Observation and evaluation of the application effect of a dynamic scoring method in the emergency department of primary hospital / 中华危重病急救医学

OBJECTIVE@#To establish a new emergency dynamic score (EDS) method based on modified early warning score (MEWS) combined with clinical symptoms, rapidly available examination results and bedside examination data in the emergency department, and to observe its applicability and feasibility in the clinical application of emergency department.@*METHODS@#A total of 500 patients admitted to the department of emergency of Xing'an County People's Hospital from July 2021 to April 2022 were selected as research objects. After admission, EDS and MEWS scores were performed first, and then acute physiology and chronic health evaluation II (APACHE II) was performed retrospectively, and the prognosis of patients was followed up. The difference of short-term mortality in patients with different score segments of EDS, MEWS and APACHE II were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the prognostic value of various scoring methods in critically ill patients.@*RESULTS@#The mortality of patients in different score groups of each scoring method increased with the increase of the score value [The mortality of 0-1, 2-3, 4-5, 6-7 and ≥ 8 of MEWS were 1.9% (3/159), 2.9% (6/208), 12.4% (11/89), 29.0% (9/31) and 61.5% (8/13), respectively. The mortality of EDS stage 1 weighted MEWS score 0-3, 4-6, 7-9, 10-12 and ≥ 13 were 0 (0/49), 3.2% (8/247), 6.6% (10/152), 31.9% (15/47) and 80.0% (4/5), respectively. The mortality of EDS stage 2 clinical symptom score 0-4, 5-9, 10-14, 15-19, ≥ 20 were 0 (0/13), 0.4% (1/235), 3.6% (6/165), 26.2% (17/65), 59.1% (13/22), respectively. The mortality of EDS stage 3 rapid test data score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 0 (0/16), 0.6% (1/159), 4.6% (6/131), 13.7% (7/51) and 65.0% (13/20), respectively. The mortality of patients with APACHE II score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 1.9% (1/53), 0.4% (1/277), 4.6% (5/108), 34.2% (13/38) and 70.8% (17/24), respectively, all P < 0.01]. When the MEWS score was more than 4, the specificity was 87.0%, the sensitivity was 67.6%, and the maximum Youden index was 0.546, which was the best cut-off point. When the weighted MEWS score of EDS in the first stage was greater than 7, the specificity of predicting the prognosis of patients was 76.2%, the sensitivity was 70.3%, and the maximum Youden index was 0.465, which was the best cut-off point. When clinical symptom score of EDS in the second stage was more than 14, the specificity and sensitivity of predicting the prognosis of patients were 87.7% and 81.1%, respectively, and the maximum Youden index was 0.688, which was the best cut-off point. When the third stage rapid test of EDS reached 15 points, the specificity of predicting the prognosis of patients was 70.9%, and the sensitivity was 96.3%, and the maximum Youden index was 0.672, which was the best cut-off point. When APACHE II score was higher than 16, the specificity was 87.9%, the sensitivity was 86.5%, and the maximum Youden index was 0.743, which was the best cut-off point. ROC curve analysis showed that: EDS score in the stage 1, 2 and 3, MEWS score and APACHE II score can predict the short-term mortality risk of critically ill patients. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.815 (0.726-0.905), 0.913 (0.867-0.959), 0.911 (0.860-0.962), 0.844 (0.755-0.933) and 0.910 (0.833-0.987), all P < 0.01. In terms of the differential ability to predict the risk of death in the short-term, the AUC in the second and third stages of EDS were highly close to APACHE II score (0.913, 0.911 vs. 0.910), and significantly higher than MEWS score (0.913, 0.911 vs. 0.844, both P < 0.05).@*CONCLUSIONS@#EDS method can dynamically evaluate emergency patients in stages, and has the characteristics of fast, simple, easy to obtain test and inspection data, which can facilitate emergency doctors to evaluate emergency patients objectively and quickly. It has strong ability to predict the prognosis of emergency patients, and is worth popularizing in emergency departments of primary hospitals.

Clinical observation of " needles therapy" in treating acute cerebral infarction and its effect on autophagy / 中国针灸

<p><b>OBJECTIVE</b>To observe the difference of clinical efficacy between " needles therapy" and conventional acupuncture in patients with acute cerebral infarction (ACI) and its relationship with autophagy.</p><p><b>METHODS</b>Sixty patients with ACI were randomly divided into an observation group (30 cases and 2 dropping) and a control group (30 cases and 3 dropping). Conventional drugs were applied in the two groups. In the observation group, acupuncture was applied at Dazhui (GV 14), Fengchi (GB 20), Qiangjian (GV 18), Baihui (GV 20), Shenting (GV 24), Yintang (GV 29), Shuigou (GV 26), Quchi (LI 11, affected side), Hegu (LI 4, affected side), Zusanli (ST 36, affected side), and EA was connected at Baihui (GV 20) and Yintang (GV 29). After 30 min, the EA and non-governor vessel acupoints were removed, and the governor vessel points were continued for 20 min. Twirling was used twice every 5 min, 1 min a time. In the control group, acupuncture was applied at Baihui (GV 20), Yintang (GV 29), Quchi (LI 11, affected side), Waiguan (TE 5, affected side), Shousanli (LI 10, affected side), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6, affected side), Taixi (KI 3, affected side), Taichong (LR 3, affected side). EA was connected at Zusanli (ST 36) and Hegu (LI 4). The treatment was given for 10 days, once every day with needle retained for 30 min. National Institute of Health stroke scale (NIHSS), mini-mental state examination (MMSE), modified Barthel index (MBI) scores were observed before and after treatment in the two groups. The clinical efficacy, the changes of contents of LC3-II and Beclin1 in peripheral serum were judged.</p><p><b>RESULTS</b>After treatment, NIHSS score was lower than that before treatment, and MMSE score and MBI score were higher than those before treatment (all <0.01), and the result in the observation group was better than that in the control group (all <0.05). Contents of LC3-Ⅱ and Beclin1 in peripheral serum were higher than those before treatment in the two groups (both <0.01), and the result in the observation group was better than that in the control group (both <0.05). The total effective rate in the observation group was 92.9% (26/28), which was better than 70.4% (19/27) in the control group (both <0.05).</p><p><b>CONCLUSION</b>" needles therapy" have better effect to relieve the clinical symptoms of patients with acute cerebral infarction than conventional acupuncture, which may be related to the increasing number of autophagic bodies and autophagy activity.</p>

Clinical Observation of Deep Needling at Tianshu (ST25) with Electroacupuncture for Post-stroke Constipation / 上海针灸杂志

Objective To observe the clinical efficacy of deep needling at Tianshu (ST25) with electroacupuncture in treating post-stroke constipation. Method Forty-eight patients with post-stroke constipation were randomized into an electroacupuncture (EA) group and a medication group, 24 cases in each group. The EA group was intervened by deep needling at Tianshu with EA, while the medication group was by Cong Rong Tong Bian oral liquid. After 1 treatment course, the constipation symptom score was observed and the clinical efficacy was calculated. Result After 1 treatment course, the symptom score, total effective rate, recovery plus markedly-effective rate of the EA group were superior to that of the control group, and the inter-group differences were statistically significant (P<0.05). Conclusion Deep needling at Tianshu with EA can significantly enhance the clinical efficacy in treating post-stroke constipation and improve the quality of life.

Clinical Observation on Acupuncture Treatment of 30 Cases with Apoplectic Pseudobulbar Palsy / 针灸推拿医学（英文版）

Objective: To investigate the factors influencing the therapeutic effect in acupuncture treatment of apoplectic pseudobulbar palsy (PBP). Methods: Sixty patients with apoplectic pseudobulbar palsy in pattern of obstruction of wind and phlegm in the meridians were randomly divided into the treatment group and control group, to observe the therapeutic effect. Results and Conclusion: The therapeutic effect was significantly better in the treatment group than in the control group (P＜0.05). It has been found in the study that with increase in the occurrence of cerebral apoplexy, the incidence rate of severe dysphagia increased and dysphagia took place progressively earlier, indicating the importance of early treatment and prevention of cerebral apoplexy.