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The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
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Humans , Consensus , Prone Position , Wakefulness , China , DyspneaABSTRACT
BackgroundSince the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. To explore the psychological distress and the psychological demand induced by COVID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal (PD) patients during the lockdown period. MethodsQuestionnaires were given to the dialysis patients in West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients trauma-related distress in response to COVID-19. Results232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms. HD patients had a significant higher IES score than PD patients (11.50 vs 8.00) (p<0.05). HD patients already got more psychological support from the medical staff. There was no significant difference on further demand of psychological support between the two groups. In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p<0.05). ConclusionsHD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.
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Objective To investigate the feasibility of reducing CT scanning dose in the process of 125I radioactive seed implantation.Methods GEMS phantom and 062 M phantom were scanned using GE Lightspeed RT large hole CT with 120 kV,100 kV and 80 kV separately,and 150-10 mA (20 mA decreased progressively).The scanning dose,CT value and noise of the region of interest were recorded and the image quality was evaluated.Image signal-to-noise ratio (SNR) and contrast to noise ratio (CNR) values were calculated.Results With the decreasing of tube voltage and current,the SNR values were reduced accorgingly.The values had significant difference with those of standard images except the images acquired with 120 kV,150-70 mA and 100 kV,150-90 mA (t =-9.294-3.717,P ＜0.05).With the decreasing of the tube voltage and current,the CNR decreased significantly.The image quality was too low to evaluate while CNR lower than 2.The high contrast resolution of the CT images were not affected obviously with the tube voltage and current lowering.Conclusions In the process of 125I radioactive seed implantation,it is feasible to choose lower tube voltage and tube current(100 kV,70 mA) to scan the same area repeatedly except for the first scan with standard chest scanning parameters.The patient radiation dose has fallen dramatically.
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Objective To investigate the efficacy and safety of amisulpride and clozapine in schizophrenia patients with predominantly negative symptoms.Methods Totally 166 cases of schizophrenia patients with predominantly negative symptoms from May 2013 to May 2016 in The Sixth People's Hospital of Hebei were divided into observation group and control group,83 cases in each group.Patients in the observation group were treated with amisulpride,and control group were treated with clozapine.The clinical effect,SANS scores,and occurring rate of abnormal electrocardiogram were compared.Results The clinical effect,emotional insipid (blunting),and attention dysfunction scores from SANS of observation group were significantly better than those of control group on week 4,8,and 12,respectively (P ＜ 0.05);The occurring rate of abnormal electrocardiogram in observation group was significantly lower than that of control group on week 12 (P ＜ 0.05).Conclusion Compared with clozapine,amisulprid has better efficacy and safety in schizophrenia patients with predominantly negative symptoms,and can effectively improve of symptom of insipid (blunting) and attention dysfunction.
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BACKGROUND:For the department of orthopedics, digital technology can be used for a three-dimensional reconstruction of the fracture site, and visual virtual reset. This not only can preoperatively plan the operation path, make reasonable operation plan, but also can predict the prognosis after surgery. OBJECTIVE:To discuss the feasibility and clinical effect of digital technology for three-dimensional measurement and preoperative design in intertrochanteric fracture patients undergoing proximal femoral nail antirotation. METHODS:Eighty patients of intertrochanteric fractures, who underwent proximal femoral nail antirotation in the Changyi People’s Hospital from January 2010 to January 2014, were selected in this study. According to the order of visiting, they were randomly divided into traditional treatment group and three-dimensional design group, with 40 cases in each group. Patients in the traditional treatment group received proximal femoral nail antirotation. Patients in the three-dimensional design group received preoperative CT scan to establish the digital three-dimensional model of intact femur. The analog was reset by technology. The length and diameter of medul ary cavity were measured. The appropriate specifications of intramedul ary nail were selected. On this basis, the plan of the operation and implementation of operation were made. Operation time, intraoperative bleeding volume and blood transfusion were recorded in the two groups. Hip function was evaluated by hip Harris score. RESULTS AND CONCLUSION:(1) Operations in the two groups were successful. Significant differences in operation time, intraoperative bleeding volume and blood transfusion were determined between the two groups (P0.05). (2) Al patients were fol owed up. Postoperative wound was healed. Broken nail or broken rod was not found at the end of the study. (3) At the end of the fol ow-up, the excel ent and good rate of Harris hip score was 95%in the traditional treatment group and 93%in the three-dimensional design group;no significant difference was detected between the two groups. (4) Results suggested that the application of digital department of orthopedics technology for the treatment of intertrochanteric fracture of femur in patients with preoperative three-dimensional measurement and surgical design can significantly shorten the operation time and improve hip function.
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BACKGROUND: Spontaneously hypertensive rats (SHR)-derived vascular smooth muscle cells (VSMCs) show exaggerated growth with a synthetic phenotype and angiotensin II (Ang II)-production. To evaluate the contribution of complement 3 (C3) or C3a toward these abnormalities in SHR, we examined effects of a C3a receptor inhibitor on proliferation, phenotype, and Ang II-production in VSMCs from SHR and Wistar-Kyoto (WKY) rats. METHODS: Expression of pre-pro-C3 messenger RNA (mRNA) and C3 protein was evaluated by reverse transcription-PCR and western blot analyses, and C3a receptor mRNA was evaluated by reverse transcription-PCR analysis in quiescent VSMCs from SHR and WKY rats. We examined the effects of the C3a inhibitor, SB290157, on proliferation and the expression of phenotype-marker and Krueppel-like factor 5 (KLF-5) mRNAs in VSMCs from SHR and WKY rats. We examined effects of C3a receptor inhibitor, SB290157, on Ang II-production in conditioned medium of VSMCs from SHR and WKY rats by a radioimmunoassay. RESULTS: Expression of pre-pro-C3 mRNA and C3 protein was significantly higher in SHR VSMCs than WKY VSMCs. SB290157 significantly inhibited proliferation of VSMCs from SHR, but not in cells from WKY rats. Relative to WKY VSMCs, SB290157 significantly increased the low expression of SM22α mRNA and decreased the high expression of osteopontin mRNA in SHR VSMCs. SB290157 significantly decreased the high expression of KLF-5 and Ang II-production in VSMCs from SHR, but not in cells from WKY rats. CONCLUSIONS: C3a induces exaggerated growth, a synthetic phenotype and Ang II-production in SHR-derived VSMCs. C3a may be primarily involved in cardiovascular remodeling in hypertension.
Subject(s)
Angiotensin II/biosynthesis , Arginine/analogs & derivatives , Benzhydryl Compounds/pharmacology , Complement C3a/physiology , Hypertension/immunology , Muscle, Smooth, Vascular/immunology , Receptors, Complement/antagonists & inhibitors , Angiotensin II/drug effects , Animals , Arginine/pharmacology , Cells, Cultured , Hypertension/metabolism , Kruppel-Like Transcription Factors/drug effects , Muscle, Smooth, Vascular/drug effects , Muscle, Smooth, Vascular/metabolism , Phenotype , RNA, Messenger/drug effects , Rats , Rats, Inbred SHR , Rats, Inbred WKY , Receptors, Complement/drug effectsABSTRACT
<p><b>OBJECTIVE</b>To investigate the complications and conversions in myeloproliferative disorders (MPD).</p><p><b>METHODS</b>Three hundred and fifty six patients with MPD were reviewed, including 78 with etiologic thrombocythemia (ET), 93 with primary myelofibrosis (MF), 185 with polythythemia vera (PV). The clinical observation, follow-up, analysis with SPSS statistic software were performed.</p><p><b>RESULTS</b>Out of the 356 cases, 101 (28.5%) developed thromboembolic events, 81 (22.8%) hemorrhage, 60 (16.9%) hypertension, 20 (5.6%) coronary heart disease, 3 (0.8%) hemolysis and 1 (0.3%) gastrointestinal ulcer, 2 (0.6%) calculus and 1 (0.3%) bone marrow necrosis. Twenty four patients (6.7%) developed MF (9 in ET, 15 in PV), 2 (0.6%) erythrocytosis (1 in ET, 1 in MF), 3 (0.8%) thrombocythemia (all in PV), 5 (1.4%) acute leukemia (2 in ET, 3 in MF) and 1 (0.3%) multiple myeloma (in ET). Eleven cases (3.1%) died, 5 (1.4%) from acute leukemia, 2 (0.6%) fatal hemorrhages, 1 (0.3%) each myocardial infarction and infectious shock, 2 (0.6%) unknown causes.</p><p><b>CONCLUSION</b>Embolism and bleeding were the main complications in MPD. Conversions among ET, MF and PV hematological malignancies could occur.</p>
