城中村新型冠状病毒肺炎疫情发生特点及其基层医疗卫生机构的防控策略分析研究

背景一段时间以来,全国多地城中村暴发聚集性新型冠状病毒肺炎疫情引发关注。城中村内道路错综,人口密集且人员结构复杂、跨区域流动频繁,给疫情防控工作带来挑战。目的城中村因其空间环境、人口结构特征、跨区域流动的特点且居民就医行为特点更容易发生传染病的区域性暴发,了解我国城中村新型冠状病毒肺炎疫情发生特点及其基层医疗卫生机构对在此类区域开展新型冠状病毒肺炎疫情防控工作的现状和存在的困难,为应对常态化防控、社会面动态清零的基层防控工作及应对未来传染病发生的防控提供借鉴。方法通过舆情分析、文献检索、城中村基层疫情防控人员和疫情防控专家在线访谈等方法,总结城中村疫情发生及防控现状,分析存在的薄弱环节和重要漏洞。结果基于相关资料共提炼出6个关注点：（1）摸底排查量大面宽,是城中村疫情防控工作的重点和难点;（2）没有严格闭环管理,病毒携带者未被及时管控,存在疫情传播扩散风险;（3）基层医疗卫生机构院感防控工作不到位,院感发生风险大;（4）属地管理原则在排查密切接触者环节存在漏洞,对于生活与工作场所不在同一行政区域的密切接触者,只排查其生活场所容易导致工作场所的次密切接触者可能存在被感染风险未被及时排查而扩散疫情;（5）超负荷工作成常态,凸显基层医疗卫生机构人力缺口大;（6）疫情防控常态化期间,居民麻痹大意,公共场所不戴口罩、人群聚集现象屡见不鲜,健康教育仍需深入并强调居民为自身健康第一责任人。结论基层医疗卫生机构工作者在城中村新型冠状病毒肺炎疫情防控中承担着社区健康管理、门诊诊疗、公共卫生服务、健康教育、新冠疫苗接种、隔离酒店驻守、联防联控等工作,发挥着重要作用。建议增设发热哨点诊所,早发现早隔离,避免疫情进一步扩散,征用出租屋满足隔离医学观察需求,加强基层医疗卫生机构院感防控,开通绿色救助通道,保障特殊群体就医,组织志愿者增援基层医疗卫生机构,健康教育强调居民是保持自身健康第一责任人,提高个人新型冠状病毒肺炎防控风险意识。     

通络扶正汤联合针刺治疗中风后偏瘫患者的效果

目的:观察通络扶正汤联合针刺治疗中风后偏瘫患者的效果。方法:选取60例中风后偏瘫患者为研究对象,采用随机数字表法分为对照组和观察组各30例。两组均行常规治疗,在此基础上对照组给予针刺治疗,观察组在对照组基础上加用通络扶正汤治疗。比较两组疗效,治疗前后神经功能[改良Rankin量表(mRS)]评分、运动功能[Fugl-Meyer运动功能量表(FMA)]评分以及生命质量[简明健康状况调查问卷(SF-36)]评分。结果:观察组治疗总有效率为94.12%,高于对照组的76.47%,差异有统计学意义(P<0.05);治疗后,两组mRS评分均低于治疗前,且观察组低于对照组,两组FMA、SF-36评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:通络扶正汤联合针刺治疗中风后偏瘫患者可提高治疗总有效率、FMA评分和生命质量评分,降低mRS评分,优于单纯针刺治疗效果。     

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

Simple regional cerebral perfusion (SRCP) or cerebro-myocardial perfusion (CMP) is selectively used in one-stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption-related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110-0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001-1.020), P = .031]. In-hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on-pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.     

冠心病患者PCI围术期心肌损伤的影响因素

目的探讨行经皮冠脉介入治疗(PCI)术的冠心病患者围术期出现心肌受损现象的影响因素。方法分析接受择期经皮冠脉介入治疗(PCI)治疗的87例冠心病患者的临床资料,其中稳定型心绞痛(SAP)患者23例,不稳定型心绞痛(UAP)患者64例。比较2组患者的一般临床资料、PCI术相关资料、PCI围术期出现心肌受损和心肌梗死的情况,采用多因素Logistic回归分析PCI围术期出现心肌受损的影响因素。比较入院时术前使用他汀1月与≤1月患者的血脂水平。结果 2组患者的一般临床资料无显著差异(P0.05)。SAP组的支架植入处的分叉病例比例显著高于UAP组(P0.05)。2组患者PCI围术期出现心肌受损、心肌梗死的概率及术后的hs-CRP水平均无显著差异(P0.05)。PCI围术期患者心肌受损的发生与载脂蛋白A、术前使用他汀1月以上、术前他汀负荷剂量治疗以及植入支架的总长度相关(P0.05)。入院时术前使用他汀1月患者的TC与LDL水平明显低于≤1月患者(P0.05)。结论载脂蛋白A的表达水平、PCI手术前采用负荷剂量的瑞舒伐他汀进行治疗以及术前应用他汀治疗1个月以上与PCI术围术期的心肌受损发生率的降低相关,冠脉内支架植入的总长度则与心肌受损发生率的上升相关。     

系统护理对IVF-ET孕妇剖宫产术后康复的影响

目的 探讨系统护理对IVF-ET孕妇剖宫产术后康复的影响.方法 选取2013年6月至2015年10月在我院产科住院的IVF-ET妊娠并行剖宫产术后孕妇78例为研究对象,随机分为观察组48例和对照组30例.对照组采取常规护理,观察组采取系统护理,对比两组孕妇剖宫产术后康复情况.结果 观察组孕妇的术后尿潴留、腹胀、术后48 h疼痛并发症发生率均低于对照组(P<0.05),24 h内排气、有效泌乳率及护理满意度均高于对照组(P<0.05).结论 IVF-ET孕妇剖宫产术后应用系统护理,产后康复效果显著,可有效减少产后并发症发生率,促进机体康复,值得在临床上推广应用.     

藤珠胃康颗粒急性毒性和长期毒性试验

目的观察藤珠胃康颗粒对小鼠的急性毒性反应和对大鼠的长期毒性反应,为临床安全用药提供参考。方法 1小鼠急性毒性试验,按一日2次以最大浓度最大灌胃剂量给予藤珠胃康颗粒,连续观察7 d。2长期毒性试验,将120只SD大鼠随机分为空白对照组和藤珠胃康颗粒高、中、低剂量组,每日给药1次,每周6 d,连续给药6个月,观察大鼠一般体征,并分别于给药3个月、6个月及停药4周后,每组解剖1/3大鼠进行血液学、血液生化学、组织病理学检查。结果 1急性毒性试验中,小鼠无一死亡,给药组80%小鼠出现腹泻,最大给药量为临床成人拟用剂量的240倍。2长期毒性试验中,给药第4周,高剂量组约1/3的动物出现不同程度的腹泻;与对照组比较,低剂量组雌性大鼠从第3周开始体重增长较快;给药6个月后,中剂量组雄性大鼠肺脏指数降低;停药一个月后,高剂量组雄性大鼠肺脏指数降低,低剂量组雌性大鼠脾脏指数升高。给药和停药期间,部分血液学指标和血液生化指标与对照组比较数值上存在明显差异,但都在正常值范围内。病理学检查未见因药物引起的组织病变。结论本品按临床拟用剂量长期服用未见严重的急性毒性反应和长期毒性反应。     

基于网络药理学探讨健脾益气方治疗DEN肝癌大鼠的分子机制及关键通路的验证

目的 利用网络药理学分析方法探讨健脾益气方治疗肝癌的活性成分与靶点;并在此基础上利用二乙基亚硝胺(DEN)诱导的肝癌大鼠,对其中筛选出的关键通路白介素-6/信号转导和转录激活因子3(IL-6/STAT3)进行验证.方法 采用中药系统药理学数据库和分析平台(TCMSP)数据库、中国知网和Swiss Target Prediction平台获取健脾益气方的活性成分和对应靶点;基于Gene Cards、CTD以及gene数据库获取肝细胞癌(HCC)相关靶点;将疾病相关靶点和药物靶点取交集后得出潜在靶点,导入Cytoscape软件绘制活性成分-靶点网络图;并利用STRING数据库对潜在靶点进行蛋白相互作用(PPI)网络构建与分析,以获取核心靶点.采用腹腔注射DEN[70 mg/(kg·d)]制备肝癌大鼠模型.将大鼠随机分为正常组,模型组,健脾益气方低、中、高剂量组(5.25、10.5、21 g/kg),STAT3抑制组(C188-9,4.5 mg/kg)和糖蛋白130(gp130)抑制组(SC144,4.5 mg/kg),均连续干预4周.采用HE染色法观察大鼠肝脏组织病理形态学变化;采用RT-qPCR法检测大鼠肝脏组织IL-6、gp130、Janus激酶1(JAK1)、Janus激酶2(JAK2)和STAT3的mRNA表达水平;采用ELISA法检测大鼠血清IL-6含量;采用Western Blot法检测大鼠肝脏组织gp130、JAK1、p-JAK1、JAK2、p-JAK2、STAT3和p-STAT3蛋白表达水平.结果 通过网络药理学分析获得64个活性成分和146个潜在靶点,这些分子参与的信号通路主要与IL-6/STAT3有关,且STAT3是其中潜在的核心靶点.动物实验结果显示,与正常组比较,模型组大鼠IL-6和STAT3 mRNA和蛋白质水平,及p-JAK1/JAK1、p-JAK2/JAK2和p-STAT3/STAT3水平均明显上调(P＜0.05或P＜0.01).与模型组比较,健脾益气方中、高剂量组,及STAT3抑制组和gp130抑制组大鼠血清IL-6含量,肝脏组织IL-6、gp130和STAT3 mRNA表达水平,gp130和STAT3蛋白水平,及p-JAK1/JAK1、p-JAK2/JAK2、p-STAT3/STAT3水平均降低(P＜0.05或P＜0.01).结论 健脾益气方可通过多成分、多靶点、多通路发挥治疗肝细胞癌的作用,而下调IL-6/STAT3炎症信号可能是健脾益气方治疗HCC的重要途径之一.     

基于ICF的慢性阻塞性肺疾病综合评估指标体系的构建研究

背景　慢性阻塞性肺疾病（COPD）的健康管理需要基于患者全面的评估后再给予综合性与个体化治疗方案,从而改善患者的生理和心理状态,提高健康行为的长期依从性。目的　构建基于《国际功能、残疾和健康分类》（ICF）的COPD（ICF-COPD）综合评估指标体系,为患者制定完整的涵盖生理、心理、功能和社会参与状态的干预方案提供依据。方法　于2019年4-8月,以国际阻塞性肺疾病ICF核心要素（综合版）为参考内容,采用德尔菲专家函询法,对从事COPD临床诊疗、临床护理、护理管理、护理教育、肺康复与心理治疗工作的专家进行两轮专家函询,结合专家建议最终确立ICF-COPD综合评估指标体系。结果　两轮专家函询应答率分别为100.0%（21/21）、95.2%（20/21）,专家权威系数（Cr）分别为0.836和0.845,一、二级指标的肯德尔协调系数分别为0.209和0.271,各级指标的重要性赋值均数为3.55~4.90分,变异系数为0.061~0.297,满分率为15%~90%。最终确定的ICF-COPD综合评估指标体系包括4项一级指标（身心功能、身体结构、活动与参与、环境因素）、53项二级指标。结论　ICF-COPD综合评估指标体系的构建过程科学合理,能保证患者制定康复干预方案前评估内容的全面性。     

Dynamic SAP102 expression in the hippocampal subregions of rats and APP/PS1 mice of various ages

The hippocampus is a structurally and functionally complex brain area that plays important and diverse roles in higher brain functions, such as learning and memory, and mounting evidence indicates that different hippocampal subregions play distinctive roles. The hippocampus is also one of the first regions in the brain to suffer damage in Alzheimer's disease (AD). Synaptic dysfunction in the hippocampus, rather than neuronal loss per se, is paralleled by behavioural and functional deficits in AD. The membrane‐associated guanylate kinase (MAGUK) family of proteins, including SAP102, PSD‐95, PSD‐93 and SAP97, have long been recognized as essential components of the postsynaptic density (PSD) at excitatory synapses. Hippocampal spines are the predominant synaptic transmission sites of excitatory glutamatergic synapses. During postnatal brain development, individual MAGUK members show distinct expression patterns. Although SAP102 has been confirmed as the dominant scaffold protein in neonatal synapses, its expression profiles in adult and ageing rodent hippocampi are discrepant. Furthermore, in AD brains, significantly reduced SAP102 protein levels have been found, suggesting that SAP102 may be related to AD progression; however, the precise mechanism underlying this result remains unclear. Herein, we observed distinct SAP102 expression profiles in the hippocampal CA1, CA3 and DG subregions of rats and APPswe/PS1dE9 (APP/PS1) mice at various ages using immunofluorescence. In Wistar rats, SAP102 was not only highly expressed in the hippocampal subregions of neonatal rats but also maintained relatively high expression levels in adult hippocampi and displayed no obvious decreases in the CA1 and DG subregions of aged rats. Surprisingly, we observed abnormally high SAP102 expression levels in the CA1 stratum moleculare and CA3 stratum polymorphum subregions of 2‐month‐old APP/PS1 mice, but low SAP102 levels in the DG and CA3 subregions of 7‐month‐old APP/PS1 mice, reflecting the subregion‐specific reactivity and vulnerability of AD mouse models in different disease stages. Our findings provide fundamental data to support the functional differences of SAP102 in different hippocampal subregions during postnatal periods and may serve as the basis for additional functional studies on SAP102 in normal physiological conditions and different stages of AD.     

膀胱非肿瘤性隆起性病变的声像图诊断

本文通过对经手术或膀胱镜证实的２０例膀胱非肿瘤性隆起性病变进行回顾性分析，阐述了腺性膀胱炎、输尿管间嵴肥厚、输尿管囊肿的各自典型的声像图表现及其与膀胱肿瘤的鉴别，旨在提高人们对膀胱隆起性病变的识别能力。