2010—2019年新疆伊宁市初治涂阳肺结核患者流行特征及治疗转归分析

目的 了解2010—2019年新疆伊宁市初治涂阳肺结核流行特征,并分析影响其治疗结局的因素,为该地区的结核病疫情防控提供理论依据。方法 通过《中国结核病管理信息系统》收集伊宁市2010—2019年初治涂阳肺结核患者的基本信息、治疗及诊断信息。人口学信息来源于2010—2019年《伊犁州统计局统计年鉴》,流行特征分析采用描述性流行病学方法,并采用多因素logistic回归模型分析纳入患者治疗转归的影响因素。结果 2010—2019年新疆伊宁市共报道了4728例初治涂阳肺结核病患者,年均报告发病率为87.16/10万,各年度报告发病率范围为66.55/10万（391例）~127.29/10万（727例）,在4728例初治涂阳患者中,HIV检查阳性患者共665例,HIV-TB双重感染年均登记报告率为12.57/10万;男性2922例,女性1806例,男性与女性的比例为1.62∶1;16~45岁［66.96%(3166/4728)］、少数民族［84.40%（3973/4728）］人群多发;患者来源主要以转诊为主,占比为42.49%（2009/4728）;患者主要为Ⅲ型肺结核［94.20%（4454/4728）］;初治涂阳肺结核流行期集中在每年的3—5月;多因素logistic回归结果显示:强化期督导（OR=0.015,95%CI:0.003~0.077）、全程督导（OR=0.067,95%CI:0.014~0.314）、全程管理（OR=0.045,95%CI:0.004~0.526）、系统管理（OR<0.001,95%CI:0.000~0.001）的初治涂阳肺结核患者更易治疗成功。结论 2010—2019年伊宁市初治涂阳肺结核报告发病率总体上呈现先下降后上升的趋势,应重点关注男性、中年、少数民族人群,在3—5月期间对以上高危人群进行结核病筛查;加强初治涂阳肺结核患者治疗过程中的系统管理和督导工作。     

子宫内膜异位症不孕并发内膜息肉的病理特征及手术后复发分析

目的:分析子宫内膜异位症(EM)不孕患者发生内膜息肉情况及病理特征。方法:收集本院2016年1月-2017年1月收治的不孕患者,EM 67例为观察组,非EM 82例为对照组,比较两组内膜息肉发生率,观察组r-AFS不同分期内膜息肉发生率、治疗后临床妊娠率,分析发生内膜息肉的病理特征。结果:观察组内膜息肉发生率(31.3%)及息肉复发率(11.9%)高于对照组(12.2%、2.4%)(P<0.05);观察组EMⅠ期患者内膜息肉发生率17.7%、无复发,Ⅱ期内膜息肉发生率32.0%、复发率8.0%,Ⅲ期内膜息肉发生率40.0%、复发率20.0%,Ⅳ期内膜息肉发生率40.0%、复发率30.0%,各期发生率及复发率比较无差异(P>0.05);卵巢型内膜息肉发生率25.0%、复发率10.0%,腹膜型内膜息肉发生率29.0%、复发率9.7%,DIE型内膜息肉发生率43.8%、复发率18.8%,EM不同病理类型内膜息肉发生率及复发率无差异(P>0.05)。结论:EM不孕患者发生内膜息肉几率较大,及时手术切除息肉可提高妊娠率,临床应及早诊断和治疗。     

胆道结石术后继发急性胆管炎病原菌及sCD14-ST和IL-8的诊断价值

目的探讨胆道结石术后继发急性胆管炎病原菌及可溶性CD14亚型(sCD14-ST)、白细胞介素-8(IL-8)的诊断价值。方法选择海南医学院第一附属医院2017年1月-2019年6月收治的胆道结石术后继发急性胆管炎患者62例作为研究对象,纳入研究组,选择同期医院收治的胆道结石术后未继发急性胆管炎的患者60例设为对照组;对研究组患者病原菌进行统计;比较不同急性胆管炎程度、不同预后结局患者血清sCD14-ST、IL-8水平;采用受试者工作特征曲线评估血清sCD14-ST、IL-8水平对于患者不良预后的诊断价值。结果 62例患者共培养分离病原菌67株,其中革兰阴性菌43株占64.18%,革兰阳性菌21株占31.34%,真菌3株占4.48%,以大肠埃希菌为主;重度急性胆管炎患者血清sCD14-ST、IL-8分别为(91.38±25.67)pg/ml、(45.28±13.61)pg/ml高于中度患者分别为(74.34±19.65)pg/ml、(32.06±10.44)pg/ml及轻度患者(P均<0.001),中度患者血清sCD14-ST、IL-8水平高于轻度患者(P均<0.001);预后不良患者急性胆管炎血清sCD14-ST、IL-8分别为(89.84±25.09)pg/ml、(41.94±12.28)pg/ml高于预后良好患者(P<0.05);sCD14-ST、IL-8对胆道结石术后急性胆管炎患者预后的截断值分别为65.65、29.31 pg/ml,其曲线下面积分别为0.841、0.768。结论胆道结石术后继发急性胆管炎病原以革兰阴性菌为主;运用血清sCD14-ST、IL-8可较好区分疾病严重程度,且对患者预后具有一定预测价值。     

Natural frequency/damping coefficient relationship of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure

Using a digital simulation method, we analyzed the relationship between natural frequency (f _n ) and damping coefficient () of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure. The pulmonary artery pressure waveform was obtained with a catheter-tip transducer and it was fed into a dynamic simulator programmed on a computer. The original waveform and the output of the simulator were compared and judged visually for the fidelity. From this analysis, the combination of f _n and was obtained and was plotted on a f _n – diagram. It showed as an area, which was convex on the left side and open on the right side. The left-convex endpoint was located at a damping coefficient of about 0.7. At a lower heart rate, this area was extended to the lower frequency side, while, at a higher heart rate, this area was limited to the higher frequency side. The f _n – diagram was also constructed theoretically by calculating the relations between natural frequencies and damping coefficients of a second order system with the amplitude and phase error tolerance set at +/–5% respectively.(Kinefuchi Y, Suzuki T, Takiguchi M, et al.: Natural frequency/Damping coefficient relationship of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure. J Anesth 7: 419--426, 1993)     

结直肠间质瘤临床病理特征及预后分析

目的 探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据.方法: 通过监测流行病学和最终结果(surveillance, epidemiology, and end results, SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性.结果: 546例结直肠间质瘤患者被纳入研究.中位发病年龄64岁,区域淋巴结转移率9.4%.546例患者多因素生存分析显示发病年龄 > 64岁,未婚/离婚,结肠间质瘤(与直肠间质瘤相比),非手术治疗,组织分化级别高,区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05), 美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P = 0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI: 0.72-0.80)和0.75(95%CI: 0.72-0.78).在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄,组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P = 0.041),未证实与总生存显著相关(P = 0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI: 0.66-0.75)和0.73(95%CI: 0.70-0.77), 能较准确预测结直肠间质瘤患者总生存率.结论: 结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据.     

Characterization and phylogenetic analysis of a neurovirulent Zika virus isolated from Cambodia in 2019

The geographic range of Zika virus (ZIKV) has expanded from Asia to the Americas, leading to the 2015–2016 pandemic with enhanced neurovirulence. At present, ZIKV is continuously circulating in many Southeast Asian countries. Unfortunately, the persistent evolution of ZIKV in Southeast Asia and its influence on the biological characteristics of the virus remain incompletely understood. In this study, the in vitro and in vivo properties of a new ZIKV isolate obtained from Cambodia in 2019 (CAM/2019) were characterized and compared with those of the Cambodian strain (CAM/2010). Compared with CAM/2010, the CAM/2019 virus showed similar plaque morphology and growth curves in cell cultures and induced comparable viremia and organ viral loads profiles in both BALB/c and A129 (IFNAR1^−/−) mice upon intraperitoneal (i.p.) inoculation. Remarkably, the CAM/2019 virus exhibited enhanced neurovirulence in neonatal mice compared with CAM/2010, with a 74-fold reduction in the 50% lethal dose (LD₅₀). Consistently, CAM/2019 produced higher viral loads in the brains of BALB/c neonatal mice than CAM/2010 did. Sequence alignment showed that the CAM/2019 virus has acquired 12 amino acid substitutions, several of which were found to be associated with neurovirulence. In particular, the CAM/2019 virus shared an A1204T substitution in NS2A with the Thai isolate SI-BKK02 that was isolated from a microcephaly case. Taken together, our results indicate that a ZIKV strain isolated with specific mutations has emerged in Cambodia, highlighting the need for extensive molecular and disease surveillance in Cambodia and other Asian countries.     

The Effects of Race,Socioeconomic Status,and Household Structure on Injury Mortality in Children and Young Adults

Objectives: Injuries are the leading killer of young persons in the United States, yet significant gaps in our understanding of this cause of death remain. By examining the independent influences of race, education, income, household structure, and residential location on injury mortality in young persons, this study addresses these gaps. Method: Using data from the National Longitudinal Mortality Study, survival analysis is used to examine the injury mortality risk faced by 0 to 17 year olds over a nine-year follow-up period. Separate models are estimated for homicide, suicide, unintentional injury deaths, and all injury deaths. Results: Household head's education has an independent effect on youth homicide and unintentional injury mortality risk. By contrast, family income and household structure do not have independent effects on any of the injury outcomes. Finally, much of the excess homicide risk faced by young African-Americans is explained by underlying racial differentials in socioeco-nomic status, household structure, and residential location. Conclusions: By finding an independent effect of household head's education on youth mortality risk from homicide and unintentional injuries, this study adds to the large body of evidence linking socioeconomic differentials to inequality in life chances.     

Comparison of serum fluoride levels after administration of monofluorophosphate-calcium carbonate or sodium fluoride: differences in peak serum concentrations

Fluoride salts are widely used in Europe in the treatment of established osteoporosis with crush fractures for their ability to increase trabecular bone mass. However, in the United States fluorides are still regarded as an experimental drug. In a prospective, randomized study we compared the fluoride pharmacokinetics of enteric-coated sodium fluoride and disodium monofluorophosphate calcium carbonate (MFP-Ca) over the period of 76 h. Twenty subjects (12 females, 8 males), aged 35–80 years, free of gastrointestinal disorders, renal impairment, and liver disease and without prior fluoride intake entered the study. Ten subjects received NaF (11.3 mg fluoride) twice a day and the other ten MFP-Ca (13.2 mg fluoride) twice a day. During the study period of 76 h the patient's usual food intake was not changed. Serum fluoride levels were determined using an ion sensitive electrode. After intake of a single drug preparation of MFPCa or NaF, MFP-Ca showed a significantly shorter lag time of absorption and a significantly higher maximal serum fluoride concentration than NaF (P<0.01). A comparison of fluoride cumulative characteristics of both drugs showed virtually identical serum fluoride levels before intake of the morning dose on all 4 study days, whereas serum fluoride concentrations measured 4 h afterwards were significantly higher for MFP-Ca than for NaF. These data provide evidence of high peak serum fluoride levels for MFP-Ca, whereas only small peak-to-trough fluctuations are seen for NaF.Abbreviations MFP-Ca disodium monofluorophosphate-calcium carbonate - C _max maximum drug concentration - T _max lag time of maximum drug concentration - AUC area under the serum concentration versus time curve Correspondence to: L. Erlacher     

Dementia lacking distinctive histopathology: clinicopathological evaluation of 32 cases

We report the neuropathological findings in 32 patients, aged 46–86 years, with demential lacking distinctive histopathology. All of the patients were classified clinically as having Pick's or atypical Pick's disease, but the routine neuropathological evaluation showed no specific histopathological changes such as Pick bodies, senile plaques, neurofibrillary tangles or Lewy bodies. In 50% of the cases the first symptoms appeared before 65 years of age. However, there were 9 patients with onset in the eighth decade. Positive family history was found only in 6 presenile cases. The retrospective evaluation of the clinical records revealed the consistent presence of frontal symptomatology, including loss of personal awareness, inappropriate euphoria and stereotyped behavior. Speech disorders were observed in 80% of the cases, whereas temporospatial disorientation and memory impairment were less frequent. Praxis and gnosis were strikingly preserved in most of the cases. The macroscopic neuropathological examination revealed frontal or temporopolar atrophy in 97% of the cases, while the hippocampus and subcortical structures were relatively spared in the majority of the cases. Histologically, four groups were recognized. Group A showed moderate to severe neuron loss and gliosis in the frontal and/or temporopolar cortex without subcortical involvement. In group B, the neocortical cell loss was widespread, and the striatum and substantia nigra displayed differential degrees of gliosis but no neuron loss. Group C patients showed a lesion distribution comparable to that observed in group B but with severe neuron loss in at least one subcortical region. Four cases formed group D, which was characterized by the preservation of the pyramidal neurons in the neocortex and variable subcortical changes. Despite these differences in the topography of pathological changes, all of the cases shared a similar clinical profile. These findings further demonstrate the epidemiological and neuropathological heterogeneity of dementia lacking distinctive histopathology. Furthermore, they suggest that the same clinical manifestations may correspond to several distinct pathological processes in this condition.     

云南富源县阿依村肺癌的流行病学特征及环境致癌因素研究

本文对富源县阿依村特定人群肺癌的流行病学特征及环境致癌因素进行调查研究。研究了该村1986～1996年肺癌调整死亡率的水平,变化趋势、死亡专率及性别比值。该村肺癌死亡率高、波动性大。男性肺癌调整死亡率高于宣威肺癌高发区1．9倍,女性肺癌调整死亡率接近宣威肺癌高发区的水平,男女合计肺癌调整死亡率高于我国重庆、上海、沈阳、大连、南京、天津、广州等工业城市9．7～12．0倍。男性高于女性2．4倍。死亡高峰年龄男女性均始于30～岁年龄组。以居民群体为暴露单位,采集了该村火塘燃烧室、地炉燃烧室、室外空气中颗粒物及有害气体样品,检测其TSP、IP、BaP、SO2浓度,结果显示上述4项污染物的浓度均是火塘燃烧室高于地炉燃烧室而室外最低。γ辐射火塘燃烧室显著高于地炉燃烧室。IP提取物的致突变活性,火塘燃烧室高于地炉燃烧室高于室外。对该村居民改炉改灶降低室内空气中污染物的浓度及致突变活性的效果进行了评定。