汶川抗震救灾医疗后送调查分析及思考

目的：分析汶川地震医疗后送工作,为完善灾害救援的医疗后送提供科学依据。方法通过对汶川地震医疗后送的系统调研和相关资料的分析,总结汶川抗震救灾医疗后送流程、医疗后送工具及分级救治情况。结果汶川地震中医疗后送总体分三个层次进行,军队独立医疗后送体系未形成,缺乏专用卫生运力,分级救治原则不尽完善。结论在特大地震医疗后送中,应严格掌握分级救治原则,重点加强前方卫勤分队的机动能力、中间卫生专用运力、后方基地化医院救治水平,并形成三者相结合的快速立体医疗后送。     

The utility of ‘country of birth’ for the classification of ethnic groups in health research: the Dutch experience

The relationship between ethnicity and health is attracting increasing attention in international health research. Different measures are used to operationalise the concept of ethnicity. Presently, self-definition of ethnicity seems to gain favour. In contrast, in the Netherlands, the use of country of birth criteria have been widely accepted as a basis for the identification of ethnic groups. In this paper, we will discuss its advantages as well as its limitations and the solutions to these limitations from the Dutch perspective with a special focus on survey studies.

The country of birth indicator has the advantage of being objective and stable, allowing for comparisons over time and between studies. Inclusion of parental country of birth provides an additional advantage for identifying the second-generation ethnic groups. The main criticisms of this indicator seem to refer to its validity. The basis for this criticism is, firstly, the argument that people who are born in the same country might have a different ethnic background. In the Dutch context, this limitation can be addressed by the employment of additional indicators such as geographical origin, language, and self-identified ethnic group. Secondly, the country of birth classification has been criticised for not covering all dimensions of ethnicity, such as culture and ethnic identity. We demonstrate in this paper how this criticism can be addressed by the use of additional indicators.

In conclusion, in the Dutch context, country of birth can be considered a useful indicator for ethnicity if complemented with additional indicators to, first, compensate for the drawbacks in certain conditions, and second, shed light on the mechanisms underlying the association between ethnicity and health.     

感染人类呼吸道的病毒及其分类新进展

近年来,随着SAPS、禽流感等重大呼吸道传染病的出现,人们对呼吸道病毒感染给予了高度重视,促进了呼吸道病毒学的发展.这主要表现在三个方面,一是对相关病毒如SARS冠状病毒和高致病性禽流感病毒的致病性、基因与抗原变异、疫苗制备等取得了进展;二是发现了一些新的呼吸道病毒如冠状病毒HCoV-NL63和HCoV-HKU1、博卡病毒;三是一些被认为与呼吸道感染关系不大的"老病毒"如某些疱疹类病毒和细小病毒,现在经常出现在呼吸道感染者的样本中.鉴于目前呼吸道病毒的范围比以前有明显扩大,此文就能够感染人类呼吸道的病毒及其分类作一综述.     

血管紧张素转化酶活性与乙型病毒性肝炎患者临床分型关系的研究

目的探讨血清血管紧张素转化酶（ACE）与乙型病毒性肝炎不同临床分型的关系及临床意义。方法利用连续监测法对健康组60例、慢性病毒性乙型肝炎组43例、Child-Pugh A级组36例、Child-Pugh B级组34例、Child-Pugh C级组32例各样本进行ACE活性和胆碱酯酶（CHE）活性的测定,比较各组ACE和CHE值,判断肝细胞损伤程度与血清ACE的活性及ACE和CHE之间的关系。结果乙型病毒性肝炎不同临床分型血清中ACE活性变化的顺序由低到高为：健康组（23．47±6．03）μmol／L,慢性病毒性乙型肝炎组（51．79±8．58）μmol／L,乙肝后肝硬化中Child-Pugh A级组（60．57±6．40）μmol／L,Child-PughB级组（68．22±6．62）μmol／L,Child-PughC级组（77．30±8．30）μmol／L,各组肝病患者血清ACE活性都明显高于健康组（P〈0．01）。CHE活性〉4000 IU／L时,ACE活性为（34．71±9．43）μmol／L,CHE在2000N4000 IU／L时,ACE活性为（53．16±8．46）t．LmolfL,CHE在1000～2000 IU／L时,ACE活性为（67．67±9．52）μmol／L,CHE〈1000 IU／L时,ACE活性为（79．27±7．53）μmol／L,各组间比较,差异有统计学意义（均P〈0．01）。结论检测病毒性乙型肝炎不同临床分型中血清ACE的活性变化,对于判断肝细胞损伤程度有一定的临床意义。     

Refractory headache: classification and nomenclature

There are a number of reasons to attempt to define and classify refractory headache disorders. Particularly important are the potential benefits in the areas of research, treatment, and medical cost reimbursement. There are challenges in attempting to classify refractory forms of headaches, including the lack of biological or other objective markers and a lack of consensus among practitioners as to what qualifies as refractoriness, or even if a separate category for refractory migraine and other refractory headaches needs to be established. A definition of refractory migraine has been proposed by Schulman et al in this issue ("Defining Refractory Migraine [RM] and Refractory Chronic Migraine [RCM]: Proposed Criteria for the Refractory Headache Special Interests Section of the American Headache Society"), which should be tested for validity and usefulness. It seems reasonable to consider adding this defined syndrome to the International Classification of Headache Disorders, second edition (ICHD-II). In this article, options for adding refractory headache syndromes to the ICHD are discussed with pros and cons for each. Two "best" options for adding the disorder "refractory migraine" to the ICHD are presented along with an illustrative case example.     

Past, present, and future prospects of medication-overuse headache classification

The 1988 classification by the International Headache Society (IHS) first defined drug-induced headache as a specific disorder, belonging to secondary headaches, subtype 8.2 (headache induced by chronic substance use or exposure). In 2004 ICHD-II, this definition was replaced by medication-overuse headache (MOH). It was established that a definite diagnosis of MOH required the improvement of the disorder after cessation of medication overuse. The specific characteristics of the various subforms were also indicated. Later revisions have first eliminated these headache characteristics and then the diagnosis of probable MOH. The diagnosis of MOH has therefore become more useful to clinical aims. However, the last revision has eliminated the need to prove that the disorder is caused by drugs, that is, the headache improves after cessation of medication overuse. The classification of MOH as a secondary headache has therefore been modified, too. Clinical trials can consequently include in the same group patients with primary headache and drug overuse and patients with MOH.
We therefore propose to continue to use the diagnosis of probable MOH to research aims. We also propose to modify the classification of MOH subforms according to the presence or absence of a dependence-producing property of overused drugs. This will allow to better analyze the role of the various medications in inducing chronic headache and the outcomes of treatments.     

有关清宫术及异位妊娠手术操作编码的探讨

目的通过分析探讨妇幼体系手术操作分类的准确编码。方法归纳常见手术操作分类在的问题;通过详细阅读病案资料特别是手术记录,查阅相关书籍,及时与临床医生沟通,了解手术操作方式;然后按照ICD-9-CM-3编码原则进行分类编码。结果严格遵循国际疾病手术分类原则,多途径查找编码,能保证手术编码准确率,提高手术分类工作效率。结论规范、准确的手术操作名称是提高手术编码质量的关键,编码员丰富的专业知识是提高手术编码质量的保证。     

Ordinal response prediction using bootstrap aggregation,with application to a high‐throughput methylation data set

Many investigators conducting translational research are performing high‐throughput genomic experiments and then developing multigenic classifiers using the resulting high‐dimensional data set. In a large number of applications, the class to be predicted may be inherently ordinal. Examples of ordinal outcomes include tumor‐node‐metastasis (TNM) stage (I, II, III, IV); drug toxicity evaluated as none, mild, moderate, or severe; and response to treatment classified as complete response, partial response, stable disease, or progressive disease. While one can apply nominal response classification methods to ordinal response data, in doing so some information is lost that may improve the predictive performance of the classifier. This study examined the effectiveness of alternative ordinal splitting functions combined with bootstrap aggregation for classifying an ordinal response. We demonstrate that the ordinal impurity and ordered twoing methods have desirable properties for classifying ordinal response data and both perform well in comparison to other previously described methods. Developing a multigenic classifier is a common goal for microarray studies, and therefore application of the ordinal ensemble methods is demonstrated on a high‐throughput methylation data set. Copyright © 2009 John Wiley & Sons, Ltd.     

Perceived discrimination and health among Puerto Rican and Mexican Americans: Buffering effect of the Lazo matrimonial?

An emerging body of research shows that perceived discrimination adversely influences the mental health of minority populations, but is it also deleterious to physical health? If yes, can marriage buffer the effect of perceived discrimination on physical health? We address these questions with data from Puerto Rican and Mexican American residents of Chicago. Multivariate regression analyses reveal that perceived discrimination is associated with more physical health problems for both Puerto Rican and Mexican Americans. In addition, an interaction effect between marital status and perceived discrimination was observed: married Mexican Americans with higher perceived discrimination had fewer physical health problems than their unmarried counterparts even after adjusting for differential effects of marriage by nativity. The findings reveal that perceived discrimination is detrimental to the physical health of both Puerto Rican and Mexican Americans, but that the stress-buffering effect of marriage on physical health exists for Mexican Americans only.