四川省德阳贫困农村糖尿病及代谢综合征的流行病学调查

目的分析德阳市中江县年龄≥20岁农村居民糖尿病和代谢综合征的患病情况及相关因素。方法采用多阶段随机抽样的方法,从中江县随机抽取20岁以上常住居民共计678例进行问卷调查、人体测量学指标测定以及实验室检查。结果中江县年龄≥20岁常住人口糖尿病患病率为7.50%,其中男性为4.42%,女性为9.4%。性别、年龄、文化程度、肥胖、糖尿病家族史、脂代谢和高血压等因素与糖尿病患病率具有显著相关性(P0.05)。代谢综合征的患病率为44.3%。在糖尿病患者中,代谢综合征患者有40例,患病率为81.6%。结论糖尿病及代谢综合征的患病与多因素相关,应针对高危人群重点防控,降低糖尿病患病率,改善生存质量。     

北京市房山区居民代谢综合征流行特征分析

目的 了解目前北京市房山区居民代谢综合征患病情况及分布特征。 方法 采用多阶段分层随机抽样的方法,对4249名20岁以上房山区居民进行调查。按2004年中华医学会糖尿病学分会的诊断标准对代谢综合征的患病情况及其分布进行分析描述。 结果 该人群代谢综合征患病率为20.38%。随着年龄的增长,代谢综合征患病率有明显的上升趋势(2=252.34,P0.001),60岁患病率达到高峰。男性患病率为20.44%,女性为20.32%,男性与女性患病率差异无统计学意义(2=0.018,P0.05)。在40岁前,男性患病率高于女性,50岁后女性患病率高于男性。 结论 代谢综合征患病率在房山区呈现明显上升趋势,已经成为房山区居民的主要健康问题,开展代谢综合征的社区综合防治刻不容缓。     

社区人群糖尿病及代谢综合征的流行病学调查

目的:调查和了解上海市平凉社区>20岁人群糖尿病、代谢综合征及相关疾病的患病率。方法:采用多级分层随机抽样的流行病学方法,对平凉社区2200例常住居民进行问卷调查,并进行口服75g葡萄糖耐量试验、血脂谱、血压、身高、体重的测定。结果:平凉社区居民糖尿病,糖调节受损的患病率分别为9.90%,11.99%,代谢综合征、高血压、血脂紊乱、超重/肥胖的患病率分别为13.38%,35.46%,41.80%,43.93%;糖尿病与代谢综合征的患病率随年龄增加而增加(P<0.01)。结论:上海市平凉社区>20岁人群糖尿病、糖调节受损的患病率较高,代谢综合征及相关疾病的患病率较高,上述疾病的患病率及患病危险性均随年龄的增加而递增。     

锡林浩特市居民糖尿病患病情况及影响因素分析

目的了解锡林浩特市18岁以上居民糖尿病的患病情况及影响因素,为防治糖尿病提供科学依据。方法采用按比例多阶段随机抽样的方法抽取锡林浩特市住满5年的18岁以上居民2 411人进行面对面的问卷调查和体格检查。结果 2 411人中,糖尿病患者117人,患病率为4.85%,其中男性患病率为4.81%,女性患病率为4.87%,男女患病差异有统计学意义(P0.05)。糖尿病患病率随年龄的增加逐渐上升,随着BMI的增加呈升高趋势。经多因素分析显示,本研究人群糖尿病患病与年龄、家族史、腰围、BMI、吸烟饮酒、食盐摄入、文化程度有关。结论锡林浩特市糖尿病流行形势不容忽视,应继续加强社区糖尿病防治工作,对有家族史、超重肥胖的人群进行重点干预。     

在职作战部队中青年军官189名代谢综合征患病率调查

目的分析中青年军官人群代谢综合征患病现况及其特点。方法于2003-03/2004-08调查在解放军杭州疗养院疗养的解放军某部在职作战部队师旅团军官189人,均为男性;≥50岁76人,<50岁113人。根据中华医学会糖尿病学分会关于代谢综合征诊断标准判定调查对象代谢综合征患病情况,同时分析代谢综合征患病特点。对受测者年龄分层的数据进行描述分析,构成比的比较采用卡方检验。结果189人均进入结果分析。①被调查对象代谢综合征患病率为24.9%(47/189),其中≥50岁者明显高于<50岁者(34.2%,18.6%,χ2=5.94,P<0.05)。②患有代谢综合征的47人中,以血脂紊乱+中心性肥胖+高血压患病率最高(48.9%),高血糖+血脂紊乱+中心性肥胖+高血压患病最少(6.4%)。结论调查对象中1/4患代谢综合征,且年龄50岁以上患病率明显高于50岁以下者;在代谢综合征各组分中以血脂紊乱和中心性肥胖最常见。     

安徽省某社区40岁以上城镇常住居民脑卒中患病率及其危险因素分析

目的了解安徽省某社区≥40岁城镇居民脑卒中患病现况及其危险因素,为制定脑卒中早期干预措施提供参考。方法采取多阶段整群随机抽样的方法对安徽省某社区3823例≥40岁城镇常住居民进行问卷调查、体格检查以及颈动脉彩色多普勒超声检查。结果安徽省某社区≥40岁城镇常住居民脑卒中患病率为6.04%,年龄标化患病率为4.61%;231例脑卒中患者中,缺血性脑卒中167例(72.29%),出血性脑卒中61例(26.41%);出血型和缺血型脑卒中两者兼有3例(1.30%);多因素非条件logistic回归分析显示,年龄越大、有高血压病、糖尿病、心脏病、血脂异常、吸烟、明显超重或肥胖以及脑卒中家族史等情况的居民罹患脑卒中的危险度高于无上述情况的居民(均P0.05),且高血压病为罹患脑卒中最大的危险因素(OR=9.875,P0.01)。结论安徽省某社区≥40岁城镇常住居民脑卒中以缺血性脑卒中为主,应采取有针对性的综合干预措施预防和控制脑卒中的发生。     

延边农村朝鲜族和汉族居民代谢综合征及其相关因素比较

目的:了解延边农村地区朝鲜族和汉族居民代谢综合征的患病水平,并探讨其相关因素。方法:调查于2004-08/09完成。在延边地区图们市随机选择2个镇,选择30岁以上朝鲜族和汉族常驻居民,均自愿参加调查,排除混血家族成员。采用面对面的询问法收集调查对象的一般人口学特征、生活方式和代谢综合征相关疾病的家族史等资料,并测量其血压、体格指标及生化指标。代谢综合征的诊断依照中华医学会糖尿病学分会的诊断标准,即符合以下3条或3条以上者:①超重及肥胖:体质量指数≥25kg/m2。②高血压:收缩压≥140mmHg和/或舒张压≥90mmHg及已确诊的高血压并治疗者。③血脂紊乱:三酰甘油≥1.7mmol/L及或高密度脂蛋白胆固醇<0.90(男),1.0(女)。④高血糖:空腹血糖≥6.1mmol/L及确诊的糖尿病并治疗者。应用多因素相关回归分析法分析代谢综合征与其相关因素的关系。结果:调查中问卷、体格检查及生化指标完整者共1120人。①不同民族不同性别调查对象代谢综合征的患病水平:朝、汉族男性代谢综合征的粗患病率分别为27.6%和13.8%,女性分别为28.0%和12.1%;其标准化患病率,朝、汉族男性分别为24.97%,12.98%,女性分别为24.06%,11.67%。无论是粗患病率还是标化患病率朝鲜族男女均显著高于汉族(P<0.01)。②代谢综合征与相关因素的相关回归分析:朝鲜族代谢综合征与性别、吸烟量、酒精摄入量、腰围、腰臀比值、总胆固醇水平、心脑血管疾病家族史密切相关;汉族与性别、吸烟量、酒精摄入量、腰围、总胆固醇水平密切相关。结论:延边农村地区朝鲜族和汉族的代谢综合征患病水平存在明显的民族差异,朝鲜族的代谢综合征与性别、吸烟量、酒精摄入量、腰围、腰臀比值、总胆固醇水平、心脑血管疾病家族史密切相关,而汉族与性别、吸烟量、酒精摄入量、腰围、总胆固醇水平密切相关。     

社区中老年人主要慢性病患病率及吸烟行为的调查分析

[目的]了解社区中老年居民主要慢性病患病情况及吸烟行为的分布特征。[方法]2010年10月在郴州市北湖区城区的社区中随机抽取年龄≥35岁的常住居民326人进行主要慢性病患病情况及吸烟行为的调查。[结果]郴州市城区社区中老年居民高血压病患病率为12.9%,慢性阻塞性肺疾病的患病率为11.0%,心血管疾病患病率为7.9%,脑血管疾病患病率为5.2%,糖尿病患病率为3.7%。现在吸烟率为31.9%,重度吸烟率为9.8%,被动吸烟率为43.7%。主要慢性病患病情况与吸烟、重度吸烟行为呈正相关。[结论]社区中老年居民慢性病的健康教育和健康促进工作应进一步加强。     

太原市居民代谢综合征流行特征及危险因素分析

目的 了解太原市成年居民代谢综合征(MS)的患病率及流行特征,探索出相关危险因素.方法 采用分层整群随机抽样的方法 ,对太原市3869名年龄20岁居民进行横断面调查.计算代谢综合征及各组分的患病率,采用多元回归分析代谢综合征的相关危险因素.结果 按照国际糖尿病联盟标准,太原市成年居民代谢综合征的标化患病率为17.8%(男性15.2%,女性20.4%,P0.001),按照美国国家胆固醇教育项目成人治疗组标准,标化患病率为12.2%(男性9.9%,女性14.6%,P0.001),按照中华医学会糖尿病学分会标准,标化患病率为17.5%(男性20.1%,女性14.8%,P0.001).年龄和体质指数增高为男性和女性代谢综合征的危险因素,职业为脑力工作者为男性的危险因素,无业、经常吃腌制食品为女性的危险因素,适量运动(4～5天/周,每天30 min以上)为男性保护因素,适量饮酒(酒精含量30 g/d)为女性的保护因素.结论 代谢综合征已成为影响太原市居民生命和健康的重大公共卫生问题,亟需制定包括控制体重、确保适量的体力活动的综合性防治策略.     

社区高尿酸血症患病及危险因素分析

本研究采用多阶段分层随机抽样的方法,对社区部分常住人口的高尿酸血症患病情况进行问卷调查,运用统计软件进行数据汇总和单因素及多因素非条件logistic回归分析。结果本社区居民血尿酸的平均值为276.0±67.8mmol/L;符合高尿酸血症诊断标准的患病率为4.1%,其中男性患病率为7.9%,女性患病率为1.8%,平均患病年龄为45.1±11.8岁,女性平均患病年龄高于男性;高甘油三酯、性别、肥胖、高血压、高血脂等是高尿酸血症的主要危险因素。本社区居民高尿酸血症患病率不高,但患病的年龄有提前的趋势,控制饮食、戒除不健康的生活方式可以有效地降低高尿酸血症的患病率。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.