华法林的临床应用

房颤药物抗凝治疗先后经历了许多临床试验的有益探索;90年代前后,国外相继组织了大规模,随机对照的临床试验,以评价华法林抗凝预防缺血性脑率中的作用。现将华法林的临床应用报告如下：     

冠心病防治之我见

目前临床治疗已经进入循证医学时代。很多国内外学术权威机构都大规模的开展随机对照临床试验,并对结果进行科学整理分析,制定出冠心病防治指南。值得大家关注的有以下几个问题: (1)依据循证医学选出的有效疗法及药物。在如ACC/AHA及中华心血管病学会等系列指南中所规定的冠心病疗法,只要无禁忌证,均可使用。     

《中国CT和MRI杂志》征订启事

由刘金来、陈璘、吴一龙主编的心血管循证医学丛书已由江西科技出版社出版。该丛书包括《循证医学纵横谈》、《心血管大规模临床试验》、《心血管疾病临床指引(上、下册)》4册。《循证医学纵横谈》系统介绍了循证医学的基本理论;《心血管大规模临床试验》荟萃了近一二十年来有关心血管疾病防治的大规模临床试验;《心血管疾病临床指引》介绍了最新的国内外医学权威机构有关心血管疾病诊断与防治的临床建议。了解并掌握这些知识将有助于临床医师的医疗实践、科研选题和设计以及临床科研水平的提高。本丛书适合于临床医师和研究生阅读,并可作为…     

治疗急性心肌梗死大样本随机临床试验与循证医学

近30年来，国内外已完成了一系列急性心肌梗死大样本随机对照临床试验，比较客观地评估了溶栓剂、抗血小板剂、血管紧张素转换酶抑制剂、β-受体阻滞剂等治疗急性心肌梗死的效果。为循证医学提供了证据，促进了临床治疗水平的提高。     

从4S到IDEAL看他汀类药物在冠心病二级预防中的循证历程

流行病学资料显示,随着总胆固醇水平的升高,冠心病死亡和发生的危险增加。但90年代初之前,降脂治疗对冠心病的疗效存在争议。围绕着这个问题,开展了大量的大样本随机对照试验。从4S到IDEAL等他汀类药物的大规模随机对照临床试验研究中,可以看到他汀类降脂治疗在冠心病二级预防中的循证历程。循证医学的精髓,在他汀类药物用于冠心病二级预防中的医学大舞台上得到了充分的展示。     

应强调风湿免疫病治疗中完全缓解的理念

近年来,随着风湿免疫病临床研究的进展,国内外对这类疾病的治疗方法和策略有了更深入的了解,尤其通过大样本、多中心的随机对照临床试验,已经证明类风湿关节炎(RA)、系统性红斑狼疮(SLE)及强直性脊柱炎(AS)等患者可以达到临床缓解.     

全面、系统收集资料是进行系统评价的先决条件——“循证医学文献检索专题”序

循证医学是近年来在临床医学实践中发展起来的一门学科,是系统搜寻、评价和应用当前研究成果的医学方法,并以此作为临床决策的依据。最有说服力的临床试验证据应来自于国际公认的大规模随机对照试验(random izedcontrolled trial,RCT),以及严格的系统分析(systematic review,SR)或Meta     

做好前瞻性临床试验,进一步提高我国临床研究水平

在刚刚过去的2010年,本刊共发表论著性稿件736篇,其中临床研究572篇(占77.7%).在临床研究中回顾性研究约占63.0%,前瞻性、随机对照研究仅占37.0%.而前瞻性随机对照研究是反映临床研究水平的重要标志,当前我国设计良好的大规模多中心随机对照临床试验仍属凤毛麟角.在发表的前瞻性研究中,不少研究的设计缺乏统计学假设和样本量的计算;在两组疗效的对比研究中,简单地以P＞0.05做出两组疗效差异无统计学意义的结论,科学性不够.     

2007年ESC／ESH高血压的新视点（一）

自2003年欧洲高血压指南发布后,国际上完成了一系列有价值的大规模随机对照临床试验,为高血压的治疗提供了许多新证据。2007年6月欧洲心脏病学会（ESC）-欧洲高血压学会（ESH）联合颁布了《欧洲高血压指南》,该指南在保留2003年指南框架的基础上,充分体现了高血压防治的战略前移,更加重视事件预防,强调高血压不是孤立性疾病,需要总体评估和预防。     

减肥有助于牛皮癣的治疗

一项随机对照临床试验研究结果表明,减肥有助于牛皮癣的治疗。     

《中国按蚊成蚊检索图》的绘制

目的为基层提供快捷方便的按蚊成蚊检索工具。方法以第3版《疟疾防治手册》按蚊成蚊检索表为依据,分组、分级绘制成《中国按蚊成蚊检索图》。结果根据《中国按蚊成蚊检索图》,最终可快捷地检索到每一种中国按蚊成蚊。结论该图具有简洁、易懂、使用方便的优点,适用于现场中国按蚊成蚊检索。     

高致病禽流感在中国的传播,预防和控制

本文综述了从1996年至今禽流感在中国的暴发流行和近年来禽流感的暴发特征。中国是世界最大的家禽生产国，并且大量候鸟迁徙途径中国，中国的禽流感防控形式非常严峻。当前不断出现的人类散发病例说明禽流感病毒仍在部分地区的禽鸟间传播。在与禽流感病毒的斗争中，中国积累了一些有效的防控经验，在禽流感防控的国际合作与相关研究方面也进行了许多积极的努力。国务院和农业部出台了一系列有针对性的法规和方案。在家禽和人类对禽流感病毒的感染途径方面，候鸟可能起了一定作用，人类感染HSN1病毒的主要方式和途径是接触感染病毒的禽类及其分泌物和排泄物，吸人禽类分泌物或排泄物中的病毒颗粒。但中国目前散养家禽的生物安全和废弃物处理状况令人堪忧，基础水平上的防控措施还有待加强。     

EPXDEMIOLOCrY AND COMMUNITY CONTROL OF HYPERTENSION, STROKE AND CORONARY HEART DISEASE IN CHINA

Cardiovascular diseases were comparatively rare in olcl China Since liberation in 1949 with continuing improvement of the people's living conclitions, acute infectioug diseases, tuberculosis, malnutrition, etc. have been put under control, but on the other hand cardio- vascular and eerebral diseases have become one of the most important health problems in our country. As in many other medical fields, in the past 2 decades much work has been done in China in the control of hypertension, stroke and coronary heart disease. This paper is a general review of the pre- valence of these diseases aud the work done in their prevention and treatment in certain regions, urban and rural, in the past, 20-30 ycars with tabulations. Certain points concerning future efforts to improve cardiovascular disease epidemiology and commnunity control are emphasized.     

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing,China: a Cross-sectional Study

Objective To examine HIV self-testing uptake and its determinates among men who have sex with men(MSM) in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio(AOR) and 95% confidence interval(CI). Results Among the 5,996 MSM included in the study, 2,383(39.7%) reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income(AOR = 1.49; CI = 1.10-2.02; P = 0.010), large number of male sex partners(≥ 2: AOR = 1.24; CI = 1.09-1.43; P = 0.002), sexual activity with commercial male sex partners(≥ 2: AOR = 1.94; CI = 1.34-2.82; P = 0.001), long-term drug use(AOR = 1.42; CI = 1.23-1.62; P 0.001), and long-term HIV voluntary counseling and testing(VCT) attendance(AOR = 3.62; CI = 3.11-4.22; P 0.001) were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.     

中国、日本、印度、南非、美国五国1970—2030年计划生育状况与趋势预测

 目的    分析并预测中国、日本、印度、南非、美国已婚/同居育龄女性计划生育状况,为满足育龄女性计划生育需要提供依据。方法    从《全球避孕及方法使用状况2016》(World Contraceptive Use 2016)中选取1970—2030年五国已婚/同居育龄女性的避孕节育数据,通过U检验和χ2检验比较五国1970—2016年间的计划生育现状及2017—2030年间的预测趋势。结果    相比于1970年,2016年五国总的计划生育需求增大,避孕节育率上升,未满足的计划生育需要下降(P<0.001)。2016年,五国避孕节育率分别为83.3%、59.9%、56.4%、64.9%、73.7%,未满足的计划生育需要分别为3.8%、13.1%、15.5%、12.2%、7.2%。同时,五国避孕方法的构成发生改变(P<0.001),现代避孕方法使用率高于传统避孕方法,且其满足总的计划生育需求的比例自1970—2016年也不断提高。2017—2030年五国总的计划生育需求、避孕节育率、未满足的计划生育需要、避孕方法的构成、未满足的现代避孕方法需要均有改变(P<0.001)。预测至2030年,中国将是避孕方法使用人数最多的国家,印度将是未满足的计划生育需要人数最多的国家;其中中国、印度有可能是现代避孕方法使用人数最多的国家,印度可能是传统避孕方法使用人数最多的国家。结论    当前五国已婚/同居育龄女性总的计划生育需求大、避孕节育率高、未满足的计划生育需要下降。预测此后至2030年间,该状况仍有可能延续,因此有必要提供适宜的避孕方法以维护生殖权利。     

中国广西,广东,四川区β—地中海贫血基因突变类型及产前基...

beta-Thalassemia is one of the most common single gene disorders in South China, and ten different point mutations and frameshifts have been observed among Chinese. We studied 150 chromosomes of 95 beta-thalassemia patients from Guangxi, Guangdong and Sichuan Provinces using the polymerase chain reaction followed by dot hybridization with specific oligonucleotide probes. The most common mutations were the frameshift at codon 41-42 and the nonsense mutation at codon 17 in Guangxi and Sichuan, and the codon 41-42 frameshift and IVS-II-654 mutation in Guangdong. The A-G mutation at -28 of the promoter was common in Sichuan but not in the other two provinces. Three mutations, -30, IVS-I-1 and IVS-I-5, were not observed. A prenatal diagnosis program using these techniques has been initiated based on these data. Fourteen pregnancies at risk for beta-thalassemia have been diagnosed successfully.     

Present epidemic situation of liver alveolar echinococcosis in Gansu Province, China

Echinococcosis is a common parasitic zoonosis in the west of China. Two types, cystic echinococcosis (CE) and alveolar echinococcosis (AE) are respectively caused by the larval stage of Echinococcus granulosus and Echinococcus multilocularis. As early as the 1960s, AE, simply named alveococcosis, was successively reported in Qinghai, Xinjiang and Gansu, and then in Ningxia,     

中国常见蝇类生物防治研究概况

蝇类生物防治包括利用致病性微生物、捕食性天敌、寄生性天敌与竞争性生物等防治蝇类。中国的蝇类生物防治虽在30～50年代就有研究,但真正的研究是从80年代才开始。研究比较突出的,是利用苏云金杆菌 H—9、蝇虫霉防治家蝇幼虫与成虫等;在捕食性天敌研究方面,建立了巨螫螨与大隐翅虫的实验种群,对其生活史,捕食作用等进行了研究;在蝇蛹寄生性天敌研究方面,建立了四种蛹寄生蜂的实验种群,对其生物学、生态学、行为以及与宿主的关系等进行了较为系统的研究。文中并对我国蝇类生物防治研究的发展提出建议。     

Alcohol Drinking,Dyslipidemia, and Diabetes:A Population-based Prospective Cohort Study among Inner Mongolians in China

ObjectiveNo previous studies have evaluated the association between dyslipidemia, alcohol drinking, and diabetes in an Inner Mongolian population. We aimed to evaluate the co-effects of drinking and dyslipidemia on diabetes incidence in this population. MethodsThe present study was based on 1880 participants from a population-based prospective cohort study among Inner Mongolians living in China. Participants were classified into four subgroups according to their drinking status and dyslipidemia. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to evaluate the association between alcohol drinking, dyslipidemia, and diabetes. ResultsDuring the follow-up period, 203 participants were found to have developed diabetes. The multivariable-adjusted odds ratios (95% confidence interval) for the incidence of non-dyslipidemia/drinkers, dyslipidemia/non-drinkers, and dyslipidemia/drinkers in diabetic patients were 1.40 (0.82-2.37), 1.73 (1.17-2.55), and 2.31 (1.38-3.87), respectively, when compared with non-dyslipidemia/non-drinkers. The area under the ROC curvefor a model containing dyslipidemia and drinking status along with conventional factors (AUC=0.746) was significantly (P=0.003) larger than the one containing only conventional factors (AUC=0.711). ConclusionThe present study showed that dyslipidemia was an independent risk factor for diabetes, and that drinkers with dyslipidemia had the highest risk of diabetes in the Mongolian population. These findings suggest that dyslipidemia and drinking status may be valuable in predicting diabetes incidence.