[Management protocol and outcome assessment of ruptured intracranial aneurysm emergency surgery during coronavirus disease 2019 pandemic].

Objective: To explore the improvement of emergency admission screening and perioperative management protocols in the scenario of the coronavirus disease 2019 (COVID-19) pandemic and its regular prevention and control for patients with ruptured intracranial aneurysms, which are the most common emergency cases with the most urgent needs for emergent surgery. Methods: The response protocol of the emergency surgical management of ruptured intracranial aneurysm during the epidemic period (from January to March, 2020) at Beijing Tiantan Hospital, Capital Medical University was reviewed. The prognosis of emergent aneurysm surgery under different levels of protection or during the same period of 2019 and 2020 was further compared to describe the operation and prognosis under the new management protocol. Results: A total of 127 emergency cases with aneurysmal subarachnoid hemorrhage were referred to Beijing Tiantan Hospital, Capital Medical University from January 20 to March 25, 2020, and 42 cases(33.1%) underwent emergent aneurysm clipping after multi-desciplinary consultation. Admissions of emergency cases required epidemiological, laboratory, and imaging screenings for COVID-19, with additional throat swab virus nucleic acid screening afterwards. During the same period, 9 cases of COVID-19 were confirmed in the emergency screening, and no false negative cases were found. Compared with the same period in 2019, the interval between emergency visits and emergency craniotomy did not increase significantly due to the preoperative screening ((37±17) hours during the epidemic period versus (29±12) hours at the same period in 2019, P=0.058). There was no significant difference in the incidence of perioperative adverse events and postoperative neurological dysfunction (P=0.779). According to the screening results, the corresponding operative and postoperative management protocol and protection standards were adopted. There was no significant difference in the prognosis of emergent surgery between patients with a negative initial screening and those who were to be excluded or suspected in the initial screening (P=0.678). Although viral nucleic acid screening tended to prolong the time interval before surgical intervention ((36±15) hours before nucleic acid screening versus (40±20) hours after nucleic acid screening, P=0.453), there was no statistically significant difference in the preoperative adverse events and postoperative neurological function (P=0.653). Conclusion: The current protocol of COVID-19 screening and stratified emergent surgery management based on screening results can effectively identify suspected and confirmed COVID-19 cases, thereby ensuring timely, safe and effective emergent surgery and prohibiting nosocomial spread.

Improvement of the Irrigation Scheme in the ORCHIDEE Land Surface Model and Impacts of Irrigation on Regional Water Budgets Over China.

In China, irrigation is widespread in 40.7% cropland to sustain crop yields. By its action on water cycle, irrigation affects water resources and local climate. In this study, a new irrigation module, including flood and paddy irrigation technologies, was developed in the ORCHIDEE-CROP land surface model which describes crop phenology and growth in order to estimate irrigation demands over China from 1982 to 2014. Three simulations were performed including NI (no irrigation), IR (with irrigation limited by local water resources), and FI (with irrigation demand fulfilled). Observations and census data were used to validate the simulations. Results showed that the estimated irrigation water withdrawal ( W ) based on IR and FI scenarios bracket statistical W with fair spatial agreements ( r = 0 . 68 ± 0 . 07 ; p < 0 . 01 ). Improving irrigation efficiency was found to be the dominant factor leading to the observed W decrease. By comparing simulated total water storage (TWS) with GRACE observations, we found that simulated TWS with irrigation well explained the TWS variation over China. However, our simulation overestimated the seasonality of TWS in the Yangtze River Basin due to ignoring regulation of artificial reservoirs. The observed TWS decrease in the Yellow River Basin caused by groundwater depletion was not totally captured in our simulation, but it can be inferred by combining simulated TWS with census data. Moreover, we demonstrated that land use change tended to drive W locally but had little effect on total W over China due to water resources limitation.

[An epidemiological survey on clinical features, self-management and cognitive level of elderly asthmatics in China].

Objective: To investigate the prevalence of asthma among the elderly people in China and to analyze the clinical features, self-management and cognitive level of elderly asthma patients. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the last epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) and seven regions (north, northeast, southern china, east, south, southwest and northwest) in China from February 2010 to August 2012. 2 034 were diagnosed as asthma. The elderly patients aged ≥65 years were selected from the 2 034 asthma patients. The clinical characteristics, comorbidities, the status of asthma control and self-management and insights of the disease in elderly asthma patients were analyzed. Results: Among the 2 034 asthma patients, 584 (28.7%) were elderly asthmatics aged ≥65 years old and 1 450 (71.3%) were<65 years old. In the elderly asthma group, Early-onset asthma accounted for 439 (75.2%) and 145 (24.8%) were late-onset. The common clinical manifestations of elderly asthma patients were: chest distress 395 (67.6%), wheezing 304 (52.1%), cough 298 (51.0%). Common comorbidities of elderly asthmatics were: chronic obstructive pulmonary disease 144 (24.7%), allergic rhinitis 122(20.9%), gastroesopheal reflux disease (GERD) 114(19.5%), allergic conjunctivitis 86 (14.7%), eczema 82 (14.0%), chronic bronchitis 76 (13.0%). The Asthma Control Test (ACT) scores of elderly asthmatics and non-elderly asthmatics were (18.5±3.2) and (21.7±3.4) respectively. There was a significant difference between the two groups (P=0.042). Of the elderly asthmatics, only 13 (2.2%) patients monitored daily using a peak flow meter. 93 (15.9%) patients aware that asthma was characterized by chronic airway inflammation. 64 (11.0%) asthmatics understood that the treatment goal. Conclusions: The clinical manifestations of elderly asthmatics are atypical, especially paroxysmal wheezing. Asthma in elderly people causes more comorbidities and mortality. The self-management and cognitive level of patients with asthma needs to be improved.

[Validity of Padua risk assessment scale for assessing the risk of deep venous thrombosis in hospitalized patients].

To analyze the clinical features of deep venous thrombosis(DVT) in hospitalized patients and evaluate the effectiveness of Padua risk assessment model.The clinical data of DVT patients were retrospectively analyzed in Beijing Shijitan Hospital from April 1 2017 to June 30, 2017.Padua risk assessment scale was used to evaluate the risk score of DVT in the departments of internal medicine and surgery. Effectiveness of predicting DVT was analyzed by receiver operating characteristic curve (ROC).Logistic regression analysis was used to evaluate the related factors of DVT.In DVT group, age (OR=0.96),acute infection(OR=8.23),prothrombin time(OR=0.76),D dimer(OR=1.00),erythrocyte sedimentation rate(OR=1.02) and platelet count(OR=1.01) were significantly associated with thrombosis(all P<0.05).The specificity of Padua model to predict DVT in internal medical patients was better than the sensitivity(80.7% vs. 50%,P<0.05).Surgical patients reported similar findings with specificity to sensitivity of 87.5% vs. 67.5%(P<0.05).The area under curve of ROC in internal medical patients was more than that in surgical patients[0.62 (95%CI 0.59-0.67) vs.0.61(95%CI 0.56-0.66), P<0.05].Padua model is more specific than sensitive to predict DVT in hospitalized patients.It has better predictive value of DVT in internal medical patients than surgical patients.

Impact of adherence to GOLD guidelines on 6-minute walk distance, MRC dyspnea scale score, lung function decline, quality of life, and quality-adjusted life years in a Shanghai suburb.

We performed a 1-year cluster-randomized field trial to assess the effect of standardized management of chronic obstructive pulmonary disease (COPD) on lung function and quality of life (QOL) measures in patients in China. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines and assessed indexes including pulmonary function, QOL, quality-adjusted life years (QALY), Medical Research Council (MRC) dyspnea scale, 6-min walk distance (6-MWD), number of emergency visits, and frequency of hospitalization. Of a total of 711 patients with chronic cough and asthma, 132 were diagnosed as having COPD and 102 participated in this study [intervention group (N = 47); control group (N = 55)]. We found that adherence to GOLD guidelines had a perceivable impact on 6-MWD, MRC dyspnea scale score, and QOL. The average QALY increased by 1.42/person/year in the intervention group, but declined by 0.95/person/year in the control group. We conclude that standardized management improves disease severity, QOL, and QALY in COPD patients when treatment protocols adhere to GOLD guidelines.

Children and adults exposed to low-frequency magnetic fields at the ICNIRP reference levels: theoretical assessment of the induced electric fields.

To avoid potentially adverse health effects, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has defined reference levels for time varying magnetic fields. Restrictions on the electric fields induced in the human body are provided based on biological response data for peripheral nerve stimulation and the induction of phosphenes. Numerical modeling is commonly used to assess the induced electric fields for various exposure configurations. The objective of this study was to assess the variations of the electric fields induced in children and adults and to compare the exposure at reference levels with the basic restrictions as function of anatomy. We used the scalar potential finite element method to calculate the induced electric fields in six children and two adults when exposed to uniform magnetic fields polarized in three orthogonal directions. We found that the induced electric fields are within the ICNIRP basic restrictions in nearly all cases. In PNS tissues, we found electric fields up to 95% (upper uncertainty limit due to discretization errors, k = 2) of the ICNIRP basic restrictions for exposures at the general public reference levels. For occupational reference levels, we found an over-exposure of maximum 79% (k = 2) in PNS tissues. We further found that the ICNIRP recommendations on spatial averaging in 2 × 2 × 2 mm³ contiguous tissue volumes and removal of peak values by the 99th percentile cause the results to depend strongly on the grid discretization step (i.e. an uncertainty of more than 50% at 2 mm) and the number of distinguished tissues in the anatomical models. The computational results obtained by various research institutes should be robust for different discretization settings and various anatomical models. Therefore, we recommend considering alternative routines for small anatomical structures such as non-contiguous averaging without taking the 99th percentile in future guidelines leading to consistent suppression of peak values amongst different simulation settings and anatomical models. The peak electric fields depend on the local tissue distribution in the various anatomical models, and we could not find a correlation with the size of the anatomy. Therefore, we recommend extending the evaluation using a sufficient set of anatomies including other than standing postures to assess the worst-case exposure setting and correspondence to the basic restrictions.