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Major natural disasters seriously threaten human life and health. After earthquakes and other catastrophes, survivors are often trapped in the confined spaces caused by the collapse of ground and buildings, with relative separation from the outside world, restricted access, complex environment, and oncoming or ongoing unsafety, leading to the rescue extremely difficult. In order to save lives and improve the outcome more efficiently in the confined spaces after natural disasters, it is very important to standardize and reasonably apply the trauma assessment and first aid workflow. This study focuses on trauma assessment and first aid. From the aspects of trauma assessment, vital signs stabilization, hemostasis and bandaging, post-trauma anti-infection, and the transportation of patients, a trauma first aid work process suitable for a small space of a major natural disaster is formed, It is helpful to realize the immediate and efficient treatment of trauma in the confined spaces after natural catastrophes, to reduce the rate of death and disability and improve the outcome of patients.
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Humans , Disasters , First Aid , Confined Spaces , EarthquakesABSTRACT
@#BACKGROUND: Emergency medical service system (EMSS) is essential in providing acute care services for health conditions. However, trends of emergency and acute care in China haven’t been studied systematically. METHODS: Relevant literature was carefully reviewed, including original and review articles, letters, government reports, yearbooks, both in Chinese and in English. Data on the number of emergency visits, physicians and beds in emergency departments (EDs), and the workforce of pre-hospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks (2006-2018). RESULTS: Over the past decade, the number of ED visits tripled from 51.9 million to 166.5 million; and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 million. In response to rapid increases in demand, the number of licensed emergency physicians raised from 20,058 to 59,409; the beds’ number increased from 10,783 to 42,367. For pre-hospital emergency care, the volume of health workforce increased from 3,687 to 8,671, with a 109% increase in the number of physicians from 1,774 to 3,712. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion were still the critical challenges faced by China’s EMSS. CONCLUSIONS: The number of emergency visits has grown with continual capability enhancement during the past decade. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion still need to be solved by China’s EMSS. These findings and comparison with the USA could offer experiences and lessons to EMSS development worldwide, especially for developing countries.
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Cardiac arrest(CA)is a common serious clinical event. The high incidence and low survival rate make it one of the important public health problems in China. We urgently need to investigate the incidence, mortality and risk factors of cardiac arrest in Chinese population. Based on epidemiological data on cardiac arrest in China, early identification of cardiac arrest and early initiation of cardiopulmonary resuscitation can significantly improve outcomes of patients with in-hospital and out-of-hospital cardiac arrest. The article summarizes the definition of cardiac arrest, the epidemiology, domestic and international gap and prospects of cardiac arrest in and out of hospital.
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BACKGROUND@#Emergency medical service system (EMSS) in China is becoming more important. However, studies on mortality of emergency departments (EDs) patients in tertiary hospitals and on the trends in mortality of ED patients all over China are stagnant. The objective of this study was to quantify and describe the trends in mortality of ED patients in China.@*METHODS@#Nine tertiary teaching hospitals were selected from tertiary teaching hospitals in different regions. The annual numbers of ED visits and deaths of these hospitals in 2004, 2009 and 2014 were recorded and analyzed. Chi-square test was used to compare the mortality of the EDs' visits. Moreover, data on the mortality of ED patients in China from 2005 to 2015 were summarized and analyzed from the China Health and Family Planning Statistical Yearbooks (2006–2016).@*RESULTS@#From 2004 to 2014, the overall annual mortalities in EDs increased among the tertiary hospitals (P<0.001). However, the overall annual mortality in EDs all over China decreased from 0.12% in 2005 to 0.08% in 2015. And the mortalities of EDs patients in the eastern, central and western regions of China all decreased. In addition, the average mortality of EDs patients in northern China was obviously higher than that in southern China (P<0.05).@*CONCLUSION@#The ED mortality was increased in tertiary hospitals while decreased all over China during the past decade, which may be partly caused by some critical challenges faced by China's EMSS, such as overcrowding and long length of stay in EDs of tertiary hospitals.
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<p><b>BACKGROUND</b>Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction (AMI). The previous reports were restricted to other countries' population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China.</p><p><b>METHODS</b>This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography (CAG) and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed.</p><p><b>RESULTS</b>A total of 60 young female AMI (<7 days) patients were enrolled. From their CAG and intracoronary imaging results, the prevalence of SCAD in young female AMI population was 35% (21/60), the prevalence of coronary atherosclerostic heart disease was 65% (39/60). In the SCAD group, 43% (9/21) presented with non-ST-elevation myocardial infarction (NSTEMI) and the remainder presenting as STEMI. SCAD usually occurred in a single vessel (20/21, 95%), especially in left anterior descending artery (14/21, 67%). Eighteen patients (18/21, 86%) underwent conservative treatment, whereas the remaining three patients (3/21, 14%) underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% (20/21), and Type I imaging was observed in 5% (1/21), Type II was observed in 67% (14/21), and Type III was 29% (6/21). The average stenosis in the group was 76.9% ± 20.6%, and the mean lesion length was 36.6 ± 8.6 mm.</p><p><b>CONCLUSIONS</b>SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.</p>
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<p><b>OBJECTIVE</b>To observe the clinical efficacy of acupuncture and moxibustion periodic therapy on folli-cular maldevelopment differentiated as spleen and kidneydeficiency.</p><p><b>METHODS</b>Sixty patients of follicular maldevelopment differentiated as spleen and kidneydeficiency were randomized as an observation group and a control group, 30 cases in each one. The conventional acupuncture-moxibustion therapy was used in the control group and the acupuncture-moxibustion periodic therapy was applied to the observation group. In the control group, the acupoints were selected in terms of spleen and kidneydeficiency, such as Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Xuehai (SP 10) and Zigong (EX-CA 1). In the observation group, the acupoints were selected in terms of the physiological characteristics of follicular phase, ovulatory phase, luteal phase and menstrual phase. The main acupoints were Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3) and Xuehai (SP 10). The acupoints for benefiting kidneywere added in the follicular phase, such as Guanyuan (CV 4) and Dahe (KI 12), etc. The acupoints for regulatingand activating blood circulation were added in the ovulatory phase, such as Hegu (LI 4) and Taichong (LR 3), etc. The moxibustion was added for tonifying kidneyin the luteal phase, such as Qihai (CV 6) and Guanyuan (CV 4). The treatment was discontinued during the menstrual phase in the two groups. In the rest phases, acupuncture and moxibustion were given once every two days, 30 min each time. The overall efficacy, basal body temperature (BBT), follicular development, the average endometrial thickness and morphology as well as TCM syndrome score of spleen and kidneydeficiency were observed in the patients after 3-month menstrual periods. The adverse reactions were recorded in the two groups.</p><p><b>RESULTS</b>In the observation group, one case gave up the treatment due to the personal reason and another one stopped the treatment due to suffering from another kind of disease. 28 cases were included totally. In the control group, 3 cases were dropped out since attempting to receive in vitro fertilization-embryo transfer (IVF-ET) and 27 cases were finally included. The total effective rate was 92.9% (26/28) in the observation group, better than 85.2% (23/27) in the control group (<0.05). Except the endometrial morphology in the control group, after treatment, BBT, follicular development, the average endometrial thickness and morphology as well as TCM syndrome score were all improved apparently after treatment in the two groups (all<0.05). The improvements in follicular development, endometrial morphology and TCM syndrome score in the observation group were more obvious as compared with those in the control group (all<0.05). The incidence of the adverse reaction was 7.1% (2/28) in the observation group and was 3.7% (1/27) in the control group, indicating mild adverse reaction that could be relieved naturally.</p><p><b>CONCLUSIONS</b>The treatment with acupuncture and moxibustion achieves the significant efficacy on follicular maldevelopment differentiated as spleen and kidneydeficiency. Compared with conventional acupuncture-moxibustion therapy, the periodic therapy of acupuncture and moxibustion achieves the much better clinical efficacy.</p>
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<p><b>BACKGROUND</b>Atrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in atrioventricular block (AVB) patients with dual-chamber (DDD) pacemaker implantation.</p><p><b>METHODS</b>This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing (VP%) ≥40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olmesartan group (20 mg per day; n = 57) or control group (n = 59). Patients were followed up using pacemaker programming, 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events (AHREs) were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours.</p><p><b>RESULTS</b>Ten (17.5%) patients in the olmesartan group and 24 patients (40.7%) in the control group occurred new-onset AF, and the difference between two groups was statistically significant (P = 0.04). AF burden was lower in olmesartan group than that in control group (8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04). There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups (P = 0.89 and P = 0.42, respectively). Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion (PD) after 24 months follow-up compared with the control group (109.5 ± 7.4 ms vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ms, P = 0.02, respectively). Left ventricular end-diastolic diameter and left ventricular ejection fraction were not significantly different between two groups (both P > 0.05).</p><p><b>CONCLUSION</b>This study suggested that 24-month of olmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.</p><p><b>CLINICAL TRIAL REGISTRATION</b>ChiCTR-TRC-12004443; http://www.chictrdb.org.</p>
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Aged , Female , Humans , Male , Middle Aged , Angiotensin Receptor Antagonists , Therapeutic Uses , Atrial Fibrillation , Drug Therapy , Atrioventricular Block , Drug Therapy , Imidazoles , Therapeutic Uses , Single-Blind Method , Tetrazoles , Therapeutic UsesABSTRACT
Objective To explore the therapeutic effect of erythropoietin (EPO)combined oral iron in patients with chronic congestive heart failure( CHF)accompanied by anemia. MethodsNinety six patients with CHF accompanied by anemia, whom were consecutively hospitalized from January 2007 to December 2009, were enrolled into this study. They were randomly divided into treatment group accepted routine anti-heart failure therapy combined EPO and oral iron, and control group solely accepted routine anti-heart failure therapy. After 6 months follow up, the changes of hemoglobin ( Hb ), cardiac function classification, left ventricular ejection fraction(LVEF) ,6-minute walking distance,readmission rate of CHF and cardiac death were compared between two groups. ResultsCompared with those before therapy, we found significant improvements of hemoglobin level ( [ 120. 12 ± 10. 42 ] g/L vs [ 86.40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2. 65 ± 0. 67 vs 3. 13 ±0. 61, P ＜ 0. 01 ), LVEF ( [ 37.21 ± 4. 96 ]％ vs [ 33. 92 ± 7. 28 ]％, P ＜ 0. 01 ), 6-minute walking distance ( [ 443.52 ± 97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in treatment group after EPO combined oral iron administration. After 6 months follow up, we also found significant improvements of Hb level ( [ 120. 12 ±10. 42 ] g/L vs [ 86. 40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2.65 ± 0. 67 vs 2. 98 ± 0. 81,P＜0.01),LVEF([37.21 ± 4.96]％ vs [34.67 ±4.10]％,P ＜ 0. 01),6-minute walking distance ( [443.52 ±97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in the comparison between treatment and control group. The readmission rate of CHF fell significantly in treatment group compared to control (20. 83％ vs 39. 58％ ,P ＜ 0. 05 ). However, we found no significant difference in cardiac death rate ( 0％ vs 4. 17％, P ＞0. 05). ConclusionTreatment of EPO combined oral iron could significantly improve the cardiac function,increase exercise tolerance,lower the readmission rate of CHF in patients with chronic congestive heart failure (CHF)accompanied by anemia.