沈阳市细菌性痢疾疫情分类回归树分析

目的探讨细菌性痢疾疫情与气象因素的关系。方法以沈阳市1950-1996年细菌性痢疾月发病率为响应变量,以气温、气压、降水量、蒸发量等气象指标为预报变量,利用软件R2.31构建回归树模型,应用SPSS13.0进行相关分析。结果对发病率进行拟合的预测值与实际值相符合,优于传统线性回归方法。在温度指标体系中,最低温度指标与细菌性痢疾关系最为密切。多因素回归树中,最低气温、降水量和气压最显著。结论回归树模型是处理异质性数据的有效工具,既简单实用又便于解释,在疫情预测方面具有广阔应用前景。     

糖尿病肾病患者中医证候要素敏感性与多样性的关系

Objective: To explore the relationship between Chinese medicine (CM) constitutive susceptibility and syndrome diversity in diabetic nephropathy (DN). Methods: Epidemiologic investigation on constitution adopting the "Constitution in Chinese Medicine Questionnaire" (CCMQ), and survey on syndrome type by CM syndrome scale (preliminary) were carried out in 180 DN patients. Cluster analysis on symptom items was used to determine the syndrome type, and canonical correlation analysis was used to analyze the relationship between patients'' constitution and syndrome. Results: Baseline levels in all enrolled patients were not different statistically. Cluster analysis showed 8 syndromes existed in DN patients, namely: Ⅰ, qi-yin deficiency with qi-stagnancy type; Ⅱ, yin-yang deficiency with heat-water-blood stasis type; Ⅲ, qi-yin deficiency with dampness-heat type; Ⅳ, yin-yang deficiency with blood-stasis and heat type; Ⅴ, qi-yin deficiency with stagnant heat type; Ⅵ, yin-yang deficiency with inner dampness-heat stagnancy type; Ⅶ, yin deficiency with heat stagnancy type; and Ⅷ, Kidney (Shen)-Spleen (Pi) deficiency with stagnant heat type. Correlation analysis on the 8 syndromes and the 9 constitutions showed statistical significant correlations between syndrome Ⅲ and dampness-heat constitution (P=0.0001); syndrome Ⅳ and blood-stasis constitution (P=0.0001); and syndrome Ⅶ and yin-deficiency constitution (P=0.0180). Conclusion: Certain relationship revealed between CM constitutions and syndrome types; constitution decides the disease genesis, its syndrome type and prognosis, as well as the change of syndromes.     

气温对兰州市细菌性痢疾发病的滞后效应研究

目的：探讨日均气温对兰州市细菌性痢疾发病的影响及其滞后效应。方法：收集兰州市2008-2015年每日细菌性痢疾发病资料,结合同期气象资料,利用分布滞后非线性模型（distributed lag non-linear model,DLNM）分析日均气温与细菌性痢疾发病的关联性。结果：日均气温与细菌性痢疾发病的暴露-反应关系呈“J”型,最低发病温度为17 ℃,对不同性别、年龄人群高温效应影响均大于中间效应。高温效应和中间效应对男、女性人群均表现为急性作用,当天的效应值最高,随后波动下降,高温效应对女性影响更大。在不同年龄段人群中,0~3岁组人群的细菌性痢疾发病的高温效应和中间效应均最大;高温效应和中间效应对0~3岁、19~64岁人群均表现为急性作用,当天的效应值最高,随后波动下降,而≥65岁者当天发病,之后下降,再缓慢波动上升。相对于最低发病温度17 ℃,高温（32 ℃）和中间温度（26 ℃）均能增加细菌性痢疾发病的风险,以滞后14 d累计效应最大,在男性、女性、0~3岁、4~11岁、12~18岁、19~64岁、≥65岁人群中,中间温度对细菌性痢疾发病RR（95%CI）值分别为2.30（1.53~3.13）、2.45（1.65~3.30）、2.41（1.59~3.28）、2.54（1.40~3.79）、1.82（0.41~3.43）、1.98（1.11~2.93）、1.73（0.68~2.88）,高温时RR（95%CI）值分别2.93（1.38~4.69）、3.08（1.48~4.9）、3.26（1.60~5.16）、3.12（1.06~5.56）、1.94（0.73~5.39）、2.31（0.54~4.36）、2.06（0.02~4.51）。结论：高温可显著增加细菌性痢疾的发病风险,女性和3岁以下人群是敏感人群。气象因素在兰州市细菌性痢疾的发生和发展中发挥重要作用,细菌性痢疾发病受到多种气象因子共同作用的影响,但首要影响因素是高温。气温对细菌性痢疾发病不是直接作用,而是通过影响细菌性痢疾发病的各个环节（居民生活习惯、传播途径与易感人群自身体质）,间接影响细菌性痢疾在人群中的分布。     

利用共同条件分析及中草药配伍确定微观层次上痴呆的研究方向

Objective： To identify the position of traditional herbal medicine in dementia research field using mapping technology. Methods： Keywords for dementia and traditional herbal medicine for treating dementia were used to extract scientific articles from the Web of Science database from January 2000 to July 2010. A co- occurrence matrix was created based on the concurrent set of author＇s keywords occurring in each scientific article, and technology network maps were created from similarity index matrices. Results： Twenty specialized research areas were identified in the dementia field, and the relationship strength was 0.2-0.6. Many research fields were associated with diagnosis and risk factors for dementia. Additionally, the mechanism or cause of dementia is an actively studied field. Traditional herbal medicine for treating dementia was located on a map near the cortical dementia diagnosis and therapy, and frontotemporal dementia research field with a relationship strength of 0.53 and 0.31-0.33 respectively, which demonstrates that traditional herbal medicine for dementia occupies an independent research area with a relationship to existing scientific research fields. Conclusion： Traditional herbal medicine can provide an alternative and complementary approach for treating dementia as evidenced by a scientific mapping analysis.     

An unusual case of cancer of the urachal remnant following repair of bladder exstrophy

Introduction

We report the first case of cancer of the urachal remnant following repair of bladder exstrophy, in a renal transplant recipient.

Method

A retrospective review of this clinical case and the associated literature were performed.

Conclusion

This unusual case highlights two very rare entities. Bladder exstrophy has an incidence of 1 in 50,000 newborns, whereas urachal cancer accounts for less than 1% of all bladder tumours.     

Clinical observation on effect of Yishen Jiedu Recipe in retarding the course of chronic renal failurein retarding the course of chronic renal failure

Objective

To observe the effect of Yishen Jiedu Recipe (YSJDR) in retarding the course of chronic renal failure (CRF)

Methods

Forty-five patients were divided into two groups, the 22 patients in Group A were treated with low-protein diet and blood pressure controlling therapy only, while the 23 patients in Group B were treated with additional YSJDR. The time (month) for doubling serum creatinine (SCr) level was taken to evaluate the speed of CRF progression

Results

In Group A, the time for SCr increased from 288.4±96.7 μmol/L to 586.3±251.3 μmol/L was 16.7±5.1 months, while in Group B the time for SCr increased from 291.2±101.2 μmol/L to 589.6±257.5 μmol/L was 28.2±8.7 months. Comparison between the two groups showed significant difference (P<0.05 )

Conclusion

On the basis of low-protein diet and blood pressure controlling therapy, the additional treatment of YSJDR could markedly retard the progression speed of CRF     

中药“性质-家族-组成”网络的关联规则挖掘研究

Objective

To explore appropriate methods for the research of the theory of Chinese medicine nature property and find the relationship between Nature-Family-Component of Chinese herbs.

Methods

From perspective of systems biology, we used Associate Network to identify useful relationships among “Nature-Family-Component” of Herbs. In this work, Associate Network combines association rules mining method and network construction method to evaluate the complicate relationship among “Nature-Family-Component” of herbs screened.

Results

The results of association rules mining showed that the families had a close relationship with nature properties of herbs. For example, the families of Magnoliaceae, Araceae had a close relationship with hot nature with confidence of 100%, the families of Cucurbitaceae has a close relationship to cold nature with confidence of 90.91%. Moreover, the results of constructed Associate Network implied that herbs belonging to the same families generally had the same natures. In addition, some herbs belonging to different families may also have same natures when they contain the same main components.

Conclusion

These results implied that the main components of herbs might affect their natures; the relationships between families and natures were based on the main compounds of herbs.     

The effect of inclement weather on trauma orthopaedic workload

Background

Climate change models predict increasing frequency of extreme weather. One of the challenges hospitals face is how to make sure they have adequate staffing at various times of the year.

Aims

The aim of this study was to examine the effect of this severe inclement weather on hospital admissions, operative workload and cost in the Irish setting. We hypothesised that there is a direct relationship between cold weather and workload in a regional orthopaedic trauma unit.

Methods

Trauma orthopaedic workload in a regional trauma unit was examined over 2 months between December 2009 and January 2010. This corresponded with a period of severe inclement weather.

Results

We identified a direct correlation between the drop in temperature and increase in workload, with a corresponding increase in demand on resources.

Conclusions

Significant cost savings could be made if these injuries were prevented. While the information contained in this study is important in the context of resource planning and staffing of hospital trauma units, it also highlights the vulnerability of the Irish population to wintery weather.     

某市暴雨洪涝对细菌性痢疾发病影响的 时间序列分析

目的 定量评价广西省柳州市暴雨洪涝对细菌性痢疾发病的健康效应。方法 运用时间序列分 析,控制长期趋势、季节趋势、滞后效应和气象因素等混杂因素的基础上,采用季节性自回归移动平均模型 （SARIMA）定量分析洪水历时与居民细菌痢疾发病的关系。结果 研究发现发生洪水月份的细菌性痢疾发病 率高于对照月份。SARIMA 回归分析显示月洪水历时与细菌性痢疾月罹患率呈负相关,月洪水历时天数每增加 1 d,其细菌性痢疾罹患率下降7.7% ～ 8.0%。结论 暴雨洪涝对细菌性痢疾的发病产生明显影响,特别是历时 短的严重洪水相比历时长的一般洪水造成细菌性痢疾发病风险更高。     

Effect of prevention and treatment of murine acute viral myocarditis and protection of lymphoid organ atrophy with xinkang oral liquid

Objective

The effect of prevention and treatment of Xinkang oral liquid, ( , XKOL) on experimental coxsackievirus B₃ (CVB₃) myocarditis mice model were investigated.

Methods

The mice were inoculated intraperitoneally with 0.3 ml of 10⁵ TCID₅₀ of CVB₃ to induce acute viral myocarditis model. These mice were divided into model control group (Group A), prevention high dosage group (Group B) and prevention low dosage group (Group C), treatment high dosage group (Group D) and treatment low dosage group (Group E), respectively. In addition, XKOL control group (Group F) and normal control group (Group G) were not infected with CVB₃ intraperitoneally. The administration of XKOL in Group B and C began 2 days before virus infection. All animals were sacrificed on day 20 for evaluation.

Results

Histological examination showed extensive myocardial necrosis and cell infiltration in most of Group A mice, but necrosis and cell infiltration were less severe in Group B,C,D and E mice. Thymus weight in Group B,C,D and E mice were heavier and less cell depletion occurred than those in Group A.

Conclussion

The XKOL could effectively inhibit myocardial CVB₃ replication, reduce the myocardial inflammatory response, lower incidence rate of myocarditis and prevent the disease associated lymphoid organ atrophy in this animal models.     

Mean platelet volume predicting carotid atherosclerosis in atherothrombotic ischemic stroke

Background

Platelets are involved in atherosclerosis. Mean platelet volume (MPV) could be a marker of platelet activation. We aim to determine whether MPV levels were correlated with the presence of atherosclerotic disease in carotid arteries of patients with stroke.

Methods

We recruited 215 patients with atherothrombotic stroke. All the participants underwent ultrasonographic evaluation of their extracranial carotid arteries. MPV was measured in automated hematology analysis system. The subjects were divided according to plaques and severity of carotid stenosis. Univariate and multivariate statistical analyses and a ROC curve to predict carotid stenosis were performed.

Results

Univariate analysis showed a positive relationship between MPV and the degree of carotid atherosclerosis (p?p?p?p?Conclusions Our results indicate that an elevated MPV could be an easily measurable marker of severity of carotid stenosis in patients with atherothrombotic stroke.     

A survey of the prevalence of persistent pain after vaginal delivery: a pilot study

Introduction

Pain that has lasted for 2 months is considered to be persistent, as defined by The International Association for the Study of Pain (IASP). To date, there is no data on the incidence of persistent pain after vaginal delivery available for Ireland. The aim of this pilot study is to determine the incidence of persistent pain in women post-vaginal delivery at 8 weeks postpartum in the Coombe Women’s & Infants University Hospital, Dublin (CWIUH).

Methods

50 women post-vaginal delivery at the CWIUH were recruited over a 2-month period. At 8 weeks after delivery, the patients were contacted by telephone interview to assess the presence of pain, if any, using a modified painDETECT Questionnaire.

Results

The incidence of persistent pain at 8 weeks from our pilot study is 28 %.     

Monitoring Clostridium difficile infection in an acute hospital: prevalence or incidence studies?

Background

Surveillance of Clostridium difficile infection (CDI) is an essential component of a CDI preventative programme.

Aims

The aim of this study was to evaluate two methods of CDI surveillance.

Methods

Prevalence of CDI, antibiotic use and associated co-morbidity was assessed weekly on two wards over 6?weeks. In addition, CDI incidence surveillance was performed on all new CDI cases over a 13-week period. Cases were assessed for CDI risk factors, disease severity, response to treatment and outcome at 6?months.

Results

Clostridium difficile infection prevalence was 3.5% (range 2.9?C6.1%) on the medical ward and 1.1% (range 0?C3.5%) on the surgical ward. Patients on the medical ward were older and more likely to be colonised with MRSA; however, recent antibiotic use was more prevalent among surgical patients. Sixty-one new CDI cases were audited. Patients were elderly (mean age 71?years) with significant co-morbidity (median age adjusted Charlson co-morbidity score 5). CDI ribotypes included 027 (29 cases) 078 (5) and 106 (4). Eight patients developed severe CDI, seven due to 027. Antibiotic use was common with 56% receiving three or more antibiotics in the preceding 8?weeks. Twenty-four patients had died at 6?months, five due to CDI.

Conclusion

Clostridium difficile infection prevalence gives a broad overview of CDI and points to areas that require more detailed surveillance and requires little time. However, patient-based CDI incidence surveillance provides a more useful analysis of CDI risk factors, disease and outcome for planning preventative programmes and focusing antibiotic stewardship efforts.     

An assessment of intrathecal catheters in the perioperative period: an analysis of 84 cases

Background

Intrathecal opioid administration yields high quality analgesia with an associated low incidence of side effects and complication. The benefits of spinal “opioid only technique” include absence of neuronal blockade, infusion pump malfunction and sympathetic blockade. This technique declined after serious side effects were reported in the 1990s.

Aims

To report on the safety and efficacy of the intrathecal catheter repeat bolus morphine technique for postoperative analgesia in patients having thoracotomy.

Methods

A 22 gauge intrathecal catheter was inserted through the lumbar 3–4 interspace prior to induction of anaesthesia for postoperative analgesia. Repeat bolus preservative-free morphine was administered for 48 h, target VAS was <4.

Results

The mean morphine administered via ITC in 48 h was 2.56 mg (±SD 0.88 mg). Only one patient required rescue morphine. There were no serious complications or sequelae at 6-month follow-up.

Conclusions

Intrathecal morphine for post-op analgesia is efficacious and safe in a post-thoracotomy population.     

Vitamin B12 status, homocysteine and mortality amongst community-dwelling Irish elders

Background

Vitamin B12 deficiency is associated with hyperhomocysteinaemia, which is associated with atherosclerosis and increased mortality. High levels of vitamin B12 have also been associated with increased mortality in certain patient populations.

Aims

We examined vitamin B12 and homocysteine status and mortality rates in a population of Irish community-dwelling elders over a 3-year period.

Methods

Prospective, community-based observational cohort study.

Results

Subjects in the highest quartile of homocysteine had increased mortality rates (14.68 vs. 7.32%, relative risk 2.09). This relationship was attenuated when controlled for the presence or absence of a history of stroke or myocardial infarction. There was no relationship between vitamin B12 status and mortality during the observation period.

Conclusion

Vitamin B12 levels are not associated with death rates in Irish community-dwelling elders. Homocysteine levels are associated with mortality and may act via the mechanism of atherosclerotic disease.     

Plasma ghrelin levels and polymorphisms of ghrelin gene in Chinese obese children and adolescents

Aim

To evaluate the role of fasting plasma ghrelin levels [ln(ghrelin)] and polymorphisms of ghrelin gene in Chinese obese children.

Methods

Genotyping for ghrelin polymorphism was performed in 230 obese and 100 normal weight children. Among them, plasma ghrelin levels were measured in 91 obese and 23 health subjects.

Results

(1) Bivariate correlation analysis showed the ln(ghrelin) was inversely correlated with abnormality of glucose metabolism (r = ?0.240, P = 0.023). Stepwise multiple regression analysis showed that abnormality of glucose metabolism was an independent determinant of plasma ghrelin levels (P = 0.023). (2) There was no difference in frequency of Leu72Met polymorphisms between obese and control groups (36.09 vs. 41.00%).

Conclusion

Ghrelin is associated with obesity in childhood, especially associated with the glucose homeostasis. Lower ghrelin levels might be a result of obesity, but not a cause of obesity. The Leu72Met polymorphism of ghrelin gene is not associated with obesity and metabolic syndrome in Chinese children.     

Risk factors for surgical site infection following operative ankle fracture fixation

Background

Ankle fracture is a common injury and there is an increasingly greater emphasis on operative fixation.

Aim

The purpose of the study was to determine the complication rate in this cohort of patients and, in doing so, determine risk factors which predispose to surgical site infection.

Methods

A prospective cohort study was performed at a tertiary referral trauma center examining risk factors for surgical site infection in operatively treated ankle fractures.

Results

Univariate and multivariate analysis was performed. Female gender and advancing age were determined to be the risk factors in univariate analysis. Drain usage and peri-operative pyrexia were found to be significant for infection in multivariate analysis.

Conclusion

This study allows surgeons to identify those at increased risk of infection and counsel them appropriately. It also allows for a high level of vigilance with regard to soft tissue handling intra-operatively in this higher risk group.     

稳定性冠心病患者中医证候演变与心血管事件的多因子降维分析

Objective： To analyze the correlation of Chinese medicine syndrome evolvement and cardiovascular events in patients with stable coronary heart disease （CHD）. Methods： This prospective cohort study investigated and collected the clinical information of patients with stable CHD and observed the syndrome type at the baseline and 6-month at follow-up, as well as the cardiovascular events during the 6-month and 12-month follow-up. The patients were divided into the event group and the non-event group. The interaction and the impact of syndrome evolvement on cardiovascular events were examined through multifactor dimensionality reduction （MDR） analysis and the results were verified by Chi-square test. Results： Totally 1,333 of 1,503 stable CHD patients enrolled met the inclusion criteria of MDR analysis. Among them, 959 （71.9%） cases were males and 374 （28.1%） cases were females. Thirty seven cases had cardiovascular events during 6 to 12 months after the study began. The results of the MDR analysis and verification using Chi-square test showed that the development of cardiovascular events was positively correlated with interaction between blood stasis and toxic syndrome at the baseline, blood stasis at the baseline and qi deficiency at the 6-month follow-up, toxic syndrome at the baseline and qi deficiency at the 6-month follow-up, toxic syndrome at the base line and blood stasis at the 6-month follow-up, qi deficiency and blood stasis at the 6-month follow-up （P〈0.05 for all）. Conclusions： Blood stasis, toxic syndrome and qi deficiency are important factors of stable CHD. There are positive correlation between cardiovascular events and syndrome evolution from blood stasis to qi deficiency, from toxic syndrome to qi deficiency and from toxic syndrome to blood stasis, indicating the pathogenesis of toxin consuming qi, toxin leading to blood-stasis in stable CHD patients prone to recurrent cardiovascular events.     

Timeliness of care and prognosis in patients with lung cancer

Background

Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain.

Aims

To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients.

Methods

A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival.

Results

A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay.

Conclusions

The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.     

Farm-related trauma in the west of Ireland: an occupational hazard

Background

Farm fatalities in Ireland remain at their highest recorded levels despite the introduction and implementation of several farm safety initiatives during recent years.

Aims

The aim of this study was to examine all farm-related morbidity and mortality presenting to a general hospital in the west of Ireland.

Methods

A consecutive series of all farm-related fatal and non-fatal injuries presenting to our institution over a 7-year period (2005–2011) was compiled by examining the hospital inpatient enquiry system and mortuary records.

Results

One hundred and thirty patients were admitted to Mayo General Hospital with non-fatal farm-related injuries during the study period. This cohort was comprised 104 males and 26 females with an average age at presentation of 46 (range 19–75) years. The most common mechanism of non-fatal injury was animal attack. The mean length of hospital stay, mean length of ICU stay and total number of bed days used were 5.2, 5.3 and 677 days, respectively. There were seven farm-related fatalities during the same study period. Four were livestock-related, two due to machinery accident and one due to fall of a heavy object. The post-mortem findings were analysed in each case.

Conclusions

This analysis outlines the incidence and severity of fatal and non-fatal injuries sustained in the farming workplace and presenting to a general hospital serving a rural catchment population. Greater awareness of our results may help reduce the longterm incidence and magnitude of such injuries.