目的 探索原位模拟在疑似高度传染性疾病患者复用手术器械处置培训中的应用效果。方法 选取2021年4月某医院60名消毒供应中心工作人员，电脑数字表法随机分为对照组和试验组，每组各30人，对照组采用传统培训方式，试验组采用原位模拟培训方式。比较两组综合能力得分、器械包清洗合格率、回收时间和清洗时间。结果 试验组综合能力得分、器械包清洗合格率显著提高（P＜0.001）,回收时间、清洗时间明显缩短（P＜0.001）。结论 原位模拟培训提高了消毒供应中心工作人员对疑似高度传染性疾病患者复用手术器械处置的综合能力和工作效率，改善工作质量，达到了培训目标。

血液透析是终末期肾病患者维持生命的重要方式,但这种治疗方式会严重降低患者的生活质量,肾移植是治疗终末期肾病的最有效手段,能极大程度上改善患者的生存质量和生存率,但由于受到供肾资源短缺的限制,中国每年在分配系统中等待肾移植的患者约有10万余人,仅有3％的患者能够成功配型并接受肾移植手术.目前,通过使用血型不相容以及扩大标准的边缘供肾等策略在一定程度上改善了肾源短缺这一现状,但仍无法满足患者对于供肾的需求,因此供需之间的巨大差异是临床亟需解决的难题.

We present a case of 80 years woman chronic smoker (10 cigarettes)/ per day for 50 years diagnosed with adenocarcinoma in the upper left lobe of her lungs in a geriatric clinic. She has no history of diabetes but taking medicine for hypertension and dyslipidemia. She was admitted and operated on for partial pneumonectomy and discharged after 11 days of care with all essential drugs, and instructions. After 4 weeks of treatment, she complained of unusual polyuria, diagnosed in the department of Geriatrics, Zhongnan Hospital of Wuhan University, China.

目的:调查武汉市中心城区社区卫生服务中心全科医生的培训需求及其影响因素,以期为切实提升全科医生培训质量提供理论依据.方法:自行设计《社区在职全科医生培训需求的调查问卷》,采用方便抽样法,邀请武汉市卫生服务中心202名全科医生对于培训内容、培训形式、培训方法等需求开展调查.采用Gamma法和Kruskal-Wallis法分析全科医生的个人特征与培训形式需求之间的相关性.结果:在培训内容方面,全科医生的需求最突出的六项分别为:最新应用于临床的药物(878/1010)、最新指南的理解与运用(877/1010)、院前急救与转诊(868/1010)、慢性病诊治康复(866/1010)、心电图(860/1010)、CT阅片(850/1010),为首选培训内容.培训形式方面,进修上级医院(871/1010)、到国内先进社区交流(842/1010)、在社区医院与专家交流(839/1010)为最具吸引力.最受欢迎的培训方法是能够亲身体验的角色扮演、模拟、训练等类型(839/1010).单因素分析显示,不同的年龄、性别、文化程度、职称、工作年限、培养类型的全科医生之间,存在培训形式上的需求差异."培训内容"对培训效果的影响最大.结论:全科医生对于培训内容的需求在医疗领域较为突出,更倾向于具有丰富的实践和交流机会的培训形式.建议加强培训内容的针对性和实用性,开展形式多样、有选择性的培训,以提高全科医生参与培训的积极性,优化培训效果.

Kidney transplantation is the most fundamental treatment for patients with end-stage renal disease. However, due to the long-term malnutrition of the patient before transplantation, coupled with the use of stress stimulation, immunosuppressive agents, and high-dose hormones after kidney transplantation, the patient is in a hypermetabolic state, and malnutrition is aggravated. The nutrition status of patients has a significant impact on the prognosis and development of kidney transplantation. Therefore, this article reviews the current status of nutrition intervention, the assessment of malnutrition, the related factors of malnutrition, and nutrition management in kidney transplantation recipients, so as to provide a reference for the nutrition and diet management of kidney transplantation recipients.

目的:探讨耳内镜下耳道入路手术方式对听神经瘤切除术患者面神经功能、术后住院时长、下床活动时间和满意度的效果,为促进患者的术后康复提供理论依据.方法:选取2020年6月至2021年6月于武汉大学人民医院耳鼻咽喉头颈外科一科行听神经瘤切除术的30例患者进行回顾性分析,根据患者肿瘤类型,选取2021年1月后符合耳内镜下耳道入路听神经瘤手术的12例患者为观察组,采用耳内镜下耳道入路进行微创手术,与2020年7月至12月期间相同大小和类型的18例听神经瘤手术患者进行对照,对照组采用常规的手术治疗方式.两组患者在术后当天、出院当天和术后1个月均进行面神经功能的评定,且在患者出院当天进行满意度调查,记录患者术后住院天数和下床活动时间.结果:观察组患者在术后不同时间点面神经功能保留情况明显优于对照组(均P<0.05),观察组58.33％的听神经瘤患者表示对手术效果和护理工作非常满意,而对照组仅有27.78％的患者表示非常满意(P<0.05).观察组患者术后住院天数(8.03±2.23)明显少于对照组(12.12±1.51),下床活动时间(3.21±1.10)早于对照组(6.25±2.34),均P<0.05.结论:耳内镜下耳道入路手术方式较传统手术方式可减少听神经瘤患者面神经功能异常的发生,缩短患者术后住院天数,促进患者早期下床活动,提高了患者的满意度.

目的:探讨护士心理资本、工作幸福感与工作绩效的关系.方法:采用方便抽样方法,选择武汉市2所三级甲等医院的283名注册护士为研究对象,应用护士心理资本量表、工作幸福感量表和护士工作绩效量表对研究对象进行问卷调查.结果:护士工作绩效总分为(202.22±16.95)分.不同性别、学历护士的工作绩效差异均无统计学意义(P>0.05),而不同年龄、婚姻状况、工作年限、职称、科室、月收入护士的工作绩效差异均有统计学意义(P<0.05～P<0.01).Pearson相关分析显示,除任务绩效与福利待遇维度无明显相关关系(P>0.05)外,护士任务绩效、情境绩效与心理资本、工作幸福感其他各维度均呈正相关关系(P<0.05～P<0.01);反生产绩效与心理资本中希望维度呈负相关关系(P<0.05).多元线性回归分析显示,希望、韧性、工作价值和福利待遇均为护士工作绩效的影响因素(P<0.01),共同解释总变异的50.3％.结论:医院护士工作绩效处于中等水平,因年龄、婚姻状况、工作年限、职称、科室、月收入而异,希望、韧性、工作价值和福利待遇是护士工作绩效的预测因素.

目的:探讨新生儿重症监护室(NICU)患儿鼻损伤发生特征并分析其危险因素,为临床NICU患儿鼻部损伤防治提供依据.方法:选取2019年1月—2020年2月武汉市某三级甲等医院NICU的526例患儿,收集相关人口学资料、病情、新生儿皮肤风险评分及发生特征等,并对相关因素进行分析.结果:NICU患儿鼻损伤发生率为26.6％,其中,鼻外观改变发生率为8.9％,鼻压力性损伤发生率为21.1％.鼻压力性损伤以双侧鼻孔多见.nCPAP使用总时长、昏睡、未使用镇痛药镇痛是nCPAP治疗患儿并发鼻损伤的独立危险因素,喂养、无躁动是鼻损伤发生的保护性因素.结论:NICU患儿是发生鼻损伤的高危人群,临床治疗护理过程中应早期识别鼻损伤的危险因素,及时干预,预防NICU患儿发生鼻损伤.

目的 探讨新生儿重症监护室(neonatal intensive care unit,NICU)经鼻持续正压通气(nasal continuous positive air-way pressure,nCPAP)患儿鼻损伤结局特点,为护理管理者提供切实可靠的管理策略和依据.方法 便利抽样选取某院采用nCPAP治疗出现鼻损伤的140例新生儿,分析影响其鼻损伤结局的相关因素.结果 90％患儿鼻损伤可在住院期间完全恢复;鼻部残留黑色印记的鼻损伤所需愈合时间最长;住院时长、鼻塞尺寸、发生损伤时体重是影响出院时鼻损伤结局的重要因素;不同出生体重、胎龄的新生儿发展为鼻损伤所需时间及鼻损伤持续时间差异有统计学意义(均P＜0.05).结论 NICU护士应掌握影响出院时鼻损伤结局的相关因素,制定nCPAP治疗护理风险知情同意书,做好入院宣教及出院后延续护理,以促进新生儿鼻损伤尽早恢复.

加速康复外科 (enhanced recovery after surgery, ERAS,也称fast track surgery,FTS) 是基于循证医学证据的一系列围术期优化处理措施, 以达到快速康复为目的[1-2].最早是由哥本哈根大学Henrik Kehlet教授于1997年提出并应用于临床,2007年由黎介寿院士的研究团队引入我国[3].其理念引入我国后, 被应用到临床上, 优势逐渐为医学界所认同, 而围手术期饮食管理在加速康复外科理念中是至关重要的一环, 直接关系到患者能否快速康复[4].研究指出,缩短患者术前禁食禁饮时间,术后早期进食进水,促进胃肠功能的快速康复是ERAS的核心机制[5].目前,国内大部分医院仍遵循术前禁食 12 h,禁水8 h,术后待肠道功能恢复后给予少量流质饮食的饮食策略.肾移植手术是目前治疗各种病理类型的终末期肾病(end stage renal disease, ESRD)最理想的方案之一,由于器官移植手术的高难度、高挑战性,ERAS理念在我国移植领域中的探究及应用较其他外科领域迟缓,整体上仍处于临床探索阶段.研究证实,肾移植术后营养不良是发生并发症的重要因素之一[6].我科基于ERAS理念, 对肾移植受者在术前及术后进行饮食管理,缩短患者进食进水的时间,并取得较好的效果,现报告 如下.

1 案 例 1.1 简要案情和病史摘要 某男,47岁,农民(农闲季节间断外出务工),某年6月3日07:47因"反复腹痛、腹泻伴发热3 d"入住某医院,空腹血糖19.3 mmol/L,诊断为"急性胃肠炎伴中度脱水,2型糖尿病伴血糖控制不佳".入院后血常规示:白细胞计数16.44×109/L,血红蛋白191 g/L,血小板计数52×109/L,红细胞计数6.18×1012/L,红细胞压积56.2％,中性粒细胞百分比89.0％,中性粒细胞绝对值14.64×109/L.甲型流感病毒抗原检测阴性,乙型流感病毒检测阴性.

在新型冠状病毒疫情中法医发挥专业优势,通过尸检为新型冠状病毒肺炎的诊疗提供了重要参考依据,在新冠肺炎的诊疗和减少恐慌、维持社会稳定中发挥了"侦察兵"作用。但我国法医学科体系也存在问题,专业设置、教育培训和鉴定管理体系存在不合理的现状和困境。后疫情时代,随着法制社会发展、公共卫生和健康社会需求,法医学科也面临挑战和发展机遇,需要重构法医学科体系,建立集约化现代法医中心管理体系,推进法医学科更好地服务于国家法制建设和人类健康,推进"健康中国2030"实施和"全健康"社会治理。

The aim of this study was to investigate the reaction of pancreatic and mesenteric artery to 5-hydroxytryptamine (5-HT, serotonin) and the mechanism of nitric oxide in diabetes. Diabetic mice were induced by streptozotocin through intraperitoneal injection. The vascular tension of the pancreatic, mesenteric and brain basilar arteries in diabetic and control mice were measured by myograph in the applications of angiotensin II, 5-HT, 5-HT2A receptor agonist 2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI), 5-HT1B/1D receptor agonist sumatriptan, 5-HT2B receptor agonist BW723C86, 5-HT1D receptor antagonist Palonosetron and 5-HT2 receptor antagonist Sarpogrelate. The effect of 5-HT on arteries pretreated with L-NAME and sodium nitroprusside (SNP) on arteries pretreated with norepinephrine were measured. The mRNA expressions of eNOS, 5-HT1B, 5-HT1D, 5-HT2A and 5-HT2B in pancreatic and mesenteric arteries were measured by Real-time PCR. The concentration of 5-HT in plasma and eNOS in pancreatic and mesenteric arteries were tested. Our results showed that the tension of pancreatic and mesenteric arteries in diabetic mice impaired to 5-HT, but not Ang II, and to DOI and sumatriptan, but normalized by incubation with L-NAME. Pancreatic and mesenteric arteries showed no differences to SNP after pretreated with NE between diabetic and control mice. The mRNA of eNOS and 5-HT receptors in pancreatic and mesenteric artery showed no difference between control and diabetic mice. We conclude that the effect of 5-HT on the tension of pancreatic and mesenteric arteries decrease in diabetic mice. It may due to the decreased activity of 5-HT receptors and the activation of eNOS, which causes nitric oxide to release more and makes the tension of vessels decreased.

Ultraviolet B (UVB) irradiation-induced DNA damage, oxidative stress, inflammatory processes, and skin pigmentation cause pigmented spots, wrinkles, inflammation, and accelerated skin aging and cancer. Maqui berry (Aristotelia chilensis) is a natural antioxidant, anticancer, and anti-inflammatory food. We investigated the photoprotective properties of the ethyl acetate fraction of maqui berry ethanol extract (MEE) in vitro and in vivo. Spectrophotometric measurements revealed dominant extinction profile of MEE in the UVB range. MEE clearly reversed the DNA damage induced by UVB irradiation in HaCaT cells by upregulating endogenous cellular enzymatic and non-enzymatic antioxidant systems containing superoxide dismutase, catalase, and glutathione and reducing the production of nitric oxide. Moreover, MEE treatment enhanced the antioxidant ability and weakened lipid peroxidation in BALB/c mice exposed to UVB radiation. It also down-regulated interleukin (IL)-6 and tumor necrosis factor-α levels and up-regulated IL-4 levels. Moreover, MEE inhibited the UVB-triggered activation of ERK and p38 MAPK. These data suggest that MEE is an effective agent against UVB-induced photodamage.

Background: The COVID-19 has become a global epidemic How to effectively treat it and reduce the fatality rate is still at exploratory stage Identification of risk factors for death is critical to optimize treatment strategies for COVID-19 Objective: To investigate risk factors for COVID-19 death, and based on this, to develop a COVID-19 death predictive scoring system Methods: Two hundred and seventy patients, who discharged or deceased with confirmed COVID-19 in Zhongnan Hospital of Wuhan University during January 1 to February 29, 2020, were reviewed Baseline data were obtained, including demographics, admission symptoms and vital signs, complications and laboratory test results According to the clinical outcome, i e discharged and deceased, the patients were divided into recovery group and death group Risk factors of death were explored by using multivariate logistic regression analysis, and used for the development of a predictive scoring system for death Results Two hundred and forty-five cases were finally included, including 212 discharged and 33 deceased during hospitalization Factors independently associated with death were age ≥ 65 years〔OR=7 177, 95%CI(1 715, 30 038), P<0 05〕, SpO2≤93%〔OR=15 456, 95%CI(3 343, 71 450), P<0 05〕, BUN≥7 mmol/L〔OR=7 115, 95%CI(1 550, 32 652), P<0 05〕, PCT≥0 1 μg/L〔OR=23 895, 95%CI(4 209, 135 639), P<0 05〕 In predicting death due to COVID-19, the AUC of ASBP(A: age, S: SpO2, B: BUN, P: PCT) scoring system was 0 967〔95%CI(0 931, 0 987)〕, and that of CURB-65 scoring system was 0 885〔95%CI(0 831, 0 926)〕, showing a significant difference(Z=2 816, P<0 01) 5 was the maximal Youden Index for ASBP scoring system and was chosen as the cut-off value, with 0 871 sensitivity and 0 957 specificity And 2 was the maximal Youden Index for CURB-65 scoring system and was chosen as the cut-off value, with 0 903 sensitivity and 0 735 specificity Conclusion: Older age, lower SpO2, higher levels of BUN and PCT were independent risk factors for COVID-19 death, and the ASBP scoring system developed based these factors might be available for the assessment of death risk of COVID-19 Copyright © 2020 by the Chinese General Practice

Objective:To explore the application effect of whole-course guided management under the concept of enhanced recovery after surgery (ERAS) in perioperative period of patients with acoustic neuroma.Methods:Retrospective analysis was performed on the patients with acoustic neuroma treated by inpatient surgery in our department from January 2018 to December 2019. The patients before January 2019 adopted the traditional outpatient and inpatient treatment management mode were in the control group. Patients admitted after January 2019 were in the observation group. The experimental group adopted the guided management mode under the concept of enhanced recovery after surgery. In other words, on the basis of the traditional management, the whole-course guided management under the concept of enhanced recovery after surgery was added, which mainly included outpatient documentation, introduction of basic disease knowledge, preoperative and postoperative life guidance, preoperative and postoperative psychological guidance and family follow-up. Patients in both groups were observed for their first medical contact-discharge time, medical and nursing satisfaction, and psychological status was assessed by self-rating depression Scale (SDS) and self-rating anxiety scale (SAS) before surgery, on the day of discharge, and 1 month after discharge.Results:The first medical contact discharge time of the whole-course oriented management group under the concept of accelerated rehabilitation surgery was significantly shorter than that of the traditional group, and its medical and nursing satisfaction was significantly improved ( P<0.05); the SDS score and SAS score before operation, on the day of discharge and 1 month after discharge in the observation group were significantly lower than those of the control group ( P<0.05). Conclusions:The whole-process guided management under the concept of enhanced recovery after surgery can significantly shorten the time of patients′ first medical contact and discharge, reduce anxiety and depression in patients with acoustic neuroma before and after surgery, and improve patients′ satisfaction with medical treatment and care.

Maqui berry (Aristotelia chilensis) is an edible berry. The study aimed to explore the therapeutic effect of maqui berry on inflammatory bowel disease. Maqui berry water extract was separated by multiple solvents extraction. The chemical bases, antioxidant and anti-inflammatory properties of different extract fractions were then compared. Dextran sodium sulfate (DSS)-induced ulcerative colitis mice were used for the pharmacological activity test in vivo. Experimental results showed that the ethyl acetate fraction of maqui berry water extract (MWE) was rich in phenols and exhibited good antioxidant and anti-inflammatory activities. MWE considerably reduced the expression of COX2 and IL-6 in LPS-stimulated RAW 264.7 cells. Inflammatory bowel disease index, MDA, NO, i-NOS, and COX2 in colon tissues and MPO, TNF-α, and IL-1β in blood serums were remarkably decreased in the treatment group compared to in the model group (p < 0.05). Intestinal histopathological damage was significantly alleviated in the treatment group, and the expression of occludin was increased (p < 0.05). MWE treatment alleviated the imbalance of gut microbiota caused by DSS injury. Overall, MWE plays a therapeutic role in ulcerative colitis through its anti-inflammatory effect, reduces immune stress, and regulates gut microbiota.

[目的]探讨急诊危重指数与早期预警评分系统对急性冠脉综合征(acute coronary syndrome,ACS)急救效率的影响,以及3种早期预警评分系统对ACS患者预后的评估价值.[方法]选择急诊科600例ACS患者,按照护理方式不同分为对照组和观察组,各300例.对照组患者给予常规护理分诊急救,观察组患者给予急诊危重度指数(emergency severity index,ESI)分级就诊,比较两组患者的急诊效率.之后以患者入院时第一次生命体征监测值为基础,对国家早期预警评分(national early warning score,NEWS)、标准早期预警评分(standard early warning score,SEWS)以及改良早期预警评分(modified early warning score,MEWS)进行计算,采用Fisher判别原理对ESI与3种评分(经由ESI分级就诊的观察组患者)的相关性进行分析,并采用交叉核实法和回代法进行误判率估算.并以患者28 d死亡为终点,将观察组患者分为生存组和死亡组两组,比较两组患者的3种评分差异,采用受试者工作特征曲线(receiver operator characteristic curve,ROC)分析3种评分对预后的评估价值.[结果]对照组患者t1、t2、t3明显高于观察组(P＜0.05).经交叉验证法和回代法验证显示,NEWS系统的误判率最低,SEWS系统的误判率最高,进一步分析,NEWS系统判别急性心肌梗死(acute myocardial infarction,AMI)患者ESI分级的特异性为92.61％,灵敏度为93.84％,准确性为93.10％,可以较好地对Ⅰ级和Ⅱ级患者进行判别.经过ROC曲线分析,NEWS、MEWS以及SEWS评分的曲线下面积(area under the curve,AUC)分别为0.878、0.830、0.782,其中NEWS的AUC最大,预后评估价值更高.[结论]应用ESI分诊系统可以提高AMI患者的急诊效率,且NEWS评分系统可以协助医生对患者病情量化、分级以及前瞻性研究,对预后也具有较好的预测效能,具有较好的临床应用价值.

对超早产儿概念、发病率等进行阐述, 综述超早产儿护理理念, 体温、呼吸、营养、感染管理, 发展性照护及出院随访等方面的主要研究进展.

Magnolia officinalis var. biloba is used as a traditional medicine in China and as a food additive in the United Kingdom and the European Union. In this study, total phenylethanoid glycosides (TPG) and magnoloside Ia (MIa) fromM. officinalis var. biloba fruits showed excellent radical scavenging activities and potent inhibition activities against ultraviolet B (UVB)-induced oxidative damage in vitro. In vivo, TPG and MIa inhibited UVB-induced skin phototoxicity in mice upon continuous irradiation for 10 days. Changes in the levels of malondialdehyde, catalase, glutathione peroxidase, superoxide dismutase, and hydroxyproline caused by UVB irradiation were remarkably reversed in a dose-dependent manner after treatment with TPG or MIa. Protein-level analysis further showed that compared with the UVB group, the TPG high-dose group or MIa group significantly down-regulated MAPK/NF-kB signaling pathways. Therefore, TPG and MIa possessed a powerful photoprotective property that can be applied in food and antiphototoxicity formulations.