浅析基于地震疾病种类变化规律的救援药品遴选

目的 依据前期对本院救援队出队参与多次国内、国外救援工作总结出的地震疾病种类变化规律,有针对性的对今后地震救援药品品种进行遴选.方法 对震后我院救援队救治过程中收治的伤病员疾病种类进行分析,并以此为依据,从震后不同时间段,对地震救援药品进行遴选.结果 在震后1～7d,疾病种类以损伤和中毒类疾病为主,药品选择应以抗休克、止血、抗感染、补液等抢救药品为主,辅以治疗其他疾病的药物;在震后8～14 d,疾病种类多元分布,除了损伤和中毒类疾病外,呼吸系统疾病、妇产小儿疾病、皮肤病、精神和行为障碍增加.药品在选用上述品种的基础上,还应包括治疗常见病多发病需要的大内科、大外科药品,特别是呼吸系统用药、消化系统用药以及妇、儿用药等.结论 以疾病种类为依据、按照时间段对药品进行遴选的方法,克服了药品品种选择的盲目性,使其更贴近震区疾病发生的实际情况.     

不同环境下地震救援药品的选择

地震后不同时间段疾病种类的变化规律为地震救援药品的选择提供了依据,救援队救治能力为救援药品的携带数量提供了参考,但是,由于地震灾害发生地区地理环境的不同,所携带救援药品不仅要考虑到一般情况下的需求,还有考虑到多种地理环境下对救援药品的需求.     

台风灾害卫生救援中药品保障和疫情防控规范化开展的思考与探讨

目的 旨在为中国救援队(医疗)应对台风类灾害医学救援药品保障提供理论依据,为救援队在灾后疫情防控提供标准化流程。方法 检索中国知网、万方数据库等医学文献数据库,统计分析台风或热带气旋等灾害后各系统疾病发生率,汇总疾病谱;根据疾病类型占比,采用决策分析法,确定台风类灾害救援药品保障目录。结果台风后,外伤、呼吸系统疾病、神经系统疾病、皮肤科疾病和消化系统疾病为主要疾病类型,在通用药品模块的基础上增补台风灾害专科药品,涉及10个系统26种药物。基于中国救援队赴莫桑比克应急救援的实践经验和相关指南,构建灾后现场疫情防控标准化流程和消杀制剂推荐目录。结论 台风类灾害应急救援药品模块的建立与疫情防控规范化流程构建,提高了应对台风灾害的医学救援速率及能力,防止了台风后传染病的发生,为国内外应对台风类灾害应急救援提供参考和依据。     

洪涝灾害救援药品保障系统快速调配特点的研究

目的 建立洪涝灾害救援药品保障系统,针对不同区域灾情特点快速调配救援药品保障的时效性.方法 建立各突发事件模块,运用系统聚类分析法,针对洪涝灾害模块中疾病特点进行划分,采用决策分析法建立药品模块的组装方案.结果 将此药品保障系统应用于洪涝灾害救援中,针对灾害特点快速调配药品准备的时效性,减少了人为差错.结论 根据灾情中疾病特点,快速调配救援药品,充分发挥出药品保障系统模块快速随机性调配灾害救援药品的作用.     

国内外重大地震灾害疾病种类的统计分析

目的 对地震后不同时间段的疾病种类进行统计分析,通过对其变化规律的研究,为救援药品的贮备提供参考依据.方法 以中国国际救援队赴国内外地震救援救治的震后伤病员疾病种类为主要依据,运用统计学中的聚类分析法,分析震后不同时间段疾病发生的聚集程度.结果 在震后1～7 d,疾病种类以损伤和中毒类疾病为主,其次是呼吸系统疾病和其他...     

中国国际救援队在巴基斯坦地震救援中的医学实践与研讨

目的 探讨进一步提高国际层次救援医学速度与效率.方法 以中国国际救援队医疗行动为主体,对2005年赴巴基斯坦地震系列医疗救援行动,包括现场急救、院内治疗、医疗后送、卫生防疫、药械保障、医疗信息管理进行回顾性分析,特别是对救治的伤病员分类、灾后时段病种分布、药品消耗及补充等进行统计学分析.结果 院外、院内及院后救治统计现场急救以外伤为主,以小组形式展开;院内治疗划分小组,分组协作、周而复始;转出比例占2%～3%;灾后时段伤病员分析地震灾害早期(灾后头14 d内)现场救治,以外伤为主,占救治伤病员总数的82%;中期(灾后14～28 d)外伤病人所占比重逐渐下降,稳定在24%,而感染性疾病逐渐增加,并以急性呼吸道感染及急性肠炎为主,呼吸道疾病呈陡升缓降趋势;后期则回归于当地平时发病率水平.药械保障统计消耗量较大的药品有抗生素,退热与止痛药,主要用于外伤及感染;药品以口服和外用为主,针剂和输液占10%.伤病救治影响因素统计灾区山地昼夜温差大,冬季雨雪之后气温骤降,灾民缺衣少食,没有可供御寒的帐篷成为诱发疾病的重要原因.结论 大规模地震灾害救援行动异常复杂,区分时段、区分地段、区分层次形成时间、空间、内容上的不同救援,更能符合灾区医疗需求;医疗救援能力始终未能满足灾区的医疗需求,要求不断完善组织管理体系,实现救助人数更多、速度更快、效果更好、能耗更省;灾害救援的技术行动、组织指挥与生活保障,三足鼎立,决定救援行动成败;巴基斯坦地震医疗救援的实践对我国灾害医学救援的组织体系、技术训练、药械保障、制度管理提供了借鉴与参考.     

巴基斯坦跨国抗洪救援中救援队队员自身保障措施

2010年8月26日,中国国际救援队接到跨国巴基斯坦首次执行抗洪救灾国际救援任务使命,第一批医疗分队在巴基斯坦南部信德省特达地区展开流动医院,实施医疗救援预计20余天.为此,中国国际救援队为确保救援期间全体队员身心健康平安回国,带队首席医疗官根据异国灾情、疫情、需求,借鉴中国国际救援队多次参加国内外地震救援实战经验,在救援人力资源有限的条件下,以及医疗救援预案中,加强了救援队内部保障力量,其中,建立生活保障小组(8人)、卫生防疫小组(6人),医疗保建小组(2人),共三组16人,在历时21 d的跨国巴基斯坦首次执行抗洪救灾任务期间,确保了易感人群无发生介水传染病暴发流行,无消化道传染病,未发生非战斗减员.     

以大救援观引领中国国际救援

中国国际救援队抽组40名队员赴印度尼西亚参加地震救援,武警总医院20人参加并承担医疗救援任务,2006年5月29日飞赴灾区,2006年6月16日安全返京,历时19 d.     

流动医院模式在印尼日惹地震救援中作用的探讨

目的 探讨流动医院模式在国际灾害救援中的作用.方法 对中国国际救援队在2006年5月30日至2006年6月15日印尼日惹参加地震灾害救援期间相关的医疗资料进行回顾性分析.结果 流动医院由2名医疗官、10名医生、6名护士及2名技师,共20人组成.所有人员均取得中级以上资格,涉及9个临床专业.携带32种医疗设备,109种医疗药品,46种医疗耗材.在此期间,共治疗患者3 015人,男性1 327人,女性1 688人,年龄45天～83岁,年龄段集中在41～70岁,43.32%为外科患者.同时进行流行病学干预,对5 000人进行心理学调查和健康教育.结论 流动医院模式符合现代化国际救援的要求,是今后灾害救援模式发展的一个方向.     

中国国际救援队参加日本3·11地震医疗救援报告

2011年3月11日日本东北部海域发生里氏9.0地震和海啸,包括中国在内的18支国际救援队到达灾区,18支救援队按〈联合国国际搜救行动指南〉配置人员与装备,在联合国现场协调中心的统一调度下开展以搜救为主要任务的救援行动.18支队伍中,1支（5%）于灾后第1 d到达,9支（50%）于灾后第2 d到达;4支（22%）于灾后第3 d到达,1支（5%）于灾后第4 d到达,平均在灾后3 d到达灾区,在灾区平均工作的时间是7 d.中国国际救援队15人,其中医疗队员1人,于震后第2 d飞抵日本.3月15日,福岛核电站发生爆炸及放射性物质泄漏,灾区遭遇降雪天气,搜救工作困难增加.多国救援队未能救出幸存者,各队也无人员伤亡.联合国倡导的融合搜索、营救与医疗三项主体行动于一体的现代城市搜救队建队模式已为众多国家,尤其是正迈向城市化的国家（包括中国）所接受.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico

Background and objectives

The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement.