75g/L氯化钠溶液对创伤失血性休克液体复苏临床疗效的Meta分析

目的 以Meta分析方法研究75 g/L氯化钠(NaCl)溶液对创伤后失血性休克液体复苏的临床疗效. 方法 检索PUBMED、EMBASE、OVID、Cochrane图书馆、EBSCO数据库,根据制定的入选标准筛选随机对照试验(randomized controlled trial,RCT),并进行文献质量评价.对选定的RCT提取和分析患者的血压、血红蛋白、血钠和病死率等指标,以等渗晶体液为参照评价75 g/L氯化钠溶液的有效性和安全性.采用Review Manager 5.0.25分析提取的相关数据. 结果 共有6篇RCT符合入选标准.分析表明75 g/L氯化钠溶液相对于等渗晶体液可以早期、快速提升血压(标准差=6.23,95％CI 2.78～9.69,P＜0.01),同时可以造成血红蛋白含量的下降(标准差=-6.11,95％CI -8.25～ -3.96,P＜0.01);75 g/L氯化钠溶液产生的短期高渗状态总体上是有效和安全的(标准差=7.97,95％ CI 7.55～ 8.38,P＜0.01);75 g/L氯化钠溶液组与等渗晶体液组比较,创伤失血性休克患者的住院病死率差异无统计学意义(风险率=0.96,95％ CI0.84 ～1.10,P＞0.05). 结论 创伤后失血性休克液体复苏中使用小容量75 g/L氯化钠溶液是安全和有效的.     

The development and validation of methods for evaluating the immune system in preweaning piglets

The preweaning piglet has been found to be a valuable research model for testing ingredients used in infant formula. As part of the safety assessment, the neonates' immune system is an important component that has to be evaluated. In this study three concurrent strategies were developed to assess immune system status. The methods included (1) immunophenotying to assess circulating innate immune cell populations, (2) monitoring of circulating cytokines, particularly in response to a positive control agent, and (3) monitoring of localized gastrointestinal tissue cytokines using immunohistochemistry (IHC), particularly in response to a positive control agent. All assays were validated using white papers and regulatory guidance within a GLP environment. To validate the assays precision, accuracy and sample stability were evaluated as needed using a fit for purpose approach. In addition animals were treated with proinflammtory substances to detect a positive versus negative signal. In conclusion, these three methods were confirmed to be robust assays to evaluate the immune system and GIT-specific immune responses of preweaning piglets.     

2014年番禺区登革热疫情分析及防控

目的：分析2014年广州市番禺区的登革热疫情现状及流行特征,通过对登革热的防控,探索适宜的防控对策。方法对番禺区2014年9~11月的登革热疫情进行检测分析,开展健康教育、环境治疗、清除无用积水和减少媒介等爱国卫生活动,并加强监督工作;同时开展“以蚊治蚊”技术阻断登革热传播。结果截止2014年11月7日,广州市番禺区总共报告登革热病例3454例,发病高峰为9月下旬~10月上旬,前6位的镇街为洛浦街、南村镇、大石街、小谷围街、市桥街、钟村街,布雷指数最高达23。经过政府、医院、社区卫生服务中心等各部门的积极防控,登革热患病率的增长率逐渐下降,而布雷指数持续下降,至2014年11月7日本区的布雷指数为0.62,达到了安全水平。结论广州市番禺区存在登革热流行的基本条件,疫情存在着明显的季节性、地方性、人群对登革热普遍易感等特征。政府、医院、社区等部门应给予高度支持,并对各部门的工作加强监督工作,做到早发现、早诊断、早隔离、早治疗,并及早开展防治伊蚊、消灭伊蚊等阻断技术。通过有效的防控,本区疫情得到控制,番禺区登革热防控经验值得借鉴。     

3种种源铁皮石斛叶黄酮类成分HPLC特征图谱比较

目的:研究不同产地种源铁皮石斛叶黄酮类成分HPLC特征图谱,并初步比较丹霞地貌种源(广东、福建、浙江、江西)、浙江本地种、铁皮兰种(广西、云南)特征图谱的差异。方法:采用Kromasil 100-5 C_(18)色谱柱(4.6 mm×250 mm,5μm);流动相甲醇-水(梯度洗脱),检测波长340 nm,柱温25℃,流速0.8 m L·min~(-1)。采用国家药典委员会"中药色谱指纹图谱相似度评价系统软件"(2004A版)生成共有模式。结果:3种种源的23批样品共标示出14个共有特征峰。其中,10批丹霞种源样品标示出12个共有特征峰(峰14为最强峰),样品相似度为0.880~0.996;6批浙江本地种源样品标示出13个共有特征峰(主要峰的相对峰面积较接近),样品相似度0.774~0.981;7批铁皮兰种源样品标示出9个共有特征峰(峰10,峰11相对峰面积较大),样品相似度0.922~0.974。丹霞种源对照图谱与浙江本地种对照图谱、铁皮兰种对照图谱的相似度分别为0.395,0.061,铁皮兰种对照图谱与浙江本地种对照图谱相似度仅为0.370。结论:该分析方法准确可靠,重复性好;相同种源铁皮石斛叶黄酮类成分群基本一致,显示铁皮石斛叶内在的稳定性;不同产地种源成分群组成及比例存在明显差异,亦为快速区分丹霞种源、浙江本地种、铁皮兰种区域特征提供了依据。     

Activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda

BackgroundStroke is a major cause of long-term disability. Information regarding the limitations in activity and participation experienced by patients with stroke in a specific setting such as Musanze district in Rwanda would assist to develop the rehabilitation programmes that would take into consideration the functional challenges experienced post stroke.ObjectiveTo explore the activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda.MethodsA qualitative phenomenological approach using in-depth face-to-face interviews with 10 participants was employed to gather the data that was analyzed using a qualitative thematic approach.ResultsThe themes that arose as activity limitations included limitations in walking, self care, and domestic life activities. The themes related to participation restrictions as expressed by the participants were inability to return to previous occupation, decreased social interactions and inability to participate in religious activities.ConclusionThe current study findings highlight the need for interventions to improve the functional status of stroke survivors.     

District‐level impacts of health system decentralization in Indonesia: A systematic review

The local‐level impacts of decentralizing national health systems are significant yet infrequently examined. This review aims to assess whether localized health services delivery in Indonesia, which commenced a health system decentralization process in 2001, achieved its objectives or could be enhanced. A systematic review was undertaken to collate published evidence regarding this topic and synthesize key findings holistically using the six building blocks framework of the World Health Organization (WHO) to categorize health system performance. Four research databases were searched in 2016 for relevant evidence published between 2001 and 2015. The inclusion criteria were relevance to the topic of decentralization impacts at the district level, original research, and published in English. Included articles were appraised for quality using a standardized tool, with key findings synthesized using the WHO building blocks. Twenty‐nine articles met the inclusion criteria and categorized under the WHO building blocks categories. The findings highlight problematic impacts of decentralization related to three building blocks: service delivery, health financing, and workforce. In the 15 years of post‐decentralization in Indonesia, the service delivery, health workforce, and health financing blocks should be prioritized for further research and policy evaluation to improve the overall health system performance at the district level.     

碱性成纤维细胞生长因子对皮肤软组织撕脱伤创面修复效果及肝肾功能影响

目的:观察碱性成纤维细胞生长因子(basic fibroblastic growth factor,bFGF)与常规换药对皮肤软组织撕脱伤创面的修复效果以及肝肾功能的影响.方法:临床纳入皮肤软组织撕脱伤患者70例,根据临床治疗方案的不同分为研究组与对照组,研究组给予bFGF药液喷雾剂喷洒后纱布覆盖,对照给予生理盐水清理常规换药.观察两组患者的创面愈合率、创面炎症反应等,同时观察治疗前后两组患者肝肾功能的变化.结果:研究组术后3、5、7d创面愈合率分别为(29.1±12.9)％、(61.4±18.7)％、(96.3±7.0)％,对照组分别为(19.9±12.1)％、(41.2±17.5)％、(71.6±22.1)％,差异均有统计学意义(P＜0.05);研究组治疗后3、5、7d创面炎症评分分别为(1.62±0.34)、(1.24±0.30)、(0.99±0.29)分,对照组分别为(1.86±0.48)、(1.82±0.45)、(1.60±0.39)分,差异均有统计学意义(P＜0.05);治疗后,两组患者肝肾功能指标未见异常,差异无统计学意义(P＞0.05).结论:bFGF治疗皮肤软组织撕脱伤具有较好的临床效果,能够促进创面的修复,减轻炎症反应,且安全性较高,值得推广.