重庆市某三甲医院消毒供应中心纯化水细菌污染情况和消毒效果调查

目的了解重庆市某三甲医院消毒供应中心(CSSD)纯化水处理系统的细菌水平、消毒方法及效果。方法运用无菌技术采集重庆市某三甲医院CSSD不同时期的纯化水进行细菌培养,根据细菌培养、余氯、硬度检测结果对纯化水处理系统采取一系列措施以改善水质,并对各项措施的实施效果进行评价。结果该院CSSD纯化水存在细菌总数超标的情况,分别经过调整加盐量、更换水处理机耗材、安装含氯消毒剂加药装置并在水处理机制水时将5%84消毒液持续低流量泵入纯化水储水罐后,细菌总数明显降低,纯化水水质达标。结论该院纯化水存在细菌污染现象,医院应加强管理,CSSD需按时维护水处理设备,定期监测水质。     

The association of general obesity,central obesity and visceral body fat with the risk of gestational diabetes mellitus: Evidence from a systematic review and meta-analysis

BackgroundStudies consistently reported that general obesity predicts gestational diabetes mellitus (GDM). However, whether other phenotypes of obesity such as central obesity and visceral adiposity might have differential associations as risk factors of GDM are less known. The objective of this study was to investigate the association of all these obesity phenotypes in developing GDM.MethodsPubMed, CINHAL, Embase, Scopus, Google Scholar and Web of Science were searched. Full-text research articles published in English from 1985 to February 2020 with cohort and cross-sectional studies design and reported an association between obesity and GDM were included. Case-control studies, case reports, conference abstract, women with previous metabolic disorders and articles considered general obesity only were excluded. A bias adjusted-quality effect meta-analysis was conducted to evaluate the association of these obesity phenotypes and GDM risk.ResultsTwenty studies met the inclusion criteria representing data of ∼50 thousand women at the reproductive age with ∼7% prevalence of GDM. Meta-analysis of 14 datasets revealed that the three types of obesity were significantly associated with an increased risk of GDM. In addition, visceral adiposity was a stronger risk factor for GDM than other obesity phenotypes (odd ratio = 3.25, 95% confidence interval = 2.01–5.26) versus (odd ratio = 2.73, 95% confidence interval = 2.20−3.38) for general obesity and (odd ratio = 2.53, 95% confidence interval = 2.04−3.14) for central obesity.ConclusionThe findings of this study suggest that general obesity, central obesity and visceral body fat were associated with an increased risk of GDM. Furthermore, the association with maternal visceral adiposity was more robust compared to general obesity and central obesity.     

陕西省血液调配机制建立与运行

建立血液调配机制,可缓解医疗资源相对丰富的中心城市临床血液供需矛盾,逐渐实现采供血服务均衡化。建立了陕西省血液调配机制,实现了省域中心城市与周边城市血液资源的均衡化。认为不断优化血液调配机制,加强中心城市与周边城市采供血机构间的沟通合作,是实现省域内血液资源均衡、缓解中心城市季节性供血紧张的有效方法之一。     

中枢性疲劳症候群临床与血清色氨酸的研究

目的：对珠海市中学生中枢性疲劳症候群的临床,患病率及与血清色氨酸的关系进行研究。方法：采用单纯随机抽样和整群一级抽样方法,对4年中学1594人进行问卷调查作为初筛,筛出有症状的部分人在医院进行以排除其它疾病为 的精查,并做血清色氨酸含量的测量,结果：临床表现自主神经症状,睡眠障碍,精神症状,推测珠海市中学生中患病率为11％,血清色氨酸含量较正常对照组低,两组有显著差异（P＜0．01）,结论：中枢性疲劳症候群是珠海地区中学生中的常见病,应积极于以防治;血中色氨酸含量的测定对诊断该疾病有一定的价值。     

阻塞性呼吸睡眠暂停综合征与中枢呼吸驱动

目的阐明不同浓度的CO     

基于SEER数据库的原发性中枢神经系统淋巴瘤不同治疗方法的疗效分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)患者的预后因素及不同治疗方法的临床效果。方法回顾性分析1975年1月至2016年12月美国SEER数据库中4812例PCNSL患者的临床资料。其中男性2831例,女性1981例,男女比例为1.4∶1.0;发病年龄<60岁者2236例(46.47%),60~<75岁者1718例(35.70%),≥75岁者858例(17.83%);幕上肿瘤2417例(50.23%),幕下肿瘤299例(6.21%),脑内多发肿瘤554例(11.51%),其他或未指明部位的脑部肿瘤1542例(32.04%);弥漫大B细胞淋巴瘤(DLBCL)3513例(73.00%),非DLBCL 234例(4.86%),其他或未指明类型的淋巴瘤1065例(22.13%);治疗方式为单独活检的2010例(41.77%),单独部分切除61例(1.27%),单独完全切除54例(1.12%),活检+化疗2384例(49.54%),部分切除+化疗159例(3.30%),完全切除+化疗144例(2.99%)。采用单因素及多因素Cox回归模型分析影响患者总体生存的预后因素;采用Fine-Gray检验与竞争风险模型研究影响患者肿瘤特异性生存的预后因素;生存分析采用Kaplan-Meier法,并通过Log-rank进行比较。结果单因素及多因素Cox风险回归模型分析结果显示,影响PCNSL患者总体生存的独立预后因素包括年龄、种族、婚姻状态、肿瘤部位、病理学亚型、手术、化疗、合并其他恶性肿瘤、合并HIV感染等。Fine-Gray检验与竞争风险模型分析结果显示,影响患者肿瘤特异生存的独立预后因素包括年龄、种族、婚姻状态、肿瘤部位、病理学亚型、手术方式、化疗、合并其他恶性肿瘤、合并HIV感染,而性别与放疗均与肿瘤特异生存无明显相关性。与活检相比,PCNSL患者可能从手术切除中获益(部分切除:HR=0.805,95%CI:0.656~0.989,P=0.04;完全切除:HR=0.521,95%CI:0.414~0.656,P<0.01)。Kaplan-Meier生存分析结果显示,活检+化疗组中位生存时间为28个月(95%CI:24.497~31.503),单独活检组为2个月(95%CI:1.756~2.244),单独部分切除组为2个月(95%CI:1.410~2.590),单独完全切除组为19个月(95%CI:0~39.311),部分切除+化疗组为67个月(95%CI:46.187~87.813),完全切除+化疗组为84个月(95%CI:57.448~110.552),使用不同治疗方法的患者的中位生存时间的差异有统计学意义(P<0.01)。结论手术切除可能改善部分PCNSL患者的预后。化疗可能使肿瘤完全切除或部分切除患者的肿瘤特异生存时间延长。     

基于“人卧血归于肝”探讨睡眠障碍对代谢相关脂肪性肝病的影响

“人卧血归于肝”是睡眠与“肝”藏象功能的重要关联,也是肝主藏血、肝主疏泄的具体体现。现基于“人卧血归于肝” 梳理睡眠与“肝”藏象的必然联系,总结睡眠障碍对肝脏糖脂代谢紊乱的影响,指出睡眠障碍通过中枢调控系统引发进食异常从而增加肝脏代谢负担,并通过其诱发的免疫反应加重肝脏代谢紊乱和肝脏炎症,也可增加胰岛素抵抗引发糖脂代谢异常并增加肝脏脂肪堆积。除此以外,睡眠障碍还可通过影响肠道菌群的变化对脂肪的消化吸收促进肝脏脂肪变性。故以“人卧血归于肝”的理论引出睡眠对于肝脏疾病的重要作用,并以期为进一步探索中西医结合防治方案提供理论参考。     

Central venous cannulation

Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.     

Anatomic Repair of the Central Slip with Anchor Suture Augmentation for Treatment of Established Boutonniere Deformity

BackgroudThe rupture of the central slip of an extensor tendon of a finger causes a boutonniere (or buttonhole) deformity, characterized by pathologic flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Currently, there are no standard treatment guidelines for this deformity. This study aimed to report clinical results of surgery to correct chronic boutonniere deformity.MethodsThis retrospective case series was conducted between January 2010 and December 2018 and only 13 patients with trauma-induced chronic deformity were included. After excision of elongated scar tissue, a direct anatomic end-to-end repair using a loop suture technique with supplemental suture anchor augmentation was conducted. Total active motion was assessed before and after surgery and self-satisfaction scores were collected from phone surveys.ResultsAll patients presented with Burton stage I deformities defined as supple and passively correctable joints. The initial mean extension lag of the PIP joint (43.5°) was improved by an average of 21.9° at the final follow-up (p < 0.001). The mean hyperextension of the DIP joint averaged 19.2° and improved by 0.8° flexion contracture (p < 0.001). The average total active motion was 220.4° (range, 160°–260°). Based on the Souter''s criteria, 69.2% (9/13) of the patients had good results. Only 1 patient reported fair outcome and 23.1% (3/13) reported poor outcome. The average Strickland formula score was 70 (range, 28.6–97.1). In total, 10 patients (77%) had excellent or good results. Of 10 patients contacted by phone, self-reported satisfaction score was very satisfied in 2, satisfied in 3, average in 3, poor in 1, and very poor in 1. Three patients reported a relapse of the deformity during range of motion exercises, 1 of whom underwent revision surgery. One patient complained of PIP joint flexion limitation, and 2 complained of DIP joint flexion limitation at final follow-up.ConclusionsIn chronic boutonniere deformity, central slip reconstruction with anchor suture augmentation can be an easily applicable surgical option, which offers fair to excellent outcome in 77% of the cases. The risk of residual extension lag and recurrence of deformity should be discussed prior to surgery.     

Central patterning of speech movements

Summary Previous speech kinematic studies have demonstrated systematic timing relations among the upper lip, lower lip, and jaw suggesting the operation of a central pattern generator (CPG). The present study evaluated the consistency of these timing relations following unanticipated perturbation of the lower lip. Using this approach, it was also possible to evaluate the influence of sensory information on the timing of motor output and subsequent coordination of the multiple speech movements. Perturbations were applied to the lower lip during the closing movement associated with the first p in sapapple. Muscle activity and movements of the upper lip, lower lip, and jaw were obtained. Changes in movement displacement, velocity and duration, the timing and sequencing of peak velocities, EMG area, and EMG rise time were analyzed for the control and load conditions. Similar to previous perturbation results, significant magnitude compensations from the muscles and movements of the upper lip, lower lip, and jaw were observed. In contrast, movement durations and the sequencing of peak velocities were relatively unaffected by the lower lip load. The timing of peak EMG amplitude and consequently the timing of peak closing velocity for all structures (UL, LL, and J) occurred earlier relative to the preceding opening movement. These results are consistent with the interaction of phasic sensory input with centrally-driven commands resulting in a phase-advanced motor output. Further, as the timing of one structure is modified so were all the functionally-linked components thereby maintaining the necessary coordination. As in other rhythmic motor behaviors such as locomotion and chewing, there appears to be a centrally patterned framework for speech movement coordination.