海南省三亚市1名间日疟原虫带虫者的调查与处置

目的分析和总结海南省三亚市天涯区高峰一名间日疟原虫带虫者的调查与处置,为防治和消除疟疾提供科学依据。方法通过回顾性调查收集该带虫者发现、诊断及处置等的相关信息,查阅三亚市历年疟疾资料等。结果在处置1起本地三日疟疫情中,通过PCR(巢式)检测发现1名间日疟无症状感染者,该无症状感染者入院治疗时无畏寒、发热等不适症状,体温正常,血常规检查未见异常,血涂片镜检和RDT检测均为阴性,但是PCR(巢式)检测为阳性;该无症状感染者为三亚本地居民,既往无疟疾史和输血史。近3年,未曾外出务工,也无畏寒、发热等疟疾临床表现;该无症状感染者经治疗后,多次随访血涂片镜检、RDT和PCR(巢式)检测均为阴性。后经另一个省级疟疾诊断参比实验室通过PCR荧光探针法检测该感染者治疗前采集的血样,其结果为阴性。随访至今该感染者无复发,现正常工作和生活。结论该间日疟原虫带虫者虽然一开始被诊断为本地间日疟无症状感染者,但其流行病学调查结果没有直接和明显的证据支持。此外,两次不同PCR方法的检测,其结果不一样,故不能排除第一次PCR检测结果为假阳性的可能。提示今后碰到此类情况,除考虑流行病学调查情况和临床表现的同时,还需寻求更多准确和有力的证据。     

万宁市原疟疾高流行地区全球基金疟疾项目实施效果评价

目的 通过评价和分析万宁市原疟疾高流行地区全球基金疟疾项目的实施效果,揭示海南山区消除疟疾的过程和规律,为海南消除疟疾提供参考.方法 对该地区4个乡镇和4个国营农场近10年来疟疾发病率监测、居民疟原虫率监测、外来流动人口疟疾监测和媒介按蚊监测资料进行综合分析.结果 显示10年来4个乡镇和4个农场均达到较高的发热病人年血检率(15％～25％),其疟疾发病率变化趋势相一致,疟疾发病率自2010年下降至零、居民疟原虫率和外来流动人口疟疾感染率也下降至零,当地两种主要传疟媒介微小按蚊和大劣按蚊种群密度已下降至很低的水平.结论 传疟媒介密度大幅度降低,加之及时发现和治疗病人,是疟疾得以稳定快速下降的主要原因.当地已步入消除疟疾阶段.全球基金疟疾项目实施加速了当地消除疟疾的进程.     

连云港市两例间日疟病例疫情分析

目的对连云港市2017年报告的两例间日疟病例开展流行病学调查处置和风险评估,指导全市有效应对疟疾疫情。方法收集病例基本信息、流行病学调查资料、血片及PCR核酸基因检测复核、疫点周边自然环境和当地媒介监测数据,并对疫点进行分类;对其中1例间日疟病例家属及四邻共40人开展主动病例侦查。结果 2例均为间日疟病例均在非洲有明确的生活史和疟疾病史,连云港市已经连续8年无本地感染的间日疟病例,主动病例侦查显示:快速诊断试纸条检测(rapid diagnostic test,RDT)和PCR检测40人结果均为阴性。结论 2例间日疟病例均为境外输入。连云港地区存在传疟媒介中华按蚊,要加强对境外输入性疟疾疫情的防控,防止继发二代病例的发生。     

成都市疟疾消除后阶段传染源监测检验方法的研究

目的评估疟疾传染源监测检验方法的诊断效率,探索监测工作中用快速诊断检测(RDT)作为常规检测手段的可能性。方法采集成都市2016年7月-2018年3月中国疾病预防控制信息系统报告的疑似、临床诊断、确诊的疟疾病人的血样。分别采用血涂片显微镜检查、RDT及聚合酶链反应(PCR)进行检测。RDT试剂分别采用国产(广东万孚)和进口(Binax Now)进行检测。结果共报告141例病例,确诊136例,均为输入性病例。镜检诊断效率为87.23%,PCR诊断效率为92.91%。进口RDT诊断效率为92.20%;对恶性疟的敏感度为98.85%,恶性疟以外疟疾的敏感度为79.59%。国产RDT诊断效率为95.74%,对恶性疟敏感度为97.72%,恶性疟以外疟疾的敏感度为95.92%。进口RDT分别与镜检及PCR结果比较差异有统计学意义(χ2=162.80,P0.05;χ2=128.77,P0.05)。诊断效率由高到低排位为:RDT、PCR、镜检。国产RDT与进口RDT检测结果比较差异有统计学意义(χ2=259.71,P0.05),国产RDT对卵形疟更灵敏。结论 RDT具有较高的诊断效率,可作为常规监测手段。在消除后疟疾监测工作中,应广泛应用于基层。     

镜检和疟原虫抗原快速检测(RDT)胶体金法及巢式PCR法在疟疾诊断中的价值

目的 探究镜检、疟原虫抗原快速检测(RDT)胶体金法、巢式PCR法在疟疾诊断中的价值.方法 选取2019年2月至2020年2月本中心收治的疑似疟疾患者50例作为研究对象,所有患者均接受镜检、RDT胶体金法、巢式PCR法,以实验室检测结合临床特征结果为金标准,比较3种方式检测结果.结果 实验室检测结合临床特征结果显示,50例疑似疟疾患者中,阳性36例,阴性14例.经镜检法检出疟疾28例,检出率为46.67％;经RDT胶体金法检出疟疾35例,检出率为58.33％;经巢式PCR法检出疟疾30例,检出率为50.00％;RDT胶体金法准确度及灵敏度均高于镜检法、巢式PCR法,差异有统计学意义(P<0.05);3种诊断方法特异度、阳性预测值、阴性预测值比较差异无统计学意义.结论 在疟疾临床诊断中,RDT胶体金法具有较高的灵敏度及检出率,且与镜检、巢式PCR法联合诊断,可进一步提高检出率,为临床治疗提供依据.     

中缅边境居民疟疾感染的疟原虫抗原检测、镜检和PCR筛查

目的 了解云南省沧源县抵边村寨居民和境外周边居民疟疾感染情况，比较疟原虫抗原检测（RDT）、镜检和PCR在低疟区和消除区居民疟疾筛查效果，为预防疟疾消除后再输入提供依据。方法 2020年8月—2021年3月，在中缅边境地区云南省临沧市沧源佤族自治县班老乡、缅甸掸邦第二特区勐冒县班歪区梅不老乡、缅甸掸邦第二特区南邓特区拥摸和大岩乡3个调查点，采集调查对象指尖血，运用RDT、疟原虫显微镜检查法、荧光定量PCR与巢式PCR法检测疟原虫感染情况。结果 共采集1 040人份血样，含中国居民606人、缅甸居民434人。其中男性506人，女性534人，年龄0～<5、5～<15、15～<30、30～<45、45～<60和≥60岁分别有51、283、187、232、205和82人。经疟原虫抗原检测试剂盒法检测1 040人均为阴性，疟原虫显微镜检查法检出间日疟阳性1份，疟原虫检出率为0.10%，荧光定量PCR与巢式PCR检出间日疟阳性1份，疟原虫检出率为0.10%。其中，缅甸掸邦第二特区勐冒县班歪区梅不老乡检出间日疟1例，疟原虫检出率为0.35%，云南省临沧市沧源佤族自治县班...     

广西30个市县消除疟疾措施与方法研究

目的研究疟疾流行规律，探讨防治措施与方法，控制疟疾流行，进一步消除疟疾。方法在建立健全市县、乡、村三级灭疟网的基础上，以自然村屯为单位，划分疟区，分类防治。全面防治阶段，按上年疟史率的高低分类防治，采取“三根治、一预防和两喷洒”的综合性措施；基本消灭疟疾阶段，采取血检发热病人为主（县为单位年血栓率10％以上）和重点村屯居民血栓以及血清学监测的“查源拔灶”措施；消除疟疾阶段，以“四热病人”血栓为主（县为单位年血栓率5％以上）和加强血清学的横向监测，进一步肃清残存传染源。结果发病率从1954年228.7／万降至1993年为零；居民血检原虫率从1951～1957年18．74％，降至1980年2.73％及1990年为零。发热病人血检阳性率从1980年8.21％降至1993年均为零。30个市县考核达标至今已有7～15年来发现当地疟疾病例；儿童间接荧光抗体阳性率为0.05％。结论研究的防治策略与技术措施科学有效，灭疟指标达到消除疟疾标准。     

贵州省首例输入性卵形疟病例的鉴定

目的对1例输入性疟疾病例进行鉴定。方法采集病例外周血制作滤纸血样和血涂片。血涂片染色后镜检,同时进行疟疾快速诊断试剂盒(RDT)检测,滤纸血样进行PCR,PCR扩增片段测序后在GenBank中进行Blast分析。结果 RDT检测提示非恶性疟的疟原虫阳性,血涂片镜检可见卵形疟原虫。PCR扩增出大小为880 bp的卵形疟特异条带,Blast分析显示与卵形疟原虫wallikeri亚种的cox3部分基因序列同源性为99.4%。结论依据RDT、镜检、PCR和序列分析等实验室检测结果,结合其流行病学资料,该例输入性疟疾病例确诊为贵州省首次由境外输入的卵形疟病例,且感染的疟原虫虫种是卵形疟原虫wallikeri亚种。     

云南省最后一例本地感染疟疾病例报告

报道2016年4月17日由云南省德宏州盈江县疾病预防控制中心通过国家疾病监测信息报告管理系统网络直报,并被确定为云南省最后一例本地感染间日疟病例的诊断、治疗、流行病学调查、疫点处置及后续追踪等相关情况,为云南省到达消除疟疾目标提供充分有力的证据。患者王某某,男,3岁,散居儿童,居住在云南省德宏州盈江县太平镇龙盆村龙盆一社。父亲是农民,母亲是当地村医,父母表示患儿从出生至今无到过缅甸或本省、本县其他高疟区的流动居住史。因发冷、发热、出汗5 d,于2016年4月15日到盈江县疾控中心就诊,疟原虫抗原快速诊断试剂（RDT）检测阳性,血涂片镜检检出单纯间日疟原虫,经盈江县和德宏州两级镜检复核确认为间日疟。后省级疟疾诊断参比实验室镜检和疟原虫核酸（PCR）复核确认为间日疟。在2016年4月18日—2019年12月31日,在疫点处置后开展8次主动病例侦查进行纵向追踪,共血检588人次,未发现阳性。2016年6—9月开展2次媒介调查,未捕获传疟媒介。同时对全省报告的1 032例和外省报告的7例云南籍病例的流行病学个案调查资料及实验室检测结果进行审查和复核,均排除本地感染,对全省开展的6 105次各级的消除疟疾工作督导检查,均未发现病例的漏报、瞒报和漏诊现象,抽检复核 5 251张阴性血片,阴性符合率100%。根据《中国消除疟疾行动计划（2010—2020）》和《消除疟疾技术方案》病例和疫点分类标准,最终判定该病例为云南省最后一例本地感染间日疟病例。2019年10月,国家消除疟疾专家组在云南省昆明市召开全国最后一例本地感染疟疾病例研讨会,确认该病例为中国最后一例本地感染疟疾病例。     

海南省海口市疟疾流行与防治历程及消除措施和评价

目的了解海口市疟疾流行概况与防治历程,总结评估海口市消除疟疾工作,为实施消除疟疾行动计划及开展评估工作提供参考和依据。方法对海口市1951—2014年疟疾防治疫情数据、报表、文件、工作计划、防治策略与措施等资料进行描述性分析和总结,根据国家卫生计生委《消除疟疾考核评估方案(2014年版)》,从保障措施、技术措施、防控效果3个方面对消除疟疾工作进行评估。结果 1955年疟疾发病率为5 482.58/10万,经控制流行、常态化管理、消除疟疾3个阶段防治。在消除疟疾阶段(2010—2014年),海口市建立多部门联防联控工作机制,经费保障到位,按《海南省消除疟疾实施方案》要求开展消除和巩固工作,乡镇卫生院以上医疗机构均设立疟防科室,疟原虫血检18 543人,年度血检数均达到总人口1‰以上,血片复核率11.37%,年报告发病率均控制在0.5/10万以下,发生14例输入疫情均及时有效控制。媒介监测未发现本地主要传疟媒介微小按蚊和大劣按蚊。结论海口市经过多年疟疾防治,2014年达到消除疟疾标准。巩固工作重点是加强输入性病例监测。     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.