快速控制江滩型流行区血吸虫病传播措施的研究

目的探讨快速控制江滩型流行区血吸虫病传播的有效控制策略和措施。方法采取区域性全覆盖药物灭螺、环境改造灭螺方法，强化消灭江滩感染性钉螺为主的综合防治措施，同时辅以人畜查治、健康教育等干预；纵向观察钉螺面积、人畜血吸虫感染、血防知识知晓率等变化。结果强化措施后钉螺面积、感染性钉螺面积逐年下降，学生和居民血防知识知晓率逐年提高，钉螺面积和居民查病阳性率随灭螺覆盖率的上升而下降，特别是感染性钉螺和急性血吸虫感染率下降最为显著，达到了血吸虫病传播控制标准。相关分析表明：钉螺面积和居民查病阳性率与药物灭螺覆盖率间有显著负相关关系（r钉螺面积＝-0．870，P=O．024；r居民阳性率＝-0．834，P＝0．039），表明药物灭螺的防治效果最为直接而有效。结论采取以消灭江滩感染性钉螺为主的综合防治措施，可在短期内快速控制江滩型地区血吸虫病传播。     

山丘型地区阻断血吸虫病传播综合措施效果评价

目的 目的 评价山丘型地区阻断血吸虫病传播综合措施效果。 方法 方法 收集2004-2014年句容市血吸虫病综合防治 和疫情资料, 评价防治效果。 结果 结果 2004-2014年, 句容市钉螺面积、 活螺密度分别自43.13 hm2 、 1.48只/0.1 m2 下降至0; 居民血吸虫病血清学阳性率持续下降; 居民和学生的血防健康教育知晓率分别自88.43%、 82.04%提高到92.56%、 95.74%; 钉螺面积与灭螺覆盖率呈显著负相关 （r = -0.864, P＜0.05）。 结论 结论 山丘型地区坚持灭螺和化疗为主的血吸 虫病综合措施可使血吸虫病疫情快速、 稳定下降, 从而推进了血吸虫病传播阻断目标的实现。     

镇江市润州区血吸虫病传播阻断策略及实施效果

目的 评价镇江市润洲区血吸虫病传播阻断策略的实施效果。方法 2001-2016年在镇江市润洲区实施以全覆盖灭螺、血吸虫病扩大化疗和健康教育为主的血吸虫病综合防治策略,以居民血吸虫感染率、有螺面积、灭螺面积和居民血防知识知晓率、行为正确率为指标评估综合防治策略的实施效果。结果 2001-2016年镇江市润州区有螺面积总体呈下降趋势,累计灭螺面积7 091.50 hm2,有螺面积和总灭螺覆盖强度呈显著负相关（[r = -0.874,P = 0]）。2001-2016年镇江市润州区常住居民血吸虫病血检阳性1 703例,粪检阳性病人199例;对粪检阳性者和血检阳性者全部采用吡喹酮进行治疗和扩大化疗;2005年后居民血检阳性率下降至1%以下,自2004年后未查出粪检阳性病人。2001-2016年问卷调查居民189 639人次,居民血防知识知晓率和行为正确率逐年提升。全区于2016年达到血吸虫病传播阻断标准。结论 江滩型血吸虫病流行区实施以全覆盖灭螺、吡喹酮扩大化疗和健康教育为主的综合防治策略可实现血吸虫病传播阻断目标。     

2005—2014年南京市栖霞区钉螺控制效果分析

目的掌握南京市栖霞区钉螺消长情况,探讨控制钉螺策略措施。方法采用回顾性方法,分析比较2005—2014年全区螺情资料和现场不同环境类型螺情指标逐年变化情况,同时比较钉螺面积与灭螺覆盖率之间的相关关系。结果全区2005前螺情居高不下,通过强化灭螺,江滩和通江河道实施综合治理等措施,钉螺面积从2005年6 554 215 ha(1 ha=10 000 m~2)降至2014年的3581 591 ha,下降了54.65%,活螺密度由6.520只/0.11 m~2下降至2.050只/0.11 m~2,有螺框出现率由81.5%下降至16.5%,呈逐年下降趋势;钉螺面积与灭螺覆盖率之间呈现负相关关系(r=-0.879,P0.05)。区内感染性钉螺最终消灭,并于2010年达到国家血吸虫病传播控制标准。结论强化灭螺并实施有螺环境全覆盖药物灭螺结合综合治理是控制辖区内螺情的直接有效措施.但仍需加强螺情监测,以巩固防治成果。     

江都市达血吸虫病传播控制标准后钉螺控制策略和效果评价

目的探讨血吸虫病传播控制后钉螺控制策略。方法每年开展药物灭螺和环境改造灭螺,同时进行钉螺调查,分析钉螺面积消长趋势和灭螺覆盖率变化。结果2000~2007年灭螺面积和巩固性灭螺面积分别为2027．24hm2和351．99hm2。加强灭螺措施后钉螺面积的上升被有效遏制并开始趋于下降。药物灭螺覆盖率和总灭螺覆盖率相关（r=0．996,P=0．000）,而环改灭螺覆盖率与总灭螺覆盖率间无明显相关（r=0.624,P=0.098）。钉螺分布现状主要在江滩和湖滩,其中有螺环境以湖滩为多,有螺面积则以江滩为多。结论达到血吸虫病传播控制标准后采取以药物灭螺为主的钉螺控制策略效果显著,但在加强灭螺的同时还需注重防控钉螺扩散。     

2010-2011年南京市栖霞区南中村国家血吸虫病监测点疫情监测

目的 了解2010-2011年南京市栖霞区南中村国家血吸虫病监测点疫情动态,为评价防治效果和制订防治策略提供科学依据。方法 按照《全国血吸虫病监测方案》要求,每年开展螺情、病情监测。结果 2011年南中村监测点活螺框出现率和活螺平均密度较2010年分别下降11.67%和95.49%,连续2年未发现感染性钉螺。常住居民血吸虫感染率从2010年的9.93%（95/957）下降为2011年的1.35%（7/519）,未发现急性血吸虫感染和晚期血吸虫病患者,亦未发现粪检阳性家畜。 结论 南中村国家血吸虫病监测点血吸虫病疫情呈逐年下降趋势,所采取的常规综合防治措施积极有效,但有螺面积未见明显有效压缩,仍处于不稳定状态。提示今后要强化灭螺措施,并确保灭螺质量;同时要积极开展江滩有螺环境治理,继续开展螺情和血吸虫传染源监测,以防止血吸虫病疫情反复。     

高淳县血吸虫病疫情回升及控制策略评价

目的分析高淳县血吸虫病疫情回升原因及评价控制策略效果。方法采用常规法进行钉螺调查和人畜血吸虫感染调查;采用哨鼠法进行水体感染性调查;实施药物灭螺、人畜化疗和健康教育措施,观察钉螺面积及人畜感染率变化。结果 1999-2007年共调查钉螺面积11 596. 96hm2;1999年春季发现钉螺面积39. 22 hmz,2000年发现感染性钉螺面积6. 70 Mr2,至2005年春季钉螺面积达100. 52 hrr12,钉螺均分布于水阳江沿线1999-2007年开展药物灭螺1 044. 39 hm2,灭螺覆盖率由63. 84%提高到790. 62%,钉螺面积降至011999-2006年同步开展人畜查治,居民感染率由5. 92%T降至O;家畜感染率由1.12%下降至O;疫水测定哨鼠感染率最高达79. 17%,2004-2006年趋于下降。结论高淳县水阳江流域受长江洪涝灾害影响,血吸虫病疫情出现严重回升,实施查灭钉螺、查治病人病畜为主的防治策略后,疫情稳步下降,重新达到了血吸虫病传播阻断标准。     

江苏省预防控制血吸虫病中长期规划效果中期评价

目的评价江苏省预防控制血吸虫病中长期规划防治策略和效果。方法采取以控制钉螺、人畜筛查化疗为主的综合性防治策略，实施预防控制血吸虫病中长期规划，纵向观察、评价防治效果。结果2003--2007年全省灭螺覆盖率和人畜化疗比率逐年增加，钉螺面积、感染性钉螺面积及人畜血吸虫感染率逐年下降。灭螺覆盖率与感染性钉螺面积、感染性钉螺环境数、人群感染率、家畜感染率及急性血吸虫病发生率均呈显著负相关（r与感染螺面积=-0．897，P=0．039；r与歙螺环境=-0．937，P=0．019；r与人群感染率=-0．913，P=0．031；r与家畜感染率=-0．991，P=0．001；r与急性血吸虫病=-0．894，P=0．041）；人、畜化疗比率与感染性钉螺面积均呈显著负相关（r人化疗比率=-0．965，P=0．008；r畜化疗比率=-0．921，P=0．027）；经费增加与人、畜感染率呈显著负相关（r经费和人感染率=-0．897，P=0．039；r经费和畜感染率=-0．971，P=0．006）。多元回归分析表明，人、畜感染率与急性血吸虫病发生率及灭螺覆盖率间均有直线关系。结论以控制钉螺、人畜筛查化疗为主的综合性防治策略效果显著；灭螺和化疗是预防控制血吸虫病最直接有效的措施；防治经费的稳定增加是有效控制和消除血吸虫病的基本保证。     

2008～2010年镇江市丹徒区国家血吸虫病监测点疫情

目的 掌握镇江市丹徒区国家血吸虫病监测点2008～2010年疫情动态变化,为评价防治效果和制订防治对策提供科学依据.方法 按照《全国血吸虫病疫情监测方案》要求,在监测区内开展病情和螺情等疫情监测,并对3年的监测数据进行统计分析.结果 监测区2008年有螺面积、感染性钉螺面积、感染性钉螺密度和人群血清学间接血凝试验阳性率分别为27.0hm2、14hm2、0.21只/0.11m2、3.10％;2010年分别为31.0hm2、0hm2、0只/0.11m2、1.37％,3年间未发生血吸虫急性感染病例和新发晚期血吸虫病病例,家畜感染率为0.结论监测区居民血吸虫病感染率维持在较低水平,家畜已不是监测区内的主要传染源;近年来药物灭螺措施的加强对感染性钉螺面积控制效果较为明显,但有螺面积仍居高不下;建议江滩灭螺要结合环境改造进行综合治理,传染源控制、监测工作仍需进一步加强.     

山丘型血吸虫病流行区小环境改造的费用—效果分析

山丘型血吸虫病流行区因地制宜进行沟渠硬化、沼泽地改塘等小环境改造措施后,钉螺面积减少了66.16％,活螺密度、活螺框出现率分别下降了76.54％和76.13％,阳性螺密度下降了100％;居民血吸病患病率略有下降,14岁以下人群感染率为0,无急性感染发生。而实施药物灭螺的对照组9年来钉螺面积仅下降了27.62％,活螺密度及活螺框出现率分别上升了26.35％和151.01％,是小环境改造点的9.84倍和11.13倍,同时居民血吸虫病患病率较1987年上升了37.44％,14岁以下人群感染率为1.21％,并有零星急性感染病例发生。小环境改造一次性投资费用高于药物灭螺,但与农田水利相结合的小环境改造措施能够产生一定的间接经济效益,因此远期效果仍将优于药物灭螺。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.