Clinical Value of Serum Calcium Level Combined With Choline Esterase and MELD-Na Score in Evaluation of Prognosis of Patients With Decompensated Cirrhosis / 胃肠病学

Background: Decompensated liver cirrhosis is a common disease in department of gastroenterology, and the prognosis is poor. There are many liver cirrhosis-related scoring models, but all have certain limitations. Aims: To explore the clinical value of serum calcium level combined choline esterase, MELD-Na score for predicting prognosis in patients with decompensated cirrhosis. Methods: A total of 169 patients with decompensated cirrhosis from Jan. 2017 to Dec. 2020 at the Quzhou Affiliated Hospital of Wenzhou Medical University were enrolled. Serum calcium level, choline esterase, creatinine, international normalized ratio (INR), prothrombin time, total bilirubin (TBIL) and serum sodium level were detected, and MELD score and MELD-Na score were calculated. ROC curve was used to analyze the value of parameters in evaluating prognosis of patients with decompensated cirrhosis. Results: After 6 months' follow-up, 125 patients survived and 44 died. TBIL, creatinine, INR, prothrombin time, MELD score, MELD-Na score were significantly lower in survival group than in death group (P<0.05), while serum albumin, sodium, calcium, choline esterase levels were significantly higher (P<0.05). ROC curve showed that AUC of serum calcium level, choline esterase, MELD score and MELD-Na score for predicting prognosis of patients with decompensated cirrhosis were 0.824, 0.783, 0.781 and 0.839, respectively. AUC of serum calcium level combined with choline esterase and MELD-Na score was 0.897. Conclusions: The combination of serum calcium level, choline esterase and MELD-Na score has a higher predictive value for the 6-months prognosis of decompensated cirrhosis patients.

Medical rescue action for large number of the sick and wounded in maritime disaster at sea / 中华急诊医学杂志

Objective To investigate the effect of medical rescue of the Maritime Medical Team (Corps) for mass sick and wounded in maritime disaster so as to improve the medical rescue capacity for maritime disasters.Method The construction of maritime medical teams (corps) constituted with various numbers of 10, 15,50 and 120 team members, and the development of algorithm in practice were reviewed. In 68 maritime disasters from January 2003 to December 2009, 937 wounded were rescued by first-aid at sea. The patients were classified and given cardiopulmonary cerebral resuscitation, emergency operation, complication prevention, comprehensive treatment for seawater immersion wound and rapidly referred to hospitals. Results Of 937 patients, 872 survived (93%) and 65 died (7%). Of the dead, 16 died in one hour (25%), 43 died in 24 hours after injury (66%),andofthem, 61died of trauma (94% ) , 2 died of drowning and 1 died of poisoning. Conclusions Besides a good command of the features of mass sick and wounded, organization and program, treatment strategies and measures, the timely and effective assignment for on-site first aid at sea and safe transfer were very important for medical rescue of mass patients in maritime disaster. After the practice of maritime medical team (corps) in medical rescue during maritime disaster, the rapid response capability, cooperation and the quality of rescue were improved, and the experience of medical service of marine medical team (corps) was enriched.

To Improve Security Quality of Medical Treatment by Enhancing Management of Antibiotic Drug Usage / 中华医院感染学杂志

OBJECTIVE To improve efficiency and quality of antibiotic drug usage in order to assure patients′ security of antibiotic drug usage. METHODS Inducted by strengthening security quality of medical treatment,we are bring antibiotic drug usage into medical quality management by using information technique,training medical workers,putting antibiotic drug into different classifications and surveillancing the usage of antibiotic drug.Moreover,we develop significant basic study for clinic to improve the level of rational use of drug. RESULTS Frequency and number of days for drug usage were reduced by putting measures into effect and inspecting numbers and sorts of drug usage.At the same time,we instituted individualized drug using scheme to critical patients,thereby many critical patients were retrieved. CONCLUSIONS Rational use of drug is a system project which must redeploy all enthusiasm and take comprehensive measures to fight for a safe,effective,economical goal in our work.