急诊昏迷患者的迅速分诊与急救方法探讨

目的:探讨急诊昏迷患者的迅速分诊与急救方法。方法:参照5级急诊预检分诊系统和急诊危重病降阶梯治疗方法,对我院2012年1月至2014年12月120例急诊治疗昏迷患者进行规范化分诊、急救护理,回顾性分析其诊疗效果。结果:120例昏迷患者有90例(75.00%)治愈出院,17例(14.17%)因病情平稳转至相关科室进行治疗,13例(10.83%)病死,急诊治疗总有效率和病死率分别为89.17%和10.83%。结论:分诊和急救处置的规范化对患者治愈和预后有重要影响。     

Perfil clínico y mortalidad a 90 días de los pacientes centenarios atendidos en servicios de urgencias hospitalarios

ObjectivesTo determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED).MethodologyThis was an observational, retrospective, multicentre cohort study including patients > 99 years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality.ResultsThe study included 209 patients aged 101 years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index ≥ 3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90 days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI = 0.97-6.04; P = .059), emergency care in the previous 3 months (OR 4.08 95% CI = 1.26-13.16; P = .019) and the hospitalization by index event (OR 8.63 95% CI = 3.25-22.9; P < .001) and this model had an area under ROC curve of 0.776 (95% CI = 0.70-0.85; P < .001).ConclusionsCentenarian patients attended in ED had a significant frailty and one in three cases died in the first 90 days after being attended, and this was associated with male sex, emergency care in the previous 3 months, and hospitalisation.     

黑龙江省辖区内“120”急救中心调度员工作量及职业压力现状研究

目的:调查黑龙江省辖区内的120急救调度中心调度员的工作量与职业压力情况,为在120急救中心进行人力资源优化配置提供支持。方法:通过基础工作量问卷与工作内容量表(JCQ)问卷对黑龙江省内8家"120"急救调度中心内共计62名急救中心调度员进行调查和统计分析,并对调度科室主任进行访谈。结果:调度员的通话量呈现明显的地区差异性并异常地高于调度量,调度员的工作属于积极型的工作状态,但是决策自主度的分数较低,而技术自主度则与通话量和调度量具有明显线性关系(P0.05),调度时间与上司支持和同事支持有显著相关性(P0.05)。结论:黑龙江省辖区内的急救调度中心依旧处于组织结构复杂化、资源分配不均的情况,需要对调度员缩短调度时间进行训练以及对市民进行急救知识教育以减少无用通话的数量。     

An Ultra‐Mechanosensitive Visco‐Poroelastic Polymer Ion Pump for Continuous Self‐Powering Kinematic Triboelectric Nanogenerators

A mechanosensitive, visco‐poroelastic polymer ion pump that can rapidly establish a dense electrical double layer via mechanical pressure, thereby significantly enhancing output performance of an ionic triboelectric nanogenerator (iTENG), is described. A working mechanism of an iTENG using a highly mechanosensitive, visco‐poroelastic ion pump is suggested and the optimal characteristics of the polymer ion pump are reported by investigating optical, mechanical, electrical, and electrochemical properties. Surprisingly, the pressure sensitivity of the iTENG reaches 23.3 V kPa^?1, which is tens of times the record value. To achieve controlled high‐frequency pulses from an iTENG, kinematic systems using a gear train and a cam are integrated with a single grounded iTENG, which produces a maximum of 600 V and 22 mA (≈2.2 W cm^?2) at an input frequency of 1.67 Hz; after power transforming, those values are converted to 1.42 V and 225 mA. A capacitor of 1 mF can be fully charged to 2 V in only 60 s, making it possible to continuously operate a wireless‐communicating self‐powered humidity sensor. Also, due to the high transparency and deformability of the polymer ion pump, a self‐powered transparent tactile sensor is successfully assembled using a 5 × 5 iTENG array.     

Rational Structure Optimized Hybrid Nanogenerator for Highly Efficient Water Wave Energy Harvesting

Water wave energy is a promising renewable energy source that may alleviate the rising concerns over current resource depletion, but it is rarely exploited due to the lack of efficient energy harvesting technologies. In this work, a hybrid system with a triboelectric nanogenerator (TENG) and an electromagnetic generator (EMG) based on an optimized inner topological structure is reported to effectively harvest water wave energy. The TENG with etched polytetrafluoroethylene films and Cu electrodes utilizing the contact‐freestanding mode is designed into a cubic structure, in which the EMG is well hybridized. An integration of TENG and EMG achieves mutual compensation of their own merits, enabling the hybrid system to deliver satisfactory output over a broad range of operation frequency. The output performance of TENG with varied inner topological structures is experimentally and theoretically compared, and a concept is proposed to further clarify the energy conversion efficiency, which should be considered in designing energy harvesting devices. The influences of oscillation frequency, amplitude, and dielectric materials on the output performance of the hybrid system are comprehensively studied on different platforms. Furthermore, the optimum operation frequency ranges for TENG and EMG are concluded. The proposed hybrid nanogenerator renders an effective approach toward large‐scale blue energy harvesting over a broad frequency range.     

Isolation of Candida in the blood cultures of patients admitted to the Emergency Room in a tertiary care hospital

BackgroundIn Spain, data of candidemia are limited to surveys conducted in specific areas or tertiary care centers. Also, in recent years, attention has shifted toward episodes of candidemia in non-ICU wards.AimsWe reviewed the cases of Candida isolates recovered from the blood of patients admitted to the Emergency Room (ER) in our tertiary care hospital.MethodsThe patients selected for this study had an isolation of Candida in the blood culture. All data were collected retrospectively from the clinical records of a 11-year period.ResultsCandida albicans and other species of the genus were present in 10 and 18 patients, respectively. The patients did not present different clinical features in comparison with other reports of hospitalized patients. All patients had several risk factors for candidemia. Only two patients had received previous antifungal therapy before admission. All the isolates of C. albicans, Candida glabrata and the only isolate of Candida tropicalis were susceptible to all the antifungal agents tested. Only one isolate of Candida parapsilosis was susceptible dose-dependent to fluconazole, and the only isolate of Candida metapsilosis was resistant to fluconazole.ConclusionsIt is essential to evaluate the risk factors, underlying conditions and clinical features in non-hospitalized patients in order to determine whether an empirical treatment for candidemia is appropriate.     

THE YANGTZE RIVER-FLOODPLAIN ECOSYSTEM: MULTIPLE THREATS AND HOLISTIC CONSERVATION北大核心CSCD

The Yangtze (Changjiang) river-floodplain is one of the most important ecosystems in China and the world, but is seriously threatened by multiple stresses. Thus, it is crucial and urgent to rehabilitate and conserve the river-floodplain. This paper reviews ecological studies conducted on the Yangtze river-floodplain, and presents suggestions for conservation and rehabilitation. First, basic concepts and research advances of riverscape and hydrological connectivity are introduced. Second, the history and current status of the Yangtze River system are summarized. Before 23 Ma, the Yangtze River cut through the Three Gorges, forming the river much like the modern one. Numerous rivers, streams, lakes (the total area 15770 km2 at present) and wetlands are distributed in the mid-lower Yangtze river-flood-plain. Such a river-lake complex ecosystem holds a unique and diverse biota, and is the most important fishery area of China. Third, main threats to the Yangtze river-floodplain ecosystem are identified, i.e., a) habitat loss, including river channelization, sharp shrinkage of lake area (ca. 10000 km2 since the 1950s), degradation of lakeshore zones and sand over-mining; b) alternations of hydrological regimes, including construction of ca. 47000 reservoirs and disconnection of most lakes from the mainstem; c) water pollution, including eutrophication, heavy metals, organic pollutants and microplastic; d) overexploitation of biological resources, including overfishing and intensive pen culture. Fourth, effects of river-lake disconnection on lake ecosystems are summarized. It was found that a) disconnection is one of the main causes of lake eutrophication; b) species diversity, biomass, production of macrophytes and macrobenthos reach maxima at some levels of intermediate river connectivity; c) disconnection greatly reduces fish species richness of each habitat guild, and natural fish larvae is severely depleted; d) disconnection simplifies macroinvertebrate food web structure, and trophic basis is more heavily relied on detritus in disconnected lakes. Last, conservation strategies are proposed. Since the Yangtze river-floodplain is a huge integrated system, the biodiversity conservation must be conducted on the whole basin scale. By establishing species-area models of fishes, the minimum protected area of Yangtze-connected lakes is estimated to be ca. 14400 km2. It means that at least 8900 km2 of disconnected lakes should be reconnected with the Yangtze mainstem, and ecohydrological operation of dams and sluices is the feasible approach. Based upon our studies on environmental flow requirements, the following measures are suggested: a) lower water levels during spring to improve germination of macrophytes, and control rising rates of water levels during spring-summer to ensure development of macrophytes; b) open sluice gates to restore migration routes for juveniles migrating into lakes during April-September, and for adults migrating back to the Yangtze mainstem during November-December. © 2019, Institute of Hydrobiology, Chinese Academy of Sciences. All rights reserved.     

Windows操作系统下二代测序数据处理平台的建立及高通量信息分析标准流程在个人计算机上的实现

当前二代测序数据的处理广泛使用基于标准版本的Linux操作系统分析方法。这一系统专业性强,成本较高,操作界面不够友好,严重限制了大多数科研人员对数据的自主分析。本文创建了一个基于微软Windows操作系统的全功能二代测序数据的生物信息学分析系统,利用该系统经优选实现当前多种高通量测序数据的主流标准化分析流程。通过RNA-Seq的代表性案例,演算实测数据与传统Linux系统驱动的数据分析结果相比较,结果显示,本系统的组件和流程在常用的数据分析过程中,可以基本取代目前主流的Linux服务器或云计算平台,在运行效率相近的情况下,其操作极为简便且成本大大降低。本系统与所配附的编译软件及流程脚本,不仅为测序数据的生物信息学分析实操演练提供全面的解决方案,而且可以直接应用于专业的测序数据分析中。     

Kin recognition and co‐operative foraging in Drosophila melanogaster larvae

A long‐standing goal for biologists and social scientists is to understand the factors that lead to the evolution and maintenance of co‐operative behaviour between conspecifics. To that end, the fruit fly, Drosophila melanogaster, is becoming an increasingly popular model species to study sociality; however, most of the research to date has focused on adult behaviours. In this study, we set out to examine group‐feeding behaviour by larvae and to determine whether the degree of relatedness between individuals mediates the expression co‐operation. In a series of assays, we manipulated the average degree of relatedness in groups of third‐instar larvae that were faced with resource scarcity, and measured the size, frequency and composition of feeding clusters, as well as the fitness benefits associated with co‐operation. Our results suggest that larval D. melanogaster are capable of kin recognition (something that has not been previously described in this species), as clusters were more numerous, larger and involved more larvae, when more closely related kin were present in the social environment. These findings are discussed in the context of the correlated fitness‐associated benefits of co‐operation, the potential mechanisms by which individuals may recognize kin, and how that kinship may play an important role in facilitating the manifestation of this co‐operative behaviour.     

Heritabilities,social environment effects and genetic correlations of social behaviours in a cooperatively breeding vertebrate

Social animals interact frequently with conspecifics, and their behaviour is influenced by social context, environmental cues and the behaviours of interaction partners, allowing for adaptive, flexible adjustments to social encounters. This flexibility can be limited by part of the behavioural variation being genetically determined. Furthermore, behaviours can be genetically correlated, potentially constraining independent evolution. Understanding social behaviour thus requires carefully disentangling genetic, environmental, maternal and social sources of variations as well as the correlation structure between behaviours. Here, we assessed heritability, maternal, common environment and social effects of eight social behaviours in Neolamprologus pulcher, a cooperatively breeding cichlid. We bred wild‐caught fish in a paternal half‐sibling design and scored ability to defend a resource against conspecifics, to integrate into a group and the propensity to help defending the group territory (“helping behaviour”). We assessed genetic, social and phenotypic correlations within clusters of behaviours predicted to be functionally related, namely “competition,” “aggression,” “aggression‐sociability,” “integration” and “integration‐help.” Helping behaviour and two affiliative behaviours were heritable, whereas there was little evidence for a genetic basis in all other traits. Phenotypic social effects explained part of the variation in a sociable and a submissive behaviour, but there were no maternal or common environment effects. Genetic and phenotypic correlation within clusters was mostly positive. A group's social environment influenced covariances of social behaviours. Genetic correlations were similar in magnitude but usually exceeding the phenotypic ones, indicating that conclusions about the evolution of social behaviours in this species could be provisionally drawn from phenotypic data in cases where data for genetic analyses are unobtainable.