乳腺癌患者的流行病学特点及中医证型分布的临床研究

目的：从流行病学特点及中医辨证分型分布探索预防和治疗乳腺癌的新思路。方法：通过回顾性调查分析,收集457例乳腺癌住院患者的流行病学基本信息、病理类型和中医辨证分型等情况,分析乳腺癌患者流行病学特点,以及病理类型与中医证型相关性。结果：纳入病例均为女性,≥45周岁的患者358例(78.34%)；产次>1次的患者274例(59.96%),引流产次>1次的患者324例(70.90%)；有吸烟史的患者30例(6.56%),有饮酒史的患者19例(4.16%)；无家族肿瘤疾病史的患者415例(90.81%)。病理类型中浸润性癌(303例)占比最大,中医证型中肝郁痰凝证(246例)、冲任失调证(128例)例数较多。病理类型与中医证型相关性结果显示早期浸润癌与肝郁痰凝证呈正相关(P<0.05),浸润性癌与肝郁痰凝证、冲任失调证呈正相关(P<0.05)。结论:乳腺癌患者中医证型多为肝郁痰凝证、冲任失调证,早期浸润癌与肝郁痰凝证,浸润性癌与肝郁痰凝证、冲任失调证具有明显相关性,该结果为中医“治未病”理论预防和治疗乳腺癌提供了新思路与新方法。     

Compliance with temperature and time requirements during in-hospital distribution of blood components: A national survey among transfusion services

IntroductionTemperature and time conditions during storage and distribution of blood components (BC) and their permissible deviations are strictly regulated. The degree of compliance with these requirements in daily practice of transfusion services (TS) is not well known.Materials and methodsWe conducted a survey among Spanish hospital TS covering different aspects of BC management in their daily activity.ResultsEighty-three TS managing 56 % of total transfusions answered the survey. Monitoring of red blood concentrates (RBC) temperature during in-hospital distribution was routinely performed by only 12 % of the TS. The main criterion for BC re-entry into the stock was the total time spent outside controlled temperature. Up to 41 % of the TS apply the “30-minute rule” to distributed RBC, while most services use a 60-minute rule for PC. No adverse events were detected when RBC that had remained longer than 30 or 60 min outside the TS were transfused. Fresh frozen plasma is usually thawed 2 h preissue and stored at 4 °C up to 24 h.Discussion and conclusionsIn the Spanish context, the 30- and 60-minute rules for re-entry of RBC and PC into the TS stock are loosely followed. Feedback for a large number of TS suggests that the extension of the 30-minute RBC rule to at least 60 min is feasible, if other safety requirements are met. Flexibility with some requirements could help reduce product loss without deleterious effect on BC safety.     

Subtype Distribution,Clinical Features,and Survival in B-cell Chronic Lymphoproliferative Disorders in China: A Review of 1592 Cases

BackgroundB-cell chronic lymphoproliferative disorders (B-CLPDs) are characterized by the sustained accumulation of monoclonal B cells. Limited studies have systematically described the clinical features and outcomes of the whole patient group, especially in Eastern populations.Patients and MethodsA total of 1592 patients with newly diagnosed B-CLPD were enrolled. Chronic lymphocytic leukemia (CLL) accounted for 39%, and Waldenström macroglobulinemia (WM), leukemic marginal zone lymphoma, follicular lymphoma (FL), and mantle cell lymphoma (MCL) constituted 13%, 13%, 9%, and 8% of cases, respectively.ResultsThe median age at diagnosis was 58 years, and the male/female ratio was 1.8:1. The 17p and 11q deletions were most common in MCL (36% and 17%, respectively), and 13q deletion and trisomy 12 were most frequent in CLL (35% and 21%, respectively). Patients with leukemic MCL had significantly worse survival than that of patients with other disease entities, with a 3-year overall survival (OS) of 58%, followed by 68.2% for WM/lymphoplasmacytic lymphoma. Those with CLL, leukemic marginal zone lymphoma, and FL had relatively favorable outcomes, with a 5-year OS > 80%. The survival of patients with B-CLPDs has improved over time with the emergence of novel drugs (3-year OS improvement from 82.1% to 92.2%). The improvement in survival mainly resulted from improvement among patients with MCL, WM/lymphoplasmacytic lymphoma, and FL. On multivariate analysis, only hemoglobin, lactate dehydrogenase, and 17p deletion were independently associated with survival (hazard ratio, 1.6, 2.0, and 3.1, respectively).ConclusionsComprehensive analysis of the clinical characteristics, immunophenotypic profiles, and cytogenetic features can be helpful in the differential diagnosis, especially for patients without a non–bone marrow biopsy specimen available. Universal prognostic factors could help with the early detection of high-risk patients and stratification for risk-adapted therapy.     

Local abundance of Ixodes scapularis in forests: Effects of environmental moisture,vegetation characteristics,and host abundance

Ixodes scapularis is the primary vector of Lyme disease spirochetes in eastern and central North America, and local densities of this tick can affect human disease risk. We sampled larvae and nymphs from sites in Massachusetts and Wisconsin, USA, using flag/drag devices and by collecting ticks from hosts, and measured environmental variables to evaluate the environmental factors that affect local distribution and abundance of I. scapularis. Our sites were all forested areas with known I. scapularis populations. Environmental variables included those associated with weather (e.g., temperature and relative humidity), vegetation characteristics (at canopy, shrub, and ground levels), and host abundance (small and medium-sized mammals and reptiles). The numbers of larvae on animals at a given site and season showed a logarithmic relationship to the numbers in flag/drag samples, suggesting limitation in the numbers on host animals. The numbers of nymphs on animals showed no relationship to the numbers in flag/drag samples. These results suggest that only a small proportion of larvae and nymphs found hosts because in neither stage did the numbers of host-seeking ticks decline with increased numbers on hosts. Canopy cover was predictive of larval and nymphal numbers in flag/drag samples, but not of numbers on hosts. Numbers of small and medium-sized mammal hosts the previous year were generally not predictive of the current year’s tick numbers, except that mouse abundance predicted log numbers of nymphs on all hosts the following year. Some measures of larval abundance were predictive of nymphal numbers the following year. The mean number of larvae per mouse was well predicted by measures of overall larval abundance (based on flag/drag samples and samples from all hosts), and some environmental factors contributed significantly to the model. In contrast, the mean numbers of nymphs per mouse were not well predicted by environmental variables, only by overall nymphal abundance on hosts. Therefore, larvae respond differently than nymphs to environmental factors. Furthermore, flag/drag samples provide different information about nymphal numbers than do samples from hosts. Flag/drag samples can provide information about human risk of acquiring nymph-borne pathogens because they provide information on the densities of ticks that might encounter humans, but to understand the epizootiology of tick-borne agents both flag/drag and host infestation data are needed.     

Deriving reference values for nerve conduction studies from existing data using mixture model clustering

Objective: to obtain locally valid reference values (RVs) from existing nerve conduction study (NCS) data.Methods: we used age, sex, height and limb temperature-based mixture model clustering (MMC) to identify normal and abnormal measurements on NCS data from two university hospitals. We compared MMC-derived RVs to published data; examined the effect of using different variables; validated MMC-derived RVs using independent data from 26 healthy control subjects and investigated their clinical applicability for the diagnosis of polyneuropathy.Results: MMC-derived RVs were similar to published RVs. Clustering can be achieved using only sex and age as variables. MMC is likely to yield reliable results with fewer abnormal than normal measurements and when the total number of measurements is at least 300. Measurements from healthy controls fell within the 95% MMC-derived prediction interval in 97.4% of cases.Conclusions: MMC can be used to obtain RVs from existing data, providing a locally valid, accurate reflection of the (ab)normality of an NCS result.Significance: MMC can be used to generate locally valid RVs for any test for which sufficient data are available.¹     

749例社区获得性肺炎儿童的病原体分布特点

【摘要】目的 探讨南充地区儿童社区获得性肺炎（CAP）的病原学分布特点。方法 选取2017 年 1 月～12 月于南充市中心医院儿科病房住院的749例CAP患儿，根据年龄分为婴儿组(319例)、幼儿组(217例)、学龄前组(154例)、学龄组(59例)，回顾性分析患儿咽深部呼吸道分泌物的细菌培养和呼吸道 11 种病原体IgM抗体血清学检测结果。结果 749例患儿中,310例检出细菌阳性,阳性率41.39%，其中肺炎链球菌82株(26.45%)，大肠埃希菌63株(20.32%)，流感嗜血杆菌39株(12.58%)； 220例检出病毒阳性,阳性率为29.37%，其中IVB208株(65.00%)，IVA41株(12.81%)，PIV39株(12.19%)；102例检出非典型肺炎病原阳性，阳性率13.62%，其中MP74株(62.18%)，CP30株(25.21%)，LP15株(12.60%)；混合病原体检出阳性者有177例，阳性率15.62%，其中细菌、病毒混合感染60例(33.90%)，细菌、非典型肺炎病原体混合感染56例(31.64%)，病毒混合感染30例(16.95%)。结论 肺炎链球菌是南充地区CAP住院患儿的首要细菌病原，IVB是首要病毒病原，MP是首要非典型肺炎病原，混合感染以细菌、病毒混合感染为主。     

基于18SrRNA序列的云南大叶千斤拔与细叶千斤拔根内丛枝菌根真菌鉴定

目的:调查云南省大叶千斤拔(Flemingia macrophylla)与细叶千斤拔(Flemingia lineata)根内丛枝菌根真菌(Arbuscular Mycorrhizal Fungi,AMF)群落结构多样性。方法:使用巢式-PCR、克隆、限制性片段长度多态性(Restriction Fragment Length Polymorphism,RFLP)分析及测序技术。结果:共获得558个含有丛枝菌根真菌18S rRNA片段的克隆子,经RFLP分析后得到83个RFLP类型,DNA序列分析可将其划分为23个可操作分类单元(Operational Taxonomic Units,OTUs),分属于5个科,Glomeraceae为优势类群。在MaarjAM数据库中进行比对后,23个OTUs可鉴定为18个虚拟分类分子种,分布于13种不同的生境。经统计分析大叶千斤拔与细叶千斤拔根内丛枝菌根真菌群落组成比较,差异有统计学意义(P<0.001)。结论:比较大叶千斤拔与细叶千斤拔根内丛枝菌根真菌群落差异,结合丛枝菌根真菌在生态系统中的分布特点,为种植千斤拔属植物的选址提供有力地环境指标数据,并为筛选促生菌株提供依据。     

中国产8种甘草的理论分类及亲缘关系的理论判别

目的:根据广义生物遗传与变异信息理论方程推导的2个生物相似度常数P_(g1)=69%,P_(g2)=61%及生物亲缘关系判别函数P_g=1/lnN_d对中国产8种甘草进行理论分类及亲缘关系判别,并提出了生物的理论品种概念。方法:基于8种甘草所含有的59种代表性黄酮类化合物,计算各种甘草之间的共有成分率及变异成分率,采用2个常数及判别函数确定各自的特征序列,根据特征序列进行分类。结果:8种甘草可以分为3类,且8种甘草之间具有紧密的亲缘关系。根据59种特征黄酮类化学成分,可以给出比经典分类结果更精细确定的分类结果,可将严格的理论分类定义为理论品种。结论:广义生物遗传与变异信息理论方程结合植物的多种化学成分,可以对生物进行绝对的理论分类及亲缘关系判别,实现基于数理原理,而不是经验知识的准确科学生物分类,提出了判别生物亲缘关系的理论标准,为确定具有相似功效的中药材提供严谨的科学依据。     

基于文献的失眠症中医证候和证素分布规律研究

目的基于文献研究,探讨失眠症的中医证候要素分布规律。方法通过检索中国知网数据库(CNKI)、万方数据库、维普全文期刊数据库2009年1月至2018年12月中医药期刊文献所报道的治疗失眠症相关文献,收集统计失眠症中医证候并提取证素信息,利用SPSS 23.0软件进行统计描述分析。结果(1)共检出文献653篇,符合要求317篇,整理后规范证名得到44种中医证候,其中以心脾两虚证、痰热内扰证、肝郁化火证、阴虚火旺证、心肾不交证等频次较高。(2)证素组合规律中以两证素、三证素、四证素组合为主。(3)在单一病性证素中以热(火)、气虚、血虚、阴虚等频次较高;病位证素以肝、心、脾、肾等频次较高。(4)在证素组合时以热(火)+肝、气虚+血虚+心+脾、热(火)+痰、热(火)+阴虚等频次较高。结论失眠症的主要病理因素以热(火)、气虚、血虚、阴虚为主,病位主要以肝、心、脾、肾为主。