接种新型冠状病毒灭活疫苗后的新型冠状病毒肺炎患者血抗体水平及病情分析

目的 探讨新型冠状病毒灭活疫苗(简称新冠疫苗)对接种后感染Delta变异株新型冠状病毒肺炎(简称新冠肺炎)人群是否具有保护作用.方法 观察2021年7月20日—8月27日在本院隔离病区住院的接种过新冠疫苗(接种1针或2针)的47例新冠肺炎成年患者的病例资料以及血新型冠状病毒免疫球蛋白M(IgM)、免疫球蛋白G(IgG)...     

新型冠状病毒奥密克戎变异株感染住院患者疫苗接种情况与危重型的相关性分析

目的 分析奥密克戎变异株感染住院患者的疫苗接种情况与奥密克戎危重型发生风险的相关性。方法 回顾性分析2022年12月1日—2023年1月31日成都市某三甲医院收治的奥密克戎感染患者的临床资料,根据病情及《新型冠状病毒诊疗方案（试行第十版）》把患者分为危重组和非危重组;根据疫苗接种情况,把患者分为未完成接种组、完成接种组、加强接种组。采用多因素Logistic回归分析疫苗接种、入院时的症状体征与危重型发生风险之间的关联。结果 最终纳入3 603例奥密克戎感染住院患者,危重组730例（20.3%）,非危重组2 873例（79.7%）。未完成接种组2 399人（66.6%）、完成接种组433人（12.0%）、加强接种组771(21.4%)。与未完成接种组相比,完成接种组和加强接种组出现危重型的比例降低,随着年龄增加危重占比增高（P<0.05）。校正年龄、性别、基础疾病后,多因素Logistic分析结果显示完全接种[OR=0.67,95%CI(0.50,0.89)]与增强接种[OR=0.76,95%CI(0.61,0.94)]均与危重型发生风险降低有关。结论 按次数接种疫苗、接种加强针均...     

细胞因子在评估新型冠状病毒肺炎患者疾病严重程度及预后中的价值

目的 研究细胞因子在评估新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者疾病严重程度及预后中的价值.方法 回顾性分析武汉市雷神山医院205例COVID-19患者资料,根据疾病严重程度分为普通型组(n=117)、重型组(n=69)和危重型组(n=19).收集患者的基本情况和细胞因子相关参数,比较3组间差异并分析其在评估COVID-19患者疾病严重程度及预后中的价值.结果 3组患者的年龄、新型冠状病毒核酸检测结果、白细胞介素(interleukin,IL)-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α差异有统计学意义(P＜0.05).相关性分析显示,年龄、新型冠状病毒核酸检测结果持续20 d阳性、IL-6水平、IL-10水平、IL-2受体水平、IL-8水平、肿瘤坏死因子-α水平与COVID-19分型具有相关性(相关系数rs分别为0.354、0.187、0.366、0.327、0.329、0.273、0.157,P＜0.05).死亡COVID-19患者的IL-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α水平高于存活患者(P＜0.05).多因素分析显示,年龄[比值比(odds ratio,OR) =1.034,95％置信区间(confidence interval,CI) (1.006,1.063),P=0.016]、IL-6水平[OR=1.030,95％CI (1.006,1.055),P=0.015]、IL-10水平[OR=1.088,95％CI(1.003,1.179),P=0.042]和IL-2受体水平[OR=1.003,95％CI (1.001,1.005),P=0.001]是普通型COVID-19患者转成重型/危重型的独立风险因素.结论 COVID-19患者体内的细胞因子水平与疾病的严重程度及预后密切相关.     

80例新型冠状病毒感染肺炎患者相关血液检测指标分析

目的研究新型冠状病毒感染肺炎患者实验室检测指标变化的情况及其临床意义,为临床诊断、治疗提供科学参考依据。方法回顾性分析本院在2020年收治的80例新冠肺炎确诊患者的相关血液检测指标,将健康体检者分为A组(n=40例),疑似新型冠状病毒感染的肺炎患者分为B组(n=40例),确诊为新型冠状病毒感染的肺炎患者分为C组(n=80例),比较三组人群的实验室血常规、T 淋巴细胞亚群免疫分型及生化等指标的变化水平。结果确诊组C组WBC、L(%)、RBC、HGB、CD3~+、CD4~+、CD8~+、BUN、UA均低于健康组A组,差异均有统计学意义(P0.05);确诊组C组G(%)、hs-CRP、ALT、AST、TB、DB、SAA、LDH、CK-MB均高于健康组A组,差异均有统计学意义(P0.05)。确诊组C组CD4~+、TnI均低于疑似组B组,差异均有统计学意义(P0.05);确诊组C组AST、SAA、LDH 、CK-MB均高于疑似组B组,差异均有统计学意义(P0.05);三组之间PLT、CD4~+/ CD8~+、CR、CYC、PCT、MYO、CK等项目差异均无统计学意义(P0.05)。多因素二元logistic逐步回归分析显示,SAA、CK-MB、LDH、AST、TB、DB越高,患新冠肺炎的危险性越大;WBC、L%、HGB、BUN、UA、CD4~+、CD8~+ 越低,患新冠肺炎的危险性也越大。结论新型冠状病毒肺炎患者的各项实验室指标有明显变化,对于病毒感染的早期诊断和治疗具有较强的参考价值,是对核酸金标准的有效补充,应予以重视。     

新型冠状病毒奥密克戎变异株感染的临床特点分析

目的 分析新型冠状病毒奥密克戎变异株本土感染患者的临床特征。方法 收集2022年3月至2022年4月本院住院治疗的52例新型冠状病毒感染患者的临床资料,回顾性分析患者流行病学特征、发病症状、血液检验、影像学特点、治疗方法等。结果 52例患者入院时无症状感染者38例,轻型11例,普通型3例。男34例,女18例;年龄(47.37±14.66)岁。临床症状表现以发热、咳嗽咳痰及全身酸痛为主,按照患者入院首次鼻咽拭子核酸检测N基因及ORF1ab基因的周期阈值(Ct值)分为Ct值≤20组及Ct值组>20,各26例。Ct值>20组比Ct值≤20组血清新冠抗体水平、中性粒细胞计数、总蛋白、血钾升高,疫苗接种剂次增加,差异有统计学意义(P<0.05)。Logistic回归分析显示,血清新型冠状病毒抗体水平高(OR=1.004,95%CI:1.00±1.01)、中性粒细胞计数高(OR=1.701,95%CI:1.09±2.66),入院首次鼻咽拭子新型冠状病毒检测Ct值>20的患者增加,差异有统计学意义。血清新型冠状病毒抗体水平及中性粒细胞计数预测患者鼻咽拭子新型冠状病毒检测Ct值...     

新型冠状病毒Delta变异株感染同船海员的临床特点分析

目的 探讨新型冠状病毒Delta变异株感染同船海员的临床特点及接种疫苗的保护作用。方法 回顾分析2021年8-11月广西防城港市第一人民医院定点隔离病区收治的新型冠状病毒Delta变异株境外输入感染者5例及同船海员17例。依据是否接种疫苗分为接种疫苗组(10例)及未接种疫苗组(12例),回顾性分析两组临床资料。结果 同船22例海员中新型冠状病毒感染共14例(63.6%);其中未接种疫苗组感染比例高于接种疫苗组(P<0.05)。除外2例为无症状感染,其余12例出现发热、嗅味觉减退、咳嗽、胸闷、咳痰、乏力及全身酸痛等。未接种疫苗组发热持续时间为(7.62±2.32)天,接种疫苗组发热持续时间为(6.25±2.50)天,差异无统计学意义(P=0.368)。经治疗后未接种疫苗组核酸转阴时间为(65.75±25.81)天,而接种疫苗组为(44.00±28.32)天,差异无统计学意义(P=0.211)。结论 我国生产疫苗对新型冠状病毒Delta变异株具有一定的保护作用。同船海员新型冠状病毒Delta变异株感染患者核酸转阴时间明显延长,但接种疫苗与核酸转阴时间无相关性。     

新型冠状病毒肺炎患者核酸转阴时间的影响因素及与淋巴细胞亚群的关系

目的分析影响新型冠状病毒肺炎(COVID-19)患者核酸转阴时间的相关因素,探讨核酸转阴时间与血液淋巴细胞亚群的关系。方法选取阜阳市第二人民医院收治的155例COVID-19患者作为研究对象,收集患者人口学资料、临床症状、治疗方案以及肺部CT影像资料,采用流式细胞仪检测血液CD4~+、CD8~+T淋巴细胞计数,计算核酸转阴时间,采用单因素和多因素Logistic回归分析的方法,分析影响核酸转阴时间的影响因素。采用Pearson相关性分析,探讨核酸转阴时间和淋巴细胞亚群的相关性。结果平均核酸转阴时间为15.88 d(修约后取16 d),分为核酸转阴时间≥16 d组(A组)和16 d组(B组),A组84人,B组71人。单因素分析显示,两组患者间性别、基础疾病合并率、武汉旅居史、发热持续时间、咳嗽持续时间、糖皮质激素、丙种球蛋白、抗病毒药物种类之间差异无统计学意义(P0.05),而年龄、临床分型、CD4~+T细胞、CD8~+T细胞、肺CT评分之间差异存在统计学意义(P0.05)。多因素Logistic回归分析显示,年龄≥60岁、重型/危重型患者以及CD8~+T细胞水平降低是影响核酸转阴的危险因素。COVID-19患者中位CD4~+、CD8~+T计数分别为428个/μL和299个/μL;核酸转阴时间与CD8~+T淋巴细胞计数呈负相关性(r=-0.689,P=0.024),与CD4~+T淋巴细胞计数无相关性(r=-0.544,P=0.137)。ROC曲线分析结果显示,CD8~+T细胞预测核酸转阴时间延长的曲线下面积(AUC)为0.714,95%可信区间(95%CI)为0.630~0.799,最佳临界值为236个/μL。结论 COVID-19患者CD8~+T淋巴细胞降低,老年人群和重症患者以及CD8~+T细胞水平显著下降可能影响新型冠状病毒核酸转阴时间,导致病程相对延长。     

新型冠状病毒肺炎患者肝功能异常的相关临床分析

目的　探讨新型冠状病毒肺炎（COVID-19）患者肝功能异常的相关性因素。方法　回顾性分析湖南省岳阳市 第一人民医院2020 年1~3 月收治的新型冠状病毒（SARS-CoV-2）感染患者80 例，根据肝功能情况分为肝功能异常 组45 例，对照组35 例，对其进行病例对照研究，选择与肝损伤有关指标进行单因素及多因素分析，探讨COVID-19 患者肝功能异常的发生机制。结果　研究显示肺炎严重程度是COVID-19 患者发生肝损伤的主要危险因素（P=0.009， OR=3.826，95%CI 1.388~10.544），而基础疾病、炎症因子水平与COVID-19 患者出现肝损伤无统计学相关性（P>0.05）。 结论　COVID-19 患者发生肝功能损害与病情进展密切相关，临床医生诊治患者时，应当遵从早发现、早治疗的原则， 避免造成肝脏进一步损伤，改善患者预后。     

肺部超声与CT对新型冠状病毒肺炎肺损伤的评估:优与劣

肺部CT是新型冠状病毒肺炎(以下简称“新冠肺炎”)暴发初期最主要的筛查手段和分级诊疗依据,是肺部损伤影像学诊断的金标准。随新冠肺炎病情进展,患者肺部CT呈现不同的病变范围与类型。肺部超声与CT相一致,随病程发展呈特征性表现。与肺部CT相比,肺部超声检查具有床旁便捷、无创等优点,减少了院内传染和转运风险,且其有助于快速鉴别呼吸衰竭的病因,实现连续动态监测,指导呼吸机参数设置、肺复张、俯卧位治疗等,在急危重症新冠肺炎的救治过程中发挥无可替代的作用。另一方面,肺部超声在探测远离胸膜病变、辨别过度通气、操作者依赖方面亦有其局限性。本文对肺部超声与CT的优劣势进行梳理,临床医师在实践过程中应取长补短,以促进新冠肺炎患者的精准诊治。     

31例新型冠状病毒性肺炎进展期的CT特殊征象分析

目的：找出新型冠状病毒性肺炎进展期的独特CT征象,以便更好地为治疗提供依据。资料与方法：汇总本地31例新冠肺炎患者进展期的多次CT扫描图像和临床资料,统计分析间质性肺水肿和肺部实变征象发生的频数和率；结果:新冠肺炎患者特殊CT征象发生率高,包括间质性肺水肿的kerley氏线(28/31,90.32%)、肺部实变的粘液拴征(31/31,100%)、坠积征(29/31,93.54%)。发现粘液栓征的分布范围和其临床危重程度呈正向相关；还发现GGO、结节实变病灶、白肺征是该病不同发展时期的相同病理改变。结论：识别出新冠肺炎独特的CT特征,可以更好地协助临床治疗。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.