胰岛细胞瘤体素内不相干运动参数与CT灌注参数的相关性

目的 评估胰岛素瘤体素内不相干运动(IVIM)相关参数和CT灌注参数及病理学分级的相关性。方法 前瞻性收集北京协和医院怀疑胰岛素瘤且行IVIM和CT灌注扫描的患者共55例,对图像进行后处理得到IVIM相关参数[包括表观扩散系数(ADC)、真实扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)]和CT灌注参数[包括血流量(BF)、血容量(BV)和渗透性(PM)]。对术后病理标本进行染色获得病理学指标(包括分级、ki-67指数和核分裂相)。比较正常胰腺不同解剖部位及正常胰腺与胰岛素瘤的IVIM相关参数差异。分析IVIM参数与CT灌注参数及病理学指标的相关性。结果 胰尾ADC值及D值均明显减低,差异有统计学意义(P均<0.001)。胰岛素瘤及正常胰腺的所有IVIM参数差异均有统计学意义(P均<0.001)。正常胰腺的ADC值、f值与BF呈正相关(r=0.437,P=0.003;r=0.357,P=0.010),余IVIM相关参数与CT灌注参数均无相关性(P均>0.05)。IVIM参数与胰岛素瘤病理学分级指标间均无相关性(P均>0.05)。结论 正常胰腺的不同解剖部位的IVIM参数有差异,IVIM参数可区分正常胰腺实质及胰岛素瘤。ADC值与CT灌注参数BF具有相关性,但相关性较弱。     

Comparison of Undernutrition Prevalence of Children under 5 Years in China between 2002 and 2013

Objective To describe the undernutrition status of children under 5-year in China, and study the trend between 2002 and 2013. Methods The study was based on two national surveys. Undernutrition wasdetermined against WHOs 2006 growth standards.The prevalence in 2013 and 2002 was weighted by China sixth National Population Census (2010). The relationship between undernutrition and gender/age groups/different areas use weighted logistic regression. Results The results indicated the overall prevalence of stunting, underweight, and wasting of Chinese children under 5-year was 8.1%, 2.4%, and 1.9% in 2013, respectively. The prevalence of stunting was higher for children aged 12-47 month, while underweight was higher for children aged 48-59 month. The prevalence of undernutrition was higher in rural areas than in urban areas, especially in poor rural areas. There was a decline of stunting, underweight, and wastingbetween 2002 and 2013 among the children, with greater reduction in rural areas than in urban areas. Conclusion The prevalence of undernutrition of children under 5-year remains high in rural areas especially in poor rural areas in China. It is urgent totake action to control undernutrition in the vulnerable areas and subgroups.     

人参皂苷和丹参注射液对犬食管大剂量辐射损伤的影响

目的:研究人参皂苷和丹参注射液对对一次性大剂量高能电子线照射的犬食管的辐射保护作用,寻找高效低毒的正常组织辐射保护剂。方法:选择12只健康杂种犬,随机分为3组,每组4只,全麻状态下实施开胸手术,并给予高能电子线20 GY局部一次性照射肺门。药物治疗组开胸照射前分别给予人参皂苷腹腔内注射(25mg/kg体重)及丹参注射液静脉注射(0.5mL/kg体重)。照射前、照射后3天、1周及2周测定外周血循环内皮细胞数量,进行硬质食管内窥镜观察食管黏膜改变并活检,同时用激光多普勒血流仪(LDF)测定食管黏膜微血流。术后第15天处死犬,对照射段食管进行常规光镜及电镜检查。结果:单纯开胸照射犬:体重,术前(17.4±0.7)kg,术后(14.4±0.7)kg;LDF值,术前52.4±11.1,术后3天64.9±11.2,术后2周43.8±9.1,CEC,术前0～1,术后2周10±1.83,血管染色,黏膜下微血管10μm,周围散在红细胞,血管染色深。光镜检查发现黏膜糜烂、充血、部分脱失。电镜下细胞器肿胀明显,线粒体空泡化,内质网脱颗粒。人参皂苷组犬,体重,术前(17.3±0.8)kg,术后(18.4±0.6)kg LDF值,术前50.1±10.5,术后3天45.6±5.7,术后2周47.4±7.4;CEC计数,术前0.25±0.5,术后2周3±0.96;黏膜下微血管管径,术前4～6μm,术后8μm,光镜下细胞结构改变轻微,电镜检查发现内皮细胞细胞器改变,但较对照组明显减轻。丹参组犬,上达各项指标与对照组相似。结论:提前给予人参皂苷能够减轻大剂量高能电子线辐射对犬食管的损伤,丹参注射液未观察到相似作用。     

An analysis of antiretroviral therapy outcomes in the Medecins Sans Frontieres/Guangxi Center for Disease Control and Prevention HIV/AIDS project

OBJECTIVE: To evaluate the 3-year outcomes of the Medecins Sans Frontieres/Guangxi Center for Disease Control and Prevention comprehensive and free of charge HIV/AIDS treatment and care project. METHODS: We present a detailed retrospective analysis of treatment outcomes of 432 cases who received highly active antiretroviral therapy (HAART) from December 2003 to December 2006. RESULTS: Among the adult patients who received HAART, the mortality rate was 6.5% and only 12 (2.8%) patients were lost to follow up. The mean CD4+ T cell count increase was 147 cells/microl and 246 cells/microl for patients receiving HAART for 9-15 and 21-27 months respectively. An adherence assessment conducted during March to December 2006 indicated that 95.9% of the study cases reached an adherence of 95% or more of the prescribed medications. Among the 30 children patients who received HAART, 4 (13.3%) cases died and the mean CD4+ T cell increase after 9-15 and 21-27 months of HAART was 673 cells/microl and 658 cells/microl respectively. 148 of the adult patients starting HAART were current or ex-intravenous drug users (IDU) and showed global death rate and lost to follow-up rate comparable to those of non-IDU patients (Log rank test, P = 0.91). CONCLUSIONS: Good mid-term therapeutic outcomes with combination antiretroviral therapy have been achieved in this project. Total free of charge care and treatment and intensive patient support/ counseling are crucial to program success.     

贫困农村地区0~3岁留守儿童心理行为发育影响因素研究

目的 分析农村0~3岁留守儿童心理行为发育异常的影响因素,为促进儿童早期发展提供基础依据。方法 利用2016年原国家卫生计生委“贫困地区农村留守儿童健康教育项目”定量调查数据中3岁以下儿童信息进行分析,调查了全国12个省27个贫困县3 249例0~3岁留守儿童样本。儿童心理行为发育的测量采用“儿童心理行为发育预警征象筛查问卷”,影响因素通过自编的调查问卷获得。结果 农村留守儿童整体可疑心理行为发育异常检出率为9.48%,其中男生(10.94%)显著高于女生(7.75%),0~18个月儿童(12.20%)显著高于19~36个月儿童(8.1%);留守儿童家庭存在看护人年龄偏大、学历普遍偏低的情况,亲子分离情况仍十分严峻;Logistic 回归分析显示,亲子互动良好(OR=0.604,95%CI:0.417~0.876,P=0.008),与兄弟姐妹一起生活(OR=0.664,95%CI:0.473~0.932,P=0.018),较高的家庭经济水平(OR=0.609,95%CI:0.414~0.897,P=0.012)和每日互动时间＞30 min(OR=0.467,95%CI:0.230~0.948,P=0.035)是儿童心理行为发育的保护因素。从未母乳喂养(OR=2.071,95%CI:1.334~3.216,P=0.001)、纯母乳喂养时间＞8个月(OR=1.793,95%CI:1.089~2.952,P=0.022)、存在照顾不周现象(OR=1.833,95%CI:1.047~3.211,P=0.034)是儿童心理行为发育的危险因素。结论 农村0~3岁留守儿童在养育环境上存在劣势,影响心理行为发育因素较多,应针对性加大关注和干预力度     

HIV感染者晚发现的影响因素研究进展

目前，HIV感染者晚发现情况不容乐观，对HIV抗病毒治疗的效果、成本和预后以及HIV传播有重大影响，是评估HIV检测工作的重要指标。本文对HIV感染者晚发现的影响因素进行综述，为制定和改善我国HIV检测策略和措施提供参考。     

男男性行为者安全套使用及影响因素分析

目的 了解男男性行为者(men who have sex with men,MSM)安全套使用状况,并分析影响因素.方法 通过MSM同伴招募调查对象,在MSM活动场所进行安全套使用等相关因素的匿名现场问卷调查.结果 共调查400人,最近1次、近6个月不同性伴肛交/阴道交安全套使用率差异均有统计学意义(分别有x2=21.82,P＜0.001和x2=28.26,P＜0.001),男性、男男卖性使用率较高(73.8％、66.7％,45.5％、46.2％),男男买性、女性使用率较低(47.1％、47.9％,29.4％、30.1％).单因素分析显示,不同年龄、近6个月男男肛交数,近1年是否做过HIV检测并知道结果、接受润滑剂免费发放、接受过同伴教育,艾滋病知识是否来源于咨询服务、宣传材料发放,是否知道性伴从不用安全套、是否知道性伴健康状况,不同场所寻找性伴这10个方面近6个月男男肛交安全套坚持使用率差异有统计学意义(x2=4.043、9.850、6.663、7.525、5.213、4.208、10.042、4.121、12.319、8.456,均有P＜0.05).多因素非条件Logistic回归分析中,最终进入回归模型的有年龄、做过HIV检测并知道结果、艾滋病知识来源于宣传材料发放、不知道性伴健康状况、寻找性伴的场所,近1年做过HIV检测并知道结果(OR=0.074)、艾滋病知识来源于宣传材料发放( OR=0.409)、以酒吧/歌舞厅/会所(OR=10.495)、浴室/公园/公厕(OR =36.601)、互联网(OR=10.807)为主要性伴寻找场所者近6个月男男肛交安全套坚持使用率较高,年龄≥35岁(OR=0.330)、不知道性伴健康状况(OR =0.892)安全套坚持使用率较低.结论 MSM人群安全套使用较低,受年龄、预防性服务、健康意识等多种因素影响,应针对性加大行为干预力度.     

中国基本药物改革：为实现最佳健康产出的选择

2009年4月,中国政府发布了《关于深化医药卫生体制改革的意见》,提出到2020年实现全民享有基本医疗卫生服务的目标。改革的重点任务之一是建立基本药物制度。在全球范围内,基本药物这一概念自1975年首次被世界卫生大会提出以来,一直具有非常重要盼意义。这一概念最初强调药物的可及性和基本药物目录。但随时间推移,这一概念的内涵逐渐演变。现在各国引入基本药物概念,主要是为了确保药物可及性与可支付性、合理用药以及药物的质量和安全性。瑞典、挪威以及经合组织国家的经验表明,基本药物的概念可灵活适用于多种情形。在中国,基本药物制度的改革已取得良好成果,在非常短的时间内使公众更多获益,继续贯彻基本药物制度将有利于在中国实现最佳健康产出。     

Burden of diabetes,hyperglycaemia in China from to 2016: Findings from the 1990 to 2016, global burden of disease study

AimsThe prevalence of diabetes in China is among the highest in the world. For this reason, findings from the 2016 Global Burden of Disease (GBD) study were used to calculate the burden of hyperglycaemia and diabetes in China.MethodsFollowing the general analytical strategy used in GBD 2016, diabetes prevalence and mortality were analyzed by age and gender. Trends in disability-adjusted life years (DALYs) due to diabetes were assessed in 33 province-level administrative units from 1990 to 2016, and similar data were provided for chronic kidney disease (CKD) related to diabetes and, as an overall summarizing measure, for hyperglycaemia expressed as high fasting plasma glucose (HFPG).ResultsFrom 1990 to 2016, all-age prevalence of diabetes rose from 3.7% to 6.6%, and all-age diabetes and diabetes-related CKD mortality rates increased by 63.5% and 33.3%, respectively, with both rates increasing more rapidly in diabetes patients aged 15–49 years than in any other age groups. In 2016, HFPG became China's sixth leading cause of DALYs, and the attributable DALYs burden was 1802.3/100,000 population. Although the number of diabetes DALYs increased by 95% from 1990 to 2016, age-standardized diabetes DALYs rates increased by only 2.3%. Also, from 1990 to 2016, rates of age-standardized DALYs due to diabetes decreased in 14 provinces, but increased in 19 provinces. High BMI Scores and diets low in whole grains, nuts and seeds were the most important risk factors for diabetes in 2016.ConclusionDiabetes and hyperglycaemia constitute a huge health burden in China. The substantial increase in diabetes-related burden represents an ongoing challenge, given the rapidly ageing Chinese population. Thus, a targeted control and preventative strategy needs to be developed at risk factor level to reduce this burden.