传染病流行的社会因素及社会控制策略刍议

传染病与社会文化因素的关系密切。应重视社会因素对传染病的发生发展影响，从社会根源上探究其发病原理，包括经济因素、科学技术、文化、人口、卫生服务和其它社会因素。人类要有与传染病长期斗争的思想准备，并制定包括大卫生观和技术合作等相应的社会策略。     

中西医结合要为妇女生殖健康创新页

45年来,复旦大学妇产科医院在中西医结合临床及科研方面取得了可喜的成就.针刺促排卵的研究,通过观察血雌激素和中枢β-内啡肽(β-EP)的关系,提出了针刺通过耗竭中枢β-EP而促排卵的新认识,认为针刺促排卵的主要适应症是青春期月经失调,并将针刺成功地应用于治疗神经性厌食;补肾化痰的俞氏温补方治疗多囊卵巢综合征(polycystic ovary syndrome, PCOS)被证实是通过提高血促卵泡激素(follicle stimulating hormone, FSH)并诱发排卵而起作用;益肾化瘀的天癸方是通过降低患者及动物模型的雄激素和胰岛素,引起以中枢阿片促黑激素皮质素原、神经肽Y和瘦素受体为主的神经-内分泌-代谢网络调节而发挥促排卵和减肥作用,对高胰岛素型PCOS有良效,并在研究中提出了对PCOS分类的新设想;益肾清火的更年春通过提高中枢与周围组织的雌激素受体及其mRNA表达来调节围绝经期妇女的神经-内分泌-免疫-代谢网络而获优越疗效.这些研究表明,疾病是外环境影响下患者生命网络的某些主脉失调所致,而且亚健康状态的妇女具有初步网络失控的现象,中西医结合将为女性生殖医学研究找到捷径,调控生命网络是防病治病的主要思路.     

Differentiating Large-scale Surge versus Daily Surge

This breakout session at the Academic Emergency Medicine 2006 Consensus Conference examined how baseline overcrowding impedes the ability of emergency departments to respond to sudden, unexpected surges in demand for patient care. Differences between daily and catastrophic surge were discussed, and the need to invoke a hospital-wide response to surge was explored.     

多层螺旋CT尿路造影在尿路梗阻性疾病中的临床应用

目的探讨多层螺旋CT尿路造影在泌尿系梗阻性疾病诊断中的应用价值。方法对48例泌尿系统梗阻性疾病者,分别进行多层螺旋CT平扫及多时相期CT增强扫描。对增强后各期图像进行相关处理,以不同的三维重建方式获得CTA、CTU影像。所有病例均经临床及手术证实。结果48例中肾脏及输尿管先天畸形者15例;输尿管阴性结石致肾盂输尿管积水者4例;泌尿系炎症者5例;肾及输尿管、膀胱结核6例;外源性压迫导致肾盂及输尿管积水者8例;泌尿系肿瘤者10例。结论多层螺旋CT泌尿系造影对尿路梗阻性疾病的诊断具有很高的应用价值。     

Validation of Probabilistic Linkage to Match De-identified Ambulance Records to a State Trauma Registry

Objectives: To validate the accuracy of using probabilistic linkage for matching de‐identified ambulance records to a state trauma registry. Methods: This was a retrospective cohort analysis. Three thousand nine hundred nineteen true matches between ambulance and state trauma registry data from 1998 to 2003 were identified by deterministic matching on trauma identification number and verified by human review. Two thousand thirty‐eight ambulance records from trauma patients not meeting criteria for a true match, and an identical number of trauma registry records randomly selected from the one local county served by a different EMS provider, were included as nonmatches. There were 17 variables considered for linkage, which included the following: age, gender, race, county, hospital, date, rural setting, call and arrival times, mechanism, penetrating injury, vital signs, intubation, and intoxication. Probabilistic linkage was used to link the two data sets, using seven different combinations of common variables (maximum, 17; minimum, 4). The sensitivity and specificity of identifying true matches and nonmatches (95% confidence intervals [95% CI]) were calculated for each combination of variables. Results: Using all 17 available variables, 3,766 of 3,919 true matches were appropriately linked (sensitivity, 96.1%; 95% CI = 95.4% to 96.7%), with eight mismatches (specificity, 99.6%; 95% CI = 99.2% to 99.8%). Sensitivity fell below 95% with < 15 variables; however, sensitivity was very dependent on the inclusion of variables with high discriminatory power. Specificity remained >98% regardless of the number of variables included. Conclusions: Probabilistic linkage is a valid method for matching ambulance records to a trauma registry without the use of patient identifiers; however, the sensitivity of identifying true matches is critically dependent on the number and type of common variables included in the analysis.     

骨水泥和种植体同期植入修复颌骨和牙列缺损的实验研究

目的：探讨高分子材料和种植体同期植入缺损区进行同步骨缺损修复和牙列缺损修复的可行性。方法：以4只杂种狗为研究对象，制备下颌骨长约2．5cm的缺损的动物模型(保留下颌骨下缘)，将骨水泥(聚甲基丙烯酸酯)植入骨缺损，同时将牙种植体植入骨水泥中并调整长轴方向，立即关闭术创。至术后3个月摄X线片，然后处死动物，局部巨检以了解骨水泥同骨组织的结合情况，并制备骨组织切片进行苏木精一伊红染色和甲苯胺蓝染色，以了解植入材料周边骨的生长情况及其对植入材料的反应。结果：术后3个月X线检查见骨缺损区充满骨水泥，骨水泥周边的骨小梁清晰，未见骨吸收或炎症表现，形成良好的骨-骨水泥界面，种植体则依赖其表面的螺纹结构与骨水泥间紧密的机械性嵌合而牢固的成为一体，植入的骨水泥块与周边天然骨结合紧密，无松动现象。植入材料周边局部脱钙骨的苏木精-伊红染色和甲苯胺蓝染色见骨结构正常，同时骨-骨水泥界有新骨形成。结论：骨水泥作为颌骨修复替代材料同期植入种植体是可行的。     

女性运动试验后QTc与ST的对比分析

作者测量100例妇女心电图运动试验后即刻QTc间期。冠心病组50例运动后即刻QTc间期比静息时明显延长(P<0.001),比正常配对组50例则明显缩短(P<0.001)。以QTc间期延长≥0.01秒力阳性指标,与ST段压低比较,其敏感性可从42％提高至70％,特异性从66％提高至76％;如综合QTc间期与ST段标准加以判断时,可使敏感性、特异性分别增至74％、88％。     

双腔右心室(附四例报告)

本文对我院1983～1985年经手术证实的4例双腔右心室病例,进行了分析讨论。本病除右心导管检查发现肺动脉与右心室有压力阶差移行曲线、右心造影时心腔内显示充盈缺损、超声心动图等检查有助于诊断外,X线心脏平片、心电图、临床症状、体征均无特异性的诊断价值。认为,由于本病多合并室缺,因此对室缺修补时,应常规探查右心室腔,以免漏诊。另外,对本病与法乐氏四联症的鉴别作了较详细的讨论。     

Serial CT findings of Paragonimus infested dogs and the Micro-CT findings of the worm cysts.

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.     

孕妇血清AFP、uE3和β-hCG水平与严重胎儿缺陷的关系

①目的 探讨孕中期血清甲胎球蛋白（AFP），游离雌三醇（uF3)和β绒毛膜促性腺激素（β-HCG）水平与严重胎儿缺陷的关系。②方法 用ELISA方法对832例16-21周妊娠妇女血清AFP、UE3和β-hCG进行检测，以筛查阳性病人。③结果 14例胎儿被确诊为异常，其中唐氏综征2例，无脑儿3例，脊柱裂3例，唇腭裂1例，腹裂肠外翻1例，孕中期自然流产2例，死胎1例，葡萄胎1例，总检出率为1.68%，假阳性15例，占被检人数的1.80%。④结论 以上3种生化指标联合检测可作为产前诊断严重胎儿缺陷的有效方法。