新型冠状病毒肺炎发病机制及临床研究进展

新型冠状病毒肺炎(Corona virus disease 2019,COVID-19)是由一种新的β冠状病毒-新型冠状病毒(2019 novel coronavirus,2019-nCoV)引起,以血管紧张素转化酶2(Angiotensin converting enzyme 2,ACE2)作为受体侵入细胞导致肺损伤,病情加重与继发引起的全身性炎症反应密切相关,重症患者会出现急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)和感染性休克,最终出现多器官功能衰竭。目前大多数药物如巴利替尼、瑞德西韦、氯喹等尚处于临床试验阶段,尚无特效药治疗。COVID-19传染性强,可引起多种严重的并发症,对全球公共安全造成了极大威胁。研究其病原学及发病机制,进而开展对治疗药物和疫苗的临床研究,对及时控制病毒传播,防止病情恶化进展,减少并发症及病死率具有重大意义。     

新型冠状病毒肺炎实验室诊断技术研究进展

 

2019年12月,湖北省武汉市发现以肺部病变为主的新型冠状病毒感染,2020年2月11日世界卫生组织（WHO）将由新型冠状病毒引发的疾病正式命名为2019冠状病毒病（coronavirus disease 2019,COVID-19）,该病毒称为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。COVID-19短时间内扩散到全国,3月11日WHO宣布COVID-19已构成全球大流行。实验室检测是确诊COVID-19的重要依据,对于该病的治疗和防疫工作至关重要。本文对COVID-19实验室临床诊断技术相关进展进行整理综述。

     

妊娠期冠状病毒感染与母婴健康研究进展

目前全球范围内正流行新型冠状病毒肺炎（COVID-19）,而其强烈的传播性已引发重大公共卫生危机。新型冠状病毒与严重急性呼吸综合征（SARS）冠状病毒、中东呼吸综合征（MERS）冠状病毒存在高度病原同源性,同为β属冠状病毒。由于孕妇群体在生理和心理上存在一定脆弱性,为疫情流行期间的易感人群和高危人群,本文将对目前所报道的孕产妇罹患SARS、MERS、COVID-19对母婴健康影响进行文献综述,旨在为COVID-19流行中孕妇健康管理与防控提供依据。     

新型冠状病毒肺炎研究进展

2019年12月底,中国暴发了一场不明微生物引发的病毒性肺炎。经研究确认,该不明微生物为一种新的冠状病毒,即严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2, SARS-CoV-2）,2020年2月,WHO将SARS-CoV-2感染的肺炎正式命名为新型冠状病毒肺炎（coronavirus disease-2019, COVID-19）。随着对SARS-CoV-2及其引发肺炎研究的深入,SARS-CoV-2特点、COVID-19临床及流行病学特征、临床诊治技术等研究内容陆续在国内外杂志报道。本文对已开展的COVID-19研究工作梳理总结,围绕溯源分析、检测手段、临床表现、药物研发、病毒传播等5个方面进行综述,以期对临床及科研工作者提供帮助。     

新型冠状病毒疫苗研发进展及接种意愿分析

新型冠状病毒肺炎（COVID-19）自2019年末爆发后迅速造成全球大流行,对公共卫生健康构成众大威胁。引发COVID-19的严重急性呼吸系统综合征冠状病毒-2（SARS-CoV-2）是高致病性病毒,各国采取多种防疫措施均未能从根本控制病毒传播,有效的疫苗对应控制疫情发生发展具有重要作用。各国通力合作,大力研发安全、有效的新型冠状病毒疫苗,本研究综述了新型冠状病毒疫苗研发的进展以及各国民众的疫苗接种意愿。     

利巴韦林联合IFN治疗冠状病毒感染的研究进展

2019年底以来新型冠状病毒肺炎（新冠肺炎）席卷全球,病毒学分类委员会将新型冠状病毒命名为SARS-CoV-2。目前对SARS-CoV-2知之甚少,尚未研发出针对该疾病的特效药物。但其与严重急性呼吸综合征冠状病毒、中东呼吸综合征冠状病毒同为β属冠状病毒,具有核苷酸同源性。既往严重急性呼吸综合征和中东呼吸综合征相关研究提示利巴韦林（ribavirin, RBV） 联合IFN抗病毒治疗有效,为新冠肺炎的治疗提供了新的方向,但联合治疗的效果及安全性有待进一步临床试验证实。本文回顾总结了RBV联合IFN治疗冠状病毒感染的研究进展,以期为新冠肺炎的治疗提供参考。     

新型冠状病毒肺炎与吸烟的相关性研究进展

目的 着重从新型冠状病毒肺炎（Coronavirus disease 2019 ,COVID-19）患者的吸烟率、吸烟对COVID-19患者预后的影响、吸烟与严重急性呼吸综合征冠状病毒2（Severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）感染机制这三个层面阐述了COVID-19与吸烟的最新潜在关系，为COVID-19与吸烟关系的进一步研究提供理论参考。方法 提取世界卫生组织报道的COVID-19最新资料，检索PubMed和中国知网数据库2000年至2021年间收录的与吸烟和COVID-19相关的文章进行综述。结果 吸烟的COVID-19患者发展为重症和出现死亡的风险更高，但关于COVID-19在吸烟者中的发病率是否比非吸烟者高，即吸烟是否会增加SARS-CoV-2感染风险，尚无定论和结论。结论 目前关于COVID-19与吸烟的研究仍处于初级阶段，在将来需要完善更多的分子、细胞水平实验和进行更严谨的调查研究，这将使COVID-19患者获益，尤其是吸烟的COVID-19患者。     

新型冠状病毒肺炎与严重急性呼吸综合症的对比分析

赵建刚①,靳素琴①#,胡云霞② 摘要 通过收集中国境内2003年严重急性呼吸综合症（SARS）和2020年1—3月新型冠状病毒肺炎（COVID-19）疫情信息,对这两种疾病从病原学、临床症状、流行特征和中医药诊治效果等方面进行了分析。2003年SARS在我国境内共累计确诊5 327例,报告死亡病例349例,病死率约为7%;2019年COVID-19在中国境内截止2020年3月31日共累计确诊81 554例,报告死亡病例3 312例,病死率约为4%,由此看出,尽管两种病毒同属于SARS相关冠状病毒,但2019年COVID-19的确诊人数远远多于SARS,但其死亡率却小于后者,究其原因可能与两种病毒的传染性、致病力和人员流动性等因素有关。     

COVID-19患者的消化道症状及营养治疗

 自2019年12月新型冠状病毒肺炎（COVID-19）暴发以来，截至2020年9月8日全球确诊人数已超过2 700万。虽然本国的疫情控制已取得初步胜利，但仍面临"外防输入、内防反弹"的压力。同时，由于世界各国抗疫模式不同、医疗资源短缺等因素，部分国家仍处于疫情扩散的高峰，大量患者仍需加强救治。COVID-19主要引起呼吸系统损伤，可伴有消化系统症状，甚至部分病例以消化系统症状为首发。同时，营养支持在COVID-19患者的预防、治疗各阶段都发挥重要作用，良好的营养支持方案是患者顺利康复的必要条件。因此，了解并关注COVID-19患者的消化道症状，给予良好的营养支持方案，对COVID-19患者的治疗十分必要。本文就已知的COVID-19相关消化道症状及营养治疗方案进行综述。     

从新型冠状病毒肺炎的流行病学特点浅谈其口岸防控

新型冠状病毒肺炎(COVID-19)疫情进入关键时期。口岸作为重要的防控环节,对控制病毒传播具有重大意义。本文依据现已掌握的COVID-19流行病学特点,结合口岸防控NCP相关措施进行探析,以期为新型冠状病毒肺炎疫情的口岸防控提供参考。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.