广州市东山区SARS流行病学调查

目的：及时了解SARS在东山区人群的流行特点，为进一步的预防控制工作提供资料。方法：通过对医院报告病例的汇总与对病例的流行病学调查，了解流行概况和流行特点。结果：累计至2003年4月30日．东山区共报告127例确诊SARS病例，其中医务人员33例，退休人员32例，家务待业8例，国家干部23例，商业、工人和其他人员19例，学生10例，儿童2例。人群对非典型性肺炎的易感性除医务人员为医院聚发外，还有6户为家庭聚发，其余均为散发。在本次SARS流行过程中，有接触史的病人共有49人，占总发病的38．6％，主要以医务人员为主，还有61．4％的病人无明显接触史。结论：此次非典型性肺炎传染性强，传播面广，应及时采取有效的相应预防措施，疫情才能得到有效控制。     

一起SARS暴发传播链的调查分析

目的 分析SARS暴发案例的传播特点,评价SARS在发病前后的传染性。方法 以一起主要发生在北京的SARS暴发为研究对象,采用回顾性调查的方法,用统一的调查表,以现场调查和电话调查相结合的方式对275例接触者进行线索追踪和个案调查。用传播链示意图分析传播关系,用接触史分析图分析传染性。结果 本起SARS暴发传播链中的接触者275人,发病41例(不包括先证者),死亡5例,罹患率14．9％,病死率12．2％。其中家族病例19例(占46．3％),单位聚集病例13例(占31．7％)、社区病例8例(占19．5％),私人诊所医生1例(占2．4％)。其传播过程可用传播链清晰地描述。41例病例均与前代病例的症状期有密切接触史;仅与前代病人潜伏期接触的114人无一人发病;未发现无症状的密切接触者有传染性。无防护地照顾护理病人最危险,其次是一起居住、看望病人和给SARS病人看病。本案例的潜伏期为1～10d,中位数为3d。结论 全部SARS病人在发病前均与其前代病例症状期有过密切接触;传染性的强弱与SARS病人与密切接触者的接触方式有关;未观察到SARS病人潜伏期有传染性。     

80例SARS病例的流行病学调查

目的:了解严重急性呼吸道综合征(Severe Acute Respiratory Syndrome, SARS,即非典型肺炎)的流行特点、规律及传播途径.方法: 对80例SARS患者进行流行病学调查分析.结果:72例患者(90%)有明确的SARS患者接触史,接触时间最短仅20 min,潜伏期2～20天,平均为(7.6±4.3)天.80例患者中医务人员占66.3%(53/80),非医务人员为33.7%(27/80);两组中有接触史的例数分别为49例(92.5%)和23例(85.2%),两者的潜伏期相近.护士的患病人数多于医生及护工,分别为29人(54.7%)、18人(34%)和6人(11.3%);非医务人员患者中职员(8/27,29.6%)和服务人员(6/27,22.2%)的比例较高.以医院或家庭聚集性发病为特点,防护和隔离措施不到位是SARS爆发流行的主要原因.结论:密切接触是SARS的主要传播途径,潜伏期为2～20天,平均(7.6±4.3) 天.发病以医院或家庭聚集形式多见,良好的防护措施可明显降低SARS的发病率;早期的隔离能有效地控制和预防SARS的传播和流行.     

2003年北京市东城区SARS爆发流行特征

目的 分析2003年3月～5月间北京市东城区严重急性呼吸综合征(severe acute respiratory syndrome,SARS)爆发流行特征。方法 根据东城区疾病预防控制中心的疫情日报表,以及从其他渠道收集补充的信息进行分析。病例的诊断按照卫生部颁布的标准。用Excel软件建立数据库,用SPSS软件统计分析。结果 东城区首例发生于3月14日(3月16日人院),至4月中、下旬发病达高峰,5月5日开始下降,5月22日后未再发生新的临床诊断病例,5月24日、6月10日曾发生3例疑似SARS,后均被排除。共报告572例住院,99例在住院治疗过程中因被确诊为上感、普通肺炎、出疹性疾病等排除了SARS的诊断,实有473例SARS及疑似SARS。各年龄组人群普遍易感,以20～50岁最多,占总病例数的68．7％,平均发病年龄为40．7岁。病例的男女比例差异无显著性。SARS病例呈现明显的家庭聚集现象。医务人员病例占总数的18．0％,离退休人员占15．4％。全区10个街道均有病例发生。按常住人口计算,罹患率为28．3／10万。报告病例中,先后在区属二级医院住院的230例,占40．2％。85例医务人员SARS及疑似SARS病例中,18例发生在四所区属二级医院,占其在SARS病房或发热门诊工作的医务人员总数的4．5％。34．7％的SARS病例在病前无任何接触史。4l例SARS病例死亡,病死率8．7％。SARS病例的密切接触者罹患率为7．4％。结论 2003年3月～5月间东城区爆发流行SARS,人群普遍易感,主要威胁青壮年、医务人员、离退休人员。与患者直接接触是主要的传播方式。民工集中的建筑工地、医院是SARS防控的重点。现行的防治策略和措施对控制SARS流行是有效的。     

北京市临床诊断SARS病例的流行病学调查资料初步分析

目的 分析北京临床诊断SARS病例流行病学资料。方法 利用SPSS软件，结合北京市2000年人口数，进行临床诊断SARS病例流行病学特征的描述和分析。结果 确诊SARS的发病率为1．04／万，死亡率为5．75／百万。病死率为5．42％。20—29岁年龄组发病率最高，医务人员(27．8％)发病比例最高，男女发病率差异不大。有明确接触史的占38．1％。结论 家庭内传播和医院内传播是病例迅速上升的主要原因，控制传染源后疫恃得到有效控制。     

广州市传染性非典型肺炎家庭聚集性情况分析

目的 了解此次传染性非典型肺炎爆发中家庭聚集病例的发病情况，发现其感染来源及传播途径，为防止家庭聚集病例发生提供参考。方法 描述性研究、电话随访。结果 家庭聚集病例感染主要来自医院，占家庭聚集总病例的77．78％；与病人只有单纯生活接触的发病较少，占家庭聚集总病例的22．22％。     

某医院医务人员院内感染SARS的流行病学调查及分析

目的 调查某医院医务人员院内感染SARS的流行病学特征。方法 对此次SARS院内感染的相关人员进行流行病学调查。结果 共13例护理人员发生院内SARS感染，输入性传染源为一女性肿瘤患者的丈夫，这名确诊SARS的丈夫在发病期间与其妻至少有2周医院内密切接触史。13例中8名是后来借调入该肿瘤患者入住科室的，她们感染SARS的平均潜伏期为12．6d。对与13例SARS病例在潜伏期内(1例为发病早期)有密切接触者共57人进行追踪观察1月．结果无l例感染SARS。结论 SARS病人在潜伏期没有传染性或传染性不大。感染SARS与接触传染源的程度以及持续接触时间有关。SARS的发病可能与机体的免疫状况有关，SARS的病理基础可能与免疫损害有关。免疫抑制病人可能成为SARS的无症状病毒携带者和传染源。     

198例SARS转归病例特征分析

目的：通过对198例转归SARS病例的分析，了解SARS病例的流行特征以及影响转归的因素。方法：采用病例调查和电话回访等方式，收集SARS病例的资料，运用SPSS、Excel进行统计分析，并建立转归影响因素的Logistic回归模型。结果：198例SARS患中治愈179例，死亡19例，病死率为9．60％，患年龄为9～79岁，男性占56．67％，女性占43．43％，医务人员占37．88％，所有病例中，平均转归时间为30．59d(痊愈病例为31．92d，死亡病例为18．21d)，有明显的家庭和医院聚集性。应用Logisitic回归分析影响转归的因素，模型为：Y=[1 e^(4.958-0.107X1 0.065X2)]^-1(X1-年龄、X2-住院时间)，年龄越大，住院时间越短，死亡的危险越高。结论：密切接触是SARS的主要传播途径，发病以家庭和医院聚集性多见，影响转归的因素主要有年龄、住院时间等。     

一起SARS爆发流行的调查研究

目的：分析一起SARS爆发流行的病例分布特点，了解传播途径，为有效控制SARS的发生与蔓延提供科学依据。方法：采用回顾性调查和现场流行病学调查方法，对SARS局部爆发进行调查，利用Exce15．0软件和SPSS10．0软件分析该起SARS病例的时间分布、空间分布和人群分布及聚集性特征。根据传播链分析传播关系。结果：由首发病例(指征病例)引起感染或继发感染病人79例，年龄分布在19～69岁，男性占51．89％，女性占48．11％。发病人群包括护士、医生、同期住院患、家属、其他人员人员，分别占36．71％、12．66％、7．59％、10.13％和32．99％。病例分布有四个时段，医护人员发病时间主要集中于第一、二个高峰时段，院内非医护人员和院外人员发病时间集中第三高峰，医务人员家属发病时间主要分布在第四个时段。密切接触是SARS传播的主要途径，尤其是近距离接触病例获得感染的机会比较大，SARS病例空间分布主要集中在几个科室，结论：该起SARS流行分布具有明显的聚集性，为典型的院内SARS爆发感染；医务人员应对飞沫和接触性传播采取严格的控制措施，加强对该病的防范意识。     

广州市43例SARS死亡病例流行病学特征分析

目的对43例SARS死亡病例进行流行病学特征分析，初步探讨SARS死亡的影响因素。方法对SARS患死亡报告资料汇总并进行描述性流行病学分析。结果广州市自2003年1月2日发生首例SARS病例，至5月17日末例止，与SARS相关的死亡病例43例，病死率为4.04％(43／1065)。其中离退休人员病死率最高，为15.15％(20／132)；医护人员病死率较低，为2．48％(7／282)。死年龄在5岁至89岁之间，以60岁以上为主，占50％。以1月份发病的病死率最高，为12.86％。死亡病例中合并有其他疾患，如高血压、糖尿病、心脏病、肺气肿、肿瘤等的占53.48％。结论SARS是可防可治的，广州市在疾病流行过程中探索出的治疗措施可有效降低病死率。SARS患死亡的危险因数是年龄60岁以上，有基础疾病，有明确接触史。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.