广西籍炎症性肠病的临床流行病学特点分析325例

目的:探讨广西籍炎症性肠病(inflammatory bowel disease,IBD)患者的流行病学特征、临床特点.方法:回顾性分析2003-05/2013-05广西医科大学第一附属医院广西籍IBD住院患者325例的流行病学及临床资料.结果:(1)325例IBD患者中,溃疡性结肠炎(ulcerative colitis,UC)266例,克罗恩病(Crohn's disease,CD)59例;IBD患者男女比为1.3∶1,高峰年龄段为30-39岁(20.92%),平均发病年龄39.62岁±18.09岁.IBD患者职业构成以脑力工作者(64.9%)为主.CD患者中吸烟(52.5%)、饮酒(32.2%)、阑尾手术(10.2%)的比例均高于UC(P<0.05);(2)发病部位:UC以广泛结肠(E3)(46.2%)发生例数最多;C D以回肠末段(L1)(37.5%)最为常见;(3)疾病活动性严重程度:UC以重度活动期患者(53.1%)为主;CD以中度活动期患者(54.2%)为主;(4)前、后5年患病组比较,CD后5年在IBD中所占的比例增加(P<0.05),前5年11例(8.8%),后5年48例(24.0%).后5年CD男性患者比例增多(P<0.05),前5年5例(45.5%),后5年37例(77.1%).结论:(1)IBD患者的发病人数呈上升趋势,CD的增幅较UC明显,男性发病多于女性,且以近5年CD男性患者增多的特征较为明显;(2)IBD患者以脑力工作者高发,吸烟、饮酒、阑尾手术可能会增加患CD的风险.

奶牛流行热的流行病学、临床症状和防控措施

奶牛流行热是由于感染流行热病毒而发生的一种急性、热性传染病,主要在夏秋季节发生,发病率较高,快速传播,通常呈良性经过,在无继发感染时死亡率只有1%~3%。病牛特征是体温升高,气喘,出血性胃肠炎,有时瘫痪。既会严重影响奶牛的正常生长,还会减少泌乳,现主要概述该病的防控措施。

Meta分析中漏斗图的绘制

在本杂志我们曾讨论过“Meta分析中失安全系数的估计问题”．它是用来识别和控制Meta分析中最常见的偏倚“发表偏倚（publication bias）”的一种方法。现我们继续讨论识别和控制Meta分析中发表偏倚的另一方法，漏斗图（funnel plots）分析法。

Clinical and epidemiological features of patients with clonorchiasis

AIM:To study the clinical and epidemiological features of patients with clonorchiasis so as to provide scientific evidences for the diagnosis and prevention of clonorchiasis. METHODS:Stools from 282 subjects suspected of having clonorchiasis were examined for helminth eggs with modified Kato's thick smear and sedimentation methods,and their sera were tested for HAV-DNA,HBV-DNA,HCV-RNA,HDV- RNA and HEV-RNA with polymerase chain reaction (PCR). Clinical symptoms of patients with clonorchiasis only were analyzed,and their blood samples were tested for circulating antigen (CAg) with Dot-ELISA,esoinophilic granulocyte count, and alanine aminotransferase (ALT).Meanwhile,they were asked to provide data of occupation,eating habit,hygienic habit and knowledge of donorchiasis.In addition,the ecosystem of the environment in epidemic areas was surveyed. RESULTS:Among the 282 patients,61 (21.43%) were infected with clonorchis sinensis only,97 (34.64%) were co-infected with clonorchis sinensis and other pathogens, 92 (32.86%) were infected with hepatitis virus only and 31 (11.07%) neither with clonorchis sinensis nor hepatitis virus. Among the 61 patients with clonorchiasis only,there were 14 (22.95%) subjects with discomfort over hepatic region or epigasfrium,12 (19.67%) with general malaise or discomfort and inertia in total body,6 (9.84%) with anorexia,indigestion and nausea,4 (6.56%) with fever,dizziness and headache (6.56%),and 25 (40.98%) without any symptoms;sixty one (100%) with CAg (+),98.33% (59160) with eosinophilic granulocytes increased and 65.00% (39/60) with ALT increased.B-mode ultrasonography revealed 61 cases with dilated and thickened walls of intrahepatic bile duct,and blurred patchy echo acoustic image in liver.Twenty-six cases had stones in the bile duct,39 cases had slightly enlarged liver with diffuse coarse spots in liver parenchyma.Twenty cases had enlarged gallbladder with thickened coarse wall and image of floating plagues,9 cases had slightly enlarged spleen.By analysis of epidemiological data,we found that the ecologic environment was favorable for the epidemiology of clonorchiasis.Most patients with clonorchiasis were lack of knowledge about the disease.Their living environment, hygienic habits,eating habits and their occupations were the related factors that caused the prevalence of the disease. CONCLUSION:The clinical symptoms of clonorchiasis are non-specific,and the main evidences for diagnosis of clonorchiasis should be provided by etiologic examination, B-mode ultrasonography and clinical history.The infection of clonorchis sinensis is related to occupations,bad eating habits and lack of knowledge about prevention of the disease.

Clinical phenotype and prevalence of hereditary nonpolyposis colorectal cancer syndrome in Chinese population

AIM: To describe systematically the clinical characteristics and phenotype of HNPCC families and the prevalence of HNPCC in the general population of CRC patients in China. METHODS: HNPCC kindreds and CRC patients were from two sources. One was that we consecutively investigated kindreds and patients by ourselves. And the other was the published Chinese and foreign literature related to Chinese HNPCC syndrome. There were 142 HNPCC families fulfilling AC I and/or AC II including 57 families with detailed data, and 3874 general primary CRC patients in all. All statistical tests were two-sided. RESULTS: In AC I families, the number of Lynch syndrome I and II families were 25 (47.2%) and 28 (52.8%) respectively. There were 215 patients (82.4%) with CRC, 67 patients (25.7%) with extracolonic cancer and 50 patients (19.2%) with multiple primary cancers. In all CRC patients, multiple primary CRC were in 41 patients (19.1%), and the first-CRC was right-sided colorectal cancer in 143 patients (66.5%) and rectal cancer in 44 patients (20.5%). 8.8% and 19.2% of the first cancer were CRC and extracolonic cancers. Among those patients whose first cancer was CRC, 66.8% and 19.9% were right-sided colorectal cancer and rectal cancer, respectively. The similar results were found in AC II families. Normal distribution was only found in the distribution of the age of diagnosis of the first cancer in both AC I families (coefficient of skewness: u = 0.81, 0.20<0.40<P<0.50; coefficient of kurtosis: u = 1.13, 0.20<P<0.40,α=0.20) and AC II families (coefficient of skewness: u=0.63, P>0.5> 0.20; coefficient of kurtosis: u = 0.84, 0.20<0.40<P<0.50, α=0.20), but not found in the distribution of the age of diagnosis of the first CRC. When patients with HNPCC-associated cancer suffered from the first malignant tumor in HNPCC families diagnosed by AC I and AC II, the mean age and median age were 45.1±12.7 years and 44.0 years, 45.2±12.7 years and 44.5 years, respectively. The median age of diagnosis of the first tumor of the patients in the later generation was younger than that in the previous generation. Many extracolonic cancers were found to be associated with HNPCC syndrome. Gastric cancer was the most frequent extracolonic cancer followed by endometrial cancer and hepatocarcinoma. In general population of CRC patients, the prevalence of HNPCC diagnosed by AC I and AC II were 1.3% and 2.2%, respectively. CONCLUSION: The clinical phenotype and prevalence of Chinese HNPCC syndrome are similar to those of Europeans and Americans. Gastric cancer is the most common extracolonic malignant tumor. The age of diagnosis of the first malignant tumor tends to be increasingly younger in patients with HNPCC-related tumors.

Hepatitis G virus

A number of new hepatitis viruses (G, TT, SEN) were discovered late in the past century. We review the data available in the literature and our own findings suggesting that the new hepatitis G virus (HGV), disclosed in the late 1990s, has been rather well studied. Analysis of many studies dealing with HGV mainly suggests the lymphotropicity of this virus. HGV or GBV-C has been ascertained to influence course and prognosis in the HIV-infected patient. Until now, the frequent presence of GBV-C in coinfections, hematological diseases, and biliary pathology gives no grounds to determine it as an "accidental tourist" that is of no significance. The similarity in properties of GBV-C and hepatitis C virus (HCV) offers the possibility of using HGV, and its induced experimental infection, as a model to study hepatitis C and to develop a hepatitis C vaccine.

Gastric malignancies in Northern Jordan with special emphasis on descriptive epidemiology

AIM:To study the epidemiology of gastric malignancies in Jordan as a model for Middle East countries where such data is scarce. METHODS:Pertinent epidemiological and clinicopathological data for 201 patients with gastric malignancy in north of Jordan between 1991 and 2001 were analyzed. RESULTS:Male:female ratio was 1.8:1.The mean age was 61.2 years,and 8.5% of the patients were younger than 40 years of age.The overall age-adjusted incidence was 5.82/100 000 population/year.The age specific incidence for males raised from 1.48 in those aged 30-39 years to 72.4 in those aged 70-79 years.Adenocarcinomas, gastric lymphomas,malignant stromal tumors,and carcinoids were found in 87.5%,8%,2.5%,and 2% respectively.There was an average of 10.1-month delay between the initial symptoms and the diagnosis.Only 82 patients underwent“curative”gastrectomy.Among adenocarcinoma groups,Lauren intestinal type was the commonest(72.2%)and the distal third was the most common localization(48.9%).The mean follow up for patients with gastric adenocarcinoma was 25.1 mo(range 1-132mo).The 5-year survival rates for stages Ⅰ(n=15), Ⅱ(n=41),Ⅲ(n=59),and Ⅳ(n=53) were 67.3%,41.3%, 5.7%,and 0% respectively(P=0.0001).The overall 5 year survival was 21.1%. CONCLUSION:Despite low inddence,some epidemiological features of gastric cancer in Jordan mimic those of high- risk areas.Patients are detected and treated after a relatively long delay.No justification in favor of a possible gastric cancer screening effort in Jordan is supported by our study;rather,the need of an earlier diagnosis and subsequent better care.

Recent trends in the epidemiology of inflammatory bowel diseases:Up or down?

Inflammatory bowel disease (IBD) is traditionally con- sidered to be common in the Western world, and its incidence has sharply increased since the early 1950s. In contrast, until the last decade, low prevalence and incidence rates have been reported from other parts of the world including Eastern Europe, South America, Asia and the Pacific region. Recent trends indicate a change in the epidemiology of IBD with previously low incidence areas now reporting a progressive rise in the incidence, while in West European and North American countries the figures have stabilized or slightly increased, with decreasing incidence rates for ulcerative colitis. Some of these changes may represent differences in diagnostic practices and increasing awareness of the disease. The quality of studies is also variable. Additional epidemio- logic studies are needed to better define the burden of illness, explore the mechanism of association with envi- ronmental factors, and identify new risk factors.

Clinical features and management of primary biliary cirrhosis

Primary biliary cirrhosis(PBC),which is characterised by progressive destruction of intrahepatic bile ducts,is not a rare disease since both prevalence and incidence are increasing during the last years mainly due to the improvement of case finding strategies.The prognosis of the disease has improved due to both the recognition of earlier and indolent cases,and to the wide use of ursodeoxycholic acid(UDCA).New indicators of prog-nosis are available that will be useful especially for the growing number of patients with less severe disease.Most patients are asymptomatic at presentation.Pruri-tus may represent the most distressing symptom and,when UDCA is ineffective,cholestyramine represents the mainstay of treatment.Complications of long-standing cholestasis may be clinically relevant only in very ad-vanced stages.Available data on the effects of UDCA on clinically relevant end points clearly indicate that the drug is able to slow but not to halt the progression of the disease while,in advanced stages,the only thera-peutic option remains liver transplantation.

Epidemiology and clinical course of Crohn's disease:Results from observational studies

The authors review the clinical outcome in patients with Crohn's disease(CD)based on studies describing the natural course of the disease.Population-based studies have demonstrated that the incidence rates and prevalence rates for CD have increased since the mid-1970s.The authors search for English language articles from 1980 until 2011.Geographical variations,incidence,prevalence,smoking habits,sex,mortality and medications are investigated.An increasing incidence and prevalence of CD have been found over the last three decades.The disease seems to be most common in northern Europe and North America,but is probably increasing also in Asia and Africa.Smoking is associated with an increased risk of developing CD.Age <40 at diagnosis,penetrating/stricturing complications,need for systemic steroids,and disease location in terminal ileum are factors associated with higher relapse rates.A slight predominance of women diagnosed with CD has been found.Ileocecal resection is the most commonly performed surgical procedure,and within the first five years after the diagnosis about one third of the patients have had intestinal surgery.Smoking is associated with a worse clinical course and withincreased risk of flare-ups.In most studies the overall mortality is comparable to the background population.To date,the most effective treatment options in acute flares are glucocorticosteroids and tumor necrosis factor(TNF)-α-blockers.Azathioprine/methotrexate and TNF-α-blockers are effective in maintaining remission.

Celecoxib-related gastroduodenal ulcer and cardiovascular events in a randomized trial for gastric cancer prevention

AIM: To evaluate the long-term risk of gastroduodenal ulcer and cardiovascular events induced by celecoxib in a population-based, randomized, double-blind, placebo-controlled study.METHODS: From 2004 to 2006, a total of 1024 Chinese patients (aged 35 to 64 years) with severe chronic atrophic gastritis, intestinal metaplasia or dysplasia were randomly assigned to receive 200 mg of celecoxib twice daily or placebo in Linqu County (Shandong Province, China), a high-risk area of gastric cancer. All gastroduodenal ulcer and cardiovascular events occurred were recorded and the patients were followed up for 1.5 years after treatment. At the end of the trial, a systematic interview survey about other adverse events was conducted. RESULTS: Gastroduodenal ulcer was detected in 19 of 463 (3.72%) patients who received celecoxib and 17 of 473 (3.31%) patients who received placebo, respectively (odds ratio = 1.13, 95% CI = 0.58-2.19). Cardiovascular (CV) events occurred in 4 patients who received celecoxib and in 5 patients who received placebo, respectively. Compared with those who received placebo, patients who received celecoxib had no signif icant increase in occurrence of CV events (hazard ratio = 0.84, 95% CI = 0.23-3.15). Among the adverse events acquired by interview survey, only the frequency of bloating was signif icantly higher in patients treated with celecoxib than in those treated with placebo. CONCLUSION: Treatment of gastric cancer with celecoxib is not associated with increased risk of gastroduodenal ulcer and cardiovascular events.

Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease

Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases(IBD).The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis.Arthritis associated with IBD belongs to the category of spondyloarthropathies.Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease.Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients.Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately.Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations.The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.

Trichinosis: Epidemiology in Thailand

Trichinosis is one of the most common food-borne para-sitic zoonoses in Thailand and many outbreaks are re-ported each year. This paper reviews the history, species, and epidemiology of the disease and food habits of the people with an emphasis on the north, northeast, cen-tral and south regions of Thailand. The earliest record of trichinosis in Thailand was in 1962 in the Mae Sariang District, Mae Hong Son Province. Since then, about 130 outbreaks have been reported involving 7392 patients and 97 deaths (1962-2005). The highest number of cas-es, 557, was recorded in 1983. The annual epidemiologi-cal surveillance reports of the Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand, show that trichinosis cases increased from 61 in 1997 to 351 in 1998. In contrast to these figures, the number of reported cases decreased to 16 in 1999 and 128 cases in 2000. There was no record of trichinosis in 2001, but then the figures for 2002, 2003 and 2004 were 289, 126 and 212 respectively. The infected pa-tients were mostly in the 35-44 years age group and the disease occurred more frequently in men than women at a ratio of 1.7-2.0:1. There were 84 reported cases of trichinosis in Chiang Rai, Nan, Chiang Mai, Si Sa ket, Nakhon Phanom, Kalasin, Nakhon Ratchasima, Nakhon Nayok, Nakhon Pathom and Surat Thani, provinces locat-ed in different parts of Thailand in 2005. The outbreaks were more common in the northern areas, especially in rural areas where people ate raw or under-cooked pork and/or wild animals. This indicates the need for health education programs to prevent and control trichinosis as soon as possible in the high-risk areas.

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.

Spontaneous bacterial peritonitis:A severe complication of liver cirrhosis

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascites-spontaneous bacterial peritonitis. Epidemiology,aetiology,pathogenesis,clinical manifestation,diagnosis and present possibilities of treatment are discussed.

猪增生性肠炎的病原、症状、鉴别与防治措施

猪增生性肠炎也叫做回肠炎,是一种肠道疾病,主要是由于感染胞内劳森氏菌而引起,主要特征是结肠、盲肠、回肠黏膜发生腺瘤样增生。该病具有较低的死亡率,但会导致病猪生长发育缓慢,推迟出栏时间,饲料转化率下降,胴体重减轻,影响繁殖等,较大程度上损害养猪业的经济效益,应加以防治。

Chemoprevention of gastrointestinal cancers by natural honey

Gastrointestinal cancers are the most common human cancers in both men and women worldwide. Several epidemiological and experimental studies suggest a relationship between gastrointestinal cancers risk and dietary factors. Natural honey has been widely used in traditional medicine for many centuries to treat a wide range of ailments and complaints. Honey contains various components that exhibit wide activities including antibacterial, anti-inflammatory, antioxidant and anticancer properties. The anticancer effects of honey are mediated via diverse mechanisms,including inhibition of proliferation, induction of apoptosis, suppression of free radicals and modulation of inflammatory signalling pathways. The present review assesses the chemopreventive effects of natural honey and its components in the modulation of gastrointestinal cancers and its modes of action in the prevention of the development of gastrointestinal tumors. Honey can be an approach as a cancer-preventive strategy which merits further experimental and clinical research in the near future.

Analysis of the features of TCM and western medicine in the diagnosis and treatment of subclinical hypothyroidism characteristics

The diagnosis and treatment of subclinical hypothyroidism are summarized by reviewing the related English and Chinese literature, the comparative analysis of traditional Chinese medicine （TCM） and western medicine in the understanding of subclinical hypothyroidism, the epidemiology, etiology, pathogenesis, the patterns addition to the therapeutic hypothyroidism, with a pr and the clinical manifestation in principle and drugs of subclinical ospect of providing insight in the clinical treatment of the disease.

浅谈绵羊痘和山羊痘综合防治

绵羊痘和山羊痘一直是困扰羊类养殖的严重传染性疾病，世界动物卫生组织也将这一疾病列入必控名单当中，其在我国畜牧业中也较为常见。本文即是对绵羊痘和山羊痘的综合防治进行研究，简要说明了这类疾病的流行病学临床、和病理特点，并阐述了其综合防治措施，以期能为相关工作提供参考。

Outcomes in children with Clostridium difficile infection:results from a nationwide survey

Objective:Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection(CDI)in adults and children;although pediatric CDI outcomes are incompletely understood.We analysed United States National Hospital Discharge Survey(NHDS)data to study CDI in hospitalized children.Methods:NHDS data for 2005–2009(demographics,diagnoses and discharge status)were obtained;cases and comorbidities were identified using ICD-9 codes.Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI;associations between CDI and outcomes[length of stay(LOS),colectomy,all-cause in-hospital mortality and discharge to a care facility(DTCF)].Results:Of an estimated 13.8 million pediatric inpatients;46176 had CDI;median age was 3 years;overall incidence was 33.5/10000 hospitalizations.The annual frequency of CDI did not vary from 2005 to 2009(0.24–0.43%;P=0.64).On univariate analyses,children with CDI had a longer median LOS(6 vs 2 days),higher rates of colectomy[odds ratio(OR)2.0;95%confidence interval(CI)1.7–2.4],mortality(OR 2.5;95% CI 2.3–2.7),and DTCF(OR 1.6;95% CI 1.6–1.7)(all P<0.0001).After adjusting for age,sex and comorbidities,CDI was an independent and the strongest predictor of increased LOS(adjusted mean difference,6.4 days;95% CI 5.4–7.4),higher rates of colectomy(OR 2.1;95% CI 1.8–2.5),mortality(OR 2.3;95% CI 2.2–2.5),and DTCF(OR 1.7;95% CI 1.6–1.8)(all P<0.0001).On excluding infants from the analysis,children with CDI had higher rates of mortality,DTCF and longer LOS than children without CDI.Conclusions:Despite increased awareness and advancements in management,CDI remains a significant problem and is associated with increased LOS,colectomy,in-hospital mortality and DTCF in hospitalized children.