Climate Change: Effects on the Older Adult

The effects of climate change include floods, hurricanes, heat waves, and fires; these natural disasters can result in respiratory, cardiovascular, and psychological harm in older adults, who experience the highest morbidity and mortality during heat waves. Advanced practice registered nurses (APRNs) need education on preparing, assessing, and treating older adults for climate-change disasters, especially heat waves. This article will help APRNs understand the effects of climate-change events on the vulnerable older adults and advocates for the need to integrate health effects of climate change into curricula, practicums, policy, and research agendas.     

利用转录组测序生物信息学初步探讨热射病预后关键基因

目的分析热射病患者外周血单个核细胞转录组测序生物信息学结果,寻找影响热射病预后的关键基因。方法选取2019-06-01~2020-08-30空军军医大学附属西京医院急诊科收治的热射病患者,按照预后分为生存组和死亡组。随机数字法在两组中分别选取患者进行外周血单个核细胞转录组测序,生物信息学分析寻找差异基因;RT-PCR验证筛选出的差异基因在生存组和死亡组中的表达。结果29例诊断为热射病患者入选,按照预后分为生存组和死亡组,其中生存组18例,死亡组11例。随机数字法选取6例生存患者和4例死亡患者,外周血单个核细胞进行转录组测序,两组患者有693个基因表达有明显差异,通过生物信息学分析筛选出趋化因子(C-C基元)配体5(CCL5)、基质金属蛋白酶8(MMP8)、MMP9基因可能与预后相关。将两组外周血单个核细胞的目标基因表达情况通过RT-PCR法表达检测,与生存组比较,死亡组MMP8基因(P=0.8955)和MMP9基因(P=0.0597)表达无明显变化,CCL5基因表达明显上升(t=7.056,P<0.05)。结论CCL5基因可能是影响热射病预后的关键基因,需要进一步深入研究。     

《邵氏医案》从血辨治痛经浅析

[目的]分析总结浙江近代著名临床医家邵兰荪治疗痛经的经验,以期为临床治疗提供借鉴。[方法]通过研读裘吉生编《邵氏医案》,筛选出其中治疗痛经的医案十余则,并结合邵氏在妇科方面的学术思想,进一步分析其辨证立法遣方特色,从而总结邵氏治疗痛经的临证经验。[结果]邵氏治疗痛经多从血辨治,且分虚实两端,其中属虚者血虚内热用益母胜金丹养血清热、活血止痛,血虚肝风治以养血柔肝、息风止痛;属实者水结血瘀用五苓散利水散瘀、行气止痛,气阻血滞治从行气活血、调经止痛。[结论]在治疗妇人痛经方面,邵氏辨治遣方确有独特经验,这些经验可为中医药治疗此类疾病拓宽诊治思路,有助于提高临床疗效。     

Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery

Objectives

To identify barriers to postpartum permanent contraception procedures after vaginal delivery and to explore contraceptive and reproductive outcomes of women who experience unfulfilled requests.

乌司他丁与连续性血液净化联合治疗热射病的效果及对机体炎性反应影响研究

目的 分析乌司他丁与连续性血液净化联用对热射病患者所产生的影响。方法 选取2017年5月—2019年2月在海南医学院第二附属医院进行治疗的88例热射病患者作为研究对象,将其分为研究组和常规组,常规组患者接受常规治疗,研究组患者在常规治疗基础上,将乌司他丁与连续性血液净化联用。分析两种治疗措施的效果。结果 治疗前两组患者的IL-17、TNF-α、cTnⅠ、β₂-MG、PT、D-D、ET和TM水平,差异无统计学意义（P>0.05）。经治疗两组患者的上述指标水平都表现出下降的趋势,相对于常规组,研究组患者下降水平更明显,差异具有统计学意义（P<0.05）。研究组治疗的总有效率为95.5%,高于常规组的72.7%,差异具有统计学意义（P<0.05）。结论 运用乌司他丁与连续性血液净化联用的疗法对热射病患者进行治疗,可获得十分理想的治疗效果,可在临床工作中推广。     

Life-threatening heat-related illness with severe hyponatremia in an aluminum smelter worker

Heat stress is a recognized occupational hazard in aluminum smelter pot rooms. This is the report of an unusual and complex case of heat-related illness in an aluminum smelter worker. The 34-year-old male US worker developed life-threatening heat-related illness in August 2018, on his first day back at work after a 7-day absence. The worker initially presented with bilateral hand then all-extremity cramping followed some hours later by a generalized seizure and acute mental status changes, including combativeness. Emergency room evaluation identified a serum sodium level of 114 mmol/L. Acute liver and kidney injury ensued along with profound rhabdomyolysis, with peak total creatinine phosphokinase level reaching over 125 000 units/L at 3 days post incident. Initial ventilatory support, careful fluid resuscitation, and electrolyte management were provided. Metabolic encephalopathy resolved. Complications included sepsis. After 5 days in the intensive care unit and eight additional days of inpatient management, observation, and the initiation of rehabilitation, the worker was discharged. Residual effects include polyneuropathy of upper and lower extremities and the postdischarge magnetic resonance imaging finding of a cerebellar lesion. Prevailing considerations in the differential diagnosis included exertional heat stroke and/or exertion-associated hyponatremia with encephalopathy.     

基于UPLC-Q/TOF-MS分析淫羊藿炮制前后黄酮组分的变化规律

目的基于UPLC-Q/TOF-MS技术建立淫羊藿炮制前后指纹图谱,对其全成分进行分析并找出标志性化学成分,以明确淫羊藿炮制前后黄酮组分的变化规律。方法采用UPLC-Q/TOF-MS技术,在正离子模式下采集淫羊藿生品及炮制品样品数据,并在此基础上根据正交-偏最小二乘判别分析(OPLS-DA)整体探究9个不同产地、批次的淫羊藿炮制前后化学成分的差异。结果从淫羊藿生品及炮制品中寻找并鉴定出9个标志性化学成分,即8-乙烯-山柰酚、淫羊藿素、淫羊藿次苷I、淫羊藿素-3-O-葡萄糖苷、异戊醇基箭藿苷B、1,3-异戊二烯基朝藿定C、1,3-异戊二烯基-箭藿苷B-7-O-葡萄糖醛酸、3-O-(4-乙酰氧基)鼠李糖-2-O-(间二乙酰氧基)葡萄糖-淫羊藿苷及其同分异构体。结论淫羊藿炮制后黄酮组分结构发生变化,次级糖苷增加,多级糖苷减少,淫羊藿黄酮组分总体向低糖苷组分转化,进一步阐明了淫羊藿加热炮制后黄酮组分的变化规律。     

加味黄连解毒汤灌肠辅助治疗重症肺炎合并胃肠功能障碍临床研究

目的:观察加味黄连解毒汤灌肠辅助治疗重症肺炎痰热壅肺证合并胃肠功能障碍的临床疗效。方法:选取64例重症肺炎痰热壅肺证合并胃肠功能障碍患者,依据不同的治疗方法分为治疗组和对照组,每组32例。对照组给予抗菌药、胃肠功能保护药、机械通气等对症治疗,治疗组在对照组基础上联合加味黄连解毒汤灌肠治疗。比较2组临床疗效、治疗前后中医证候积分及血清降钙素原(PCT)水平,记录不良反应发生情况。结果:治疗组总有效率93.75%,高于对照组的71.88%,差异有统计学意义(P<0.05)。治疗后,2组中医证候积分均较治疗前降低,治疗组中医证候积分比对照组下降更明显,差异均有统计学意义(P<0.05)。治疗3天与治疗7天,治疗组PCT水平均低于对照组,差异均有统计学意义(P<0.05)。治疗期间,治疗组发生不良反应5例,对照组发生不良反应4例,未经处理均自行缓解。结论:加味黄连解毒汤灌肠辅助治疗重症肺炎痰热壅肺证合并胃肠功能障碍,可以有效减轻患者的临床症状,改善胃肠功能,抑制炎症反应。