右美托咪定复合七氟烷用于困难气道插管30例临床评价

目的：评价右美托咪定复合七氟烷在困难气道插管中的安全性及有效性。方法选择美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级、年龄20~60岁的困难气道患者60例,随机均分为右美托咪定组（D组）和空白对照组（C组）。D组插管前15 min静脉输入右美托咪定0.5μg/kg,10 min后以0.5μg/（ kg＆#183;h ）的速率泵注;C组以同样的方式静脉输注0.9%氯化钠溶液。两组患者均以七氟烷行诱导插管。记录两组患者麻醉前（T0）、插管前即刻（T1）、窥视会厌（T2）、插管成功即刻（T3）、插管后1 min（T4）、插管后3 min（T5）时心率（HR）、平均动脉压（MAP）变化,并观察患者呛咳、恶心及躁动等不良反应,脉搏血氧饱和度（SpO2）下降及插管知晓的发生率。结果两组T0时点的HR,MAP无明显差异（ P＞0.05）;与T0比较,D组T1~T5时HR降低（ P〈0.05）,但组间比较无显著差异（ P＞0.05）;C组T2~T3时HR显著增加（ P〈0.05）,明显高于D组（ P〈0.05）;与T0比较,C组T2~T3时MAP增高（ P〈0.05）,且高于D组（ P〈0.05）,而D组各时点MAP无明显变化（ P＞0.05）;D组患者插管反应、插管知晓及SpO2下降发生率均明显低于C组（ P〈0.05）。结论与单纯应用七氟烷诱导困难气道插管相比,右美托咪定复合七氟烷可提供更稳定的血流动力学且不良反应发生率低。     

2014—2020年上海市松江区登革热流行病学特征分析

目的    分析上海市松江区登革热流行病学特征,为登革热防治提供科学依据。方法    通过国家疾病监测信息报告管理系统获得2014—2020年松江区登革热病例信息,用描述性流行病学方法分析病例的发病时间、空间、人群分布等流行病学特征。结果    2014—2020年松江区累计报告登革热病例20例,均为输入性病例,无本地病例发生;无死亡病例。主要来自东南亚,占所有报告病例的95.0%（19/20）。时间分布呈单峰,以7—8月为高峰。男女性别比为4[∶]1,发病年龄中位数37岁,以青壮年为主（65.0%）。职业以公司职员（35.0%）、商业服务人员（20.0%）和工人（20.0%）为主。全区15个街道（镇）中7个有登革热病例报告。20例病例发病到确诊的时间间隔中位数为6 d。实验室检测检出DENV-1型和DENV-2型,以DENV-2型为主（71.4%）。结论    上海市松江区登革热疫情以输入性病例为主,有明显的季节性。登革热疫情防控的重点是严防输入,控制本地疫情的发生与流行。     

取穴大肠、直肠下段、三焦和神门埋豆对痔术后排便困难的影响

摘要：目的 探讨取穴大肠、直肠下段、三焦和神门埋豆对痔术后排便困难的治疗效果。方法 选取2018年9月—2019年4月收治于我院中医住院痔手术后患者80例,随机分为两组,治疗组和对照组,每组各40人。对照组实施常规护理,治疗组在此基础上取穴大肠、直肠下段、三焦和神门耳穴埋豆治疗,比较两组患者术后排便情况和住院满意度。结果 两组患者在术后排便困难的治愈率、好转率及未愈率的比较,差异有统计学意义（P<0.05）;两组患者在住院满意度的比较, 差异有统计学意义（P<0.05）。结论 取穴大肠、直肠下段、三焦和神门埋豆能有效缓解痔术后的排便困难,提高患者满意度。     

What Do Medical Students Do and Want When Caring for “Difficult Patients”?

Phenomenon: Medical students, like physicians, experience negative emotions such as frustration when interacting with some patients, and many of these interactions occur for the first time during clinical clerkships. Students receive preclinical training in the social and behavioral sciences, often including learning about “difficult patient” interactions, yet little is known about their desire for training during clinical education. We explored students’ strategies in these difficult clinical interactions, whether they felt prepared by the curriculum, and what support they would have liked. These data inform proposed strategies for supporting clinical learning. Approach: We interviewed 4th-year students about interactions with patients toward whom they felt negative emotions and sought to identify strategies and supports needed in these interactions. Interviews ended when theoretical sufficiency was achieved. We used qualitative content analysis to organize strategies into themes about areas benefiting from curricular supports. We mapped students’ desired curricular support examples to cognitive apprenticeship teaching methods—modeling, coaching, reflection, scaffolding, exploration, and articulation—and aligned them with traditional pedagogical techniques. Findings: We interviewed 26 medical students (44 volunteered/180 invited). Their strategies formed five themes: finding empathy (with a subtheme of focusing on social determinants of health), using learned communication approaches, anticipating challenging interactions, seeking support, and considering it an opportunity for more responsibility. Students described ideal clinical teaching, including postinteraction debriefs with an emphasis on validating their emotional reactions and challenges. Students mentioned all cognitive apprenticeship teaching methods, most prominently modeling (observing supervisors in such interactions) and supported oral reflection. They also identified a need for faculty and resident development to enact these teaching methods. Insights: Although students use some learned strategies in interactions in which they feel negative emotions toward patients, they desire more preparation and support during their clinical rotations. Their desires map to traditional pedagogical techniques and to methods of cognitive apprenticeship. Our findings point to the need to use these techniques to enhance clinical learning for students who experience emotionally challenging patient interactions.     

中国2009—2012年报告的境外麻疹病例流行病学特征分析

目的分析中国2009～2012年报告的境外（包括香港、澳门特别行政区和台湾地区以及外籍,下同）麻疹病例的流行病学特征,评估境外麻疹病毒输入中国的风险,为消除麻疹提供参考。方法用描述流行病学方法,对中国2009—2012年通过麻疹监测系统报告的境外麻疹病例个案信息进行统计分析。结果中国2009—2012年报告的境外麻疹229例,69．87％来自亚洲国家,其中缅甸（110例）、中国香港特别行政区（16例）和台湾地区（10例）居前三位。66．81％的病例为〈10岁儿童,1—9岁病例中有含麻疹成分疫苗免疫史的仅占10．58％。报告境外麻疹病例的季节高峰与境内一致,每年5月前后为高峰,2012年报告病例数较往年明显上升。66．83％的病例发病前在发病所在县（区、市）居住〉21d。结论尽管〉60％境外麻疹病例在中国感染病毒,但中国局部地区仍存在输入麻疹病毒的风险。     

Evaluation of a parenting program for children with behavioural problems: Signposts in Singapore

Abstract

Background The Signposts for Building Better Behaviour program, developed by the Parenting Research Centre, Victoria, Australia, was conducted at a public hospital facility in Singapore.

Method More than 1,000 parents completed the program, and filled in questionnaires about their child's behaviours.

Results Parents rated themselves in the questionnaires as being significantly less hassled, stressed, depressed, and anxious after attending the program. They were more confident and satisfied with managing their child, and rated their children's behaviours as having improved. Effect sizes ranged from 0.12 to 0.59. The findings were maintained 3 months after completion of the program.

Conclusions The study provides evidence of the cross-cultural applicability of the principles underlying the Signposts program. As there are long-term repercussions when children's behaviour problems are not dealt with appropriately, such behaviour management programs should be made more available to parents and caregivers.     

新型冠状病毒肺炎疑似患者隔离病房的建立与管理

面对突如其来的疫情,大型综合医院紧急成立新型冠状病毒肺炎疑似病例隔离病房,要求做到分秒必争、隔离设施严密、功能到位、人员组建迅速,同时应注重护理人员的管理,增强凝聚力和协作精神,才能使我们进行有效快速的反应,也是顺利完成救治任务的重要保证。     

Molecular and cytogenetic analysis of the fragile X syndrome in a series of 453 mentally retarded subjects: A study of 87 families

We report on a series of 453 mentally retarded subjects investigated for fragile X syndrome from 1982 to July 1995. The 22% rate of efficiency of FRAX positivity indicated a significant preselection by the clinicians. However, this rate dropped to 11% in the last year. Since 1992, Southern blot analysis was extended to include family members of the 87 positive subjects, for a total of 442 individuals examined with the probe StB12.3. In addition to premutated (118), fully mutated (148), and pre/full mutation mosaic subjects (27), 14 atypical cases were found. Some of these cases are described in more detail. In particular, we report on the hybridization and polymerase chain reaction data of 2 fragile X subjects with full mutation and a 2.8-kb allele and 1 with full mutation and a 2.4-kb allele. An intellectually normal male with 18% of fraXq27.3 and an unmethylated full mutation is also described. Finally, a mentally retarded child with only a lower allele of 2.7 kb is presented. © 1996 Wiley-Liss, Inc.     

李顺民治疗慢性肾衰处方用药分析

目的:应用数据挖掘技术,总结名老中医李顺民教授诊治慢性肾衰的临床用药经验与规律。方法:收集李顺民教授近5年在医院,临床诊治慢性肾衰(CRF)的处方,并对用药情况进行了整理与分析。结果:研究发现李顺民教授辨治慢性肾衰所使用中药品种多达249种,使用频率大于50%以上的有9种,依次为黄芪(97%)、大黄(94%)、甘草(91%)、山药(86%)、白术(71%)等。配伍用药分析提示,总计有3 946种药对,其中使用频率大于50%以上的27对,主要有黄芪、甘草(87%),黄芪、山药(85%),黄芪、大黄(83%)等。运用方剂词库表检测后,涉及用方总数为539首,其中使用最频繁的方剂为李顺民经验方--健脾益肾方,高达88%。中药性味归经方面,李顺民教授辨治慢性肾衰使用温药最多,其次为平性药和寒性药,热性药物少用。药味以甘味药最多,其次为苦味和辛味药。归经以归脾经药物比例最高,其次为归肺、肾、肝、大肠经。结论:李顺民教授辨治慢性肾衰竭,常用黄芪、大黄、甘草、山药、白术等补益脾肾、调和阴阳,兼攻下、活血、解表、固精的药物。数据挖掘技术是整理中医药名老中医经验的有效工具。