人感染H7N9禽流感诊疗方案(2013年第2版)

人感染H7N9禽流感是由H7N9亚型禽流感病毒引起的急性呼吸道传染病.自2013年2月以来,上海市、安徽省、江苏省、浙江省先后发生不明原因重症肺炎病例,其中确诊人感染H7N9禽流感33例,9例死亡.均为散发病例. 早发现、早报告、早诊断、早治疗,加强重症病例救治,注意中西医并重,是有效防控、提高治愈率、降低病死率的关键. 1 病原学 禽流感病毒属正黏病毒科甲型流感病毒属.禽甲型流感病毒颗粒呈多形性,其中球形直径80 ～ 120 nm,有囊膜.基因组为分节段单股负链RNA.依据其外膜血凝素(H)和神经氨酸酶(N)蛋白抗原性不同,目前可分为16个H亚型(H1 ～H16)和9个N亚型(N1 ～ N9).禽甲型流感病毒除感染禽外,还可感染人、猪、马、水貂和海洋哺乳动物.可感染人的禽流感病毒亚型为H5N1、H9N2、H7N7、H7N2、H7N3,此次报道的为H7N9禽流感病毒.该病毒为新型重配病毒,其内部基因来自于H9N2禽流感病毒.     

人感染禽流感防治知识问答

近期,在我国部分地区陆续发生了人感染H7N9禽流感疫情。为应对疫情,认真贯彻领导指示精神,科学宣传介绍有关预防H7N9禽流感知识,增强大众防控人感染H7N9禽流感的知识和能力,人民卫生出版社有限公司立即针对大众出版科普读物,组织临床及疾病预防控制专家撰写《人感染禽流感防治知识问答》。     

人感染H7N9禽流感诊疗方案（2014年版）

人感染H7N9禽流感是由H7N9禽流感病毒引起的急性呼吸道感染性疾病,其中重症肺炎病例常可合并急性呼吸窘迫综合征、感染性休克,甚至多器官功能衰竭.早发现、早报告、早诊断、早治疗,加强重症病例救治,注意中西医并重,是有效防控、提高治愈率、降低病死率的关键.     

浙江省湖州地区人感染H7N9禽流感七例临床分析

继严重急性呼吸综合征(SARS)、H5N1禽流感、甲型H1N1流感之后,2013年3月在中国局部地区又发生了人感染H7N9禽流感疫情.H7N9病毒是全球首次发现的新亚型流感病毒,病例分布于北京、上海、江苏、浙江、安徽、山东、河南、台湾和福建等地.浙江省湖州市中心医院作为市级定点医院,自2013年4月3日至5月7日共收治7例人感染H7N9禽流感患者,现对这些患者的临床资料进行分析.     

再谈人感染H7N9禽流感的防控和临床救治

自2013年3月出现首例人感染H7N9禽流感病毒至2014年2月7日,全球已确诊308例H7N9禽流感病毒感染者,其中中国长江三角洲地区的病例数占60％以上.进入2014年疫情有上升态势,短短1个多月报告的病例数就逼近去年全年报告的病例数[1],且散发的人感染H7N9禽流感病毒病例数预计还会不断增加.因此,我们临床医师尤其是基层首诊医师应提高警惕,做到早期诊断、早期治疗、降低病死率,以缓解民众恐慌.     

科学实施人感染H7N9禽流感医院感染预防与控制措施

2013年3月31日中华人民共和国国家卫生和计划生育委员会(国家卫计委)通报,上海市和安徽省发现3例人感染H7N9禽流感病例.首例患者:上海市患者李某,男,87岁,2013年2月19日发病,3月4日经积极抢救无效死亡.笔者曾于2月26日应邀会诊该首例患者,当时患者一家三口先后出现发热、重症肺炎,而血常规白细胞不高或降低,当地有关部门对患者样本检测已知病毒均阴性,因为发现其临床症状与甲型流感相似,故笔者考虑该家庭聚集性病例可能为新发病毒性疾病.考虑到流感最常见,所以,当时所有患者均使用了奥司他韦,并协调将样本运送至上海市公共卫生临床中心生物安全实验室.笔者会诊时已经要求院方严格按照呼吸道传染病医院感染控制的要求采取严格措施.随着病毒学研究进展,中国大陆地区防治人感染H7N9禽流感疫情的大幕拉开,世界卫生组织(WHO)和国家卫计委密切关注各地疫情流行情况.随着各地人感染H7N9禽流感病例的增加,如何更科学地实施医院感染预防与控制措施,做到适度、有效、正确地实施医院感染控制,成为摆在我们面前的一个挑战.本文希冀通过抛砖引玉,让更多专家与学者加入到科学实施人感染H7 N9禽流感医院感染预防与控制措施讨论中,通过广泛、深入地探讨为人感染H7N9禽流感医院感染预防与控制措施的发展出谋划策.     

人感染H7N9禽流感临床特征及防治策略

禽流感病毒属正黏病毒科甲型流感病毒属,可感染人的禽流感病毒亚型为H5N1、H9N2、H7N7、H7N2和H7N3.此次人感染的H7N9禽流感病毒是全球首次发现的新亚型流感病毒. 相比较10年前的严重急性呼吸综合征(SARS),此次我国科学家在应对新发的H7N9禽流感方面显得更加从容.     

摘译:人类感染活禽市场来源的新型H7N9禽流感病毒的临床分析和病毒基因组特征

2013年2月,中国华东地区出现人类由于接触家禽而感染H7N9亚型禽流感病毒的病例.该文报道了人感染H7N9亚型禽流感的临床和病毒学特征,并分析比较了人和活禽市场来源分离到的H7 N9亚型禽流感病毒基因组. 将2013年3月7日至4月8日有新发呼吸道症状、原因不明的影像学浸润、实验室确诊H7N9病毒感染的住院患者纳入研究范围,记录病史、体检、血液、生化、影像、微生物等结果.采集患者的咽拭子和痰样本,采用RT-PCR检测病毒的M、H7和N9基因,用MDCK细胞培养病毒.分析患者的合并感染情况,并检测血清细胞因子和趋化因子水平.同时还在有流行病学关联的活禽市场收集了86份禽类泄殖腔拭子样本接种于鸡胚.通过测序对从人和鸡分离到的病毒进行鉴定和分型,对病毒的8个基因片段进行进化分析,并构建了H、N、PB2和NS基因的系统进化树.     

血浆血管紧张素Ⅱ水平与H7N9患者疾病的严重程度相关并能预测患者的致命预后

2013年春季，一种新型H7N9禽流感病毒首次出现在中国华东地区，2014年1月以来，H7N9禽流感不断发生。病毒引起人类严重的疾病，包括急性的甚至致命的呼吸衰竭。对于不同的感染者，会呈现不同的预后。那么究竟有没有一种标志物，可以用来判断H7N9患者疾病严重程度及预后？     

新型冠状病毒疫情期间骨科患者手术器械消毒灭菌与管理的流程与策略

2019年12月以来,新型冠状病毒肺炎(COVID-19)已在世界多地暴发。虽然疫情在我国得到控制,随着复工复产的逐步深入,部分COVID-19患者治愈后"复阳",特别是近1个月以来,境外输入病例逐渐增多,因此疫情防控形势仍然严峻,医疗机构在未来一段时间内仍面临巨大压力。基于2016版《医院消毒供应中心清洗消毒及灭菌技术操作规范》、2012版《医疗机构消毒技术规范》、《新型冠状病毒肺炎防控方案(第五版)》及《新型冠状病毒肺炎诊疗方案(试行第六版)》等相关标准,河北医科大学第三医院消毒供应中心制定本科室"新型冠状病毒(2019-nCoV)感染复用器械处理流程、2019-nCoV感染器械回收流程、2019-nCoV感染器械转运车处理流程"等应急预案。为疫情防控期间消毒供应中心(CSSD)各项防控管理措施提供参考。     

James Alison Glover (1874-963), OBE (1919) CBE (1941) MD (1905) DPH (1905) FRCP (1933)

James Allison Glover served in the Boer War and World War I. In 1917 he was appointed to the Cerebro-spinal Laboratory in London. There, his work on cerebrospinal fever resulted in the "spacing out" of beds in huts and earned him the name of "good friend of the private soldier". In 1919 he proceeded OBE for his work during the war. In 1920 he was appointed medical officer to the new Ministry of Health. He made significant contributions to rheumatology and the understanding and treatment of tonsillitis, and to public health more widely.     

热毒清对家兔内毒素性DIC急性肺损伤的保护作用

采用间隔２４小时两次注射大肠杆菌内毒素方法复制家兔急性肺损伤模型，检测血浆、肺组织及支气管肺泡灌洗液（ＢＡＬＦ）中白细胞介素８（ＩＬ－８）、硝酸盐／亚硝酸盐（ＮＯ２／ＮＯ３）水平及有关指标改变，观察中药制剂热毒清（ＲＤＱ）对家兔内毒素性肺损伤的保护作用。发现ＲＤＱ可降低肺系数及通透指数，减少ＢＡＬＦ中白细胞计数；ＩＬ－８、ＮＯ２－／ＮＯ３－水平、酸性磷酸酶（ＡＣＰ）活性亦显著降低（Ｐ＜０．０１），肺组织学损伤减轻。证实ＲＤＱ对内毒素所致的家兔急性肺损伤具有一定的保护作用。     

Anaplastic (undifferentiated) thyroid carcinoma (ATC)

BACKGROUND: Old age, reduced general condition and far advanced tumor stage associated with poor prognosis induced the belief that, apart from verifying the diagnosis of anaplastic thyroid carcinoma (ATC) by biopsy, no additional surgery would be justified. However, in some cases, an ultraradical approach was recommended in order to improve the quality of life and survival. METHODS: These are the results of a retrospective analysis involving 120 patients subjected to restricted radical surgery (excising as much as possible of the tumor and local metastases, foregoing ultraradical removal of vital organs such as esophagus, larynx and trachea). RESULTS: Irrespective of the surgical approach used, 6+/-2% of the patients were alive after 5 years (median survival time: 3.1 months). Patients without tumor residues (R0-resections; extending to soft tissue only; Kaplan-Meier estimate - cumulative survival 15+/-5%) had a significantly better prognosis than patients with tumor residues (R1/R2-resections; no patient survived 5 years; P<0.001). Tumor morphology (spindle cells, giant cells, mixed cells) or differentiated parts of the tumor as well as lymph-node involvement had no statistically significant impact on the prognosis. CONCLUSIONS: In ATC, the objective should be to remove as much of the carcinoma as possible (in the ideal case, a thyroidectomy); if lymph nodes are affected, neck dissection should be the goal, if possible (restricted radical approach, improving quality of life). Ultraradical surgery to include segmental resection of larynx, trachea or esophagus do not seem to be indicated, as prolonged survival is questionable and quality of life is certainly diminished.     

High-resolution EEG (HR-EEG) and magnetoencephalography (MEG)

HR-EEG (high resolution EEG) and MEG (magnetoencephalography) allow the recording of cerebral electromagnetic activities with excellent temporal resolution. These tools have also considerably progressed in spatial resolution and now constitute real methods of Electric and Magnetic Source Imaging. Their limits and the precision of the results obtained are discussed in distinct types of partial epilepsy. HR-EEG and MEG allow localization of scalp-EEG interictal spikes and more rarely ictal activities. They now contribute to the presurgical evaluation of pharmacoresistant partial epilepsies. These investigations appear to be of particular importance in presurgical assessment of MRI-negative epilepsy.     

Biodistribution of55Fe (II) phthalocyanine tetrasulphonate (55Fe (II)-TsPc)

Phthalocyanines may be an alternative group of macrocycles applicable for use in photodynamic therapy (PDT) of cancer. Although as a class, phthalocyanines localize in tumours, efficacy of cytotoxicity appears to depend to some degree on the specific compound. Biodistribution patterns of the phthalocyanines are similar to those for dihaematoporphyrin ether (DHE); the major sites of deposition being liver, kidney and spleen while the remaining organs show varying degrees of accumulation. The optimal time for PDT when using phthalocyanine appears to be between 24 and 48 h.     

Endotoxin (LPS) increases mesenteric vascular resistance (MVR) and bacterial translocation (BT)

Endotoxemia is responsible for many of the pathophysiologic alterations that occur with Gram-negative sepsis. We utilized a chronic ovine model to determine the hemodynamic disturbances in the gastrointestinal tract during endotoxemia. Sheep with indwelling arterial, venous, and pulmonary arterial catheters were used. An ultrasonic flow probe was placed on the cephalic mesenteric artery. The animals were subjected to: 1) Ringer's lactate infusion (sham n = 6); or 2) 1.5 mcg/kg E. coli endotoxin (n = 6) over over a period of one half hour and were monitored for 48 hours. They were then sacrificed and specimens of mesenteric lymph node, liver, spleen, kidney, and lung obtained for bacteriologic cultures and histologic analysis. Sheep receiving endotoxin showed more than 50% reduction in the mesenteric blood flow. Mesenteric vascular resistance increased while non-mesenteric systemic vascular resistance decreased. The increase in the total systemic vascular resistance, noted during endotoxemia, was thus likely due to the increase in the mesenteric vascular resistance. At autopsy there were positive cultures for microorganism in the mesenteric lymph nodes in six out of six sheep with endotoxemia as compared to one out of six of control. Thus the vasoconstriction in the mesenteric areas may have resulted in bacterial translocation from the GI tract.