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Objective:To explore the predictive value of MB isoenzyme of creatine kinase (CK-MB) and poisoning severity score (PSS) in the clinical prognosis of patients with wasp sting.Methods:A retrospective study was conducted. The clinical data of patients who were stung by wasps admitted to emergency department of the First Affiliated Hospital of Henan University of Science and Technology from July 2017 to November 2019 were collected. The 24-hour acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), CK-MB and PSS scores of the patients were collected after admission, and 28-day outcome was recorded. Spearman correlation analysis method was used to analyze the correlation between CK-MB and PSS score. Logistic regression model was used to construct joint predictors, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of various indicators for 28-day prognosis of patients with wasp stings.Results:Finally 90 patients were included in the analysis. There were 67 patients survived at 28 days, and 23 dead with the 28-day mortality of 25.6%. APACHEⅡ score, CK-MB and PSS score in the death group were significantly higher than those in the survival group [APACHEⅡscore: 19.7±2.7 vs. 13.7±2.3, CK-MB (U/L): 183 (151, 243) vs. 36 (21, 75), PSS score: 17.7±2.6 vs. 9.3±4.5, all P < 0.01]. The correlation analysis showed that CK-MB and PSS score were positively correlated ( r = 0.843, P < 0.01). Logistic regression model fitted CK-MB and PSS score, and Hosmer-Lemeshow test showed that the model fitted well. ROC curve analysis showed that the area under ROC curve (AUC) of CK-MB for predicting 28-day outcome was 0.957, the sensitivity was 91.3%, and the specificity was 88.1%; the AUC of PSS score was 0.908, the sensitivity was 91.3%, and the specificity was 90.8%. The AUC of CK-MB combined with PSS score was 0.964, the sensitivity was 100%, and the specificity was 79.4%, indicating that CK-MB combined with PSS score had higher predictive value and higher sensitivity for 28-day prognosis of patients with wasp sting. Conclusions:High CK-MB level and high PSS score in early stage of wasp sting injury indicate poor prognosis. Both CK-MB and PSS score can be used as predictors for predicting the prognosis of patients with wasp stings. In addition, CK-MB combined with PSS score have greater predictive value .
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To evaluate the prognostic value of early white blood cell count (WBC) in patient of acute paraquat poisoning. Methods The literatures about the studies on early WBC and prognosis after paraquat poisoning published in journals at home and abroad were searched. The Chinese literature database contained CNKI, VIP, Wanfang Database, and China Biomedicine Database (CBM), and the journals were limited to the core journals. The foreign language database included PubMed, Embase and Cochrane library clinical controlled trial database. The retrieval date was from the initial publication to April 22nd in 2019, without the limitation of languages. Two researchers independently extracted literature information, and the Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality. The odds ratio (OR), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) were combined and analyzed through the Stata 15.0 software to evaluate the predictive value of early WBC after acute paraquat poisoning. Publication bias was analyzed by Deeks funnel graph. Results There were 7 retrospective studies and 1 prospective study in a total of 980 paraquat poisoning patients, 5 of them were English literatures, the others were Chinese literatures. There was no heterogeneity among the studies (I 2 = 43.5%, P > 0.05). The OR and its 95% confidence interval (95%CI) of the literature was combined through the fixed effect model. The Meta-analysis results were statistically significant (OR = 18.63, 95%CI = 13.63-25.48, P < 0.001), suggesting that the WBC was significantly correlated with the mortality of patients. The combined sensitivity, specificity, PLR, NLR and DOR were 0.75 (95%CI = 0.66-0.82), 0.85 (95%CI = 0.80-0.90), 5.14 (95%CI = 3.86-6.86), 0.29 (95%CI = 0.22-0.39), 17.53 (95%CI = 12.23-25.13) respectively, and the area under the SROC of the WBC was 0.88 (95%CI = 0.85-0.91). Deeks funnel plot was symmetrical (P = 0.21), and there was no obvious publication bias. Conclusion The early WBC has a certain predictive value for the prognosis of acute paraquat poisoning patients.
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Objective To systematically evaluate the diagnostic accuracy and clinical applicability of recognition of stroke in the emergency room (ROSIER) scale by systematic review and Meta-analysis. Methods The Chinese and English literatures concerning the diagnostic accuracy of ROSIER published from January 1st 2005 to December 31st 2018 by PubMed, Embase, Wanfang, VIP and CNKI databases were searched comprehensively and systematically. The sensitivity, specificity, and diagnostic odds ratio (DOR) of ROSIER in total population and subgroup analysis were pooled by using bivariate mixed effects model. Sensitivity analysis was used to evaluate the stability of the results. Deek funnel plot was utilized to evaluate publication bias. The clinical applicability of ROSIER was evaluated by Fagan Nomogram. Results A total of 28 studies incorporating 7 579 subjects were enrolled in this Meta-analysis. Meta-analysis in total population showed that the pooled sensitivity, specificity and DOR of ROSIER was 0.89 [95% confidence interval (95%CI) = 0.86-0.91, P = 0.00], 0.74 (95%CI = 0.67-0.80, P = 0.00) and 22.09 (95%CI =14.86-32.82, P = 0.00), respectively. Subgroup analysis of pooled sensitivity of ROSIER showed that Asian patients was significantly higher than European patients [0.89 (95%CI = 0.86-0.92) vs. 0.74 (95%CI = 0.66-0.82), P < 0.01], prospective study was significantly higher than retrospective study [0.89 (95%CI = 0.87-0.92) vs. 0.74 (95%CI = 0.61-0.88), P < 0.05], pre-hospital emergency was significantly higher than emergency department [0.87 (95%CI = 0.80-0.94) vs. 0.85 (95%CI = 0.81-0.90), P < 0.01], study with sample size ≤ 200 was significantly higher than study with sample size > 200 [0.88 (95%CI = 0.83-0.93) vs. 0.82 (95%CI = 0.76-0.88), P < 0.05], but there was no significant difference between different evaluators or different male to female ratio subgroups. Subgroup analysis of pooled specificity of ROSIER showed that European patients was significantly higher than Asian patients [0.81 (95%CI = 0.73-0.89) vs. 0.79 (95%CI = 0.73-0.85), P < 0.05], retrospective study was significantly higher than prospective study [0.88 (95%CI =0.78-0.97) vs. 0.79 (95%CI = 0.73-0.84), P < 0.05], pre-hospital emergency was significantly higher than emergency department [0.82 (95%CI = 0.73-0.91) vs. 0.79 (95%CI = 0.73-0.85), P < 0.01], emergency physicians was significantly higher than other medical workers [0.80 (95%CI = 0.74-0.86) vs. 0.79 (95%CI = 0.69-0.90), P < 0.05], study with sample size ≤ 200 was significantly higher than study with sample size > 200 [0.82 (95%CI = 0.76-0.89) vs. 0.78 (95%CI = 0.71-0.85), P < 0.05], but there was no significant difference between different male or female ratio subgroups. Sensitivity analysis showed that there was no significant change in pooled DOR before and after excluding each study, indicating that the results were stable. Funnel plot showed that there was a significant publication bias in the total population (P = 0.04), but there was no publication bias in the European population (P = 0.57) or the Asian population (P = 0.08). According to the results of the Fagan Nomogram, with the pretest probability of 50%, when ROSIER was positive, the probability of being diagnosed with stroke increased to 77%, and when ROSIER was negative, the probability of being diagnosed with non-stroke decreased to 13%. It was suggested that ROSIER had good applicability and high clinical diagnostic value. Conclusions ROSIER has high diagnostic sensitivity and specificity, and has high clinical diagnostic value. It is a valid stroke identification tool which can be widely used in Asian population, pre-hospital emergency and be utilized by trained medical worker.
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Objective To investigate the status of cardiopulmonary resuscitation (CPR) in patients with sudden cardiac arrest (CA) in the emergency department. Methods A multicenter prospective observational study was conducted. The patients with CA admitted to 13 hospitals from 6 provinces in four different regions, including North China, Southern China, East China, Southwest China, from July 1st, 2015 to July 31st, 2017 were enrolled. A modified Utstein template was applied to collect clinical data, including general data, CA related data and prognosis, and primary outcome indicator was the return of spontaneous circulation (ROSC) rate, and the secondary outcome indicator was 28-day survival rate. The influence factors of ROSC were screened by Logistic regression analysis. Results The data of 613 patients with CA in 13 hospitals were enrolled. The ROSC rate in Beijing and Guangdong Province was higher, but there was no significant difference in 28-day survival rate among hospitals from different provinces. ① In 613 patients with CA, there were 413 patients suffering from in-hospital cardiac arrest (IHCA, 67.4%), and 200 suffering from out-hospital cardiac arrest (OHCA, 32.6%). 208 patients had ROSC at least once (33.9%), only 20 patients survived within 28 days (3.3%). ROSC rate in IHCA patients was significantly higher than that in OHCA patients [37.3% (154/413) vs. 27.0% (54/200), P < 0.01]. There was no statistic difference in 28-day survival rate between patients with IHCA and OHCA. The patients received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, but 28-day survival rate showed no significant difference. Multivariate Logistic regression analysis showed that IHCA [odds ratio (OR) = 1.893, 95% confidence interval (95%CI) = 1.253-2.858, P = 0.002], manual chest compression (OR = 0.506, 95%CI = 0.348-0.736, P = 0.000), electric defibrillation (OR = 0.458, 95%CI = 0.300-0.699, P = 0.000), and total adrenalin ≤ 4 mg (OR = 0.317, 95%CI = 0.216-0.464, P = 0.000) were the protective factors of ROSC in CA patients. ② In 200 OHCA patients, there were 49 patients had ROSC (24.5%), only 5 patients survived (2.5%). The patients aging < 65 years, with witnesses of CPR, received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, and the ROSC rate was higher in ambulances than that at home and in public sites, but 28-day survival rate showed no significant difference. Multivariable Logistic regression analysis showed that age < 65 years old (OR = 2.749, 95%CI = 1.192-6.336, P = 0.018), manual chest compressions (OR = 0.196, 95%CI =0.072-0.535, P = 0.001), electric defibrillation (OR = 0.263, 95%CI = 0.108-0.641, P = 0.003), total adrenaline dose ≤4 mg (OR = 0.122, 95%CI = 0.049-0.303, P = 0.000) and the ambulance CA (OR = 2.441, 95%CI = 1.334-4.468, P = 0.004) were protective factors of ROSC in OHCA patients. Conclusions The survival of sudden CA in emergency department was still poor. Early electric defibrillation, manual chest compression, CA occurred in hospital or in ambulance, and witness CPR can improve the ROSC rate of CA patients. Excessive use of adrenaline is not beneficial to patients with CA. Clinical Trial Registration Clinical Trials, NCT01987245.
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Objective To evaluate the effect of levosimendan on prognosis and circulation disorders of sepsis patients. Methods With the guidance of these following Chinese or English key words, such as sepsis, severe sepsis, septic shock, simendan, levosimendan, etc., some of Chinese and foreign published literatures on randomized controlled trials (RCTs) concerning the effects of levosimendan on the prognosis and circulatory function of septic patients were searched through China National Knowledge Infrastructure (CNKI) internet, VIP and Wanfang Databases, China Biomedicine Database (CMB), Pubmed in American National library, Holland Medical Abstract Database (Embase), Cochrane Library, etc databases, from the creation of above various databases to May 2017. The quality of the collected RCTs was evaluated by modified Jadad score; Revman 5.3 software was used to carry out Meta analysis; the publication bias was assessed by the funnel plots. Results A total of 18 RCTs, 9 in Chinese and 9 in English, but only half of the literatures were of high quality, and the other 9 of low quality, containing 688 cases in control group and 704 cases in experimental group were ultimately enrolled in this analysis. The Meta analyses showed that there was no statistical significant difference in the mortality between the experimental group and the control group [relative risk (RR) = 0.92, 95% confidence interval (95%CI) = 0.80 - 1.06, P = 0.27]; compared with control group, the time of stay in ICU was shortened [mean difference (MD) = -2.02, 95%CI = -2.90 to -1.13, P < 0.000 01], cardic output index was increased (MD = 0.63, 95%CI = 0.39 - 0.87, P < 0.000 01), and blood lactate level was decreased (MD = -1.37, 95%CI = -1.51 to-1.23, P < 0.000 01) in the experimental group, being significantly improved after levosimendan therapy. The funnel map evaluation showed that there might be a certain bias in the publication of the literature. Conclusion Levosimendan can improve circulatory disorders and reduce the time of stay in ICU for septic patients, but can not reduce their mortality.
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Objective To explore the associated risk factors on patients with organophosphorus poisoning combine with respiratory failure secondary pulmonary infection.Methods Two hundred and twenty-four clinical data of organophosphorus poisoning combine with respiratory failure were collected from January 2009 to May 2013.Retrospectively analyzed the situation of pulmonary infection and Logistic regression model were used to analyzed the relative risk of organophosphorus poisoning combine with respiratory failure secondary pulmonary infection.Results The secondary pulmonary infection rate of organophosphorus poisoning combine with respiratory failure was 68.75％ (154/224).Logistic regression analysis showed that combined with aspiration,hand hygiene,breathing machine,the decrease of cholinesterase activity were the relative risk factors (P ＜ 0.05).Conclusions The secondary pulmonary infection rate of organophosphorus poisoning combine with respiratory failure is higher.Combined with aspiration,hand hygiene,breathing machine,the decrease of cholinesterase activity may be the relative risk factors.
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Objective To evaluate the efficacy and safety of Xuebijing combined with corticosteroid injection treating paraquat poisoning with regression analysis. Methods 146 patients of paraquat poisoning in 3 years were divided into two groups: control group and therapeutic group. 50 patients in the control group were treated with Methylprednisolone, while 96 patients in the therapeutic group were treated with Xuebijing injection (300～400 ml/d, intravenous drip) and Methylprednisolone. The patients' clinical symptoms, signs and the levels of white blood cell (WBC), Neutrophils (N), C-reactive protein (CRP), glutamic-pyruvic transaminase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr) and arterial partial pressure of oxygen were collected. And patients did chest CT examinations every three days. All the data were compared between the two groups. Results ① The biochemical indicators of the control group in the 14th day [WBC,N,CRP, and PaO2 is (16.49±4.30), (84.22±21.07), (24.58±7.06), and (83.20±22.95) respectively]were better than those in the third day[WBC, N, CRP, and PaO2 is (19.21 ±5.34), (85.04± 12.33), (27.98±6.51), and (73.42±11.43)respectively], but there was not significant difference between them(P>0.05). While the biochemical indicators of the therapeutic group in the 14th day [WBC,N, CRP, and PaO2 is (9.16 ± 3.23 ), (70.48 ± 10.79), ( 17.48 ± 4.7), and (95.04± 11.93) respectively] were much better than those in the third day [WBC,N,CRP, and PaO2 is (16.96±9.95),(84.82±9.34), (27.34± 10.03), and (89.12±9.47) respectively], and there was significant difference between them( P< 0.05 ). ② The survival rate in the control group was 32% comparing to 67.71% in the therapeutic group, showing significant difference between the two group (x2=9.588, P<0.05) . ③ The patients' chest CT examinations in the therapeutic group were better than those in the control group. Conclusion Xuebijing injection combined with methylprednisolone had good effects m treating paraquat poisoning.
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Objective:To check the cleansing effect of light catalyst compound atomization in the hospital environment. Methods: Bacterium quantities were compared in the rooms treated with light catalyst compound atomization or routine cleansing. Results: In the room treated with light catalyst compound atomization,the rate of air bacterium reduction was 90.83% at 1 h,53.61% at 24 h,and 55.82% in average from 1 week to 12 weeks.Bacterium on object surfaces were kept lower for 8 weeks in the light catalyst compound sprayed room than in the routinely cleansed room.Conclusion:The light catalyst compound atomization can chronically cleanse the hospital environment without pollution.
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To prevent the spread of bird flu to human,we applied four effective means of infection control: concept introduction,light-accelerant method,tracking administration,and draft of coping measures,which displayed the characteristics of infection control in scientific and affectionate ways,and enhanced the level of public health service.
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Objective: To inspect dynamically the air-microorganism in important hospital departments. Methods: Plate sedimentation was used for examination. Results: The average rate of reaching standard is 93.01% for the important hospital departments from 2001 to 2004.The rates of reaching standard for region Ⅰ,Ⅱ and Ⅲof the hospital were 76.89%,90.14% and 97.03%,respectively. Conclusion: The content of air-microorganism is affected by personnel flow,airy condition,season and disinfection measure.
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Objective: In order to kuow the germicidal efficacy of orthophthalaldhyde. Methods: Carrier quantitative germicidal test and clinical use study. Results: the showed that 23℃,the average killing ratc after exposure to the stock solution of orthophthalaldhyde disinfectant for 90 min was 100% of Bacillus Subtitis Var.niger on carriers and for 10 min contact time could destroy completely the antigenicity of serum HBsAg,and for 5 min was 100% of bacteria. Incontinuous use for 10 days ,immersion in for 14 days it was no corrosion of carben steel and stainless steel apparatus, and no irritative to skin and mucous membrane. Conclusion: Orthophthalaldhyde has good germicidal efficacy and belongs actually no corrosion and no irritative disinfectant.
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To discuss hospital infection control for laminar flow operation room. Ten measures of hospital infection control have been formulated for laminar flow operation room based on the danger factors of the surgery incision infection and the principle of the air purify process and filtration setting. A set of management system and detailed rules have been founded for the use of laminar flow operation room, to strengthen the notion that the patients are the all. It has met the requirement for the use of air-clean technique and setting, and guaranteed air purity.
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AIDS is a serious disease which threatens the health and safety of the doctors and nurses and the social colony,it also affects the development of society and the steady of economy. Our hospital has carried out country and army's documents, by enforcing management,developing special topic education, fulfiling prevention measures,foundding diagnose laboratory,practicing special report order, which has made remarkable effects.
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This article mainly discussed that infection control is an important part of hospital management and plays an important role in medical quality management by reviewing and summarizing the development of the department of hospital infection control in nanjing general hospital.It put forward the goal and plan of the subject build in the future.
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Objectives:In order to prevent and control hospital infection efficiently, comprehensive management is put into effect on the quality of disinfectant and sterilization. Methods:The management model which spot-supervision, bacteria monitor and scientific modification are integrated has been applied in hospital. Results and Conclusions:The sterilization mind of staffs has been steadily strengthened and the qualified ratios of various monitor items has increased annually.