简介：摘要A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge.

简介：AbstractBackground:A cluster of pneumonia cases were reported by Wuhan Municipal Health Commission, China in December 2019. A novel coronavirus was eventually identified, and became the COVID-19 epidemic that affected public health and life. We investigated the psychological status and behavior changes of the general public in China from January 30 to February 3, 2020.Methods:Respondents were recruited via social media (WeChat) and completed an online questionnaire. We used the State-Trait Anxiety Inventory, Self-rating Depression Scale, and Symptom Checklist-90 to evaluate psychological status. We also investigated respondents’ behavior changes. Quantitative data were analyzed by t-tests or analysis of variance, and classified data were analyzed with chi-square tests.Results:In total, 608 valid questionnaires were obtained. More respondents had state anxiety than trait anxiety (15.8% vs 4.0%). Depression was found among 27.1% of respondents and 7.7% had psychological abnormalities. About 10.1% of respondents suffered from phobia. Our analysis of the relationship between subgroup characteristics and psychological status showed that age, gender, knowledge about COVID-19, degree of worry about epidemiological infection, and confidence about overcoming the outbreak significantly influenced psychological status. Around 93.3% of respondents avoided going to public places and almost all respondents reduced Spring Festival-related activities. At least 70.9% of respondents chose to take three or more preventive measures to avoid infection. The three most commonly used prevention measures were making fewer trips outside and avoiding contact (98.0%), wearing a mask (83.7%), and hand hygiene (82.4%).Conclusions:We need to pay more attention to public psychological stress, especially among young people, as they are likely to experience anxiety, depression, and psychological abnormalities. Different psychological interventions could be formulated according to the psychological characteristics of different gender and age groups. The majority of respondents followed specific behaviors required by the authorities, but it will take time to observe the effects of these behaviors on the epidemic.

简介：摘要OBJECTIVEThe COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands.METHODSA pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19, and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit (ICU). An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group.RESULTSThe recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the ICU, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (-assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.

简介：AbstractMalaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.

简介：AbstractCOVID-19 is known for its magical infectivity, fast transmission and high death toll based on the large number of infected people. From the perspective of the clinical manifestation, autopsy examination and pathophysiology, the essence of COVID-19 should be viewed as a sepsis induced by viral infection, and has the essential characteristics as sepsis induced by other pathogens. Therefore, in addition to etiological and supportive treatment, immunomodulatory therapy is also appropriate to severe COVID-19. Although there is still a lack of consensus on immunotherapy for sepsis so far, relatively rich experiences have been accumulated in the past decades, which will help us in the treatment of severe COVID-19. This article will elaborate immunotherapy of sepsis, though it may not be consistent.

简介：摘要中华医学会、中华医学会神经病学分会主办的"第19次中国脑血管病大会"于2019年4月11—13日在南京召开。本次会议邀请了国内外脑血管病的临床和基础研究专家，介绍了国内外最新的研究进展和临床研究、诊疗指南。尤为精彩的是疑难型脑血管病的病例讨论。

简介：【摘要】目的 评价严重急性呼吸综合征冠状病毒 2（ SAS-CoV-2）特异性免疫球蛋白 G（ IgG）和免疫球蛋白 M（ IgM）检测在 2019年新型冠状病毒疾病（ COVID-19）诊断中的应用价值。方法 本试验采用回顾性研究方法，收集了 2020年 1月 20日～ 4月 16日确诊为 COVID-19患者的 94例血清标本为研究对象，对照组为 161例确诊为非 COVID-19的其他疾病患者的血清标本。通过胶体金免疫层析法检测血清中的 SARS-CoV-2特异性 IgG和 IgM抗体，分析抗体检测对 COVID-19的诊断价值。结果 SAS-CoV-2特异性 IgG/IgM抗体诊断 COVID-19的敏感性 96.81%，特异性 98.14%，准确度 97.65%，显示出良好的诊断效果；发病时间在 0-7d的 COVID-19患者的 IgG抗体阳性和 IgM抗体阳性结果间的差异有统计学意义（ P＜ 0.05）。结论 SAS-CoV-2特异性 IgG或 IgM抗体检测在 COVID-19的临床诊断中有重要应用价值，是 COVID-19的重要诊断和筛查指标。

简介：摘要新冠状病毒病(COVID－19)自2019年12月在我国发现以来，目前已在全球213个国家爆发，540多万人受累，并导致近35万人死亡，WHO将其定义为全球大流行。COVID－19除了表现为呼吸系统病变，在重症患者还可能合并有其他脏器损伤，部分患者可出现肾脏损伤，如发生血尿、蛋白尿，血尿素氮或血清肌酐水平升高等；危重症患者中急性肾损伤的发生率较高且影响患者预后。本文将从COVID－19患者肾损伤流行病学及临床特点、发病机制、病理表现、治疗和预后等方面综述，希望能从肾脏病专科角度为COVID－19的防控提供相关信息。

简介：摘要2019冠状病毒病（COVID-19）在我国暴发以来，目前进入全民防控阶段，其主要传染源是新型冠状病毒肺炎患者，但无症状感染者也可能成为传染源，因孕妇机体处于免疫抑制状态，对呼吸道病原体更易感，易发展为重症。疫情期间，孕产妇仍需要至医院进行必要的产前检查或终止妊娠等产科干预。针对以上特殊性，首都医科大学附属北京佑安医院制定了在疫情之下孕产妇的诊疗流程，调整和优化门诊产检及住院治疗过程，力求把疫情对孕产妇诊疗的影响降到最低，保证母婴健康。同时制定医护人员相关防护流程，有效避免院内感染发生，为疫情期间产科诊疗方案的制定提供参考。

简介：AbstractCoronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.

简介：摘要原发性甲状腺淋巴瘤（primary thyroid lymphoma, PTL）在人群中罕见，随着粗针穿刺活检技术诊断效率的提高，PTL手术治疗的作用减小，但在不能明确病理亚型时手术活检仍是不可取代的，PTL的预后主要和病理类型及疾病的分期有关。

简介：摘要目的分析新型冠状病毒肺炎(COVID-19)老年患者临床特征及预后影响因素，为临床诊治提供参考依据。方法回顾性分析确诊COVID-19住院患者109例，其中老年组39例，非老年组70例，比较两组的各项临床资料及预后。结果COVID-19老年组发生重型、危重型比例高于非老年组[48.7%(19/39)]比[15.7%(11/70)]，P＝0.032。老年组有慢性基础病患者比例明显高于非老年组[84.6%(33/39) ]比[30%(21/70)]，P＝0.003。老年组伴有胸闷15例(38.5%)、喘憋12例(30.8%)高于非老年组胸闷13例(18.6%)、喘憋3例(43%)，P<0.05。实验室检查指标中老年组外周血淋巴细胞绝对计数比非老年组明显降低(P＝0.029)。老年组C-反应蛋白、粒淋比(NLR)比非老年组明显升高(P<0.001)。老年组丙氨酸氨基转移酶(ALT)、谷氨酸氨基转移酶(AST)、白蛋白(ALB)、肌酐(CREA)、肌酸激酶(CK)、肌红蛋白(MYO)异常值高于非老年组(P<0.05)。其中年龄、基础病、NLR是影响预后的独立危险因素。结论COVID-19老年组患者常合并多种基础病，更易出现心、肝、肾功能异常，更易发展为重型、危重型病例。影响预后的因素包括年龄大于60岁、有基础病和血清NLR水平。

简介：AbstractBackground:The ongoing new coronavirus pneumonia (Corona Virus Disease 2019, COVID-19) outbreak is spreading in China, but it has not yet reached its peak. Five million people emigrated from Wuhan before lockdown, potentially representing a source of virus infection. Determining case distribution and its correlation with population emigration from Wuhan in the early stage of the epidemic is of great importance for early warning and for the prevention of future outbreaks.Methods:The official case report on the COVID-19 epidemic was collected as of January 30, 2020. Time and location information on COVID-19 cases was extracted and analyzed using ArcGIS and WinBUGS software. Data on population migration from Wuhan city and Hubei province were extracted from Baidu Qianxi, and their correlation with the number of cases was analyzed.Results:The COVID-19 confirmed and death cases in Hubei province accounted for 59.91% (5806/9692) and 95.77% (204/213) of the total cases in China, respectively. Hot spot provinces included Sichuan and Yunnan, which are adjacent to Hubei. The time risk of Hubei province on the following day was 1.960 times that on the previous day. The number of cases in some cities was relatively low, but the time risk appeared to be continuously rising. The correlation coefficient between the provincial number of cases and emigration from Wuhan was up to 0.943. The lockdown of 17 cities in Hubei province and the implementation of nationwide control measures efficiently prevented an exponential growth in the number of cases.Conclusions:The population that emigrated from Wuhan was the main infection source in other cities and provinces. Some cities with a low number of cases showed a rapid increase in case load. Owing to the upcoming Spring Festival return wave, understanding the risk trends in different regions is crucial to ensure preparedness at both the individual and organization levels and to prevent new outbreaks.

简介：摘要目的对安徽省新型冠状病毒肺炎(COVID-19)病例标本进行新型冠状病毒核酸检测，分析各类标本检出情况，为病例确诊及判断样本带毒风险提供依据。方法采用实时荧光RT-PCR方法检测197病例466份临床标本，病毒靶基因为ORF1ab和N，应用卡方检验探讨不同标本在不同临床分型和发病时间核酸阳性率差异。结果COVID-19病例痰液标本在各临床标本中阳性率最高94.67%(160/169)，其次为咽拭子88.83%(159/179)，血清6.78%(4/59)，全血标本阳性率较低，为5.08%(3/59)。发病0～7 d普通型患者咽拭子阳性率和痰液阳性检出率差异有统计学意义(χ2＝8.994，P＝0.003)。结论痰液标本核酸阳性检出率高于咽拭子标本，COVID-19病例血液标本存在病毒核酸，存在感染风险。

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简介：摘要目的研究血清微小RNA-21(miRNA-21)与肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白(CYFRA21-1)、神经元特异性烯醇化酶(NSE)]对早期非小细胞肺癌的诊断价值。方法从2018年1月至2019年3月大庆龙南医院所收治的恶性肿瘤患者中选取22例非小细胞肺癌患者为研究组，再选择相同时间段内在该院进行健康体检的22例为对照组。对两组对象进行相应检查，对血清miRNA-21、主要肿瘤标志物的水平、以及病理类型与标志物水平的关系进行分析。结果研究组血清miRNA-21(2.15±0.9)、CEA(34.1±4.9)ng/mL、NSE(27.1±2.2)ng/mL、CYFRA21-1(12.1±1.2)ng/mL，均高于对照组(t＝6.524、27.392、23.339、27.685，均P＝0.000)；腺癌患者血清微小RNA-21(1.88±1.14)、CEA(30.1±19.9)ng/mL、细胞角蛋白(12.8±5.2)ng/mL，均低于鳞癌患者，NSE[(26.1±3.2)ng/mL]水平高于鳞癌患者，差异均有统计学意义(t＝1.158、1.192、0.423、1.913，P＝0.260、0.247、0.677、0.070)；Ⅲ～Ⅳ期非小细胞肺癌患者血清miRNA-21(2.58±0.96)、CEA(38.1±17.9)ng/mL、CYFRA21-1(16.8±6.2)ng/mL、NSE(26.9±10.2)ng/mL，均高于Ⅰ～Ⅱ期非小细胞肺癌患者，但仅CYFRA21-1差异有统计学意义(P<0.05)，其它三项差异无统计学意义(t＝1.478、0.574、2.114、1.015，P＝0.155、0.573、0.047、0.322)。结论非小细胞肺癌患者接受血清miRNA-21与肿瘤标志物CEA、CYFRA21-1、NSE的联合检查，诊断准确率较高，这对于患者的诊治与预后评估等十分关键，可作为非小细胞肺癌患者的首选诊断方式。

简介：摘要目的观察CD5+CD19+B细胞在体外是否具有分泌IL-10的功能，并探讨其在HBV感染过程中对CD8+细胞的作用和机制。方法纳入2017年7月至2018年6月在南京医科大学附属无锡第二医院确诊的慢性乙型肝炎(乙肝组)23例、肝硬化(肝硬化组)18例患者，以及同期健康对照(健康对照组)19名。通过外周血单个核细胞(PBMC)分离、细胞培养、流式细胞术分析、CD5+CD19+B细胞分离等操作，比较3组CD5+CD19+B细胞含量较多(占淋巴细胞百分比>6%)的患者比例、CD5+CD19+B细胞分泌IL-10的情况和IL-10+细胞含量较多(占淋巴细胞百分比>4%)的患者比例，分析CD5+CD19+B细胞对CD8+细胞分泌γ干扰素的影响和可能机制。通过对慢性乙型肝炎13例和肝硬化5例患者行肝活组织和免疫组织化学检查，分析CD5+CD19+B细胞在人体肝组织中表达情况。统计学分析采用卡方检验和Fisher确切概率法。结果肝硬化组中CD5+CD19+B细胞含量较多的患者比例高于健康对照组(8/18比2/19)，差异有统计学意义(Fisher确切概率法，P＝0.029)。健康对照组(10名)、乙肝组(23例)、肝硬化组(18例)的CD5+CD19+B细胞分别占IL-10+细胞的81.6%、82.3%、70.1%，IL-10+细胞含量较多的患者分别为2、7和2例，3组比较差异均无统计学意义(P均>0.05)。在脂多糖刺激培养48 h后，健康对照组(10名)CD8+γ干扰素+细胞占淋巴细胞百分比与乙肝组(10例)、肝硬化组(10例)比较(10.73%比7.05%和9.52%)差异均无统计学意义(P均>0.05)；剔除CD5+CD19+B细胞后，健康对照组(10名)、乙肝组(10例)和肝硬化组(10例)中分别有5、4、4例患者CD8+γ干扰素+细胞占淋巴细胞百分比升高。添加IL-10受体阻滞剂后，PBMC中CD8+γ干扰素+占淋巴细胞百分比较添加IL-10受体阻滞剂前升高(7.23%比6.87%)。肝活组织标本免疫组织化学分析结果显示，CD4+和CD8+细胞在患者肝小叶汇管区强表达，CD5+和CD19+细胞较少表达。结论CD5+CD19+B细胞在HBV慢性感染的进展过程中并未体现出明显数量和功能上的差异，但对CD8+细胞分泌γ干扰素的能力具有抑制作用，并且可能是通过分泌IL-10而不是通过细胞间的直接接触实现。

简介：摘要慢性鼻-鼻窦炎是发生在鼻腔及鼻窦黏膜的炎症性疾病，可受多种免疫细胞、免疫因子的调节。白细胞介素-19（IL-19）可引起上皮细胞介导的固有免疫反应并维持上皮细胞的屏障功能；同时，可以促进损伤组织的愈合，对疾病的发展具有保护性作用。研究发现，白细胞介素-27（IL-27）可抑制Th2细胞和Th17细胞分化，同时上调调节性T细胞水平，从而抑制炎症反应。本文基于IL-19和IL-27相关生物学特性及在慢性鼻窦炎发病机制中的作用进行综述。

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简介：摘要:为了较好的培养学生的习作的能力，进一步提升学生完成习作作业的积极性，教师在教学过程中通常会运用到片段训练的方式，要想保证片段训练的实际效果，就要注重片段训练的命题思路的调整，同时也要建立科学系统的评价机制。命题时，需要注意命题的合理性，在发挥学生想象力的同时，也要能够达到教师片段训练的目的。科学的高质量命题对于锻炼学生的观察能力具有积极的作用，也能够使学生通过片段训练的过程，进一步提升表达能力，这对于改善学生的习作能力可以打下坚实的基础。对于教师而言，良好的片段训练质量可以改善教师的教学效果，对于改善师生互动的积极性具有实际价值，这对于激发学生的学习兴趣和改善教师的教学积极性具有益处。