四川省绵阳市2019—2021年流行性感冒流行病学特征分析

目的 了解绵阳市2019—2021年流行性感冒流行病学特征,为绵阳市流感防控工作提供重要依据。方法 收集绵阳市2019—2021年流感监测相关数据,采用描述性流行病学方法进行统计学分析。结果 绵阳市2019—2021年流感共报告发病55 970例,年均报告发病率388.08/10万。报告流感样病例（influenza-like illness cases, ILI） 103 723例,年平均ILI%为3.58%。2019年流感报告发病率、ILI%、阳性检出率均远超过历年同期水平。人群分类构成以15岁以下学生为主。报告发病数居前三位的地区分别为涪城区20 118例（占35.94%）、游仙区6 394例（占11.42%）、江油市5 800例（占10.36%）。2019—2021年共收到并检测ILI标本10 126份,阳性率19.53%;标本阳性检出率以15岁以下学生为主。历年流感病毒优势毒株呈现出交替流行的趋势,2019年以A（H3）型为主,2020年受新冠疫情影响,全年阳性检出率均较低,2021年除检出2份A（H9）型外,其余均为BV型。2019—2021年共报告ILI暴发疫情43起,发生时间主要集中在冬季,场所以小学居多。结论 2019—2021年绵阳市流感病例、ILI、病原学监测、暴发疫情的特征基本一致,15岁以下的学生及学校仍为重点关注人群及场所。而新型冠状病毒肺炎疫情大流行下,流感的低发水平进一步印证非药物干预措施对流感防控工作的重要性。     

1990—2019年中国女性乳腺癌发病及死亡趋势的年龄-时期-队列模型分析

背景 乳腺癌位居全球女性癌因死亡首位,具有发病率高、疾病负担重等特点。目的 评估1990—2019年中国女性乳腺癌发病率及死亡率的流行变化趋势。方法 提取《2019年全球疾病负担》数据库中1990—2019年中国≥15岁女性乳腺癌发病及死亡数据,应用年龄-时期-队列的贝叶斯模型对中国1990—2019年女性乳腺癌发病及死亡趋势进行拟合,进一步估计中国女性乳腺癌发病及死亡风险中的年龄效应、时期效应和队列效应。结果 1990—2019年中国女性乳腺癌粗发病率从14.14/10万升至52.81/10万,粗死亡率从7.22/10万升至13.40/10万。乳腺癌标化发病率总体呈上升趋势(1990年为17.07/10万,2019年为35.61/10万),标化死亡率呈平稳略减趋势(1990年为9.16/10万,2019年为8.98/10万)。年龄-时期-队列模型分析结果显示：所有年龄组女性乳腺癌发病率净漂移值为2.58%〔95%CI(2.34%,2.83%)〕,局部漂移值在65～69岁年龄段达到最高,为3.46%〔95%CI(3.11%,3.80%)〕;死亡率净漂移值为-0.75%〔95%CI(-1...     

Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia

Aim: To examine the influence of diabetes mellitus (DM) on the outcome of infrainguinal bypass operations performed for critical foot ischaemia in Chinese patients. Methods: A prospective audit of 265 consecutive infrainguinal bypass operations. Results: Diabetic patients suffered more frequently from ischaemic heart disease (48%vs 25%, P= 0.001) and tissue loss (90%vs 79%, P = 0.01) at presentation. Cigarette smoking was more prevalent in the non‐diabetic (NDM) group (72%vs 51%, P = 0.001). Arterial segments distal to the common femoral artery were more often used as inflow to bypass graft in DM patients (36%vs 22%, P = 0.02). Operative mortality (seven DM vs one NDM, P = 0.19). Early graft failure (7% in DM group vs 10% in NDM group, P = 0.24), wound infection rate (24% in DM group vs 17% in NDM group, P = 0.21), early limb loss (9% in DM group vs 6% in NDM group, P = 0.66) were comparable. However, hospital mortality was higher in DM patients (8%vs 1%, P = 0.04). DM patients more frequently required further surgical debridement postoperatively (20%vs 9%, P = 0.04). Long‐term, patient survival was inferior in the DM group (43% NDM vs 33% DM at 5 years, P = 0.03). Primary graft patency (46% DM vs 34% NDM at 4 years P = 0.19), secondary graft patency (57% DM vs 47% NDM at 4 years P = 0.14) and limb salvage rate (78%vs 81% at 5 years, P = 0.79) were comparable. Conclusion: Diabetes mellitus adversely affects hospital mortality and long‐term survival. Graft patency and limb salvage are not compromised by the presence of DM.     

围术期应激性高血糖的研究进展

背景 应激性高血糖是机体在严重创伤、危重病、重大手术等应激状态下所产生的一种代谢反应.目前很多研究已经证实围手术期应激性高血糖与临床不良预后有关,是术后并发症和病死率增加的独立危险因素.目的 强调积极干预应激性高血糖的必要性和重要性,以及临床医师对于术中发生应激性高血糖患者的处理需要注意的一些问题.内容 阐述有关应激性高血糖的最新进展知识包括其发生机制和病理生理改变.趋向 临床上对于应激性高血糖患者的治疗逐渐个体化,控制血糖在合理水平以减少术后并发症,改善患者预后.     

Heat stress and strain in exercise and sport

Heat stress arising from the thermal environment is of concern to sports medicine and to sports administration because of the perceived risk of heat casualties, in particular heat stroke. Many sports organizations recommend environmental indices such as the WBGT for assessing risk and setting environmental limits for training and competition. But the limits are not justified by evidence. This article describes the nature of heat stress in sport and how it may be assessed objectively. Heat stress and the principal human responses to exercise heat stress are reviewed briefly. Metabolic heat production and the thermal environment provoke separate and largely independent physiological strains. Metabolic heat production drives body core temperature, and the thermal environment drives skin temperature; the combined stresses are integrated to drive sweat rate. Control of core temperature depends on adequate sweat production and the capacity of the environment to evaporate the sweat. The nature of exercise heat stress is demonstrated by rational analysis of the physical heat exchanges between the body and the environment. The principles of this analysis are applied to critical review of current practice in the assessment of heat stress in sport. The article concludes with discussion of research to establish methods for objective sport-specific assessment of heat stress.     

Remifentanil in the ICU: a new approach to patient care

In recent years, it has become increasingly common practice to sedate patients continuously during their stay in intensive care units (ICUs). The aim has been to keep them calm and comfortable, avoid anxiety and agitation and facilitate processes such as ventilatory support, tracheostomy and extubation. In large part this trend has been due to the availability of the new sedative/hypnotic agents propofol and midazolam, which can provide effective long-term sedation.The focus on sedation (which might more properly be termed hypnosis, since its aim is to make the patient sleepy) has been at the expense of a more precise attention to analgesia. Today we usually titrate the sedative to effect, and consider pain relief as adjunctive therapy. The consequence of this approach is that often our patients are over-sedated. This not only brings the danger of increased morbidity and mortality, it also increases costs, through the need for a greater number of expensive tests such as CAT scans of the brain, prolonged mechanical ventilation and longer stays in both the ICU and hospital. Furthermore, many patients in the ICU continue to feel pain and complain of insufficient analgesia.In future, we should concentrate on pain relief first and add sedation and anxiolysis as and when necessary. Analgesia will in itself relieve much anxiety and many patients will not require sedatives at all.The adoption of a ‘pain relief first’ policy has in the past, however, been hampered by the lack of suitable opioids, due to their unpredictability and their slow onset and offset times. The introduction of a new opioid, remifentanil, should overcome these difficulties. Remifentanil is a new and novel opioid. Unlike many other opioids, which are non-specific, it is selective for the μ receptors that mediate pain. It has uniquely predictable effects, including a rapid onset time (around 1min) and a rapid offset (recovery) time (<10min). This mode of action allows the depth of analgesia to be quickly titratable to the patient's needs. It also means a reduced use in sedative/hypnotic drugs such as propofol and midazolam.The consequences should be an improvement in patient care (not least in better communications between patients, relatives and carers), a reduction in costs and a more efficient use of resources. Improvements in morbidity and mortality might also be expected. Further detailed studies need to be carried out to confirm that routine analgesia with remifentanil improves patient comfort, reduces mortality and mortality and cuts costs.     

凉粉草胶稀溶液的性质

研究了凉粉草胶多糖在20-40℃之间特性粘度对温度的敏感性，计算得其稀溶液的临界线团交叠值C^＊[η]平均为1．13，半稀释区斜率b为0．8～1．2，与其他多糖进行了比较。结果表明：凉粉草胶多糖的特性粘度在所测温度区域内的变化不敏感；凉粉草胶多糖在水溶液中，分子链构象可能为刚性杆状结构。     

“互联网+”远程实时心电监测用于心血管危重症患者院前救护

目的探讨远程实时心电监测管理在心血管危重症患者院前救护中的应用效果。方法将2016年1~12月院前转运至我院心血管内科收住住院的240例危重症患者按转运时间分为两组,每组各120例。对照组院前转运时采用常规心电监护仪监测患者病情变化,观察组院前转运时给予"互联网+"远程实时心电监测病情变化,比较两组院前救护阶段抢救时间和院前抢救成功率。结果观察组患者抢救成功率显著高于对照组,而抢救时间较对照组显著减少(P0.05,P0.01)。结论 "互联网+"远程实时心电监测管理有助于提高心血管危重症患者抢救成功率,缩短抢救时间,节约医疗卫生资源,可常规将"互联网+"远程心电监测管理应用到心血管危重症患者院前救护工作。     

Cardiac Disease‐Induced Post‐traumatic Stress Symptoms (CDI‐PTSS) Among Patients' Partners

It is well established that a patient's partner can be deeply affected by the traumatizing nature of the patient's illness. Yet, no study to date has focused on post‐traumatic stress symptoms (PTSS) among partners of patients coping with an acute coronary syndrome (ACS). The current study's main aims were to address this gap and to evaluate cardiac disease‐induced (CDI) PTSS prevalence in partners of patients who experienced ACS. Patients who experienced ACS and their partners were interviewed by telephone 2 to 6 months after patients' hospitalization. All patients and partners were screened for CDI‐PTSS. Demographic and medical variables as well as partners' level of exposure to the cardiac event were assessed. Prevalence of CDI‐PTSS was higher among partners than among patients. Partners' number of CDI‐PTSS was not significantly associated with patients' number of CDI‐PTSS or with any of the other explanatory factors measured, except for education level. The preliminary results that arose from the current study point to the vast number of individuals who must act as caregivers for their ill partners while having to cope with their own PTSS. Much effort should be channelled into integrating partners into cardiac recovery programmes. Copyright © 2016 John Wiley & Sons, Ltd.