2008-2018年中国5岁及以下儿童手足口病死亡病例流行病学特征

目的 分析2008-2018年我国≤5岁儿童手足口病死亡病例的特征,为制定针对性措施,减少死亡病例发生提供依据。方法 从全国疾病监测信息报告管理系统中收集2008-2018年手足口病监测数据,采用描述性分析方法分析手足口病死亡病例的人群特征、空间分布、诊断和报告情况及病原构成变化,采用logistic回归模型分析导致死亡的危险因素。结果 2008-2018年全国共报告手足口病≤5岁儿童死亡病例3 646例,男性多于女性（1.82：1）,以≤2岁儿童为主（87.71%）。2010年之后全国≤5岁儿童报告手足口病调整后的死亡率由0.87/10万下降至2018年的0.11/10万（APC=-23.20%）。2 523例实验室确诊的死亡病例中,2 323例（92.07%）为肠道病毒71型（EV-A71）感染,但柯萨奇病毒A组16型（CV-A16）和其他肠道病毒构成呈现增加趋势。死亡病例发病至诊断时间间隔M=2（P₂₅～P₇₅：2～4）d,发病至死亡时间间隔M=3（P₂₅～P₇₅：2～4）d。0～1岁、EV-A71感染、发病诊断时间间隔较长和居住地为农村是手足口病死亡的危险因素。结论 2010年后,我国手足口病死亡水平呈下降趋势;死亡病例中优势病原仍为EV-A71,应加强死亡病例中非EV-A71和非CV-A16肠道病毒基因分型;西部省份、农村地区和小年龄组病例应当加强EV 71灭活疫苗接种宣传,提高诊断、救治及时性,降低死亡风险。     

Endothelin (ET)-1 inhibits nicotinamide adenine dinucleotide phosphate oxidase activity in human abdominal aortic endothelial cells: a novel function of ETB1 receptors

Endothelin (ET)-1 stimulates nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and increases superoxide production in some cells such as vascular smooth muscle cells. Here, we reported that ET1 inhibited NADPH oxidase activity, superoxide generation, and cell proliferation in human abdominal aortic endothelial cells (HAAECs) via the ETB1-Pyk2-Rac1-Nox1 pathway. Superoxide production was determined by assessing ethidium fluorescence using flow cytometry in HAAECs exposed to ET1 (10-30 nm) at different time intervals. ET1 significantly decreased superoxide production in HAAECs in the presence of NG-nitro-L-arginine methyl ester, indicating that ET1 suppressed superoxide generation independent of nitric oxide synthase. ET1 significantly attenuated NADPH oxidase activity and cell proliferation, which could be abolished by silence of Nox1 gene, suggesting that ET1-induced inhibition of NADPH oxidase activity was mediated by Nox1. Furthermore, RNA interference silence of ETB1 receptors significantly increased NADPH oxidase activity, and blocked the inhibitory effect of ET1 on NADPH oxidase activity. Activation of ETB1 receptors by ET1 suppressed protein phosphorylation of pyk2 (Y402) and Rac1, suggesting that ET1 inhibited NADPH oxidase activity via ETB1-Pyk2-Rac1 pathway. Indeed, inhibition of Pyk2 by AG-17 abolished ET1-induced suppression of NADPH oxidase activity. ET1 also attenuated angiotensin II-induced activation of NADPH oxidase and cell proliferation. This study demonstrated, for the first time, that ET1, via ETB1, inhibited NADPH oxidase activity in HAAECs by suppressing the Pyk2-Rac1-Nox1 pathway. This finding reveals a novel function of ETB1 receptors in regulating endothelial NADPH oxidase activity, superoxide production, and cell proliferation, opening a new avenue for understanding the role of ETB1 receptors in protecting endothelial cells.     

Efficient synthesis of D6‐clenproperol and D6‐cimaterol using deuterium isopropylamine as labelled precursor

This report presents an efficient synthesis of D₆‐clenproperol and D₆‐cimaterol with 99.5% and 99.7% isotopic abundance in acceptable yields and excellent chemical purities with deuterium isopropylamine as labelled precursor. Their structures and the isotope‐abundance were confirmed by proton nuclear magnetic resonance and liquid chromatography–mass spectrometry.     

双极食管导联刺激同步记录在心脏电生理检查中的应用

为了解食管法心脏电生理检查能否观察到瞬间发生的心律失常,对120例患者行经食管刺激心房时同步记录I、aVF、V_1双极食管导联心电图.结果显示受检患者中35%能在双极食管导联中清晰记录到位于电脉冲波后的P波;47%能清晰记录到刺激停止后的即刻心电图;18%无法记录到即刻双极食管导联心电图.提示使用该法能基本了解刺激停止后诱发瞬间心律失常的发生机制,尤适合只能诱发出数次折返回波而机制不明者,能完善和扩大食管电生理检查的方法和范围,具有较高的临床应用价值.     

4种抗原检测日本血吸虫病人血清中特异性IgG和IgG_4考核疗效的比较研究

目的探讨ＳｊＭＡｇ、ＫＬＨ及ｒＳｊ３２检测日本血吸虫病人的特异性和敏感性及疗效考核价值。方法采用ＥＬＩＳＡ法,用ＳｊＭＡｇ、ＫＬＨ及ｒＳｊ３２及ＳＥＡ检测治疗前及治疗后不同时期血吸虫病人血清中的特异性ＩｇＧ、ＩｇＧ４及正常人和肺吸虫、肝吸虫、囊虫病人血清中的非特异抗体。结果ＳｊＭＡｇ、ＫＬＨ及ｒＳｊ３２的敏感性和特异性与ＳＥＡ比较差异均无显著性（均Ｐ＞０．０５）;用ＳｊＭＡｇ和ＫＬＨ分别检测治疗后１２个月血清中ＩｇＧ和ＩｇＧ４的阴转率均显著高于ＳＥＡ（Ｐ＜０．０１）、检测治疗后２４个月血清中ＩｇＧ４的阴转率均达９７．６％。结论ＳｊＭＡｇ、ＫＬＨ及ｒＳｊ３２具有与ＳＥＡ相似的诊断价值和较高的疗效考核价值;特异性ＩｇＧ４可能系一种疗效敏感抗体,可望成为疗效考核评价指标。     

先天性食管闭锁术后患儿短期预后的分析

目的 通过回顾性分析先天性食管闭锁接受手术治疗的患儿临床资料,了解影响其短期预后的因素,以改善食管闭锁手术患儿的预后。方法 收集并分析笔者医院2008年1月～2014年12月接受过手术治疗的46例先天性食管闭锁患儿的临床资料。结果 46例患儿中3例术中因食管闭锁两盲端距离过大放弃。43例患儿完成手术治疗,其中转院2例。26例治愈出院的患儿,出生体重2976.0±554.6g;15例死亡患儿,出生体重2337.3±498.1g;这41例患儿,足月儿有31例,死亡7例,早产儿10例,死亡8例。较大的出生体重（P=0.008）和较长的胎龄（P=0.002）有助于患儿术后生存;发生术后吻合口瘘14例,发生率为34.15%,其中死亡10例,治愈4例,吻合口瘘患儿病死率高于无该并发症患儿（P=0.001）;Ⅲa型20例,发生吻合口瘘6例,Ⅲb型21例,吻合口瘘8例,吻合口瘘发生与疾病分型无关（P>0.05）。结论 小胎龄、低体重以及术后吻合口瘘是先天性食管闭锁术后患儿短期预后不良的主要因素,加强护理,减少吻合口瘘的发生将可能助于改善患儿预后。近端食管肌层环形切开延伸术,可以减少吻合口张力,减少吻合口瘘的发生。     

开展急救时效学研究

随着我们放开视野,从对意外伤害开始观察时,才开始对伤病的全过程救治有了整体的认识。当我们把医疗救援放在应急反应的全过程时,我们才对时效概念有了更深刻的认识。我们才能从既往由工作空间决定只思考自己的工作环节的狭隘视角转换出大视角,这样才能真正比既往全面、公正地思考急救和救援工作。由于时间、空间、分工、资源等重要因素的影响,急救与救援被分割成为若干环节,各个环节的工作可能在理论和实践上较为完善了。