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Novel coronavirus Omicron variant infection can cause severe illness and even death in certain populations. Omicron variant infection may lead to systemic inflammatory response, coagulation disorder, multi-organ dysfunction and other pathophysiological changes, which are different from other Novel coronavirus variants to a certain extent, so therapeutic strategies should not be the same. The National Medical Center for Major Public Health Events invited experts in fields of infectious diseases, respiratory medicine, intensive care, pediatrics and fever clinic to develop this quick guideline based on the current best evidence and extensive clinical practices. This quick guideline aims to standardize the diagnosis and treatment of novel coronavirus Omicron infection, and to improve the disease management abilities of clinicians.
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Since 2010, the incidence of severe fever with thrombocytopenia syndrome (SFTS) has been increased. Owing the progress in diagnosis and treatment, the overall mortality of SFTS in China has decreased, while the mortality in critical SFTS patients is still high. In order to provide guidance and working procedures for clinicians to diagnose and treat critical SFTS, the National Medical Center for Major Public Health Events invited experts to discuss and formulate this consensus based on their experience and up-to-date knowledge on SFTS.
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Quality of care and safety are the lifeline of hospital performance and hospital management.With reference to the KTQ hospital quality certification system of Germany,Tongji Hospital built platforms to supervise outpatient,emergency,inpatient,surgical operation,nursing, hospital-acquired infection,and pharmacy management.By the connection and reaction of both online and offline systems,Tongji Hospital has built a systematic,informationized and precise medical quality and safety system for large public hospitals,safeguarding quality of care and safety of patients.
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Objective To investigate current status of narcotic analgesic use in patients with cancer pain in our hospital, in order to promote the rationalization of prescribing narcotic drugs and the rational use of analgesics. Methods A total of 400 narcotic prescriptions ( 100 of outpatients and 300 of inpatients ) in Tongji hospital were randomly selected from March to May in 2014.Basic index and consumption of anesthetic drugs, money consumption distribution on different tumor types, and unreasonable prescription were analyzed. Results The overall prevalence of irrational prescriptions was 11. 00%, with 13.00% from inpatient and 10. 33% from outpatient, respectively. Reasons for irrational prescriptions mainly included vague instructions on dosage and administration, incomplete clinical diagnosis, lack of pharmacist check and inappropriate dosage. In the basic indexes, proportions of reasonable prescription and drugs within the national formulary were higher in the inpatient than in the outpatient service.The average money consumption of outpatient prescription was significantly higher than that of inpatient prescription.Most types of diagnosis were lung cancer in outpatient and inpatient departments, and total cost of lung cancer drugs was the highest.Morphine hydrochloride of outpatient had the highest average consumption, followed by codeine phosphate of the outpatient and the inpatient, and oxycodone hydrochloride controlled-release tablets cost more in inpatient. Conclusion The narcotic analgesic used in our hospital is basically rational. Most doctors prescribe according to the guidelines, but standardized training of prescription for cancer patients with pain medication needs to be strengthened, and supervision of narcotic analgesic medication should be enhanced.
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Objective To study the pathological and immunohistochemical features of alimentary tract mesenchymal tumors and compare with computed tomographic virtue endoscopy (CTVE) imaging technology to evaluate the diagnostic value of CTVE in alimentary tract mesenchymal tumors. Methods Seventy-four pathological specimens of alimentary tract mesenchymal tumors were collected. The pathological features and the expression of CD117, CD34, SMA and S-100 were observed by immunohistochemical method with light microscope. The pathological types and characteristics were determined by pathologists and compared with CTVE imaging technology. Results In the 74 cases of alimentary tract mesenchymal tumors,40 cases were diagnosed as stromal tumor with pathological and immunohistochemical methods (54. 1%).Sixteen of them were malignant, accounting for 40% of the stromal tumor while 33 cases were diagnosed as leiomyoma(44. 6%)and 1 case as schwannoma(1.4%) . In the 74 GIMTs cases ,33 were jejunum GIMTs,21 were ileum GIMTs and 20 were large intestine GIMTs. Immunohistochemistry assay in the 74 GIMTs cases showed that 51.4% GIMTs were positive for CD117, approximately 36. 5% were positive for CD34 , 62.2% were positive for smooth-muscle actin (SMA) and 1. 4% were positive for S-100 protein. In the 74 GIMTs cases,69 cases were diagnosed right in the accuracy for location with CTVE(93. 2%) with 51 cases in small intestinal (94. 4%) and 18 cases in large intestinal (90. 0%). The sensitivity and the specificity of CTVE to distinguish benign from malignant stromal tumors by CTVE characteristics were 84. 2% and 85. 7%respectively. Conclusions GIST is common in GIMTs and is often originated from the small intestinal. The immunohistochemistry has great value in diagnosing alimentary tract mesenchymal tumors. The CTVE imaging technology also has great value in diagnosing alimentary tract mesenchymal tumors which can show the localization, shape size and artery of the tumor clearly. The diagnostic sensitivity and specificity of CTVE are high to distinguish benign from malignant alimentary tract GISTs. CTVE plays an important role in guiding the clinical management of GISTs.
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Objective To investigate the expressions of PI3K, AKT and MRP protein in pancreatic carcinoma and to determine the clinicopathological significance and the correlation among three protein expressions. Methods The immunohistochemical method was used to detect the expressions of PI3K, AKT and MRP in forty three pancreatic carcinoma, nine chronic pancreatitis and eight normal pancreatic tissue samples. Results The positive expression rates of PI3K, AKT and MRP were 46.51%, 55.81% and 39.53%, respectively in pancreatic carcinoma, which were remarkably higher than those in normal pancreatic tissue and in chronic pancreatitis (P<0.01 and P<0.05, respectively). The aberrant expression of PI3K, AKT and MRP were associated with lymph node metastasis and TNM stages (P<0.05). The abnormal expression rate in both MRP and PI3K was 32.56%, the normal expression rate of both MRP and PI3K was 46.51%, and there was positive correlation between the expression of MRP and PI3K(r=0.581, P<0.01). The abnormal expression rate of both MRP and AKT was 32.56%, the normal expression rate was 37.21%, and there was a positive correlation between MRP and PI3K (r=0.432,P<0.05). The abnormal expression rate of both MRP and PI3K was 37.21%, the normal expression rate of both MRP and PI3K was 32.56%, there was also a positive correlation between MRP and PI3K (r=0.306,P<0.05). Conclusions The expressions of PI3K, AKT and MRP were up-regulated in pancreatic carcinoma. The expressions of PI3K and AKT may be related to the lymph node metastasis and TNM staging.
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This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series,with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.
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Objective To observe prospectively the role of endoscopic diagnosis and treatment of biliary leakages in patients with liver transplantation, and the incidence of bile duct stricture after healing of the leakage. Methods Six eases of T-tube leakage and seven cases of anastomosis leakage complicating liver transplantation were enrolled in this prospective study. Six patients treated by endoscopic plastic stent placement , 2 by naso-biliary catheter drainage, 2 by papillosphincterotomy and 3 by naso-biliary catheter drainage combined with plastic stent placement. Some patients received growth hormone treatment. Results The bile leak resolution time was between 10-35 days in 10 patients with complete document. The median time of leak resolution was 15. 3 days. Four cases of anastomosis stricture, three cases of common hepatic duct and one ease of multiple bile duct stenosis were observed by followed-up nasobiliary catheter cholangiography or ER-CP. Conclusion Endoscopic nasobiliary catheter or plastic stent placement is a safe and effective treatment for bile duct stricture occurred after bile leak resolution in most of liver transplantation patients. Naso-biliary catheter combined with plastic stent placement maybe the best choice for treating bile leak, because, theoretically, it may prevent serious condition happened at accidental nasobiliary catheter dislocation, and it may have prophylactic effect on upcoming bile duct stricture and should be further confirmed.
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The effects of pro-hepatocyte growth factor (pHGF) on the changes of renal cellular proliferative cycle of partial hepatectomized rats were observed by flow cytometry (FCM). S phase fraction (SPF) of control rats (group A) accounted for 7.58 % and increased gradually within 6 h, following a peak at 12th or 36th h after operation, but in pHGF-treated rats (group B) the peak appeared at 24th h after operation. Proliferation index (PI) of group A was 13.2%before partial hepatectomy, increased within 6 h and reached a peak at 12th or 36th h after operation, and in group B the peak appeared at 48th h after operation. There were significant differences in SPF and PI between two groups (P＜0.01). These findings suggest that pHGF may nonspecifically promote the DNA synthesis of renal cells.
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The effects of pro-hepatocyte growth factor (pHGF) on the changes of renal cellular proliferative cycle of partial hepatectomized rats were observed by flow cytometry (FCM). S phase fraction (SPF) of control rats (group A) accounted for 7.58 % and increased gradually within 6 h, following a peak at 12th or 36th h after operation, but in pHGF-treated rats (group B) the peak appeared at 24th h after operation. Proliferation index (PI) of group A was 13.2%before partial hepatectomy, increased within 6 h and reached a peak at 12th or 36th h after operation, and in group B the peak appeared at 48th h after operation. There were significant differences in SPF and PI between two groups (P＜0.01). These findings suggest that pHGF may nonspecifically promote the DNA synthesis of renal cells.