广州花都和贵州黔西地区急性胰腺炎发病病因及临床特征的对比研究

目的探讨广州花都地区和贵州黔西地区急性胰腺炎(AP)的发病病因及临床特征。方法回顾性分析2008年1月至2018年12月广州市花都区人民医院及贵州省黔西县人民医院收治的1 832例AP患者临床资料,对不同地区AP占同期总住院人数的比例、入院时BISAP评分、急性生理功能和慢性健康状况评分II(APACHE-II)、Ranson评分、病因分型、各种并发症及病死率进行统计学对比分析。结果广州花都地区(沿海地区)AP占同期总住院人数的0.21%,贵州黔西地区(山区地区)AP占同期总住院人数的0.47%,沿海地区胆源性胰腺炎占比较山区地区高(57.3% vs 35.8%,P<0.05),而高脂血症性胰腺炎及酒精性胰腺炎山区地区占比较沿海地区高(28.0% vs 19.6%,P<0.05);在基本相同的生长抑素使用率及住院费用情况下,山区地区急性胰腺炎并发器官衰竭及病死率较沿海地区高(7.8% vs 2.6%,P<0.05)。结论山区地区AP发病率较沿海地区高,两地AP病因均以胆源性为主;病因占比方面,沿海地区胆源性AP占比较山区地区高,而酒精性和高脂血症性AP则后者高于前者;山区地区AP病情普遍较沿海地区严重,器官衰竭发生率及病死率较沿海地区高。

内蒙古临河地区异常血红蛋白一级结构分析及群体遗传学研究

目的研究内蒙古西部临河地区异常血红蛋白变异类型和异常血红蛋白基因频率。方法运用Hardy-Weinberg平衡法则计算异常血红蛋白在临河地区的基因频率。同时,应用异常血红蛋白化学结构分析方法对内蒙古临河地区发现的5例异常血红蛋白进行了一级结构分析。结果对5例异常血红蛋白一级结构分析,证明其分别为Hb G Taipei [β229(B4)Glu-Gly]2例;Hb G Coushatta[β22(B4)Glu-Ala]1例;Hb D Los Angeles[β121(GH4)Glu-Gln]1例和Hb Legnano [α141(HC3)Arg-Leu]1例。临河地区异常血红蛋白的基因频率为:α链异常5.77×10^(-5),β链异常1.15×10^(-4)。结论内蒙古临河地区共发现5种异常血红蛋白,其中Hb Legnano在我国为首次发现。

Imaging manifestations and the related clinical characteristics of chest trauma during the Yushu Earthquake

The purpose of this study was focused on the imaging features of the chest trauma and its relation to clinical characteristics. All the injured patients were from the Yushu Earthquake areas on days April 14 - 23,2010. After an initial treatment,the injurers were rapidly transported from Yushu at an altitude of 4 000 m via air to Xining at 2 260 m within 6~8 h,and promptly admitted to Qinghai Provincial People’s Hospital. A total of 130 wounded injurers who had high suspicion of chest injuries all had examinations of Chest X-ray and computed tomography(CT)images. Of them 63 injurers presented at least one of the features of the chest trauma in imaging with a positive rate of 48.5 %. Of these,37 cases (28.5 %) were multi-system with multiple injuries ,33 cases (25.4 %) were chest trauma with multi-injury types,which included thoracic fractures in 54 cases (85.7 %),pleural injury in 56 cases (88.9 %),lung injury in 54 cases (85.7 %),lungs complications in 37 cases (58.7 %),and extrapulmonary complications of 35 cases (55.6 %). The radiological data were analyzed retrospectively. The features of chest trauma in Yushu Earthquake,the complications of chest injuries,and the relation between imaging findings and clinical manifestations,as well as the differences of chest trauma between Yushu Earthquake and Wenchuan Earthquake were discussed in detail.

Epidemiological and clinical features of hepatitis B virus related liver failure in China

AIM： To examine the epidemiologic and clinical characteristics of hepatitis B virus （HBV） related liver failure in patients in China. METHODS： This study was conducted with a retro- spective design to examine 1066 patients with HBV- related liver failure in the southwest of China. RESULTS： There were more male than female patients. Young and middle-aged people comprised most of the patients. Farmers and laborers comprised the larg- est proportion （63.09%）. Han Chinese accounted for 98.12%, while minority ethnic groups only accounted for 0.88% of patients. A total of 43.47% patients had a family history of HBV-related liver failure and 56.66% patients had a history of drinking alcohol. A total of 42.59% patients with HBV-related liver failure had defi- nite causes. With regard to the clinical manifestation of HBV-related liver failure, the symptoms were： hypodynamia, anorexia and abdominal distension. Total bilirubin （TBIL） and alanine aminotransferase （ALT） levels were altered in 46.23% of patients with evident damage of the liver. Univariate logistic regression analysis showed that the patients＇ prognoses were correlated with ALT, aspartate aminotransferase, albumin, TBIL, prothrombin activity （PTA）, and alpha-fetoprotein levels, and drinking alcohol, ascites, hepatorenal syndrome, infection and 〉i 2 complications. Multifactor logistic regression analysis showed that the activity of thrombinogen and the number of complications were related to the prognosis. CONCLUSION： Alcohol influences the patients＇ prognosis and condition. PTA and complications are independent factors that can be used for estimating the prognosis of HBV-related liver failure.

ICH E17多地区临床试验指导原则的临床视角解读

随着我国新药研发和临床研究水平的不断提高,国内众多医疗机构越来越多地参加多地区/多中心临床试验。为了促进全球化药物同步研发,提高全球注册效率,2017年11月,ICH E17专家工作组通过人用药品注册技术要求国际协调会议(International Council for Harmonization,ICH)再次修订了"多地区临床试验计划与设计的总体原则",期望在2018年推进此指导原则的实施。本文将从临床角度介绍E17指导原则中的主要内容,并简述多地区/多中心临床试验在国内的发展概况。