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Cancer anorexia/cachexia syndrome (cancer anorexia cachexia syndrome, CACS) is a common complication in advanced cancer patients, which is characterized by reduced feeding, sustained weight loss, general fatigue and weakness. CACS related symptoms make patients suffer from a series of adverse psychosocial effects, such as anxiety, pain and social isolation, thus bringing serious adverse effects on patients′ individuals, families and society. This paper reviewed the symptoms associated with CACS and their psychosocial effects, as well as the interventions related to adverse psychosocial effects, in order to provide theoretical reference for alleviating psychosocial distress and improving health-related quality of life of patients with CACS.
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This paper was reviewed the research status of health literacy of cancer caregivers, including an overview of health literacy, assessment tools for health literacy of cancer caregivers, factors affecting health literacy of cancer caregivers and measures to improve health literacy of cancer caregivers. To provide theoretical basis for the localized development of health literacy assessment tools for cancer caregivers and further research.
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With the progresses of aggravation of social population aging degree and elevation of health awareness, the emergency medical resources are difficult to meet the increasing demand for emergency medical services of patients, leading to the increase of congestion in the Department of Emergency that has threatened the safety of the entire medical and health system. Among the patients, because the elderly patient diseases are characterized by coexistence of multiple diseases, the complexity of diagnosis and treatment, etc, they occupy a large number of emergency medical resources, resulting in the main important factor affecting the overcrowding in emergency department. Therefore, we have comprehensively analyzed the domestic and foreign researches related to the overcrowding in emergency departments, summarized the effect of elderly patients on the overcrowding and reviewed the corresponding mitigation measures, expecting to provide a reference for the study of emergency department overcrowding in China.
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Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.
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Objective To explore the impact of atrial fibrillation (AF) recognized at primary diagnosis on clinical features and outcomes of patients with AF in emergency service.Methods Data were collected from consecutive patients admitted in resuscitation room in the Department of Emergency (ED) of a major comprehensive teaching hospital,from January 1,2011 through December 31,2015.Patients were checked by electrocardiogram examination and / or monitored in resuscitation room after admission,and were divided into patients with AF recognized at a primary diagnosis and those with AF judged by alternative primary diagnoses in ED.The main criteria of prognosis were the length of resuscitation room stay,number of repeated ED visits,and outcome scale (such as death,transferred to intensive units,transferred to general wards,or direct discharge).Non-paired student t test,x2,and circular distribution analysis were performed using SPSS 10.0 and EXCEL 2007 software.Results A total of 929 patients with mean age of (70.3 ± 12.7) years,and 502 (54.0％) female were enrolled.There were 122 cases with AF not recognized at primary diagnosis but by an alternative primary diagnosis (non-primary group,NPG),and 807 cases with AF recognized at primary diagnosis (primary group,PG).Compared with the PG,the patients were older [(76.9 ±9.3) vs.(68.7 ± 14.4),P ＜0.01],had more comorbidities [(1.75 ± 1.26) vs.(0.08±0.39),P＜0.01],higher APACHE Ⅱ scores [(17.89±8.19) vs.(8.64±4.15),P＜ 0.01],longer resuscitation room stay (P ＜ 0.01),higher mortality (11.5％ vs.0.2％,OR =52.176,95％ CI:11.698-232.710,x2 =78.928,P ＜ 0.01) and a higher percentage of transferring to intensive careunit (14.8％ vs.5.1％,OR=3.234,95％CI:1.791-5.838,x2 =16.674,P＜0.01) in NPG.There were no significant difference in number of repeated-visits in ED between the PG and the NPG.Conclusion Patients with AF in the ED judged by alternative primary diagnosis are older and have more comorbidities,higher mortality and higher probability to be transferred to intensive care unit than patients with AF directly recognized by a primary diagnosis.This cohort of patients with special characteristics should be meticulously cared for and be distinguished from the patients with AF crystal clear at a primary diagnosis.Future studies are needed to examine the specific impact of AF on outcomes in the setting of primarydiagnoses in ED.
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Tracheal intubation is one of the most important emergency techniques, and it is a key and difficult point in advanced life support training for cardiopulmonary resuscitation. Our treatment is trying to combine standard video with visual laryngoscopes for tracheal intubation teaching. Firstly, the students watch the standard video. Then, the teacher shows how to perform a tracheal intubation by visual laryngo-scope. Finally, the students practice the intubation process on the simulation device. In this way, the teach-ing process is more intuitive, easier to be mastered, more normalized and repeatable. This method is worth to be promoted.
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Objective To explore the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and repeated emergency department (ED) visits.Methods Patients with AF were examined and analyzed retrospectively.Data were collected from consecutive patients from resuscitation room in the Department of Emergency of a large-scale general teaching hospital,from January 1,2011 to December 31,2015.The patients were verified by electrocardiographic examination and/or monitoring.The main outcomes were length of resuscitation room stay and outcome scales (defined as death,transfer to intensive units,to ordinary wards,or direct discharge).Results 908 patients were enrolled in the study with a mean age of 70.3 ± 12.8 years,and 494(54.4％) were female.There were 262(28.9％) cases visited ED for more than one time,and 646(71.1％) visited ED without repetition.Compared with the patients without repeated visit,patients with repeated visits were older (73.0 ± 9.8 years versus 69.2 ± 13.6 years,t=4.705,P＜0.001),and had a larger proportion of patients with CHADS2-VASc score greater or equals to 2(70.6％ versus 60.2％,x2 =8.660,P=0.003),whereas those patients had a shorter stay in the resuscitation room (13.6 ± 27.1h versus 27.0 ± 89.7h,t=3.370,P=0.001),and a higher percentage of directly discharge (73.3％ versus 61.9％,x2=10.607,P=0.001).In multiple logistic regression analysis,a higher CHADS2-VASc score and a lower quartile of the resuscitation room stay were independently predictive factors of repeated ED visits.Conclusion Patients with AF and repeated ED visits would have relatively complex condition and more comorbidities.High CHADS2-VASc score and short ED stay are independently predictive factors for repeated ED visits.
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Objective To explore the relationship between content of fine particulate matter (PM2.5) in atmospheric and the number of emergency room (ER) visits with acute coronary syndrome (ACS).Methods Daily data of ER visits to Peking University Third Hospital for ACS was collected from December 1st,2013 to November 30th,2014.All patients were resident population of Haidian District,Beijing.The daily meteorological data and contents of air pollutants in Beijing were also collected in the same time period.Generalized Additive Model (GAM) was fitted to estimate the association between the ambient PM2.5 and the ER visits for ACS,under controlling for time trends,holiday effect,day of week effect and weather conditions.Results The annual average amount of PM2.5 was 85.44 μg/m3 over the study period.There were 619 cases with ACS as ER visits.PM2.5 was positive related with PM10,NO2 and SO2.The corresponding correlation coefficients were 0.87,0.48 and 0.67,respectively (P ＜ 0.05).But PM2.5 was negative related with mean temperature (r =-0.04,P ＜ 0.05).In the polluted model,there was positive association between PM2.5 and ER visits with ACS.When each increament in PM2.2 with 10 μg/m3,the relative risk strength of ER visits with ACS was 1.019 (95％ CI:1.000-1.038).PM2.5 concentrations had a delayed effect on the onset of ACS occurred on the next day.This lagged 1 day phenomenon showed the most significant influence of PM2.5 on ER visits for ACS.Conclusions The ambient concentrations of PM2.5 are positively associated with ER visits for ACS.And there is a lag effect.
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Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.
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Taking a national continuing education program with hand in hand mode as an example, the advantages and disadvantages of hand in hand mode and traditional mode are com-pared. Hand in hand mode realizes a door-to-door teaching, and the curriculum is more targeted. Moreover, the time and physical power of trainees are saved, so the training effect is better. The na-tional continuing medical education program withhand in hand is worthy of promotion in the teach-ing practice.
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Emergency specialist training in our country is still in its infancy and perfecting stage. The United States has perfect emergency specialist training system. From training target, access system, program personnel, training content and assessment and evaluation, this study explores the difference of the emergency physician training program of the University of Michigan and the emer-gency physician training rules of Beijing University. The emergency specialist training program in the United States has a strict elimination mechanism and a more rigorous training system for the training parties, making the training plan can be implemented and worth learning from.
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<p><b>BACKGROUND</b>Although pulmonary embolism (PE) with normal blood D-dimer (DD) concentrations is considered rare, in practice the incidence may be greater than is generally believed. Overlooking PE is potentially dangerous. The aim of this study was to explore the incidence and clinical features of PE with normal DD concentrations.</p><p><b>METHODS</b>We retrospectively analyzed the records of 29 patients with PE and normal DD concentrations from the past seven years. We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal DD concentrations. We evaluated the probabilities of differences by computing pretest probability scores (Wells score and revised Geneva score).</p><p><b>RESULTS</b>The frequency of normal DD concentrations in patients with PE was 4%. Previous episode(s) of PE were more common in patients with normal DD concentrations than in those with abnormal DD concentrations (P = 0.001). Fever, tachycardia, and tachypnea occurred less frequently in the former group (P < 0.05) and time between onset of symptoms and DD testing was longer (P = 0.001). The diagnosis of PE was delayed in 22 of the 29 cases. Nineteen and seven cases with normal DD concentrations were classified according to pretest scores as intermediate and low risk, respectively.</p><p><b>CONCLUSIONS</b>PE with normal DD concentrations is uncommon. Although most diagnoses of PE are ruled out by normal DD values, a small number of cases with PE are missed. A combination of pretest probability score and normal DD concentration increases the probability of making the correct diagnosis, but cannot completely exclude patients with suspected PE. When the clinical manifestations cannot be otherwise explained, clinicians should be alert to the possibility of PE with normal DD concentrations in patients with previous episode(s) of PE or a long interval between onset of symptoms and DD testing.</p>
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Aged , Female , Humans , Male , Middle Aged , Fibrin Fibrinogen Degradation Products , Metabolism , Pulmonary Embolism , Blood , Diagnosis , Retrospective StudiesABSTRACT
To observe the dynamic changes of the TGF-beta1 expressed in the infarct and non-infarcted region of rat heart during the ventricular remodeling (day 3, 7, 28, 180), myocardial infarction rat model was made and relationship between the cytokine and indicator of myocardial remodeling was analyzed. After the detection of hemodynamic parameter was performed by the Powerlab devices, the size of myocardial infarction and the morphology change was detected by TTC and HE, respectively. The relative levels of mRNA of TGF- beta1, collagen type I, III, and fetal gene beta-MHC were detected by RT-PCR. The distribution of TGF- beta1 protein in the myocardium was detected by immunohistochemistry. The results showed that the size of infarction was higher than that of the sham operated groups in the infarcted group (44.5 +/- 0.5 vs 0). The difference in hemodynamic parameters between the infarcted group and sham operated group was significant (P < 0.01). HE staining showed that inflammatory cells were accumulated in the infarcted region at the beginning of the 3rd day, which lasted 4 weeks. Then, it decreased gradually. beta-MHC in the non-infarcted region rose from the 3rd day, reaching its peak at the 4th week, and it decreased gradually. The ratio of the collagen type I/III showed similar changes as compared with the sham operated groups (P < 0.01). And the relative mRNA levels in the non-infarcted group were significantly higher than that in the infarcted and sham operated group (P < 0.01) at day 180. Linear regression analysis indicated that the TGF-beta1 was positively correlated with the ventricular remodeling. It was concluded that the cytokine TGF-beta1 participates in the process of the myocardial remodeling, which could be a strategy in the interference of myocardial remodeling.
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To observe the dynamic changes of the TGF-β1 expressed in the infarct and non-infarcted region of rat heart during the ventricular remodeling (day 3, 7, 28, 180), myocardial infarction rat model was made and relationship between the cytokine and indicator of myocardial remodeling was analyzed. After the detection of hemodynamic parameter was performed by the Powerlab devices, the size of myocardial infarction and the morphology change was detected by TTC and HE, respectively.The relative levels of mRNA of TGF- β 1, collagen type Ⅰ, Ⅲ, and fetal gene beta-MHC were detected by RT-PCR. The distribution of TGF- β1 protein in the myocardium was detected by immunohistochemistry. The results showed that the size of infarction was higher than that of the sham operated groups in the infarcted group (44.5±0.5 vs 0). The difference in hemodynamic parameters between the infarcted group and sham operated group was significant (P＜0.01). HE staining showed that inflammatory cells were accumulated in the infarcted region at the beginning of the 3rd day,which lasted 4 weeks. Then, it decreased gradually. β-MHC in the non-infarcted region rose from the 3rd day, reaching its peak at the 4th week, and it decreased gradually. The ratio of the collagen type Ⅰ/Ⅲ showed similar changes as compared with the sham operated groups (P＜0.01). And the relative mRNA levels in the non-infarcted group were significantly higher than that in the infarcted and sham operated group (P＜0.01) at day 180. Linear regression analysis indicated that the TGF-β1 was positively correlated with the ventricular remodeling. It was concluded that the cytokine TGF- β1 participates in the process of the myocardial remodeling, which could be a strategy in the interference of myocardial remodeling.
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AIM: To explore the molecular mechanisms about fibrosis and transforming growth factor (TGF) - β1 as well as inflammation in rats heart after acute myocardial infarction (AMI). METHODS: AMI model in rats was produced by left coronary artery ligation. Samples of rat cardiac tissue were collected at the end of 1 week, 4 weeks and 8 weeks. Hemodynamics had been performed before rats were sacrificed. Reverse transcription polymerase chain reaction (RT- PCR) and immunohistochemical methods were used to analyze mRNA expression and protein production of TGF- β1, respectively. Hydroxyproline was determined by chloramines T method. HE staining was resorted to analyze pathological myocardium after AMI. RESULTS: There were remarkable differences in hemodynamics between AMI groups and sham group (P＜0.01). Compared with sham group, TGF-β1mRNA expression and protein production and hydroxyproline quantification were enhanced greatly. Among them, the levels of TGF -β1 and hydroxyproline at 1 week were higher than those at 4 weeks or 8 weeks. A positive correlation between TGF- β1 protein and hydroxyproline was presented (r=0.75 - 0.99, P＜0.05). In microscope, leucocytes infiltrated significantly in the infarcted and border myocardium at 1 week after AMI, and were rarely seen at 4 weeks and 8 weeks. TGF - β1 protein were detected in cytoplasm of cardiac myocyte and leucocytes at 1 week, and at 4 and 8 weeks in myofibroblast and interstitial. CONCLUSIONS:TGF- β1 is upregulated and found in cytoplasm of cardiac myocyte and leucocytes as well as myofibroblast in heart after AMI,which is associated with dynamic changes of hydroxyproline content and inflammation. TGF - β1 is showed to play an important role in myocardial inflammatory repair and ventricular remodeling after AMI.
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AIM: To clarify the relationship between the cytokine and collagen in myocardial remodeling after acute myocardial infarction(MI) in rats.METHODS: In MI group,Wistar rats were undergone acute myocardial infarction by ligation of the anterior descending coronary artery.Sham operation was made in rats as control.The mRNA expression of collagen and cytokines such as TNF-? and TGF-?_1 in infract and non-infarct region of left myocardium were detected by RT-PCR at different time point(3 d,1 and 4 weeks).RESULTS: Collagen type Ⅰ and Ⅲ elevated as well as the TNF-? and TGF-?_1 in the MI group at 3th day.Expression of collagen type Ⅰ and Ⅲ were higher in the infarct region than that in the non-infarct region even at 4 weeks.TNF-? and TGF-?_1 peaked at 1 week and declined gradually to the baseline,which was still higher than those in control group(P
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AIM: The study explored the significance of the imbalance of Th1/Th2 function after acute myocardial infarction (AMI). METHODS: Peripheral blood mononuclear cells from 33 AMI patients, 22 unstable angina (UA) patients and splenocytes from 35 AMI rats were collected. Cytokine-producing Th cells were monitored by 3-color flow cytometry after stimulated with phorbol myristate acetate (PMA) and ionomycin. IFN-? and IL-4 mRNA in the rat myocardium and chemokine receptors CCR3, CCR5 and CXCR3 mRNA on the surface of rat T lymphocytes after AMI were measured by RT-PCR. RESULTS: Th1 associated cytokine IFN-? significantly increased in patients with AMI and UA within 24 hours after the onset of symptom. the high ratio of IFN-?-producing T cells lasted short in patients with UA and recovered 1 week after the onset. In AMI patients, the high ratio of IFN-?-producing T cells could be examined 1 week and even 1 month after the onset. There was no significant difference on the frequencies of IL-4-producing peripheral T cells between each group. 1 week, 2 weeks and 1 month after AMI, IFN-? mRNA increased in the myocardium of rats, but there was no significant change on cytokine-producing Th cells and chemokine receptors on the surface of rat T lymphocytes. CONCLUSIONS: The Th1/Th2 functional imbalance and up-regulation of Th1 cell-functions exist after AMI and perhaps participate in the onset of AMI. Th1/Th2 functional imbalance may participate in the immune-mediated myocardial injury and ventricular remodeling after AMI as one of the pathogenesises of autoimmune disease.
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AIM: Recent studies have identified the importance of inflammation in the development and progression of heart failure.Chemokines are essential factors in the recruitment and activation of leukocytes.They are closely related with inflammation.So the relation between chemokines expression and lymphocytes recruitment and cardiac function after acute myocardial infarction(AMI) was studied.METHODS: Ligating left interventricular branch induced AMI.Experimental rats were divided into three groups: heart failure group(MI-HF),non-heart failure group(MI-NF) and sham group(sham).Sham group was made by the same procedure only without ligation.The blood dynamics of rats was examined after 3 days,1 week and 2 weeks following ligation.Rats,which had a left ventricular end-diastolic pressure(LVEDP) above 15 mmHg,were considered to be in heart failure.Reverse transcription polymerase chain reaction(RT-PCR) was used to analyze the mRNA expression of chemokines,including monokine induced by IFN-?(MIG),macrophage inflammatory protein-1 alpha(MIP-1?) and regulated upon activation,normal T cell expressed and secreted(RANTES),in the infarcted region(circumjacent region included).The numbers of lymphocytes infiltrated in the infarcted region were also counted.RESULTS: MIP-1?,RANTES and MIG mRNA increased at 3 days and reached the peak at 1 week after AMI,significantly higher in MI-HF group than those in MI-NF group(RANTES,0.83?0.05 vs 0.51?0.19,P