Mixed venous to arterial CO 2 gap as a marker to identify fluid responsiveness in septic shock patients / 中华急诊医学杂志

Objective:To investigate the value of the venous-to-arterial CO 2 gap (Δ CO 2 gap) before and after the fluid challenge (FC) in determining the fluid responsivenessin septic shock patients. Methods:A total of 104 septic shock patients admitted to the Medical Intensive Care Unit (MICU) of Peking Union Medical College Hospital were included in the retrospective study. All patients were monitored by Swan Ganz floating catheter during the FC. Hemodynamics and blood gas indices were collected before FC (T0) and immediately (T1), 10 min (T2), 30 min (T3) and 60 min (T4) after FC. Responders were defined as patients with a > 10% increase in cardiac output (CO) after FC. Spearman correlation analysis was used to evaluate the correlation between CO 2 gap and CO. The value of ΔCO2 gap were calculated by the area under the receiver operating characteristic (AUROC) curve in the whole population. Results:Among 104 patients, the effective rates of FC at T1, T2, T3 and T4 were 59% (61/104), 72% (75/104), 73% (76/104), and 77% (80/104), respectively. CO of patients in the reactive group was lower than that in the non-reactive group at T2 [6.0 (4.7, 7.5) vs. 7.2 (6.4, 8.5) L/min, P=0.019], and there was no significant difference in CO 2 gap between the two groups before FC. Spearman correlation analysis showed that CO 2 gap was negatively correlated with CO, and the correlations between CO 2 content gap and CO was -0.34, and -0.33 of CO 2 pressure gap and CO, respectively (both P <0.05). ROC curve analysis showed that the ΔCO 2 gap at T1 could weakly judge the reactivity at T2, T3 and T4, but could not judge the reactivity at T1. The AUROC at T2 was 0.669 of ΔCO 2 content gap and 0.684 of ΔCO 2 pressure gap (both P <0.05). Conclusions:The evaluate time judging the effect of FC should be appropriately extended. The change value of CO 2 gap before and immediately after volume expansion in septic shock patients can judge the fluid responsiveness within 10 min after FC.

Comunicação de más notícias em emergências pediátricas: experiências dos profissionais no contexto pré-hospitalar / Comunicación de malas noticias en urgencias pediátricas: experiencias de profesionales en el contexto prehospitalario / Communication of bad news in pediatric emergencies: experiences of professionals in the pre-hospital context

Objetivo: compreender como os profissionais de saúde que atuam no pré-hospitalar vivenciam a comunicação de más notícias à família na emergência pediátrica, bem como propor um protocolo de comunicação baseado nessas experiências. Método: pesquisa qualitativa com sustentação teórico-metodológica baseada no Interacionismo Simbólico e na Análise Temática Indutiva, mediante entrevistas semiestruturadas, no 2º semestre de 2019. Resultados: os profissionais vivenciaram o difícil processo de comunicação sob a influência do ambiente hostil. Eles estabeleceram ações para tentar cuidar e acolher a família. O cuidado com a família gerou reflexões e desejo de oferecer um atendimento adequado. Após a análise dessas experiências, foi proposto o Protocolo Acolher. Considerações finais: os profissionais de saúde que atuam no pré-hospitalar sentem-se pouco preparados e extremamente desconfortáveis diante da comunicação de más notícias. O protocolo desenvolvido pode colaborar no direcionamento aos profissionais do Atendimento Pré-Hospitalar e ajudá-los no processo de comunicação de más notícias.

Objetivo: comprender cómo los profesionales sanitarios que trabajan en el prehospitalario experimentan la comunicación de malas noticias a la familia en la emergencia pediátrica, así como proponer un protocolo de comunicación basado en estas experiencias. Método: investigación cualitativa con soporte teórico-metodológico basado en el Interaccionismo Simbólico y el Análisis Temático Inductivo, a través de entrevistas semiestructuradas, en el 2º semestre de 2019. Resultados: los profesionales experimentaron el difícil proceso de comunicación bajo la influencia del ambiente hostil. Establecen acciones para tratar de cuidar y acoger a la familia. El cuidado familiar generó reflexiones y un deseo de brindar una atención adecuada. Tras el análisis de estas experiencias, se propuso el Protocolo de Bienvenida. Consideraciones finales: los profesionales de la salud que trabajan en el prehospitalario se sienten poco preparados y extremadamente incómodos ante la comunicación de malas noticias. El protocolo desarrollado puede colaborar en la dirección de los profesionales de la atención prehospitalaria y ayudarles en el proceso de comunicación de malas noticias.

Objective: to understand how health professionals working in the pre-hospital experience the communication of bad news to the family in the pediatric emergency, as well as to propose a communication protocol based on these experiences. Method: qualitative research with theoretical-methodological support based on Symbolic Interactionism and Inductive Thematic Analysis, through semi-structured interviews, in the 2nd semester of 2019. Results: the professionals experienced the difficult communication process under the influence of the hostile environment. They set out actions to try to care for and receive the family. Family care generated reflections and a desire to provide adequate care. After the analysis of these experiences, the Protocolo Acolher was proposed. Final considerations: health professionals working in the pre-hospital feel unprepared and extremely uncomfortable before communicating bad news. The protocol developed can collaborate in directing pre-hospital care professionals and help them in the process of communicating bad news.

Non-pharmacological therapies for the treatment of post-traumatic stress disorder among emergency responders: a scoping review / Terapias no farmacológicas de tratamiento del trastorno de estrés postraumático en emergencistas: revisión de alcance / Terapias não farmacológicas no tratamento de transtorno do estresse pós-traumático em emergencistas: revisão de escopo

ABSTRACT Objective: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders. Method: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine. Results: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment. Conclusion: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.

RESUMEN Objetivo: Identificar las terapias no farmacológicas utilizadas para tratamiento del trastorno de estrés postraumático en profesionales emergencistas. Método: Revisión de alcance conforme indicaciones del Instituto Joanna Briggs y del protocolo PRISMA-ScR. Búsqueda realizada en nueve bases de datos, portales de tesis y disertaciones, y mediante buscador electrónico. Resultados: Fueron seleccionados y caracterizados 23 estudios, categorizados en seis ejes temáticos, a saber: terapia con suplemento alimentario de omega 3; arteterapia, terapia con ejercicios físicos, terapia con técnica de mindfulness, terapia con elementos de la naturaleza y psicoterapia, todos ellos destacados como tratamientos no farmacológicos para esta patología en profesionales emergencistas, así como el recurso de la psicoterapia vía telesalud como alternativa de tratamiento. Conclusión: Se necesita mayor cantidad de evidencias respaldando la terapia alimentaria, mientras que las demás alternativas terapéuticas encontradas demostraron resultados positivos, hallando respaldo en recomendaciones nacionales e internacionales de tratamiento y práctica clínica.

RESUMO Objetivo: Identificar as terapias não farmacológicas utilizadas no tratamento do transtorno de estresse pós-traumático em profissionais emergencistas. Método: Revisão de escopo conforme orientações do Instituto Joanna Briggs e do protocolo PRISMA-ScR. A busca foi realizada em nove bases de dados, portais de teses e dissertações e por meio de buscador eletrônico. Resultados: Foram selecionados e caracterizados 23 estudos, que foram categorizados em seis eixos temáticos, sendo eles: terapia com suplementação alimentar com ômega 3, arteterapia, terapia com exercícios físicos, terapia envolvendo a técnica mindfulness, terapia com elementos da natureza e psicoterapia, que foram apontados como tratamentos não farmacológicos para esta psicopatologia em profissionais emergencistas e, ainda, o recurso da psicoterapia via telessaúde como uma alternativa no tratamento. Conclusão: É necessário maior número de evidências que suportem a terapia dietética, enquanto as demais alternativas terapêuticas encontradas apresentaram resultados positivos, encontrando suporte nas recomendações nacionais e internacionais de tratamento e prática clínica.

Aspirin & clopidogrel non-responsiveness & its association with genetic polymorphisms in patients with myocardial infarction

Background & objectives: Cytochrome P450, P2Y 12, cyclooxygenase-1 (COX1) and glycoprotein V1 (GPVI) gene polymorphisms are known to affect patient responsiveness towards aspirin and clopidogrel dual antiplatelet therapy (DAPT). The present study was undertaken to identify aspirin and clopidogrel non-responsiveness and its association with genetic polymorphism in patients with myocardial infarction (MI). Methods: A total of 207 MI patients who were on DAPT, were included. The DAPT non-responsiveness was determined by light transmittance aggregometry using arachidonic acid and adenosine diphosphate and high platelet reactivity by collagen. Platelet activation biomarkers, thromboxane B2 (TxB2)andsoluble CD40 ligand (sCD40L) were measured in plasma. Patient compliance was checked by estimating drug and its metabolite levels (aspirin and clopidogrel) in plasma using liquid chromatography-mass spectrometry/mass spectrometry. Genomic DNA was extracted, amplified by polymerase chain reaction and subsequently sequenced to identify CYP450, P2Y 12, COX1 and GPVI gene polymorphisms. Results: Of the 207 patients, 32 were non-responders. The DAPT non-responsiveness was found in 15.5 per cent patients. The non-responsiveness showed a significant and an independent association with gender [odds ratio (OR)=0.18, 95% confidence interval (CI)=0.01-0.78, P=0.023], TxB2(OR=1.00, 95% CI=1.00-1.01, P=0.013), CYP2C19*2 G>A (OR=3.33, 95% CI=1.04-10.69, P=0.044) and GPVI T>C (OR=0.23, 95% CI=0.08-0.67, P=0.007) after adjusting the demographic, clinical and genetic confounding factors when assessed between non-responder and responder compliant patients. Interpretation & conclusions: The study showed a significant association of genetic polymorphisms (CYP2C19*2 G>A and GPVI T>C) with DAPT non-responsiveness in MI patients. The findings of this study need further validation in a large cohort of patients with clinical follow up.

Incidence and predictors of super-response to cardiac resynchronization therapy

Objectives Cardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed “super-responders”. The characteristics of this subset of patients in Indian and Asian population have not been well studied. In this study, we sought to assess the prevalence and clinical characteristics of this cohort of patients. Methods This was a retrospective study involving patients undergoing CRT. Changes in ejection fraction and LVESV at the end of one year of follow-up following device implantation were assessed, and patients were stratified into non-responders, responders, and super-responders. Responders had a 15–29% decrease in LVESV while super-responders had a >30% decrease in LVESV. Results Of the 74 patients who had undergone CRT-P/CRT-D implantation, 16 patients did not have echocardiograms at the end of one year of follow-up and were excluded from the analysis. Thus, 58 patients were enrolled for analysis. We identified 16 patients (27.6%) to be super-responders, 26 patients (44.8%) to be responders, and 16 patients (27.6%) to be non-responders. Factors associated with a super-response were a diagnosis of dilated cardiomyopathy as against ischemic cardiomyopathy (93.7% vs 6.3%; p – 0.01), prior right ventricular (RV) apical pacing (25% vs 2.4%; p – 0.02) and absence of a prior history of myocardial infarction (MI) (0% vs 33.3%; p – 0.02). Conclusion In our study, 27.6% of patients were super-responders, and a diagnosis of dilated cardiomyopathy, absence of a prior history of MI and prior RV apical pacing predicted a super-response to CRT.

Seroprevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) in public health workers responding to a MERS outbreak in Seoul, Republic of Korea, in 2015

@#The first case of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Republic of Korea was confirmed in May 2015 after a traveller returned from the Middle East. There were 186 cases, including 38 deaths, within two months. The potential of a single MERS-confirmed patient to result in such a large MERS outbreak constitutes a serious global health concern.

Interpretation:recommendations of the 6st World Symposium on Pulmonary Hypertension（Ⅱ）——haemodynamic definitions and updated clinical classification of pulmonary hypertension / 中国实用内科杂志

Pulmonary hypertension(PH)has been defined as mean pulmonary arterial pressure(mPAP）≥25 mmHg at rest,measured by right heart catheterisation. The 6 th WSPH suggested a new pressure level to define an abnormal elevation as the mPAP>20 mmHg and the need for PVR≥3 WU to define the presence of pre-capillary PH. Regarding clinical classification,the main changes were the inclusion in group 1 of a subgroup“pulmonary arterial hypertension(PAH)long-term responders to calcium channel blockers”and a subgroup“PAH with overt features of venous/capillaries involvement“.

Response time in the emergency services. Systematic review

Abstract The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Guía para la enseñanza del apoyo vital socorrista. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching life support. Agreement for the project of training and research in life support. Cienfuegos, 2018

Fundamento: la parada cardiaca primaria es un problema de salud mundial y una de sus soluciones es disponer, tanto la población como los profesionales de la salud, de conocimientos en reanimación cardiopulmocerebral. El proyecto para la formación e investigación en apoyo vital en emergencias y desastres puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del socorrismo. Métodos: taller nacional realizado en julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del socorrismo tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso "Apoyo vital socorrista" permiten el abordaje de la enseñanza de los primeros auxilios tanto a la población como a grupos especializados de socorristas.

Foundation: Primary cardiac failure is a worldwide Health problem and one of its solutions is to count on health professionals and the population in general with knowledge in cardio-pulmonary-cerebral resuscitation. The project for the training and research in life support in emergencies and disasters may be an academic framework to achieve it. Objective: to update, for the project, the teaching guides and strategy for first aids. Methods: national workshop developed in July 2018 in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming, and nominal group, semi-structured questionnaire and documentary review were used. Results: it is proposed for teaching first aids to undergraduate students and postgradutes as well: the objectives, specific aspects, teaching strategy, contents, scope, skills to develop, future research, and areas for inter-institutional collaboration. Conclusion: academic proposals for the course "Life Support" allows approaching treaching first aids to the population and specialized groups as well.

Guía para la enseñanza del apoyo vital avanzado ante múltiples víctimas. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching advanced life support in the presence of mass casualty. Consensus for the project of training and research in life support. Cienfuegos, 2018

Fundamento: en situaciones de desastres, cuando el número de enfermos o lesionados es alto y los recursos limitados, la atención médica precisa de cambios de estructura y procesos si se quiere salvar un número elevado de personas. El personal de salud debe estar entrenado para enfrentar esta situación cada vez más frecuente. El "Proyecto para la formación e investigación en apoyo vital en emergencias y desastres" puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante víctimas múltiples. Métodos: taller nacional realizado el 10-11 de julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del apoyo vital en situaciones de desastres, tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso "Apoyo vital avanzado ante víctimas múltiples" permiten la preparación de los profesionales de la salud para brindar asistencia médica en situaciones de desastres, con escasos recursos y en ambientes complejos.

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course "Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments.

Efficacy and safety of prucalopride in the treatment of chronic constipation

Background: Chronic constipation is a common condition that significantly impacts health care utilization, productivity, and quality of life. Laxatives are commonly used, although often insufficient in restoring normal bowel function or providing adequate relief. There remains a significant need for the development of novel agents to optimize treatment of this condition. Prucalopride, a selective, high-affinity 5-hydroxytryptamine 4 receptor agonist, stimulates gastrointestinal and colonic motility and alleviates common symptoms of chronic constipation. Here authors are evaluating efficacy and safety study of this drug in chronic constipation patient.Methods: This is a prospective observational study where chronic constipation patient treated with prucalopride 2 mg daily once were enrolled during 6 month period. Data at one week and four weeks were observed along with adverse effects. Efficacy assessed by the number of Spontaneous Complete Bowel Movements (SCBMs) per week recorded by patient diaries. Patients were defined as responders when they had a mean of three or more SCBMs per week over the whole treatment period. The primary efficacy end point was proportion of responders after 1 week and after 4 weeks of treatment.Results: A total of 43 patients diagnosed with chronic constipation and treated with prucalopride were included in study. The proportions of patients in the present study with at least three SCBMs per week (responders) were 44.2% (19 out of 43 patients) at 1 week and 46.5% (20 out of 43 patients) at 4 weeks. Treatment was well tolerated with minimal side effects. Common adverse effects reported in our study were gastrointestinal disorders like diarrhea, nausea and abdominal pain and nervous system disorders like headache and dizziness.Conclusions: Prucalopride is effective, has a good safety profile, and is well tolerated in chronic constipation treatment.

Does the placement of automated external defibrillators affect first responders' willingness to perform cardiopulmonary resuscitation in high-rise residential buildings?

OBJECTIVE: The increasing number of people living in high-rise apartments may result in a delayed response from emergency medical technicians called out for an out-of-hospital cardiac arrest, making the role of apartment managers as the first responders extremely important. This study investigated whether automated external defibrillator (AED) placement influences the willingness of apartment managers to perform cardiopulmonary resuscitation (CPR) and use an AED. METHODS: A cross-sectional target population-based survey was conducted in Daegu, July 2016. Questionnaires were sent to apartment managers working in apartments with more than 500 households. The general characteristics of the respondents, status of CPR education, and knowledge about and willingness to perform CPR and use an AED were investigated. RESULTS: Of the 1,445 respondents, 758 (52.5%) worked in apartments with AEDs, of which 77.8% and 70.8% were willing to perform CPR and use an AED, respectively, compared with 68.1% and 60.0% of respondents who worked in apartments without AEDs. After adjusting for potential confounders, AED placement was associated with the willingness to perform CPR (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.04–1.71) and use an AED (OR, 1.39; 95% CI, 1.10–1.75). Prior CPR training and accurate knowledge of CPR skills were also associated with the willingness to perform CPR and use an AED. CONCLUSION: Placing AEDs in high-rise apartment buildings and providing refresher CPR education for maintaining CPR skills will be necessary to support apartment managers in their role as first responders.

Evaluación de la respuesta densitométrica en pacientes con osteoporosis posmenopáusica tratadas con ranelato de estroncio o denosumab / Densitometric response in postmenopausal osteoporosis treated with strontium ranelate or denosumab

Tanto el ranelato de estroncio (RSr) como el denosumab (Dmab) son eficaces en el tratamiento de la osteoporosis (OP) posmenopáusica (PM). El efecto de cada fármaco por separado sobre la densidad mineral ósea (DMO) ha sido estudiado recientemente. Con ambas drogas se observó, al año de tratamiento, un aumento significativo de la DMO en columna lumbar (CL), cuello femoral (CF) y cadera total (CT). En este trabajo comparamos la respuesta densitométrica al año de tratamiento con una y otra droga. Utilizamos los registros de 425 pacientes PMOP tratadas con Dmab y 441 tratadas con RSr. En cada paciente analizamos el porcentaje de cambio; se clasificaron como respondedoras aquellas que mostraron un cambio ≥3%. Adicionalmente se comparó la respuesta en pacientes no previamente tratadas con bifosfonatos (BF-naïve) en comparación con pacientes que habían recibido previamente un BF. Al analizar el grupo completo para Dmab, el porcentaje de pacientes respondedoras fue de 68,4% en CL, 63,3% en CF y 49,3% en CT. Por otro lado, en el grupo de pacientes tratadas con RSr, el porcentaje de respondedoras (53,8% en CL, 40,0% en CF y 35,6% en CT) fue estadísticamente menor. Cuando comparamos la respuesta entre las pacientes BF-naïve que recibieron RSr o Dmab, el Dmab indujo mayor respuesta en CL y CF que el grupo RSr, sin diferencias en CT. Cuando se analizaron los subgrupos BF-previo, las tratadas con Dmab mostraron mayor respuesta en todas las regiones. Conclusión: en pacientes con OP-PM, el tratamiento con Dmab produjo mayores incrementos densitométricos que el RSr, siendo el porcentaje de pacientes respondedoras mayor con Dmab que con RSr. (AU)

Both strontium ranelate (SrR) and denosumab (Dmab) are effective in the treatment of postmenopausal osteoporosis (PMOP). The effect of each drug on bone mineral density (BMD) has been studied separately by us. With both treatments, there was a significant increase after one year of treatment at the lumbar spine (LS) and hip. In this paper we compared the densitometric response after one year of treatment with both drugs used separately. We used the clinical records of 425 PM patients treated with Dmab and 441 treated with SrR. For each patient we analyzed the percentage of change; those who showed a change ≥3% were classified as responders. Additionally, the response was compared in patients not previously treated with bisphosphonates (BP-naïve) compared to patients who had previously received a BP. When analyzing the complete group for Dmab, the percentage of "responders" was 65.2% at the LS, 62.9% at the femoral neck (FN) and 47.4% at the total hip (TH). On the other hand, in the group of patients treated with SrR the percentage of responders (53.8% at the LS, 40.0% at the FN and 35.6% at the TH) was statistically lower. When comparing the response between in BF-naïve patients receiving RSr or Dmab, Dmab induced a greater response at the LS and FN than the RSr group, with no statistical differences at the TH. When the subgroups with prior BP treatment were analyzed, those treated with Dmab showed greater response in all regions. Conclusion: in patients with PMOP treatment with Dmab produced greater densitometric increments than SrR, and the percentage of responders was higher with Dmab than with SrR. (AU)

The existent main problems and countermeasures on the training of medical response to nuclear and radiological emergency in China / 中国医学装备

Objective: To improve the training system of medical response to nuclear and radiological emergency, and strengthen the capability construction of medical response staff. Methods: By drawing lessons from the training management experiences on medical response of nuclear and radiological emergency of the developed countries and combining with the situation and status quo of China, to discuss how to improve the training system construction on medical response of nuclear and radiological emergency under the guidance of relevant polices. Results:Through researching, a series of countermeasures, such as standard organization system, improving contents and methods of training, strengthening the construction of teacher team, carrying out the evaluation for training effect and intensifying the medical response awareness for the whole people, were adopted based on the existent main problems on medical response training of nuclear and radiological emergency in China. Conclusion: The medical response training of nuclear and radiological emergency is a long term work involved with strong specialty and wide knowledge range. This work need constant innovation so as to strengthen the training system construction of medical response, and train high competent talents on medical response of nuclear and radiological emergency, and then to establish a omnibearing, multilateral, scientific, systematic and long-acting training mode.

Safety and immunogenicity evaluation of 60μg recombinant hepatitis B vaccine (Saccharomyces Cerecisiae) in population aged 16 and above / 预防医学

Objective To evaluate the safety of 60μg recombinant hepatitis B vaccine(Saccharomyces Cerecisiae)in healthy population over 16 years old and immunogenicity in non-responders.Methods A total of 4345 eligible subjects over 16 years old were selected and vaccinated with 60 μg recombinant hepatitis B vaccine, including 3415 participants who have never been vaccined before and 930 non-responders. All participants were monitored for any adverse events occurring within 30 min after each injection and instructed to record selected injection-site reactions and systemic reactions on the day of vaccination and the subsequent 28 days. Blood samples were collected from non-responders at pre-vaccination and one month after vaccination,in order to determine anti-HBs levels,positive rates of anti-HBs and the mean geometric titre(GMT)of anti-HBs.Results Among 4345 vaccinated participants,16.39 % of them reported at least one injection-site or systemic adverse reaction. The most common injection-site and systemic adverse reactions were Grade 1 adverse reactions with the incidence of 15.12 %(657/4345)and 4.05%(176/4345)respectively. No serious adverse events were observed. Among 930 non-responders,the positive rate of anti-HBs was 87.03 % with active responder of 76.74 %(551 / 718)and the GMT of anti-HBs was 479.28 mIU / ml. The positive rate of anti-HBs was not associated with gender or age (P>0.05). The GMT of anti-HBs demonstrated significant differences between female and male(560.66 mIU / mL VS. 404.91 mIU / mL,P<0.05),but there was no significant differences in different age groups (P>0.05).Conclusion 60μg recombinant hepatitis B vaccine was safe for healthy adults above 16 years and had good immunity efficacy among non-responders who had no or low response to standard immunization regimen of hepatitis B vaccine.

Anti-HBs persistence after revaccination with three doses of hepatitis B vaccine among low-responder infants following primary vaccination: 4-year of follow-up / 中华预防医学杂志

Objective@#Assess the 4-year antibody against hepatitis B surface antigen (anti-HBs) persistence after revaccination with 3-dose of hepatitis B vaccine (HepB) among low-responder infants following primary vaccination.@*Methods@#According to stratified cluster sampling, a total of 4 147 infants were enrolled and primarily vaccinated with 5 μg HepB derived in Saccharomyces Cerevisiae (HepB-SC) at 0-1-6 months schedule from 75 towns of Jinan, Weifang, Yantai, Weihai prefectures, Shandong Province, China in Aug and Sep 2009. Blood samples were collected one to six months after the third dose of primary immunization and tested for anti-HBs using chemiluminescence microparticle immunoassay (CMIA). 717 infants who appeared low response (10 mU/ml ≤ anti-HBs<100 mU/ml) were revaccinated with 3-dose of HepB. Blood samples were collected from a total of 315 infants one month (T0), four years (T1) after revaccination and anti-HBs, antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected by CMIA. Information about their birth, primary vaccination were collected. The risk factors associated with positive rate of anti-HBs and GMC of anti-HBs were identified by multiple non-conditional logistic regression analysis and multifactor linear regression model analysis, respectively.@*Results@#Among 315 children, 165 (52.38%) were male and 150 (47.62%) were female. The positive rate was 83.81% (264/315) at T0 and it decreased to 16.51% (149/529) at T1. The corresponding GMC decreased from 473.15 mU/ml to 17.37 mU/ml. The average annual decreasing rate of positive rate and GMC was 33.38% and 56.23% from T0 to T1. Multivariable analysis showed the positive rate and GMC among those whose anti-HBs titer higher at T0 were significantly higher at T1. The positive rate at T1 among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000, ≥1 000 mU/ml at T0 were significantly higher than those whose anti-HBs titer less than 200 mU/ml. The OR (95%CI) of the positive rate was 4.29 (1.03-17.84), 4.53 (1.25-16.47), 4.19 (1.10-15.97) and 9.13 (2.91-28.63), respectively. The GMC at T1 among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000 mU/ml and those whose anti-HBs titer ≥1 000 mU/ml at T0 were higher than those whose anti-HBs titer<200 mU/ml. The b value (95% CI) of GMC was 0.84 (0.06-1.62), 1.13 (0.46-1.79), 1.33 (0.65-2.01) and 1.88 (1.33-2.44), respectively. GMC among full-term infants were significantly higher than premature infants at T1. The b value (95% CI) of GMC was 0.86 (0.04-1.68).@*Conclusion@#Anti-HBs GMC decreased rapidly 4 years after revaccination among low-responder infants, but still kept good protection. The anti-HBs persistence after revaccination was associated with anti-HBs level of titer one month after revaccination.

Prevalence of non-responsiveness to an indigenous recombinant hepatitis B vaccine: A study among South Indian health care workers in a tertiary hospital.

Background and Aim: Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. Study Design and Method: Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay AxSYM AUSAB, (Abbott, Germany). HLA typing was done using SSP-PCR assay AllSet+™ Gold SSP (Invitrogen, USA). Results: The overall seroconversion rate (anti-HBs > 10 mIU/mL) was 98.89% wherein 90.8% had titers >1000mIU/mL, 7.6% had titers 100–1000mIU/mL, 0.43% had titers < 100 mIU/mL and 1.1% were non-responsive (<10 mIU/mL) to the initial 3-dose regimen. Antibody titers <1000 mIU/mL were signifi cantly associated with the highest quartile of body mass index (BMI) (P < 0.001). We found no signifi cant difference in seroprotection rate between gender (P = 0.088). There was no difference in seroprotection rates among various ethnic groups (P = 0.62). Subjects who were non-responsive in our study had at least one HLA allele earlier known to be associated with non-responsiveness to the vaccine. Conclusion: Our fi ndings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might infl uence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as postvaccination anti-HBs testing to prevent HAHI among HCWs.

Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea / 예방의학회지

OBJECTIVES: Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea. METHODS: A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test. RESULTS: The mean age of the participants was 34.8+/-15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001). CONCLUSIONS: IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed.

Hardiness em profissionais de primeira resposta: uma revisão sistemática / Hardiness in first responders: a systematic revision

Esta revisão sistemática da literatura trata do construto teórico de hardiness dirigido a profissionais de primeira resposta, detectando sua aplicabilidade em contextos de exposição regular a incidentes críticos. Consultou-se bases de dados (EBSCO, Web of Science e PsycINFO) no período de abril a junho de 2013, restringindo-se a artigos em português, inglês e espanhol publicados entre 2003 e 2013. Assim, 10 artigos compuseram esta revisão, sendo estes agrupados em um bloco temático ­ hardiness como agente amortecedor dos efeitos nocivos do estresse. Bombeiros, profissionais de enfermagem, médicos, paramédicos, militares e policiais compuseram os profissionais estudados. Hardiness mostrou estar negativamente relacionado ao mal-estar psíquico, ao desenvolvimento de quadros de adoecimento emocional e exercer influência negativa no uso de mecanismos desadaptativos e de risco, considerando as amostras elencadas nas pesquisas. Também mostrou relação positiva com bem estar psicológico e com a capacidade de enfretamento eficiente, útil e saudável em ambientes altamente estressantes.(AU)

This article provides a systematic revision in the literature regarding the hardiness construct, aimed to first responders, checking its applicability on scenarios where there is a regular exposure to critical incidents. From April to June, 2013, the EBSCO, Web of Science and PsycINFO databases were searched, looking for articles in Portuguese, English and Spanish, published between 2003 and 2013. After applying the inclusion and exclusion criteria, 10 articles ended up being included in this revision. They were then grouped, based on their goals and identified associations, in a single thematic block ­ hardiness as a weakening agent from the harmful effects of stress. The professionals studied comprised firemen, nurses, doctors, paramedics, military and policemen. From the studies analysis it is concluded that hardiness was shown to be negatively related to psychological distress, development of emotional illness and negatively influence the use of maladaptive and risky mechanisms, considering the samples listed in researches. Likewise, it showed a positive relationship with psychological well-being and the ability of efficient, helpful and healthful coping in highly stressful environments.(AU)

Revisiting epidermal growth factor receptor in glioblastoma multiforme: Does it play a role in response to therapy.

Background and Aim: Glioblastoma multiforme (GBM) are the most aggressive class of cancer of central nervous system with hallmark characteristics that include rampant proliferation, necrosis, and endothelial proliferation. Epidermal growth factor receptor (EGFR) has been implicated as the primary contributor to glioblastoma initiation and succession. The present study was designed to evaluate EGFR protein expression in GBM as predictor of response to therapy and survival. Materials and Methods: Epidermal growth factor receptor was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots (10 high-power fields). The study group comprised of 35 cases of GBM. All cases underwent surgical resection and subsequently underwent radiotherapy (n = 17) or radiotherapy with adjuvant temozolomide chemotherapy (n = 18). Immediate response to therapy was assessed at 3 months using World Health Organization response evaluation criteria in solid tumors criteria and cases followed up for survival. Results: Twenty-four cases (68.6%) expressed EGFR while 11/35 (31.4%) cases were negative. Response to therapy was evident in 21/35 cases (60.0%) and 14/35 were (40.0%) nonresponders. Mean EGFR protein expression in responders was 37.23 ± 33.70 and in nonresponders was 59.5 ± 39.46 (P = 0.542). The percentage of responders which were EGFR negative was 72.7% and while response in EGFR positive cases was observed in 54.2%. Mean survival in EGFR positive and negative GBM was 394.37 ± 189.11 and 420.54 ± 191.23 days, respectively. Conclusion: The EGFR negative cases appear to respond better to therapy, however, the difference is not statistically significant (P = 0.298). Further, EGFR protein expression does not play a definitive role in predicting survival. This is an original study evaluating EGFR in terms of therapeutic response.