Experiences of prevention and control of hospital infection in the emergency wards:the designated hospital treating new novel coronavirus disease in Shanghai as an example / 上海预防医学

Since the outbreak of novel coronavirus pneumonia, the World Health Organization and the National Health Commission have issued multiple guidance documents.Medical facilities across the nation have actively implemented the countermeasures in response to the epidemic.However, in the real scenario of prevention and control, hospital infection remains a great concern.It is crucial to formulate measures and procedures based on standard prevention and transmission route prevention to avoid cross infection between medical workers and patients.Based on the practice, we summarize the institutional management, layout process, prevention and control of hospital infection in the emergency wards for further discussion and improvement.

Outcome of transcatheter closure of perimembranous ventricular septal defect with modified double-disk occluder device / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and adverse effects of transcatheter closure of perimembranous ventricular septal defect (pmVSD) with modified double-disk occluder device (MDVO).</p><p><b>METHODS</b>Clinical data including clinical examination, electrocardiography daily after the procedure for a week, chest-X-rays and TTE before discharge and at 3-5 days after the procedure were analyzed from 604 patients underwent percutaneous closure of a pmVSD with MDVO at our department between December 2001 and December 2008.</p><p><b>RESULTS</b>Procedure was successful in 576 out of 604 patients (95.4%) and 583 VSD occluders were placed. Endocarditis, thromboembolism, or deaths were not observed after procedure. Conduction block occurred in 81 patients (56 RBBB, 14 LBBB) and transient nonparoxysmal ventricular tachycardia in 31 patients after the procedure. Complete heart block occurred in 11 patients, 9 of them recovered in 3 weeks, permanent pacemaker was implanted in 2 patients (one had transient III degrees AVB before the procedure, the other underwent simultaneous closure of ventricular septal defect and atrial septal defect). Trivial/small residual shunts were found in 69 patients (12.0%). The residual shunts disappeared in 31 patients and remained unchanged in 38 patients (6.6%) 7 days after procedures. Aortic regurgitation developed in 5 patients (2 trivial/small, 3 small/moderate), and tricuspid regurgitation was present in 35 patients (32 trivial/small, 3 moderate). Five patients developed haemolysis (device retrieved via catheter in 1 patient due to persistent haemolysis, the other 4 patients recovered 3-14 days post procedure). Pseudoaneurysm of femoral artery occurred in 1 patient, and disappeared by pressure dressing. Device was successfully replaced in 2 patients with either device embolization (n = 1) or device misplacement (n = 1) after device retrieval by catheter.</p><p><b>CONCLUSION</b>It is safe and effective to close congenital perimembranous ventricular septal defect with domestic-made occluder device.</p>

Treatment of severe acute biliary pancreatitis in the elderly by integrated traditional Chinese and Western medicine / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To summarize the therapeutic effect of integrated traditional Chinese and Western medicine (ICWM) on severe acute biliary pancreatitis (SABP), and to discuss the opportunity of operation.</p><p><b>METHODS</b>The hospitalization duration, incidence of complications, operation transmitting rate and mortality were analyzed in 96 senile SABP patients (Group A) treated by ICWM, and 32 senile SABP patients treated by conventional Western medicine, they were hospitalized from January 2000 to December 2007.</p><p><b>RESULTS</b>(1) The average hospitalization duration in Group A and B was 28.2 +/- 11.3 days and 32.7 +/- 14.3 days respectively, showing insignificant difference between them (P>0.05); (2) The early stage incidence of complications being 29.2% (28/96) in Group A and 34.4% (11/32) in Group B, no significant difference between groups was shown, but a significant difference did show at the late stage, 36.5% (35/96) vs 53.1% (17/32), the incidence in Group A was lower significantly (P<0.05). (3) The two groups were not different in operation transmitting rate 36.4% (35/96) vs 43.8% (14/32), P>0.05. (4) The mortality in Group A, 21.9% (21/96) was lower than that in Group B, 37.5% (12/32), P <0.05.</p><p><b>CONCLUSION</b>ICWM has good effect in treating SABP, and the opportunity of operation transmitting should be decided according to whether there obstruction of biliary tract exists or not.</p>

Effect of stromal cell-derived factor-1 and its receptor CXCR4 on liver metastasis of human colon cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of chemokine stromal cell-derived factor-1 (SDF-1) and its receptor CXCR4 on liver metastasis of human colon cancer.</p><p><b>METHODS</b>Expression of CXCR4 in different colon cancer cell lines and SDF-1 in different tissues were detected by using Western-blot technique. Effect of SDF-1 and anti-CXCR4 monoclonal antibody (McAb) on proliferation and migration of HT-29 cells were measured using MTT methods. Model mimicking liver metastasis of human colon cancer was established by injecting HT-29 cells intrasplenically into BALB/C nude mice. Mice were randomly divided into AMD3100 treated group and control group. Liver metastatic rate and tumor foci were measured 7 weeks after.</p><p><b>RESULTS</b>HT-29 cells expressed higher level of CXCR4 protein, and liver tissue expressed higher level of SDF-1 protein. Compared with the control, SDF-1 could significantly induced the proliferation and migration of the HT-29 cells, and anti-CXCR4 McAb could inhibited both functions of SDF-1. The liver metastasis rate in the control group was 100%, and it was 40% in the AMD3100 treating group (P < 0.05). The mean liver metastasis number also significantly decreased by AMD3100 (7.8 +/- 2.6 vs 22.4 +/- 8.6, P < 0.05).</p><p><b>CONCLUSIONS</b>SDF-1/CXCR4 biological axis play an important role in liver metastasis of human colon cancer. Arrest of CXCR4 can inhibit liver metastasis of colon cancer through blocking cell proliferation and migration induced by SDF-1.</p>

A clinical intervention study among 463 essential hypertensive patients with metabolic syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the role of baseline risk factors in predicting the onset of diabetes among essential hypertensive patients with metabolic syndrome (MS) and to evaluate an ideal therapeutic regime that could reduce the risk factors and risk of onset of diabetes.</p><p><b>METHODS</b>A randomized parallel clinical trial in essential hypertensive patients of grade 1 or 2 was conducted. Two of the three components (1) increased waist circumference and/or BMI; (2) increased triglycerides (TG) and/or decreased high-density lipoprotein cholesterol; (3) impaired glucose tolerance (IGT) were present define the MS. The three intervention therapy groups were: indapamide + fosinopril (I + F, n = 151); atenolol + nitrendipine (A + N, n = 160); atenolol + nitrendipine + metformin (A + N + M, n = 152). Each case was followed-up monthly and the dosage of medicine taken be adjusted according to their BP level. The plasma glucose during fasting and two hours after taking 75 g glucose orally was also measured every six months. The new onset of diabetes was diagnosed according to the criteria. OGTT, insulin release test, lipid analysis, body weight and waist circumference were measured again at the last follow-up.</p><p><b>RESULTS</b>(1) The lowering of BP was similar among the three groups (P > 0.05). 23 new diabetes onsets occurred, being 10 in group I + F and 8 in group A + N and 5 in group A + N + M, respectively (P > 0.05); (2) Proportions of patients' risk factors decreased significantly in group A + N or A + N + M, e.g. the proportions of high TG in each group reduced by 14.7% and 9.3% respectively (P < 0.05), the central fat distribution reduced by 16.7% and 15.9% respectively (P < 0.05) and the IGT reduced by 6.6% and 29.6% respectively (P < 0.05). However no changes were found in group I + F; (3) After 1 year and 5 months' follow-up, the proportions of main risk factors (high TG, central fat distribution and IGT) in the three groups were 91%, 96%, 83% and 90%, 88%, 47%, respectively. The difference of IGT was significant between two groups (P < 0.01) and the proportions of having three risk factors were 70% and 31% in the two groups (P < 0.01); (4) I + F group was better than A + N group in reduction of TG and central fat distribution. And A + N + M group improved in all risk factors.</p><p><b>CONCLUSIONS</b>IGT alone or combined with increased TG plus abdominal obesity are the most important risk factors in predicting a new onset of diabetes among essential hypertensive patients with MS. Metformin in combination with atenolol plus nitrendipine can significantly prevent the onset of diabetes as well as improve patients' metabolic abnormality.</p>