The effectiveness evaluation of helicopter emergency medical services on transporting critical patients / 中华急诊医学杂志

Objective To explore the advantages and disadvantages of helicopter emergency medical services of South China in the long-distance transport for critical patients.Methods A total of 30 patients who received helicopter emergency medical services by Guangdong Generral Hospital from August 2004 to December 2014 were selected as the observation group,and the other 30 patients with similar conditions who received ground emergency medical services were selected as the control group.To analyses the difference between the two groups in the disease,transport distance,transportation time,costs and compliction by χ2-test,t-test and nonparametric test according types of data.Results There were significantly difference between two groups in transport distances (km) [578.0 (313.0,707.5)vs.214.5 (101.5,313.5),P 0.05).Conclusions Helicopter emergency medical services could shorten the transportation time of critical patients on long distance transportation,and improve the efficiency of first-aid.However,there were many disadvantages that need to be improved in the helicopter emergency medical service of China.

Academic thoughts on Practice of acupuncture and moxibustion written by CHEN Jingwen, the acupuncture master in the Republic of China / 中国针灸

Through the collection of Practice of acupuncture and moxibustion written by CHEN Jingwen, the acupuncture master in the Republic of China, the academic characteristics on acupuncture and moxibusiton were analyzed. The literature comparison method was adopted to compare the works of LUO Zhaoju, ZENG Tianzhi and LI Wenxian, etc. at the same period. It was discovered that CHEN Jingwen was the medical master who systematicly brought up the theory of acupoint properties earlier in the modern times. Classifying drugs based on acupoints was his academic feature. Additionally, the compatibility therapy of Chinese medicine was introduced to explain the essential ideas on the acupoints combination. The treatment was determined on the basis of zangxiang theory and the reinforcing and reducing therapy of acupuncture was emphasized in the determination of treatment and prescription. CHEN Jingwen's theory of acupoint property had been stressed and spread among the medical scholars in the Republic of China and he had made the beneficial exploration for the development of modern acupuncture and moxibustion therapy.

International Progress and Understanding of Discharge Planning / 中国康复理论与实践

With the social development and the transformation of medical model, providing patients with continuous services and seam-less transfer between different medical institutions, namely continuity care, is inevitable. Discharge planning take patients as the center and patient's needs as the guidance. Patients and their families should actively take part in the plan. Through multi-disciplinary and multi-institu-tional cooperation, patients can continue to enjoy health services after discharge. Discharge planning is the basis of continuous medical ser-vice. This article summrized the background and situation of discharge planning in the United States, Canada, Brazil, the United Kingdom, Ireland, Australia, Japan, India, South Africa, and Hong Kong, Taiwan and mainland in China. When heavy medical burden, aging, im-balence between supply and demand occurred, discharge planning could be helpful to make rational use of medical resources, save medical costs, guarantee the quality of medical service continuity, avoid the occurrence of adverse events after discharge and improve the patients' function and quality of life. This article reviewed group members, time, institutions and process of discharge planning in order to provide ev-idence-based basis for the development of discharge planning in China.

Discharge Planning in China / 中国康复理论与实践

Discharge planning is the basis of continuous medical service. It could shorten the length of hospital stay, improve bed occu-pancy, reduce readmission rate, save medical costs, and improve the quality of life. It's considered to be important and supplemented by rele-vant policies and regulations to promote development in the United States, the United Kingdom, Canada, Australia and other developed countries. In China, even though Hong Kong and Taiwan have issued discharge planning policies, the mainland is still at the stage of explora-tion. Discharge planning in Chinese mainland has problems like restricted objectives, imperfect content, un-optimized process, unestablished professionals and organizations and so on. Standardized discharge planning guide still needs further research. As the health service system including hospitals, public health institutions and primary health institutions coverd urban and rural gradually, and the new pattern of grad-ing diagnosis and treatment established, it's necessary to analyze the necessity, importance, obstacles and measures of discharge planning in China.

The Preliminary Results of Left Atrial Appendage Occlusion in Patients With Non-valvular Atrial Fibrillation / 中国循环杂志

Objective: To explore the feasibility with the safety at peri-operative and early post-operative periods for left atrial appendage occlusion in patients with non-valvular atrial ifbrillation (AF). Methods: A total of 17 non-valvular AF patients with transesophageal echocardiography (TEE) and CAHDS2 evaluation who received left atrial appendage occlusion in our hospital were summarized. The effect and complications during peri-operative and 1 month post-operative periods were analyzed. Results: All 17 patients had successful operation without severe complications. There were 8 patients having small amount residual shunt by TEE examination, 2 having ecchymosis near the puncture point at peri-operative period and 3 having small amount of hydropericardium by peri-cardio ultrasound examination. At the average of 45 days follow-up study, only 3 patients had small amount residual shunt, no left atrium thrombus and hydropericardium were observed. Conclusion: Left atrial appendage occlusion has the high success rate, it is safe during peri-operative and early post-operative periods in non-valvular AF patients.

Esmolol improves clinical outcome and tissue oxygen metabolism in patients with septic shock through controlling heart rate / 中华危重病急救医学

ObjectiveTo investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock.Methods A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed therapy (EGDT) with pulmonary artery wedge pressure≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure (CVP)≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP)≥ 65 mmHg and HR≥95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg·kg-1·min-1 with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)]before and 24, 48, 72 hours after the treatment.Results A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group.① The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75±8.68 vs. 21.70±6.06,t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24),χ2 = 6.857,P = 0.009].② The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, ScvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4±3.5 vs. 111.2±7.2,P< 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa·s·L-1·m-2): 137.9±1.6 vs. 126.9±1.3, ScvO2: 0.652±0.017 vs. 0.620±0.017, bothP< 0.01]; SVI was significantly increased (mL/m2: 39.9±2.2 vs. 36.8±1.7,P< 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8±0.3 vs. 3.4±0.3,P< 0.01).Conclusion The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

The analysis of risk factors of pulmonary embolism in patients with negative D-dimer / 中华急诊医学杂志

Objective To analyze the risk factors of pulmonary embolism in patients with negative Ddimer in serum in order to determine the need of pulmonary computed tomography angiograph (CTA) to confirm the final diagnosis in those patients for avoidance of misdiagnosis.Methods A retrospective analysis of 106 patients suspected to suffer from pulmonary embolism (PE) with serum negative D-dimer checked with pulmonary CTA was carried out.According to the results of CTA, the patients were divided into two groups, namely PE group (n =41) and non-PE group (n =65).The difference in clinic presentation, the time elapsed from onset to visit, N-terminal pro-brain natriuretic peptide (NT-proBNP), high risk factors (such as immobilization for 3 weeks, leg swelling and pain to palpation, history of deep vein thrombosis, malignancy) and Wells score (≥ 4 points indicates probability of PE).And logistic regression analysis was made to investigate the risk factors in PE with negative D-dimer.Results The analysis study showed that 38.6％ of total patients suspected to suffer from PE with serum negative D-dimer were checked by CTA to confirm the presence of PE.One important characteristics of the D-dimer negative PE patients was the longer time consumed from onset to visit [(9.51 ±2.01) d vs.(4.01 ±1.92) d, P＜ 0.05], and majority of the CTA positive patients suspected to suffer from PE with negative D-dimer had high risks of PE (P ＜0.01).Compared with the non-PE group, the Wells score ≥4 points and the level of serum NT-proBNP significantly increased in the PE group (P ＜ 0.01).Logistic regression analysis revealed that dyspnea, high NT-proBNP level and Wells sore ≥ 4 points were risk factors for D-dimer negative PE.Conclusion Delayed treatment was the main cause of misdiagnosis of D-dimer negative PE.Dyspnea, high NT-proBNP level and Wells sore ≥4 points were risk factors for suspected PE patients with negative D-dimer, and these patients should be confirmed by pulmonary CTA.On the contrary, PE could be excluded if patients with D-dimer negative had no these risk factors.

Evaluation of the effect of early postoperative aural/oral rehabilitation of prelingual deaf children with cochlear implants / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the effect of aural/oral rehabilitation in the prelingual deaf children with cochlear implants, analyze the relationship between the age at the time of surgery and the rehabilitation effect, and explore the law of aural/oral rehabilitation in the prelingual deaf children after cochlear implantation.@*METHOD@#Prelingual deaf children with cochlear implants were divided by age into 1.3-2.9 group (17 cases), 3.0-4.9 group(14 cases)and 5.0-7.9 group (26 cases). All the children were evaluated by CAP and SIR questionnaires 3 months, 6 months, 9 months and 12 months after the surgery.@*RESULT@#The scores of CAP and SIR in different age groups were all increased with time after cochlear implantation. The score of CAP in 1.3-2.9 group rose the fastest, which was lowest at the end of the 3rd month and was highest at the end of the 12th month. There were no differences between the CAP scores of 1.3-2.9 group and 5.0-7.9 group in the later test. The score of SIR rose the fastest in 1.3-2.9 group, which was lowest at the end of the 3rd month and highest at the end of the 12th month and rose the slowest in 5.0-7.9 group, which was lower than the other groups at the end of the 12th month.@*CONCLUSION@#Within one year after cochlear implantation, the younger the age, the better the effect of aural/oral rehabilitation.

Results of different postoperative adjuvant therapies for stage Ⅰ b-Ⅱ a cervical carcinoma with risk factors / 中华妇产科杂志

Objective To investigate the effects of postoperative adjuvant chemotherapy (CT) and chemoradiotherapy (CRT) or radiotherapy(RT) for Ⅰ b-Ⅱ a cervical cancer with risk factors.Methods From March 1995 to June 2010,there were 137 patients underwent radical hysterectomy and systematic pelvic lymphadenectomy for stage Ⅰ b-Ⅱ a cervical cancer admitted at Peking University First Hospital.These patients had risk factors,intermediate risk factors including bulky tumor (＞4 cm),lymph vascular space invasion,deep stromal invasion; high risk factors including positive surgical margin,parametrial invasion,lymph node involvement.Of the all patients,79 cases of them were treated with CT,58 of them were treated with RT or CRT.The 5-year survival and prognosis factors were analyzed retrospectively,the prognosis was compared between two adjuvant therapy groups.Results The univariate analysis shown that types of pathology,different grade of risk factors,stroma invasion and lymph node involvement were prognostic factors of 5-year overall survival Patients with squamous cell carcinoma,intermediate risk factors,no parametrial invasion,and no lymph node involvement had better prognosis (P ＜ 0.05).Whether patients with high-risk factors or intermediate-risk factors,the 5-year overall survival and 3-year disease-free survival had no difference between CT and RCT or RT groups respectively.Cox regression multivariate analysis of survival indicated that clinical stages,types of histology,different grade of risk factors were independent prognostic indicator.Patients with early stage,squamous cell carcinoma,intermediate risk factors had better prognosis.Univariate and multivariate analysis indicated that different postoperative adjuvant therapies had no effects on the prognosis.The 5-year overall survival was 88.6％ in patients treated with CT,and 89.7％ in patients treated with RT or CRT (P =0.455).Conclusion There are equivalent therapeutic results between CT and RT or CRT for patients with risk factors after radical surgery,CT may be as one choice of postoperative adjuvant therapy for stage Ⅰ b-Ⅱ a cervical carcinoma with risk factors.

Factors facilitating the successful post-pyloric placement of spiral naso-jejunum tube in critically ill patients / 中华急诊医学杂志

Objective To analyze the potential factors facilitating post-pyloric placement of spiral naso-jejunum tube in critically ill patients.Methods A retrospective study was carried out in patients requiring enteral nutrition (EN) from Apr 2005 through Dec 2011 in Intensive Care Unit (ICU).Severity of illness was assessed with APACHE Ⅱ score (acute physiology and chronic health evaluation Ⅱ).A selfpropelled spiral naso-jejunum tube was placed and observed for 24 hours.The forward movement and place of the tube tip was checked by bedside X-ray.The APACHE Ⅱ score,therapeutic measures,agents administered within 24 hours after tube insertion were recorded.The patients were divided into the success group and the failure group identified by bedside X-ray whether the tube tip entered into jejunum or not.Univariate analysis and multivariate Logistic regression analysis were used to find out the potential factors impacting on the success or failure in post-pyloric placement of naso-jejunum tube.Results A total of 508 patients composed of 337 male and 171 female,and aged (62.0 ± 19.2) years with APACHE Ⅱ score of (21.9 ± 7.3) were enrolled for study.The placement was successful in 205 (40.4％) of 508 patients.Univariate analysis showed that APACHE Ⅱ score ≥ 20,sedatives and analgesics,catecholamines,prokinetics,artificial airway and mechanical ventilation were potential factors facilitating the post-pyloric placement of naso-jejunum tube.Multivariate logistic regression identified that APACHE Ⅱ score ≥ 20,sedatives and analgesics and prokinetics were independent factors facilitating the post-pyloric placement of naso-jejunum tube.Conclusions The success rate of self-propelled spiral nasojejunal tubes insertion was relatively low.The prokinetics contributed higher success rate of naso-jejunum tube placement than factors of APACHE Ⅱ score ≥ 20,sedative and analgesic,catecholamine drugs,artificial airway and mechanical ventilation.There were no effects of age and gender on the placement of naso-jejunum tube.

Ilaprazole in the treatment of duodenal ulcer:a Meta analysis / 中国医师进修杂志

Objective To systematically review the efficacy of ilaprazole in duodenal ulcer by Meta analysis.Methods Randomized controlled trial (RCT) comparing ilaprazole with other proton pump inhibitors in duodenal ulcer were searohed for Meta analysis.Results Six RCT met the inclusion criteria and 1319 patients were included.Meta analysis showed that the healing rate at 4-week in the dose of ilaprazole 10 mg/d was higher than that in control group [ 89.1％ (591/663 ) vs.86.4％ (426/493) ],but there was no significant difference (P＞ 0.05 ).When including high-quality literature,English literature,Chinese literature,or the literature using omeprazole as control,there was no significant difference either (P ＞ 0.05 ).The adverse rate in the two groups had no significant difference [ 9.7％ (64/663) vs.12.6％ (62/493)] (P ＞0.05 ).The 4-week healing rate between the doses of ilaprazole 5 mg/d and 10 mg/d had no significant difference [84.7％(138/163) vs.84.0％(131/156)](P＞0.05).Conclusions Ilaprazole has high healing rate for duodenal ulcer,with low adverse rate.The effect of the dose ot5 mg/d is comparable to 10 mg/d.

Octreotide for advanced hepatocellular carcinoma：Meta-analysis of randomized controlled trials / 中国医师进修杂志

Objective To evaluate the effect of octreotide on the survival of patients with advanced hepatocellular carcinoma(HCC).Methods Electronic databases searches were conducted.Meta-analysis of all randomized controlled trials (RCTs) comparing octreotide versus placebo or no treatment was performed.Results Five RCTs including 579 patients with HCC wers assessed.Meta-analysis of the five studies showed that octreotide had no significant effect on the 6,12 and 24 months survival rates of the patients(6months:OR=1.69,95%CI 0.89-3.21,P=0.11;12 months:OR=2.41,95%CI 0.83-6.93,P=0.10;24months:OR=0.58,95%CI 0.28-1.17,P=0.13).To perform the sensitivity analysis,the blank study,the trial detecting somatostatin receptor expression,the study with short survival or the two trials with short follow-up intervals were excluded,and the results also showed that the octreotide treatment had no significant effect on the 6 and 12 months survival rates.A sensitivity analysis based on two trials indicated that the 24months survival rate of the octreotide group was even lower than that of the control group(OR=0.51,95% CI0.27-0.98,P=0.04).Conclusions This Meta-analysis demonstrates that octreotide could not improve the survival of patients with advanced HCC.The administration of octreotide should not be recommended for the treatment of advaneed HCC.

Application of receiver operating characteristic curve in the evaluation of predictive value of serum NT-proBNP in weaning outcome of patients with mechanical ventilation / 中华急诊医学杂志

Objective To evaluate the value of NT-proBNP in predicting weaning outcomes of the patients with mechanical ventilation by using the receiver operating characteristic (ROC)curve. Method The data of patients after the weaning of mechanical ventilation and spontaneous breathing trial (SBT) in the intensive care unit,from July 2008 to January 2010, were retrospective reviewed. All patients were divided into the success group and failure group as per the outcomes of weaning. Demographics and the serum NT-proBNP levels measured before weaning were compared between two groups with Student t -test and Chi-square test. The ROC curve was drawn to evaluate the value of serum NT-proBNP in predicting outcomes after weaning. Results A total of 160 patients were eligible for inclusion in the study, and there were 106 cases in success group and 54 cases in failure group.Compared with the failure group, the patients of success group were younger (63.17 ± 17.00 vs. 71.28 ± 12.56,t = 2.063,P =0.024), and no difference in gender (χ2 = 0.06, P ＞ 0.05). The NT-proBNP levels of failure group were significantly higher than those of success group (Lg NT-proBNP 2.80 ± 0.72 vs. 3.75 ± 0.56, t =2.351,P =0.014). The area under cure (AUC) of the ROC cure of NT-proBNPto predict the failure of weaning was 0.855 ±0.036 (95%CI0.784 ～ 0.925) when the cut-off level of NT-proBNP was 3635.5 pg/mL. And, this NT-proBNP level had a followed predictive efficiency in weaning outcome (Youden's index: 0. 60, accuracy:82.5%, sensitivity: 75%, specificity: 84.7%, positive likelihood ratio: 4.90, negative likelihood ratio:0.295,Kappa value: 0.62). Conclusions The levels of NT-proBNP before weaning have predictive value in weaning outcome, and it may be used as one of the screening indicators for weaning.

The clinical research of different dose of esomeprazole-based triple therapies for Helicobacter pylori eradication / 中国医师进修杂志

Objective To compare the efficacy of different dose esomeprazole-based triplen therapies for Helicobacter pylori (Hp)eradication. Methods Two hundred and forty Hp-infected patients were randomly assigned to undergo high-dose (40 mg) or low-dose (20 mg) esomeprasole combined with clarithromycin (500 mg) and amoxicillin (1g) twice a day for one week. Hp eradication test was performed at 4 weeks after the end of treatment to evaluate the response to therapy. Results One hundred and fourteen patients were followed up in high-dose patients, and 104 were Hp eradication. One hundred and thirteen patients were followed up in low-dose patients, and 101 were Hp eradication. There was no significant difference in eradication rate of intention-to treat analysis and per protocol analysis between high-dose and low-dose patients [86.7%(104/120) vs 84.2% (101/120) and 91.2% (104/114) vs 89.4% (101/113), P>0.05]. There was no significant difference in the rate of adverse effect between high-dose and low-dose patients (8.3%(10/120)vs 6.7%(8/120), P>0.05). Conclusion It demonstrates that low-dose esomeprazole-based triple therapy has a similar Hp eradication rate compared with high-dose esomeprazole-based therapy in China.

Effect of psychological intervention on prevention of postoperation infection in patients with breast cancer / 中国实用护理杂志

Objective To discuss the effect of psychological intervention on prevention of posloperation infection in patients with breast cancer .Methods 336 patients with breast cancer after operation were divided into the control group and the intervention group with 168 cases in each group.The control group received routine nursing while the intervention group Was given psychological intervention based upon routine nursing.The incidence of postopemtion infection was observed in the two groups.Results Incidenc of infection took place in 27 patients(8.04%)among 336 cases.The incidence rate infection in the control group was 12.50%,which was evidently higher than that of the intervention group(3.57%),x2=9.06,P＜0.01.The infection location and time in the intervention group was better than that of the control group.Conclusion Psychological intervention could reduce the incidence rate of posteperation infection in patients with breast cancer.

Design of subsystem for clinical application and approval based on No.1 Military Medical Project system in our hospital / 医疗卫生装备

A subsystem for clinical application and approval is fulfilled based on No.1 Military Medical Project system in our hospital.It is developed by PowerBuild8.0.and possesses such functions as the clinical data application,examination & approval,maintenance and statistics.It changes the low efficiency mode for paper applications transfer by handwork in our hospital.

Design and realization of the interface between "No.1 Military" Project and health insurance system of Xinqiao Hospital / 医疗卫生装备

With the wide spread of social health insurance system,Xinqiao hospital,a health insurance unit,interfaces HIS with health insurance system.With the application to Xinqiao Hospital and key features of health insurance system presented,this paper introduces the method for interfacing HIS of ″No.1 Military″ Project with health insurance system,thus can be referenced by other hospitals.

Hairless Gene Mutations in a Sporadic Case of Atrichia with Papular Lesions / 中华皮肤科杂志

Objective To identify the hairless gene mutations in a family of atrichia with papular lesions. Methods Skin biopsies were taken from typical lesions for histopathological examination. Genomic DNA was extracted from blood samples of the family members. Complete encoding sequences of hairless gene Dwere detected by polymerase chain reaction (PCR) and DNA sequencing. Results Compound heterozygous mutations were identified in the patient: G337D in exon 3 and Q498X in exon 4. There was only one of the mutations in his parents and a younger brother. Conclusions G337D and Q498X mutations in hairless gene seem to be responsible for the phenotypes in the patient suffered from atrichia with papular lesions.

Expression of recombinant N-glycosylation interleukin 24 and study of inducing tumor cells apoptosis in vitro / 中国药理学通报

Aim To obtain recombinant human IL-24 secretorily expressed in Pichia pastoris,and study the activity of inducing tumor cells apoptosis of this N-glycosylation protein. Methods By the recombinant plasmid ?/pUC18,the confirmed IL-24 gene was inserted between the sites of BamH Ⅰ and EcoR Ⅰ of expression plasmid pPIC9K. The recombinant plasmid IL-24/pPIC9K was transformed into P. pastoris strain GS115. Yeast transformants were induced for expression of recombinant human IL-24 with methanol. The desired protein was identified with Tricine-SDS-PAGE and Western blot.Amount of IL-24 was assayed with ELISA and the glycosylation was analyzed by PNGase F.The activity of inducing tumor cells apoptosis was confirmed by MTT assay and Hoechst assay in vitro.Results Recombinant expression plasmid IL-24/pPIC9K was successfully constructed. 5 transformants were screened with G418 and PCR. Induced with methanol,the expression level of IL-24 was (81.31?14.46) mg?L-1 at flask fermentation,and 70 % IL-24 generated N-glycosylation.Recombinant IL-24 induced apoptosis in MCF-7 cells,but not in NHLF.Conclusion The secretorily expression of the N-glycosylation IL-24 protein in P. pastoris and the study of inducing tumor cells apoptosis lay the foundation for the further study of molecular mechanism of IL-24 on anti-tumors and the potential application.