远航期间任务人员晕船反应调查及原因分析

目的:研究和平方舟医院船上任务人员在远航期间晕船反应发生情况,分析晕船反应发生的原因,为今后医院船合理配置任务人员及降低任务人员晕船反应发生率提供参考依据。方法:根据自愿原则,采用自制问卷对和平方舟医院船上260名任务人员进行问卷调查,问卷内容主要包括两部分,第一部分基本情况调查,包括性别、年龄、体质量、吸烟史等;第二部分影响晕船反应发生的因素调查,包括出海次数、人员类别、住舱所在甲板位置、登船前是否每日进行体育锻炼、登船后是否每日进行体育锻炼等信息。回收有效问卷251份。采用SPSS 19.0统计软件及Empower Stats软件对数据进行统计分析。结果:单因素分析发现晕船反应发生与性别、体质量、是否抽烟、既往是否执行过出海任务、住舱所在甲板位置、人员类别之间明显相关( P<0.05)。多元回归分析表明,女性及既往未执行过出海任务是晕船反应发生的危险因素( P<0.05)。阈值饱和效应分析显示,从第2个航段开始,每经历1个航段,任务人员晕船反应发生率降低0.51%。 结论:医院船在配置任务人员时应综合评估任务人员基本情况,在安排住舱位置时,应将晕船人员尽量安排在靠近船体中部底层。任务人员平时应注重身体锻炼,保持营养摄入平衡,增强抗晕船适应性训练。     

Performance of the Steno type 1 risk engine for cardiovascular disease prediction in Italian patients with type 1 diabetes

Background and aimsPremature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.Materials and methodsWe included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.ResultsAmong 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2–6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08–1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12–14; p < 0.001).ConclusionThe Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results.     

Time spent in target range assessed by self-monitoring blood glucose associates with glycated hemoglobin in insulin treated patients with diabetes

Background and aimsSelf-monitoring blood glucose (SMBG) remains a widespread tool to monitor blood glucose. The development of diabetes management systems (DMS) allows SMBG to provide additional information as time spent in target range (TIR). This study evaluates the association between HbA1c and TIR, evaluated through DMS, over 2 months, and 2 weeks.Methods and resultsType 1 (T1D) and Type 2 (T2D) insulin-treated patients with diabetes were enrolled. We used the term PIR (Points in Range) instead of TIR, since SMBG provides point-in-time glucose values rather than a continuous trend over time. PIR was calculated in 2-month and 2-week time ranges before available HbA1c measurement.One-hundred ninety-seven patients with T1D and 36 with T2D were recruited. HbA1c and PIR were inversely associated (2 months: R -0.72, 2 weeks R -0.70; p < 0.0001) in all subjects. The relationship did not change when T1D and T2D patients were analyzed separately. For every 10% change of PIR, there was a change of HbA1c by 0.4%.ConclusionsOur study, for the first time, demonstrates a significant correlation between HbA1c and PIR calculated by DMS. DMS offers additional information useful in disease management of patients with T1D and T2D performing SMBG.     

内镜经泪前隐窝入路治疗上颌窦前内下壁病变

目的　探讨鼻内镜下经泪前隐窝径路治疗上颌窦病变的临床效果。 方法　回顾性分析了2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的采用内镜辅助下经泪前隐窝入路治疗的各种上颌窦病变患者67例的临床资料。 结果　上颌窦内下壁囊肿20例,上颌窦内下壁息肉6例,内翻性乳头状瘤2例,真菌球性鼻-鼻窦炎23例,变态反应性真菌性鼻-鼻窦炎13例,慢性侵袭性真菌性鼻-鼻窦炎1例。所有患者术后定期随访半年以上未见复发。 结论　鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,能够有效治疗上颌窦各种良性病变,如有明显的泪前隐窝及齿槽隐窝存在,可作为上颌窦前内下壁病变的首选手术入路。     

低聚肽调节免疫功能及其对冠状病毒感染的影响

低聚肽是蛋白质分解为氨基酸过程中的中间产物,其不仅具有蛋白质的营养支撑作用,还具有强大的调节抗氧化和免疫功能的作用。本文就动物、植物和微生物来源的低聚肽对免疫系统的调控作用进行了论述,对其提高免疫系统功能及对冠状病毒感染的防御作用进行了分析,旨在为更合理地利用不同来源和性质的低聚肽制备而成的复合肽类产品,更有效地增强人体免疫功能,为预防和治疗新型冠状病毒肺炎(COVID-19)提供营养支撑。     

创面修复科护士职业标准的全国专家共识

创面修复科是一门新兴学科,目前尚没有护士职业标准。为更好地规范和加强创面修复科护士队伍的能力和体系建设,中国老年医学学会烧创伤分会、中国医师协会中国创面修复科标准化建设专家委员会、全国创面修复专科联盟组织国内专家,从术语和定义、通用条件、职业要求、技能要求、培训要求、考试考核及颁证等方面,撰写了创面修复科护士职业标准的全国专家共识,供全国同行参考。     

Tim-1-Fc suppresses chronic cardiac allograft rejection and vasculopathy by reducing IL-17 production

Previously, we demonstrated that Tim-1-Fc prevents acute cardiac graft rejection by inhibiting Th1 response. In the present report, we tackled the impact of Tim-1-Fc on Th17 cells in a model of cardiac chronic rejection. Administration of Tim-1-Fc did not result in a detectable impact on innate immunity and regulatory T cells, while it provided protection for Bm12-derive cardiac grafts against chronic rejection in B6 recipients, as manifested by the reduction of inflammatory infiltration along with less severity of vasculopathy. Studies in T-bet^-/- recipients by implanting Bm12-derived cardiac grafts further revealed that Tim-1-Fc significantly protected cardiac grafts from chronic rejection along with attenuated production of IL-17 producing T cells. Depletion of CD4 and CD8 T cells or blockade of IL-17 in T-bet^-/- recipients demonstrated that Tim-1-Fc selectively suppresses Th17 differentiation along with attenuated IL-17 secretion. Together, our data suggest that Tim-1-Fc protects cardiac grafts from chronic rejection by suppressing CD4 Th17 development and functionality. Therefore, Tim-1-Fc might be a potential immunosuppressive agent in the setting of cardiac transplantation.