Respuesta rápida a COVID-19, estrategias de escalada y desescalada para ajustar la capacidad suplementaria de camas de UVI a una epidemia de gran magnitud

BackgroundA major challenge during the COVID-19 outbreak is the sudden increase in ICU bed occupancy rate. In this article we reviewed the strategies of escalation and de-escalation put in place at a large university hospital in Madrid during the COVID-19 outbreak, in order to meet the growing demand of ICU beds.Materials and methodsThe data displayed originated from the hospital information system and the hospital contingency plan.ResultsThe COVID-19 outbreak produced a surge of ICU patients which saturated the available ICU capacity within a few days. A total of four new ICUs had to be opened in order to accommodate all necessary new ICU admissions. Management challenges included infrastructure, material allocation and ICU staffing. Through the strategies put in place the hospital was able to generate a surge capacity of ICU beds of 340%, meet all requirements and also maintain minimal surgical activity.ConclusionsHospital surge capacity is to date hardly quantifiable and often has to face physical limitations (material, personnel, spaces). However an extremely flexible and adaptable management strategy can help to overcome some of these limitations and stretch the system capacities during times of extreme need.     

黑龙江省社区卫生服务机构生殖健康咨询服务能力调查

目的:了解黑龙江省社区卫生服务机构生殖健康咨询服务能力现状,为黑龙江省有针对性地提高生殖健康咨询服务的可及性和有效性提供参考建议。方法:2020年7—9月采取随机抽样方法在黑龙江省抽取7个地市,每个地市随机选取2所社区卫生服务机构,对生殖健康服务相关医务人员开展问卷调查。结果:对301份有效问卷进行统计学分析,调查对象生殖健康服务相关知识正确率最高的为健康促进知识(28.2%)。调查对象生殖健康咨询服务培训率为26.6%。可以提供的生殖健康咨询服务第1位是避孕节育咨询(93.4%)。调查对象的咨询概念化能力评分均值为(30.79±13.62)分,咨询实践操作能力均值为(48.99±19.00)分,总分均值为(79.78±31.72)分。统计分析发现,生殖健康咨询能力与年龄、工作岗位、是否获得生殖健康咨询员/咨询师资格和是否接受生殖健康咨询服务培训等有关,进一步分析发现,后两个变量是咨询能力自我评估得分的主要影响因素(P<0.05)。调查对象最希望得到的工作支持为医院领导对相关科室的协调(94.0%)。结论:黑龙江省社区卫生服务机构生殖健康服务人员相关知识较为薄弱,咨询概念化能力及咨询实践操作能力有待提高。应加强基层社区卫生服务机构相关人员培训,促进生殖健康咨询服务职业化、专业化发展,提升生殖健康咨询服务供给水平。     

自然界郑州中华按蚊传疟媒介能量的研究

目的了解自然界郑州中华按蚊传播间日疟的潜在能力。方法采用媒介能量诸因素定量调查和运用数学模型的方法。结果计算出中华按蚊叮人率、人血指数、叮人习性、经产蚊比率、生殖营养周期、每日存活率、预期寿命、孢子增殖时间、有传疟性蚊的比率,预期传疟蚊寿命、媒介能量等参数值。结论每年7月下旬、8月上、中旬郑州中华按蚊的媒介能量最高,潜在存在着间日疟流行或暴发流行的可能。     

Functional capacity in healthy volunteers before and following β-blockade with controlled-release metoprolol

The effects of the ₁-selective -adrenergic blocker metoprolol on physiological responses, exercise capacity and gas exchange parameters were measured in healthy men using different graded bicycle exercise protocols on separate days before and following administration of 200 mg controlled-release metoprolol. Eleven men performed in randomised order maximal cardiopulmonary exercise testing on 50-W/6-min stage, 50-W/3-min stage and ramp (15-W/min^–1) protocols. Peak heart rate and peak heart rate-blood pressure products were similar on all exercise protocols, and were significantly reduced by metoprolol. Submaximal and peak oxygen consumption were similar before and following -adrenoceptor blockade. Depending on the exercise protocol applied, an insignificant decrease of 4–10% in maximal cumulated exercise capacity (work-rate × time integral) was observed following administration of metoprolol. It is concluded that in healthy men evaluated with different exercise protocols the ₁-selective controlled-release -adrenoceptor blocker metoprolol does not influence exercise capacity despite a marked reduction of heart rate and rate-pressure product.     

红景天提取物的制备及其抗缺氧抗疲劳作用

目的 :探讨红景天对提高缺氧耐力和劳动能力的机理 ,为提高运动能力和在缺氧环境下的工作能力提出防护办法。方法 :对红景天提取物进行初步纯化 ,以小鼠常压缺氧和力竭游泳时间作为耐氧能力和劳动能力指标 ,对动物服药前后的体重变化进行考察。结果 :红景天可明显提高动物的缺氧耐力和劳动能力 ,减轻体重。提示服用红景天可以作为缺氧环境下提高工作能力的有效措施 ,并可作为舰艇长航人员防止体力耐力下降、肥胖人员减肥、轻量级运动员提高运动能力的保健药物。     

麦芽醇对提高兔抗氧化能力的研究

目的：观察麦芽醇在动物体内对其抗氧化能力及生理功能的影响。方法：每周１次对兔耳缘静脉注射７００μｍｏｌ／Ｌ的麦芽醇生理盐水,连续３个月。用药前后取血测定生化及抗氧化指标。结果：麦芽醇能显著降低红细胞谷胱甘肽过氧化物酶活力（Ｐ＜００５）、血清过氧化脂质（Ｐ＜００１）和尿酸（Ｐ＜００１）的含量,并且对兔的肝、肾、心功能无毒性影响。结论：麦芽醇具有减轻脂质过氧化反应,清除过氧化氢（Ｈ２Ｏ２）对红细胞的氧化,并且在体内也具有抗氧化抗衰老的作用。     

Hypothesized neural dynamics of working memory: several chunks might be marked simultaneously by harmonic frequencies within an octave band of brain waves

The capacity of working memory (WM) for up to about seven simple items holds true both for humans and other species, and may depend upon a common characteristic of mammalian brains. This paper develops the conjecture that each WM item is represented by a different brain wave frequency. The binding-by-synchrony hypothesis, now being widely investigated, holds that the attributes of a single cognitive element cohere because electroencephalogram (EEG) synchrony temporarily unifies their substrates, which are distributed among different brain regions. However, thought requires keeping active more than one cognitive element, or WM "chunk," at a time. If there is indeed a brain wave frequency code for cognitive item-representations that are copresent within the same volume of neural tissue, the simple mathematical relationships of harmonies could provide a basis for maintaining distinctness and for orderly changes. Thus, a basic aspect of music may provide a model for an essential characteristic of WM. Music is a communicative phenomenon of "intermediate complexity," more highly organized than the firing patterns of individual neurons but simpler than language. If there is a distinct level of neural processing within which the microscopic physiological activity of neurons self-organizes into the macroscopic psychology of the organism, it might require such moderate complexity. Some of the obvious properties of music--orderly mixing and transitions among limited numbers of signal lines-are suggestive of properties that a dynamic neural process might need in order to organize and reorganize WM markers, but there are a number of additional, nonobvious advantageous properties of summating sinusoids in music-like relationships. In particular, harmonies register a stable periodic signal in the briefest possible time. Thus, the regularity of summating sinusoids whose frequencies bear harmony ratios suggests a particular kind of tradeoff between parallel and serial processing. When there are few copresent waves, at EEG frequencies, this sort of parallel coding retains behaviorally meaningful brief periods. A necessary companion hypothesis is that the brain wave frequencies underlying WM are confined to a single octave; that is, the upper and lower bounds of the band are in the ratio of 2:1. This hypothesized restriction, suggested by an empirical property of EEG bands that has been widely reported but rarely commented upon, has the important property of precluding spurious difference rhythms. A restriction to an octave, of "harmonious" frequency-markers for WM items, also seems consistent with a great deal of behavioral data suggesting that WM comprises a rapidly fading trace process in which only up to three or four item-representations are strongly activated simultaneously. There is also an additional, sequential renewal-or-revision process, within which up to another three or four items are being actively refreshed by rehearsal or replaced. Such serial processing may involve a less stringent octave band crowding problem.     

酸枣、山楂、葡萄的体外抗氧化作用研究

采用Ｆｅ２＋－半胱氨酸诱发大鼠肝微粒体生成丙二醛（ＭＤＡ）和用过氧化叔丁醇（ｔｅｒｔ－ｂｕｔｙｌｈｙ－ｄｒｏｐｅｒｏｘｉｄｅ）损伤大鼠红细胞生成ＭＤＡ两种损伤体系,分别观察酸枣、山楂、葡萄３种果汁的体外抗脂质过氧化作用。结果表明,在２．５～３．３ｍｇ／ｍｌ浓度下,葡萄、山楂和酸枣３种果汁对Ｆｅ２＋－半胱氨酸诱发大鼠肝微粒体ＭＤＡ生成的抑制率分别达到４６．２％、９８．３％和９９．１％,这３种果汁对过氧化叔丁醇所致大鼠红细胞生成ＭＤＡ的抑制率分别为葡萄汁（５５．６ｍｇ／ｍｌ）５８．５％、山楂汁（１３．９ｍｇ／ｍｌ）３８．７％和酸枣汁（８．３ｍｇ／ｍｌ）３８．７％。采用ＥＳＲ测定３种果汁对Ｏ－２和ＯＨ自由基的清除作用。结果表明高浓度时,葡萄汁（１３４ｍｇ／ｍｌ）、山楂汁（５０ｍｇ／ｍｌ）和酸枣汁（５０ｍｇ／ｍｌ）对Ｏ－２的清除率分别为７４．７％、８５．８％和８４．０％,对ＯＨ自由基的清除率分别为８６．３％、９７．８％和９６．７％。上述结果表明,这３种果汁具有较强的抗氧化作用。     

Study of a new oral beta-adrenergic drug,clenbuterol, in patients with chronic bronchitis

Summary In a double-blind, placebo-controlled, incomplete cross-over study the bronchodilator, cardiovascular, respiratory and metabolic effects of 3 different oral doses of clenbuterol were studied in 12 patients suffering from partly reversible airways obstruction due to chronic bronchitis. The ventilatory response to oral clenbuterol or placebo was assessed by measurement of specific airway resistance (sRaw) to detect changes in central airways, and of flow at 85% of vital capacity ( _{85% VC}) to detect change in peripheral airways. Clenbuterol 20, 30 and 40 µg produced a significant decrease in sRaw between 15 and 480 min after administration. Its effect on the large airways was not related to the dose. Clenbuterol 30 and 40 µg caused a significant increase in _{85% VC} between 60 and 480 min after administration. After 20 µg a significant improvement in _{85% VC} was found between 120 and 240 min. The over-all effect of 30 µg on the small airways was significantly more pronounced than that of 20 µg and was more sustained than that of 40 µg 120 min after administration. No significant changes in heart rate, ECG or blood pressure were noted. Decreases in PaO₂ and O₂-saturation after clenbuterol were not related to dose. Slight falls in PaO₂ and O₂-saturation were also observed after placebo. These observations are briefly discussed. There was negligible lipid mobilization after either the placebo or bronchodilator. A slight but insignificant rise in blood glucose was observed after both 30 and 40 µg of clenbuterol.