我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

目的 分析我国消除丙型肝炎（丙肝）的普通人群HCV检测策略的成本效果,明确最佳成本效果的HCV检测年龄。方法 运用TreeAge pro 2019软件构建决策树马尔科夫模型,以1年为周期,模拟10万名20~59岁各年龄组人群HCV检测和治疗结果,以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比（ICER）,效益指标为净货币效益（NMB）,以我国2022年人均国内生产总值（85 698元）为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。结果 在20~59岁人群HCV检测有成本效果,在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较,增量成本为161.24元/人,增量效用为0.003 6质量调整寿命年（QALYs）/人,ICER为45 197.26元/QALY,ICER小于意愿支付阈值,具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较,ICER为42 055.06~53 249.43元/QALY,NMB为96.52~169.86元/人,其中40~49岁年龄组的ICER最低,NMB最高。单因素敏感性分析结果显示,贴现率、丙肝抗体（抗-HCV）检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大,但改变参数取值,结论不变。概率敏感性分析结果表明模型分析结果稳定。结论 医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果,以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略,能降低人群丙肝疾病负担。     

Social construction of Anangu disability

ABSTRACT: The usual and common-sense definition of disability is based on a medical model that sees disability as a limitation or lack of competence on the part of the individual. This definition fails to acknowledge that in some cultures disability as a concept does not exist. This paper, based on research undertaken in 1994/1995, examines how the social construction of disability among the A n angu of the cross border region of Western Australia, South Australia and the Northern Territory, takes into consideration the important factors of history, culture and language. The theoretical underpinning of the research was symbolic interactionism, which led to collaborative ethnography becoming the methodology employed to collect and analyse the data. The findings of the research indicate that the social construction of disability among the A n angu occurs in three historical phases: the impairment, oppression and empowerment phases. The paper's purpose is to offer service providers to Aboriginal people with disabilities, information that will help them understand some of the attitudes, customs, mores and beliefs of their clientele.     

糖尿病中医证型的分布及动态资料对比分析

目的:掌握糖尿病住院患者中医证型的分布及动态发展资料。方法:运用统计学方法,对本院1996-1998年所有糖尿病患者的中医病证进行编码、分类、统计。结果:1996年糖尿病患者中医证候分布主要顺位为:肺胃燥热证(29.8%)、气阴两虚证(25.7%)、肾阴亏虚证(22.2%)、阴阳两虚证类(11.1%)。1997年中医证候谱发生变化,顺位为气阴两虚证(41.4%)、肺胃燥热证(24.5%)、阴阳两虚证(20.7%)、肾阴亏虚证(13.8%)。1998年为肺胃燥热证(33.2%)、气阴两虚证(30.5%)、阴阳两虚证(21.3%)、肾阴亏虚证(14.9%)。结论:危害糖尿病患者较重的阴阳两虚证所占病例逐年增多,要引起高度警惕,如不及时治疗,消渴病证候将向严重方向转移,威胁患者生命     

Effect of distance and population size on patient trips in a prefecture of Japan: Application of a transportation distribution model to the demand for and supply of health services

The gravity model, a method for analyzing transportation distribution in transportation engineering, was used to explain patient trips between ten health service regions in a Japanese prefecture. The OD (Origin-Destination) tables were constructed with zoning by regions, distinguishing between out- and inpatients. The observed trips were determined from the data of a survey conducted in 1992 that reported the locations of patient residences and chosen medical facilities. The base values used in the model calculations were the population size of each region and the road distance between the centers of regions. Problems of intrazonal trip were avoided by setting a mean intrazonal movement distance. This model was calibrated by the linear regression method with simultaneous validation by the index of correlation coefficients. The model was found to accurately simulate the effect of distance on the choice of medical facilities and the differences between the characteristics of in- and out-patients. The population value in use showed the relation not only with demand but also the supply of clinical services. It was suggested that the model presented here was useful in the allocation of medical resources and would help explain the relationship between suppliers and consumers of medical services.     

Left-ventricular pressure gradients: a computer-model simulation

Both invasive left-ventricular pressure measurements and non-invasive colour M-mode echographic measurements have shown the existence of intraventricular pressure gradients (IVPGs) during early filling. The mechanisms responsible for these IVPG cannot be completely explained by the experiments. Therefore a one-dimensional numerical model is developed and validated. The model describes filling (both velocities and pressures) along a left ventricular (LV) base-apex axis. Blood-wall interaction in the left ventricle with moving boundaries is taken into account. The computational results for a canine heart indicate that the observed IVPGs during filling are the consequence of a complex interaction between, on the one hand, pressure waves travelling in the LV and, on the other hand, LV geometry, relaxation and compliance. The computational results indicate the pressure dependency of wavespeed (0.77-1.90 m-1 s) for different mean intraventricular pressures (0.88-5.00 mmHg) and IVPGs up to 2 mmHg, independent of the ratio of end systolic volume and equilibrium volume. Increasing relaxation rate not only decreases minimum basal pressure (2.8 instead of 3.6 mmHg) but also has a strong influence on the time delay between the minimum basal and apical pressures (14 ms instead of 49 ms). The results sustain the hypothesis that pressure-wave propagation determines IVPGs and that IVPGs are no proof of elastic recoil.     

Extracellular signal-regulated kinase (ERK) activation by the pre-T cell receptor in developing thymocytes in vivo

The first checkpoint in T cell development occurs between the CD4(-)CD8(-) and CD4(+)CD8(+) stages and is associated with formation of the pre-T cell receptor (TCR). The signaling mechanisms that drive this progression remain largely unknown. Here, we show that extracellular signal-regulated kinases (ERKs)-1/2 are activated upon engagement of the pre-TCR. Using a novel experimental system, we demonstrate that expression of the pre-TCR by developing thymocytes induces ERK-1/2 activation within the thymus. In addition, the activation of this pre-TCR signaling cascade is mediated through Lck. These findings directly link pre-TCR complex formation with specific downstream signaling components in vivo.     

肿瘤抗原脉冲致敏的树突状细胞疫苗抗肿瘤作用的实验研究

目的：进一步研究体外肿瘤抗原脉冲致敏的骨髓树突状细胞瘤苗主动免疫诱导小鼠体内抗肿瘤免疫应答,并观察其抵抗野生性肿瘤攻击的免疫保护作用及对荷瘤小鼠模型的免疫应答。方法：采用本室建立的骨髓树突状细胞分离与细胞因子体外扩增培养方法,并在体外经灭活ＮＳ１骨髓瘤细胞及其裂解产物脉冲刺激后直接作为疫苗,然后进行免疫预防与治疗的在体动物实验。结果：可从１只小鼠股骨中获得（３～５）×１０５个树突状细胞（ＤＣ）,其纯度为９５％以上,对混合Ｔ淋巴细胞具有强刺激活性。主动免疫同系健康ＢＡＬＢ／Ｃ小鼠的试验显示,ＤＣ疫苗能诱导抗原特异的细胞毒性Ｔ淋巴细胞（ＣＴＬ）活性,免疫１次的动物首次受到肿瘤攻击后诱发肿瘤形成率为０％,再次攻击的肿瘤形成率为２０％;而免疫３次的动物两次攻击的肿瘤形成率皆为０％。主动免疫治疗同种荷瘤动物的试验表明,ＤＣ疫苗也能抑制肿瘤生长,荷瘤动物存活率提高及生存期明显延长。结论：肿瘤抗原体外致敏的树突状细胞能诱导宿主体内的抗肿瘤免疫保护性反应,且对荷瘤模型动物具有明显的免疫治疗作用。     

骨髓树突状细胞融合瘤苗抗肿瘤免疫预防与治疗的实验研究

目的：进一步研究树突状细胞与肿瘤细胞的融合瘤苗细胞主动免疫诱导体内抗肿瘤免疫反应及对荷瘤小鼠的免疫治疗效果。方法：直接分离骨髓树突状细胞和体外生长因子诱导扩增培养相结合,获得大量高纯度的树突状细胞,再以５００ｇ／ＬＰＥＧ诱导其与ＮＳ１骨髓细胞融合,ＨＡＴ选择培养得到两者的融合细胞,体外进行混合淋巴细胞培养,并进行免疫预防与治疗的在体动物实验。结果：融合细胞也能诱导淋巴细胞的增殖反应,而ＮＳ１无此作用。体内免疫预防试验表明,融合细胞活瘤苗１次免疫后,诱导出较强的细胞毒性Ｔ淋巴细胞（ＣＴＬ）,并获得抵抗野生型ＮＳ１攻击的保护性反应,但对无关瘤株则无此抵抗力。融合细胞对荷瘤小鼠的免疫治疗试验显示,融合细胞静脉注射后,能够明显抑制肿瘤生长,延长其生存期。结论：树突状细胞与肿瘤细胞融合后的瘤苗体内免疫,能有效地诱导抗肿瘤免疫反应,可望成为肿瘤免疫预防和免疫治疗的新途径。     

抗人胸腺细胞单克隆抗体2G_2B_2和2G_2C_2的制备及特性鉴定

用杂交瘤技术制备２株单克隆抗体（单抗）２Ｇ２Ｂ２、２Ｇ２Ｃ２。经研究发现,它们主要与胸腺细胞、脐血及ＰＨＡ激活的外周血单个核细胞等反应;免疫组化显示其主要作用于皮质胸腺细胞;与造血系统中分化早期的瘤细胞、骨髓瘤细胞等反应阳性率较高。生物学特性鉴定结果提示,单抗均属免疫球蛋白ＩｇＧ１亚类,腹水效价达１：１２８０００,所识别抗原分子量为４５／４６ＫＤａ,无抗原调变作用。故２Ｇ２Ｂ２、２Ｇ２Ｃ２是类似ＯＫＴ１０的抗ＣＤ３８单抗,但竞争抑制结果表明三者分别作用于不同的抗原决定簇,即２Ｇ２Ｂ２、２Ｇ２Ｃ２是两个抗ＣＤ３８新单抗。     

开肺化痰解毒法治疗小儿病毒性肺炎痰热壅肺证临床观察

目的：应用开肺化痰解毒活血的清肺口服液方治疗小儿病毒性肺炎痰热壅肺证。方法：观察治疗组用清肺口服液（麻黄、杏仁、石膏、葶苈子、虎杖等）;对照组辨证用药加用头孢菌素Ｖ等抗生素,２组对照观察。结果：观察组显效率及有效率分别为８６．７％和９６．７％,同中药辨证加西药抗生素的对照组相比,疗效无显著性差异。观察组的咳嗽咯痰好转时间为（６．９０±２．０６）ｄ,显著短于对照组的（９．９３±２．９３）ｄ（Ｐ＜０．０５）;观察组治疗后的甲皱微循环总积分为０．５１±０．３９,显著小于对照组的１．８３±１．１９（Ｐ＜０．０１）。结论：清肺口服液方治疗小儿病毒性肺炎痰热壅肺证具有肯定的疗效。