1995~2015年南京市疟疾疫情分析

目的  分析南京市1995年以来疟疾疫情的变化情况,为疟疾防控对策的制定提供科学依据。 方法  通过疫情监测报告、个案调查、发热病人血检等,对1995~2015年的本地病例和输入性病例进行统计分析。 结果  1995~2015年南京市共报告疟疾确诊病例905例。其中本地疟疾病例为407例,输入性疟疾病例498例;全部疟疾病例中,间日疟占85.6%（774/905）,恶性疟占13.4%（121/905）,其他占1.00%（9/905）。各型疟疾均有境外输入性病例,恶性疟全部为境外输入,且2007年后恶性疟病例数呈逐渐增加趋势,2007~2015年的恶性疟病例占该型疟疾病例总数的95.0%（115/121）。实验室血检发热病人898 035人,本地人口血检阳性率0.038%,流动人口血检阳性率为0.692%,两者差异有统计学意义（χ2=2 907.7,P<0.01）;媒介调查共捕获按蚊10 982只,中华按蚊为10 716只,占97.6%（10 716/10 982）,嗜人按蚊221只,占2.0%（221/10 982）。嗜人按蚊自2003年后均未捕获。 结论  南京市境外输入性疟疾逐年增多,应加强对境外输入性疟疾的监测,提高各医疗机构的镜检能力,确保输入性疟疾病例能及时诊治。     

2004-2017年镇江市疟疾疫情分析

目的 分析2004-2017年镇江市疟疾疫情及流行特征,为制定合理的疟疾防控策略和措施提供科学依据。方法 收集2004-2017年镇江市疟疾疫情资料,采用描述性流行病学方法对疟疾疫情、流行特征、病例类型及发热病人血检情况进行分析。结果 2004-2017年镇江市共报告疟疾病例182例,其中间日疟123例（67.58%）,恶性疟55例（30.22%）;本地感染病例41例（22.53%）,国内输入性病例66例（36.26%）,境外输入性病例75例（41.21%）。182例疟疾病例主要为男性（133例）;年龄集中在20～50岁,占59.89%;职业以农民和工人为主,分别占24.73%（45/182）和24.18%（44/182）;发病高峰集中在每年7-9月。2004-2017年镇江市血检发热病人258 879人,本地人口血检阳性率为0.007%,流动人口血检阳性率为0.724%,两者差异有统计学意义（P＜0.01）。结论 镇江市自2011年起已无本地感染疟疾病例报告,境外输入性疟疾防控已成为本市疟疾防控的重点。     

1980-2012年韶关市疟疾流行病学特征分析

目的总结分析广东省韶关市1980-2012年疟疾流行特点,为韶关市2014年消除疟疾提供参考依据。方法采用描述性流行病学方法,对韶关市1980-2012年疟疾防治总结和中国疾病预防控制中心疾病监测信息报告管理系统的疟疾疫情报告进行分析。结果 1980-2012年韶关市累计共报告疟疾病例3 094例,其中,间日疟3 041例,输入性恶性疟4例,未分型49例;年平均报告疟疾病例94例,年平均疟疾发病率2.78/10万。其中1982年报告疟疾发病最多为651例,年发病率最高为14.13/10万;2006-2011年仅2008年报告1例疟疾病例,其余5年均没有病例报告。1980-2012年,5-11月份报告疟疾病例2 625例,占总病例数的84.84%(2 625/3 094)。男女性别比为4.34∶1。在报告疟疾病例3 094例中,发病年龄主要集中在20~45岁年龄组,共报告疟疾病例2 486例,占总病例数的80.34%。1980-2012年,全市共血检475 337人次,检出疟原虫阳性2 127例次,平均阳性率为0.45%。1980-1994年,居民原虫率调查,共血检31 139人次,检出阳性474例次,阳性率1.52%。结论韶关市1980-2012年疟疾发病逐年下降,20~45岁年龄组是疟疾的好发年龄组;近几年疟疾病例均为输入性病例,疫情平稳。     

004-2015年丹阳市疟疾流行特征分析

目的 分析2004-2015年丹阳市疟疾流行特征,为科学制定防治策略提供依据。方法 收集2004-2015年丹阳市疟疾血检统计数据、传染病报告信息管理系统上报的疟疾病例与流行病学个案调查表,以及2008-2015年蚊媒监测数据等,进行统计分析。结果 2004-2015年丹阳市累计报告疟疾病例58例,年平均发病率为0.60/10万。其中间日疟占65.52%（38/58）,恶性疟占5.17%（3/58）,卵形疟占1.72%（1/58）,未分型占27.59%（16/58）。本地感染病例占31.03%（18/58）,输入性病例占68.97%（40/58）;2011年起无本地感染病例发生。中华按蚊作为丹阳市唯一的疟疾传播媒介在境内仍普遍存在,但密度较低。结论 输入性疟疾严重威胁丹阳市消除疟疾成果,需加强输入性疟疾疫情的监测和处置。     

2012-2013年扬州市输入性疟疾防治管理效果评估

的 评估扬州市输入性疟疾防治管理效果,为制定输入性疟疾防控策略提供参考依据。方法 统计2012-2013年扬州市劳务输出及回国发热人员疟原虫血检率、疟疾病例中实验室确诊病例比例、恶性疟病例发病24 h内得到规范治疗的比例以及劳务输出信息平台建立情况等,对扬州市输入性疟疾防治管理效果进行综合分析评价。结果 2012-2013年扬州市共报告输入性疟疾82例。全市7个县（市、区）均开展了劳务输出及回归人员监测,覆盖率为100%。2012-2013年共有劳务输出人员5 808人次,其中接受医学提醒5 575人次,服务覆盖率达95.99%;5 808名劳务输出人员中有5 525人接受健康行为,健康行为养成率达95.13%。对全市153个镜检站以及医疗、疾控专业人员进行疟疾镜检培训,两年累计达410人,培训覆盖率达100%。82例输入性疟疾病人从发病到初诊时间平均为2.5 d,从发病到确诊时间平均为2.75 d;所有病人均治愈出院,救治康复率为100%;初诊血检78人,初诊血检率为95.12%。78例初检血检均检出疟原虫,血检确诊率为100%;69例恶性疟报告病例均得到实验室确诊。69例恶性疟病例在初诊后24 h内得到规范治疗的有58例,占84.06%。结论 扬州市输入性疟疾防治管理效果明显,但仍需加强对劳务输出人员的健康教育以及对医务人员的培训,以进一步防控输入性恶性疟。     

1995～2004年广西疟疾监测措施与防治效果

目的分析广西壮族自治区1995~2004年疟疾监测结果,评价监测措施,为制定疟疾防治对策提供科学依据。方法收集1995~2004年广西区92个县(市)当地居民发热病人、病灶点居民和流动人口监测资料进行描述和分析。结果10年间全区92个县(市)共血检当地发热病人1092万人次,病灶点居民42.7万人次,外出回归人群24.6万人次,外来人群25.4万人次,4类人群血检阳性率分别为0.009%、0.079%、1.386%和0.324%,共检出疟疾病例5517例,本地感染病例占总病例的23.29%(1285/5517),输入性病例占76.71%(4232/5517)。结论广西区连续17年疟疾发病率控制在1/万以下,当地感染病例少,输入性疟疾病例多、分布面广、高度分散,但输入继发病例发生率较低,现行疟疾监测与防治措施能有效监控疟疾流行动态。     

1995～2009年黔桂两省灭疟联防区24县疟疾疫情分析

目的了解黔桂两省灭疟联防区24个县1995～2009年疟疾疫情。方法收集、整理和分析两省24个县当地居民和流动人口疟疾病例资料。结果该区域1995～2009年共报告疟疾病例10711例,其中血检阳性病例8156例,临床诊断病例2555例。其中广西境内的12个县市报告疟疾病例1644例,血检阳性病例1543例,临床诊断病例101例;贵州境内的12个县市共报告疟疾病例9067例,血检阳性病例6613例,临床诊断病例2454例。共报告恶性疟病例61例,其中贵州19例,广西42例,感染者均为出国回归者。结论疟疾在该区域得到有效控制,其发病率逐渐下降,但流动人口疟疾病例在增多。     

2004-2014年孝感市网络直报疟疾疫情分析

目的分析实施传染病网络直报以来孝感市疟疾疫情,为我市疟疾消除和防控工作提供科学依据。方法采用Excel 2003和SPSS17.0软件对孝感市2004—2014年疟疾疫情数据进行整理分析。结果孝感市2004—2014累计报告疟疾病例844例,年平均发病率为1.58/10万,2005年发病率3.35/10万最高,2012年发病率0.12/10万最低。其中间日疟742例,疟疾未分型66例,恶性疟36例,本地感染病例802例,输入性病例42例,前几年以本地间日疟为主,近几年以输入性恶性疟为主。本地疟疾病例在5—9月份呈明显发病高峰,孝昌、安陆、孝南、大悟报告病例较多,发病人群20岁以上成年人为主,占报告病例总数的85.31%,农民为主,男性多于女性(1.52:1)。输入性疟疾无明显的季节性分布,孝南、安陆、大悟报告病例较多,20岁以上病例占97.62%,90.42%为非洲务工归国人员,青壮年男性居多。结论孝感市本地感染疟疾疫情已得到有效控制,输入性疟疾疫情呈上升趋势,做好输入性疟疾疫情监测将是今后防治工作的重点。     

2004~2013年中国疟疾发病情况及趋势分析

目的分析2004~2013年7月全国疟疾发病趋势和规律,为消除疟疾工作的开展提供依据。方法利用中国疾病预防控制中心疾病监测信息报告管理系统(网络直报系统)以及全国疾病控制调查制度《疟疾防治工作调查表》(年报系统),收集2004~2013年7月全国疟疾疫情数据资料,用Excel 2010软件进行统计分析。结果 2004~2013年7月,网络直报系统共报告疟疾病例241 430例,其中间日疟、恶性疟和未分型病例分别占76.54%、8.33%和15.13%;患者以男性青壮年为主;主要分布在安徽(占45.16%)、云南(占22.26%)、海南(占9.68%)、河南(占8.16%)和湖北(占4.28%)五省;临床诊断病例和实验室确诊病例分别占33.02%和66.98%;死亡病例235例,其中恶性疟占87.66%;2004~2012年,全国年报系统共报告本地感染病例204 613例和输入性病例47 439例,分别占81.18%和18.82%;2013年1~7月,全国网络直报系统共报告疟疾病例2 987例,其中临床诊断病例占0.87%,恶性疟病例占74.89%,本地感染病例仅34例。结论全国疟疾疫情已得到有效控制,但输入性疟疾尤其是输入性恶性疟所占比例呈大幅度上升趋势。     

2005-2013年泰兴市疟疾疫情分析

目的分析近年来泰兴市疟疾流行状况和防治效果,为今后制定合理的防治对策提供科学依据。方法收集2005-2013年泰兴市疟疾疫情、发热病人血检报表以及疟疾病人流行病学调查表,分析疟疾发病率、流行特征、输入性疟疾等指标。结果 2005-2013年泰兴市共报告疟疾37例,年发病率为0.007 8/万~0.066 9/万,上升幅度较大。输入性疟疾34例,占总病例的91.89%,其中本地人口本省外市感染2例、外省感染2例、境外感染30例。境外感染的30例中,间日疟1例、卵形疟2例、恶性疟27例。每个月均有发病,无明显季节性。30~49岁青壮年病例占83.78%(31/37)。结论泰兴市疟疾以境外输入性恶性疟为主,呈上升趋势,应加强流动人口和现症病人的监测、管理。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.