万佛山自然保护区蕨类植物区系特征及资源利用

目的:对安徽大别山东南部的万佛山蕨类植物进行资源调查,探明其区系特征与资源利用。方法:对万佛山区进行实地调查,标本采集和鉴定,并对它们的区系类型进行了分析。结果:蕨类植物有71种,隶属24科,39属,集中分布于海拔400~1100 m;具有明显热带性质和丰富的温带成分;并以水龙骨科、鳞毛蕨科、蹄盖蕨科等在系统演化上较高级的类群占优势。结论:万佛山区蕨类植物资源较为丰富,值得合理利用。     

Blood Glucose Monitor Performance: A Review of Standards and Statistics Used to Describe Blood Glucose Monitor Performance

Glucose performance is reviewed in the context of total error, which includes error from all sources, not just analytical. Many standards require less than 100% of results to be within specific tolerance limits. Analytical error represents the difference between tested glucose and reference method glucose. Medical errors include analytical errors whose magnitude is great enough to likely result in patient harm. The 95% requirements of International Organization for Standardization 15197 and others make little sense, as up to 5% of results can be medically unacceptable. The current American Diabetes Association standard lacks a specification for user error. Error grids can meaningfully specify allowable glucose error. Infrequently, glucose meters do not provide a glucose result; such an occurrence can be devastating when associated with a life-threatening event. Nonreporting failures are ignored by standards. Estimates of analytical error can be classified into the four following categories: imprecision, random patient interferences, protocol-independent bias, and protocol-dependent bias. Methods to estimate total error are parametric, nonparametric, modeling, or direct. The Westgard method underestimates total error by failing to account for random patient interferences. Lawton''s method is a more complete model. Bland–Altman, mountain plots, and error grids are direct methods and are easier to use as they do not require modeling. Three types of protocols can be used to estimate glucose errors: method comparison, special studies and risk management, and monitoring performance of meters in the field. Current standards for glucose meter performance are inadequate. The level of performance required in regulatory standards should be based on clinical needs but can only deal with currently achievable performance. Clinical standards state what is needed, whether it can be achieved or not. Rational regulatory decisions about glucose monitors should be based on robust statistical analyses of performance.     

高原工作者高原反应及应对策略

短期进入高原从事高强度工作所致高原反应是值得探讨的问题,查阅文献,探讨其病因及发病机理、临床表现,总结国内外在诊断、预防及治疗方面的经验,探索一套可行、有效的预防及治疗措施,具有重要的临床意义。     

Non‐invasive positive pressure ventilation during sleep at 3800 m: Relationship to acute mountain sickness and sleeping oxyhaemoglobin saturation

Background and objective: Ascent to high altitude results in hypobaric hypoxia and some individuals will develop acute mountain sickness (AMS), which has been shown to be associated with low oxyhaemoglobin saturation during sleep. Previous research has shown that positive end‐expiratory pressure by use of expiratory valves in a face mask while awake results in a reduction in AMS symptoms and higher oxyhaemoglobin saturation. We aimed to determine whether positive pressure ventilation would prevent AMS by increasing oxygenation during sleep. Methods: We compared sleeping oxyhaemoglobin saturation and the incidence and severity of AMS in seven subjects sleeping for two consecutive nights at 3800 m above sea level using either non‐invasive positive pressure ventilation that delivered positive inspiratory and expiratory airway pressure via a face mask, or sleeping without assisted ventilation. The presence and severity of AMS were assessed by administration of the Lake Louise questionnaire. Results: We found significant increases in the mean and minimum sleeping oxyhaemoglobin saturation and decreases in AMS symptoms in subjects who used positive pressure ventilation during sleep. Mean and minimum sleeping SaO₂ was lower in subjects who developed AMS after the night spent without positive pressure ventilation. Conclusions: The use of positive pressure ventilation during sleep at 3800 m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO₂. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation.     

急性高原反应的循证防治

目的探讨在时间有限、快速进入高原后药物乙酰唑胺、藏药红景天是否能预防急性高原反应。方法运用循证医学方法全面检索相关的临床治疗证据并进行质量评价。结果一个系统评价和多个高质量随机对照试验RCT显示:乙酰唑胺与对照组相比疗效是肯定的,相对危险度是2·18、95%可信区间1·52～3·15、NNT2·9(2·0～5·2)。但对其使用剂量尚有争议。只检索到2篇RCT试验显示藏药红景天有疗效(P<0·01),未发现有副作用。结论除了高原习服、渐进进入高原地区外,在时间有限的情况下药物防治(乙酰唑胺、藏药红景天)可改善急性高原病的症状,能帮助人们更好的快速适应高原环境。     

514例山区儿童莱姆病感染的血清学调查分析

目的为了解莱姆病在山区儿童中的流行状况及特点。方法应用间接免疫荧光法（IFA）检测了514例山区儿童抗莱姆病螺旋体IgG、IgM抗体水平，并进行了传播媒介、带菌率、病理检查及心电图检查等。结果514名儿童中，抗莱姆病螺旋体IgG抗体阳性率8．17％，IgM抗体阳性率2．14％，传播媒介为长角血蜱，蜱的带菌率为30％。结论山区儿童中存在莱姆病感染，约50％的感染儿童为无症状隐性感染，应注意早期发现及时诊治。     

野山人参的性状和商品等级的研究

目的：研究野山人参的性状鉴别特征和商品等级划分。方法；生药学研究和鉴别特征聚类分析。结果：野山人参的芦与主根等较主根长，上有明显芦碗。主根人形、疙瘩状，或圆柱形，外皮黄褐色，顶部有细密凹陷较深的螺旋状横纹，下部侧根一般两条，自然形成一个夹角。须根少，细长不乱，柔韧而不易折断，上有明显疣状突起。结论：性状是野山人参鉴别的主要特征，参重是野山人参商品等级划分的主要依据，再参照主根的直径和侧根之间的夹角大小。     

症状评分、分度法诊断急性高原反应的应用与体会

本文报告应用症状评分、分度法对部队急进高原人群进行急性高原反应诊断的体会。现场调查结果;第1～3天发病率为18.5～37.9％,比临床症状学方法结果低。评分法具有量化、客观、简便等优点。对定量评价急性高原反应,指导临床与科研工作,使结果更具统一性和可比性,以及客观评价高原医学科研成果,具有理论和实际意义。     

长居海平面试飞人员进入高原工作的机体变化

目的：探讨长居海平面工作和生活试飞人员在高原工作的生理机能变化。方法：对长居海平面70名试飞人员，在2000m-5000m处试飞工作中，随同问询、诊查机体各系统的生理变化。结果：低氧分压是高山病各种症状的主要原因，加之高原特有的环境因素，使人体各系统产生许多异常症状。结论：生物机体不仅能接受环境因素的变化，发生一定的反应，而且在某些环境因素下，能相应改变自己的生理机能，但在适当卫生预防保健措施下，绝大多数人可很好地适应，而顺利完成工作。     

对快速进入高原部队预防急性高原病的措施探讨

目的了解急性高原病（AMS）的发病情况并探讨其预防措施。方法2006--2007年两次进入高原某地进行军事演练，伴随卫勤保障任务，通过在平原集结时之前，进行身体调整，加大训练强度，进人高原后，延长休整天数，进行心理干预，开展AMS知识的宣传教育，采用问卷、卫生队、卫生室进行病员登统计、个别问诊、检查的方法，了解部队进入高原后AMS的发病情况。结果2006年9—10月份与2007年9-10月份两次进入高原人员年龄分布无统计学差异（P〉0．05），而发病率由21．6％下降为13．4％及住院率0．72％下降为0．48％，2007年9—10月份与2006年9-10月份重度急性高原反应、高原肺水肿和高原脑水肿发病率都有所减低。结论在常规的卫勤保障基础上，应调整进入高原的休整期，一般7d左右为宜，加强高原卫生宣传教育，正确引导官兵们对低氧危害性和机体代偿能力的认识，克服高原恐惧心理和麻痹大意思想；提高医务人员的业务水平，增强责任心。这样可以大大地降低AMS的发病率和住院率，有效地保障官兵的身体健康。