Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists

To determine the time course of hemoglobin mass (Hb_mass) to natural altitude training, Hb_mass, erythropoietin [EPO], reticulocytes, ferritin and soluble transferrin receptor (sTfR) were measured in 13 elite cyclists during, and 10 days after, 3 weeks of sea level (n=5) or altitude (n=8, 2760 m) training. Mean Hb_mass, with a typical error of ～2%, increased during the first 11 days at altitude (mean ± standard deviation 2.9 ± 2.0%) and was 3.5 ± 2.5% higher than baseline after 19 days. [EPO] increased 64.2 ± 18.8% after 2 nights at altitude but was not different from baseline after 12 nights. Hb_mass and [EPO] did not increase in sea level. Reticulocytes (%) were slightly elevated in altitude at Days 5 and 12 (18.9 ± 17.7% and 20.4 ± 25.3%), sTfR was elevated at Day 12 (18.9 ± 15.0%), but both returned to baseline by Day 20. Hb_mass and [EPO] decreased on descent to sea level while ferritin increased. The mean increase in Hb_mass observed after 11 days (～300 h) of altitude training was beyond the measurement error and consitent with the mean increase after 300 h of simulated live high:train low altitude. Our results suggest that in elite cyclists, Hb_mass increases progressively with 3 weeks of natural altitude exposure, with greater increases expected as exposure persists.     

综合医院体检人群青光眼认知度影响因素分析

目的:探讨普通人群对青光眼认知度的影响因素,为青光眼知识宣传和防治提供临床依据。方法:选取2012年1月~2013年8月在我院进行体检的821名人群作为研究对象,进行青光眼认知度问卷调查,对数据进行单因素和多因素logistic回归分析。结果:性别、教育背景、医疗相关职业从业史、近视史、家族史、眼部就医史为其主要影响因素,经多因素logistic回归分析表明,教育背景、医疗相关职业从业史、家族史和眼部就医史是影响青光眼认知度的显著影响因素(P0.05)。结论:教育程度较高、家族中有青光眼患者、有近视史和眼部就医史、有医疗相关职业从业史的患者对青光眼的认知度更好,对近视眼患者、低教育程度者、无医疗职业背景、家族中无青光眼患者、未进行过眼部治疗和检查的人群需要加强宣传教育。     

Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: Observational study of neurological and infectious outcomes

Introduction

Neuromuscular blockade (NMB) is widely used during therapeutic hypothermia (TH) after cardiac arrest but its effect on patient outcomes is unclear. We compared the effects of NMB on neurological outcomes and frequency of early-onset pneumonia in cardiac-arrest survivors managed with TH.

Methods

We retrospectively studied consecutive adult cardiac-arrest survivors managed with TH in a tertiary-level intensive care unit between January 2008 and July 2013. Patients given continuous NMB for persistent shivering were compared to those managed without NMB. Cases of early-onset pneumonia and vital status at ICU discharge were recorded. To avoid bias due to between-group baseline differences, we adjusted the analysis on a propensity score.

Results

Of 311 cardiac-arrest survivors, 144 received TH, including 117 with continuous NMB and 27 without NMBs. ICU mortality was lower with NMB (hazard ratio [HR], 0.54 [0.32; 0.89], p = 0.016) but the difference was not significant after adjustment on the propensity score (HR, 0.70 [0.39; 1.25], p = 0.22). The proportion of patients with good neurological outcomes was not significantly different (36% with and 22% without NMB, p = 0.16). Early-onset pneumonia was more common with NMB (HR, 2.36 [1.24; 4.50], p = 0.009) but the difference was not significant after adjustment on the propensity score (HR, 1.68 [0.90; 3.16], p = 0.10).

Conclusions

Continuous intravenous NMB during TH after cardiac arrest has potential owns effects on ICU survival with a trend increase in the frequency of early-onset pneumonia. Randomised controlled trials are needed to define the role for NMB among treatments for TH-induced shivering.     

国营航班延误下旅客群体突发事件发生机理与风险控制策略研究

  目的  了解航空旅客焦虑情绪特征及其影响因素,为提高旅客服务质量及完善航空卫生保健机制提供借鉴。  方法  2015年1月 — 2016年12月,采用简单随机抽样法,分别对民航东北、华北、华东、中南、西南等地区的10个机场共计2 526名航空旅客进行特质焦虑量表、简易应对方式量表、自编基于心理需求的焦虑倾向量表调查。  结果  旅客特质焦虑为（38.85 ± 8.23）分、积极应对为（23.65 ± 5.44）分、消极应对为（15.77 ± 3.92）分、焦虑倾向为（70.33 ± 6.55）分。航班延误知情权为（4.01 ± 0.97）分,延误餐宿解决质量为（3.83 ± 0.92）分,航班正点率为（3.68 ± 1.12）分,起飞降落平稳性为（3.62 ± 0.86）分,行李完好性为（3.57 ± 0.91）分,是影响旅客焦虑的主要因素;行李安全与质量[4.43 ± 0.82分],通知及时性[4.28 ± 0.86分],餐宿安排质量[4.27 ± 0.99分],延误知情权[4.25 ± 1.13分],延误赔偿承诺[4.14 ± 0.80分],是旅客最期望解决的因素。不同年龄、飞行时间、出行去向的旅客的特质焦虑差异有统计学意义（均P < 0.001）,不同性别、年龄、飞行频率的旅客的积极应对差异均有统计学意义（均P < 0.05）,不同性别、年龄、飞行频率、飞行时间、出行方向的旅客的消极应对差异均有统计学意义（均P < 0.01）,不同性别、年龄、飞行频率、飞行时间、出行方向的旅客的焦虑倾向差异均有统计学意义（均P < 0.001）。特质焦虑、应对方式、焦虑倾向之间均呈明显相关关系。应对方式在特质焦虑与焦虑倾向间的多重中介效应显著,其效应量占总效应量的34.8 %;积极应对、消极应对的中介作用效应显著,其中介效应量分别占间接效应的60.5 %、39.5 %。61.8 %、41.6 %、35.9 %、32.3 %、31.8 %的旅客分别在航班延误、起飞、提取行李、候机、值机阶段产生焦虑情绪,41.8 %、32.5 %、31.8 %、21.9 %的旅客分别伴随有心跳加速、耳痛、头晕头痛、恶心等身体症状,51.5 %、44.2 %的旅客常以睡觉、听音乐/看报/看视频等方式来应对。  结论  航空公司、机场等运营管理部门可在航班延误应急处置、行李安全质量保障、客舱服务等方面制定针对性强的管理策略与服务模式,提升旅客卫生保健工作质量与效率。     

口腔医学毕业临床技能考核模式的改革与实践

口腔医学是一门实践性很强的经验型学科,口腔医学专业学生不仅要具备扎实的医学理论知识,最重要的是培养临床操作能力。现阶段口腔医学专业的毕业技能考核陈旧、单一,很难对即将毕业的学生进行临床技能的综合评定,随着生活水平的提高和对口腔保健的大量需求,对口腔实用型人才的培养的要求越来越高,为充分体现毕业考试对口腔应用型人才培养的激励作用,培养适合现代医疗水平的高质量口腔医学实用型人才,口腔实践技能的能力要求已成为此口腔医学培养的核心内容,提高口腔临床技能的操作能力,一直是口腔医学教育的难题,目前本校口腔医学院的毕业考试的形式已不符合现代口腔医学培养的目标,本课题将建立以培养目标达成度为导向的口腔医学专业多站式毕业技能考核体系,从考核内容、考核模式、监督机制和效果评价等方面全面改革毕业的形式,探求一个适合现代口腔执业医师要求和能力的考核考试方法,以适应口腔执业医师考试的形式和提高口腔医学专业学生的实践操作技能。     

Train disaster survivors: Long-term effects on mental health and well-being

Disastrous train accidents have been relatively common in Sweden during the last three decades. Between the years 1970 and 1978 more than 20 serious accidents occurred. In total 70 persons were killed and 396 were officially registered as somatically injured. This article presents a retrospective follow-up study using questionnaires. Both the somatic injuries and the different psychological stressors and stress effects are presented. The need for psychological support together with a low rate of drug usage was prominent. The two main stressors for survivors after a train accident seemed to be personal bereavement and somatic injuries.     

Long-term depression of a sympathetic ganglionic response to opioids by prolonged synaptic activity and by phorbol esters

We studied the effect of the adenylate cyclase activator forskolin, of protein kinase C-activating phorbol esters and of prolonged preganglionic input activation on the inhibitory response of the perfused superior cervical ganglion of the cat to exogenous met-enkephalin (Met-ENK). Met-ENK inhibited, in a concentration-dependent manner, the postganglionic compound action potential evoked by cervical sympathetic trunk stimulation. The inhibition was reversible, was blocked by naloxone as well as by pertussis toxin and showed no homologous desensitization in the concentration range 0.01–10 μM. Pretreatment of the ganglion with 4β-phorbol 12,13-dibutyrate or 4β-phorbol 12,13-diacetate depressed the Met-ENK response for several hours, while pretreatment with forskolin had no effect. This action of phorbol esters was prevented by the protein kinase inhibitor H-7 but not by the calmodulin antagonist W-7 or the protein kinase A inhibitor HA 1004 and was calcium-dependent. Recovery of the response from the depression produced by phorbol esters was not affected by a protein synthesis inhibitor. A 40 Hz 20 min stimulus train to the cervical sympathetic trunk mimicked the effect of phorbol esters, depressing for several hours the inhibition produced by Met-ENK. Stimulus trains of duration shorter than 5 min or frequency lower than 5 Hz were ineffective. This effect of prolonged preganglionic stimulation occurred even when the stimulus train was delivered during complete block of nicotinic and muscarinic ganglionic transmission but was lost when the stimulus train was delivered during perfusion with calcium-free Krebs. The protein kinase inhibitor H-7 prevented the depression of the Met-ENK response by the train, while W-7 and HA 1004 had no effect. These findings suggest that, in the superior cervical ganglion of the cat, a kinase, activated by phorbol esters and inhibited by H-7, exerts a long-term control of the ganglion cell responsiveness to opiate receptor activation. A similar mechanism can be synaptically activated by a non-cholinergic transmitter, released by the preganglionic axons during prolonged, high frequency, activity.     

血培养采用溶血增菌法结果观察

本文就血培养;采用溶血增菌与常规增菌培养进行对比观察,406份血培养标本,常规增菌阳性54例,阳性率为13.3%,溶血增菌阳性93例,阳性率为22.9%,以检出例数最多的表皮葡萄球菌及微球菌为检验依据,进行两种方法比较,经统计学处理(P<0.05)有显著性差异,提示溶血增菌培养优于常规增菌培养。