主体建模方法介绍及其在医学应用的实例

目的 阐述主体建模（agent-based model,ABM）的基本思想,促进其在医学研究中的应用。方法 介绍主体建模方法的基本概念、建模步骤和计算机实现方法,并通过一个流感（流行性感冒）疫情控制案例介绍其在医学研究中的应用。结果 通过模型发现三种间断型延长周末休息时间干预措施能有效缓解季节性流感暴发疫情,且同样休息天数的连续型方案效果更好。结论 主体建模为解决复杂医学问题提供了新的思路,可作为传统建模方法的有益补充。     

Cyclosporine A administered during reperfusion fails to restore cardioprotection in prediabetic Zucker obese rats in vivo

Background and aimsHyperglycaemia blocks sevoflurane-induced postconditioning, and cardioprotection in hyperglycaemic myocardium can be restored by inhibition of the mitochondrial permeability transition pore (mPTP). We investigated whether sevoflurane-induced postconditioning is also blocked in the prediabetic heart and if so, whether cardioprotection could be restored by inhibiting mPTP.Methods and resultsZucker lean (ZL) and Zucker obese (ZO) rats were assigned to one of seven groups. Animals underwent 25 min of ischaemia and 120 min of reperfusion. Control (ZL-/ZO Con) animals were not further treated. postconditioning groups (ZL-/ZO Sevo-post) received sevoflurane for 5 min starting 1 min prior to the onset of reperfusion. The mPTP inhibitor cyclosporine A (CsA) was administered intravenously in a concentration of 5 (ZO CsA and ZO CsA + Sevo-post) or 10 mg/kg (ZO CsA10 + Sevo-post) 5 min before the onset of reperfusion. At the end of reperfusion, infarct sizes were measured by TTC staining. Blood samples were collected to measure plasma levels of insulin, cholesterol and triglycerides.Sevoflurane postconditioning reduced infarct size in ZL rats to 35 ± 12% (p < 0.05 vs. ZL Con: 60 ± 6%). In ZO rats sevoflurane postconditioning was abolished (ZO Sevo-post: 59 ± 12%, n.s. vs. ZO Con: 58 ± 6%). 5 mg and 10 mg CsA could not restore cardioprotection (ZO CsA + Sevo-post: 59 ± 7%, ZO CsA10 + Sevo-post: 57 ± 14%; n.s. vs. ZO Con). In ZO rats insulin, cholesterol and triglyceride levels were significant higher than in ZL rats (all p < 0.05).ConclusionInhibition of mPTP with CsA failed to restore cardioprotection in the prediabetic but normoglycaemic heart of Zucker obese rats in vivo.     

Comparative epidemiology and virology of fatal and nonfatal cases of hand,foot and mouth disease in mainland China from 2008 to 2014

This study aimed to analyze the epidemiology and virology of fatal and nonfatal hand, foot, and mouth disease (HFMD) cases in Mainland China. A total of 10 714 237 survivors and 3046 deaths were reported from 2008 to 2014 June, with a case fatality rate of 0.03%. The morbidity of the survivors increased from 37.6/100 000 in 2008 to 139.6/100 000 in 2013 and peaked in 2012 at 166.8/100 000. However, the mortality varied around 0.03–0.04/100 000 across the time. Most of the survivors were distributed in the southern and eastern China, predominantly in the Guangxi and Hainan Province, whereas deaths were dominant in southern (Guangxi) and southwestern (Guizhou) China. The two groups showed similar seasonal fluctuations from 2008 to 2014, peaking in spring and early summer. Of the total cases, 93.97% were children less than 5 years of age, with those ≤ 2 years old accounting for 60.08% versus 84.02% in the survivor and death groups, respectively. Boys were at higher risk of infection than girls in both groups. Five years of virological surveillance showed that 43.73%, 22.04%, and 34.22% of HFMD cases were due to EV71, CoxA16 and other enteroviruses, respectively. EV71 was encountered in most deaths, with no substantial effect of age, gender, month, and year on incidence. Subgenotype C4a was the prevalent EV71 strain in Mainland China, with no significant difference in the VP1 gene related to virulence between the two groups. In conclusion, based on the largest population study, fatal and nonfatal HFMD cases, mainly caused by C4a of EV71, are circulating in Mainland China with a low‐cause fatality rate. Copyright © 2015 John Wiley & Sons, Ltd.     

低血铅暴露与神经系统症状的关系

目的 探讨油漆工人的低血铅暴露与神经系统症状之间的关系。方法 采用整群抽样的方法, 抽取2个油漆相关企业的所有接触油漆的工人为样本, 对其进行问卷调查、生化检测及体格检查。采用单因素χ²检验和多因素非条件logistic回归分析的方法探讨低血铅和其他因素暴露对神经系统症状的影响。结果 收集到完整资料的有525例, 其中血铅阳性者55例(10.5%);血铅阳性者的血铅均值为(0.088 4±0.053 9)mg/L;278例(52.95%)出现类神经征;69例(13.14%)出现周围神经病症状。多因素非条件logistic回归分析显示:工龄(OR=1.827)、饮酒(OR=1.607)、健康状况(OR=3.862)、血铅(OR=1.983)与类神经征有关。工龄(OR=2.282)、饮酒(OR=2.704)与周围神经病有关。结论 低浓度血铅暴露可能与类神经征的发生相关。     

胰岛素强化治疗对急性胰腺炎患者血清炎症因子水平的影响

目的探讨胰岛素强化治疗对急性胰腺炎患者血清炎症因子的影响。方法79例未合并糖尿病的急性胰腺炎患者随机分为常规治疗组（n=39）和胰岛素强化治疗组（n=40）。常规组使用常规药物治疗；胰岛素强化治疗组在常规治疗基础上加用胰岛素治疗，将血糖维持在4.4-6、1mmol／L。分剐于治疗前和治疗24、72h抽血测定IL-6及超敏c反应蛋白（CRP）水平。同时设70例正常健康人群用于分析比较。用酶联免疫吸附法检测IL-6，用免疫比浊法测定cRP。结果①与健康对照组相比，急性胰腺炎患者外周血IL-6（58．7±9．6ng／Lvs．6．4±2．4ng／L，P〈0．01）和CRP（118．1±13．2mg/L VS．2．7±1．1mg／L，P〈0．01）均有显著性升高。②外周血IL-6（18．4±6．2ng／L vs．60．7±10．1ng／L，P〈0．01）、cRP的水平（15．6±6．3mg／L VS．121．1±14．3mg／L，P〈0．01）在胰岛素强化治疗72h后有显著性降低。结论胰岛素强化治疗可降低急性胰腺炎患者血清IL-6和CRP的炎症因子水平。     

湘乡市2001-2006年狂犬病流行情况及防制对策

目的分析湘乡市近6年的狂犬病流行特征,探讨发病率回升的原因并提出相应的防制对策。方法收集2001-2006年湘乡市狂犬病病例调查、疫情报告及监测资料进行分析。结果共报告狂犬病例53例,年均发病率为0.9882/10万;在2003-2004年有一发病高峰;全年均有病例发生,夏秋季相对较多;96.23%的病例发生在农村;人群分布以男性、10岁以下和40～59岁年龄组、农民为主;致伤动物犬类占96.23%;88.68%的病例未进行任何伤口处理和免疫接种。结论湘乡市仍为狂犬病高发区,犬只数量多且缺乏监管,犬只免疫率低,带毒率较高、宣传力度不够,群众防疫意识不强,暴露后规范处理和免疫接种率低,疫情监测和报告制度不严等是狂犬病发病率回升的主要原因。必须加强犬类管理,加大健康教育力度,规范暴露后伤口处理,加强对医务人员的培训等。     

长沙市2003～2006年突发公共卫生事件流行病学分析

目的了解长沙市突发公共卫生事件的流行特征,为预防、控制和有效处理突发公共卫生事件提供依据。方法收集长沙市2003～2006年突发公共卫生事件资料,应用描述性流行病学分析。结果全市2003～2006年共报告75起突发公共卫生事件,发病人数为3 640人,死亡1人,病死率0.03%。发生时间以6月、9月相对较高,事件类型以传染病暴发疫情为主,事件发生场所主要在学校。结论突发公共卫生事件严重危害人民群众的身体健康和生命安全,长沙市农村地区和学校是突发共卫生事件防控的重点。     

长沙市电子行业工人职业应激及其影响因素研究

目的了解电子行业工人的职业应激状况及其影响因素,为采取有效干预措施提供科学依据。方法采用分层随机整群抽样方法,选取788名电子行业工人为调查对象,采用自制的一般情况调查问卷进行调查;采用中文版的(occupational stress inventory-revised edition,OSI-R)问卷进行职业应激测评。采用Epidata3.1建库,应用SPSS13.0进行统计分析。结果职业任务得分(180.66±24.15)、个体紧张反应得分(101.63±20.57)均高于西南常模,差异有统计学意义(P0.05);个体应变能力得分(118.33±19.48)低于西南常模,差异有统计学意义(P0.05)。多元线性回归分析发现:流水性作业(t=2.687,P0.05)、任务不适(t=4.087,P0.05)、任务模糊(t=2.263,P0.05)、任务冲突(t=11.729,P0.05)、责任感(t=5.354,P0.05)、工作环境(t=10.144,P0.05)是紧张反应的危险因素;和家人一起住(t=-1.981,P0.05)、高年龄组(t=-2.841,P0.05)、娱乐休闲(t=-2.817,P0.05)、自我保健(t=-3.064,P0.05)、社会支持(t=-3.726,P0.05)是紧张反应的保护因素。结论长沙市电子行业工人的应激程度较一般职业人群高,建议该行业采取优化组织结构与管理、改善工作环境、宣传职业卫生相关健康知识、加强职业健康监护、营造良好企业文化氛围等措施减缓职业应激,促进其身心健康。