关键词： 新型冠状病毒   Omicron变异株   肾移植   血肌酐   合并症  

摘要： 目的 报道和分析肾移植受者(KTRs)合并新型冠状病毒(SARS-CoV-2)Omicron变异株感染患者的临床特征并探究影响血肌酐变化的可能因素。方法 回顾性观察2022年10月至2023年12月于该院行同种异体肾移植术且合并Omicron变异株感染的患者,收集并分析其临床资料、基础合并症及预后情况等,分析影响血肌酐变化的可能因素。结果 本研究纳入的114例KTRs合并Omicron变异株感染的患者中,居家管理组(A组)90例(78.9%)、非重症隔离病房组(B组)18例(15.8%)、ICU组(C组)6例(5.3%),出现最多的症状依次是发热(90.4%)、乏力(65.8%)和咳嗽(61.4%),临床表现以上呼吸道感染症状为主,整体病死率为2.6%(3/114),且死亡患者均为C组患者。C组基础合并症数量较B组及A组更高(P<0.05)。患者再分为肌酐升高组(D组)33例(28.9%),肌酐不变组(E组)71例(62.3%),肌酐下降组(F组)10例(8.8%),F组均为Omicron变异株感染轻型和中型的A组患者,D组和F组较E组都有更大比例的患者停用或减量钙调神经磷酸酶抑制剂类药物。结论 Omicron变异株对KTRs的危害性较前其他变异株已大幅下降,实现抗感染与抗排斥间的免疫平衡是预防KTRs肾功能损害的有效措施。

关键词： 新冠肺炎   疫情   基层公共卫生   应急管理   传染病   流行病学调查  

摘要： 本文以山东省乳山市为例,回顾了在突发重大传染病疫情背景下,构建基层突发公共卫生事件应急管理体系的主要做法,包括应急完成山东省第二例新型冠状病毒肺炎确诊病例的临床救治工作、精准进行流行病学调查、建设高效综合防控体系、推进多部门综合协调能力、针对地域特点加强输入性冷链管理等有效做法,探讨了在协同联动机制、专业应急能力、信息传递、防控措施实施等方面存在的短板。提出了建立健全基层突发公共卫生事件应急管理体系、提升卫生专业队伍的公共卫生应急能力、强化部门间信息沟通效率等方面的对策与建议,进而构建响应迅速、高效运行的基层公共卫生体系,为完善重大突发公共卫生事件应急体系提供依据。

关键词： 2019-nCoV nucleic acid detection kit   Ion Proton   MGI Tech (DNBSEQ-G99)   Next-generation sequencing   Performance evaluation  

摘要： Purpose: To evaluate the performance of a newly developed 2019-nCoV nucleic acid detection kit based on Ion Proton sequencing platform and make comparation with MGI Tech (DNBSEQ-G99) platform. Methods: References and clinical samples were used to evaluate the precision, agreement rate, limit of detection (LOD), anti-interference ability and analytical specificity. Twenty-seven clinical specimens were used to make comparison between two platforms. Results: The kit showed good intra-assay, inter-assay, inter-day precision between different operators and laboratories, fine agreement rate with references, a relatively low LOD of 1 x 10 3 copies/ml, anti-interference capability of 5 % whole blood and 1mg/ml mucin and no cross reaction with twenty-nine common clinical pathogens. Consistency of variant classification was observed between two platforms. The WGS from Ion Proton tended to have higher coverage and less missing data. Conclusions: The newly developed kit has shown satisfactory performances and excellent consistency with DNBSEQ-G99, making it a good alternative choice clinically.

关键词： 冠状病毒感染   抗病毒治疗   小分子药物   早期   专家共识  

摘要： 新型冠状病毒(新冠病毒)感染虽已不再构成"国际关注的突发公共卫生事件",但仍在全球范围内处于低水平流行.小分子口服药物是我国目前推荐的针对新冠病毒感染的主要抗病毒治疗方案.虽然国内已上市多种抗新冠病毒小分子药物,但目前尚无针对特殊人群的具体用药推荐.中华医学会细菌感染与耐药防治分会联合国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心组织国内呼吸、病毒学、感染、重症、急诊、药学等各领域专家制订了本共识.本共识的主要内容包括7种抗新冠病毒小分子药物介绍,重点阐述了老年人群、合并慢性疾病人群、肿瘤患者、孕妇、儿童等14种特殊人群用药推荐,为临床医师规范用药提供建议.

摘要： The ChAdOx1 nCoV-19 (COVISHIELD) vaccine has emerged as a pivotal tool in the global fight against the COVID-19 pandemic. In our previous study eligible subjects were supplemented with calcifediol, a direct precursor to the biologically active form of vitamin D, calcitriol with an objective to enhance the immunogenicity of the COVISHIELD vaccine. Herein we investigated the effects of calcifediol supplementation on gene expression profiles in individuals who received the COVISHIELD vaccine. Peripheral blood mononuclear cells were isolated from vaccinated individuals with and without calcifediol supplementation at baseline, 3rd and 6th month, and the gene expression profiles were analyzed using high-throughput sequencing. The results revealed distinct patterns of gene expression associated with calcifediol supplementation, suggesting potential molecular mechanisms underlying the beneficial effects of calcifediol in improving the efficacy of COVISHIELD vaccine via augmentation of T cell activation, proliferation and T cell memory responses. Additionally, there was upregulation of NOD like receptor, JAK/STAT and TGF beta signaling pathways. Calcifediol supplementation in vaccinated individuals also downregulated the pathways related to the Coronavirus disease. Taken together, our findings provide valuable insights into the interplay between vitamin D receptor (VDR) signaling and vaccine-induced immune responses and offer another approach in improving vaccination induced antiviral responses.

关键词： "Herpeszoster"   "SARS-CoV-2vaccine"   "Varicellaencephalitis"  

摘要： A middle-aged gentleman, presented to our outpatient department with painful skin lesions suggestive of disseminated herpes zoster. Further examination revealed bilateral cerebellar signs. He had a history of receiving a third dose of AZD1222 vaccine fourteen days prior to the onset of skin lesions but had no other significant medical history. The patient was also evaluated for retroviral infection and other immunodeficient states, workup for which were negative. The patient was initially treated with intravenous acyclovir 7.5 mg/kg/q8H;however, the patient developed varicella encephalitis on treatment, which was followed by pneumonia and haemorrhagic cystitis. Subsequently, treatment was started with acyclovir 10 mg/kg/q8H for 14 days, followed by valacyclovir for eight days, following which there was near-complete resolution of symptoms with the persistence of minimal rigidity. Although there have been several reports of herpes zoster following SARS-CoV-2 vaccination, we found few reports of varicella zoster with systemic manifestations following ChAdOx1 nCoV-19 (AZD1222) vaccination. This case highlights the importance of considering varicella zoster reactivation in a patient presenting with encephalitis or pneumonia post SARS-CoV-2 vaccination.

关键词： 医护人员   疫情常态化   心理弹性  

摘要： 目的:通过了解新冠疫情常态化防控时期医务人员心理弹性状况,分析其心理弹性的影响因素,为可能出现的公共卫生事件提供应对措施。方法:采用便利抽样,在30余家医院选取参与常态化防控时期的医务人员,发放近2000份问卷,采用SPSS 26.0进行数据分析。结果:1. 医务人员心理弹性现状。医务人员心理弹性问卷:得分 ≤ 60分占62.9%;得分为61~69分占比19.4%;得分70~79分占比11.0%;得分 ≥ 80分占比6.8%。2. 职称与心理弹性之间存在显著差异(P 0.05)。结论:1. 接受调查的人员心理弹性普遍偏低,说明改善医务人员心理健康的迫切性;2. 性别、年龄、身体健康状况、职称对一线医护人员的心理弹性造成影响。在工作中,应综合考虑上述因素,并采取针对性的支持措施,例如提供心理支持和培训机会,建立健康的工作环境,促进身心健康的整体发展。Objective: The aims are to investigate the mental resilience of medical staff during the normal prevention and control after the period of novel coronavirus pneumonia epidemic, and to analyze the effect factors of their mental resilience, so as to provide a reference basis for formulating corresponding measures for possible large-scale public health events in the future. Method: From August 6, 2023 to November 6, 2023, the survey was conducted in more than 30 hospitals in one province by means of convenient sampling and questionnaire distribution. Medical personnel participating in the normal post-epidemic prevention and control were selected as the research objects, the general data survey scale and psychological resilience survey scale were used for questionnaire design, and SPSS 26.0 was used for data analysis. Results: 1. Current mental resilience of medical staff. In the mental resilience questionnaire, 62.9% of medical staff scored ≤ 60 points, 19.4% scored 61~69 points, 11.0% scored 70~79 points, 6.8% scored ≥80 points. 2. There were significant differences between the mental resilience of different gender, age, physical health status and professional title groups (P 0.05). Conclusions: 1. The mental resilience of the surveyed personnel is generally low, which further emphasizes the urgency and importance of improving the mental health of medical personnel. Gender, age, physical health status and professional title can affect the mental resilience of front-line medical staff. To improve the mental resilience of medical staff, these factors should be taken into account comprehensively, an

关键词： 新型冠状病毒感染   呼吸亚重症病房   病房管理   制度建设  

摘要： 随着我国新型冠状病毒感染防控措施的不断优化和调整,临床医疗工作重心逐步向“保健康、防重症”转移。为了提升危重症患者的救治能力,北京大学第三医院改造了21个亚重症病房,打破科室、专业壁垒,进行统筹协调。文章介绍了呼吸亚重症病房的实施路径和制度建设,总结了相关经验和成效,对平战结合联合病房管理模式进行了思考。

关键词： 新型冠状病毒   胸腔镜检查   肺疾病   住院时间   并发症  

摘要： 目的研究既往新型冠状病毒感染患者行胸腔镜下肺部手术的预后及住院时间的影响因素。方法选择首都医科大学电力教学医院2022年7月至2023年4月择期行胸腔镜下肺部手术患者的临床信息资料进行回顾性比较研究。根据患者既往病史中是否感染新型冠状病毒分为2组,即感染组和非感染组。比较2组患者的一般资料、手术资料和临床结局,分析影响既往新型冠状病毒感染患者住院时间的危险因素。结果有198例患者纳入本研究,感染组97例,非感染组101例。2组患者一般资料、手术资料、术后ICU的入住率、术后死亡率、术后住院时间比较差异无统计学意义(P>0.05)。2组患者术后最常见的并发症是呼吸道感染,但比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,各变量之间不存在共线性(均VIF<10),肺部并发症是影响术后住院时间的独立危险因素。结论既往新型冠状病毒感染患者痊愈8周后行胸腔镜下肺部手术不影响手术效果,不增加术后并发症。影响术后住院时间的因素是肺部并发症。