Early SARS-CoV-2 Reinfections within 60 Days and Implications for Retesting Policies

Illustrated by a clinical case supplemented by epidemiologic data, early reinfections with SARS-CoV-2 Omicron BA.1 after infection with Delta variant, and reinfection with Omicron BA.2 after Omicron BA.1 infection, can occur within 60 days, especially in young, unvaccinated persons. The case definition of reinfection, which influences retesting policies, should be reconsidered.     

Investigation of COVID-19 Outbreak among Wildland Firefighters during Wildfire Response,Colorado, USA, 2020

A COVID-19 outbreak occurred among Cameron Peak Fire responders in Colorado, USA, during August 2020–January 2021. The Cameron Peak Fire was the largest recorded wildfire in Colorado history, lasting August–December 2020. At least 6,123 responders were involved, including 1,260 firefighters in 63 crews who mobilized to the fire camps. A total of 79 COVID-19 cases were identified among responders, and 273 close contacts were quarantined. State and local public health investigated the outbreak and coordinated with wildfire management teams to prevent disease spread. We performed whole-genome sequencing and applied social network analysis to visualize clusters and transmission dynamics. Phylogenetic analysis identified 8 lineages among sequenced specimens, implying multiple introductions. Social network analysis identified spread between and within crews. Strategies such as implementing symptom screening and testing of arriving responders, educating responders about overlapping symptoms of smoke inhalation and COVID-19, improving physical distancing of crews, and encouraging vaccinations are recommended.     

血清降钙素原清除率评估重型颅脑损伤肺部感染的价值

目的 对血清降钙素原清除率对于重型颅脑损伤患者肺部感染的治疗效果和预后评估价值进行分析。方法 选择2019年1月—2020年1月我院接诊的重型颅脑损伤患者80例作为本研究观察对象,所选80例重型颅脑损伤患者中包含恶化组患者40例、有效组患者40例,两组重型颅脑损伤患者全部接受血清降钙素原和血清降钙素原清除率检测,分析两组检测结果。结果 接受临床治疗前,两组重型颅脑损伤患者的血清降钙素原水平比较,差异无统计学意义（P> 0.05）,治疗后恶化组重型颅脑损伤患者的血清降钙素原水平显著高于有效组患者,差异有统计学意义（P <0.05）;治疗后1、3、7 d,恶化组40例重型颅脑损伤患者的血清降钙素原清除率水平显著高于有效组患者,差异有统计学意义（P <0.05）。结论 临床中采取动态观察重型颅脑损伤肺部感染患者的血清降钙素原水平和血清降钙素原清除率,能够良好地预测患者肺部感染的临床治疗效果和预后情况,应该给予大力推广与应用。     

重症肺炎后闭塞性细支气管炎的危险因素分析

目的 探讨引起感染后闭塞性细支气管炎（postinfectious bronchiolitis obliterans,PIBO）的重症肺炎的临床特征及危险因素。方法 回顾性分析2014年4月—2019年4月在深圳市儿童医院因重症肺炎住院治疗并最终诊断为PIBO的病例为观察组,并随机抽取同期诊断为重症肺炎未发生PIBO的病例为对照组。分析观察组重症肺炎的临床特征,并分析发生PIBO的危险因素。结果 观察组49例,对照组98例。观察组男33例,女16例;发病年龄≤2岁45例（91.8%）,患者发热、咳嗽49例（100%）,热程（12.898±5.818）d,喘息22例（44.9%）、气促19例（38.8%）。出院时肺部仍有啰音28例（57.1%）。胸部影像病初表现为间质性改变11例（78.6%,11/14）,病程中主要表现为实变19例（57.6%,19/33）。病原腺病毒26例（53.1%）,肺炎支原体17例（34.7%）。入住PICU 31例（63.3%）,使用有创呼吸机19例（38.8%）,使用激素25例（51.0%）,使用人免疫球蛋白28例（57.1%）。多因素Logistic回归结...     

精细化护理在重症颅脑损伤患者肠内营养中的应用

目的 研究重症颅脑损伤患者肠内营养中运用精细化护理的临床干预效果。方法 共选取医院在2019年1月—2020年10月收治的50例重症颅脑损伤患者作为主要研究对象,所有患者均行肠内营养支持。用随机数字表法将其分为两组,每组25例。对照组行常规护理,观察组行精细化护理,比较两种护理模式对营养学指标、并发症发生率、GCS评分、生活质量以及患者满意度产生影响的异同。结果 经护理后,两组患者血清白蛋白、血红蛋白和总蛋白均显著高于护理前,且观察组护理后的血清白蛋白、血红蛋白和总蛋白均明显高于对照组,差异有统计学意义（P <0.05）;观察组和对照组相比患者的并发症发生率相对较低,两组相比差异有统计学意义（P <0.05）;护理后两组的GCS评分均明显高于护理前,且观察组护理后的GCS评分显著高于对照组,差异有统计学意义（P <0.05）;观察组护理后患者的生活质量与对照组相比更高,并且患者对于护理工作的整体满意度也较对照组高,并且两项指标的比较差异有统计学意义（P <0.05）。结论 重症颅脑损伤患者肠内营养中运用精细化护理有利于改善机体营养状态,降低并发症的发生风险,降低...     

黄芪颗粒联合常规治疗对重症肺炎患者的临床疗效

目的 探讨黄芪颗粒联合常规治疗对重症肺炎患者的临床疗效.方法 98例患者随机分为对照组和观察组,每组49例,对照组给予常规治疗(机械通气、内环境纠正、吸痰等),观察组在对照组基础上加用黄芪颗粒,疗程2周.检测临床疗效、中医证候评分、APACHE Ⅱ评分、CPIS评分、症状控制情况、血气指标(PaO2、PaCO2、PaO...     

气囊漂浮导管在重度冠心病冠脉搭桥术后的应用

目的探讨气囊漂浮导管对重度冠心病冠脉搭桥术后心血管功能监测的方法和结果。方法观察22例重度冠心病冠脉搭桥术后的患者,插入气囊漂浮导管同时进行血液动力学监测。对病情判断及治疗进行整体效果的评估,同时选用重度冠心病18人进行全身麻醉体外循环下搭桥并进行监测。结果该组22例患者病情好转出院,术后心指数基本正常,肾功能衰竭、高血压、围手术期心肌梗死、脑血管意外、二次开胸止血等严重并发症没有发生。两组相比,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论气囊漂浮导管在重度冠心病冠脉搭桥术后的心血管功能监测上具有良好的效果,临床上应该推广应用。     

多中心评价银杏内酯注射液治疗重症缺血性脑卒中药物经济学

目的 研究多中心银杏内酯注射液治疗重症缺血性脑卒中的临床疗效、经济性、安全性,评价药物经济价值。方法 采用前瞻性队列研究方法,纳入了2013年8月-2013年12月各中心重症缺血性脑卒中患者共119例,以银杏内酯注射液加常规治疗的患者为治疗组,共78例;对照组41例,患者在常规治疗基础上可使用其他活血化瘀类药物。在出院后3、6、12个月对两组患者进行电话随访,获取药效指标：日常生活活动能力评价（ADL）评分、生活自理患者比例、痊愈率、复发率、全因死亡率;经济学指标：成本效果比（CER）;以及不良事件发生情况,评估患者采用不同治疗方案的远期获益差异。结果 出院后3、6、12个月,治疗组ADL评分、痊愈率和自理率均优于对照组,且差异显著（P<0.05）;出院后6个月,治疗组复发率优于对照组,且差异显著（P<0.05）;出院后12个月,治疗组复发率和死亡率优于对照组,且差异显著（P<0.05）;出院后3、6、12个月,治疗组的CER均明显小于对照组;两组不良反应发生率均较低。结论 远期评估发现,经银杏内酯注射液治疗患者较未接受其治疗患者临床效果更佳,CER更优,证明了银杏内酯注射液治疗重症脑卒中的有效性及经济性。     

Small envelope protein E of SARS：cloning,expression, purification, CD determination, and bioinformatics analysis

AIM:To obtain the pure sample of SARS small envelope E protein (SARS E protein), study its properties and analyze its possible functions. METHODS: The plasmid of SARS E protein was constructed by the polymerase chain reaction (PCR), and the protein was expressed in the E coli strain. The secondary structure feature of the protein was determined by circular dichroism (CD) technique. The possible functions of this protein were annotated by bioinformatics methods, and its possible three-dimensional model was constructed by molecular modeling. RESULTS: The pure sample of SARS E protein was obtained. The secondary structure feature derived from CD determination is similar to that from the secondary structure prediction. Bioinformatics analysis indicated that the key residues of SARS E protein were much conserved compared to the E proteins of other coronaviruses. In particular, the primary amino acid sequence of SARS E protien is much more similar to that of murine hepatitis virus(MHV) and other mammal coronaviruses. The transmembrane (TM) segment of the SARS E protein is relatively more conserved in the whole protein than other regions. CONCLUSION: The success of expressing the SARS E protein is a good starting point for investigating the structure and functions of this protein and SARS coronavirus itself as well. The SARS E protein may fold in water solution in a similar way as it in membrane-water mixed environment. It is possible that β-sheet I of the SARS E protein interacts with the membrane surface via hydrogen bonding, this β-sheet may uncoil to a random structure in water solution.     

丹参注射液对中重度妊高征患者凝血功能和血流动力学的影响研究

目的:探讨丹参注射液对中重度妊高征患者凝血功能和血流动力学的影响及临床疗效。方法:将102例中重度妊高征患者随机分为治疗组和对照组。对照组采用常规治疗,治疗组在对照组基础上加用丹参注射液治疗,检测治疗前后患者凝血功能3项:凝血酶原时间(PT)、凝血活酶时间(APTT)、纤维蛋白(Fbg);血液流变学指标4项:全血粘度、血桨粘度、血细胞压积、血沉,评价临床疗效。结果:①治疗后治疗组患者血浆PT、APTT水平与治疗前、对照组比较均显著上升(P<0.05),Fbg水平与治疗前、对照组比较显著下降(P<0.05),对照组凝血功能指标3项均无明显改变(P>0.05);②治疗组全血黏度、血浆黏度、红细胞压积与治疗前、对照组比较均显著下降(P<0.05),血沉与治疗前、对照组比较均显著上升(P<0.05),对照组血液流变学指标无明显改变(P>0.05);③治疗组临床疗效总有效率显著高于对照组(P<0.05)。结论:丹参注射液可降低中重妊高征患者血液粘度,改善患者凝血功能和血液流变学异常,疗效显著,值得临床推广应用。