Trends and Differences Among Three New Indicators of HIV Infection Progression

Objective

This study proposes three indicators of, and assesses the disparities and trends in, the risk of HIV infection progression among people living with diagnosed HIV infection in the United States.

Methods

Using data reported to national HIV surveillance through June 2012, we calculated the AIDS diagnosis hazard, HIV (including AIDS) death hazard, and AIDS death hazard for people living with diagnosed HIV infection for each calendar year from 1997 to 2010. We also calculated a stratified hazard in 2010 by age, race/ethnicity, mode of transmission, region of residence at diagnosis, and year of diagnosis.

Results

The risk of HIV infection progression among people living with diagnosed HIV infection decreased significantly from 1997 to 2010. The risks of progression to AIDS and death in 2010 were higher among African Americans and people of multiple races, males exposed through injection drug use (IDU) or heterosexual contact, females exposed through IDU, people residing in the South at diagnosis, and people diagnosed in 2009 compared with white individuals, men who have sex with men, females with infection attributed to heterosexual contact, those residing in the Northeast, and those diagnosed in previous years, respectively. People aged 15–29 years had the highest AIDS diagnosis hazard in 2010.

Conclusion

Continued efforts are needed to ensure early HIV diagnosis as well as initial linkage to and continued engagement in HIV medical care among all people living with HIV. Targeted interventions are needed to improve health-care and supportive services for those with worse health outcomes.In the United States, the number of people aged 13 years and older living with human immunodeficiency virus (HIV) infection was estimated to be more than 1.1 million as of December 2010, a 9% increase from 2006.¹ For people living with HIV, increasing their access to care and eliminating disparities are primary goals of the National HIV/AIDS Strategy (NHAS) and the Healthy People 2020 objectives.^2,3 Assuring that all people with HIV are diagnosed early, promptly linked to care, retained in care, and offered antiretroviral treatment is essential to achieve the ultimate goal of the continuum of care,⁴ leading to viral suppression, improved health, survival, and prevention of HIV transmission.Several studies have used national HIV surveillance data to examine the disparities and determinants of progression to acquired immunodeficiency syndrome (AIDS; i.e., stage 3 HIV infection⁵) and death after HIV diagnosis. These studies have focused on individuals diagnosed in a certain time period and have examined the differences in time from HIV diagnoses to AIDS and death (i.e., the number of months/years from HIV diagnosis to AIDS or death) using survival analyses, including Kaplan-Meier survival curves, the Cox proportional hazard model, or the standardized relative risk.^6–8 However, previous studies have not assessed the risks of progression to AIDS and death among all people living with HIV, and have not reported the trends in these outcomes.To fill this gap, we propose in this study three cross-sectional indicators to estimate the risks of progression to AIDS and death in a calendar year after HIV diagnoses among people living with diagnosed HIV infection, regardless of their time of diagnosis (i.e., the year when an HIV infection was first diagnosed). The results allow for an annual assessment of the risks of HIV infection progression and can be used to monitor the trends in these outcomes among people living with HIV.Specifically, this study (1) examined the disparities in the risk of progression to AIDS in 2010 among people living with diagnosed HIV (not AIDS) infection at year-end 2009 (AIDS diagnosis hazard), the risk of death in 2010 among those living with diagnosed HIV (including AIDS) infection at year-end 2009 (HIV death hazard), and the risk of death in 2010 among individuals living with AIDS at year-end 2009 (AIDS death hazard); and (2) assessed the trends in the risks of HIV infection progression among people living with diagnosed HIV infection from 1997 to 2010 using the three indicators.     

北京市2013－2014年肠道门诊腹泻患者中诺如病毒感染的流行病学及临床特征分析

目的 了解北京市肠道门诊腹泻患者诺如病毒感染的流行状况及临床特点。方法 采集2013年4月至2014年3月北京市肠道门诊1 892名腹泻患者粪便标本, 并收集患者的流行病学及临床症状资料。使用real time RT-PCR对诺如病毒核酸进行检测, 采用描述性流行病学方法进行分析。结果 2013年4月至2014年3月北京市肠道门诊腹泻患者诺如病毒阳性率为14.2%(269/1 892);寒冷月份阳性率较高;怀柔区、延庆县等西北部山区阳性率较高;6月龄至5岁儿童诺如病毒阳性率高于其他年龄组, 差异有统计学意义(P=0.006), 散居托幼儿童诺如病毒阳性率高于其他职业人群, 差异有统计学意义(P=0.025);诺如病毒阳性腹泻患者恶心、呕吐症状发生率高于阴性患者, 差异有统计学意义(P<0.05)。结论 诺如病毒是肠道门诊腹泻患者的重要病原, 6月龄至5岁腹泻儿童诺如病毒感染率高于其他人群, 恶心、呕吐为诺如病毒感染的常见症状。     

The Relationship Between Disability-Adjusted Life Years of Cataracts and Ambient Erythemal Ultraviolet Radiation in China

Background

Cataracts are one of the major public health problems worldwide. Ultraviolet radiation (UVR) is one of the risk factors for cataract development. We analyzed the relationship between disability-adjusted life year (DALY) rates of cataracts and UVR exposure in China.

Methods

DALY rates of cataracts and UVR exposure in 31 regions of China were calculated based on data from the Second China National Sample Survey on Disability and the United States’ National Aeronautics and Space Administration database. The relationship between the DALY rates of cataracts and UVR was estimated by Spearman rank correlation analysis and linear regression analysis.

Results

The elderly (≥65 years) had higher DALY rates of cataracts than the whole population. The DALY rate of cataracts in the agricultural population was higher than that observed in the non-agricultural population. The DALY rates of cataracts were positively associated with UVR The DALY rates of cataracts in regions with higher UVR were higher than those in regions with lower UVR. An increase in the daily ambient erythemal UVR of 1000 J/m² was associated with an increase in the DALY rates of cataracts by 92 DALYs/100 000 (R² = 0.676) among the whole population, 34 DALYs/100 000 among the population <65 years old (R² = 0.423), 607 DALYs/100 000 among the population aged 65–74 years (R² = 0.617), and by 1342 DALYs/100 000 among the population ≥75 years old (R² = 0.758).

Conclusions

DALY rates of cataracts increased with increases in UVR exposure in 31 regions of China. Greater exposure to UVR increases the disease burden of cataracts in the whole population, especially in the elderly and among the agricultural population.Key words: cataract, UVR exposure, disease burden, DALYs     

医院和社区纵向服务整合影响因素的指标体系研究

目的 建立一套医院和社区卫生服务机构在纵向服务整合过程中影响其实施效果的影响因素指标体系.方法 通过文献复习、问卷调查、个人深入访谈等形式收集初步数据,运用层次分析法和德尔菲专家咨询法构建影响因素指标体系.结果 形成了与南京、武汉、镇江3个地区医院和社区卫生服务机构纵向服务整合现状相吻合的影响因素指标体系,包括一级指标4个、二级指标10个、三级指标35个.结论 本研究为医院和社区卫生服务机构完善服务整合制度提供了依据,弥补了国内医疗服务体系纵向整合实施效果影响因素研究方面的不足,对其他地区和模式的医疗服务体系纵向整合有一定的借鉴意义和价值.     

沉默ABCG2增强膀胱癌T24对X线的敏感性研究

目的明确沉默ABCG2后膀胱癌T24对X线的敏感性是否增强。方法常规培养T24,经4 Gy X线照射后,从存活能力、克隆形成、迁移和侵袭能力四个方面评价了沉默ABCG2后T24对X线敏感性的变化。结果经X线照射,沉默ABCG2后,T24的存活能力、克隆形成、迁移、侵袭能力显著减弱(P<0.05)。结论沉默ABCG2增强了膀胱癌T24对X线的敏感性,ABCG2的抑制剂可能成为膀胱癌的放疗增敏剂。     

射干麻黄汤对哮喘患者气道高反应性的影响

目的观察射干麻黄汤对寒哮患者气道高反应性的影响。方法 51例轻、中度寒哮患者随机分为两组。对照组给予沙丁胺醇气雾剂,治疗组在对照组的基础上加用射干麻黄汤中药配方颗粒冲服,两组均治疗12周,分别于治疗前和治疗后进行哮喘控制测试评分(ACT评分)、最大呼气峰流速(PEF)、肺通气功能及支气管激发或舒张试验检测,并进行疗效判定。结果治疗组疗效优于对照组(P0.05),两组FEV1、FEV1%预计值、PEF均较治疗前显著改善(P0.05),而治疗组气道高反应性(支气管激发或舒张实验阳性率)及PEF变异率均较对照组下降(P0.05),ACT评分较对照组明显改善(P0.05)。结论射干麻黄汤能改善哮喘患者的症状及气道高反应性。     

1764例血培养病原菌分布及耐药性分析

目的：了解血培养中常见病原菌的组成以及各类病原菌对抗菌药物的耐药性,为临床医生合理选用抗菌药物解决患者病痛提供依据。方法收集临床送检的血培养标本,应用法国生物梅里埃公司 BacT／Alert3D 全自动血培养仪、配套培养基、鉴定仪系统鉴定菌种及药敏试验。结果1764份血培养分离出病原菌179株,其阳性率为10．1％,其中革兰阳性菌68株（38．0％）,革兰阴性菌111株（62．0％）;病原菌中占首位的是大肠埃希菌,其次是凝固酶阴性菌、肺炎克雷伯菌、铜绿假单胞菌。药敏结果显示绝大部分检出的病原菌均有耐药情况出现。结论临床医生应重视患者早期的血培养检验,并严格根据药敏结果合理使用抗菌药物。对血培养的检测应更加规范,从而提高病原菌的检出率,并及时检测病原菌变化及耐药趋势。     

IVF/ICSI-ET术后双胎妊娠的临床结局及预防对策

目的:分析体外受精 (in vitro fertilization,IVF)/卵细胞浆单精子注射-胚胎移植 (intracytoplasmic sperm injection-embryo transfer,ICSI-ET)术后双胎妊娠的临床生殖结局,探讨降低辅助生殖技术中多胎率的有效治疗措施?方法:回顾性分析IVF/ICSI-ET术后获得双胎妊娠的425例孕妇的妊娠并发症?分娩方式和围产期结局?结果:①行IVF/ICSI-ET 4 603个治疗周期,双胎率23.35%,流产率9.18%,妊娠并发症发生率13.41%,出生缺陷发生率1.60%;②活胎双胎组孕周[(29.66 ± 3.64周) vs. (30.69 ± 3.47周)]? 出生体重[(2.64 ± 0.45)kg vs. (3.12 ± 0.64)kg]低于活胎单胎组,剖宫产率(97.68% vs. 77.38%)?早产率(41.06% vs. 16.67%)?低体重儿发生率(42.05% vs. 19.05%)高于活胎单胎组,两组间比较差异有统计学意义;③多胎减胎组和自然减胎组比未减胎组获得良好的生殖结局,孕周[(38.00 ± 2.03)周?(37.89 ± 2.46)周 vs. (36.43 ± 1.77)周)]和出生体重[(3.05 ± 0.65)kg?(3.15 ± 0.63)kg vs. (2.64 ± 0.45)kg]?早产率(13.64%?15.71% vs 37.24%)等方面比较,差异均有统计学意义?结论:在辅助生殖技术中,双胎较单胎妊娠发生早产?低出生体重不良风险高,需重视其围生期保健和产前检查?临床早期预测并进行减胎等补救性手段是安全有效的干预措施?     

正交设计法优选合欢花黄酮的乙醇浸提工艺

目的 :采用正交设计法对合欢花黄酮浸提工艺参数进行优化。方法:采用分光光度法测定黄酮得率。在单因素试验的基础上,采用正交试验法,考察乙醇浓度、料液比、浸提温度、浸提时间对合欢花黄酮得率的影响,对浸提条件进行优化。结果:各因素对合欢花黄酮得率的影响程度依次为:料液比乙醇浓度时间温度。最佳工艺条件为:料液比1∶20,乙醇浓度60%,浸提时间2 h,浸提温度70℃,合欢花黄酮得率为2.31%。结论:该工艺稳定、合理、可行,适用于工业化生产。     

新诊断2型糖尿病患者采取沙格列汀联合二甲双胍治疗的疗效及安全性分析

目的：探究新诊断2型糖尿病患者开展沙格列汀联合二甲双胍治疗的临床疗效及安全性,并为这类患者最优化诊疗服务积累循证经验。方法选取该院内分泌科2012年2月—2014年1月收治的94例新诊断2型糖尿病患者,利用随机数字表法进行分组,分别设为观察组和对照组,每组各47例。其中对照组给予阿卡波糖联合二甲双胍治疗方案,观察组给予沙格列汀联合二甲双胍治疗方案。记录二组患者治疗前后空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素、胰岛素抵抗指数（HOM A －IR）、体重及体质指数,同时比较二组服药依从性情况及不良反应发生率。结果二组治疗前FBG、2hPG及HbA1 c值差异无统计学意义（P＞0．05）;治疗后,观察组FBG、2hPG及 HbA1 c值均低于对照组,差异有统计学意义（P＜0．05）。二组治疗前空腹胰岛素水平及 HOMA －IR值差异无统计学意义（P＞0．05）;治疗后,观察组空腹胰岛素水平高于对照组（P＜0．05）,HOMA －IR值低于对照组（P＜0．05）。二组治疗期间低血糖发生率差异无统计学意义（P＞0．05）;观察组 HbA1 c达标率高于对照组,差异有统计学意义（P＜0．05）。二组治疗前后体重及体重指数差异无统计学意义（P＞0．05）。观察组药物漏服率及错服率均低于对照组,差异有统计学意义（P＜0．05）。结论二甲双胍配伍沙格列汀治疗2型糖尿病患者的临床疗效优于二甲双胍配伍阿卡波糖方案,且安全性尚佳,值得在临床上进一步推广。