卒中医疗体系之急诊医疗服务的实施策略:美国心脏协会/美国卒中协会急诊医疗服务体系专家组和卒中委员会的政策声明

尽管卒中的预防、诊断、治疗和康复已取得一些进展,但卒中在美国仍然是第三大死亡原因和长期残疾的主要原因.每年约有70万人新发或复发卒中[1].在过去10年里,急性卒中诊治的一些进展,包括纤溶和其他短期疗法的引入,突出显示了急诊医疗服务(emergency medical services,EMS)机构和急诊医疗服务体系(emergency medical services systems,EMSS)在优化卒中医疗中的关键作用[2-7].     

Giant cell arteritis or polymyalgia rheumatica after influenza vaccination: A study of 12 patients and a literature review

IntroductionGiant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory rheumatic diseases common in people over the age of 50 years. Seasonal influenza vaccination (IV) is strongly recommended in this population, among whom it is considered to be effective and well tolerated. IV-induced GCA or PMR are thought to be exceptional.Patients and methodsWe retrieved all post-IV cases from an inception cohort of patients with newly diagnosed GCA. We also included two patients with post-IV PMR and reviewed all published reports of post-IV GCA or PMR, with selection of cases demonstrating disease onset within 1 month following IV. We compared the results of HLA-DRB1 typing, performed in seven patients with post-IV GCA or PMR, with those of 11 GCA patients with familial aggregation and 16 randomly selected GCA patients without a reported trigger.ResultsOf 358 GCA recruited since 2002, 10 (2.8%) qualified for post-IV GCA, of whom two also showed familial aggregation. Thirty-two patients (19 with GCA and 13 with PMR) including our patients were reviewed; their mean age was 71.8 ± 7.4 years and the M/F ratio was 0.8. Six patients (19%) had a history of PMR. Patients with post-IV GCA/PMR had the DRB1*13:01 haplotype more frequently compared to those with familial GCA (5/7 vs. 2/11, p = 0.048) or with GCA without a known trigger (3/16, p = 0.026). Post-IV PMR generally appeared self-limited, whereas post-IV GCA often displayed a more protracted course (chronic relapsing disease in one-third of the patients).ConclusionPost-IV onset of GCA/PMR is not an exceptional occurrence and may be part of the spectrum of the autoimmune syndrome induced by adjuvants (ASIA). IV can trigger GCA or PMR, especially in persons at higher spontaneous risk, such as those with a personal or familial history of GCA/PMR. Whether the presence of the DRB1*13:01 allele further increases the risk of post-IV GCA/PMR through a stronger vaccine-induced immune reaction deserves further investigation. Unlike PMR, GCA can be a serious complication of IV.     

Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress

The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.     

Filtration efficiency of surgical sterilization fabric for respiratory protection during COVID-19 pandemic

BackgroundDue to COVID-19 and high demand for respirators, some healthcare professionals have been using the Halyard H600 fabric as an alternative to N95 respirators without testing the filtration efficiency of the fabric with established scientific methods. The purpose of this study was to assess the efficiency of the Halyard H600 as a respirator filtering material as compared to the NIOSH-certified N95 and P100 filters, and determine if H600 is a good alternative for respiratory protection for healthcare professionals during the COVID-19 pandemic.MethodsThree filter types (Halyard H600, N95, and P100) were challenged with salt particles inside an exposure chamber at a flow rate of 43 LPM and relative humidity of 40 ± 2%. N95 and P100 respirator filters were tested initially to establish the validity of the chamber, followed by the Halyard H600 fabric. Particle penetration was measured using an aerosol spectrometer. The filtration efficiency was calculated for different particle sizes by measuring the particle number concentration upstream and downstream of the filter. The pressure drop across the filter materials was measured using a manometer.ResultsThe efficiency of the P100 for particles ≥250 nm was 100%. The N95 efficiency was 97 ± 1% at 275 nm, 99 ± 0% at 324 nm, and 100% for larger particles. The Halyard H600 fabric had a variable efficiency with an average of 62 ± 28% at 275 nm, 89 ± 8% at 324 nm, and 100% efficiency for particles >450 nm. The pressure drop values for P100 and N95 were 32 and 8 mmH₂O, respectively. The Halyard H600 fabric resistance increased dramatically from 30 mmH₂O at the start of the exposure to 65 mmH₂O after 16-minutes of exposure.ConclusionThe high variability in filter efficiency for particles ≤324 nm and the increased fabric breathing resistance demonstrate that the Halyard H600 has an inferior performance and is not a good substitute for N95 and P100. Thus, the use of the Halyard H600 fabric for respiratory protection is not recommended.