野外急救多功能气道防护屏的研制

研制一种适合野外急救使用的多功能气道防护屏,以解决气道相关操作时患者呼吸道分泌物喷溅的问题。多功能气道防护屏由一个底部为直角"目"型框架,两个体部为直角"∏"形不锈钢支架,一个双层开放气道体位调节垫和一个透明塑料罩组成,具有可拆卸、可折叠及视野清晰的多功能呼吸道防护装备;防护屏设计具有可调节头颈后仰卧位,能充分显露气道提高气管插管成功率,可提高医护人员安全性和满意度;在防护屏内建立人工气道、实施各种气道护理,可防止患者呼吸道分泌物喷溅,使周围环境处于相对安全状态,有效避免职业暴露及交叉感染。     

多院区综合医院应对新冠肺炎救治策略研究

大型多院区综合医院一般都具有较强的空间集中性、人口密集性和影响辐射性,在新发重大传染病暴发的情况下,大型多院区综合性医院必然成为新发重大传染病救治的前沿部门和关键环节,其救治策略直接对新发重大传染病的最后结果造成很大的影响。以泰州市某三甲多院区综合医院救治新冠肺炎为例,总结出多院区综合医院"集中患者、集中专家、集中资源和集中救治"的管理策略,供相关单位参考借鉴。     

急诊内科昏迷患者的紧急抢救及临床护理干预分析研究

目的探讨急诊内科昏迷患者的紧急抢救及临床护理干预措施。方法选择我院2018年6月～2019年6月收治的218例患者随机分为观察组(n=109)和对照组(n=109)。两组均给予紧急抢救,对照组给予常规护理干预,观察组给予综合护理干预。观察比较两组抢救成功率、病死率、住院时间及护理满意度情况。结果观察组抢救成功96例,抢救成功率88.07%;对照组抢救成功101例,抢救成功率92.66%;两组分别有13例(11.93%)和8例(7.34%)患者抢救无效死亡。两组患者抢救成功率比较差异无统计学意义(χ~2=1.317,P=0.251)。观察组住院时间(18.57±2.34)d,明显低于对照组的(22.15±2.89)d(t=-10.051,P=0.000);观察组护理非常满意48例(44.04%)、基本满意57例(52.29%)、不满意4例(3.67%),整体护理情况优于对照组(Z=-2.453,P=0.014);观察组护理满意度为96.33%,明显高于对照组的80.73%(χ~2=13.057,P=0.000)。结论对急诊内科昏迷患者,在紧急抢救的同时,应给予相关综合临床护理干预,医护密切配合,有效提高患者抢救成功率及护理满意度,改善患者预后。     

优化急诊护理对急性心肌梗死患者抢救效果的影响

目的评价急性心肌梗死(心肌梗死)患者抢救期间配合应用优化急诊护理干预对抢救效果的影响。方法选择本院收治的急性心肌梗死患者,总计80例。除抢救治疗外,给予患者随机分组进行护理干预,对照组40例急性心肌梗死患者采取常规急诊护理,试验组40例急性心肌梗死患者采取优化急诊护理干预。比较对照组与试验组急性心肌梗死患者组间分诊评估时间、急救总时间、住院时间、救治成功率、护理满意度。结果经优化急诊护理的试验组急性心肌梗死患者的分诊评估、急救以及住院时间均少于对照组,护理满意度高于对照组(P<0.05)。另外,组间救治成功率比较(P>0.05)。结论急性心肌梗死患者抢救中运用优化急诊护理可以缩短患者抢救时间、提高抢救成功率。     

机场应急救护“三无”演练的探索与运用

应急救护演练是提升机场应急救护能力的重要方法。但机场医疗应急救护演练如无不能体现突然性和不确定性,就起不到应有作用。本文从分析机场突发紧急事件、机场应急救护演练的特点入手,提出机场应急救护演练中需重点加强的方面,同时借鉴某机场应急救护演练的成功经验,认为“三无”演练是一种值得探索与运用的演练方式。     

Community rescue in experimental metacommunities

The conditions that allow biodiversity to recover following severe environmental degradation are poorly understood. We studied community rescue, the recovery of a viable community through the evolutionary rescue of many populations within an evolving community, in metacommunities of soil microbes adapting to a herbicide. The metacommunities occupied a landscape of crossed spatial gradients of the herbicide (Dalapon) and a resource (glucose), whereas their constituent communities were either isolated or connected by dispersal. The spread of adapted communities across the landscape and the persistence of communities when that landscape was degraded were strongly promoted by dispersal, and the capacity to adapt to lethal stress was also related to community size and initial diversity. After abrupt and lethal stress, community rescue was most frequent in communities that had previously experienced sublethal levels of stress and had been connected by dispersal. Community rescue occurred through the evolutionary rescue of both initially common taxa, which remained common, and of initially rare taxa, which grew to dominate the evolved community. Community rescue may allow productivity and biodiversity to recover from severe environmental degradation.Global environmental change is challenging the adaptive capacity of entire ecological communities. Communities exposed to severe anthropogenic stress may experience loss of biodiversity through species extirpation and large changes in ecosystem function. Populations of individual species may recover from stress via evolutionary rescue, if they possess sufficiently large and interconnected populations (1, 2) containing substantial genetic variation (3) and have experienced prior exposure to the stress (refs. 4 and 5; reviewed in ref. 6).We extend the idea of evolutionary rescue to complex ecological communities, which may also survive initially lethal conditions and recover diversity through a combination of ecological and evolutionary processes. Community rescue occurs when a community comprising many species exhibits a rapid ecoevolutionary response to environmental stress that was lethal to the original community and all of its constituent populations (7), resulting in the recovery of a viable community. In this case the populations of many species will recover and some will increase from initial rarity. Communities can resist extirpation caused by the degradation of their environment or expand their range to degraded environments (8) through three kinds of processes. First, the harsh environment can trigger plastic changes eliciting the tolerance of some of the organisms via, for example, the activation or expression of physiological pathways. Second, the sorting of stress-tolerant species already present in the metacommunity can occur in the short term, in a fashion akin to the sorting of standing genetic variation in an asexual population by natural selection (9, 10). Third, when conditions are lethal to the original community and all of its constituent organisms, community rescue is required. Community rescue involves genetic change, including beneficial mutations, arising within populations in the longer term, leading to the evolutionary rescue of several or many initially susceptible species. Community rescue differs from community resistance [the maintenance of species composition when a community faces a disturbance (11)] and community resilience [the return of communities to their original species composition after experiencing a disturbance (11)], because the degraded conditions were initially lethal to the whole community, so that community rescue, enabled by evolution, will result in a new community able to tolerate the degraded environment. The properties of the new community may differ from their original state and incorporate changes in species diversity, abundance, and interactions within the rescued community.The processes that govern community rescue and mediate the frequency with which it occurs are poorly understood beyond simple models (7). Extending the conclusions reached from experiments with single species in metapopulations (1–5) to the rescue of diverse communities in a metacommunity, we expect community rescue following exposure to severe stress to be more frequent in diverse communities with high overall abundance that have previously experienced sublethal levels of the same stress. Prior exposure to sublethal levels of stress can occur through time when an environment is gradually degraded or through space when communities are dispersed across a heterogeneous landscape that contains conditions ranging from benign to those lethal to the initial community. Dispersal is expected to be a particularly important process governing the probability of community rescue. Preventing dispersal is known to hamper the survival of individual species and reduce the ecological and evolutionary resilience of communities (12, 13). Dispersal maintains local and regional diversity, allows gene flow, and enables species to shift their ranges to track habitable sites across the landscape through time (10). We designed an experiment to examine how the likelihood of community rescue is mediated by the interaction between environmental stress and dispersal within evolving metacommunities.We used high-throughput methods to study community rescue in complex microbial communities responding to severe environmental stress caused by administering the herbicide Dalapon (2-2-dichloropropionic acid; background and justification for Dalapon use are provided in Methods). The source communities were soil and sediment samples from four sites in old-growth forest at Mont St-Hilaire, Québec, for which there is no history of exposure to any herbicide. The experiment proceeded in two phases. In phase 1, we evolved metacommunities on a heterogeneous landscape formed by a gradient of Dalapon pollution, increasing in concentration from zero to lethal, crossed with a gradient of glucose concentration, from zero to sufficient. In phase 2, we studied the response of these evolved communities to an abrupt degradation of their environment by transplanting adapted metacommunities to a uniform landscape in which Dalapon pollution levels were lethal to all source communities and all their constituent organisms. The composition of source and evolved communities was evaluated using amplicon sequencing.     

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灾难事件正对有限的医疗公共卫生资源提出严峻挑战,并日益对其提出更多的要求。在应对各种灾难或其他突发事件时,牙科医生的地位和作用正在发生改变,他们将在更大范围发挥更多的作用。笔者参考大量国外文献向大家介绍在大规模灾难事件中,牙科医生可以在允许的范围内提供救灾服务,同时强调有计划地教育培训牙科医生在灾难中发挥应有的作用,同时牙科医生在政府部门支持下形成一套完整的紧急预案是非常必要的。     

紧急异地救援抗击新型冠状病毒肺炎的护士早期心理困扰调查

目的 了解紧急异地驰援武汉抗击新型冠状病毒肺炎的护士早期心理困扰现状及其影响因素,为采取针对性心理干预提供参考。 方法 采用心理困扰管理筛查工具,对216名紧急异地驰援武汉抗击新型冠状病毒肺炎的护士进行调查,并分析影响因素。 结果 216名紧急异地救援护士心理困扰得分为（4.42±2.15）分,40.74%的护士存在显著心理困扰,其中情绪问题最多;性别、应急救援经历是紧急异地救援护士心理困扰的影响因素（均P＜0.01）。 结论 紧急异地救援抗击新型冠状病毒肺炎的护士早期心理困扰较高,建议加强组织支持,重点关注女性、缺乏应急救援经历护士的心理状况,以降低其心理困扰。     

常规IVF完全/部分受精失败后行早期补救ICSI的应用

目的探讨常规短时受精联合早期补救卵胞浆内单精子注射(R-ICSI)在常规体外受精(IVF)失败和低受精率周期中的临床应用效果。方法回顾性分析2012年1月至2017年12月在河北省生殖医学中心接受IVF/ICSI-ET助孕治疗的2811个周期的临床资料,根据受精方式不同分为3组:R-ICSI组(210个周期):实施早期R-ICSI;IVF组(2062个周期):行常规IVF助孕;ICSI组(539个周期):直接行ICSI助孕。比较3组患者的一般情况、实验室指标和妊娠结局。结果R-ICSI组的原发不育比例显著高于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。3组患者的平均获卵数、移植胚胎数及MⅡ率比较均无显著性差异(P>0.05);R-ICSI组患者的受精率显著高于IVF组和ICSI组(P<0.05);R-ICSI组患者的2PN率显著低于ICSI组(P<0.05),但与IVF组比较无显著性差异(P>0.05);R-ICSI组的多PN率显著高于ICSI组,但显著低于IVF组(P<0.05);R-ICSI组患者的优胚率、可利用胚胎率及临床妊娠率均显著低于IVF组和ICSI组(P<0.05);R-ICSI组患者的着床率显著低于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。结论常规IVF受精失败及低受精的患者行早期R-ICSI可有效克服受精障碍,提高受精率,获得较好的妊娠结局。