The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic

BackgroundEffective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19.MethodsThis was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients.Results27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy.ConclusionIn-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.     

乙型脑炎减毒活疫苗安全性和免疫原性观察

目的 观察乙型脑炎（乙脑）减毒活疫苗的接种反应和免疫原性.方法 分别选择52名（8月龄～50岁）和607名（8月龄～12岁）健康志愿者进行Ⅰ和Ⅲ期临床试验.试验组每人接种1次由上海生物制品研究所有限责任公司研制的乙脑减毒活疫苗（0.5 ml）,对照组接种同样剂量的已上市乙脑减毒活疫苗.两组接种后的不良反应率和中和抗体阳转率用x2检验进行比较,中和抗体几何平均滴度用t检验进行比较.结果 试验组接种后有5.91％的人体温升高,对照组为7.96％,两组的体温反应发生率差异无统计学意义（x^2 =0.917,P=0.338）.试验组Ⅰ期试验局部反应率为1.92％,Ⅲ期试验为0.25％,对照组Ⅲ期试验局部反应率为0.50％,两组的局部反应率差异无统计学意义（确切概率法,P=0.553）.Ⅲ期免疫原性试验中,试验组的血清中和抗体阳转率为89.00％,抗体几何平均滴度为29.69;而对照组分别为74.59％和19.25,差异均有统计学意义（x^2=11.708,P=0.001;t=4.281,P=0.001）.结论 本研究的试验性乙脑减毒活疫苗接种反应轻微,并具有良好的免疫原性.     

实施职业卫生分类分级监管的实践体会

流行性乙型脑炎（乙脑）是由乙脑病毒感染所致的中枢神经系统急性传染病，患者有高热、呼吸衰竭、意识障碍、抽搐等神经系统明显受损的表现。目前，该病缺乏特效治疗药物，临床主要依靠积极对症治疗和支持治疗。近年来，依靠先进的器官支持技术和优质的护理措施最大限度提高了流行性乙脑整体救治成功率，但极重型流行性乙脑患者会导致严重神经系统后遗症，其致残率仍然居高不下。本文就流行性乙脑后遗症处理中面临的诸多非医学问题，从生理、心理、社会、伦理等多方面进行探讨，分析其原因和对策，为提高患者生存质量提供参考。     

A patient with fever,abdominal pain and bicytopenia: Trouble once again with these IgM antibodies!

We here report the case of a 30-year old man with a history of ulcerative colitis, who presented clinical and biological features compatible with a viral hepatitis. Initial serological results revealed the presence of IgM antibodies against many viruses, and the most likely diagnosis was viral hepatitis A. However, further investigations were performed and concluded to cytomegalovirus primary infection.     

Neuropeptides in epilepsy

Neuropeptides play an important role in modulating seizures and epilepsy. Unlike neurotransmitters which operate on a millisecond time-scale, neuropeptides have longer half lives; this leads to modulation of neuronal and network activity over prolonged periods, so contributing to setting the seizure threshold. Most neuropeptides are stored in large dense vesicles and co-localize with inhibitory interneurons. They are released upon high frequency stimulation making them attractive targets for modulation of seizures, during which high frequency discharges occur. Numerous neuropeptides have been implicated in epilepsy; one, ACTH, is already used in clinical practice to suppress seizures. Here, we concentrate on neuropeptides that have a direct effect on seizures, and for which therapeutic interventions are being developed. We have thus reviewed the abundant reports that support a role for neuropeptide Y (NPY), galanin, ghrelin, somatostatin and dynorphin in suppressing seizures and epileptogenesis, and for tachykinins having pro-epileptic effects. Most in vitro and in vivo studies are performed in hippocampal tissue in which receptor expression is usually high, making translation to other brain areas less clear. We highlight recent therapeutic strategies to treat epilepsy with neuropeptides, which are based on viral vector technology, and outline how such interventions need to be refined in order to address human disease.     

Update on the Human Immunodeficiency Virus

At the end of 2011, UNAIDS estimated that 34 million (31.4 to 35.9) individuals were infected by HIV worldwide and that 2.5 million were newly infected during the year. Since 2001, we have observed an increased number of HIV-infected patients in the world, due to an expanded access to antiretroviral drugs. More than 23,5 million (22.1 to 24.8) HIV-infected patients live in Sub-Saharan Africa. The number of HIV-infected patients in France is estimated at 152,000. Two types of HIV cause AIDS: HIV-1 and HIV-2 that are subdivided in groups (M, N, O, P for HIV-1; A to H for HIV-2), subtypes (A-D, F-H, J-K for HIV-1 group M), sub-subtype (A1-A4 for subtype A, F1 and F2 for subtype F in HIV-1 group M), circulating recombinant forms (CRF), and unique recombinant forms in a small number of patients. Virological diagnostic and monitoring techniques have been constantly upgraded since HIV-1 was isolated in 1983 and the first serological tests became available in 1985. This is especially true for HIV-1, the most prevalent worldwide.     

病毒性心肌炎患儿血清CK—MB与心肌肌钙蛋白I的检测诊断价值

目的研究血清肌酸激酶同工酶（CK—MB）与心肌肌钙蛋白I（cTnI）检测在病毒性心肌炎患儿诊断中的价值。方法将39例病毒性心肌炎患儿作为观察组，以同期行常规体检的39例健康儿童作为对照组，对比两组的cTnI、CK—MB的检测结果，并在观察组内对比cTnI与CK—MB的阳性率。结果观察组患儿发病1～2d时cTnI与CK—MB与对照组均有显著差异：发病7d及14d时观察组cTnI与对照组有显著差异。观察组内患儿发病1～2d时cTnI检测阳性率明显高于CK—MB；7d与14d时cTnI检测的阳性率则显著高于CK—MB．结论cTnI在病毒性心肌类的诊断中均且有较高的特异唐与敏威唐     

Upsurge of tick-borne encephalitis in the Baltic States at the time of political transition, independent of changes in public health practices

Despite evidence that socio-economic factors associated with political transition played a major causal role in the abrupt upsurge in tick-borne encephalitis (TBE) in the newly independent Baltic States, doubts are still repeatedly expressed about the importance of these factors relative to changes in public health practices that may have affected merely the registration of cases. In response to these doubts, evidence of relevant practices of surveillance, registration, diagnosis, awareness and immunization is presented as taken from archived data and interviews with experienced medical practitioners. There were changes that could have had neutral, negative or positive impacts on recorded TBE incidence, but the variable timing in these changes at both national and regional levels is not consistent with their having been responsible for the epidemiological patterns observed in the early 1990s.     

Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease

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