Work‐related injuries in the Alaska logging industry, 1991‐2014

Background

Although loggers in Alaska are at high risk for occupational injury, no comprehensive review of such injuries has been performed since the mid‐1990s. We investigated work‐related injuries in the Alaska logging industry during 1991‐2014.

Methods

Using data from the Alaska Trauma Registry and the Alaska Occupational Injury Surveillance System, we described fatal and nonfatal injuries by factors including worker sex and age, timing and geographic location of injuries, and four injury characteristics. Annual injury rates and associated 5‐year simple moving averages were calculated.

Results

We identified an increase in the 5‐year simple moving averages of fatal injury rates beginning around 2005. While injury characteristics were largely consistent between the first 14 and most recent 10 years of the investigation, the size of logging companies declined significantly between these periods.

Conclusions

Factors associated with declines in the size of Alaska logging companies might have contributed to the observed increase in fatal injury rates.

     

新癀片对比清开灵胶囊治疗带状疱疹的成本-效果分析

目的：比较新癀片与清开灵胶囊治疗带状疱疹的经济性,为临床用药提供参考。方法：检索中国知网（CNKI）、维普中文科技期刊全文数据库（CQVIP）等电子资料源数据库,查寻国内关于新癀片及清开灵胶囊治疗带状疱疹的临床疗效文献,并通过构建决策树模型对新癀片及清开灵胶囊治疗方案进行成本效果分析。结果：新癀片方案治疗带状疱疹的总成本为55.09元,清开灵胶囊方案的总成本为61.07元;新癀片方案的有效率为97.6%,清开灵胶囊方案的有效率为83.3%。与清开灵胶囊相比,增量成本效果比（ICER）显示新癀片治疗带状疱疹为绝对优势方案。结论：与清开灵胶囊相比,新癀片在治疗带状疱疹方面更具成本效果优势。     

基于决策树算法的热毒宁注射液金银花青蒿醇沉过程质量控制研究

目的基于决策树算法,深入挖掘热毒宁注射液金银花青蒿醇沉过程(金青醇沉)数据并探究潜在生产规律,提升该过程质量控制水平。方法依托数字化中药提取工厂数据平台收集205批金银花和青蒿浸膏(金青浸膏)历史数据并整合成数据矩阵。将数据集随机划分为训练集和测试集后分别采用分类与回归树(classification and regression tree,CART)、随机森林(random forests,RF)和TreeNet算法建立金青醇沉过程模型,比较各模型性能并基于历史数据划分关键变量控制范围。结果 RF和TreeNet模型性能较好且性能接近,综合各模型分析结果得出醇提罐料液比及金银花浓缩收率为重要的影响因素,对重要变量进行依存度分析并优选批次,并以优选批次的金银花分配浸膏质量及加醇量做控制图,密度为1.11 g/cm3的金银花浸膏分配控制范围为557.92～639.62 kg,加醇量的控制范围为3.370～3.828 m3;密度为1.12 g/cm3的金银花浸膏的控制范围为540.4～616.9 kg,加醇量的控制范围为3.317～3.859 m~3。结论决策树算法建立的金青浸膏醇沉过程模型能够有效地挖掘潜在的生产过程规律,为生产过程的质量控制提升提供技术支撑。     

基于故障树理论和eCASH理念的ICU患者镇静镇痛管理策略

目的 基于故障树理论构建ICU患者镇静镇痛管理策略,并进行应用。方法 通过故障树分析法明确镇静镇痛的现存问题,基于eCASH镇静模式,构建了统一评估工具与方法、严密监测镇静效果与再评估、加强相关培训与考核、落实镇静镇痛护理措施、镇静镇痛追踪的综合管理策略,通过半年的临床应用,明确ICU镇静镇痛管理策略的效果。结果 通过实施镇静镇痛综合管理策略,ICU机械通气患者浅镇静率达57.98%,谵妄发生率降至26.67%,平均机械通气时间由7.63 d降至6.57 d,ICU平均住院时间由8.94 d降至7.25 d,与实施前比较,差异有统计学意义（P＜0.05）。 结论 在eCASH镇静镇痛管理原则指导下,基于故障树理论构建的ICU镇静镇痛管理策略,能有效改善机械通气患者的镇静镇痛效果。     

Predicting intraoperative feasibility of combined TES-mMEP and cSSEP monitoring during scoliosis surgery based on preoperative neurophysiological assessment

Background contextCombined monitoring of muscle motor evoked potentials elicited by transcranial electric stimulation (TES-mMEP) and cortical somatosensory evoked potentials (cSSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, TES-mMEP/cSSEP is not always feasible. Predictors of feasibility would help to plan the monitoring strategy.PurposeTo identify predictors of the feasibility of TES-mMEP/cSSEP during scoliosis surgery.Study design/settingProspective cohort study in a clinical neurophysiology unit and pediatric orthopedic department of a French university hospital.Patient sampleA total of 103 children aged 2 to 19 years scheduled for scoliosis surgery.Outcome measuresFeasibility rate of intraoperative TES-mMEP/cSSEP monitoring.MethodsAll patients underwent a preoperative neurological evaluation and preoperative mMEP and cSSEP recordings at both legs. For each factor associated with feasibility, we computed sensitivity, specificity, positive predictive value (PPV), and negative predictive value. A decision tree was designed.ResultsPresence of any of the following factors was associated with 100% feasibility, 100% specificity, and 100% PPV: idiopathic scoliosis, normal preoperative neurological findings, and normal preoperative mMEP and cSSEP recordings. Feasibility was 0% in the eight patients with no recordable mMEPs or cSSEPs during preoperative testing. A decision tree involving three screening steps can be used to identify patients in whom intraoperative TES-mMEP/cSSEP is feasible.ConclusionsPreoperative neurological and neurophysiological assessments are helpful for identifying patients who can be successfully monitored by TES-mMEP/cSSEP during scoliosis surgery.     

蚊科系统发育关系重建研究进展

该文综述了依据形态和分子特征重建蚊科各阶元系统发育关系的研究现状,并分析了该领域研究存在的问题以及未来研究的方向.以形态特征为依据的系统发育关系重建,仅在蚊科部分类群中有探讨,按蚊亚科研究较多.以分子特征为依据的研究,尚在起步阶段.应用系统基因组学重建蚊科系统发育关系应是未来研究的方向.     

Pathology and immunopathology of immunoglobulin G4-related sclerosing cholangitis: The latest addition to the sclerosing cholangitis family

Sclerosing cholangitis is heterogeneous in its etiopathogenesis. Recently, sclerosing cholangitis showing abundant immunoglobulin (Ig)G4+ plasma cell infiltration was added to the sclerosing cholangitis group. This form was frequently associated with sclerosing pancreatitis (autoimmune pancreatitis) and also occasionally with other diseases such as chronic sclerosing sialadenitis, all of which falls within IgG4-related sclerosing disease. Herein, this new member, called IgG4-related sclerosing cholangitis (IgG4-SC), is reviewed. IgG4-SC shows grossly medullary and fleshy lesions along the biliary tree, and histologically marked lymphoplasmacytic infiltration with extensive fibrosis, and obliterative phlebitis, sharing histopathological features with sclerosing pancreatitis. Peribiliary glands are also severely affected. Interestingly, hepatic inflammatory pseudotumor (HIP) is not infrequently associated with IgG4-SC, and is thought as a local exaggeration of IgG4-SC. Immunohistochemically, many IgG4+ plasma cells and CD4+/CD25+ regulatory T cells are found around the affected bile ducts and portal tracts. Incontrast, these cells are scarce in the affected bile ducts of primary sclerosing cholangitis (PSC), a prototype of sclerosing cholangitis. Biliary lining epithelia are relatively spared in IgG4-SC in comparison with those of PSC showing degeneration and ulceration. In some cases of IgG4-SC, IgG4+ plasma cells are also found considerably in small portal tracts, so needle liver biopsy is useful for the diagnosis of IgG4-SC. Therapeutically, IgG4-SC responds well to steroid therapy, while such character is not reported in PSC. Taken together, IgG4-SC may be etiologically different from PSC, and immunopathological processes relating to IgG4 and regulatory T cells may be involved in the pathogenesis of IgG4-SC. Further studies are needed to clarify the etiopathogenesis of IgG4-SC and its related disorders.     

河南和新疆地区HIV-1毒株gp120和gag基因的变异分析

目的分析中国河南和新疆地区艾滋病病毒Ⅰ型(HIV-1)毒株gp120和gag基因全长序列的变异特征。方法PCR扩增河南和新疆HIV-1确认阳性样本前病毒DNA gp120和gag全长基因,测序得到40份gp120和41份gag基因序列,用GCG软件包等软件进行分析。结果河南省HIV-1毒株为B′亚型,新疆维吾尔自治区HIV-1毒株为CRF07 BC亚型。B′亚型毒株gp120基因中变异程度最大的区段是V5区段,最小的是C1区段;CRF07BC亚型毒株中变异最大的是V1区段,最小的是C4区段。两种亚型毒株gp120和gag基因的Ks/Ka值<1(P<0.05)。结论对于病毒基因全长序列的分析可以更多地反映病毒的特性。gp120基因各个区段在B′和CRF07BC亚型毒株中的变异程度不一致。B′和CRF07 BC亚型毒株的gp120基因和gag基因都受到正向选择压力的作用。     

利什曼原虫K26序列应用于我国利什曼原虫分离株鉴定的价值分析

目的评价利什曼原虫K26序列应用于我国利什曼原虫分离株鉴定的价值。方法收集我国不同流行区的利什曼原虫16个分离株和6个国际参照株,培养后收集前鞭毛体,提取DNA,扩增K26序列并测序,应用ClustalX2进行序列比对,从GenBank下载同源性较高的利什曼原虫分离株的K26序列,构建系统进化树,分析我国不同流行区的利什曼原虫分离株的亲缘关系。结果我国16个利什曼原虫分离株和国际参照株DD8均扩增出单一条带,而5个非杜氏利什曼原虫复合体虫株均未扩增出任何条带。序列分析结果表明,我国人源型利什曼病流行区的3个分离株801、KS-2和KS-6均扩增出920 bp片段,自然疫源型利什曼病流行区的4个分离株XJ771、JIASHI-1、JIASHI-2和JIASHI-5均扩增出491 bp片段,人犬共患型利什曼病流行区4个分离株Cy、SC6、Hebei-Lv和Shanxi-Yang均扩增出404 bp片段,皮肤利什曼病流行区的5个分离株KXG-Xu、KXG-Liu、KXG-65、KXG-918和KXG-927均扩增出449 bp片段,且各流行区内虫株间的序列一致性均为100%。各流行区之间的虫株间的序列一致性较低,为40.2%~91.4%。系统进化树分析结果显示,我国16个利什曼原虫分离株聚集成2个群3个亚群,其中KXG-Xu、KXG-Liu、KXG-65、KXG-918、KXG-927、XJ771、JIASHI-1、JIASHI-2、JIASHI-5分离株聚集为A亚群,Cy、SC6、Hebei-Lv、Shanxi-Yang与婴儿利什曼原虫聚集为B亚群,A亚群和B亚群聚集为Ⅰ群;801、KS-2和KS-6分离株与杜氏利什曼原虫聚集为C亚群,进一步与国际参照株DD8聚集为Ⅱ群。结论利什曼原虫K26序列可应用于我国利什曼原虫分离株的鉴定。