湖南省郴州市一起新型冠状病毒肺炎聚集性疫情流行病学调查

目的 通过分析郴州市一起新冠肺炎聚集性疫情相关病例发病确诊过程,探讨新冠病例早发现、早报告以及病例诊断和隔离观察解除的策略依据。 方法 对该起新冠肺炎聚集性疫情的病例和密切接触者进行现场流行病学调查,描述性分析流行病学史、临床和实验室资料。 结果 利用大数据比对监测,在转送监测对象至集中场所隔离医学观察时发现了新冠肺炎确诊病例何某华,由此发现一起新冠肺炎家庭聚集性疫情,何某的5名密切接触者中有3人发病确诊（包含1名重症病例）,其中重症病例黄某第7次新型冠状病毒核酸检测阳性进而确诊,密切接触者中胡某有流行病学史、血常规白细胞下降和肺炎影像学改变,但是5次咽拭子核酸检测阴性,未确诊。 结论 大数据比对监测对发现传染病有积极作用;早期对有流行病学史人员单独隔离医学观察对防止聚集性疫情发生有重要意义;将2次核酸检测阴性作为新冠肺炎病例的排除标准和将核酸检测阳性作为确诊新冠肺炎病例的必备条件,值得探讨,这都可能放走传染源,导致新冠肺炎传播。     

集束化干预在急性胰腺炎肠内营养患者中的应用效果观察

目的 探讨集束化干预在急性胰腺炎肠内营养患者中的临床价值。方法 将2018年1月至2019年12月于南通大学附属医院就诊的82例重症急性胰腺炎患者采用数字表法随机分为观察组及对照组,每组41例。对照组给予传统的营养支持,采取常规护理。观察组接受集束化干预,留置鼻肠管,进行肠内营养治疗,内容如下：构建肠内营养管理小组,加强对小组成员肠内营养输注集束化策略的培训并考核,完善肠内营养干预措施,实施持续质量管理。结果 观察组患者肠内营养相关性合并症及住院时间均低于对照组[7.32% vs 26.83%,（21.04±5.23）d vs（25.22±6.56）d,P<0.05]。实施肠内营养20 d后,观察组白蛋白高于对照组[（38.69±2.46）g/L vs（33.16±3.07）g/L,P<0.05]。结论 对急性胰腺炎患者实施集束化干预措施,进行肠内营养支持,可有效降低肠内营养相关性合并症的发生,改善患者营养状态,缩短住院时间。     

Direct binding of GABAA receptor β2 and β3 subunits to gephyrin

GABAergic transmission is essential to brain function, and a large repertoire of GABA type A receptor (GABA_AR) subunits is at a neuron's disposition to serve this function. The glycine receptor (GlyR)‐associated protein gephyrin has been shown to be essential for the clustering of a subset of GABA_AR. Despite recent progress in the field of gephyrin‐dependent mechanisms of postsynaptic GABA_AR stabilisation, the role of gephyrin in synaptic GABA_AR localisation has remained a complex matter with many open questions. Here, we analysed comparatively the interaction of purified rat gephyrin and mouse brain gephyrin with the large cytoplasmic loops of GABA_AR α1, α2, β2 and β3 subunits. Binding affinities were determined using surface plasmon resonance spectroscopy, and showed an ~ 20‐fold lower affinity of the β2 loop to gephyrin as compared to the GlyR β loop–gephyrin interaction. We also probed in vivo binding in primary cortical neurons by the well‐established use of chimaeras of GlyR α1 that harbour respective gephyrin‐binding motifs derived from the different GABA_AR subunits. These studies identify a novel gephyrin‐binding motif in GABA_AR β2 and β3 large cytoplasmic loops.     

基于隐结构模型和聚类分析的2 907例支气管扩张症中医证型研究

目的 对支气管扩张症的中医证候特征进行探究。方法 基于2 907例支气管扩张症住院患者的电子病历数据,运用Lantern 5.0和SPSS 20.0软件分别进行频次描述性统计、隐结构及系统聚类分析,综合判断潜在证型,为提出支气管扩张症的临床常见中医证型提供依据。结果 纳入的2 907份病历记录中涉及43个证型,其中频率大于5%的有痰热蕴肺证（52%）、痰湿阻肺证（25.5%）、肺气阴两虚证（9.1%）、痰瘀阻肺证（7.8%）、肺脾气虚证（7.1%）、肺肾气虚证（6.6%）;共记录有219个症状,将出现频次＞30次的67个症状作为显变量,综合聚类成风热犯肺证、痰热蕴肺证、痰湿阻肺证、痰瘀阻肺证、阴虚肺热证、肺肾气虚证、肺脾气虚证、肺气阴两虚证共8个证候;对频次＞60次的52个症状进行系统聚类分析,得到风热犯肺证、痰热蕴肺证、痰湿阻肺证、肺气阴两虚证、肺脾气虚兼外感证、阴虚内热兼血瘀证、肺肾气虚证、脾气虚证、兼证络伤咳血证共10个证候。以上3种方法推断出的证型中,重复出现至少两次的证型共有8个,即可认定为支气管扩张症常见证型。结论 支气管扩张症8个常见的证型为风热犯肺证、痰热蕴肺证、痰湿阻肺证、痰瘀阻肺证、阴虚肺热证、肺肾气虚证、肺脾气虚证、肺气阴两虚证。     

The Adhesion Between a Microvillus-Bearing Cell and a Ligand-Coated Substrate: A Monte Carlo Study

In biology, specific cell adhesion is mediated by receptor–ligand interactions. Consequently, its strength correlates with the strength of single receptor–ligand bonds that can be measured with a variety of techniques. However, whether single receptor–ligand bonds are truly present in an experiment is often a concern. In this paper, we present a Monte Carlo simulation of the adhesion between a microvillus-bearing cell and a ligand-coated substrate. In the simulation, ligands were immobilized on the substrate either uniformly or in clusters of three and seven, while receptors were distributed uniformly on the microvillus tip and they moved randomly on the cellular surface. How ligand clustering affects the adhesion frequency and forward rate constant was studied. Other factors that were studied include receptor aggregation on the microvillus tip, ligand density, receptor density, contact time, and binding pocket size. In the case of uniformly distributed ligands, our simulation results agree well with those obtained from probabilistic analysis. We found that, even with clustered ligands on the substrate, most of the adhesion events were mediated by a single bond if the total adhesion frequency was less than 20%. Besides, ligand clustering decreased the total adhesion frequency and forward rate constant, but increased the single-bond adhesion frequency under comparable conditions. These findings should lend us some assistance in identifying single bonds in cell–substrate or cell–bead adhesion measurements and in illustrating some biological mechanisms that involve clustered ligands.     

Spatial clusters of daytime sleepiness and association with nighttime noise levels in a Swiss general population (GeoHypnoLaus)

Introduction

Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters.

山东省平阴县农村地区出生缺陷聚集性分析

目的 分析山东省平阴县农村地区出生缺陷聚集性分布特征,为进一步病因学研究和防治提供线索和依据。方法 收集平阴县2004-2016年出生缺陷登记资料,描述出生缺陷地理分布,计算每个村庄的出生缺陷发病例数,对出生缺陷数据资料进行Poisson分布和负二项分布拟合优度检验。结果 出生缺陷发病数据不符合Poisson分布(χ²=30.33,P<0.001),但符合负二项分布(χ²=4.56,P=0.336)。结论 平阴县农村地区出生缺陷在村级层面上具有空间聚集性。     

基于层次聚类与复杂症状网络的广泛性焦虑障碍之上热下寒证的症状关系

目的 全面系统地探究广泛性焦虑障碍(generalized anxiety disorder, GAD)之上热下寒证的症状特点。方法 使用广泛性焦虑障碍中医证候调查表评估首都医科大学附属北京安定医院门诊收治的168例GAD患者的中医四诊信息与西医精神症状信息。专家判定其中100例为上热下寒证患者,68例为非上热下寒证患者。通过频数分析研究上热下寒证的常见寒、热症状分布特点。通过层次聚类分析GAD之上热下寒证的病位证素、病性证素。再通过提取GAD之上热下寒证的核心症状,进行核心症状间的复杂症状网络分析,探究上热与下寒症状间的内在逻辑关系。最后联合聚类分析与复杂网络分析结果,探寻GAD之上热下寒证的核心病机。结果 GAD上热下寒证的患者较非上热下寒证的患者病程更长,焦虑程度显著较高,常见症状(频率>30%)更多。GAD上热下寒证常见(频率>30%)的寒、热症状有:口舌干燥、舌苔白、两目干痒、下肢不温、面部洪热潮热、口苦、口渴欲饮、小腹畏寒、腰凉、盗汗、头热汗出、脉滑、手热足冷、足胫寒冷、面部多汗。GAD上热下寒证的病位证素为:心、胃、肾、督脉、脾、胆;病性证素为:火热、寒凝、气滞、气虚、阳虚。精神焦虑在核心症状的复杂症状网络中的作用最大。结论 精神症状在GAD上热下寒证的症状中占据主导地位,其潜在的核心病机可能是“君火失明,相火离位”,其治疗则为清热安神,辅以温阳。     

五类栽培白芷与兴安白芷的挥发油成分及其化学亲缘关系

目的 测定5类栽培白芷及野生兴安白芷（根）的挥发油成分及含量并分析各类白芷间的化学亲缘关系。方法 水蒸气蒸馏法提取6类白芷挥发油,采用GC-MS法对其组分分离及鉴定,采用面积归一化法计算各组分相对含量,并对挥发油成分进行聚类分析和主成分分析。结果 5类栽培白芷（川白芷、杭白芷、祁白芷、禹白芷、毫白芷）和野生兴安白芷共鉴定出81种化合物,分别鉴定出27、34、24、32、28、34种。主要为烷烃类、烯烃类、酯类、有机酸类、醇类等五大类化合物。壬基环丙烷、环十二烷和正十六酸分别为各类白芷共有成分中相对含量最高的挥发油成分。化学聚类结果显示：兴安白芷与5类栽培白芷形成2个分支,栽培白芷又可分为2小类,即川白芷、禹白芷、杭白芷聚为1小类,祁白芷和亳白芷聚为另1小类。主成分分析结果与聚类结果基本一致。结论 六类白芷的挥发油组份及其含量存在一定差异,壬基环丙烷、环十二烷和正十六酸在各类白芷中含量较高。六类白芷总体上分为野生与栽培2大类。