关于军事认知医学的预测及发展策略的思考

新军事变革给军事医学提出新的挑战,认知科学的快速发展为军事认知医学的涌现奠定了科学基础,美军在军事认知研究方面已经有所探索.本文在充分调研的基础上,提出了军事认知医学的概念、研究内容,分析了其学科及技术平台基础,并就我军发展军事认知医学提出了相应的策略建议.     

现有乙型肝炎多表位疫苗在中国人群中的理论免疫效果评价

目的预测现有乙型肝炎（HBV）多表位疫苗在中国的理论免疫应答率,并做出评价。方法利用“中国多表位疫苗设计的HLA Ⅰ积累表型频率空间预测系统”计算现有的HBV表位DNA疫苗所涉及的HLA A、B限制性表位组合在中国人群中的累积表型频率（CPF）,得出理论免疫应答率,并绘制CPF预测等值线图,给出评价。结果现有各HBV多表位疫苗对中国人群的理论免疫应答率偏低,仅较多表位组合的疫苗理论免疫应答率高。现有HBV多表位疫苗存在不同方面的问题：大部分此类疫苗对中国人群的理论免疫应答率低;少数此类疫苗理论免疫应答率高,但为较多表位的组合,不符合多表位疫苗设计的原则,并没有用最少的表位组合达到最高的免疫应答率。结论现有的几种主要的HBV多表位疫苗并不能较好地符合中国人群的特点,效果不佳。     

Colorectal Cancer Trends in Kerman Province,the LargestProvince in Iran,with Forecasting until 2016

Colorectal cancer is one of the most common cancers. The aim of this study is determination its trends inKerman province and individual cities separately until year 2016. This analytical and modeling study was basedof cancer registry data of Kerman University of Medical Sciences, collected during 2001-2010. Among 20,351cancer case, 792 were colorectal cancer cases in age group 18-93 years with a mean of 59.4 and standard deviationof 15.1. By applying time series and data trends, incidences were predicted until 2016 for the province and eachcity, with adjustment for population size. In colorectal cases, 413 (52%) were male, and 379 (48%) were female.The annual increasing rate in Kerman province overall was and can be expected to be 6%, and in the cities ofthe province Rafsanjan, Bardsir, Bam, Kerman, Baft, Sirjan, Jiroft, Kahnuj and Manujan had an increasingrange from 5 to 14% by the year 2016. But in Ravar, Zarand and Shahrbabak reduction in rates of at least 2%could be predicted. The time series showed that the trend of colorectal cancer in female will increase 15% andin male 7% by year 2016. Given the trend of this cancer is increasing so that resources will be consumed in thetreatment of the patients, efforts shoudlbe focused on prevention and early diagnosis of the disease. Screeningcould have an important role leading to improved survival.     

2010-2014年张家港市幼托儿童手足口病流行特征分析

摘要:目的 分析张家港市幼托儿童手足口病的流行特征,制定流行趋势预警预测值,为采取针对性防控措施提供科学依据。方法 对2010-2014年传染病报告信息管理系统报告的张家港市幼托儿童手足口病疫情资料进行描述流行病学分析。结果 张家港市2010-2014年共报告幼托儿童手足口病病例4 041例,年均发病率2.29%,其中重症病例28例,年均发病率15.87/10万;男女性别比为1.57∶1, 重症病例男女性别比为2.5∶1;病原学方面EV71型肠道病毒、CoXA16型病毒和其他肠道病毒感染所占比例分别为38.81%、 29.85%和31.34%;发病主要以3～4岁儿童为主,共2 714例,占发病总数的67.16%。重症病例也是3～4岁为主,共23例,占重症病例总数的82.14%;发病时间曲线有两个明显的高峰和低谷,报告发病数增减的趋势,与幼托儿童在校、放假的时间有明显的关联性。结论 张家港市幼托儿童手足口病发病存在明显的时间和年龄分布特征,在常规防控措施的基础上,应加强幼托机构健康宣教的力度,培养幼托儿童良好的卫生习惯。     

ARIMA和VARMA模型在医院管理中的应用

目的通过对医院门诊量、急诊量和住院量三项指标的预测,对医院运营状况进行早期预警,评价医院的经营策略。方法通过对某三级医院1999—2008年月门、急诊量、住院量分析,分别为门诊量、急诊量和住院量建立ARIMA模型,以整体数据建立VARMA模型,然后用上述模型对某医院2008年1~12月的门诊量、急诊量和住院量预测并和实际值比较。结果 AR IMA模型预测急诊量、住院量数据可靠,平均相对误差分别为5.63%和3.11%,在预测门诊量时不太理想,平均相对误差达到13%;VARMA模型在预测整体数据时良好,预测门诊量改善尤其明显,平均相对误差降低到8.97%,在预测急诊量、住院量,平均相对误差有所增加。结论单用某一预测方法时,总存在着一定的缺陷,综合应用AR IMA和VARMA模型可为医院管理者提供合理的决策。     

急性重症脑梗死静脉溶栓患者 预后影响因素的分析

目的 观察新发的重症脑梗死患者溶栓前后动态脑电图的变化,为重症脑梗死患者的预后提供参 考。方法 选取2015 年1 月—2016 年12 月于乐山市人民医院就诊的符合重组组织型纤溶酶原激活剂静脉溶 栓标准的98 例重症脑梗死患者,监测患者动态脑电图溶栓前后脑电波的变化。详细记录患者的一般资料、溶 栓前后脑电图及头颅影像学检查结果。用Excel 建立数据库,应用单变量和Logistic 回归分析判断重症脑梗死 患者的预后。结果 两组患者年龄、发病至就诊时间、脑电图检查及头颅影像学检查结果比较,差异有统计 学意义（P <0.05）;多因素Logistic 回归分析显示,重症脑梗死患者年龄≥ 65 岁[Ol ^ R=2.958（95% CI ：1.347, 6.495）]、发病至就诊时间>3.5 h[Ol ^ R=3.643（95% CI ：0.563,5.267）] 脑电图检查阳性[Ol ^ R=4.079（95% CI ：1.588,10.477）]、头颅影像学检查阳性[Ol ^ R=3.021（95% CI ：1.554,5.870）] 是预后差的独立危险因素。 结论 入组前年龄>65 岁、溶栓后脑电图波形异常及头颅影像学检查结果异常是重症脑梗死患者预后差的独 立危险因素。将动态脑电图监测应用于重症脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓,对于预测重症 脑梗死患者的预后具有重大意义。     

Japanese Encephalitis: Estimating Future Trends in Asia

Limited surveillance programs and lack of diagnostic laboratory testing capacity in many low and middle income Asian countries have made it difficult to validate epidemiological patterns and anticipate future changes in disease risk. In this study, we consider the case of Japanese Encephalitis in Asia and examine how populations of human hosts and animal reservoirs are expected to change over the next three decades. Growth was modelled at the sub-national level for rural and urban areas to estimate where high-density, susceptible populations will potentially overlap with populations of the virus'' amplifying host. High-risk areas based on these projections were compared to the current distribution of Japanese Encephalitis, and known immunization activities in order to identify areas of highest priority for concern. Results indicated that mapping JE risk factors at the sub-national level is an effective way to contextualize and supplement JE surveillance data. New patterns of risk factor change occurring in Southeast Asia were identified, including around major urban areas experiencing both urbanization and growth in pig populations. A hotspot analysis of pig-to-population ratio found a significant spatial cluster extending northward through Southeast Asia and interior China. Mapping forecasted changes in risk factors for JE highlights regions vulnerable to emerging zoonoses and may be an important tool for developing effecting transnational health policies.     

急性重症胆管炎急诊手术时机选择的探讨

对142例急性重症胆管炎(ACST)的临床回顾性和前瞻性研究结果表明,ACST的临床治疗原则应是急诊手术和保守治疗相结合,对于病程短,并发症少的ACST病人,在作好术前准备的前提下,积极的保守治疗具有可行性,ACST生存数学模型有助于ACST急诊手术时机的选择,模型回归值0.40可作为ACST急诊手术预测分界点参考值,它的应用较传统方法可能具有优越性。     

Home blood glucose prediction: clinical feasibility and validation in islet cell transplantation candidates

Aims/hypothesis Diabetic subjects do home monitoring to substantiate their success (or failure) in meeting blood glucose targets set by their providers. To succeed, patients require decision support, which, until now, has not included knowledge of future blood glucose levels or of hypoglycaemia. To remedy this, we devised a glucose prediction engine. This study validates its predictions.Methods The prediction engine is a computer program that accesses a central database in which daily records of self-monitored blood glucose data and life-style parameters are stored. New data are captured by an interactive voice response server on-line 24 h a day, 7 days a week. Study subjects included 24 patients with debilitating hypoglycaemia (unawareness), which qualified them for islet cell transplantation. Comparison of each prediction with the actually observed data was done using a Clarke Error Grid (CEG). Patients and providers were blinded as to the predictions.Results Prior to transplantation, a total of 31,878 blood glucose levels were reported by the study subjects. Some 31,353 blood glucose predictions were made by the engine on a total of 8,733 days-used. Of these, 79.4% were in the clinically acceptable Zones of the CEG. Of 728 observed episodes of hypoglycaemia, 384 were predicted. After transplantation, a total of 45,529 glucose measurements were reported on a total of 12,906 days-used. Some 42,316 glucose predictions were made, of which 97.5% were in the acceptable CEG Zones A and B. Successful transplantation eliminated hypoglycaemia, improved glycaemic control, lowered HbA₁c and freed 10 of 24 patients from daily insulin therapy.Conclusions/interpretation It is clinically feasible to generate valid predictions of future blood glucose levels. Prediction accuracy is related to glycaemic stability. Risk of hypoglycaemia can be predicted. Such knowledge may be useful in self-management.