫病的风险要高于男性(10.9%)。内蒙古不同职业中儿童、教师及医务人员发病率较低,牧民阳性率最高(15.8%)。在牧区工作生活、到过牧区、在牧区吃生菜喝生水、养狗及附近有狐狸野鼠活动均增加阳性率患病风险。多因素分析内蒙古地区结果进一步得出在牧区工作生活、附近有狐狸野鼠活动会增加阳性风险。结论 感染包虫病最重要的危险因素是农牧民不良的生活方式和风俗习惯。这项研究可能对相关政府部门管制定有效的肝包虫病预防措施提供依据。     

A linear programming model for allocating HIV prevention funds with state agencies: a pilot study

Given the initiatives to improve resource allocation decisions for HIV prevention activities, a linear programming model was designed specifically for use by state and local decision-makers. A pilot study using information from the state of Florida was conducted and studied under a series of scenarios depicting the impact of common resource allocation constraints. Improvements over the past allocation strategy in the number of potential infections averted were observed in all scenarios with a maximal improvement of 73%. When allocating limited resources, policymakers must balance efficiency and equity. In this pilot study, the optimal allocation (i.e., most-efficient strategy) would not distribute resources in an equitable manner. Instead, only 12% of at-risk people would receive prevention funds. We find that less efficient strategies, where 58% fewer infections are averted, result in significantly more equitable allocations. This tool serves as a guide for allocating funds for prevention activities. Funding: This research was supported by Cooperative Agreement Number R18/CCR420943 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the CDC.     

The impacts of the State Children's Health Insurance Program on children who enroll: findings from ten states

OBJECTIVE: Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees. DATA SOURCES/STUDY SETTING: Surveys of 16,700 SCHIP enrollees were conducted in 2002 as part of a congressionally mandated study. Three domains of SCHIP enrollees were included: (1) children who were recently enrolled in SCHIP, (2) those who had been enrolled in SCHIP for 5 months or more, and (3) those who had recently disenrolled from SCHIP. Response rates varied across states and domains but were clustered between 75 and 80 percent. Five different types of indicators were examined: (1) service use; (2) unmet need; (3) parental perceptions about being able to meet their child's health care needs; (4) presence and type of a usual source of care; and (5) provider communication and accessibility. STUDY DESIGN: The experiences SCHIP enrollees have while on the program are compared with those a separate sample of children had before enrolling using a separate sample pretest and posttest design, controlling for observable characteristics of the children and their families. DATA COLLECTION/EXTRACTION METHODS: The sample was drawn based on a list frame of SCHIP enrollees. The survey was administered in English and Spanish, by Computer-Assisted Telephone Interviewing (CATI). Field follow-up was used to locate families who could not be reached by telephone and these interviews were conducted by cellular telephone. PRINCIPAL FINDINGS: SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups. CONCLUSIONS: Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.     

50例麻痹性痴呆患者认知障碍特征

目的探讨麻痹性痴呆（GPI）患者认知障碍的特征。 方法选取首都医科大学附属北京地坛医院神经内科确诊的麻痹性痴呆患者50例及同期相匹配的无症状型神经梅毒（ANS）患者50例作为研究对象,采用简易精神状态量表（MMSE）评估各组患者认知障碍情况,比较不同痴呆程度GPI患者量表评分,采用多因素线性回归分析GPI患者MMSE评分的影响因素。 结果GPI组患者MMSE总分（22.50 ± 5.26）低于ANS组（28.60 ± 1.56）,差异有统计学意义（t = 7.852、P < 0.001）。两组患者MMSE各分项得分比较显示,GPI组患者定向力（6.78 ± 2.50）、注意力与计算力（3.16 ± 1.82）、回忆力（1.48 ± 1.05）和语言能力（7.28 ± 1.49）等均显著低于ANS组（9.68 ± 0.55、4.30 ± 1.07、2.70 ± 0.54、8.00 ± 0.00）,差异均有统计学意义（t = 8.006、P = 0.000,t = 3.811、P < 0.001,t = 7.271,P < 0.001,t = 3.428、P = 0.001)。中重度GPI患者的定向力、记忆力、回忆力及语言能力等各分项得分低于轻度组,但差异无统计学意义（t = 0.791、P = 0.433,t = 0.350、P = 0.728,t = 0.250,P = 0.804,t = 1.452、P = 0.153）。多因素线性回归分析显示,年龄影响MMSE评分,GPI患者年龄越大,MMSE评分越低（β =-0.365、P < 0.001）。 结论麻痹性痴呆患者存在全面性认知功能下降,年龄因素对认知障碍具有影响。     

平板运动试验联合动态心电图检查在心肌缺血性冠心病诊断中的效能

目的:观察平板运动试验联合动态心电图检查在心肌缺血性冠状动脉粥样硬化性心脏病(冠心病)诊断中的效能。方法:选取126例疑似心肌缺血性冠心病患者为研究对象,均行平板运动试验和动态心电图检查,以冠状动脉造影检查结果为“金标准”,比较平板运动试验、动态心电图单项检查与联合检查诊断结果及不同血管病变的检出准确度。结果:126例疑似心肌缺血性冠心病患者中,冠状动脉造影检查确诊心肌缺血性冠心病阳性113例,阴性13例;平板运动试验联合动态心电图检查诊断心肌缺血性冠心病的灵敏度、特异度、准确度、阳性预测值、阴性预测值及不同血管病变检出准确度均高于单独检查,漏诊率、误诊率均低于单独平板运动试验检查或动态心电图检查,差异有统计学意义(P<0.05)。结论:平板运动试验联合动态心电图检查诊断心肌缺血性冠心病的效能高于单项检查。     

1.5T MR多序列检查在小肝癌诊断中的应用

目的探究1.5T磁共振(MR)多序列检查在小肝癌诊断中的应用价值。方法回顾性分析我院影像科收治的48例经临床病理证实的小肝癌患者临床资料,48例患者共52个病灶,均经CT扫描、1.5T MR常规扫描及增强扫描,MR常规扫描序列包括T₁WI、T2WI、DWI,比较不同方法的小肝癌检出率,分析1.5T MR扫描各序列的信号特征及强化方式。结果CT平扫及增强扫描动脉期、门静脉期、延迟期小肝癌检出率分别为67.31%、90.38%、73.08%、75.00%,1.5T MR扫描T₁WI、T₂WI、DWI序列及增强扫描动脉期、门静脉期、延迟期小肝癌检出率分别为75.00%、84.62%、100.00%,92.31%、79.08%、80.77%,MR平扫小肝癌检出率显著高于CT平扫(P<0.05),两种检查方式增强扫描小肝癌检出率比较差异无统计学意义(P>0.05)。结论1.5T MR较CT平扫具有更高小肝癌检出率,1.5T MR多序列检查中DWI序列想肝癌检出率最高,1.5T MR多序列检查可明显提高小肝癌检出率,具有重要诊断价值。     

退役人员尿咖啡因代谢物含量与夜间睡眠时长的关联性研究

目的：探讨退役人员咖啡因摄入对夜间睡眠时长的影响。方法：目前仅美国全国健康和营养检查调查(NHANES)提供退役人员公开数据。仅2009-2014年包括尿咖啡因数据,但只有2009-2010年周期数据检测方法一致。因此本研究纳入806名2009-2010年国家健康与营养调查(NHANES)被试,根据是否服过兵役分为退役组(n=221)、未服役组(n=594)。分析美军退役人员与未服役人员尿咖啡因及其主要代谢物含量差异及与夜间睡眠时长的相关性。结果：退役人员目前夜间睡眠时长短于未服役人员且差异有统计学意义(P＜0.05)。退役人员尿1-甲基尿酸(1-MU)和咖啡因含量高于未服役人员且差异有统计学意义(P＜0.05)。退役人员尿1-MU含量与夜间睡眠时长呈负相关(r=-0.226;P=0.001)。多元线性回归分析表明,校正年龄,教育水平,种族和吸烟后,退役人员尿1-MU含量与夜间睡眠时长呈负相关(β=-0.226;P=0.001)。结论：退役人员咖啡因摄入量降低夜间睡眠时长。为我退役军人的睡眠健康提供理论证据和借鉴。     

醒脑静注射液联合康复护理对阿尔茨海默病的护理研究

目的:观察醒脑静注射液联合康复护理对阿尔茨海默病(AD)患者临床效果。方法:纳入60例AD患者展开对照研究,将其分为观察组(醒脑静注射液联合康复护理)与对照组(康复护理)各30例,分组方法为随机数字表法,比较简易智能状态检查表(MMSE)、阿尔茨海默病评价量表-认知分量表(ADAS-cog)、日常生活能力量表(ADL)评分。结果:治疗前,2组MMSE评分比较,差异无统计学意义(P>0.05)。观察组治疗后1个月、治疗后3个月MMSE评分较对照组高,差异有统计学意义(P<0.05)。治疗前,2组ADAS-cog评分比较,差异无统计学意义(P>0.05)。观察组治疗后1个月、治疗后3个月ADAS-cog评分比对照组低(P<0.05)。治疗前,2组ADL评分比较,差异无统计学意义(P>0.05)。观察组治疗后1个月、治疗后3个月ADL评分比对照组低(P<0.05)。结论:醒脑静注射液联合康复护理应用于AD患者,可显著改善患者的临床症状,延缓病情进展。