小儿耳鼻喉手术麻醉的新进展

因小儿耳鼻喉手术刺激强,时间短,且常与气道相关,故麻醉的控制有一定难度,现对国内外现阶段小儿耳鼻喉手术麻醉的改良方法及新观点进行评述,以期对临床工作有较好的指导意义。     

Malaria in children in Birmingham in the 1970s

Thirty-two children with malaria were admitted to Dudley Road Hospital, Birmingham, in the 1970s. None was admitted before 1974 and there was a rapid increase after that. All the infections were due to Plasmodium vivax and occurred in children of Asian immigrant families who had been born in or had visited India or Pakistan apart from one infant born in England who acquired the disease transplacentally. All presented within 12 months of entering or re-entering the United Kingdom. The clinical features of the 32 patients have been analysed and it is suggested that more effort should be made to educate travellers about the need for anti-malarial chemoprophylaxis and the necessity to continue it for one month after return.     

大鼠脑出血灶周围星形胶质细胞内糖原含量的变化

目的：研究脑出血后局部超微结构的变化，探讨脑出血的病理生理过程，为临床治疗提供理论依据．方法：健康雄性SD大鼠4只，随机等分为实验组和对照组．实验组采用细菌胶原酶注射制作纹状体脑出血模型，对照组采用相同方法在相应部位注入等体积生理盐水，采用透射电镜观察脑出血后24h病变局部及其周围和对照组超微结构的变化和糖原的水平变化．结果：电镜观察到在脑出血动物出血灶周围区，不同类型的细胞内均可见到各种各样的超微结构改变．最为醒目的是在脑内血肿周围星形胶质细胞胞质和突起内有大量的糖原颗粒聚集，尤其在毛细血管周围的胶质细胞突起内非常明显；小胶质细胞和少突胶质细胞内均未发现明显糖原颗粒存在．在生理盐水对照组动物，相应部位的各种细胞的超微结构正常；而且神经元、各种胶质细胞和毛细血管内皮细胞内均无明显糖原颗粒聚集．结论：脑出血周围糖原含量增高，局部存在明显的糖代谢障碍．     

云南省2006年登革热监测分析

目的了解云南省登革热的疫情动态、人群抗体水平、媒介伊蚊种群（包括成幼虫孳生和密度变化）的动态变化、为登革热流行趋势的预测、预警和制定防治对策、措施提供科学依据。方法各级医疗、卫生、检疫机构的医务人员对疑似、临床病例进行及时发现和诊断;在流行季节前随机抽取正常人群血清,-20℃保存,用ELISA方法进行血清学检测;在6～10月采用定时、定点调查法,对登革热的主要传播媒介白纹伊蚊、埃及伊蚊的种群、孳生环境、伊蚊幼虫指数和成蚊密度进行监测,每月1次。结果2006年云南省发生输入性登革热病例18例;健康人群登革热IgG抗体阳性率8．09％。伊蚊幼虫密度布雷图指数（BI）、容器指数（Cl）分别在14～98、4．7～73．68之间,白纹伊蚊成蚊密度在3．5～34只,人工小时之间。结论云南省输入性登革热疫情有不断上升的趋势;人群抗体水平登革热IgG抗体阳性率较高,提示当地人群中可能存在该病毒的既往感染或隐性感染;媒介伊蚊幼虫布雷图指数、容器指数和白纹伊蚊成蚊密度均较高。对登革热传播具有极高的危险性,应引起高度注意。     

Divergences in antihypertensive therapy in special situations in nephrology.

CONTEXT AND OBJECTIVE: The choice of an antihypertensive drug is based on several criteria and specific situations give rise to doubt and controversy. The aim here was to evaluate physicians approaches towards treatment with antihypertensive agents in specific situations. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de S?o Paulo, S?o Paulo. METHODS: A questionnaire was applied during a nephrology meeting to evaluate individual approaches towards each hypothetical clinical situation. The questionnaire consisted of five multiple-choice questions (clinical cases) concerning controversial aspects of antihypertensive therapy. RESULTS: A total of 165 questionnaires were analyzed. Most participants were nephrologists (93.2%). There was a preference for angiotensin-converting enzyme (ACE) inhibitors in at least two of the cases. Only 57.2% of the physicians were correct in choosing beta-blockers as the first-line drugs for patients with ischemic coronary disease. Moreover, 66.2% chose ACE inhibitors as the first-line drugs for patients with chronic kidney disease and proteinuria. About 5% of the physicians did not follow the current recommendations for the use of ACE inhibitors in diabetic patients with microalbuminuria. The most controversial question concerned the first-line drug for advanced chronic kidney disease. Most physicians were correct in choosing calcium channel blockers and avoiding ACE inhibitors in renovascular hypertension in the case of a patient with a single functioning kidney. CONCLUSIONS: Most physicians adopted the correct approach, but some had an alternative strategy for the same situations that was not based on evidence.     

Menarche in African girls in some post-secondary institutions in Kenya

Researchers administered a questionnaire to 457 female students (mean age, 22 years) in 4 teacher and 1 agricultural training colleges in Kenya to examine adolescent fertility. The average age at menarche for these post secondary female students stood at 14.4 years with a range of 9-16.5 years. This mean age was 13.9 years for secondary school girls in another similar study in Kenya. The leading source of information about the menstrual period was a friend (36.2%), followed by a teacher/nurse (23.3%) and then the mother (21.6%). Menstruation lasted between 3-4 days for 75.6% of the students. 64.8% experienced moderate to severe pain during their period which may have an impact on school performance. Almost all believed that family life education should be part of the school's curriculum and 58% said it should be taught to students between 12-15 years old. 35.9% felt it should be taught to those 12 years old. 98.7% said a woman should teach the course. 71.1% believed it should be taught to both sexes in the same room. 58.2% reported no access to family planning services. 40.2% did not practice any family planning (some of these may not have yet had sexual intercourse, however). Only 19.1% used modern contraceptives, e.g., oral contraceptives and the diaphragm. The results of this study revealed that the schools need to better inform females about menstruation and family planning. Further, family planning professionals must target female officials and family planning leaders need to review those regulations that prohibit family planning services to post secondary schools.     

2001年我国医药研究的若干进展

随着国内外生命科学和生物技术等的飞速发展,我国医药技术在2001年取得了长足的进步。提前完成了我国所承担的人类基因组汁划中的1％测序任务,到2000年,中国科学家在功能基因研究和基因组多样性领域共完成研究论文1850篇,遍及医药各领域,研究手段和水平可于国际先进水平媲美,中国完全有条件在“后基因时代”成为主角之一。     

2005年汕头市登革热定点监测结果分析

目的 通过定点监测为汕头市登革热流行趋势的预测、预警和制定防治对策、措施提供科学依据。方法收集监测点的登革热疫情、人群抗体水平和媒介伊蚊等监测资料，用EPI2002软件统计分析。结果2005年汕头市无登革热疫情，抗登革热病毒IgG、IgM阳性率低，伊蚊幼虫孳生密度高峰在6、8、9、10月份，低谷在4、7、11月份，孳生情况随着月平均降水量、平均气温变化而变化；孳生场所以农村、暂时性容器为主。结论汕头市有登革热流行的自然、社会环境条件，人群普遍对登革热易感，8～10月是发动爱国卫生运动，清除伊蚊孳生地，预防、控制登革热流行的适当时机。     

云南省2001年流动人口疟疾感染情况分析

目的：分析2001年云南省流动人口疟疾感染及管理状况。方法：按照边境地区及元江流域疟疾联防规划，实施对流动人口的疟疾管理。结果：流动人口共查出发热病人81496例，疟原虫阳性率为6．73％。另外，检查非发热病人4968例，症原虫阳性率为11．00％。由国外返回的当地流动人口原虫阳性率最高，蕨是由外县进入的流动人群。结论：国外和外地进入的流动人群是造成当地疟疾传染源扩散的主要原因。因此，加强流动人口的疟疾管理，是提高防治效果的必要措施。     

Progress in malaria control in China

Purpose To summarize the main achievements of the control of malaria in the People’s Republic of China. Data sources The data are from national case reporting system ( 1955-1998), and bibliographic reviews of textbooks and review articles. Study selection Successes in control and research of malaria were identified and selected to address the stated purpose. Data extraction In the past 50 years, large-scale malaria control activities were conducted in the country, relying on primary health care networks and community participation. The control of malaria was implemented according to the time- and locality- oriented approaches. As a result, remarkable success has been achieved. By the end of 1998, there were 31. 3 thousand malaria cases in China, with a morbidity of 0.25 per ten thousand, which dropped by 99% in comparison with that in the 1950s.Results Most of the original hyper- endemic areas became meso- or hypo- endemic and for most of the previously meso- or hypo- endemic areas, the disease became sporadic. Malaria distribution and epidemic pattern also demonstrated great changes. Conclusions Malaria control in China has been considerably successful in the past 50 years, which coincides with the target of the World Health Organization’s 'Health for all by the year 2000'.     

滨海新区婴幼儿血流感染病原菌分析

目的:研究婴幼儿血流感染的病原菌组成及阳性报警时间,为血流感染的早期诊断与抗生素合理应用提供依据。方法:选取滨海新区疑似血流感染患儿943例,经血培养分析病原菌种类及对临床常用药物的敏感性。结果:非重复菌株共收集到91株,其中位居前3名的是22株凝固酶阴性葡萄球菌（CoNS）、14株大肠埃希菌和8株无乳链球菌。未分离到万古霉素、利奈唑胺和替加环素耐药的革兰氏阳性球菌,大肠埃希菌和肺炎克雷伯菌对头孢替坦、亚胺培南、哌拉西林/他唑巴坦、美洛培南和阿米卡星的敏感性为100%。阴沟肠杆菌的TTP[（8.96±2.24） h]最短,光滑假丝酵母菌的TTP[（44.4±16.59）h]最长。结论:滨海新区婴幼儿血流感染主要是革兰阳性菌,病原菌对常用的抗菌药物敏感性较高,临床医生应根据试验结果选择合理的抗菌药物。     

广东高州市2005年医疗机构消毒质量监测分析

目的评价辖区内医疗机构消毒灭菌质量，督促各医疗单位提高消毒灭菌效果，防止医源性感染的发生。方法对辖区内的医疗单位已消毒或灭菌的用品进行抽样检测，将检测结果进行统计学分析。结果这次采集使用中消毒液、无菌器械、物体表面、手术室空气和医务人员手共3556份，检测达卫生标准2955份，符合率为83、10％，不同样品检测达卫生标准百分率依次为97．37％、95．56％、86．25％、75．41％和62、49％。结论高州市医疗机构消毒灭菌质量用卫生指标评价，卫生站的符合卫生标准率低于医院，手术室空气和医务人员手的监测合格率低于使用中消毒液和无菌器械。     

纤维连接蛋白在肾脏疾病中变化的意义

测２０例尿毒症患者血浆纤维连接蛋白含量，证实尿毒症者血浆Ｆｎ降低，并与患者中性粒细胞吞噬功能低下有关联。体外实验证实Ｆｎ有促进ＰＭＮ吞噬功能作用，且与其浓度正相关。表明血浆Ｆｎ与机体免疫防御功能关系密切，其水平可反映患者细胞吞噬功能状态。     

Cohort Mortality Study in Three Ceramic Factories in Jingdezhen in China

To investigate the health impacts of crystalline silica mixed dust and other potential occupational hazards on workers in ceramic factories, a cohort study of 4851 workers registered in the employment records in 3 ceramic factories in Jingdezhen city of China between 1972 and 1974 was identified. The cohort mortality was traced throughout 2003 with an accumulation of 128970.2 person-years, revealed 1542 deaths. Standardized mortality ratios （SMRs） were calculated for the main causes of death by using Chinese national mortality rates as reference. The mortality from all causes in three ceramic factories was 12.0‰ and the cumulative mortality was 31.8%. Malignant neoplasm, cardiovascular diseases, respiratory diseases, infectious diseases were the first four illnesses that threaten workers’ life, and they accounted for 73.2% of all deaths. The results of this study showed that the standardized mortality ratio for all subjects was 1.02, which is very close to that expected on the basis of the China national mortality rates. Statistically significant mortality excesses for respiratory disease （SMR=1.36）, pneumoconiosis （SMR=37.34）, infectious disease （SMR=5.70） and pul- monary tuberculosis （SMR=3.88） were observed. The mortality of 2938 dust-exposed workers was higher than that of 1913 non dust-exposed workers. Except for pneumoconiosis, the mortality from lung cancer, non-malignant respiratory diseases and pulmonary tuberculosis in dust-exposed workers were significantly increased as compared with that in non-exposed workers, and the relative risks （RRs） were 1.86 （1.16–2.99）, 2.50 （1.84–3.40）, 1.81 （1.34–2.45）. The exposure-response relationships between cumulative dust exposure level and mortality from all causes, colorectal cancer, lung cancer, respiratory diseases, and pulmonary tuberculosis were also identified. The findings indicated that silica mixed dust in ceramic factories has harmful impact on the workers’ health and life span in ceramic factory.     

Progress in schistosomiasis control in China

Ｏｆａｌｌｔｈｅｍａｊｏｒｓｃｈｉｓｔｏｓｏｍｅｓｔｈａｔｉｎｆｅｃｔｍａｎ,Ｓｃｈｉｓｔｏｓｏｍａｊａｐｏｎｉｃｕｍ（Ｓ－ｊａｐｏｎｉｃｕｍ）ｉｓｃｏｎｓｉｄｅｒｅｄｔｏｃａｕｓｅｔｈｅｍｏｓｔｓｅｒｉｏｕｓｄｉｓｅａｓｅ－ＴｈｉｓｍａｙｂｅｄｕｅｔｏｔｈｅｆａｃｔｔｈａｔＳ－ｊａｐｏｎｉｃｕｍｆｅｍａｌｅｗｏｒｍｓｈａｖｅａｍｕｃｈｈｉｇｈｅｒｅｇｇｏｕｔｐｕｔａｎｄｔｈｅｅｇｇｓａｒｅｌａｉｄｉｎｌａｒｇｅａｇｇｒｅｇａｔｅｓｔｈａｔｉｎｄｕｃｅｉｎｔｅｎｓｉｖｅｔｉｓｓｕｅｒｅａｃｔｉｏ…     

Malocclusions in Xia Dynasty in China

Background  The prevalence of malocclusion in modern population is higher than that in the excavated samples from the ancient times. Presently, the prevalence of juvenile malocclusion in the early stage of permanent teeth is as high as 72.92% in China. This study aimed to observe and evaluate the prevalence and severity of malocclusions in a sample of Xia Dynasty in China, and to compare these findings with the modern Chinese population.

Methods  The material consisted of 38 male and 18 female protohistoric skulls of Xia Dynasty 4000 years ago. Of 86 dental arches, 29 cases had the jaw relationships. Tooth crowding, diastema, individual tooth malposition and malocclusion were studied.

Results  Of the samples, 23.3% showed tooth alignment problems including crowding (8.1%), diastema (9.3%), and individual tooth malposition (5.8%). The prevalence of malocclusion was 27.6%, mainly presented as Angle Class I.

Conclusions  It is indicated that over thousands of years from Neolithic Age (6000–7000 years ago) to Xia Dynasty (4000 years ago), the prevalence of malocclusion did not change significantly. The prevalence of malocclusion of Xia Dynasty samples was much lower than that of modern population.

     

麻醉学双语教学体会

麻醉学双语教学在高校中的开展和推进具有重要性和迫切性。重庆医科大学麻醉学教研室通过近10年对双语教学的尝试,取得了一定的效果。同时体会到需要正确认识双语教学,采用高效的教学方法,注重提高学生学习的主动性,重视师资力量的培养及营造良好的双语学习氛围,以便更好地推进麻醉学双语教学的开展。     

重庆地区汉族CD14启动子区多态性分析

目的调查CD14(-260)多态性在重庆地区汉族中的分布特征,及检验该随机样本遗传学研究的可靠性.方法对110名重庆汉族个体,采用降落式PCR和限制性片段长度多态性法(RFLP)进行基因型分析.结果重庆地区汉族CD14(-260)多态性TT、TC、CC 3种基因型频率分别为43.6%、39.1%和17.3%; 样本分布符合Hardy-Weinberg平衡.结论重庆汉族CD14(-260)多态性基因型分布特征与白种人存在明显差异.样本为H-W平衡群体,可进一步用于重庆汉族全身性炎症反应的关联分析.     

2009年泉州市流感监测结果分析

目的了解泉州市2009年流感活动情况及其型别特征。结论通过流行病学和病原学监测,对泉州市流感流行情况进行分析。结果 2009年全市流感样病例占就诊人数的0.26%～2.34%;全年采集监测标本1392份,经RT-PCR法检测样本阳性率为22.34%;经MDCK细胞分离流感毒株134株,其中季节性H3N2和HINl型各占60.45%和11.19%,甲型H1N1流感占21.64%,B型占6.70%。结论 2009年泉州市流感春夏季以季节性H3N2亚型流感为优势毒株,秋冬季以甲型H1N1流感为流行株,需加强泉州市流感监测和流感病毒抗原变异研究。