Preparing IR for COVID-19: The Singapore Experience

This paper describes country-wide special measures undertaken for interventional radiology staff during the current coronavirus disease 2019 (COVID-19) pandemic. Although each interventional radiology service around the world faces unique challenges, the principles outlined in this article will be useful when designing or strengthening individual practices and integrating them within wider hospital and national measures. Moving beyond the current outbreak, these measures will be useful for any future infectious diseases which are likely to arise.     

乙肝孕妇血清标志物模式与HBV-DNA载量及肝功能关系研究

目的探讨乙肝孕妇血清标志物模式、HBV-DNA载量及肝功能三者之间的关系,为孕期乙肝病毒感染情况的监控和乙肝病毒母婴传播的预防提供参考。方法选取2019年1月-11月在我院产检的767例乙肝表面抗原阳性孕妇的乙肝血清标志物模式、肝功能指标的丙氨酸氨基转移酶(alamine aminotransferase,ALT)及HBVDNA载量进行研究,探讨三者间的关系。结果HBsAg、HBeAg、HBcAb阳性组孕妇HBV-DNA阳性率及病毒载量均高于其余两组(P<0.05);ALT升高程度与HBV-DNA载量具有一定相关性(r=0.255,χ^2=80.150,P=0.000);HBeAg阳性组和HBeAg阴性组间HBV-DNA阳性率、ALT异常率差异均有统计学意义。结论HBV-M、HBV-DNA与肝功能之间有一定的相关性,大三阳孕妇中高病毒载量比例高,应加强乙肝孕妇孕期各项指标的监测,必要时进行干预治疗。     

Simeprevir added to peginterferon and ribavirin lessens time with fatigue,depressive symptoms and functional limitations in patients with chronic hepatitis C compared with peginterferon and ribavirin: results from 1161 patients in the QUEST‐1, QUEST‐2 and PROMISE studies

The value of adding simeprevir (SMV) vs placebo (PBO) to peginterferon and ribavirin (PR) for treatment of chronic hepatitis C virus infection was examined using patient‐reported outcomes (PROs); further, concordance of PROs with virology endpoints and adverse events (AEs) was explored. Patients (n = 768 SMV/PR, n = 393 PBO/PR) rated fatigue (FSS), depressive symptoms (CES‐D) and functional impairment (WPAI: Hepatitis C Productivity, Daily Activity and Absenteeism) at baseline and throughout treatment in three randomised, double‐blind trials comparing the addition of SMV or PBO during initial 12 weeks of PR. PR was administered for 48 weeks (PBO group) and 24/48 weeks (SMV group) using a response‐guided therapy (RGT) approach. Mean PRO scores (except Absenteeism) worsened from baseline to Week 4 to the same extent in both groups but reverted after Week 24 for SMV/PR and only after Week 48 for PBO/PR. Accordingly, there was a significantly lower area under the curve (baseline–Week 60, AUC₆₀) and fewer weeks with clinically important worsening of scores in the SMV/PR group at any time point. Incidences of patients with fatigue and anaemia AEs were similar in both groups, but FSS scores showed that clinically important increases in fatigue lasted a mean of 6.9 weeks longer with PBO/PR (P < 0.001). PRO score subgroup analysis indicated better outcomes for patients who met the criteria for RGT or achieved sustained virological response 12 weeks post‐treatment (SVR12); differences in mean PRO scores associated with fibrosis level were only observed with PBO/PR. Greater efficacy of SMV/PR enabled reduced treatment duration and reduced time with PR‐related AEs without adding to AE severity.     

单侧外固定治疗重度Pilon骨折的临床疗效探究

目的探讨单侧外固定治疗重度Pilon骨折的临床疗效。方法回顾性分析2017年6月-2018年12月南京中大医院江北院区骨科收治的重度Pilon骨折患者100例,男性54例,女性46例;年龄18~65岁,平均35.5岁;Ruedi-AllgowerⅡ型39例,Ⅲ型61例。按照不同固定方法分为常规固定组和单侧外固定组,各50例,比较两组患者住院时间、完全负重下地时间、骨折愈合时间,评价治疗前及治疗后3个月踝关节活动度、踝关节功能恢复情况、疼痛程度,并统计患者的治疗效果及并发症发生情况。结果单侧外固定组住院时间、完全负重下地时间、骨折愈合时间分别为(16.50±1.50)d、(132.56±10.25)d、(14.16±0.69)周,均短于常规固定组(19.25±2.35)d、(198.65±16.58)d、(17.58±1.50)周(t/P=6.975/0.001、23.970/0.001、14.650/0.001)。治疗后3个月,单侧外固定组踝关节Mazur评分为(85.67±6.59)分,显著高于常规固定组(62.78±3.45)分,VAS评分为(2.23±0.36)分,低于常规固定组(4.59±0.89)分(t/P=21.760/0.001、17.380/0.001);单侧外固定组患者踝关节活动度分别为(17.29±0.16)°、(28.36±1.23)°、(19.68±0.16)°、(16.89±2.12)°,均高于常规固定组(10.62±1.25)°、(21.57±2.58)°、(14.36±1.62)°、(14.25±0.57)°(t/P=37.430/0.001、16.800/0.001、23.110/0.001、8.503/0.001)。单侧外固定组治疗优良率为90.00%,显著高于常规固定组74.00%(χ^2/P=4.336/0.037)。单侧外固定组总并发症发生率为4.00%,显著低于常规固定组的18.00%(χ^2/P=5.005/0.025)。结论单侧外固定支架治疗重度Pilon骨折可有效减轻患者疼痛症状,提高患者踝关节活动度,恢复患者功能,治疗效果显著,安全性较高。     

护士分层级管理对急性肝炎患者护理满意度的影响

目的分析护士分层级管理的实施对急性肝炎患者护理满意度的影响。方法该院自2018年3月起实施护士分层级管理,以该院10名肝病科护理人员为研究对象,其中2017年3月—2018年2月实施前(对照组)及2018年3月—2019年2月实施后(研究组)的管理效果。结果与对照组比较,研究组患者的病房管理、患者护理、文书书写、基础护理、入院宣教方面的护理质量评分均明显升高(P<0.05);与对照组82.29%的护理总满意率比较,研究组护理总满意率显著升高,达到了97.92%(P<0.05);与对照组工作自我满意度比较,研究组患者的自我价值体现等方面的工作自我满意度评分均明显升高(P<0.05)。结论护士分层级管理策略的实施,有效提高了急性肝炎患者护理满意度,提升了科室护理质量。     

经鼻导管高流量吸氧与经鼻气道正压通气在重症毛细支气管炎呼吸支持中的应用价值比较

目的：比较经鼻导管高流量吸氧（HFNC）与经鼻气道正压通气（nCPAP）在重症毛细支气管炎呼吸支持中的应用价值，为临床治疗方案的选择提供参考。方法：选取2016年12月至2018年12月我院儿科收治的重症毛细支气管炎患儿90例，采用随机数字表法分为观察组和对照组各45例。两组患儿入院后均给予常规综合治疗以保证呼吸道通畅，在此基础上观察组采用HFNC治疗，对照组采用nCPAP治疗，比较两组患儿治疗前和治疗24 h后呼吸频率、经皮血氧饱和度（TcSO2）、呼吸窘迫评分体系（CSS）评分、动脉血氧分压（PaO2）等呼吸相关指标及治疗前后临床症状体征改善情况。结果：两组患儿治疗24 h后呼吸频率、CSS评分均降低，且观察组降低程度更大，TcSO2、PaO2于治疗24 h后升高，观察组升高幅度较对照组明显；治疗后两组患儿咳嗽及肺部湿啰音、肺部炎症情况均改善，观察组症状体征消失时间早于对照组，差异均有统计学意义（P<0.05）。结论：重症毛细支气管炎患儿采用HFNC治疗可明显改善通气功能和临床症状，治疗效果优于nCPAP治疗，可扩大样本量进一步观察。     

Pharmacotherapeutic strategies for critical asthma syndrome: a look at the state of the art

ABSTRACT

Introduction

‘Critical Asthma Syndrome’ (CAS) is an umbrella term proposed to include several forms of asthma, responsible for acute and life-threatening exacerbations. CAS requires urgent and adequate supportive and pharmacological treatments to prevent serious outcomes.     

PCR仪与测序仪应用于丙型肝炎病毒基因型检测的临床效果观察

目的:观察PCR仪与测序仪在丙型肝炎病毒(HCV)基因型检测中的应用。方法:选择2018年1月~2018年12月收治的134例HCV感染患者为研究对象,给予患者PCR仪检测、测序仪检测。结果:测序仪检测134例均可分型,PCR仪检测130例患者可分型,4例未能分型。PCR检测结果:134例HCV感染患者中,1b型59例,2a型47例,3a型6例,3b型15例,6a型3例,4例为分出型别。基因测序结果:134例均可分型:1型59例,2a型40例,2i型7例,3a型6例,3b型15例,6a型3例,6n型4例。PCR仪检测法检测符合率97.0%。结论:PCR仪测序仪检测用于丙型肝炎病毒基因型检测,操作便捷,但其只能检测探针覆盖的型别,个别罕见型别不能分型。