德宏口岸入境人员传染病监测结果分析

目的 掌握德宏口岸入境遣返回国人员传染病监测结果分析，为加强重点人群的防治提供信息。方法 对2002年11月9日从德宏口岸入境遣返回国的68人进行健康检查，对检出的传染病感染进行流行病学调查和统计分析。结果检出的传染病感染24例，检出率为35．29％，其中检出10例：HIV感染，检出率为14．71％；7例疟疾感染，检出率为10．27％；6例乙型肝炎感染，检出率为8．82％；1例梅毒感染，检出率为1．47％。在检出的24例感染中，男性23例，女性1例，男女性别比为23：1；从年龄来看，年龄最大为52岁，最小为18岁，高发人群为23～39岁。从职业上看，15例为工人，占感染的62．5％；其次5例为商人，占感染的20．83％；4例为驾驶员，占感染的16．67％。从化程度看，7例为小学化，占感染的29．17％；ll例为初中化，占感染的45．83％；6例为盲，占感染的25％。结论23～39岁的青壮年是德宏口岸入境人员高危重点监测人群。     

HDGF与恶性肿瘤研究进展

在危害人类健康的所有疾病当中,恶性肿瘤的病死率高居各类疾病之首,号称人类的超级杀手。虽然目前对恶性肿瘤的病因研究的在不断深入,手术治疗方法的不断改进,新的治疗技术的广泛开展应用,新型抗肿瘤药物的不断研发,使得恶性肿瘤的诊疗水平已经有了较大的进步,但它仍是当今医学界尚未攻克的一个难题。在1994年WinkinS提出蛋白质组学的概念以及近年来人类基因组计划的完成,生命科学进入了后基因时代,开始从蛋白水平研究恶性肿瘤。寻找肿瘤诊断和预后的特异性分子标志物以及药物治疗的靶标已成为当前研究的热点。在这些分子标志物当中,肝癌衍生生长因子（HDGF）成为一个新的热点,HDGF是从人肝癌细胞系HuH-7培养的上清液中分离得到的一种促生长因子,在人体内有广泛的分布。HDGF参与细胞的增殖、分化,组织器官生长发育,损伤后组织修复等,HDGF在肝癌、非小细胞肺癌、胰腺癌等肿瘤组织中表达增高,众多国内外的研究表明HDGF的表达与一些恶性肿瘤的侵袭,转移及预后紧密相关,可能会是一些恶性肿瘤的分子标志物,对HDGF的研究可能为恶性肿瘤的治疗提供一些启迪和帮助。     

On model prespecification in confirmatory randomized studies.

Typically, the primary purpose of confirmatory randomized trials, such as drug trials sponsored by the pharmaceutical industry, is to determine whether there is a treatment effect, and if there is, to estimate the size of the effect. For such studies it is accepted practice to prespecify the statistical model to be used in the primary analysis. The reason for this is a concern that if the model were to be chosen on the basis of the data, the model most favourable to the sponsor might be chosen, with consequent inflation of the type I error. The purpose of this article is to show that, in a sense, this concern is needless. It is shown that if the model is chosen in a blinded fashion and randomization-based tests for no treatment effect are used, then the type I error is controlled. A similar technique to derive unbiased estimates of treatment effect is also described. This approach may be of value when there is uncertainty as to the correct model when the study is being planned.     

The manager and continuing education

Continuing education in health care organizations consists of that which is required by law or regulation and that which is optional. The required is done because it must be done; the other, including most management development and some staff education, is often ignored. Nonrequired education is one of the first items to go during budget-cutting exercises. Yet continuing education at all levels, for managers as well as nonmanagers, is essential in keeping health care workers abreast of rapid change. Much continuing education, even that for rank-and-file staff, is up to the department manager, and with few exceptions, the pursuit of continuing management development is left largely to the individual manager. The department manager is an educator of staff and is also largely responsible for self-development.     

注射用氢化可的松琥珀酸钠临床经验总结

目的随着人类医学的发展,糖皮质激素越来越被人们重视。根据糖皮质激素作用时间长短,分为长效激素和短效激素。长效激素抗炎效力强,但对下丘脑-垂体-肾上腺皮质（Hypothalamic-Pituitary-Adrenal cortex,HPA）轴的抑制较严重适宜于长疗程的用药。而短效激素对HPA轴的危害较轻,与长效激素做等量换算后其抗炎效力基本相同,因其作用时间短,更适用于急诊。所以,准确认识并合理地应用短效糖皮质激素是治疗疾病急性发作期的关键。方法氢化可的松琥珀酸钠是短效激素的代表,本文根据个人临床应用经验,就其优缺点谈谈体会。结果短效糖皮质激素氢化可的松琥珀酸钠是一种起效快、作用强的激素。结论氢化可的松琥珀酸钠的临床应用广泛,尤其适用于急诊,其发展前景很好。     

Medical judgement on driving capability

Driving is an activity which puts forward the question of whether the driver is able to competently fulfill the task or not. Driving is affected or altered by age and various illnesses and the driver may not always concede that his/her driving ability is affected by these. The examination of driver capability is an important target. This can be seen especially during car accidents when the driver is examined and it is discovered that he/she is aggressive, has poor vision, old age, is epileptic, or consumed alcohol or drugs.     

The active fraction of psyllium seed husk

A series of experiments and evaluations of fractions isolated from psyllium seed husk (PSH) were used to test the overall hypothesis that a gel-forming component of PSH is not fermented and that it is this component that is responsible for the laxative and cholesterol-lowering properties of PSH. A gel is isolated from human stools collected during a controlled diet study when PSH is consumed but not when the control diet only is consumed. Evaluations of three fractions isolated from PSH suggest that gel-forming fraction B, which is about 55% of PSH, is poorly fermented and is the component that increases stool moisture and faecal bile acid excretion, the latter leading to lower blood cholesterol levels. Fraction C, representing < 15% of PSH, is viscous, but is rapidly fermented. Fraction A is alkali-insoluble material that is not fermented. In concentrations comparable with their presence in PSH, fractions A and C do not alter moisture and bile acid output. The active fraction of PSH is a highly-branched arabinoxylan consisting of a xylose backbone and arabinose- and xylose-containing side chains. In contrast to arabinoxylans in cereal grains that are extensively fermented, PSH possesses a structural feature, as yet unidentified, that hinders its fermentation by typical colonic microflora.     

When must a new approach to treatment be introduced? The ethics of technology assessment.

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.     

长春城区人体蠕形螨流行病学及在人体面部与躯干分布的调查分析

作者于1991年7～10月采用透明胶带法,对长春城区612人进行了调查。结果表明,人体蠕形螨总感染率为22.4%;以脂蠕形螨感染为主(60.6%),毛囊蠕形螨次之(25.5%),混合感染最少(13.9%)。感染以I°居多(92.0%)。男、女性感染率无显著差异。感染率随年龄增长而增高。职业分布,以医务工作者感染率最高(45.8%),学前儿童未发现感染;亦未发现明显的家庭集聚性。面部和躯干38个部位的调查结果表明,感染度面部明显大于躯干,面部又以口旁、鼻唇沟、颊下、鼻尖、口上最高;躯干则以乳头为最高。     

钒对大白鼠肝脏生长发育的影响

目的:研究微量元素钒对大白鼠肝脏生长发育的影响,探讨饮水中添加钒的适宜剂量和中毒剂量。方法:将试验大白鼠分成5组,每千克饮水中添加不同剂量的钒(0、10、20、406、0 mg/kg),于饮饲后第2、4、6、8、10周时断脊处死,取肝脏称重并用Bouin液固定,制作石蜡切片,HE染色,利用光学显微镜观察组织结构,显微摄影。结果:饮饲10、20、40 mg/kg钒,可见大白鼠肝脏重量较对照组增加,以试验Ⅱ组肝脏增重显著(P<0.05),试验Ⅳ组较对照组重量减轻;显微观察可见试验Ⅰ组、试验Ⅱ组肝脏组织结构清晰,肝细胞大而圆,试验Ⅲ组肝细胞有脱落现象且轻度水肿。试验Ⅳ组肝脏重量与同一周对照组相比轻,肝细胞界限不清晰且水肿、颗粒及脂肪变性严重。结论:大白鼠饮水中添加40 mg/kg以下剂量的钒对大白鼠是安全的,饮饲60 mg/kg钒对大白鼠肝脏有毒害作用。     

石墨炉原子吸收法测水中痕量铅

目的 :探索水中痕量铅的石墨炉原子吸收法测定。方法 :采用更灵敏的 2 17 0nm谱线 ,还原钯作基体改进剂。结果 :采用还原钯作基体改进剂允许灰化温度高达 10 0 0℃。高灰化温度降低了背景吸收 ,消除了基体干扰 ,铅检出限 0 .0 2 4 μl/L ,精密度为 1.90 %～ 6 .10 % ,回收率为 96 .0 %～ 10 4 .8%。结论 :方法简便、快速 ,无需化学预处理 ,灵敏度高 ,适合水中痕量铅的测定。     

THE HEALTH OF THE COLLEGE

Colleges are generally weak in public health administration, according to this author. Standards for milk and water supplies are low, ventilation is a closed book, supervised exercise is usually wanting, personal hygiene instruction is not followed up, and off-campus living is little supervised. Here, where example is needed, health administration is often hap-hazard, usually inexpert.     

THE HEALTH OF THE COLLEGE

Colleges are generally weak in public health administration, according to this author. Standards for milk and water supplies are low, ventilation is a closed book, supervised exercise is usually wanting, personal hygiene instruction is not followed up, and off-campus living is little supervised. Here, where example is needed, health administration is often hap-hazard, usually inexpert.     

基于虚拟仪器的胎儿心电图仪的研制

介绍了一种基于虚拟仪器的电脑胎儿心电图系统。该系统由两部分组成:以PIC单片机为核心硬件的数据采集装置和PC平台的处理分析系统。硬件电路功耗低,直接采用端口供电。软件平台采用可视化语言LabView6.1编程实现,由于使用其大量成熟软件模块,大大提高了开发效率。介绍了LabView实现的匹配滤波器等算法,并改进了匹配滤波的模板更新方法。临床试用取得了满意效果。     

62例病毒性重症肝炎死亡原因分析

目的总结重症肝炎的诊治经验,提高抢救成功率。方法对2001年1月~2005年12月我院62例住院病毒性重症肝炎死亡病例进行统计分析。结果62例重症肝炎死亡病例中,60例肝性昏迷,为重症肝炎死亡的首要死亡原因,占96.77%;其次是出血倾向,占75.81%;第三是感染,占54.84%;第四是肝肾综合征,占37.10%,并发症为重症肝炎病人死亡的主要原因,并发症越多,死亡率越高。结论早期诊断,早期预防及治疗并发症,是提高重症肝炎存活率、降低死亡率的重要措施。     

戊型病毒性肝炎研究进展

戊型病毒性肝炎（戊肝）是由戊肝病毒（HepatitisE Virus,HEV）引起的急性病毒性肝炎。HEV是一种单链、非包膜的RNA病毒,分为4个基因型,主要通过粪口途径传播,也可以通过输血传播和母婴传播。戊肝主要在发展中国家流行,但欧美等发达国家亦有散发病例。戊肝是一种人畜共患病。酶联免疫吸附实验（ELISA）是目前用于检测血清HEV抗体最常用的方法。HEV RNA检测可证实HEV感染。目前,HEV疫苗的研究主要集中在HEV基因工程疫苗的研制。2012年10月HEV疫苗上市。采用切断传播途径为主的综合性预防措施可控制该病的流行,接种疫苗也是预防戊型肝炎的重要措施。     

黄石地区2000～2005年出入境人员健康体检传染性疾病和非传染性疾病结果分析

目的掌握黄石地区出入境人员中传染性疾病和非传染性疾病的发病情况,有针对性的开展出入境人员的传染病监督监测工作,探讨非传染性疾病的检出在出入境人员健康体检工作中的重要性。方法2000-2005年在黄石出入境检验检疫局进行健康体检的3 365例出入境人员,胸部x光片,心电图,B超,内科,外科,五官科检查,血清样本HIV,HBsAg,梅毒抗体,ALT检测。结果黄石地区出入境人员中乙肝病毒的携带率为5．53％,肺结核的感染率为1．34％,梅毒的感染率为0．15％,非传染性疾病中高血压的患病率为12．69％,心电图异常为10．25％,肝胆B超检查异常为5．73％,色觉异常为1．99％。结论加强对出入境人员的传染病的监督和监测工作,是防止传染病传入、传出国境的重要措施,梅毒等性传播疾病(STD)在出入境人员中的检出率已大大高于中国平均水平,由于这部份人群活动量大,活动区域广而成为感染、携带和传播性传播疾病的重要环节。同时做好非传染性疾病的检查工作。     

The impact of varying diagnostic thresholds on affected sib pair linkage analysis

For Mendelian disorders, it is usually simple to classify individuals as either affected or unaffected. By contrast, for “complex” phenotypes, the diagnostic boundary of the disorder is often uncertain. This paper explores the following question: to most efficiently detect linkage in such a complex phenotype by the affected sib pair method, where should the diagnostic threshold be drawn? The model assumes that the disorder is due to a generalized two-allele single major locus (SML) where liability in each genotype is normally distributed. Evidence for linkage between the marker and disease loci is highly dependent on the location of the threshold. The relationship between the placement of the threshold and population linkage information (PLI) is Gaussian-like. At high thresholds, linkage efficiency (LE) (or the amount of linkage information per affected sib pair) is high but PLI is low because the number of affected sib pairs is very small. At low thresholds, the number of affected sib pairs is high, but PLI is low because LE is very low. The model is applied to published SML parameters for schizophrenia, and maximal PLI is achieved at thresholds broader than those for schizophrenia alone.     

俘获再俘获法在制药行业职工白细胞降低者总估校正现患率的应用及探讨

造反本市某制约厂工人连续两年健康监护资料，应用俘获再俘获法，计算其外周血白细胞降低者的总估校正现患率（ＡＣＰＲ）。结果：接触组为４５．２７％（３２．４０～５７．９９％），对照组为２１．７８％（５．４４％～３７．６２％），两组有非常显著性差异（Ｐ〈０．０１），虽在ＡＣＰＲ９５％可信限内，但低于ＡＣＰＲ值。制药行业职工白细胞降低者ＡＣＰＲ高于苯作业者，两组有显著性差异（Ｐ〈０．０５）。ＡＣＰＲ计算方法     

Understanding the feasibility of integrated care: a rival viewpoint on the influence of actions and the institutional context

There is in Europe growing awareness that the delivery of integrated care is required to meet the demands of an increasing number of patients with multiple problems. It is also clear that the provision of integrated care is difficult to achieve. As yet, the debate about the circumstances enabling or hindering provision is not settled. The objective of this article is to generate more knowledge on this issue. It is often assumed that the feasibility of integrated care provision is caused by characteristics of the legislation, the financing system and other aspects of the institutional context. Here it is argued that these characteristics are relevant but not decisive. Based on empirical evidence from the Dutch case a rival viewpoint is presented, suggesting that it is the commitment of the actors involved, their support, and the way developments are being managed, that make the difference. Following presentation of the evidence, the implications of the findings for integrated care policy are discussed.