成都379例新型冠状病毒肺炎的临床分析

目的分析新型冠状病毒肺炎(COVID-19)患者的临床特征及预后。方法纳入成都市公共卫生临床医疗中心2020年1月16日至11月30日收治的379例COVID-19确诊病例,按照年龄分为老年组(42例,年龄≥60岁)和非老年组(337例,年龄<60岁),比较两组患者的流行病学、临床特征、实验室检查、治疗及预后。结果379例患者年龄2个月至87岁,平均41.2岁,其中男286例(75.5%),女93例。老年组平均年龄为69.5岁,女性更多见(占61.9%),大多为武汉输入和本土续发(占73.8%),以普通型和危重型为主(88.1%)。非老年组的平均年龄为37.8岁,男性更多见(80.1%),主要来自境外输入(75.7%),以轻型和普通型为主(95.0%)。179例患者(47.2%)合并一种或多种基础疾病,老年组以高血压病(15例,35.7%)及糖尿病(11例,26.2%)多见,而非老年组则以非酒精性脂肪性肝炎(132例,39.2%)多见。最常见的临床表现是发热(138例,36.4%)和咳嗽(129例,34.0%),但老年组的发热、咳嗽、呼吸困难及乏力等症状较非老年组更多见(P<0.05)。与非老年组相比,老年组的总淋巴细胞计数、CD4⁺及CD8⁺T淋巴细胞计数更低,而心肌损伤标志物及炎症指标更高(P<0.05)。139例患者(36.7%)的心脏彩色超声心动图异常,主要为左室舒张功能降低(22.7%)及心脏瓣膜反流(14.0%),且老年组患者的心脏彩色超声心动图异常率明显高于非老年组(85.7%vs.30.6%,P<0.05)。经治疗后,除老年组死亡3例外,其余均已治愈出院;但老年组的住院时间较非老年组更长(22.1 d vs.18.8 d,P=0.033)。结论成都老年COVID19患者主要来自武汉输入和本地续发,以普通型和危重型为主,常合并高血压或糖尿病等基础疾病;成都非老年COVID-19患者主要来自境外输入,以轻型和普通型为主,常合并非酒精性脂肪性肝炎;经治疗后,患者大多预后良好。     

Objective Assessment of Resident Teaching Competency Through a Longitudinal,Clinically Integrated,Resident-as-Teacher Curriculum

ObjectiveCompetency-based training should be paired with objective assessments. To date, there has been limited objective assessment of resident-as-teacher curricula (RATC). We sought to assess the impact of a longitudinal RATC on postgraduate year-1 (PGY1) resident teaching competency using Observed Structured Teaching Encounters (OSTEs) for the skills of 1) brief didactic teaching [DT], 2) feedback [FB], and 3) precepting [PR].MethodsA controlled, prospective, educational study was conducted from May 2015 to June 2016. The RATC consisted of a workshop series with reinforcement of key skills (DT, FB) during clinical rotations. Intervention residents participated in the RATC and completed OSTEs at the beginning and end of the academic year. A control group, PGY1 residents that matriculated the year previously, completed the OSTEs before starting their PGY2 year. OSTEs were reviewed by 2 blinded study personnel. We assessed reliability between raters via intraclass correlation coefficients and differences in OSTE scores via least squared mean differences (LSMD).ResultsIn total, 92.5% (n = 37) of eligible control and 100% (n = 41) of eligible intervention residents participated. The OSTEs demonstrated excellent agreement between reviewers (DT: 0.99, FB: 0.89, PR: 0.98). A significant pre-post difference was demonstrated in the intervention group for DT (LSMD [95% confidence interval], 3.14 [2.49-3.79], P < .0001), FB (0.93 [0.49–1.37], P < .0001), and PR (0.64 [0.09–1.18], P < .022). A significant difference between the control and intervention groups was demonstrated for DT (3.00 [2.05–3.96], P < .0001).ConclusionsSkill-based OSTEs can be used to detect changes in residents’ teaching competency and may represent a potential component of programmatic evaluation of resident-as-teacher curricula.     

热环境对机体功能影响的机制及防护研究进展

热环境增加高温作业人员发生热损伤的风险,充分认识热环境对高温作业人员机体的影响和危害,对提高高温作业人员防暑意识、减少作业时的职业性热损伤具有重要意义。笔者主要从热环境的定义、热环境对人体主要功能系统影响的机制、热应激的影响因素及防护研究进展进行综述,为高温作业人员对热致疾病的认识及防护提供参考。     

支气管哮喘患儿诱导痰中炎性细胞类型及炎症相关细胞因子的临床价值研究

目的探讨支气管哮喘患儿诱导痰中炎性细胞类型及炎症相关细胞因子的临床价值。方法选取支气管哮喘患儿54例(研究组)作为研究对象,根据哮喘发作期严重程度将研究组分为轻度哮喘组、中度哮喘组和重度哮喘组。另选取性别和年龄相当的支气管肺炎(不合并哮喘)患儿42例作为对照组,检测对照组和研究组治疗前、后诱导痰中炎性细胞类型、T淋巴细胞免疫球蛋白黏蛋白-3(Tim-3)mRNA,以及白细胞介素(IL)-2、IL-4、IL-10、IL-13、干扰素-γ(IFN-γ)等炎症相关细胞因子水平,分析诱导痰中炎症细胞类型以及炎症相关细胞因子在儿童支气管哮喘临床诊断中的价值。结果治疗前,研究组诱导痰中嗜酸性粒细胞百分比、淋巴细胞百分比、Tim-3 mRNA、IL-4、IL-13、IFN-γ及IFN-γ/IL-10水平均高于对照组,差异有统计学意义(P<0.05);IL-2、IL-10及辅助性T细胞(Th)1/Th2水平均低于对照组,差异有统计学意义(P<0.05)。中度哮喘组和重度哮喘组患儿嗜酸性粒细胞百分比、中性粒细胞百分比、淋巴细胞百分比、Tim-3 mRNA、IL-4、IL-13、IFN-γ及IFN-γ/IL-10水平高于轻度哮喘组、对照组患儿,差异有统计学意义(P<0.05);IL-2、IL-10及Th1/Th2低于轻度哮喘组、对照组患儿,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,嗜酸性粒细胞比例、Tim-3 mRNA、IFN-γ、IL-10、IFN-γ/IL-10及Th1/Th2为儿童支气管哮喘的独立影响因素。受试者工作特征(ROC)曲线分析结果显示,嗜酸性粒细胞百分比、Tim-3 mRNA、IFN-γ、IFN-γ/IL-10及Th1/Th2对儿童支气管哮喘及支气管肺炎(不合并哮喘)具有一定的鉴别作用。结论支气管哮喘患儿诱导痰中嗜酸性粒细胞百分比、Tim-3 mRNA、IFN-γ、IFN-γ/IL-10及Th1/Th2的表达异常有助于疾病的病情监测、疗效评估以及与儿童支气管肺炎(不合并哮喘)的鉴别诊断。     

Tangent function transformation of the Abbreviated Injury Scale improves accuracy and simplifies scoring

Introduction

The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments after trauma. We present here the Tangent Injury Severity Score (TISS), which transforms the Abbreviated Injury Scale (AIS) as a predictor of mortality.

Material and methods

The TISS is defined as the sum of the tangent function of AIS/6 to the power 3.04 multiplied by 18.67 of a patient''s three most severe AIS injuries regardless of body regions. TISS values were calculated for every patient in two large independent data sets: 3,908 and 4,171 patients treated during a 6-year period at level-3 first-class comprehensive hospitals: the Affiliated Hospital of Hangzhou Normal University and Fengtian Hospital Affiliated to Shenyang Medical College, China. The power of TISS to predict mortality was compared with previously calculated NISS values for the same patients in each data set.

Results

The TISS is more predictive of survival than NISS (Hangzhou: receiver operating characteristic (ROC): NISS = 0.929, TISS = 0.949; p = 0.002; Shenyang: ROC: NISS = 0.924, TISS = 0.942; p = 0.008). Moreover, TISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Hangzhou NISS = 29.71; p < 0.001, TISS = 19.59; p = 0.003; Hosmer Lemeshow statistic for Shenyang NISS = 33.49; p < 0.001, TISS = 21.19; p = 0.002).

Conclusions

The TISS shows more accurate prediction of prognosis and a linear relation to mortality. The TISS might be a better injury scoring tool with simple computation.     

喉罩在院前急救人工气道中的应用效果

目的探讨喉罩在院前急救人工气道中的应用效果。方法选取2012年3月—2013年4月我院收治的急危重症患者90例,将其随机分为喉罩组和气管插管组,各45例。观察两组患者插管效果、操作时间,记录并发症发生情况。结果喉罩组插管成功率高于气管插管组,操作时间短于气管插管组,并发症发生率低于气管插管组(P0.05)。结论喉罩在院前急救中能安全、有效地开放人工气道,具有方便、快捷、成功率高及并发症发生率低等优势,值得推广使用。     

医院呼吸机管理平台设计与实现

目的设计一个可实现设备管理与临床行为互联互通的医院呼吸机管理平台,实现呼吸机的使用全过程管理。方法结合现有设备科软件平台合理分析本平台需求,依据需求分析建立呼吸机信息管理、上机管理、使用数据分析管理等九大管理模块,基于B/S架构、MVC模式、Microsoft SQL Server数据库等开发实现呼吸机管理平台。结果本平台实现了呼吸机使用全过程管理,可直观展示呼吸机使用情况,同时依据使用情况为呼吸机维护、报废提供数据支撑和提示。结论医院呼吸机管理平台的建立将实现呼吸机使用过程的精细化管理,提高呼吸机使用管理效率。