武汉大学同仁医院暨武汉市第三医院烧伤科在应对新型冠状病毒肺炎疫情下的应急管理策略

武汉市作为新型冠状病毒肺炎疫情重灾区,新型冠状病毒肺炎患者数量自始至终占到全国的绝大多数,对本地医疗系统形成严峻挑战,尤其是对普通疾病治疗造成了巨大冲击。本文介绍了疫情暴发以来的战时状态下,武汉大学同仁医院暨武汉市第三医院烧伤科在医疗处置、感染防控、人力资源管理、工作模式转换、医务人员人性化关怀等方面采取的管理举措,以期对疫情期间各地烧伤科的临床工作提供参考与借鉴。     

新型冠状病毒肺炎疫区烧伤与创面诊疗工作建议

湖北省及武汉市作为新型冠状病毒肺炎患者最集中的疫区,疫情高峰期,几乎所有医院绝大部分医务人员都投入到抗击疫情中,普通诊疗基本停止。烧伤、创伤及伴基础疾病的各类慢性创面如糖尿病足等治疗难度较大,并有可能危及生命。如何在新型冠状病毒肺炎疫情防控期间做好这类患者救治,是亟待规范和完善的紧要任务。湖北省医学会烧伤与创面修复分会组织部分省内专家,结合相关指导文件及临床工作经验,对疫区烧伤与创面修复外科工作提出了推荐意见。主要内容包括疫区烧伤与创面修复外科工作中的人员防护、诊疗场所消毒、门急诊与住院管理、专科手术管理、人员管理、分级诊疗及转诊管理等。希望通过指导疫情期间烧伤与创面修复临床工作,避免不规范诊疗所致疫情扩散,保证患者及医务人员安全。     

烧伤患者中心静脉导管相关性血流感染的危险因素研究

目的 探讨烧伤患者发生中心静脉导管(CVC)的导管相关性血流感染(CRBSI)的危险因素.方法 前瞻性选择武汉大学同仁医院暨武汉市第三医院烧伤科2016年1月至2017年12月收治住院的烧伤患者,收集置管患者例数、置管例次、性别、年龄、置管血管种类、是否经创面置管、导管留置时间、烧伤面积以及统计CRBSI发生率,分析C...     

北京市烧伤专科应对新型冠状病毒肺炎疫情的防控建议

北京市因常住人口多(2 153.6万)、外来人口比例高(34.6%)、返京人口流量大、入境人员密集等原因,新型冠状病毒肺炎疫情的防控形势较湖北省以外的其他地区更加严峻。解放军总医院第四医学中心烧伤整形科,依据新型冠状病毒肺炎疫情防控相关指导文件,结合北京市的特殊性和烧伤专科工作特点,如:烧伤创面暴露、常因行动不便陪诊家属多、小儿烧伤易合并发热以及需要反复门诊换药等,制定和实施了网络预约挂号、预检分诊、诊疗分区、车内等候-电话叫号和微信指导患者居家换药、入院筛查、设置新入院患者过渡隔离病房、停止探视、手术分类管理、加强通风和消毒等系列措施,并引导医务人员正确认识北京市疫情防控工作的特殊性,重视医务人员相互防护,实施工作人员分区、分时段进餐等,形成了北京市烧伤专科应对新型冠状病毒肺炎疫情的防控建议。     

致敬新型冠状病毒肺炎战疫前线的“华西勇士”

2020年初,新型冠状病毒肺炎疫情爆发后,四川大学华西医院先后派出五支医疗队共243名来自我院医疗、护理、医技、管理岗位的人员支援疫情前线。这五支医疗队分别是:1月25日,第一支医疗队共21名勇士,驰援武汉大学中南医院、武汉市红十字会医院。2月2日,第二支医疗队共10名勇士,驰援武汉大学人民医院、武汉市红十字会医院。2月7日,第三支医疗队共130名勇士,驰援武汉大学人民医院东院区。2月16日,第四支医疗队共69名勇士,驰援成都市公共卫生临床医疗中心重症病区。2月21日,第五支医疗队共13名勇士,驰援武汉市武昌医院、武汉市五医院、汉阳体校方舱医院。     

新型冠状病毒肺炎武汉一线支援队华西医疗队驻地管理

随着新型冠状病毒肺炎(简称新冠肺炎)(COVID-19)确诊病例的增加,武汉疫情防控难度增大,四川大学华西医院再次派出第三批医疗队到武汉支援。为了确保医疗队员在紧张繁重的新冠肺炎救治工作后有一个安全安心的休息环境,做好医疗队驻地的全方位管理至关重要。现总结华西医疗队驻地的管理经验,为抗击疫情的支援医疗团队提供参考。     

新型冠状病毒肺炎疫情期间援鄂医务人员不适现状调查及影响因素分析

目的 调查新型冠状病毒肺炎疫情期间援鄂医务人员不适现状并分析其影响因素.方法 采用便利抽样法选取2020年2月至4月在湖北省某3家新型冠状病毒肺炎定点收治医院工作的医务人员为研究对象.由研究者自行设计人口学特征问卷及援鄂医务人员不适症状问卷,其中人口学特征问卷包括性别、年龄、原单位级别、职业、工作年限等因素;援鄂医务人...     

严重烧伤患者休克期心电图分析

目的探讨分析大面积严重烧伤患者休克期心电图变化及原因。方法武汉市第三医院暨武汉大学同仁医院烧伤科对收治的65例48h内入院的烧伤患者（烧伤面积50％～100％TBSA,深度Ⅱ度～Ⅲ度）每日台十二导联心电图直至伤后第5天,结合患者病情分析异常改变。结果65例患者均被检测到心电图异常。包括窦性心动过速51例（78．5％）、ST—T改变30例（46．2％）、低电压20例（30．8％）、电轴偏移15例（23．1％）、传导阻滞6例（9．2％）、心律失常1例（3．3％）。结论严重烧伤后血流动力学、神经内分泌等改变所致心功能不全是心电图发生改变的主因。化学物质、毒素、坏死组织代谢产物吸收,酸碱失衡,胃肠功能素乱及发热等可加重心电图改变。     

回顾分析免疫球蛋白和补体联合白细胞水平对重症COVID-19转归的预测价值

目的:回顾性分析武汉市第三医院收治的重症新型冠状病毒肺炎(COVID-19)患者血液白细胞计数(WBC)、淋巴细胞计数(LYM)、淋巴细胞%(LYM%)、血清免疫球蛋白(IGA、IGG、IGM)以及补体(C3、C4)等指标水平,探讨其与COVID-19重症患者转归的相关性并评价其预测价值。方法:随机筛选武汉市第三医院确...     

新型冠状病毒肺炎防控期间上海市烧伤科临床质量控制工作的指导性意见(第一版)

正时值全国上下抗击新型冠状病毒肺炎疫情之际,国家及上海市卫生健康委员会下发多项疫情防控文件,指导各医疗单位临床执业工作,上海市烧伤科临床质量控制中心遵从国家及上海市上级主管部门相关管理之规定,结合烧伤科临床工作实际情况,征求相关专家委员建议意见后,对上海市烧伤科专科及开展烧伤科门诊的医疗单位在新型冠状病毒肺     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008