2017年7—8月全球主要疫情回顾

本刊对2017年7—8月全球重点传染病疫情(截至8月30日)汇总如下. 1 亚洲和非洲部分国家霍乱疫情持续升温 亚洲和非洲部分国家霍乱疫情依然严峻.也门自2017年4月27日暴发霍乱以来,截至8月26日,共报告565041例霍乱病例,死亡2018例.2016年9月19日—2017年7月16日,索马里共有69948例霍乱病例,死亡1119例.2016年8月15日—2017年8月29日,苏丹共有2.4万例霍乱病例,死亡约900例.2016年6月18日—2017年7月30日,南苏丹累计报告疑似病例19532例,死亡352例.报告病例的1/5为<5岁的儿童.随着雨季的到来,在人口密度较高且饮水条件较差的地区,霍乱疫情将持续蔓延.刚果(金)霍乱疫情近期有严重化趋势,自2017年2月份疫情暴发以来,截至7月11日,共报告15456例霍乱疑似病例,死亡441例.     

2017年5—6月全球主要疫情回顾

本刊对 2017 年 5—6 月全球重点传 / 感染病疫情(截至 6 月 24 日)汇总如下. 1 也门、索马里等国霍乱疫情严峻 也门于 2016 年年底暴发霍乱,随后疫情得到控制,但 2017 年 4月底再度暴发.至 6 月 27 日,该国 23 个州共报告 218798 例霍乱疑似病例及相关死亡病例 1400 例.目前也门每 200 人中就有 1例疑似感染霍乱,疑似病例数已创历史新高.目前疑似病例中重症患者约占 50%,超过此类疫情通常情况的 2 倍.     

2009—2017年甘肃省陇南市手足口病流行病学特征分析

目的了解2009—2017年甘肃省陇南市手足口病流行病学特征,为制定科学有效的防控策略提供参考依据。方法疫情资料来源于国家疾病监测信息报告管理系统,用描述流行病学方法分析2009—2017年甘肃省陇南市手足口病的流行特征。结果 2009—2017年陇南市共报告手足口病7 247例,年平均报告发病率为30.80/10万,其中两当县最高(109.41/10万)、礼县最低(8.80/10万);每年发病基本呈现单峰分布、4—7月高发,报告发病率男性(34.79/10万)高于女性(26.44/10万),差异有统计学意义(χ~2=133.32,P<0.001);以散居儿童和托幼儿童为主,5岁及以下儿童占90.12%,报告发病率5岁及以下儿童(375.59/10万)高于6岁及以上人群(3.29/10万),差异有统计学意义(χ~2=504.15,P<0.001);以EV71病原为主、占46.75%,不同年度优势毒株交替出现。结论甘肃省陇南市手足口病时间、地区和人群分布均有一定的特征;在高发季节对重点地区应加强监测、做好宣传教育,提高适龄儿童预防EV71疫苗的接种率,降低手足口病发病率。     

美国《Emerging Infectious Diseases》2016年第3期有关人兽共患病论文摘译

<正>P410 2010-2011年海地霍乱疫情流行期间死亡率研究//Francisco J.Luquero,Marc Rondy,Jacques Boncy,等2010在海地发生的霍乱疫情是有记录以来最为严重的霍乱疫情。为了估计第一波疫情流行期间的死亡人数,我们对海地北部4个地区进行了回顾性调查。总计有70 903人被纳入调查;所有调查地区的粗死亡率(19.1-35.4死亡人数/1000人-年)     

艾滋病与结核病

艾滋病和结核病均为目前全球严重的公共卫生问题,两者互为影响,流行日趋严重,必须引起高度重视。一、流行概况1、艾滋病疫情:2005年全球新增HIV感染者500万比2003年增加65%,HIV感染总数4030万,死于艾滋病者310万,其中57万为15岁以下儿童。最严重地区为撒哈拉以南非洲国家,总数为2580万,其中320万为新感染者。东结核病健康教育2006年第1期全球部分国家HIV感染与结核病患病、死亡的关系年份199019952000HIV/TB双重感染人数(万)31.773.8141.0HIV引起结核占总结核病的比例(%)4.28.413.8HIV( )者结核死亡人数(万)11.626.650.0HIV合并结…     

疟疾流行简况及其抗药性

据WHO报道,全球约有90个国家或地区受到疟疾的威胁,非洲是疟疾流行最严重的地区。全世界每年死于疟疾的人数约为150～170万,且多在非洲,其中100万5岁以下的儿童因此病或其并发症而死亡。     

2021年全球传染病重要疫情事件回顾

2021年,新型冠状病毒肺炎继续肆虐全球,导致2.8亿人患病,520万人死亡.阿富汗和巴基斯坦野生1型脊髓灰质炎病例大幅减少,缩短了全球消灭脊髓灰质炎的进程.登革热疫情较上一年明显缓解,非洲埃博拉疫情仍有反复.一些不发达地区仍然遭受伤寒和霍乱的大规模侵害.本文对2021年重要的传染病疫情进行回顾.同时参考WHO在202...     

阿克苏地区50岁及以上人群HIV/AIDS流行病学分析

目的分析2013—2017年新疆阿克苏地区50岁及以上艾滋病人群流行病学特征和趋势,为制定有针对性的艾滋病防控措施提供参考依据。方法应用描述流行病学方法,分析2013—2017年阿克苏地区报告的50岁及以上人群HIV感染者/艾滋病病例(HIV/AIDS)数据。结果阿克苏地区共报告50岁及以上1 286例HIV/AIDS,占全地区总报告病例的23.71%,发病率由2013年的50.66/10万上升至2017年的106.70/10万;地区报告发病率居前三位的是沙雅县(113.93/10万)、新和县(107.42/10万)和库车县(75.28/10万),其中男性占25.47%,男女性别比为1.56∶1,以50～59岁为主、占67.96%,农民为主、占60.33%,小学文化程度为主、占48.06%,异性传播为主、占96.20%。结论阿克苏地区50岁及以上HIV/AIDS艾滋病疫情增长迅速,防控形势仍然十分严峻;应采取有针对性的防控措施,降低老年人群艾滋病感染风险。     

新疆喀什地区百日咳流行特征分析及6岁以下儿童抗体水平调查

目的掌握2004—2015年新疆喀什地区百日咳病例分布情况,包括发病的主要人群、发病时间及地区分布特征,了解人群对百日咳的真实免疫水平及发病情况,为今后做好百日咳预防控制提供科学依据。方法收集中国疾病预防控制中心疾病监测管理系统2004—2015年新疆喀什地区百日咳发病资料,运用描述流行病学方法进行分析,应用Excel 2007录入数据并统计处理;在新疆喀什地区选择0~6岁健康儿童751人,收集流行病学信息并采集血清标本,使用ELISA检测百日咳IgG抗体。结果 2004—2015年新疆喀什地区累计报告百日咳病例2 249例,占全疆百日咳报告病例的40.63%,死亡5例,年平均报告发病率4.82/10万,年平均死亡率为0.043/10万;病例主要集中在小年龄组,以2岁以下儿童为主,共报告发病1 599例,占总报告发病数的71.10%,以散发人群为主;在751名0~6岁健康儿童中,百日咳抗体阳性143人,阳性率19.04%;百日咳抗体阳性率随年龄增加而增加,5岁及以上组儿童抗体阳性率最高,阳性率25.13%;4剂次"百白破"疫苗接种史的儿童中,全程接种儿童其抗体阳性率明显高于其他儿童。结论新疆喀什地区百日咳疫情仍较严峻,全地区0~6岁儿童百日咳IgG抗体阳性率较低,儿童处于百日咳发病高危状态,应加强该地区百日咳的监测,进一步提高疫苗接种水平,防止疫情的进一步扩大。     

艾滋病的迅速蔓延及对儿童的影响

1 全球儿童状况 迄今,全球已有1400万人死于艾滋病,其中1100万例发生在非洲,大约25％的受害者系儿童。在10个受艾滋病影响严重的非洲国家,预计2000～2005年,5岁以下儿童的死亡率将由科特迪瓦的17％达到博茨瓦纳的64％之高;预计中国届时将有1400名0～14岁的儿童感染艾滋病病毒。这个数字与1994～1997年相比增长了4倍。越南亦如此。这些数字表明艾滋病的控制工作在亚洲国家已迫在眉睫。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.