老年2型糖尿病下肢血管病变的研究

目的探讨老年2型糖尿病患者下肢动静脉血管病变的特点及动静脉病变间是否存在相关性。方法用彩色多普勒超声对24例老年2型糖尿病患者及36例非2型糖尿病老年患者进行双下肢血管检查,同时测定了血压、血脂、CRP。结果老年2型糖尿病组在年龄、性别构成比、BMI、血压、血脂、动脉硬化程度及动脉内径等指标与对照组无明显差异的情况下,动脉收缩期流速峰值明显快于对照组,静脉流速峰值则较对照组慢。结论老年2型糖尿病患者在下肢动脉血管病变尚未引起内径明显改变时,可能存在其他因素引起的血管狭窄;并同时存在下肢静脉血流缓慢。     

阿尔茨海默病遗传学研究进展

阿尔茨海默病(Alzheimer's disease,AD),以65岁为界可分为早发性(early-onset Alzheimer's disease,EOAD)和晚发性(late-onset Alzheimer's disease,LOAD)两种,其中LOAD占90%以上。两者均是遗传因素和环境因素相互作用的结果,其中LOAD的遗传度高达80%。随着人类基因组计划的完成,全基因组关联研究和二代基因测序技术的进展,一系列基因(BIN1、CLU、ABCA7、CR1、PICALM、MS4A4A/MS4A6A/MS4A4E、EPHA1、CD2AP、CD33)被发现与LOAD的易感性相关。本文综述了与LOAD发病相关的易感基因研究进展。     

当前呼吸内科临床实习中的问题与对策

临床实习是将医学生培养成为临床医生最重要的环节之一。但现阶段医学生在呼吸内科的临床实习中面临着一些问题,如实习管理松懈、带教老师轻视教学、医学实习生面临“考研”、“择业”压力忽视呼吸内科实习,以及呼吸内科学科自身的一些原因等。文章分析了影响当前呼吸内科实习质量“教”与“学”的多方面因素,提出解决呼吸内科临床实习的一些建议。     

甘肃省新型农村合作医疗制度现状分析与对策

新型农村合作医疗制度是一项系统且复杂的惠民工程,它是社会保障体系的重要组成部分,对保障广大农民身体健康、促进农村经济和社会发展起着重要作用。甘肃省的新农合在各级政府政策大力支持下取得了一定的成绩并充分发挥了作用,但其在运行过程中仍然存在着很多问题,如农民人均收入与医疗费用上涨比例失调、地方政府筹资困难、医疗卫生基础设施落后等。提出如控制医药费用不合理增长,建立科学筹资机制,加强农村卫生服务机构建设、提高卫生技术人员素质,加大宣传力度、提高参合积极性以及相关配套措施等相关建议。为完善甘肃省新农合制度的持续有效运行提供借鉴。     

中医治未病理论对疾病防控的启示和应用价值

中医治未病理论就是以健康为核心,防患于未然,即无病养生以维持健康,欲病救萌以防微杜渐,已病早治以防其传变,病后调摄以防止复发。传统中医药以其丰富的养生保健预防医疗理论基础和实践手段,应用于我国疾病预防控制工作,对于推动我国医疗卫生事业的改革发展,提高我国民众的健康水平,增强综合国力和科技竞争力,具有重要的现实意义。     

Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan

Since most poliovirus infections occur with no paralytic symptoms, the possibility of silent circulation complicates the confirmation of the end of poliovirus transmission. Based on empirical field experience and theoretical modeling results, the Global Polio Eradication Initiative identified three years without observing paralytic cases from wild polioviruses with good acute flaccid paralysis surveillance as an indication of sufficient confidence that poliovirus circulation stopped. The complexities of real populations and the imperfect nature of real surveillance systems subsequently demonstrated the importance of specific modeling for areas at high risk of undetected circulation, resulting in varying periods of time required to obtain the same level of confidence about no undetected circulation. Using a poliovirus transmission model that accounts for variability in transmissibility and neurovirulence for different poliovirus serotypes and characterizes country‐specific factors (e.g., vaccination and surveillance activities, demographics) related to wild and vaccine‐derived poliovirus transmission in Pakistan and Afghanistan, we consider the probability of undetected poliovirus circulation for those countries once apparent die‐out occurs (i.e., in the absence of any epidemiological signals). We find that gaps in poliovirus surveillance or reaching elimination with borderline sufficient population immunity could significantly increase the time to reach high confidence about interruption of live poliovirus transmission, such that the path taken to achieve and maintain poliovirus elimination matters. Pakistan and Afghanistan will need to sustain high‐quality surveillance for polioviruses after apparent interruption of transmission and recognize that as efforts to identify cases or circulating live polioviruses decrease, the risks of undetected circulation increase and significantly delay the global polio endgame.     

Modeling the Airborne Infection Risk of Tuberculosis for a Research Facility in eMalahleni,South Africa

A detailed mathematical modeling framework for the risk of airborne infectious disease transmission in indoor spaces was developed to enable mathematical analysis of experiments conducted at the Airborne Infections Research (AIR) facility, eMalahleni, South Africa. A model was built using this framework to explore possible causes of why an experiment at the AIR facility did not produce expected results. The experiment was conducted at the AIR facility from August 31, 2015 to December 4, 2015, in which the efficacy of upper room germicidal ultraviolet (GUV) irradiation as an environmental control was tested. However, the experiment did not produce the expected outcome of having fewer infections in the test animal room than the control room. The simulation results indicate that dynamic effects, caused by switching the GUV lights, power outages, or introduction of new patients, did not result in the unexpected outcomes. However, a sensitivity analysis highlights that significant uncertainty exists with risk of transmission predictions based on current measurement practices, due to the reliance on large viable literature ranges for parameters.     

Bayesian Hierarchical Structure for Quantifying Population Variability to Inform Probabilistic Health Risk Assessments

Human variability is a very important factor considered in human health risk assessment for protecting sensitive populations from chemical exposure. Traditionally, to account for this variability, an interhuman uncertainty factor is applied to lower the exposure limit. However, using a fixed uncertainty factor rather than probabilistically accounting for human variability can hardly support probabilistic risk assessment advocated by a number of researchers; new methods are needed to probabilistically quantify human population variability. We propose a Bayesian hierarchical model to quantify variability among different populations. This approach jointly characterizes the distribution of risk at background exposure and the sensitivity of response to exposure, which are commonly represented by model parameters. We demonstrate, through both an application to real data and a simulation study, that using the proposed hierarchical structure adequately characterizes variability across different populations.     

Using a grey relational analysis in an improved Grunow–Finke assessment tool to detect unnatural epidemics

The Grunow–Finke epidemiological assessment tool (GFT) has several limitations in its ability to differentiate between natural and man-made epidemics. Our study aimed to improve the GFT and analyze historical epidemics to validate the model. Using a gray relational analysis (GRA), we improved the GFT by revising the existing standards and adding five new standards. We then removed the artificial weights and final decision threshold. Finally, by using typically unnatural epidemic events as references, we used the GRA to calculate the unnatural probability and obtain assessment results. Using the advanced tool, we conducted retrospective and case analyses to test its performance. In the validation set of 13 historical epidemics, unnatural and natural epidemics were divided into two categories near the unnatural probability of 45%, showing evident differences (p < 0.01) and an assessment accuracy close to 100%. The unnatural probabilities of the Ebola virus disease of 2013 and Middle East Respiratory Syndrome of 2012 were 30.6% and 36.1%, respectively. Our advanced epidemic assessment tool improved the accuracy of the original GFT from approximately 55% to approximately 100% and reduced the impact of human factors on these outcomes effectively.     

中华鳖皮肤溃烂病的病原研究

从病鳖肝脏、颈、腿部皮肤溃烂处分离得到菌株M－3、M－6、J－8、J－10株细菌。经人工感染试验证明这四株菌为鳖皮肤溃烂病的病原菌。对菌体形态特征、培养特性和生理生化反应的鉴定证明J-8、J-10为温和气单胞菌（Aeromonassobira），M-3、M-6为摩根氏菌（Morganella，mor－ganii）。