Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators?

Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in mid-2012, there has been controversy over the respiratory precaution recommendations in different guidelines from various international bodies. Our understanding of MERS-CoV is still evolving. Current recommendations on infection control practices are heavily influenced by the lessons learnt from severe acute respiratory syndrome. A debate on respiratory precautions for MERS-CoV was organised by Infection Control Association (Singapore) and the Society of Infectious Disease (Singapore). We herein discuss and present the evidence for surgical masks for the protection of healthcare workers from MERS-CoV.     

脑梗死合并肺部感染患者TNF-α、HMGBl、TLR4-NF-κB信号通路改变研究

目的探究脑梗死合并肺部感染患者的肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)和高迁移率族蛋白Bl(High mobility group protein Bl,HMGBl)水平及其临床价值研究。方法2018年1月-2019年2月儋州市人民医院收治的急性脑梗死患者作为研究对象,其中急性脑梗死合并肺部感染患者30例作为感染组,急性脑梗死无肺部感染患者80例作为非感染组,选择同期于此医院体检的健康者30名作为对照组。采用酶联免疫吸附法(Enzyme-linked immuno sorbent assay,ELISA)检测血清HMGB1和细胞因子IL-6、TNF-α水平,采用Western Blot法检测血清Toll样家族受体-4(Toll like receptor-4,TLR4)、核因子κB(nuclear factor kappa-B,NF-κB)、髓样分化因子(myeloiddifferentiationfactor88,MyD88)表达水平。结果感染组的血清HMGB1、TLR4、NF-κB、MyD88表达及细胞因子IL-6、TNF-α水平均高于非感染组和对照组(P<0.05);感染组患者大梗死灶、中等梗死灶、小梗死灶各指标总体水平差异具有统计学意义(P<0.05)。大梗死灶、中等梗死灶两亚组患者的血清HMGB1、TLR4、NF-κB、MyD88表达及细胞因子IL-6、TNF-α水平均高于小梗死灶亚组(P<0.05);急性脑梗死合并肺部感染患者的血清HMGB1和TNF-α水平呈正相关(r=0.523,P<0.001)。结论脑梗死合并肺部感染患者伴随TNF-α、HMGBl、TLR4-NF-κB信号通路的明显改变,且与梗死灶大小具有相关性,其机制有待进一步研究。     

间歇性负压封闭引流联合自体皮瓣原位弹性绷带加压包扎对溃疡期压疮疗效分析

目的探讨间歇性负压封闭引流(VSD)联合自体皮瓣原位弹性绷带加压包扎对III~Ⅳ期溃疡期压疮疗效的影响。方法选择2009年4月~2014年3月我科住院治疗的溃疡性压疮患者40例作为观察组,采用间歇性VSD联合自体皮瓣原位弹性绷带加压包扎的治疗方法。选择同期我科住院治疗的III~Ⅳ期溃疡性压疮患者25例作为对照组,采用常规换药联合自体皮瓣原位弹性绷带加压包扎的治疗方法。观察两组感染发生率、愈合情况及住院时间,并进行比较。结果观察组感染率为0,对照组感染率为76%,两组比较有显著性差异(P0.05);观察组皮瓣修复术前住院时间、术后住院时间、总住院时间较对照组明显缩短,两组比较有显著性差异差异(P0.05)。两组皮瓣面积、一期愈合、复发情况比较无显著性差异(P0.05)。结论间歇性VSD联合自体皮瓣原位弹性绷带加压包扎,能阻止溃疡期压疮创面感染,促进创面愈合,改善预后。     

Posterior lamellar reconstruction: a comprehensive review of the literature

The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages.

We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: “posterior lamella,” “eyelid reconstruction,” “tarsoconjunctival,” “flap,” and “graft.” Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search.

The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there’s no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon’s choice. The use of biomaterials can avoid possible complications of the donor site.     

尘肺合并肺结核136例患者的护理

目的观察并探究尘肺合并肺结核临床护理方法及效果。方法选取我院收治的136例尘肺合并肺结核患者为研究对象,随机分为对照组与实验组,每组68例。给予对照组常规护理,实验组则接受针对性综合护理服务,对两组护理效果及患者满意度进行统计并比较。结果经过一段时间的护理服务后,实验组的总有效率与患者满意度分别为94.1%与100%,对照组分别为85.3%与86.8%,数据差异显著,具备统计学意义(P0.05)。结论在对尘肺合并肺结核患者进行治疗过程中,通过加强对其心理护理及健康宣教等综合护理,大大改善了患者的呼吸功能,促进其痊愈,充分提高了患者的满意度,值得临床推广与应用。