Developing the Disaster Medical Responder's Course in Singapore.

Problem: Emergency medical teams (EMTs) deployed to mass casualty incidents (MCIs) are required to work outside their usual settings and according to different principles, which may affect their performance and the survival of casualties. Prior to 2013, training offered to domestic EMTs was limited to ad hoc and infrequent simulation exercises. Context: Domestic EMTs are activated from public tertiary hospitals to provide pre-hospital medical support to the Singapore Civil Defence Force and establish a first-aid post (FAP) for triaging, stabilizing and treating casualties. These casualties are then evacuated to public hospitals for further management. Action: Recognizing the need for a more systematic approach to the training of domestic EMTs, the Disaster Medical Responder's Course (the Course) was developed as a multiinstitutional collaboration to equip EMT members attending a MCI with the necessary skills to perform effectively at the FAP. Outcome: The Course was first run in 2013 and is usually offered six to eight times a year. Since June 2019, a total of 414 health-care staff and allied health professionals have participated. There have been numerous revisions of the course content and delivery to reflect the latest concepts in operations and global best practice, as well as developments in educational methodologies. Discussion: Preparedness is crucial to optimize the survival and outcomes of casualties. The Course provides standardized training of domestic EMTs and plays a pivotal role in ensuring operational readiness for MCIs in Singapore.

Artificial intelligence deep learning for 3D IC reliability prediction.

Three-dimensional integrated circuit (3D IC) technologies have been receiving much attention recently due to the near-ending of Moore's law of minimization in 2D IC. However, the reliability of 3D IC, which is greatly influenced by voids and failure in interconnects during the fabrication processes, typically requires slow testing and relies on human's judgement. Thus, the growing demand for 3D IC has generated considerable attention on the importance of reliability analysis and failure prediction. This research conducts 3D X-ray tomographic images combining with AI deep learning based on a convolutional neural network (CNN) for non-destructive analysis of solder interconnects. By training the AI machine using a reliable database of collected images, the AI can quickly detect and predict the interconnect operational faults of solder joints with an accuracy of up to 89.9% based on non-destructive 3D X-ray tomographic images. The important features which determine the "Good" or "Failure" condition for a reflowed microbump, such as area loss percentage at the middle cross-section, are also revealed.

Two-dose COVID-19 vaccination and possible arthritis flare among patients with rheumatoid arthritis in Hong Kong.

OBJECTIVES: To investigate the relationship between COVID-19 full vaccination (two completed doses) and possible arthritis flare. METHODS: Patients with rheumatoid arthritis (RA) were identified from population-based electronic medical records with vaccination linkage and categorised into BNT162b2 (mRNA vaccine), CoronaVac (inactive virus vaccine) and non-vaccinated groups. The risk of possible arthritis flare after vaccination was compared using a propensity-weighted cohort study design. We defined possible arthritis flare as hospitalisation and outpatient consultation related to RA or reactive arthritis, based on diagnosis records during the episode. Weekly prescriptions of rheumatic drugs since the launch of COVID-19 vaccination programme were compared to complement the findings from a diagnosis-based analysis. RESULTS: Among 5493 patients with RA (BNT162b2: 653; CoronaVac: 671; non-vaccinated: 4169), propensity-scored weighted Poisson regression showed no significant association between arthritis flare and COVID-19 vaccination ((BNT162b2: adjusted incidence rate ratio 0.86, 95% Confidence Interval 0.73 to 1.01); CoronaVac: 0.87 (0.74 to 1.02)). The distribution of weekly rheumatic drug prescriptions showed no significant differences among the three groups since the launch of the mass vaccination programme (all p values >0.1 from Kruskal-Wallis test). CONCLUSIONS: Current evidence does not support that full vaccination of mRNA or inactivated virus COVID-19 vaccines is associated with possible arthritis flare.

Bracing for impact: operational upshots from the National Centre for Infectious Diseases Screening Centre (Singapore) during the COVID-19 outbreak.

To combat the ongoing COVID-19 pandemic, Singapore has adopted a rigorous screening approach that involves aggressive contact tracing, rapid isolation of confirmed or suspect cases, and immediate ring-fencing of emerging local clusters and hotspots. Our screening centre team has been involved in running Singapore's designated screening centre since the end of January this year. With a well-defined blueprint and substantial pre-outbreak preparatory work, initial operations at our screening centre commenced within a day on activation and full operational status was attained in 3 days. As of 8 April 2020, the screening centre had screened more than 14,000 patients. We have adopted a "whole-of-hospital" approach, enlisting the help from other departments and subspecialties to augment manpower. Meticulous infrastructure planning to facilitate patient flow and strict measures to prevent nosocomial transmission and occupational exposure were instituted to safeguard both the staff and patients. This paper aims to describe our key takeaways in the course of operations and discuss the challenges encountered.

Prognostic role of red blood cell distribution width in patients with sepsis: a systematic review and meta-analysis.

BACKGROUND: Outcome prediction for patients with sepsis may be conductive to early aggressive interventions. Numerous biomarkers and multiple scoring systems have been utilized in predicting outcomes, however, these tools were either expensive or inconvenient. We performed a meta-analysis to evaluate the prognostic role of red blood cell distribution width (RDW) in patients with sepsis. METHODS: The online databases of Embase, Web of science, Pubmed, Corchrane library, Chinese Wanfang database, CNKI database were systematically searched from the inception dates to June, 24th, 2020, using the keywords red cell distribution width and sepsis. The odds ratio (OR) or Hazards ratio (HR) with corresponding 95% confidence intervals (95%CI) were pooled to evaluate the association between baseline RDW and sepsis. A random-effects model was used to pool the data, and statistical heterogeneity between studies was evaluated using the I2 statistic. Sensitivity and subgroup analyses were performed to detect the publication bias and origin of heterogeneity. RESULTS: Eleven studies with 17,961 patients with sepsis were included in the meta-analysis. The pooled analyses indicated that increased baseline RDW was associated with mortality (HR = 1.14, 95%CI 1.09-1.20, Z = 5.78, P < 0.001) with significant heterogeneity (I2 = 80%, Pheterogeneity < 0.001). Similar results were found in the subgroup analysis stratified by site of infection, comorbidity, Newcastle-Ottawa Scale (NOS) score, study design, patients' country. The predefined subgroup analysis showed that NOS score may be the origin of heterogeneity. CONCLUSIONS: For patients with sepsis, baseline RDW may be a useful predictor of mortality, patients with increased RDW are more likely to have higher mortality.

[Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis].

OBJECTIVE: To study the clinical value of red blood cell distribution width (RDW) in the early prediction of acute kidney injury (AKI) in children with sepsis. METHODS: A total of 126 children with sepsis were divided into an AKI group (n=66) and a non-AKI group (n=60) according to the presence or absence of AKI. These patients were also classified into high-RDW and low-RDW groups according to the mean RDW. The groups were compared in terms of age, male-to-female ratio, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), serum C-reactive protein (CRP), and routine blood test results. Independent factors associated with RDW were analyzed by multiple linear regression. RESULTS: Age, male-to-female ratio, BMI, CRP, SOFA score, and APACHE II score did not differ significantly between the AKI and non-AKI groups (P>0.05), but the AKI group had significantly higher BUN, Cr, UA, and RDW levels than the non-AKI group (P<0.05). Age, male-to-female ratio, and BMI did not differ significantly between the high-RDW and low-RDW groups (P>0.05), but the high-RDW group had significantly higher BUN, Cr, UA, CRP, SOFA score, APACHE II score, Hb, and mean corpuscular volume (MCV) than the low-RDW group (P<0.05). The multiple linear regression analysis showed that age, sex, APACHE II score, Cr, Hb, and MCV were independent factors associated with RDW. CONCLUSIONS: RDW has a certain clinical value in the early prediction of AKI in children with sepsis.

Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical value of red blood cell distribution width (RDW) in the early prediction of acute kidney injury (AKI) in children with sepsis.</p><p><b>METHODS</b>A total of 126 children with sepsis were divided into an AKI group (n=66) and a non-AKI group (n=60) according to the presence or absence of AKI. These patients were also classified into high-RDW and low-RDW groups according to the mean RDW. The groups were compared in terms of age, male-to-female ratio, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), serum C-reactive protein (CRP), and routine blood test results. Independent factors associated with RDW were analyzed by multiple linear regression.</p><p><b>RESULTS</b>Age, male-to-female ratio, BMI, CRP, SOFA score, and APACHE II score did not differ significantly between the AKI and non-AKI groups (P>0.05), but the AKI group had significantly higher BUN, Cr, UA, and RDW levels than the non-AKI group (P<0.05). Age, male-to-female ratio, and BMI did not differ significantly between the high-RDW and low-RDW groups (P>0.05), but the high-RDW group had significantly higher BUN, Cr, UA, CRP, SOFA score, APACHE II score, Hb, and mean corpuscular volume (MCV) than the low-RDW group (P<0.05). The multiple linear regression analysis showed that age, sex, APACHE II score, Cr, Hb, and MCV were independent factors associated with RDW.</p><p><b>CONCLUSIONS</b>RDW has a certain clinical value in the early prediction of AKI in children with sepsis.</p>

Focal zone integral and multiple axial scanning based acoustic resolution photoacoustic microscopy with high lateral resolution in-depth / 生物医学工程学杂志

Acoustic resolution photoacoustic microscopy (ARPAM) combines the advantages of high optical contrast, and high ultrasonic spatial resolution and penetration. However, in photoacoustic microscopy (PAM), the information from deep regions can be greatly affected by the shallow targets, and most importantly, the irreconcilable conflict between the lateral resolution and depth of fields has always be a major factor that limits the imaging quality. In this work, an ARPAM system was developed, in which a non-coaxial arrangement of light illumination and acoustic detection was adopted to alleviate the influence of the tissue surface on the deep targets, and a novel focal zone integral algorithm was applied with multiple axial scanning to improve the lateral resolution. Phantom experiment results show that, the build system can maintain a consistent high lateral resolution of 0.6 mm over a large range in axial direction, which is close to the theoretical calculations. The following tumor imaging results on nude mice indicate that, the proposed method can provide more in-depth information compared with the conventional back detection ARPAM method. With the development of fast repetition lasers and image scanning technologies, the proposed method may play an important role in cerebral vascular imaging, cervical cancer photoacoustic endoscopic detection, and superficial tumor imaging.

Is Platelet Transfusion Effective in Patients Taking Antiplatelet Agents Who Suffer an Intracranial Hemorrhage?

BACKGROUND: Patients taking antiplatelet agents (APAs) with intracranial hemorrhage (ICH) may be treated with platelet transfusion. OBJECTIVES: We conducted a systematic review of the use of platelet transfusion in the management of APA-related ICH. METHODS: We searched the Cochrane, Medline, Embase, and CINAHL databases. Included studies were randomized, case-controlled, or cohort studies comparing outcomes in adult patients with APA-related ICH who received or did not receive platelet transfusion. Study quality was measured using appropriate scores. The primary outcome of interest was in-hospital mortality rate. Secondary outcomes included rates of craniotomy, neurological, medical, or radiological deterioration; mean length of hospital stay, delayed mortality, and functional status at discharge. We reported proportions, medians with interquartile ranges, and pooled odds ratios with their 95% confidence intervals. p values < 0.05 were considered statistically significant. RESULTS: There were no randomized controlled trials. Seven retrospective cohort studies (four traumatic, three primary ICH) were included. For APA-related traumatic ICH, the pooled odds ratio (OR) for in-hospital mortality with platelet transfusion was 1.77 (95% confidence interval [CI] 1.00-3.13). There were no statistically significant differences for secondary outcomes except for proportion with medical decline (6/44 vs. 2/64; p = 0.006). For APA-related primary ICH, the pooled OR for in-hospital mortality with platelet transfusion was 0.49 (95% CI 0.24-0.98). There were no statistically significant differences for most secondary outcomes between the two groups. These studies had important methodological limitations. CONCLUSIONS: The evidence for platelet transfusion in APA-related ICH was inconclusive due to methodological limitations.

Comparison and analysis of two detection measures for anti-double stranded DNA antibody / 国际检验医学杂志

Objective To investigate the characteristics and clinical application value of anti-double stranded DNA antibody de-tected by Crithidia indirect immunofluorescence assay method and enzyme linked immunosorbent assay method.Methods Eighty-five patients with systemic lupus erythematosus,20 disease controls and 75 healthy controls were selected.The serum anti-double stranded DNA antibody was detected simultaneously by the methods of Crithidia indirect immunofluorescence assay and enzyme linked immunosorbent assay and their diagnostic efficacies for detection were compared.Results For each method the positive rate in the systemic lupus erythematosus group was significantly higher than that in the disease control group and healthy control group. The difference had statistical significance (P <0.05).The positive rates of Crithidia indirect immunofluorescence assay and enzyme linked immunosorbent assay in the systemic lupus erythematosus group were 72.94% and 88.24% respectively,and the positive predictive value of enzyme linked immunosorbent assay is lower(P <0.05).Meanwhile the anti-double stranded DNA antibody con-centrations detected by enzyme linked immunosorbent assay method showed statistically significant difference among the active sys-temic lupus erythematosus group,the stable systemic lupus erythematosus group and the control group (P <0.05 )and presented linear trend.Conclusion Using Crithidia indirect immunofluorescence assay method to detect anti-double stranded DNA antibody for the systemic lupus erythematosus group has high specificity and is helpful for the diagnosis of systemic lupus erythematosus. Enzyme linked immunosorbent assay can be used to detect anti-double stranded DNA antibody concentration quantitatively,which is linearly related with systemic lupus erythematosus activity and the method is of high sensitivity,which can effectively screen the pa-tients with systemic lupus erythematosus.

Laboratory diagnostic value of COPD with congestive cardiac failure / 国际检验医学杂志

Objective To investigate the Laboratory diagnostic value of COPD with congestive cardiac failure .The clinical signif‐icance on the combined detection of the serum B‐type natriuretic peptide(BNP) ,high sensitive C reactive protein (hs‐CRP) ,and he‐moglobin(Hb) in COPD with congestive cardiac failure .Methods The serum levels of BNP ,hs‐CRP and Hb in 205 patients with different etiological factors and grades(according to the pulmonary function test Ⅰ - Ⅳ) and 100 healthy controls were determined . The sensitivity and specificity of 3 parameters were evaluated .Results The levels of BNP ,hs‐CRP ,and Hb in different grades of COPD had statistical significance(P0 .05) .The sensitivity of combined detection was 90 .2% in early COPD diagnosis ,which was higher significantly than that of the individual detection (P<0 .05) .Conclusion The significant clinical significance on the combined detection of the serum BNP ,hs‐CRP and Hb provides reference support in the diagnosis of early COPD .

Preparation of monoclonal antibodies against neutrophil gelatinase-associated lipocalin (NGAL) and development of an antibody-based chemiluminescence immune quantification assay / 中国生化药物杂志

Objective To obtain monoclonal antibodies ( mAbs ) against neutrophil gelatinase-associated lipocalin ( NGAL ) and a chemiluminescense immune quantification assay based one paired mAbs.Methods Six-to-eight weeks old female BALB/c mice were immunized with the purified recombinant human NGAL antigen( rhNGAL) that was produced by the Escherichia coil expression system.The spleen was fused with hybridoma for screening anti-NGAL monoclonal antibodies by indirect ELISA.Western blot was implemented to identify the reactivity with native NGAL. Results The rhNGAL antigen was found to form disulfide cross-linked dimers and present excellent immunogenicity.The reaction titer of the immune serum of NGAL immunized mice was about 106.Thirty mAbs were screened by indirect ELISA, hereinto;the EC50 values of mAb23C12 and 38D10 were 0.034 g/mL, 0.022 g/mL respectively.The antibodies pair, 38D10/23C12-SAE labeled with AcridiniumEster(AE), were shown to work well in chemiluminescense immune response quantitative detection which was screened by NGAL standardand clinical urine samples.This detection can resolve positive and negative samples with a statistically significant difference (P<0.0001).And the correlation coefficient R2between NGAL quantitative results and that of the Abbott's NGAL chemiluminescence immune assay kit was greater than 0.97.The detection linear range was 10-1500 ng/mL, analytical sensitivity of the method was 0.63 ng/mL.Conclusion Highly purified rhNGAL antigen and specific anti-NGAL monoclonal antibodies are generated in this study.The detection capability of method is comparable with that of the international commercial kit.

Expression of the HIF-2α in epithelial ovarian cancer and clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To investigate the expression of hypoxia inducible factor 2α (HIF-2α) in every clinical stage and the pathological grade of epithelial ovarian cancer, and to discuss the role of HIF-2α in carcinogenesis, progression and outcomes of epithelial ovarian tumors.@*METHODS@#Protein expression of HIF-2α in epithelial ovarian tissue from 77 randomly selected specimens was detected by SP immunohistochemistry staining. The relation between the expression of HIF-2α and prognosis of 40 patients with epithelial ovarian cancer was analyzed by Cox regression model.@*RESULTS@#There was positive relation between the positivity rates of HIF-2α and malignant grade, FIGO stage, histological grade and invasive metastasis. The live time of the patients with HIF-2α positive expression was shorter than those with negative expression.@*CONCLUSION@#HIF-2α may play an important role in the genesis, development, invasion and metastasis of ovarian cancer and it may possess the vital clinical significance for prognosis evaluation.

Optimizing of ELISA assay for HBV serum markers / 国际检验医学杂志

Objective To analyze and approach the optimizing of ELISA assay for HBV serum markers.Methods To compare the critical value rate of flushing with distilled water,flushing with cleaning tap water and flushing without anything.Results The HBsAg critical value rates of flushing with distilled water,flushing with cleaning tap water and flushing without anything were 0.52%,2.60% and 5.56%.The HBsAb critical value rates of flushing with distilled water,flushing with cleaning tap water and flushing without anything were 5.52%,8.02% and 14.86%.The HBeAg critical value rate of flushing with distilled water,flush-ing with cleaning tap water and flushing without anything were 2.82%,2.92%and 3.55%.Conclusion Flushing with distilled wa-ter or flushing with cleaning tap water can reduce the high critical value rate because of enzyme or developer pollution.Flushing with distilled water exhibits more efficacy than flushing with cleaning tap water.

[Role of procalcitonin in the diagnosis of acute pyelonephritis in children].

OBJECTIVE: To study the role of procalcitonin (PCT) in the diagnosis of acute pyelonephritis (APN) in children. METHODS: Retrospective analysis was performed on the clinical records of children aged under 3 years who were diagnosed with primary urinary tract infection (UTI) from September 2011 to February 2012. These children were divided into those with upper UTI (UUTI) (APN) and those with lower UTI (LUTI) (non-APN) based on 99mTc-dimercaptosuccinic acid (DMSA) renal scan results as a gold standard. The UUTI and LUTI groups were compared in terms of serum levels of PCT and C-reactive protein (CRP). Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic values of serum PCT and CRP. RESULTS: Sixty-five children with UTI, including 39 cases of APN and 26 cases of LUTI, were included in this study. The APN cases had significantly higher serum levels of PCT (3.08 ng/mL vs 0.37 ng/Ml; P<0.01) and CRP (6.25 mg/L vs 3.01 mg/L; P<0.01) than the LUTI cases. The sensitivity and specificity of serum PCT level for APN were 84.6% and 88.5%, respectively, with an area under the ROC curve (AUC) of 0.873 (95%CI=0.781-0.965) and an optimal threshold point of 1.03 ng/mL. The sensitivity and specificity of serum CRP level for APN were 71.8% and 69.2%, respectively, with an AUC of 0.735 (95%CI=0.612-0.858) and an optimal threshold point of 3.91 mg/L. CONCLUSIONS: As a result of its high sensitivity and specificity for the disease, serum PCT can be used as a marker in the early diagnosis of APN in children.

Role of procalcitonin in the diagnosis of acute pyelonephritis in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the role of procalcitonin (PCT) in the diagnosis of acute pyelonephritis (APN) in children.</p><p><b>METHODS</b>Retrospective analysis was performed on the clinical records of children aged under 3 years who were diagnosed with primary urinary tract infection (UTI) from September 2011 to February 2012. These children were divided into those with upper UTI (UUTI) (APN) and those with lower UTI (LUTI) (non-APN) based on 99mTc-dimercaptosuccinic acid (DMSA) renal scan results as a gold standard. The UUTI and LUTI groups were compared in terms of serum levels of PCT and C-reactive protein (CRP). Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic values of serum PCT and CRP.</p><p><b>RESULTS</b>Sixty-five children with UTI, including 39 cases of APN and 26 cases of LUTI, were included in this study. The APN cases had significantly higher serum levels of PCT (3.08 ng/mL vs 0.37 ng/Ml; P<0.01) and CRP (6.25 mg/L vs 3.01 mg/L; P<0.01) than the LUTI cases. The sensitivity and specificity of serum PCT level for APN were 84.6% and 88.5%, respectively, with an area under the ROC curve (AUC) of 0.873 (95%CI=0.781-0.965) and an optimal threshold point of 1.03 ng/mL. The sensitivity and specificity of serum CRP level for APN were 71.8% and 69.2%, respectively, with an AUC of 0.735 (95%CI=0.612-0.858) and an optimal threshold point of 3.91 mg/L.</p><p><b>CONCLUSIONS</b>As a result of its high sensitivity and specificity for the disease, serum PCT can be used as a marker in the early diagnosis of APN in children.</p>

Proteomic analysis of hepatitis B virus-infected human liver tissues / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To search for the difference of protein molecules expression of HBV infection.</p><p><b>METHODS</b>Specimens taken from human normal liver tissues (group A), HBV infected human liver tissues which were HBsAg positive, and HBsAg, anti-HBe, and anti-HBc positive in serum (group B) were analysed through the methods of 2-dimensional electrophoresis (2-DE) and matrix-assisted laser-desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS/MS).</p><p><b>RESULTS</b>Totally 1125 plus/minus 56 (n=3) spots were detected in the sample of group A, 1203 plus/minus 42 (n=3) in group B samples. The percent volume of the protein spots was compared to show the proteome alteration in HBV infected human liver tissues. Forty proteins were found to present variations of two or more than two fold in quantity and 22 differentially expressed protein sports were finally identified by MALDI-TOF-MS/MS, including human mitochondrial aldehyde dehydrogenase, haptoglobin Hp2, peroxiredoxin 2, etc.</p><p><b>CONCLUSION</b>The protein profile of human normal liver tissue and HBV infected liver tissues showed obviously difference.</p>