Drivers of Emerging Infectious Disease Events as a Framework for Digital Detection

The growing field of digital disease detection, or epidemic intelligence, attempts to improve timely detection and awareness of infectious disease (ID) events. Early detection remains an important priority; thus, the next frontier for ID surveillance is to improve the recognition and monitoring of drivers (antecedent conditions) of ID emergence for signals that precede disease events. These data could help alert public health officials to indicators of elevated ID risk, thereby triggering targeted active surveillance and interventions. We believe that ID emergence risks can be anticipated through surveillance of their drivers, just as successful warning systems of climate-based, meteorologically sensitive diseases are supported by improved temperature and precipitation data. We present approaches to driver surveillance, gaps in the current literature, and a scientific framework for the creation of a digital warning system. Fulfilling the promise of driver surveillance will require concerted action to expand the collection of appropriate digital driver data.     

An unusual case of endocarditis- a rare occurrence with unique etiology

The seeding of endocarditis directly to the non-valvular areas of the heart is extremely rare. We report a case of a 36-year-old woman presenting with sudden-onset lower-extremity pain and swelling, who was found to have mitral valve endocarditis with pulmonary vein vegetation. Echocardiography showed a large linear mitral valve mass coming into contact with the base of the left inferior pulmonary vein with each ventricular contraction. Spread into the atrium from mitral valve endocarditis is generally thought to be caused by jet lesions, whereas direct seeding as in this case is not well described. The location in the pulmonary vein is also unique, with no case reports being found in the literature, although the significance remains to be ascertained.     

慢性氟中毒大鼠脑组织中c-Jun氨基末端激酶表达水平观察

目的 观察慢性氟中毒大鼠脑组织中c-Jun氨基末端激酶(JNK)信号转导激酶表达变化,进一步揭示慢性氟中毒神经损伤的分子机制.方法 SD大鼠随机分为3组:对照组、低氟组、高氟组,每组24只,饮用水含氟量分别为＜0.5和5.0、50.0 mg/L,实验期为6个月.用氟离子选择电极法测定大鼠尿氟及血氟,用Western blotting和免疫组织化学方法检测脑组织中JNK信号转导激酶的表达和分布,并分析血氟与活化的JNK激酶的相关关系.结果低氟组和高氟组大鼠尿氟[(2.56±0.91)、(5.73±3.14)mg/L]和血氟[(0.36±0.14)、(0.50±0.18)mg/L]均较对照组[(0.92±0.30)、(0.12±0.07)mg/L]升高(P均＜0.05).高氟组(1.74±0.69)脑组织phospho-JNK表达高于对照组(1.00±0.37)和低氟组(1.20±0.28,P均＜0.05);total-JNK蛋白表达水平3组间比较,差异无统计学意义(F=0.046,P＞0.05).phospho-JNK、total-JNK阳性表达神经元主要集中在皮质、海马和背侧丘脑,其中高氟组大鼠phospho-JNK在顶叶皮质(119.3±14.1)、枕叶皮质(112.7±5.4)、海马CA3区(100.6±8.9)、背侧丘脑(117.8±10.4)及橄榄核(112.6±5.9)中阳性表达较对照组(104.1±8.9、106.6±9.6、106.6±9.7、108.9±6.4、100.3±8.4)和低氟组(96.7±17.1、102.5±8.3、106.4±6.5、110.2±9.3、102.4±4.7、102.5±9.8)明显增高(P均＜0.05),而total-JNK在各组大鼠脑组织中阳性表达分布未见明显改变(P均＞0.05).相关分析结果发现,随大鼠血氟升高,脑组织中phospho-JNK表达呈增高趋势,二者存在正相关关系(r=0.677).结论慢性氟中毒导致脑组织中磷酸化JNK表达改变,并与机体中氟蓄积量存在相关关系,这些改变可能与慢性氟中毒导致的神经损伤有关系.     

二甲双胍单药治疗临床应用中的继发失效问题

美国糖尿病协会(ADA)与欧洲糖尿病研究协会(EASD)共同新推出的2型糖尿病(T2DM)治疗指南中,推荐糖尿患者一旦确诊,应在生活方式干预同时服用二甲双胍.一些临床观察表明,在血糖水平较低时就开始服用二甲双胍,治疗有效而且持久,但这些研究中糖尿病病程(延迟治疗)不预示失效时间.据作者所知还没有研究用糖化血红蛋白(HbA1c)=7%作为达标值比较二甲双胍即刻起用和晚用的差异.     

Survey of senior resident training in urologic laparoscopy,robotics and endourology surgery in Canada

Introduction:

We determined the status of Canadian training during senior residency in laparoscopic, robotic and endourologic surgery.

Methods:

Fifty-six residents in their final year of urology residency training were surveyed in person in 2007 or 2008.

Results:

All residents completed the survey. Most residents (85.7%) train at centres performing more than 50 laparoscopic procedures yearly and almost all (96.4%) believe laparoscopic radical nephrectomy is the gold standard. About 82% of residents participated in a laparoscopic partial nephrectomy in 2008, compared to 64.7% in 2007. Of the respondents, 66% have participated in a laparoscopic prostatectomy and 54% believe the procedure has promising potential. Exposure and training in robotic-assisted laparoscopic procedures seem to be increasing as 35.7% of 2008 residents have access to a surgical robot and 7% consider themselves trained in robotic-assisted procedures. Most residents (71.4%) train at centres that perform percutaneous ablation. However, 65% state the procedure is performed solely by radiologists. Percutaneous nephrolithotomy is widely performed (98.2%), but only 37.5% of residents report training in obtaining primary percutaneous renal access. Despite only 12.5% of residents ranking their laparoscopic experience as below average or poor, an increasing proportion of graduating residents are pursuing fellowships in minimally-invasive urology.

Conclusion:

Laparoscopic nephrectomy is commonly performed and is considered the standard of care by Canadian urology residents. Robotic-assisted surgery is becoming more common but will require continued evaluation by educators who will ultimately define its role in the urological residency training curriculum. Minimally-invasive surgical fellowships remain popular, as Canadian residents do not feel adequately trained in certain advanced procedures. Urologists must strive to learn and adapt to new technologies or risk losing them to other specialties.     

构建麻醉专业多层面临床实践教学新模式

临床实习教学是高等医学教育的重要环节,是培养高素质医学人才目标的关键阶段。为保证实习质量,我院以医学专科生为培养对象,探讨麻醉专业的临床实习教学培养模式,在教学医院中尚属新的尝试,所构建的多层面临床实习培养模式,体现了先进的教学理念,对于医学专科生麻醉专业培养有参考价值。     

盆底骨骼肌细胞机械刺激后肌纤维的改变

目的研究盆底骨骼肌细胞在受到机械力刺激情况下Ⅰ型及Ⅱ型肌纤维含量的改变及肌球蛋白重链亚型(MHCⅠ、MHCⅡa、MHCⅡb和MHCⅡx)的改变。方法选取2012年3月行直肠癌根治术患者的肛提肌组织,显微镜下大体组织标本鉴定为肛提肌组织,且无肿瘤浸润。采用两步消化法及差速贴壁法进行细胞培养;采用Flexcell-4000细胞柔性基底拉伸系统进行对细胞进行正弦波的拉伸应变加载实验(频率为3Hz,加力强度分别为3%、6%),以未加载力的静态细胞作为对照组。用ATP酶染色法鉴定Ⅰ型和Ⅱ型肌纤维并比较对照组及受力6、24hⅠ型及Ⅱ型肌纤维含量的改变;用十二烷基硫酸钠聚丙烯酰胺凝胶电泳(SDS-PAGE)凝胶电泳观察肌球蛋白重链亚型在不同受力时间的改变。结果①加力强度为3%,加力时间为6h使Ⅰ型肌纤维的面密度增加(P<0.01),Ⅱ型肌纤维的面密度减少(P<0.05)。②加力强度为3%,加力时间为24h;加力强度为6%,加力时间为6h使Ⅰ型肌纤维的面密度减少,Ⅱ型肌纤维的面密度增加(P<0.05)。③加力强度为3%,加力时间为6h使肌纤维MHCⅠ%升高,MHCⅡb%降低(P<0.01);加力强度为3%,加力时间为24h;加力强度为6%,加力时间为6h使肌纤维MHCⅠ%和MHCⅡb%降低,MHCIIa%升高(P<0.01)。结论不同受力情况MHC亚型之间发生变化,加力强度3%加力时间6h机械力刺激引起MHCⅡb向MHCⅡx、MHCⅡa、MHCⅠ方向变化;加力强度3%加力时间24h、加力强度6%加力时间6h和加力强度6%加力时间24h机械力刺激引起MHCⅠ、MHCⅡb向MHCⅡx、MHCⅡa变化。