阿托伐他汀药物在脑卒中高危人群中应用的效果研究

目的:通过有效的阿托伐他汀药物干预,探讨药物在卒中发病前及脑细胞并未处于完全性缺血缺氧状态下给予有效干预措施的效果。方法:于2017年4—6月,在上海市青浦区选择人口密度、经济水平相当但不相邻的2个社区60岁以上老年人进行高危险因素调查,筛选出至少具有2种危险因素的暴露人群,并对其进行颈动脉B超检查,筛选出颈动脉斑块的人群217例作为重点观察对象,其中一个社区为干预组(108例),口服立普妥及阿司匹林药物,另一个社区为对照组(109例),仅服用阿司匹林药物作为干预手段,比较两组治疗前后血脂和颈动脉斑块内-中膜厚度的变化情况。结果:干预组TC、LDL-C和HDL-C较对照组有明显的改善,干预组70.4%高血脂症转归至正常血脂,对照组仅有18.5%的高血脂症转归为正常;干预组中13.2%的人有新发内膜增厚现象,而在对照组中有31.3%的病例发生IMT内膜增厚;干预组中9.2%的研究对象由单侧斑块发展为双侧斑块,对照组中21.2%病例由单侧斑块发展为双侧斑块;且差异存在统计学意义。结论:立普妥可作为颈动脉粥样硬化斑块脑卒中高危人群的有效干预措施,辅以多普勒超声进行干预前后观察斑块变化,操作性强,重复性好,便于普及,必将在缺血性卒中的防治中发挥更大的作用。     

黑龙江省2017—2020年流感样病例暴发疫情特征分析

目的 分析黑龙江省2017—2020年流感样病例暴发疫情流行特点及影响因素,为流感的防控提供科学依据。方法 收集“突发公共卫生事件报告管理信息系统”和“中国流感监测信息系统”报告的流感暴发疫情资料,对数据进行统计分析。结果 2017—2020监测年度黑龙江省共报告流感暴发疫情29起,累计报告发病数1 028例,报告时间主要集中在冬春季,12月份和4月份报告最多,占96.55%;场所分布主要以中小学校为主,占暴发疫情总数的93.10%;暴发疫情规模以10～29例居多,占暴发疫情总数的65.52%;病原学结果显示流感病毒流行株由A型（H3）转变为A型（新甲H1）,之后又为A型（H3）和B型（Victoria）共同流行。结论 黑龙江省流感暴发疫情冬春季高发,集中在中小学校,流感优势株变换频繁,应做好监测并及时控制疫情的发展。     

2015—2019年四川省流感哨点监测结果分析

目的 描述四川省2015—2019年流感病毒流行特征,为疫情防控提供依据。方法 对流感监测系统上报的流感样病例数据开展回顾性流行病学分析。结果 2015—2019年间,四川省共监测流感样病例标本131 477份,其中阳性标本23 844份,流感阳性率为18.14%。2015—2019年四川省优势流感亚型主要为甲型H1N1,季节性H3N2和B(Victoria)系流感。流感阳性率随月份、季节而改变,四川省流感阳性率高峰主要出现在冬季,其次为秋季。甲型流感主要在秋冬季流行,乙型流感主要在冬春季流行。流感病毒阳性检出率在5～14岁组年龄段最高。结论 四川省流感有明显的冬季流行高峰,各型别呈交替流行。秋冬季应加强流感防控工作;甲型和乙型流感好发于5～14岁群体,应继续加强对儿童学生流感的防控。     

关思友治疗疑难病的临床辨证思路撷菁

关思友先生治疗疑难病时,在辨证论治的基础上,借鉴前医经验,注重逆向思维,取得良好的临床疗效。临证时,不囿表面所见,把细究病因放在重要地位,并提倡“治病不可因循守旧,固守古训,要圆机活法,因人、因地、因时治宜,有是证用是药。”     

Clinical presentation,viral kinetics,and management of human monkeypox cases from New Delhi,India 2022

We describe the clinical and demographic characteristics, virological follow-up, and management of five confirmed monkeypox cases from New Delhi, India without any international travel history. The viral load kinetics and viral clearance were estimated in oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), EDTA blood, serum, urine, and various lesion specimens on every fourth day of follow-up ranging from 5 to 24 post onset day (POD) of illness. All five cases presented with mild to moderate-grade intermittent fever, myalgia, and lesions on the genitals, groins, lower limb, trunk, and upper limb. Four cases had non-tender firm lymphadenopathy. No secondary complications or sexually transmitted infections were recorded in these cases except for the presence of viral hepatitis B infection marker hepatitis B virus surface antigen (HBsAg) in one case. All the cases were mild and had a good recovery. A higher viral load was detected in lesion fluid (POD 9), followed by lesion roof (POD 9), urine (POD 5), lesion base (POD 5), and OPS/NPS (POD 5). The monkeypox virus (MPXV) DNA was detected in clinical samples from 5th to 24th POD. These monkeypox cases without international travel history suggest the underdiagnosed monkeypox infection in the community. This emphasizes the need for active surveillance of MPXV in the high-risk population such as men having sex with men and female sex workers.     

头颈部恶性肿瘤累及颈动脉的治疗(附3例报告)

报告３例头颈部恶性肿瘤颈部转移累及颈动脉,术中保留预动脉,术后４～６ｄ颈动脉破裂大出血。分析原因为伤口感染和颈动脉已被肿瘤浸润所致,提示受肿瘤侵犯的颈动脉不宜保留。     

Mathematical aspects of the paternity index I=X/Y,especially in relation to the chance of non-exclusion of non-fathers

Summary In a previous paper the author mentioned some aspects of the paternity index I (=X/Y): Among false triplets the frequency of those with I equal to or higher than an (observed) I value of I ^x is considerably lower than 1/I ^x; among false triplets the mean value of I is equal to 1, and among non-excluded non-fathers it is equal to the inverse of the chance of non-exclusion; among true triplets the mean value of 1/I (=i) is equal to the chance of non-exclusion of non-fathers. In a statistical material rather strong deviations from some of these expectations were observed.In the present paper further characteristics of the distribution of I values were taken into consideration, and especially those that should hold if lnI would fit in with a normal distribution. It was supposed that with the aid of such a distribution the deviations mentioned above could be recognized as chance variability. It appears, however, that neither the logarithms of the paternity index, nor those of the zygosity index of twins (chosen as an analogous model that is more easily analysable than the paternity index) are really normally distributed. This, in turn, makes that estimates of probability of paternity, based on such a supposition, are of doubtful reliability. Besides it is concluded that also for other reasons other estimates than Essen-Möller's W (or I or i), as probability of first type errors, lead in practice to conclusions that are equally subdue to a priori suppositions as are W values and may be, in fact, much more erroneous than those.Special attention is paid to the statistical analysis of paternity studies with more than one alleged father, and it is concluded that in such cases the general formula that may be considered to be equivalent with Essen-Möller's formula for one-man paternity cases, i.e., W=X/(X+Y) or I/(I+1), must be W ₁=I ₁/(I+n); W ₂=I ₂/(I+n) etc. and certainly not W ₁=I ₁/(I+1); W ₂=I ₂/(I+1) etc.Dedicated to Prof. Dr. Erik Essen-Möller on the occasion of his 80th birthday     

纳洛酮加清开灵治疗野生蕈中毒30例疗效观察

目的：观察纳洛酮与清开灵合用治疗急性野生蕈中毒的临床疗效。方法：采用随机数字表法将86例患者随机分为3组。治疗组30例以纳络酮加清开灵治疗，纳洛酮组26例单用纳洛酮治疗，清开灵组30例单用清开灵治疗。观察3组患者症状好转时间、症状消失时间、重症清醒时间。治疗5天为1疗程，共治2－8疗程。结果：治疗组在症状好转时间、症状消失时间、清醒时间均明显短于纳洛酮组和清开灵组（P＜0．05，P＜0．01）。结论：纳洛酮与清开灵合用，可以从不同途径作用于脑组织，尽快改善中毒症状，减少脑损伤，二者合用尚可减少纳洛酮的用量，从而减少纳洛酮的心血管效应。     

口头尸检对河池市5～60岁死亡病例进行死因评估结果分析

目的 分析河池市5～60岁居民死亡主要原因，分析口头尸检(Verlbal Autopsy，VA)进行死因调查的效果。方法 建立死亡监测系统，对所有报告的监测区内5～60岁死亡个案进行口头尸检调查。结果 2002年7月-2003年6月金城江镇、东江镇共死亡624人，全人口总粗死亡率为4．67‰，标化死亡率为5．34‰，男女之比为1．71：1；5～60岁死亡病例248例，粗死亡率为2．10‰；导致5～60岁居民主要死亡原因为意外死亡、恶性肿瘤、心脑血管疾病、消化系统疾病等，其中意外死亡占死亡构成比的1／3；通过VA进行死因调查，使3．000%的错误死因定义得到更正、5．00％的不明死因得到诊断；无因伤寒导致的死亡。结论 交通事故成为当地5～60岁居民死亡的主要因素；随着社会经济发展，伤寒等肠道传染病已不是导致死亡的重要因素；使用VA对于死因的判定比一般的监测系统报告更为准确。     

Cox模型影响点识别诊断统计量的模拟研究

目的 探讨Cox比例风险模型影响点的有效识别方法 .方法 通过Monte-Carlo模拟研究,比较了六种诊断统计量及相应诊断图对影响点的诊断效能.结果 模拟研究表明,加权score残差、似然距离和最大影响曲率及其诊断图可从模型拟合不同角度有效识别影响点.结论 影响分析应是Cox模型分析的一个重要组成部分,加权score残差、似然距离和最大影响曲率是有效识别影响点的诊断统计量.