Prevention and control strategy of nosocomial infection in elderly COVID-19 patients / 中华医院管理杂志

Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.

Accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization / 中华麻醉学杂志

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Role of dendritic cells in lipopolysaccharide induced cardiac dysfunction in mice / 中华危重病急救医学

Objective To observe the role of dendritic cells (DC) in lipopolysaccharide (LPS)-induced myocardial dysfunction in mice. Methods Eighty wild type male C57BL/6 mice were divided into four groups, according to random number table method: sham group, DC inhibitors in control group (VAG539-sham group), LPS sepsis model group (LPS group) and DC inhibitors pretreatment group (VAG539-LPS group), 20 in each group. The cardiac dysfunction model of sepsis mice was established by LPS intraperitoneal injection; the sham group was injected with the same dose of normal saline. VAG539-sham group and VAG539-LPS group were injected with the DC inhibitor VAG539 (30 mg/kg, twice per day, for 2 days) before injection with normal saline or LPS, respectively. Ten mice in each group were used to observe the 14-day survival rate. Mean arterial pressure (MAP) of the remaining 10 mice was measured through the small animal tail artery cannula; the cardiac function [including the heart rate (HR), left ventricular ejection fraction (LVEF) and short axial shortening rate (FS)] were evaluated by small animal echocardiography; the aggregation and maturation of myocardial DC were detected by flow cytometry; and serum inflammatory factors [including tumor necrosis factor-α (TNF-α), interleukins (IL-12, IL-6)] were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with sham group, the 14-day cumulative survival rate in LPS group was significantly reduced, while HR, MAP, LVEF and FS were significantly decreased, and the number of DC in myocardial tissues was significantly increased, and the levels of serum inflammatory factors were increased significantly. The 14-day cumulative survival rate in VAG539-LPS group was significantly higher than that in the LPS group (55% vs. 15%, P < 0.05). Compared with LPS group, after pretreatment by VAG539, the HR, MAP, LVEF and FS were significantly increased [HR (bpm): 610±25 vs. 556±28, MAP (mmHg, 1 mmHg = 0.133 kPa): 68±6 vs. 42±2, LVEF: 0.48±0.02 vs. 0.30±0.03, FS: (34±3)% vs. (14±2)%, P < 0.05]; the number of DC in myocardial tissue was significantly decreased from 6.5% to 3.7%; the level of serum inflammatory factors were significantly decreased [TNF-α(ng/L): 192.00±25.45 vs. 291.34±23.12, IL-12 (ng/L): 58.44±12.37 vs. 78.43±11.24, IL-6 (ng/L): 46.97±8.12 vs. 149.12±15.45, all P <0.05]. Conclusion Sepsis can cause cardiac dysfunction, and it can play an important role by inhibiting the DC cell function of myocardium and reducing the expression of inflammatory factors.

A retrospective analysis of cardioversion for paroxysmal supraventricular tachycardia in emergency department / 中华急诊医学杂志

Objective To analyze retrospectively the cardioversion for paroxysmal supraventricular tachycardia (PSVT) in emergency department in order to explore rational guidance for the diagnosis and treatment for PSVT.Methods A retrospective analysis of PSVT patients in the emergency department admitted from June 2015 to December 2015 was carried out.First,all the patients were divided into two groups according to the cardioversion achieved by Valsalva's maneuvre or not.Forty patients were enrolled in study.There were 11 patients got cardioversion successfully achieved by the Valsalva's maneuvre and 29 patients failed to get cardioversion.Then,comparisons of demographics,vital sign,serum CTNI,potassium and NTproBNP level were carried out between these groups of patients using statistical analysis.The categorical variable was expressed in percentage and the continuous variable was described by mean±standard deviation and the comparisons of parameters were conducted by group t-test and chi-square test.Results The success rate of PSVT maneuvre cardioversion was 27.5％.In addition,there were no significant differences in demographics vital sign,TNI and NTproBNP between the two groups while there were significant differences in serum potassium level between the two groups [(3.8±0.4)mmol/L vs.(3.5±0.35)mmol/L P＜0.05].There was no significant difference in successful rate of cardioversion between the standard Valsalva's maneuvre(n=6) the modified Valsalva's maneuvre(n=5).The second-line treatment mainly included propafenone,adenosine,electroversion,verapamil and amiodarone.The propafenone was the most common second-line agent used for PSVT cardioversion accounting for 58.6％.Conclusions The success rate of Valsalva's maneuver cardioversion was low.Keeping properly a higher level of serum potassium could increase the success rate of cardioversion by Valsalva's maneuvre.

The mechanisms of LPS-induced cardiac dysfunction in septic mice / 中华急诊医学杂志

Objective To study about the cardiac function of the mice suffering from sepsis induced by lipopolysaccharide (LPS) so as to probe the physiopathologic mechanism of the cardiac dysfunction of the mice.Method Sixty male C57BL/6 mice of eight weeks old were randomly (random number) divided into four groups:one control group (n =15) and three experimental groups (n =15 in each group).The mice of control group received intra-peritoneal injection of normal saline (10 mg/kg) while the mice of experimental groups got intra-peritoneal injection of LPS (10 mg/kg).The cardiac function of mice (n =12) was determined by echocardiography 6 h,12 h and 24 h later,respectively.The heart,kidney and lung tissues of mice (n =6) were stained with Haematoxylin-Eosin (HE) staining after embedding with paraffin for observing the histopathological changes under optic microscopy.The expressions of PECAM-1 and α-SMA of the heart tissue of mice (n =3) in three groups determined by immunohistochemical method.The RT-PCR method was used to test the expressions of VEGF (vascular endothelial growth factor) and HIF-α (hypoxia-inducible factor) of the myocardium of mice.In addition,the Western blot method was employed to test the levels of p53 and HIF-1α proteins in myocardium of mice,while ELISA was utilized to detect the level of tumor necrosis factor-α (TNF-α) and the interleukin-6 (IL-6).The data were analyzed by independent samples of t-test and one-way ANOVA respectively.Results The experiment result proved that the thickness of anterior wall of left ventricle of mice during systolic and diastolic periods increased and the inner diameter of the left ventricle also increased during the diastolic period in mice of the experimental group,while the stroke volume decreased compared with the control group (P ＜ 0.05).The immunohistochemical method showed that the new vessels of the mice' s heart in experimental groups increased compared with the control group (P ＜ 0.05).RT-PCR showed the expressions of VEGF and HIF-1α of the mice heart of experimental group increased (P ＜ 0.05) and Western blot showed the levels of HIF-1 α and p53 proteins in experimental groups increased significantly compared with the control group.The experimental group had higher levds of VEGF,HIF-1α,and IL-6 were evidenced by using ELISA than those of the control group (P ＜ 0.05).Conclusions The lipopolysaccharide can lead to cardiac dysfunction.In this process,myocardium angiogenesis and apoptosis phenomenon coexists,as VEGF and HIF-1α participating in angiogenesis,whereas BAX and p53 playing a role in the process of apoptosis.

Health risk factors and health-related presenteeism in medical staff of a tertiary grade A hospital / 中华健康管理学杂志

Objective To study the relationships of health risk factors and health-related presenteeism in medical personnel of a tertiary grade A hospital. Methods A literature review and expert consultation were used to identify 14 health risk factors included in the survey, and the Michigan's Health Risk Appraisal Questionnaire was modified. Medical personnel of a tertiary grade A hospital in Beijing were selected for this cross-sectional study, including doctors, nurses, medical technicians, pharmacists, as well as scientific researchers, and staff members responsible for education, medical affairs, journal editors and other work. Physical measurement and questionnaire survey were conducted to collect demographic data, distribution of health risk factors of medical staff, and productivity information. Results Among 14 health risk factors, pressure or stress had the highest proportion (80.2%), followed by poor quality of sleep (63.7%), high blood lipid (33.8%), low physical activity (30.9%), and unreasonable diet (29.6%). Medical staff of different ages( c 2=16.141, P=0.001) and different occupations( c 2=15.982, P=0.003) had different probability of presenteeism. Medical staff under 30 years of age were most likely to be presenteeism (38.3%). The probability of presenteeism in nurse was the highest(56.2%). Under a high pressure and taking relax medicine seemed more likely to be presenteeism. Conclusion In the 14 kinds of health risk factors, pressure and taking relax medicine in medical staff may be associated with health-related presenteeism.

An anlysis of the education training situation and demand of rural doctors in the east and center-west region in China / 中华医学教育探索杂志

ObjectiveThe study was designed to understand the education training situation and demand of rural doctors,identify problems in training and provide theoretical basis for the relevant government departments to further the development of rural doctors education,explore the pattem of ru ral health education and improve the effectiveness of training.MethodsThe participants were a sample of rural doctors among the east and center-west region in China (Beijing Municipality,Jiangsu,Zhejiang,Hainan,Shanxi,Guangxi Zhuang Autonomous Region,Guizhou,Yunan and Gansu).20 288questionnaires were issued,18 259 of them were taken back,which occupied 90.1％ recovery rate.Group interview method and stratification-cluster sample method were conducted in the Cross-sectional study.Results70.2％ were male doctors,with an average age of 44.3 ±10.9 years,63.0％ of whom received technical school education and technical secondary school Training time was mainly less than 12 days per year (48.8％),training content was mainly about clinical skills(80.6％),and traning mode was mainly conference traning (56.6％).There was a certain gap between training status and demand.ConclusionThe on-site clinically guide-based,comprehensive and short-term non-job training should be demand-orientedly carried out aiming at young doctors in rural areas.

Factors influencing prehospital delay for patients with acute myocardial infarction / 老年心脏病学杂志（英文版）

Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI).Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

Changes of several sero-enzyme activities in patients with chronic cor pulmonale / 中国医师进修杂志

Objective To explore the changes of several sero-enzyme activity including lactate dehydrogenase (LDH),aspartate aminotransferase(AST),alanine aminotransferase (ALT),creeatine phosphatase kinase (CPK) and its isoenzyme (CK-MB),?-hdroxybutyrate dehydrogenase (HBDH) in patients with chronic cor disease and its clinical significance. Methods The sera LDH,AST,ALT,CPK,CPK-MB and HBDH from 15 healthy controls and 61 patients with chronic cor disease were examined before and after treatment.CPK-MB/CPK and HBDH/LDH were calculated and simultaneously the blood gas analysis was performed. Results In experimental group all the sera enzymes contents before treatment were significantly higher than those after treatment (P

Effect of ligustrazine on the calcium contants and calmodulin activity of lung tissue in rats of the bleomycin-induced pulmonary fibrosis / 中国临床药理学与治疗学

AIM: To observe the effect of ligustrazine on the calcium contents and calmodulin activity of lung tissue in rats of the bleomycin-induced pulmonary fibrosis. METHODS: Thirty-two SD rats were replicated into pulmonary fibrosis models by intratracheal injection of bleomycin A 5 in one lump and were divided into two groups randomly, untreated model group (n=16) and ligustrazine group(n=16). The calcium contents and calmodulin activity of the lung of the rats of each group were assayed on d 14, d 28 after the injection and compared with control group (n=8). RESULTS: The calcium contents and calmodulin activity of model group were obviously higher than control group (P