云南省德宏州2010—2011年新报告HIV-1感染者中新近感染比例及其影响因素

采用BED HIV-1捕获酶联法(BED Capture EIA,BED-CEIA)可区别近期感染与既往感染以估算新近感染率。云南省德宏州对2010—2011年新报告HIV感染者进行了BED-CEIA检测研究。     

Art in medical education: Especially plastic surgery

The importance of art studies in the training of plastic surgeons has not been well recognized. Presently, very few medical schools offer courses on art or include it in the humanities. Because the study of art is a great experience that helps to develop the trained eye, the inclusion of art in medical education is recommended. For plastic and aesthetic surgeons, art knowledge can greatly add to the development of surgical skill. Courses in drawing, modeling, and casting are recommended along with lectures or seminars on art appreciation.Delivered as the Nojarova Lecture at the New York Academy of Medicine, the New York Regional Society of Plastic and Reconstructive Surgery, March 3, 1990. Also given at the Italian-American Conference of Plastic Surgeons, Venice, Italy, September 23, 1990     

Asn540Lys mutation in fibroblast growth factor receptor 3 and phenotype in hypochondroplasia

Hypochondroplasia is characterized by a disproportionate short stature with rhizomelic shortening of the limbs. Amino acid substitutions Asn540Lys, Asn540Thr and Ile538Val in the fibroblast growth factor receptor 3 (FGFR3) are considered to cause hypochondroplasia. In this study we examined the FGFR3 gene for the previously described hypochondroplasia mutations and the phenotype of 23 probands with clinically and radiologically diagnosed hypochondroplasia. For the phenotype comparison, the patients were divided into two groups: Group 1: hypochondroplasia with Asn540Lys substitution; Group 2: hypochondroplasia with no mutations identified so far. A three-generation family negative for the known hypochondroplasia mutations was examined with polymorphic markers flanking the FGFR1, FGFR2 and FGFR3 genes. Nine (39%) of 23 probands were found to be heterozygous for the Asn540Lys substitution. The individuals positive for the Asn540Lys substitution were significantly more disproportionate than the individuals without this mutation. In this respect, a genotype-phenotype correlation was found in our patients. However, some individuals belonging to the group without mutations identified so far showed similarly abnormal proportions. Genotyping/haplotyping in the three-generation family with hypochondroplasia showed that FGFR1, FGFR2 and FGFR3 genes were not linked to the hypochondroplasia phenotype in this family, thus further confirming the genetic heterogeneity of hypochondroplasia.

Conclusion: Individuals with hypochondroplasia heterozygous for the Asn540Lys substitution are significantly more disproportionate than individuals without this mutation. Our study further confirms the clinical and genetic heterogeneity of hypochondroplasia.     

川芎-香附不同配比提取物中主要成分含量变化研究

目的比较川芎-香附不同配比提取产物藁本内酯、阿魏酸和α-香附酮含量变化,为药对的药效学和药物代谢动力学研究提供依据。方法分别测定川芎、香附药材及1∶2、1∶1、2∶1比例的川芎-香附药对提取液中指标成分的含量,确定不同比例川芎-香附药对提取液中有效成分与其药对比例变化的相关性。结果川芎-香附药对比例为1∶1时,香附中α-香附酮的溶出度明显增大;川芎-香附药对比例为2∶1时,川芎中藁本内酯溶出度显著增加。结论不同配比的川芎-香附药对在提取过程中有效成分溶出度不同。     

德宏州 驻马店市报告的HIV/AIDS死亡病例的死因调查

目的了解云南省德宏州和河南省驻马店市艾滋病(HIV/AIDS)死亡原因构成。方法 2011年下半年,采用回顾性调查方法,利用定量的"艾滋病死亡原因调查表"获取调查对象相关信息。结果对2010年1月1日-2011年6月30日间云南省德宏州新报告的529死亡病例和河南省驻马店市新报告的631死亡病例进行调查,分别完成523例和627例,死亡病例接受高效抗反转录病毒治疗(HAART)的比例分别为28.7%和67.8%;艾滋病相关死亡病例所占比例分别为65.4%(342/523)和71.0%(445/627),艾滋病无关死亡病例所占比例分别为34.6%(181/523)和29.0%(182/627)。结论德宏州和驻马店市的艾滋病死亡病例的主要死因为艾滋病相关疾病。     

Optimal placebo response rates for comparing two binomial proportions

This paper considers the problem of comparing proportions in clinical trials where two parallel groups are studied. The question of what will happen to the response rate of an active therapy if some external factor affects the placebo rate is asked and two different, but similar, answers are proposed. Assuming either a logistic or probit model has substantial influence on the sample size required to detect differences and optimal comparisons are suggested. The idea is illustrated by a clinical trial of treatment for peptic ulcer and suggestions for other possible applications are presented.     

Crescents proportion no lower than 14% were significantly associated with renal function and outcomes of IgA nephropathy patients

Objective To explore the clinicopathological features and outcomes of IgA nephropathy patients with different proportions of crescents. Methods A total of 270 patients who were diagnosed as IgA nephropathy by renal biopsies from January 2010 to December 2015 in the First Affiliated Hospital of Shenzhen University were enrolled. All patients were divided into 3 groups according to the optimal cutoff level of crescents proportion in the Receiver Operating Characteristic Curve (ROC) as follows: 0%, ＜14%; ≥14%. The endpoint was defined as the doubling of baseline serum creatinine (Scr) and/or end-stage renal disease (ESRD). Kaplan-Meier curve and Cox regression model were used to analyze the renal survival among three groups. Results One hundred and four patients (38.5%) without any crescents; 84 patients (31.1%) with crescents proportion＜14% and 82 patients (31.4%) with crescents proportion ≥14%. Patients with crescents proportion ≥14% group were older and had higher level of systolic blood pressure and diastolic blood pressure, 24-hour urine protein and serum uric acid level; more patients treated with RAS blocker, glucocorticoid and immunotherapy, but lower eGFR, hemoglobin and serum albumin level than those with crescents proportion＜14%. Compared with those without crescents and crescent proportion＜14%, patients with crescent proportion ≥ 14% also had higher proportion of global glomerulosclerosis, more endocapillary hypercellularity and severe tubulointerstitial lesions, higher degree of IgA and C3 depositions in renal. 24-hour proteinuria, serum uric acid level, low hemoglobin level, endocapillary hypercellularity and renal C3 depositions were risk factors for crescents formation. Patients were followed-up for a median of (31.7±21.0) months, and Kaplan-Meier analysis revealed that renal survival rate was significantly lower in patients with crescents proportion ≥14% compared with other groups (P=0.001). But there was no significant difference between no crescent group and crescents proportion＜14% group. However, multivariate Cox analysis showed no significant difference between crescents proportion and renal survival. Conclusion Crescents proportion is associated with higher risk of renal function and renal progression.     

SIMULTANEOUS TESTING STRATEGY FOR COMPARING TWO TREATMENTS IN A STRATIFIED BINOMIAL TRIAL

The Mantel–Haenszel (M–H) procedure is commonly used to compare two treatments in a stratified binomial trial. However, this procedure is asymptotically optimal only if the odds ratio is constant across strata. We propose an alternative analytic strategy based on the simultaneous use of two statistics, Z _S and Z _I, each involving a weighted averaging of within-stratum differences between proportions. The two treatments are declared significantly different at overall level α if either min (|Z_S |, |Z_I |) > Z _α/2 or max (|Z_S |, |Z_I |) > Z _α^*/2, where α^* is data dependent. Our strategy is shown to be more powerful than the M–H and other related procedures. Numerical examples are provided for illustration.     

1998年--2007年住院精神疾病病种构成情况分析

目的分析该院10年病种分布,为精神卫生事业提供参考资料。方法回顾性研究1998年～2007年出院病例资料。结果精神疾病病种构成比较20世纪80年代前发生了明显变化,精神分裂症构成比下降,心境障碍、神经症等构成比上升,但近10年间病种构成比则相对稳定。结论精神卫生专科医院应针对性加强对心境障碍、轻型精神障碍的诊治工作。