新型冠状病毒肺炎疫情期间破裂颅内动脉瘤显微手术患者的围手术期管理

目的分享新型冠状病毒肺炎(简称新冠肺炎)疫情期间脑血管病中心对破裂颅内动脉瘤显微手术患者的围手术期管理经验。方法回顾性连续纳入2020年1月19日至2月28日十堰市太和医院脑血管疾病诊疗中心收治的22例破裂颅内动脉瘤患者,总结疫情期间破裂动脉瘤患者院前转诊、入院检查及术前评估、手术策略、术后管理完整的管理经验,所有患者按照严格的流程进行管理,分析患者治疗效果及医护人员防护效果。结果 22例破裂动脉瘤患者中无新冠肺炎确诊患者,有2例新冠肺炎疑似患者;出院时患者改良Rankin量表评分0～1分17例,2分4例,4分1例,无致死病例;无患者发生院内感染,参与患者管理的医护人员无1人感染新冠肺炎。结论新冠肺炎疫情期间,完整的颅内破裂动脉瘤患者管理流程,可以为患者提供及时有效的治疗,同时也能保障医护人员的安全,为包括破裂颅内动脉瘤患者在内的危重脑血管病患者管理提供参考。     

新型冠状病毒肺炎疫情下肝癌患者外科诊疗的思考与建议

新型冠状病毒肺炎（新冠肺炎）对人民的生命健康造成了巨大的威胁。在新冠肺炎疫情下,如何应对肝胆外科肝癌患者的门诊筛查、病房管理以及安全地实施肝癌手术,都是对肝胆外科医师提出的新挑战。我们认为,该病的临床处置应在筛查新冠肺炎的前提下,遵循正规操作流程,做好充分防护。对于需要急诊治疗但无法排除新冠肺炎的肝癌患者,须综合考虑患者的病情严重程度、手术方式及手术室条件,慎重制定个体化治疗方案。整个诊疗过程必须遵从既保证患者的安全及疗效,又要降低医护人员感染风险的原则。     

新型冠状病毒肺炎恢复期患者出院半年后的生命质量调查及其影响因素分析

目的 调查新型冠状病毒肺炎恢复期患者出院半年后的生命质量,并分析其影响因素.方法 基于由北京中医药大学第三附属医院牵头建立的新型冠状病毒肺炎病例登记系统,以2020年1月17日—3月17日在湖北武汉新冠肺炎定点医院住院治疗的117例新冠肺炎恢复期患者为研究对象,在出院半年后进行随访,面对面采用世界卫生组织生存质量测定量...     

玉屏风散预防新型冠状病毒肺炎的可行性

新型冠状病毒肺炎(简称新冠肺炎),因其感染力强、传播快对公共卫生造成了重大威胁,极大地加重了社会负担。由于新冠肺炎尚无特效药,因此做好预防,阻止疫情蔓延是防疫工作的重点。新冠肺炎属于中医学“疫病”、“瘟疫”范畴。疫病在中国古代就有过大流行,无论是《黄帝内经》、《伤寒论》,还是在明清时期的温病学派的著作中都可以见到关于“疫病”的论述。几千年来,中医学在不断与疫病斗争的过程中,在预防疫病的传播与流行方面积累了大量的宝贵经验。中药预防一直是中医学与疫病斗争的法宝之一。随着此次新冠肺炎疫情的进展,尤其是在武汉隔离点及方舱医院,中医药参与救治新冠肺炎的例数占治愈出院病例总数的比例不断提高。这无疑为中医药参与新冠肺炎的防治增强了信心。     

综合培训和管理在新型冠状病毒肺炎患者诊疗及护理中的应用

目的分析和总结新型冠状病毒肺炎(简称新冠肺炎)患者的临床表现、心理特点及护理干预措施,为优化处置此类病情提供依据。方法以2020年1至2月东部战区总医院秦淮医疗区感染内科收治的2例新冠肺炎患者为观察对象,完善隔离和防护措施,密切监测生命体征,动态观察心理变化,积极给予心理疏导,防治并发症。结果新冠肺炎的新发性、高传染性、有一定的致死性以及隔离的强制性会给患者带来紧张、焦虑、悲观等心理状态。2例患者经抗病毒、对症支持治疗、专科护理,以及针对发病、转归和防护情况的心理疏导后,其焦虑心理明显缓解,能积极配合隔离和治疗,咽痛、咳嗽、发热及全身乏力等症状逐渐消退,最终均达治愈标准出院。结论新冠肺炎患者的心理状态、病情、治疗和防护均具有特殊性,通过综合培训和管理可促使患者改善心理状态,积极配合隔离诊治,促进病情恢复。     

新冠肺炎疫情下炎症性肠病日间病房的运行管理策略

新冠肺炎疫情形势严峻,给需要及时到医院救治的其他疾病患者带来诸多不便。针对炎症性肠病患者中接受生物制剂治疗的患者需定期到医院住院治疗的问题,中南大学湘雅医院消化内科通过落实人员环境管理,严格控制入院收治标准,优化入出院流程,制定周密的转运隔离预案,全面观察监测病情,加强对患者的沟通宣教,重视医护患的心理健康等措施,保证患者在接受及时有效治疗的同时,最大程度降低或规避被感染的风险。     

支气管肺泡灌洗液诊断新型冠状病毒肺炎二例

本文报道我院收治并行支气管肺泡灌洗诊断新型冠状病毒肺炎2例,1例有流行病学史、临床症状及影像学高度疑似,但反复咽拭子阴性患者;1例确诊新型冠状病毒肺炎患者,出院前临床症状消失,胸部CT显示影像学表现明显好转,咽拭子2次阴性,达到出院标准。我们对2例患者的支气管肺泡灌洗液,分别进行新冠病毒ORF 1ab基因、N基因及新冠病毒核酸检测。结果表明,支气管肺泡灌洗液新型冠状病毒核酸检测阳性率高,对疑诊或者确诊新型冠状病毒肺炎患者出院咽拭子核酸检测阴性但肺部仍残留病灶行支气管肺泡灌洗有助于尽早诊断及指导治疗、判断预后。     

合并高血压的新型冠状病毒肺炎患者无需停用血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂类药物

最近,网络上出现了几篇有关新型冠状病毒肺炎(新冠肺炎)患者如何进行血压管理的文章。有些文章建议,对轻型普通新冠肺炎合并高血压患者,考虑停用血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitor,ACEI)和血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB),改用钙拮抗剂;重症新冠肺炎合并高血压患者,应立即停用ACEI和ARB,改用直接肾素抑制剂阿利吉仑。     

某传染病专科医院对新型冠状病毒肺炎疫情防控经验及启示

自2019年12月以来我国湖北省武汉市相继发现了新型冠状病毒肺炎(新冠肺炎)患者,该病主要经呼吸道飞沫及密切接触传播。我国新冠肺炎疫情形势严峻复杂,该病已纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防、控制措施。我中心作为全军惟一"三防"卫勤力量和此次北京地区惟一定点收治新冠肺炎患者的军队医院,承担了确诊新冠肺炎患者的院前处置、转运、收治等任务。中心实现了工作人员"零感染",并圆满完成国家和军队赋予的任务。本文通过归纳总结在人员抽组、培训,医疗后勤物资准备,规章制度建设,工作人员管理等方面的经验,为今后疫情防控工作提供指导。     

新型冠状病毒肺炎市级定点收治医院防控诊疗及护理管理模式探讨

目的 探讨新型冠状病毒肺炎(简称新冠肺炎)市级定点收治医院防控、临床诊疗及护理管理模式,为建立有效的防控体系和提高临床诊治水平提供参考。方法 参照国家卫生健康委员会颁发的新冠肺炎第1～5版的诊疗方案,结合该院的实际情况制定防控、临床诊疗及护理管理模式。结果 2020-01-21～2020-03-02该院新冠肺炎专科发热门诊共接诊发热患者2 330人次,其中疑似病例70例,收治确诊新冠肺炎病例58例,其中普通型51例,重型5例,危重型2例;已治愈出院56例,转院2例,院内治愈率为100%。防控、临床诊疗及护理管理模式运转流畅,各项工作有序开展,全院无医务人员被感染。结论 科学、规范和行之有效的防控、临床诊疗及护理管理模式不仅有助于对新冠肺炎患者进行早识别、早分流、早隔离、早治疗,而且能有效地预防院内交叉感染,提高治愈率,降低病死率。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.