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The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety.
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【Objective】 To detect alleles of rare blood group systems of red blood cells (RBC) of Duffy, Diego, Kidd, Dombrock, MNS, Lutheran, Kell, Colton, Scianna, YT, Knops, Indian and Vel of Li Ethnic Group in Hainan, so as to investigate the distribution characteristics of rare blood group alleles and provide references for safe blood transfusion. 【Methods】 The genotypes of 13 rare blood group systems in 300 Li people in Hainan were analyzed by PCR-SSP, and the gene frequency was analyzed . 【Results】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS, and Lutheran blood group systems of 300 Li people were as follows: Duffy: Fya=0.958 3, Fyb=0.041 7; Diego: Dia=0.066 7, Dib=0.933 3; Kidd: Jka=0.450 0, Jkb=0.550 0; Dombrock: Doa=0.101 7, Dob=0.898 3; MNS: M=0.818 3, N=0.181 7, S=0.028 3, s=0.971 7, Mur+ =0.576 7; Lutheran: Aua=0.835 0, Aub=0.165 0. The antigen genes of Kell, Colton, Scianna, Yt, Knops, Indian, Vel blood group systems were not polymorphic, and the genetypes were kk, CoaCoa, Sc1Sc1, YtaYta, KnaKna, InbInb and Vel+, respectively. 【Conclusion】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS and Lutheran blood group systems of Li ethnic group in Hainan were polymorphic, while the allele frequencies of Kell, Scianna, Yt, Knops, Colton, Indian and Vel blood group systems were monomorphic.
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Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class ⅢGrade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in ClassⅢGrade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 ClassⅢGrade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach α coefficient was 0.93. The prevalence of pressure sores was 2.28% (165/7 248), of which 66.06% (109/ 165) was family involvement, 30.30% (50/165) was hospital acquired, 3.03% (5/165) was community involvement,and 0.61% (1/165) was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%(30/165) of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94% (93/194). The proportion of pressure ulcer in stageⅡwas the highest (35.57% , 69/194). 52.01% (647/1 244) of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40% (1 013/1 244) of patients' main compression sites were not covered by dressings.35.50%(442/1 244) of patients did not according to plans or regularly turn over, only 56.19% (699/1 244) patients turned over every 2 hours. 61.57% (442/1 244) patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries: the prevalence of incontinence related dermatitis was 0.88%(64/7 248), and the prevalence of avulsion skin injury was 0.37%(27/7 248). Conclusions The incidence of acquired pressure ulcer in ClassⅢGrade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers.
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Objective To research the effect of GGCX gene on MMP13 in rabbit osteoarthritis cartilage cells and investigate its effect on osteoarthritis cartilage degeneration.Methods Six Japanese big ear rabbits weighted (2.0±0.2)kg were randomly di vided into three groups,each group seted a rabbit as control.Anterior cruciate ligament transection method was used to build osteoarthritis cartilage degeneration model at second,forth,sixth week.Articular cartilage was separated successfully after the model were built,cartilage cells were divided from articular cartilage and cultured in 6-well cell culture plate.Cartilage cells were divided into blank group,negative control group and transfection group.PCR method and Western blot were conducted to detect GGCX and MMP13 expressed at the level of mRNA and protein.Results Compare with blank group and negative control group,the expressin level of GGCX incresed,while the MMP13 expression level dcresed(P<0.05).Conclusion Over expression of GGCX gene can ob viously decrease the expression of MMP13,it provide experimental basis for osteoarthritis of the in vitro gene therapy.
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Objective To investigate the characteristics of thyroid surgical emergency related disease and prognosis,provide the basis to improve treatment.Methods Retrospective analysis of 24 cases of thyroid surgical emergency patients in Peking Union Medical College Hospital,Chinese Academy of Medical between 2004 and 2014who was performed,and the Fisher analytic method was used.Results According to the condition of diseases,conservative treatment for 1 case,surgical treatment for 23 cases,interventional therapy for 2 cases were performed.The overall preoperative diagnosis rate was 45.8%.The overall perioperative death were 5 cases (20.8%),total death were 7 cases(29.2%).8 cases preoperative diagnosed or highly suspected thyroid lymphoma patients were received oral or intravenous corticosteroid treatment,with the use of corticosteroids perioperative survival rate increased from 50% to 100%.Conclusions (1) Thyroid surgical emergency with different causes should quickly make a clinical diagnosis based.on the patient's history and examination,select rational treatments.(2) Thyroid lymphoma patients that preoperative highly suspected or diagnosed,immediate received glucocorticoid treatment can reduce airway obstruction and decrease mortality,should be promoted.
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Objective To evaluate dopamine D2/D3 receptors status in striatal and extra?striatal re?gions with 18 F?Fallypride PET/CT. Methods A total of 11 healthy volunteers ( 4 males, 7 females, age (43.5±13.7) years) underwent PET/CT at 1 h after 18F?Fallypride injection. Imaging data was analyzed u?sing visual and ROI methods. The SUV ratios of different brain regions to cerebellar lobe were calculated. In?formed consent was obtained from all volunteers. The study was approved by the Ethics Committee of the PLA General Hospital. Results 18 F?Fallypride was widely distributed in striatal and extra?striatal brain re?gions. Distribution of 18 F?Fallypride was consistent in all healthy subjects and the rank order of receptor con?centration(brain region SUV/cerebellum SUV) was putamen(15.72±3.69)>pituitary(10.24±6.55)>cau?date(8.38±1.26)>amygdala(6.92±1.32)>thalamus(4.87±1.50)>colliculi(3.91±1.08)>substantia nigra (3.20±0.95)>cortex(temporal cortex: 2.11±1.34, parietal cortex: 1.51±0.57, occipital cortex: 1.31± 0?11, frontal cortex:1?30±0.25). Conclusion 18F?Fallypride PET/CT is suitable to study D2/D3 recep?tors status in striatal and extra?striatal brain regions.
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Objective To analyse the pain analgesic efficacy and safety evaluation of diclofenac sodium and lidocaine hydrochloride combined with anisodamine in patients with bone fractures.Methods 54 patients who were diagnosed with acute fracture in the hospital were collected and randomly divided into experimental group and control group, 27 cases in each group, control group was treated with diclofenac sodium and lidocaine hydrochloride, and experimental group was treated with anisodamine on the basis of control group.Before 30 min and 2 h after treatment, the effect of 5-hydroxytryptamine ( 5-HT ), prostaglandin E2 ( PGE2 ), analgesic effect, tolerability and adverse reactions were detected in all patients. ResuIts Compared with control group post treatment, the plasma 5-HT content was significantly lower in experimental group ( P<0.05 ); the plasma PGE2 content in experimental group was significantly lower (P<0.05); the pain rating index (PRI) total score,PRI feel score, PRI emotion score, present pain intensity (PPI) and visual analogue scale (VAS) in experimental group was significantly lower (P<0.05).The tolerance of experimental group was 92.59%, which was significantly higher than 66.67% of control group (χ2 =5.59,P<0.05).ConcIusion Diclofenac sodium and lidocaine hydrochloride combined with anisodamine could significantly decrease 5-HT and PGE2 in patients with fracture pain, enhance the analgesic effect, reduce the incidence of adverse reactions, with a good tolerance, which have the guiding significance on clinical therapy.
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Background and purpose: Multidrug resistance (MDR) is the dominating obstacle to the chemotherapy. There is strong evidence that the phosphoinositide 3-kinases (PI3Ks) signaling pathway is involved in MDR phenotype, however, the mechanism of MDR occurrence is still unknown. This study tended to investigate the regulating effect of PI3K/Akt signaling pathway and its downstream target genes in P-glycoprotein (P-gp) (ABCB1 gene encoding)-mediated MDR in human colon carcinoma HCT-116/L-OHP cells. Methods:Pretreatment with PI3K selective inhibitor LY294002 (20μmol/L) for 2 h, the sensitivity of L-OHP was evaluated by the CCK-8 (cell counting kit-8) assay in HCT-116/L-OHP cells, and the expressions of P-gp, LRP, MRP-2, Akt, p-Akt, IκB and p-IκB were evaluated by Western blot. The activity of ABCB1 promoter was evaluated by chromatin immunoprecipitation analysis (CHIP). Results: After inhibiting the activity of PI3K/Akt signaling pathway, the IC50 value of L-OHP decreased from(157.48±16.73)μg/mL to (53.68±3.18)μg/mL in HCT-116/L-OHP cells, and the reversal index was 2.93 (P<0.01). The expressions of P-gp, p-Akt and p-IκB were down-regulation compared with the concrol group (P<0.01), but the expressions of LRP, MRP-2, Akt and IκB didn't change signiifcantly. CHIP result has conifrmed that NF-κB protein could bind to the region of ABCB1 gene promoter in HCT116/L-OHP cells. Conclusion:Blocking of PI3K/Akt/NF-kB signal pathway could increase the drug sensitivity to MDR cells, inhibit the phosphorylation of p-Akt and p-IκB, and reversing ABCB1/P-glycoprotein-mediated multidrug resistance in colon carcinoma cells.
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Objective To investigate the feasibility of the lower cervical spine (C3 -C7 ) laminar screw technique for fixing adult posterior cervical spine .Methods We chose 9 formalin fixed moist adult cervical specimens ,which consist of male 6 and female 3 of the age 38 to 63 years old .The average age is 51 .9 years old and the average height is 165 .6 cm .Then we measured the thickness and heightof C3 -C7 lamina ,the lamina length of L1 ,L2 ,and the lamina of axis and the sagittal plane angle .Results The thickness and height of C3 -C7 lamina ,and the lamina length of L1 and L2 of adult male is bigger than adult women .There was statistical sig-nificance between the thickness ,height ,lamina length difference of different genders lamina (P 0 .05) .The average lamina thickness of C2 ,C3 ,C4 ,C5 ,C6 ,C7 were respectively 4 .70 ,3 .87 , 3 .30 ,3 .84 and 5 .16 mm .The lamina thickness which was more than 4 .00 mm accounted for 54 .4% .The lamina thickness of C3 , C4 ,C6 ,C7 which was more than 4 .00 mm accounted respectively for 77 .8% ,61 .1% ,33 .3% ,and 88 .9% .Conclusion Crossing laminar screws in cervical spine is feasible in anatomy .The operation can make under direct vision ,and can accurately estimate the screw path length and entry angle .Patients with anatomic abnormalities can be used as an alternative fixation technique or as fixed in the fixed mode fails .So the results can provide a reference for clinical application .
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To investigate the clinical improvement of limping gait in patients with ankylotic hips and limb length discrepancy.Methods:From 1996 to 2005,12 patients with ankylotic hips and limb length discrepancy were treated by distraction osteogenesis with a mono-lateral external fixator and an intramedullary nail.The limb length discrepancy was 6.20-12.50 (median 8.45) cm.Limping gait was classified according to the recommendations of the American Academy of Orthopedic Surgeons/Hip Society and scored according to Harris:no limping scored 11 points,mild limping scored 8 points,moderate limping scored 5 points,while severe limping scored 0 points.Limping gait was severe in all patients pre-operatively and the total score was 0.Results:All patients were followed up for 30.00-46.00 (median 38.55) months,and all reported improvement in limping gait.The gain in length was 6.00-12.50 (median 8.20) cm,and the mean residual limb length discrepancy was 0-0.50 (median 0.20) cm.The total treatment time was 41.00-82.00 (median 61.50) weeks,the lengthening time was 14.00-38.00 (median 29.55) weeks.At the last follow-up,10patients had mild limping gait and 2 had moderate limping gait; the total score was 90.00.The median score was 7.50 (P25 was 8.00,P75 was 8.00).According to Wilcoxon signed rank test,the post-operative limping gait scores were significantly higher than pre-operative (P=0.001 ).Conclusion:Femoral lengthening can improve the limping gait significantly in ankylotic hips and limb length discrepancy.
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BACKGROUND: Dedifferentiation changes in monolayer culture and limited resource are 2 problems in chondrocyte study. There are few reports concerning the phenotype, biological characteristics, and three-dimensional culture SW1353 human chondrosarcoma cells.OBJECTIVE: To observe the kinetics characteristics and ultramicro location of type Ⅱ collagen in three-dimensional cultured SW1353 human chondrosarcoma cells.DESIGN, TIME AND SETTING: The material-cytology in vitro observation was performed at the Xiangya School of Medicine, Central South University, from August 2004 to January 2006.MATERIALS: SW1353 human chondrosarcoma cells were provided by ATCC Company.METHODS: After resuscitation, the cells were cultured in DMEM containing fetal bovine serum and vitamin C. Then the cell aggregate was suspended in alginate solution, with final concentration of 2×10~9/L, gel solution was dropped to obtain alginate beads. At weeks 8 after three-dimensional culture, citrate sodium was added to breakdown gel, and the chondrocyte was harvested. The growth characteristics of SW1353 between in monolayer and in alginate three-dimensional were compared. MAIN OUTCOME MEASURES: Phenotype shift was observed by Toluidine blue staining. Type Ⅱ collagen expression in cell was directed by immunohistochemistry. The location of type Ⅱ collagen in ultrastructure was observed by Immunoelectron microscope. Isotope 14C-proline pulse chase experiment was performed to find out the kinetics of collagen Ⅱ in synthesis and secretion. RESULTS: There were phenotype changes after 8 weeks monolayer cultured in SW1353 as the articular chondrocytes had done. Compare with the monolayer culture, the good phenotype was maintained and the proliferation was slow when the cell was cultured in alginate culture and the type Ⅱ collagen in suspension and alginate matrix was decreased either. Type Ⅱ collagen expression in cell can be directed both in cells and outside of cells; type Ⅱ collagen locate almost in rough endoplasmic reticulum in Immunoelectron microscope; Pulse chase experiment found that the 180 minute was the peak of synthesis and secretion of collagen Ⅱ after intervention by ~(14)C-proline. ELISA confirmed that the expression of type Ⅱ collagen was obvious increased at 8 weeks than 1 week in the suspension of monolayer culture (P < 0.05), which was greater than that in alginate matrix of three-dimensional. CONCLUSION: Long term monolayer culture in SW1353 may lead to cell phenotype change. Alginate three-dimensional can improve the phenotype changes by decrease cells metabolism and maintaining the dormancy situation of SW1353. Expression of type n collagen in SW1353 was abundant. This cell line can be a good research model of chondrocyte function.
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The psychological quality of military personnel is an important research topic in military psychology. The present rating scale for psychological quality of military personnel consisted of 30 items, and with this scale 94 military officers of 3 different rank groups were subjected to the test. 18 items were screened out as the items concerning basic psychological quality of military personnel according to the following two criteria: (1) more than 80% of the officers selected this item; (2) the mean score of the item was more than 1.00. Analysis of the results showed that, the connotation and denotation of the psychological quality of military personnel were in a certain degree similar to that of the general definition, and they also represented some special characteristics required by military settings. This study suggested that these 18 items reflected the basic elements of structural extension of the psychological quality of military personnel.
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Objective To approach the effect of psychological recuperation on the mental health of the medical personnel working in SARS ward. Methods A total of 131 medical workers working in SARS ward were randomly selected as the objects to be psychologically recuperated. Results Both groups' score on somatization, obsessive, interpersonal sensitivity, depression, anxiety and phobia anxiety is higher than that of the local norm before the training, there is no significant difference between the training group and the control group. After the training, there is no significant difference between the training group and the local norm except somatization; the control group's score in somatization, obsessive, interpersonal sensitivity, depression, hostility is higher than that of the local norm, while the training group′s scores in the five dimensions is obvious lower than that of control group. Conclusion Psychological behavior training played a positive role on the' mental health of the medical personnel working in SARS ward.