COVID-19 convalescent plasma: current status,lessons from the past and future perspectives

When the COVID-19 pandemic hit, blood transfusion services worldwide started collection of convalescent plasma as early as possible, as exemplified by the response in Norway. There were challenges related to donor selection, donor safety, testing for relevant antibodies and indications for and dosing of the convalescent plasma. As more knowledge became available, the product quality was more standardised. Multiple case reports, observational studies and some randomized studies were published during the pandemic, as well as laboratory studies reporting different approaches to antibody testing. The results were conflicting and the importance of convalescent plasma was disputed.Even though there has been strong international collaboration with involvement of many key organisations, we may better prepare for the next pandemic. An even stronger, more formalised collaboration between these organisations could provide more clear evidence of the importance of convalescent plasma, based on the principles of passive immunisation.     

浅谈不同年龄结节性甲状腺肿合并甲状腺癌患者甲状腺超声特征的临床比较

目的:给予不同年龄结节性甲状腺肿合并甲状腺癌患者实施甲状腺超声检查,对相应的超声检查特征展开分析。方法:选择2018年6月~2019年6月的114例患者为对象,所有患者均被确诊为结节性甲状腺肿合并甲状腺癌,并且利用甲状腺二维超声及多普勒超声对患者进行检查,依据患者年龄阶段均分为两组,每组中各纳入57例患者,年龄超过60岁以上的患者为老年组;年龄在60岁以下的患者为中青年组,对比两组患者的血流相关指标与钙化情况数据。结果:老年组中的平均收缩期流速、阻力指数等数据明显低于中青年组,且比较后P<0.05,具有临床可比较意义。老年组中钙化的总例数为21例,总钙化率占比为36.84%,中青年组中钙化的总例数为38例,总钙化率占比为66.67%,前者数据显著低于后者钙化率,P<0.05。结论:在对结节性甲状腺肿合并甲状腺癌患者实施超声检查后,中青年组患者的病灶呈现低回声、高回声以及伴微小钙化、血流分布以内部血流为主、血流阻力大的特点明显高于老年组,能够显著提升诊断效果,为日后的临床治疗提供了图像依据。     

Efficacy,immunogenicity, and safety of available vaccines in children on biologics: A systematic review and meta-analysis

Vaccinations are essential for preventing infectious diseases in children with chronic diseases as they have increased risk of infection from frequent use of biologics. Response to immunizations in this group is not well known.ObjectiveA systematic review was performed to evaluate three primary outcomes: efficacy; immunogenicity; and safety of vaccines in children with chronic conditions treated with biologics.MethodsThe protocol for our systematic review and meta-analysis was registered and published with PROSPERO. We searched electronic bibliographic databases for studies published from 2009 to 2019, focusing on vaccinations in children with chronic conditions treated with biologics.ResultsWe retrieved 532 records. Thirty-one full-text articles were selected, and 14 were included in the meta-analysis. No significant publication bias was found. Efficacy: limited data are available regarding the efficacy of vaccination, as most studies have focused on immunogenicity as surrogate outcome for efficacy. Immunogenicity: patients receiving anti-TNF-alpha therapy had a statistically significant risk of poor seroconversion (p = 0.028) and seroprotection by the serotype B influenza vaccine [inflammatory bowel disease (IBD) p = 0.013; juvenile idiopathic arthritis (JIA) p = 0.004]. We found adequate responses with H1N1 and H3N2 serotypes. Few studies existed for pneumococcal, hepatitis A virus, hepatitis B virus, varicella-zoster virus, Measles Mumps Rubella virus, and multiple vaccine administration. Safety: vaccine administration was not associated with serious side effects, but JIA patients on anti-TNF alpha therapy had a statistically significant risk of presenting with myalgia or arthralgia postinfluenza vaccine (p = 0.014).ConclusionsMore evidence concerning efficacy, immunogenicity, and safety of vaccinations is needed to guide physicians in the vaccine decision process for this pediatric population.     

《医疗质量管理办法》中医疗质量概念及相关问题探讨

采用文献复习和实证研究经验的方法对《医疗质量管理办法》中涉及的医疗质量概念及相关问题进行探讨。《医疗质量管理办法》中的医疗质量的定义存在重大缺失,没有涉及医疗服务的结果,特别是患者安全。医疗质量的定义应与国际相关权威机构保持一致,应高度重视医疗服务的结果,特别是患者安全。     

鸟巢式护理模式对早产儿生长发育及肠胃功能的影响

目的 探讨鸟巢式护理模式在早产儿护理中的应用价值。方法 选取2016年6月—2020年5月本院收治的早产儿94例,采用随机数表法将其分为两组,每组各47例。对照组给予早产儿采取常规护理,观察组在早产儿常规护理上实施鸟巢式护理模式。比较两组临床效果、护理前后生长发育情况、肠胃功能及家属护理满意度。结果 观察组体温波动幅度低于对照组,睡眠时间长于对照组,血氧饱和度高于对照组,出暖箱时间短于对照组,差异有统计学意义(P<0.05)。护理前,两组头围、身高、体质量比较,差异无统计学意义(t=0.381,P=0.704、t=0.211,P=0.833、t=1.472,P=0.144);护理后2周,观察组头围(28.44±1.35)cm、身高(44.86±2.05)cm、体质量(2 336.93±12.47)g,高于对照组的(27.76±1.87)cm、(42.46±2.43)cm、(2 310.14±13.56)g,差异有统计学意义(t=2.021,P=0.046、t=5.175,P<0.001、t=9.970,P<0.001);观察组首次胎便时间、胎便转黄时间分别为(21.74±7.35)h、(58.91±12.44)h,短于对照组的(25.02±8.13)h、(63.87±13.74)h,排便次数及进奶量的增加分别为(5.67±1.32)次/d、(3.38±1.43)mL/d,高于对照组的(4.21±1.84)次/d、(2.13±0.27)mL/d,差异有统计学意义(t=2.052,P=0.043、t=4.420,P<0.001、t=2.205,P=0.030、t=5.889,P<0.001);观察组护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论 鸟巢式护理模式可减少早产儿体温波动幅度,提供适宜的恒温环境,促进早产儿生长发育,效果确切,值得广泛应用。     

慢阻肺急性加重期患者延迟就医与家庭动力学的相关性研究

目的研究慢阻肺急性加重期患者延迟就医与家庭动力学的相关性,希望能够为慢阻肺急性加重期患者拟定护理措施提供科学依据。方法选取2017年1月-2019年12月我院240例诊断为慢阻肺急性加重期的患者为研究对象。根据患者入院就医的时间进行分组,时间≥24h的延迟就医的患者为观察组,时间<24h的及时就医患者为对照组。结果两组患者在文化水平、家庭年收入、在职状态、医疗保险和婚姻状况和APACHEⅡ评分比较(P<0.05)。观察组患者疾病观念、个性化、系统逻辑和家庭氛围得分比对照组高(P<0.05)。Pearman的相关性分析结果显示:慢阻肺急性加重期患者延迟就医时间与各个层面分数以及家庭动力总分呈现负相关性(P<0.05)。应变量为延迟就医为应变量,患者的一般资料为自变量,经Logistic回归分析结果表明:延迟就医的影响因素为文化水平、家庭动力评分、职业状态、家庭收入、婚姻状况和APACHEⅡ评分。结论慢阻肺急性加重期患者家庭动力总分与疾病观念、个性化、系统逻辑和家庭氛围得分与延迟就医时间呈现负相关性,患者延迟就医的影响因素是家庭动力学评分。     

物理治疗翻转课堂教学应用效果的系统综述

目的 系统评价翻转课堂教学模式在物理治疗学教学中的应用效果。方法 计算机检索CENTRAL、MEDLINE、EMBASE、CINAHL Plus、Academic Search Premier、Teacher Reference Center、ERIC以及Education Research,纳入翻转课堂教学模式应用于物理治疗学教学的原始研究。检索时限为建库至2021年6月。由2名研究人员独立完成文献筛选、数据提取、质量评价,对翻转课堂教学模式对比传统教学模式在物理治疗学教学中的效果进行综述。结果与结论 共检索文献1 307篇,最终纳入7篇,包括至少770名学生。发表时间集中在2013年至2019年,研究对象为物理治疗学专业学生,主要结局指标为考试成绩。翻转课堂教学模式总体说来可提高学生的笔试成绩,增强高阶思维能力,得到了学生和教师的积极评价。     

Systemic therapy for hormone receptor-positive/human epidermal growth factor receptor 2-negative early stage and metastatic breast cancer

Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer is defined by the presence of the estrogen receptor and/or the progesterone receptor and the absence of HER2 gene amplification. HR-positive/HER2-negative breast cancer accounts for 65%–70% of all breast cancers, and incidence increases with increasing age. Treatment varies by stage, and endocrine therapy is the mainstay of treatment in both early stage and late-stage disease. Combinations with cyclin-dependent kinase 4/6 inhibitors have reduced distant recurrence in the early stage setting and improved overall survival in the metastatic setting. Chemotherapy is used based on stage and tumor biology in the early stage setting and after endocrine resistance for advanced disease. New therapies, including novel endocrine agents and antibody-drug conjugates, are now changing the treatment landscape. With the availability of new treatment options, it is important to define the optimal sequence of treatment to maximize clinical benefit while minimizing toxicity. In this review, the authors first discuss the pathologic and molecular features of HR-positive/HER2-negative breast cancer and mechanisms of endocrine resistance. Then, they discuss current and emerging therapies for both early stage and metastatic HR-positive/HER2-negative breast cancer, including treatment algorithms based on current data.