Ulinastatin in the treatment of severe acute pancreatitis:A singlecenter randomized controlled trial

BACKGROUND Severe acute pancreatitis(AP)is one of the most common diseases of the gastrointestinal tract and carries a significant financial burden with high disability and mortality.There are no effective drugs in the clinical management of severe AP,and there is an absence of evidence-based medicine concerning the treatment of severe AP.AIM To explore whether ulinastatin(UTI)can improve the outcome of severe AP.METHODS The present research included patients who were hospitalized in intensive critical care units(ICUs)after being diagnosed with severe AP.Patients received UTI(400000 IU)or placebos utilizing computer-based random sequencing(in a 1:1 ratio).The primary outcome measures were 7-d mortality,clinical efficacy,inflammatory response,coagulation function,infection,liver function,renal function,and drug-related adverse effects were evaluated.RESULTS A total of 181 individuals were classified into two groups,namely,the placebo group(n=90)and the UTI group(n=91).There were no statistically significant differences in baseline clinical data between the two groups.The 7-d mortality and clinical efficacy in the UTI group were remarkably improved compared with those in the placebo group.UTI can protect against hyperinflammation and improve coagulation dysfunction,infection,liver function,and renal function.UTI patients had markedly decreased hospital stays and hospitalization expenditures compared with the placebo group.CONCLUSION The findings from the present research indicated that UTI can improve the clinical outcomes of patients with severe AP and has fewer adverse reactions.

Influence of separator control on the characteristics of severe slugging flow

Due to the special structure of offshore multiphase pipes, it is easy for severe slugging to occur in the riser at low gas-liquid velocity. Violent pressure fluctuations and dramatic changes of flow rate are the main characteristics of severe slugging, leading to the risk of serious damage. In this paper, the separator control is adopted to accurately control the separator liquid level and pressure under severe slugging flow conditions. This indicates that the separator liquid level control alone does not have a significant impact on the upstream flow, but it is beneficial for normal operation and pressure control of the separator. As the separator pressure increases, the peak pressure in the riser apparently diminishes, and the amplitude of pressure fluctuation gradually decreases, which means that severe slugging is inhibited. During the slug blowing out, the gas/liquid slipping in the riser intensifies. The long gas plug quickly flows through the riser, and then tends to morph into short and slowly flowing gas bubbles. The elimination effect of the pressure control strategy on severe slugging is related to the relative rate of the superficial gas/liquid flow.

Infection control in severely burned patients

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections(NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag(Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help thecontrol of infection in these immunocomprimised patients. Strict infection control practices(physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Application of Quality Control Circle Activity in Improving Effectiveness of Drug Intervention in Lung Cancer Patients with Moderate to Severe Pain

Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.

Risk prevention and control strategies for the severely affected areas of snow disaster in the Three Rivers Source Region(TRSR), China

Historically,frequent and heavy snow disaster(SD)has caused serious livestock death and casualties,resulting in a devastating impact on animal husbandry development in the Three Rivers Source Region(TRSR).From winter in 2018 to spring in 2019,the largest SD occurred in this area over the past 10 years,especially in core zones of the Lancang River Source Region.Field research results show that the main causes of the major SD include weak infrastructure(i.e.,roads,communications,warm sheds,and insufficient forage reserve),low rate of domestic animals for sale before the SD,and low loss settlement rate.SD occurrence could furtherly reduce the ability of disaster prevention,mitigation and relief of disaster loss.In the future,heavily affected SD areas should improve the forecasting ability of snowfall incidents,strengthen infrastructure construction,implement grass and livestock balance strategies,optimize livestock structure,improve loss settlement rate,and develop a modern compound model of animal husbandry development model that combines breeding,slaughtering and deep processing of animal product.

Damage control surgery for severe pancreatic trauma

Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS

Evaluation of the Severity of Maxillo-Facial Injuries by Motorcycle Road Accident in the Teaching Hospital of Conakry: A Case-Control Study

Introduction: Maxillofacial injuries caused by motorcycle road accidents are serious and represent a real public health issue. They mainly affect young adult males. The objectives of this study were to determine the frequency of motorcycle road accidents, describe the socio-demographic characteristics of the injured, determine the degree of severity of motorcycle injuries compared to car injuries, and describe the therapeutic modalities. Materials and Method: This study was a prospective case-control study carried out in the Department of Odontostomatology, Maxillofacial Surgery and Surgical Emergencies at the National Hospital of Donka. The data was collected over a period of six months from January 1st to June 30th, 2017. All victims of road accidents by motorcycle (cases) or car (controls) that received care and post-surgical follow up were included. Results: A total of 505 patients with maxillofacial injuries were reviewed during the period of the study. From the review, 205 (40.6%) motorcycle accidents were recorded as “cases” and 109 (21.58%) car accidents were classified as “controls” group. Men were the most affected in both groups, n = 254 (177 males in the case group and 77 in the control) (p = 0.01). There was a proportionate relationship between helmet use and death (p = 0.015). A motorcycle accident victim is more likely to develop a mandibular fracture (p = 0.029) and limb injury (p = 0.034) when compared to a car accident victim. However, there was no significant difference between cases and controls for head trauma (p = 0.4878), Facial Injury Severity Scale (FISS) (p = 0.130), and Glasgow score (p = 0.709). Conclusion: Maxillofacial injuries caused by motorcycle accidents are increasing in Guinea. Young adult males have the highest incidence of motorcycle accidents. The death rate related to motorcycle road accidents is high, and mandatory use of a helmet for all drivers and passengers is recommended. These preventative actions could reduce the mortality and morbidity of motorcycle road accidents in Guinea.

济南市发热伴血小板减少综合征发病与动物接触相关性调查研究

目的探索发热伴血小板减少综合征发病与动物接触相关性分析,为防控提供参考依据。方法采用病例对照研究方法,将2019—2023年济南市发热伴血小板减少综合征确诊患者纳入病例组,按比例选择病例发病同期居住地附近的健康居民为对照组,收集相关信息,进行相关性分析。结果本研究共纳入485例确诊病例和1455例健康居民,相关因素分析显示,家中饲养动物(OR=2.146,95%CI:1.738~2.651)、饲养犬(OR=1.847,95%CI:1.468~2.324)、饲养猫(OR=1.392,95%CI:1.038~1.867)、饲养羊(OR=2.076,95%CI:1.470~2.932)、饲养家禽(OR=1.542,95%CI:1.141~2.083)、饲养兔子(OR=4.339,95%CI:2.346~8.024)、住宅内有动物圈舍(OR=1.560,95%CI:1.193~2.039)是发热伴血小板减少综合征发病的危险因素。结论饲养动物是发热伴血小板减少综合征发病的危险因素,应加强高风险人员健康教育及行为干预,来预防和控制发热伴血小板减少综合征的发病。

支气管哮喘患儿血清LCN2、SDC⁃1水平及临床意义

目的分析支气管哮喘患儿血清脂质运载蛋白2(LCN2)和多配体蛋白聚糖1(SDC⁃1)水平,并探讨两者与病情严重程度、哮喘控制水平的关系,以及对儿童支气管哮喘的诊断价值。方法纳入112例支气管哮喘患儿作为哮喘组,104例健康儿童作为正常组。根据病情严重程度再将哮喘组患儿分为轻度间歇组(36例)、轻度持续组(25例)、中度持续组(32例)和重度持续组(19例)。比较哮喘组与正常组之间,以及哮喘组不同病情严重程度患儿之间血清LCN2、SDC⁃1水平。分析哮喘组患儿血清LCN2和SDC⁃1的相关性,以及二者与第1秒用力呼气量(FEV_(1))、FEV_(1)/用力肺活量(FVC)值、儿童哮喘控制测试(C⁃ACT)评分的相关性。绘制受试者工作特征(ROC)曲线分析血清LCN2、SDC⁃1水平对儿童支气管哮喘的诊断价值。结果与正常组相比,哮喘组血清LCN2、SDC⁃1水平升高(P<0.05)。轻度间歇组、轻度持续组、中度持续组、重度持续组支气管哮喘患儿血清LCN2、SDC⁃1水平依次升高(P<0.05)。支气管哮喘患儿血清LCN2水平与血清SDC⁃1水平呈正相关,血清LCN2和SDC⁃1水平分别与FEV_(1)、FEV_(1)/FVC值、C⁃ACT评分呈负相关(P<0.05)。血清LCN2、SDC⁃1水平联合诊断儿童支气管哮喘的曲线下面积(AUC)为0.881,大于血清LCN2、SDC⁃1水平单独诊断的AUC(分别为0.778和0.768,P<0.05)。结论支气管哮喘患儿血清LCN2、SDC⁃1水平升高,且与病情严重程度和哮喘控制水平有关。血清LCN2、SDC⁃1水平可作为辅助诊断儿童支气管哮喘的生物标志物,且两者联合诊断的效能更高。

有创颅内压监测下控制性阶梯式减压在重型颅脑损伤中的应用

目的:探讨有创颅内压监测下控制性阶梯式减压法治疗重型颅脑损伤者的应用价值。方法:选取2022年7月—2023年7月肇庆市第一人民医院收治的82例重型颅脑外伤者作为研究对象,将其分为对照组和试验组,每组各41例。患者均未行手术治疗,且处于急性期。对照组常规监测生命体征变化情况,试验组行脑室型有创颅内压监测探头植入术。比较两组颅内压、并发症发生率(迟发血肿、术后脑梗塞)、死亡率、格拉斯哥昏迷评分法(Glasgow Coma Scale,GCS)评分及预后情况。结果:术后6 h、12 h、24 h,对照组颅内压指标高于试验组,差异有统计学意义(P<0.05)。对照组术后并发症发生率高于试验组,差异有统计学意义(P<0.05)。术后24 h、72 h、7 d,两组GCS评分比较,差异无统计学意义(P>0.05)。术后3个月,对照组恢复良好率低于试验组,差异有统计学意义(P<0.05)。结论:有创颅内压监测下控制性阶梯式减压疗法应用于重型颅脑损伤患者中效果理想,可改善患者颅内压指标,降低术后并发症发生率及死亡率,患者可更快恢复意识,改善预后。

重度颅脑创伤病人损伤控制复苏护理方案的构建

目的:构建重度颅脑创伤病人损伤控制复苏护理方案。方法:组建研究团队,通过回顾文献、相关问题讨论,拟定临床护理方案的初稿,采用德尔菲法进行两轮专家函询,征询专家意见,最终确定重度颅脑创伤病人损伤控制复苏的护理方案。结果:两轮专家函询问卷的有效回收率分别为93.33%、100.00%,专家权威系数为0.83,0.87,专家意见的肯德尔和谐系数为0.35,0.39,最终形成的护理方案包括2个一级条目,15个二级条目,46个三级条目。结论:构建的重度颅脑创伤病人损伤控制复苏护理方案科学、可靠、适用,可为临床护理工作提供参考。

送端交流系统故障引发逆变侧换相失败机理分析及抑制策略

针对送端交流系统故障恢复期间引发逆变侧换相失败的问题,首先,基于交直流系统无功功率交互作用机理及关断角表达式深入剖析了逆变侧的运行特性,阐明了不同故障严重程度下直流电流上升速度与幅值变化规律,得出直流电流在轻微故障下过大的幅值及严重故障下过快的上升速度是导致换相失败的主要原因。其次,定量计算了不同故障严重程度下的整流器无功消耗量指令值,建立了整流器无功消耗量与直流电流、直流电压的数学关系,据此提出一种基于整流器无功功率控制的换相失败抑制策略。最后,基于PSCAD/EMTDC的仿真结果验证了理论分析的准确性以及所提抑制策略的有效性。

血必净联合控制性阶梯式减压术对重型颅脑损伤疗效及脑血流动力学的影响

目的:探讨血必净联合控制性阶梯式减压术对重型颅脑损伤患者疗效及脑血流动力学的影响。方法:选取2019年7月—2022年10月新泰市人民医院收治的68例重型颅脑损伤患者,以随机数字表法分成研究组(n=34)与对照组(n=34)。对照组给予控制性阶梯式减压术治疗,研究组给予血必净联合控制性阶梯式减压术治疗。比较两组临床疗效、脑血流动力学、神经功能、预后及并发症发生率。结果:研究组治疗总有效率(97.06%)较对照组(76.47%)更高(P<0.05)。术后7 d,两组脑血容量(CBV)、脑血流量(CBF)较术前均增加(P<0.05),达峰时间(TTP)、平均通过时间(MTT)均缩短(P<0.05);与对照组相比,研究组CBV、CBF均更高(P<0.05),TTP、MTT均更短(P<0.05)。术后7 d,两组格拉斯哥预后(GOS)评分较术前均提高(P<0.05),神经功能缺损程度评分量表(CSS)评分较术前均降低(P<0.05);与对照组相比,研究组GOS评分更高(P<0.05),CSS评分更低(P<0.05)。研究组并发症发生率(5.88%)较对照组(26.47%)更低(P<0.05)。结论:血必净联合控制性阶梯式减压术用于治疗重型颅脑损伤,可促进临床疗效提高,增强脑血流动力学,改善患者神经功能及预后,降低并发症发生风险。

硝苯地平控释片联合厄贝沙坦氢氯噻嗪治疗社区中重度高血压的临床疗效研究

目的探讨对于社区中重度高血压患者实施硝苯地平控释片联合厄贝沙坦氢氯噻嗪方案进行治疗的效果。方法选取社区服务中心在2021年3月至2023年3月此阶段内就诊的中重度高血压患者,以其中100例进行随机分组研究,对照组50例以硝苯地平控释片治疗,观察组50例在对照组基础上联合厄贝沙坦氢氯噻嗪,对两组血压控制情况,安全性等进行比较。结果治疗前,两组血压水平比较差异不明显(P>0.05);经干预后均改善,且观察组治疗后的DBP、SBP水平低于对照组(P<0.05);观察组经联合治疗后其血压得到良好控制,其总有效率达到96.00%较对照组高(P<0.05);在治疗后的生活质量方面方面,观察组干预后的生活质量得分多于对照组(P<0.05);药物安全性方面,观察组出现不良反应发生率较对照组要低(P<0.05)。结论对于社区收治的中重度高血压患者,采取硝苯地平控释片联合厄贝沙坦氢氯噻嗪治疗方案,效果肯定,血压控制率良好,且进一步降低血压水平,提高生活质量,且降低用药期间不良反应发生率。

超早期复苏性主动脉球囊阻断术治疗失血性休克猪模型

目的构建标准化复苏性主动脉球囊阻断术(REBOA)进行损害控制性复苏治疗失血性休克猪模型。方法10只约克夏猪雌雄不限,平均体重(39.0±3.0)kg,随机选择2只作为预实验,其余按密封信封抽签的方法随机分成对照组和REBOA组,每组4只(最终各组成功入组2只)。两组通过肠系膜上动脉一级分支放血自体容量45%来制作失血性休克猪模型。两组均进行损害控制性液体复苏,包括输液扩容、药物升压等。其中REBOA组在此基础上予REBOA阻断控制出血,阻断40 min后在10 min内缓慢放松球囊,恢复膈肌以下血流灌注10 min,反复阻断3个周期。实验开始记为T0,开始救治时间记为T1,每间隔1 h记为时间点T2、T3、T4,观察终点记为T5,分别记录6个时间点的HR、MAP、pH、乳酸(Lac)、碱剩余(SBE);记录T0、T1、T4、T5共4个时间点的Hb、HCT、PT、APTT、纤维蛋白原(FIB)。结果与对照组相比较,REBOA组具有较好的血流动力学和循环代谢,主要表现在T1~T5期间HR、MAP、pH、Lac、SBE变化区间较小,区间差值小于对照组(HR53.0次/min vs.116.0次/min,MAP 47.0 mmHg vs.66.0 mmHg,pH 0.37 vs.0.50,Lac 10.6 mmol/L vs.15.0 mmol/L,SBE 21.6 mmol/L vs.25.1 mmol/L),且在观察终点T5时REBOA组优于对照组(HR89.0次/min vs.50.0次/min,MAP 78.0 mmHg vs.27.0 mmHg,pH 7.23 vs.6.90,Lac 6.6 mmol/L vs.16.9 mmol/L,SBE-6.1 mmol/L vs.-18.9 mmol/L)。REBOA组的Hb、HCT在T4、T5时均高于对照组。与对照组相比,REBOA组凝血功能更优,主要表现在观察终点T5时APTT低于对照组,FIB高于对照组,而两组PT差异不大。结论超早期应用REBOA进行损害控制性复苏是治疗严重创伤、不可压迫躯干出血的有效手段,本研究可为今后进一步研究REBOA提供标准化动物模型。

控制性减压一体化策略对重型颅脑创伤患者颅内压、神经递质、血管内皮功能的影响

目的 探讨控制性减压一体化策略对重型颅脑创伤(STBI)患者颅内压、神经递质、血管内皮功能的影响。方法 选取2020年6月至2022年6月湖南省脑科医院收治的85例STBI患者为研究对象,采用随机数字表法分为控制性减压组(给予控制性减压一体化策略下去骨瓣减压术,43例)和非控制性减压组(给予常规去骨瓣减压术,42例)。比较分析两组患者手术前后的颅内压、格拉斯哥昏迷量表(GCS)评分、神经递质[γ-氨基丁酸(GABA)、天冬氨酸(Asp)]、血流动力学水平[搏动指数(PI)、平均血流速度(Vm)、收缩期最大血流速度(Vs)]、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)]。比较分析两组患者术后7 d的不良反应发生情况以及术后6个月的预后情况。结果 与术前比较,两组患者术后3、7 d的颅内压、Asp、PI、ET-1均降低,GCS评分、GABA、Vm、Vs、NO均升高,差异均有统计学意义(P<0.05)。术后3、7d,控制性减压组患者的颅内压、Asp、PI、ET-1均低于非控制性减压组,GCS评分、GABA、Vm、Vs、NO均高于非控制性减压组,差异均有统计学意义(P<0.05)。术后7 d,控制性减压组患者的不良反应发生率低于非控制性减压组,差异有统计学意义(P<0.05)。术后6个月,控制性减压组患者的预后优于非控制性减压组,差异有统计学意义(P<0.05)。结论 应用控制性减压一体化策略可有效降低STBI患者的颅内压,改善血管内皮功能,促进神经功能恢复及预后改善,且安全性较好。

2022年嘉兴市稻田杂草重发特点、原因分析及防控对策

由于异常高温干旱天气影响除草效果、直播栽培模式利于杂草生长、田间管理粗放易形成草害或药害等,2022年浙北平原稻区杂草发生程度重、发生类型多、防治效果差,草害明显重于常年。文章以嘉兴市为例,分析了2022年嘉兴地区稻田杂草重发特点及其原因,提出了下一步稻田杂草综合治理的对策及建议:一要完善农田基础设施,推进高标准农田建设,增强防灾减灾能力;二要大力推广水稻机插秧,改直播为移栽,减轻杂草发生;三要完善杂草防治技术,大力宣传推广,提高技术覆盖率。

循证护理在重症脑卒中患者呼吸机相关性肺炎中的应用

目的分析循证护理在重症脑卒中患者呼吸机相关性肺炎中的应用效果。方法随机选取2021年1月-2023年1月丰县人民医院急诊监护室收治的90例重症脑卒中合并呼吸机相关性肺炎患者为研究对象,按随机数表法分为对照组与观察组,每组45例。对照组采用常规护理,观察组采用循证护理。分析比较两组生活质量等指标。结果与对照组相比,观察组患者生活质量、舒适度评分较高,差异有统计学意义(P均<0.05)。观察组护理满意度(100.00%)高于对照组,差异有统计学意义(χ^(2)=11.250,P<0.05)。结论在重症脑卒中呼吸机相关性肺炎患者中采用循证护理的效果较好。

严寒地区电厂锅炉房底层负压控制及余热利用的研究与应用

严寒地区电厂锅炉房是具有内热源的超高大空间建筑,冬季底层负压大,供暖效果难以保障。本文提出了从锅炉房上部送入室外空气的解决方案。采用该方案可以使室内压力增大,底层负压和冷风渗透量减小,还能使热量向下传递。由于锅炉房设备散热量远大于供暖热负荷,在送风量合适的情况下,可关停供暖系统而不影响底层的供暖效果,既保证了底层设备不被冻坏,又节省了供暖热能,还改善了锅炉房上部的工作环境。

损伤控制性急救一体化在严重多发伤患者救治中的应用

目的:分析损伤控制性急救一体化在严重多发伤患者救治中的应用效果。方法:回顾性分析贵州省骨科医院2020年3月—2023年2月收治的78例严重多发伤患者临床资料,根据不同急救方法进行分组,各39例。参照组实施常规急救模式,研究组实施损伤控制性急救一体化模式。对比两组院内急救时间、确诊时间、住院时间、急救成功率和血浆、浓缩红细胞、晶体溶液输注量,以及创伤严重程度评分(ISS)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分。统计两组不良事件发生率。结果:研究组院内急救时间、确诊时间、住院时间均短于参照组,浓缩红细胞、血浆、晶体溶液输注量均少于参照组(P<0.05);研究组急救成功率为87.18%,高于参照组的66.67%(P<0.05)。急救后,研究组ISS、APACHEⅡ评分均低于参照组(P<0.05)。研究组不良事件总发生率低于参照组(P<0.05)。结论:在严重多发伤患者救治中采用损伤控制性急救一体化模式可提高急救时间效能,有效减少其失血量,提高急救成功率,降低不良事件发生率。