平顶山市湛河区一起水痘爆发疫情的调查

目的 通过分析此起水痘爆发疫情的特征及发生原因,指导今后水痘防治工作.方法 对水痘病例进行流行病学调查分析.结果 2008年5月14日至2008年6月15日,平顶山市湛河区曹镇乡褚庄村发生水痘爆发疫情.疫情历时31d,累计发生病例 28例,5月29日为发病高峰,病例数15例,占总病例的53.57%;4岁为高发年龄,发病人数10例,占总病例的35.71％;男女性别比例为 2.1:1.病例集中在村小学及幼儿园,患者均无水痘疫苗免疫史.经采取综合性防治措施,疫情得到有效控制.结论 疫情报告不及时,错过最佳处理时机;免疫接种空白,易感人群积累是引起水痘爆发的主要原因.提高免疫接种率,适时开展水痘强化免疫是控制水痘爆发的主要措施.     

四川某幼儿园水痘爆发流行病学调查分析

目的核实诊断,确定是否爆发,查明病因;描述爆发的分布特征;及时找到应采取的有效措施,以防止本病的蔓延。方法 2008年10月22日到对四川某幼儿园于2008年10月22日至2008年11月17日间发生的水痘疫情进行流行病学现况调查,对资料进行描述性分析。结果有二代病例出现;患儿中男性发病10例,发病率3.68%;女性发病9例,发率3.31%。接种过水痘疫苗组总数为74例,发病数为0例。未接种水痘疫苗组总数为198例,发病数为19例,发病率为9.6%。结论未接种疫苗组的发病率明显高于接种组,广大适龄儿童应尽可能地接种水痘疫苗。     

2010年～2011年上海市水痘监测疫情分析

目的:分析上海市水痘流行特征和趋势,为控制上海市水痘疫情提供流行病学依据。方法:利用描述性流行病学方法对上海市水痘疫情进行分析。结果:上海市2010年和2011年分别报告水痘病例17 784例和19 711例,发病率分别为92.58/10万和85.66/10万,病死率分别为0.005/10万和0.004/10万;发病季节以冬春季为主;男女性别比分别为1.24∶1和1.26∶1;水痘发病率高发年龄分别为5~7岁和5~9岁,学生占报告病例的51.40%。共报告水痘爆发疫情29起,主要发生在学校和托幼机构。结论:儿童为水痘高发人群,应加强托幼机构及学校水痘疫情的监测,及时采取隔离病例、接种水痘疫苗等控制措施,以减少爆发疫情的发生,进一步降低水痘发病率。     

一起学校内水痘爆发的流行病学调查

目的通过对某小学水痘爆发的流行病学调查分析，了解水痘在学校内爆发流行的流行病学规律，为防治工作提供科学依据。方法用描述流行病学方法对茂名市区某小学2006年一起水痘爆发的调查资料进行流行病学分析。结果2006年11月24日～12月6日茂名市区低埒小学发生一起水痘爆发流疫情，共发生病例29例，罹患率2．27％；病例呈明显聚集在学前1班，所有病例均未接种水痘疫苗，并且明显集中在某个预防接种工作最薄弱的居委，该居委儿童持证率仅17．4％，接种水痘接种率仅8．7％。结论儿童水痘疫苗接种率低，免疫空白儿童聚集和传染源的引入是学校内易发生水痘爆发流行的主要因素。     

北京市某寄宿小学水痘突发公共卫生事件分析及防控措施探讨

方法了解北京市某寄宿小学水痘突发公共卫生事件的流行病学特征及防控措施,为有效防控小学水痘突发/暴发疫情提供经验。方法采取现场流行病学调查,对某寄宿小学水痘病例流行病学资料进行分析。结果本次疫情共有15名学生发病,罹患率为4.64%,病例主要集中在8岁以上年龄组,所有病例均有水痘疫苗免疫史,免疫史均超过5年。结论疫苗接种时间较长、人群免疫水平较低是某小学水痘暴发疫情发生的主要原因。建议进一步研究水痘疫苗实际保护效果,适时对小学在校学生实施水痘疫苗第2剂补种,以增强抗体保护性。     

陕西省渭南市华州区某小学水痘暴发疫情的调查分析

目的通过对一起水痘暴发流行因素的调查分析,为学校水痘防控提供借鉴。方法采用描述性流行病学方法研究水痘暴发疫情的基本概况和流行特征。结果楼层两端和楼梯口教室发生水痘病例的几率明显低于夹在两个教室之间的教室(P0.05);一年级学生发病率最高(11.63%),五年级学生的发病率最低(0.76%);暴发病例均有皮疹和散发疱疹,61.76%的病例有发热症状;有水痘疫苗免疫史者发病率为21.52%,无免疫史者发病率为23.08%,差异无统计学意义(P0.05);水痘疫苗保护率为6.76%。结论不同年级之间相互接触、教学区域内通风不良、水痘疫苗保护效率欠佳是疫情暴发的危险因素,学校没有及时按相关要求停课导致了疫情的持续蔓延。     

广州市东山区某小学水痘爆发流行的调查

目的查明广州市东山区某小学水痘爆发流行的原因。方法采用直接和间接询问及现场观察等流行病学个案调查方法。结果全校592名学生中36例水痘病例,患病率为6．1％,病例主要集中在首发病例的班级,共26例,占77．2％。结论免疫空白人群的存在和疫情报告不及时是导致该起水痘爆发流行的主要原因。     

麻疹疫苗效力与接种率及其影响因素的调查研究

目的 了解学龄儿童麻疹疫苗效力和接种率及其影响因素,为采取措施控制学龄儿童麻疹暴发提供依据.方法 采用病例对照方法在确诊的暴发病例中,选6～15岁、接种史明确的学生为病例组,共170例,与其性别相同、年龄相近、同班或邻居、接种史明确而又未患过麻疹的学生为对照,共345名.结果 学龄儿童中1剂次麻疹疫苗效力估计为75%,2剂次麻疹疫苗效力估计为83%,≥1剂次麻疹疫苗效力估计值为77%.1剂次麻疹疫苗估计接种率为77.64%,2剂次麻疹疫苗接种率为41%,≥1剂次麻疹疫苗估计接种率为85%.多因素分析显示儿童年龄、母亲职业、文化程度、居住地等是影响学龄儿童麻疹疫苗接种率的主要因素.结论 学龄儿童中较低的麻疹疫苗效力和2剂次麻疹疫苗接种率是麻疹暴发的主要原因.提高2剂次麻疹疫苗接种率是预防麻疹暴发的关键.加强健康教育,提高儿童及其父母对该病的重视程度是提高麻疹疫苗接种率的关键.     

深圳某小学水痘聚集性疫情的流行病学调查

目的 调查分析一起水痘爆发疫情的原因和特点,为集体单位水痘疫情控制总结经验和提供参考依据.方法 自行设计水痘危险因素调查表,通过现场调查和电话访问等方法描述本次爆发的流行病学特征,通过回顾性队列研究探讨疫情发生的风险因素.结果 此次聚集性疫情共发病10例,全部发生在该学校的小学部二(4)班,班级罹患率为20.8％.病例分布在该班级的6个组中,对6个组进行组间发病聚集性的二项分布拟合检验,表明发病有组间聚集性(合并x2 =9.88,P＜0.05).相对于既不乘车也不午休的人群,午休且乘坐校车人群水痘罹患率最高,RR值为8.6(95％ Cl:1.2 ～63.6).接种水痘疫苗人群发病率低于未接种疫苗人群(P=0.042),疫苗保护率为74.1％.结论 这是一起发生在深圳市某学校的水痘聚集性疫情,主要危险因素为校内午餐、午休和乘坐校车等综合因素导致水痘在该学校小学部二(4)班扩散传播.     

水痘疫苗不同免疫策略的卫生经济学评价

目的: 比较水痘疫苗不同免疫策略的成本和效益。方法: 通过问卷调查的形式获取浙江省因罹患水痘导致的直接和间接经济负担;结合浙江省水痘流行特征数据,应用Matlab软件建立浙江省水痘传播动力学模型,预测从2017年开始后续40年（2017-2056年）采用水痘疫苗不同免疫策略（不接种疫苗、接种一剂、接种两剂）时水痘病例发生情况;以不接种疫苗策略为对照,计算效益-成本比,并对设定的主要参数进行敏感性分析。结果: 完成浙江省105例水痘病例调查,人均直接和间接经济负担分别为506.84元和1045.39元,合计1552.23元。40年间,接种一剂疫苗累计发生709.08万例水痘病例,比不接种疫苗（1759.89万例）减少了59.71%;疫苗接种费用总投入为23.66亿元,所获得的总收益为337.41亿元,效益-成本比为14.26：1。若接种两剂疫苗,40年累计发生272.49万例水痘病例,比不接种疫苗减少了84.52%;总投入和总收益分别为44.95亿元和443.09亿元,效益-成本比为9.86：1。敏感性分析结果显示,无论接种一剂还是接种两剂,疫苗价格均最为敏感,其次为无疫苗状态下的水痘发病率。结论: 浙江省将水痘疫苗纳入免疫规划符合经济性原则,建议将接种一剂甚至两剂全程纳入免疫规划。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.