亚洲流行模型在凉山州艾滋病疫情估计及干预效果预测中的应用

目的探讨亚洲流行模型(AEM)在艾滋病疫情估计及干预效果预测中的应用。方法运用AEM预测凉山州艾滋病疫情变化趋势,并通过AEM Intervention预测改变综合干预覆盖率后,2011-2015年新发感染的变化情况。结果近年来,凉山州艾滋病报告与估计疫情比例持续上升。截止2009年底,实际报告数已超过疫情估计数的1/2。在今后5年,各类人群中,注射吸毒人群、暗娼和嫖客人群的HIV感染率变化均不大,但男男性行为人群的HIV感染率将呈快速上升趋势;同时,偶遇性行为所占传播比例将逐年增加。若保持现有综合干预力度不变,未来5年凉山州HIV新发感染率仍将呈现上升趋势;当干预覆盖率达到70%及以上时,新发感染率开始出现下降趋势;当覆盖率达到90%时,下降趋势才明显。结论凉山州艾滋病疫情发现能力大幅提高;应重视男男性行为与偶遇性行为在凉山州艾滋病传播中的作用;需进一步提高艾滋病综合干预覆盖面,并注意干预频率和强度。     

中国乌头的研究——ⅩⅩ.赣皖乌头的研究

本文报道了从赣皖乌头Aconitum finetianum Hand-Mazz的根中分到三个二萜类生物碱A.B.c。经鉴定B和C分别为lappaconitine和ranaconitine。碱A,C₃₂H₄₄N₂O₁₀,熔点220～221℃,[α]_D²²+44.7°(甲醇),为一个新生物碱,暂称赣乌碱finaconitine,经光谱推定化学结构为10-β-羟基-冉乌头碱。     

超声测量评估阻塞性睡眠呼吸暂停低通气综合征患者困难气道的价值

目的探究超声测量正中位舌骨到皮肤距离、声带水平前联合到皮肤的距离以及颏舌骨肌长度对于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者困难气道预测的可行性。方法择期行全麻气管插管改良腭咽成形术的OSAHS患者37例,男32例,女5例,年龄20~69岁,ASAⅠ-Ⅲ级。术前评估改良Mallampati气道分级,超声测量正中位舌骨到皮肤距离、声带水平前联合到皮肤距离以及颏舌骨肌长度。根据Cormack-Lehane分级法评定普通喉镜暴露程度(Ⅲ、Ⅳ级为困难气道),采用ROC曲线分析各指标预测困难气道的效能。结果 37例患者中11例纳入困难气道组,26例纳入非困难气道组。困难气道组声带水平前联合到皮肤距离明显长于非困难气道组(P<0.05),而颏舌骨肌长度明显短于非困难气道组(P<0.05)。两组正中位舌骨刮皮肤距离差异无统计学意义。改良Mallampati气道分级、声带水平前联合到皮肤距离及颏舌骨肌长度预测困难气道的AUC及其95%CI分别为0.788(0.640~0.937)、0.804(0.643~0.966)和0.788(0.642~0.935),三者联合的AUC及其95%CI为0.955(0.895~1.000),敏感性100%,特异性84.6%。结论超声测量声带水平前联合到皮肤距离及颏舌骨肌长度对于OSAHS患者困难插管有一定的预测价值,且综合三种预测方法,可提高预测的准确性。     

Rutgers alcohol problem index scores at age 18 predict alcohol dependence diagnoses 7 years later

Background: The Rutgers Alcohol Problem Index (RAPI) is widely used to assess adolescent drinking‐related problems. We asked how well RAPI, administered in late adolescence, predicts alcohol diagnoses at age 25 in a 7‐year follow‐up. Methods: At age 18, a population‐based sample of Finnish twins completed RAPI by postal questionnaire; 597 (300 male) twins, from pairs discordant and concordant for age 18 RAPI scores, were interviewed at age 25 with the SSAGA, yielding DSM‐IIIR diagnoses. Polychoric correlations between RAPI and alcohol diagnoses and symptoms, the area under the response operator characteristic (ROC) curve, and the odds ratio of outcome diagnosis per unit change in adolescent RAPI were analyzed. Twin pairs discordant for both adolescent RAPI and adult diagnoses permitted within‐family replications for the full sample and separately by sex. Results: Nearly half the interviewed twins met diagnostic criteria for alcohol dependency (46.2%) or abuse (1.5%). Age 18 RAPI scores significantly correlated with diagnoses (0.52) and symptom counts (0.55). ROC analysis found a 74% probability that adolescent RAPI scores will be higher among those with an alcohol diagnosis at age 25 than for those without. The odds ratio of outcome alcohol diagnosis per unit increase in adolescent 18 RAPI exceeded 10.0. Within‐family comparisons of 117 twin pairs discordant for both age 18 RAPI and age 25 alcohol diagnoses replicated the between‐family associations. In both between‐family and within‐family analyses, RAPI was more predictive of alcohol diagnoses among females. Conclusions: Our results offer evidence, including that from informative comparisons of co‐twins discordant for both predictor and outcome, that RAPI scores in late adolescence robustly predict alcohol diagnoses in early adulthood. Accordingly, our results also provide new evidence that one pathway to problem drinking in early adulthood is a direct one from problem drinking in adolescence.     

危重症甲型H1N1流感临床初期危险因素的早期快速识别探讨

目的 探讨提高临床急诊医师对甲型H1N1流感危重症病例的快速识别能力.方法 回顾性分析65例甲型H1N1流感重症病例初期的临床特征,采用成组比较的病例对照研究方法,通过单因素分析筛选及多因素Logistic回归分析确定危重症病例发生的高危因素;拟定预测危重病例发生的预测重症甲型H1N1流感评分系统(PCIS)并进行拟合优度检验.结果 65例甲型H1N1流感重症病例中危重症(22例)和重症(43例)两组年龄、合并1个以上基础疾病、存在慢性心血管疾病、合并肿瘤性疾病、咯痰、肌肉或关节酸痛、呼吸困难、入院时脉搏血氧饱和度(SpO2)8个因素比较差异均有统计学意义.多因素Logistic回归分析显示,合并1个以上基础疾病[相对比值比(OR)=7.611,95%可信区间(95%CI)1.635～35.429]、肌肉或关节酸痛(OR=7.523,95%CI 1.462～38.716)、呼吸困难(OR=11.090,95%CI 1.373～89.565)、入院时SpO2＜0.95(OR=8.088,95%CI 1.019～84.969)是发生危重症的独立危险因素(均P＜0.05);受试者工作特征曲线(ROC)下面积(AUC)为0.922(95%CI 0.860～0.985,P=0.000).PCIS分级(低危0～1分、中危2分、高危3分、极高危≥4分)与实际危重病例吻合度良好,判定系数(R2)为0.940 6,P=0.030 1.结论 急诊临床医师可以根据基础疾病的多少、有无肌肉或关节酸痛、呼吸困难、入院时SpO2水平的综合评分(PCIS)早期快速识别易发生危重症甲型H1N1流感患者.

Abstract：

Objective To investigate clinical risky factors and improve the ability to discover critically ill patients suffering from influenza A H1N1 in emergency department. Methods A retrospective study of 65 cases with severe influenza A H1N1 was conducted. Univariate analysis and multivariate Logistic regression analysis were used to identify independent predictors of critically ill cases. Goodness of Fit test was performed on an established clinical predicting scoring (prediction of critically ill with influenza score,PCIS) system. Results Univariate analysis showed that significant difference between critically ill and severe group consisted of eight factors including age distribution, more than one comorbidity, chronic cardiovascular disease, oncologic diseases, sputum, myalgia/arthralgia, dyspnea and oxygen saturation at admission. A multivariate Logistic regression showed an association between development of critical illness and more than one comorbidity [odds ratio (OR) = 7. 611, 95% confidence interval (95%CI) 1. 635 -35. 429], myalgia/arthralgia (OR=7. 523, 95%CI 1.462 - 38. 716), dyspnea (OR= 11. 090, 95%CI 1. 373 -89. 565), and oxygen saturation＜0. 95 at admission (OR=8. 088, 95%CI 1. 019 - 84. 969, all P＜0. 05).The prognostic criteria had a good discriminative ability [area under receiver operating characteristic curve (AUC) was 0. 922, 95 %CI 0. 860 - 0. 985, P = 0. 000]. The PCIS scoring system was established according to the level of four high risk factors. Low risk (PCIS 0 - 1), intermediate risk (PCIS 2), high risk (PCIS 3), and very high risk (PCIS≥4) were categorized for predicting the occurrence of critical illness, and the Goodness of Fit test was good (R2= 0. 940 6, P = 0. 030 1). Conclusion Emergency physician can predict the development of critical condition in patients with influenza A H1N1 by using clinical characteristics including comorbidity, myalgia/arthralgia, dyspnea, and oxygen saturation at admission, and it is helpful in making clinical decision.     

Predicting Risky Drinking Outcomes Longitudinally: What Kind of Advance Notice Can We Get?

This paper summarizes the proceedings of a symposium presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, that spans the interval from toddlerhood to early middle adulthood and addresses questions about how far ahead developmentally we can anticipate alcohol problems and related substance use disorder and how such work informs our understanding of the causes and course of alcohol problems and alcohol use disorder. The context of these questions both historically and developmentally is set by Robert Zucker in an introductory section. Next, Maria Wong and colleagues describe the developmental trajectories of behavioral and affective control from preschool to early adolescence in a high risk for alcoholism longitudinal study and demonstrate their ability to predict alcohol and drug outcomes in adolescence. Duncan Clark and Jack Cornelius follow with a report on the predictive utility of parental disruptive behavior disorders in predicting onset of alcohol problems in their adolescent offspring in late adolescence. Next, Kenneth Leonard and Gregory Homish report on adult development study findings relating baseline individual, spouse, and peer network drinking indicators at marriage onset that distinguish different patterns of stability and change in alcohol problems over the first 2 years of marriage. In the final paper, John Schulenberg and colleagues, utilizing national panel data from the Monitoring the Future Study, which cover the 18- to 35-year age span, show how trajectories of alcohol use in early adulthood predict differential alcohol abuse and dependence outcomes at age 35. Finally, Robert Zucker examines the degree to which the core symposium questions are answered and comments on next step research and clinical practice changes that are called for by these findings.     

肺部手术患者双侧支气管呼气末二氧化碳分压差值预测术后肺部并发症的效能

目的 评估肺部手术患者双肺的通气期间左右两侧支气管呼气末二氧化碳分压(P_ETCO₂)差值预测术后肺部并发症(PPCs)的效能。方法 选择择期行胸腔镜下肺部手术患者200例,男86例,女114例,年龄18～80岁,BMI 17～32 kg/m²,ASAⅡ或Ⅲ级。根据是否发生PPCs将患者分为两组：PPCs组和无PPCs组。测量并记录双腔支气管插管后仰卧位双肺通气后5 min(T₀)、改侧卧位双肺通气后5 min(T₁)、关胸后侧卧位双肺通气后5 min(T₂)、术后恢复仰卧位双肺通气后5 min (T₃)的气管、术侧和健侧P_ETCO₂,计算健侧与术侧P_ETCO₂差值(D-P_ETCO₂)。记录单肺通气时间、手术时间、术后胸管总引流量、术后胸管留置时间和术后住院时间。采用受试者工作特征曲线(ROC)并计算曲线下...     

急性呼吸窘迫综合征患者早期呼吸支持模式选择的预警因素

目的：探讨急性呼吸窘迫综合征（ ARDS）患者呼吸模式调整的预警因素。方法回顾性分析49例ARDS患者入科24 h内接受不同呼吸模式的临床资料，收集入科时的22项定量指标及5项分类变量。呼吸模式以能维持24 h为准，分为有创通气组及无创通气组。结果7 d及28 d死亡率在有创通气组分别为46．1％（12／26）及65．3％（17／26），高于无创通气组的0（0／23）及13．0％（3／23）。两组基本资料中是否需要血管活性药物、肺内外因素、心率、GCS评分、APACHEⅡ评分、肌酐、乳酸及血小板计数比较差异均有统计学意义（ P ＜0．05）。二项式Logistic回归分析证实，以上8项指标对调整为有创通气具有预测价值，但并非独立预警因素。采用受试者工作特征（ ROC）曲线，计算出其中6项定量指标的参考阈值为APACHEⅡ评分＞17分、GCS评分≤13分、心率＞123次／min、乳酸＞3．6 mmol／L、血小板≤191×109／L和肌酐＞66 mmol／L。结论8项预警因素提示机体存在失去代偿风险，无创通气往往无法满足需要，需尽早调整为有创通气支持。     

Human chorionic gonadotropin levels are equally predictive for pregnancy outcome after fresh and vitrified-warmed blastocyst transfer

Purpose

The aim of the present study was to evaluate if the live birth predictive values of β-hCG levels differ in fresh and vitrified-warmed blastocyst transfer cycles.

Methods

In the retrospectively designed study, 775 cycles with positive β-hCG values 13 days after fresh blastocyst transfer (fresh ET; n = 568) or vitrified-warmed blastocyst transfer (FET; n = 207) were selected for analysis. Average β-hCG levels stratified according to pregnancy outcome (biochemical pregnancy, spontaneous abortion, ectopic pregnancy, and singleton or twin birth) were compared between fresh ET and FET cycles. To determine the optimal sensitivity and specificity of β-hCG levels for live birth prediction, a ROC curve was constructed. Fisher’s exact test was used to compare the positive predictive values (PPV).

Results

Average β-hCG levels stratified according to pregnancy outcome were not statistically different between fresh ET and FET cycles. In fresh ET and in FET group, the β-hCG levels were significantly higher in pregnancies resulting in live birth compared to non-viable pregnancies (1,035 vs. 462 IU/L, p < 0.001 and 968 vs. 411 IU/L, p < 0.001). Optimal cut-off level for live birth prediction was 495 IU/L (sensitivity 83.0 %, specificity 71.8 %) after ET and 527 IU/L (sensitivity 80.0 % and specificity 76.6 %) after FET. The PPV for live birth rate in the groups after ET and FET were 90.6 % and 84.9 % respectively, without statistically significant difference (p > 0.05).

Conclusion

Beta-hCG levels after fresh and vitrified-warmed blastocyst transfer are equally predictive for pregnancy outcome. Clinicians can be encouraged to interpret β-hCG results in the same manner.