Clinical and genetic analysis for two Chinese siblings with 17α-hydroxylase/17,20-lyase deficiency.

AIMS: 17α-hydroxylase/17,20-lyase deficiency (17OHD) is characterized by impaired productions of gonadal steroids and cortisol, a subsequent elevation of adrenocorticotropic hormone, and accumulation of steroid precusors, which are shunted into the mineralocorticoid synthesis pathway. This disease is caused by mutations in the CYP17 gene. In this paper, we will describe the clinical features and genetic alterations on two female siblings of 46,XY and 46,XX from a family with complete 17OHD. METHODS: This study employed a spectrum of methods, including clinical, hormonal, radiological and genetic analyses. Blood samples from the siblings and their family members were taken for genetic tests. Genomic DNA was extracted from peripheral blood leukocytes, and coding sequence abnormalities of the CYP17 gene were assessed by polymerase chain reaction and direct sequencing analysis. RESULTS: Genetic analysis of the CYP17 gene revealed a homozygous mutation in the two siblings. The mutation is a microdeletion, located in exon 8, Asp487-Ser488-Phe489 deletion. This deletion may be a prevalent CYP17 mutation in the Chinese population. CONCLUSION: Our study showed that a possible founder effect may account for the recurrent mutation Asp487-Ser488-Phe489 deletion in Chinese patients with 17OHD. And genetic testing could provide a useful method for a definitive diagnosis of 17OHD.

[Message measurement and feedback cardiopulmonary resuscitation board: a monitor for standard cardiopulmonary resuscitation].

OBJECTIVE: To invest a message measurement and feedback cardiopulmonary resuscitation (CPR) board which could guide the first aid to perform standard CPR. METHODS: The multifunctional and intelligent CPR board which could not only support but also provide standard parameters and frequency of compression for first aid was placed underneath the patient's back, with his head in the concave headrest at the top of the board. The operator exerted chest compression with his hands according to the 2005 American heart association (AHA) guidelines for CPR, and adjusted the pressure and rate according to that showed on the board to achieve the force and frequency of chest compression according to the standard. RESULTS: The operation of the chest compression which was carried out on the message measurement and feedback CPR board was significantly better than that carried out on the ordinary board because that the former could show the pressure and rate of chest compression, so it could guide the first aid to attain an optimal CPR according to the standard. Furthermore, as the force of chest compression exerted was optimized, adverse effects of forcible chest compression such as fracture of sternum or ribs could be avoided. CONCLUSION: The message measurement and feedback CPR board is able to feed back the pressure and rate of the process of chest compression in CPR. Therefore, it can help monitor the CPR manipulation, thus improves its quality and also avoids unfavorable side effects.

[A new method of cardiopulmonary resuscitation executed by rhythmic abdominal lifting and compression].

BACKGROUND AND OBJECTIVE: When cardiac arrest occurs, in about 1/3 patients may suffer from fracture of ribs as a result of the traditional method of cardiopulmonary resuscitation (CPR) with strong compression of the chest wall. Consequently, there would be a marked decrease in amplitude of chest compression and expansion, thus reducing the effect of CPR. Rhythmic abdominal compression, which is a new method recently recognized to be effective for CPR, only allows the diaphragm to fall back to its original position, therefore the extent of its movement is not enough to affect lung expansion. Thus, the maneuver could not restore effective heart beat and respiration. We have invented a new equipment which is called abdominal lifting and compression equipment for CPR. METHODS: The new equipment for CPR consists a sucking device to attach on the abdominal wall, and with a handle, the abdominal wall can be lifted and compressed rhythmically to produce the effect of CPR. RESULTS: The method readily got rid of the defects of the conventional CPR such as the risk of rib fracture, and made full use of "heart-pump and thoracic-pump effects", and at the same time it improved the ventilation. CONCLUSION: The abdominal lifting and compression equipment for CPR is an innovation of conventional CPR method, and may seem a mainstream method of CPR.

Visualizing the History and Perspectives of Disaster Medicine: A Bibliometric Analysis.

OBJECTIVE: To analyze the development of disaster medicine and to identify the main obstacles to improving disaster medicine research and application. METHODS: A topic search strategy was used to search the Web of Science Core Collection database. The 100 articles with the highest local citation scores were selected for bibliometric analysis; summarizing informetric indicators; and preparing a historiography, themes network, and key word co-occurrence map. RESULTS: The 100 articles with the highest local citation scores were published from 1983 to 2013 in 9 countries, mainly in the United States. The most productive authors were Koenig and Rubinson. The lead research institution was Columbia University. The most commonly cited journal was the Annals of Emergency Medicine. The development of disaster medicine could be separated into 3 consecutive periods. All results indicate that the development of disaster medicine faces some obstacles that need to be addressed. CONCLUSIONS: Research works have provided a solid foundation for disaster medicine, but its development has been in a slow growth period for a long time. Obstacles to the development of disaster medicine include the lack of scientist communities, transdisciplinary research, innovative research perspectives, and continuous research. Future research should overcome these obstacles so as to make further advances in this field.

Knowledge Maps of Disaster Medicine in China Based on Co-Word Analysis.

OBJECTIVE: We analyzed research themes in the field of disaster medicine in China to provide references for researchers to understand the research status and developing trends of this field. METHODS: Published journal articles were retrieved. A social network analysis was conducted to visualize the relations of high-frequency key words. A cluster analysis was used to classify key words. A strategic diagram analysis was conducted to visualize clusters across the entire research field. RESULTS: We retrieved 3,079 articles, from which 1,749 articles and 8,284 key words were identified after screening. High-frequency key words were classified into 6 clusters. "Medical rescue" had the highest degree and betweenness centralities. Cluster 4 was located in Quadrant I of the strategic diagrams. CONCLUSIONS: "Medical rescue" is the core key word, and it serves a pivotal "bridge" function. "Emergencies" and similar terms are key words with special statuses. "Natural disaster medical rescue" and "fundamental theories of disaster medicine" constitute the primary and secondary core themes, respectively. "On-site emergency treatment techniques" is a marginalized theme. The other themes are emerging themes that offer considerable scope for future development. Generally, the scope and depth of investigations in this field should be improved. (Disaster Med Public Health Preparedness. 2019;13:405-409).

Effect of NHE1 antisense gene transfection on the biological behavior of SGC-7901 human gastric carcinoma cells.

AIM: To study the effect of type 1 Na(+)/H(+) exchanger (NHE1) antisense human gene transfection on the biological behavior of gastric carcinoma cell line SGC-7901. METHODS: Antisense NHE1 eukaryotic expression on vector pcDNA3.1 was constructed by recombinant DNA technique and transfected into gastric carcinoma cell line SGC-7901 with DOTAP liposome transfection method. Morphological changes of cells were observed with optic and electron microscopes. Changes in cell proliferative capacity, apoptosis, intracellular pH (pH(i)), cell cycle, clone formation in two-layer soft agar, and tumorigenicity in nude mice were examined. RESULTS: Antisense eukaryotic expressing vectors were successfully constructed and transfected into SGC-7901. The transfectant obtained named 7901-antisense (7901-AS) stablely produced antisense NHE1. There was a significant difference between the pH(i) of 7901-AS cells (6.77 +/- 0.05) and that of 7901-zeo cells and SGC-7901 cells (7.24 +/- 0.03 and 7.26 +/- 0.03, P < 0.01). Compared with SGC-7901 and 7901-zeo cells, 7901-AS cells mostly showed cell proliferation inhibition, G1/G0 phase arrest, increased cell apoptotic rate, recovery of contact inhibition, and density contact. The tumorigenicity in nude mice and cloning efficiency in the two-layer soft agar were clearly inhibited. CONCLUSION: NHE1 antisense gene significantly restrains the malignant behavior of human gastric carcinoma cells, suppresses cell growth and induces cell apoptosis, and partially reverses the malignant phenotypes of SGC-7901. These results suggest a potential role for human tumor gene therapy.

Screening China Emergency Medical Team (CEMT) Members: A Self-Leadership Perspective.

OBJECTIVE: This study aims at establishing the self-leadership development model (SLM) of China Emergency Medical Team (CEMT) members as a supplement to current selection standards of CEMT members. METHODS: Raw dataset was obtained through two ways: in-depth interviews and documentary materials (memoirs and articles). The in-depth interviews were conducted with a purposive sample of 12 CEMT members, all of whom have participated in multiple disaster relief activities and have been CEMT members for more than two years. This paper followed a grounded theory methodology dealing with all data. RESULTS: Based on tasks, the SLM-CEMT consists of three basic parts: (1) making plans; (2) action; and (3) outcomes. Different parts involve various self-leadership strategies, of which five are the original dimensions of previous research (goal-setting, visualizing successful performance, self-talk, self-reward, and self-correcting feedback) and three are new dimensions (role clarity, self-initiative, and self-vigilance). CONCLUSIONS: The SLM-CEMT, with the three new parts, provides a new look at screening CEMT members as well as pondering on future research. Based on the SLM-CEMT, administrators could screen more qualified CEMT members. For the limitations, future work will be on the generalization and confirmation of this model. HaoX, LiX, ZhengJ. Screening China Emergency Medical Team (CEMT) members: a self-leadership perspective. Prehosp Disaster Med. 2018;33(6):596-601.

Autologous chyle fat grafting for the treatment of hypertrophic scars and scar-related conditions.

BACKGROUND: Scarring is the product of natural restoration, yet its treatment remains challenging. Both collagen and fibroblasts are abnormally abundant in scars, leading to scar hyperplasia or contracture. Several clinical studies have reported that wrinkles at the recipient site are reduced, pores are narrowed, pigmentation is decreased, and skin is softened after autologous fat transplantation. In this study, we investigated the ability of autologous chyle fat injection to normalize the fibroblasts and collagen of scar tissue in 80 adult patients with hypertrophic scars resulting from severe burns received more than 1 year previously. METHODS: The patients underwent autologous chyle fat injection, and scar samples were collected at different time points. Differences in the number of adipocytes before and after chylosis were assessed by cell culture, and changes in the structural organization of the scars were detected via histologic and immunohistochemical analyses. RESULTS: After preparation, the chyle fat contained few autologous adipocytes and large amounts of extracellular matrix. Following the injection of chyle fat, the thickness, color, and elasticity of hypertrophic scar tissue tended toward normalization, and patient satisfaction increased. The three adipose tissue donor sites used for the preparation of chyle fat were the abdomen, buttocks, and inner thigh, of which the inner thigh yielded the best therapeutic outcomes. The density and quantity of fibroblasts in the scars decreased following the injection of chyle fat, and the arrangement, quantity, and shape of type III collagen fibers tended toward normalization. After three treatments, the results of immunohistochemical staining showed that type III collagen was significantly less abundant than before treatment. CONCLUSIONS: Autologous chyle fat transplantation has a good therapeutic effect on hypertrophic scar tissue. The injection of chyle fat into hypertrophic scar tissue reduced the density and quantity of fibroblasts and prompted the arrangement, quantity, and shape of type III collagen to normalize.

Mass Casualty Incident Primary Triage Methods in China.

OBJECTIVE: To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China. DATA SOURCES: Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014). The English literature was searched by PubMed (MEDLINE) (1950 to June 2014). We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/), National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/), and China Earthquake Information (http://www.csi.ac.cn/). STUDY SELECTION: We included studies associated with mass casualty events related to China, the PT applied in China, guidelines and standards, and application and development of the carding PT method in China. RESULTS: From 3976 potentially relevant articles, 22 met the inclusion criteria, 20 Chinese, and 2 English. These articles included 13 case reports, 3 retrospective analyses of MCI, two methods introductions, three national or sectoral criteria, and one simulated field testing and validation. There were a total of 19 kinds of MCI PT methods that have been reported in China from 1950 to 2014. In addition, there were 15 kinds of PT methods reported in the literature from the instance of the application. CONCLUSIONS: The national and sectoral current triage criteria are developed mainly for earthquake relief. Classification is not clear. Vague criteria (especially between moderate and severe injuries) operability are not practical. There are no triage methods and research for children and special populations. There is no data and evidence supported triage method. We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real, practical, and efficient PT method.

C-reactive Protein -717A>G and -286C>T>A Gene Polymorphism and Ischemic Stroke.

BACKGROUND: Inflammation plays a pivotal role in the formation and progression of ischemic stroke. Recently, more and more epidemiological studies have focused on the association between C-reactive protein (CRP) -717A > G and -286C > T > A genetic polymorphisms and ischemic stroke. However, the findings of these researches are not conclusive. METHODS: We performed a meta-analysis to determine whether these two polymorphisms are associated with the risk of ischemic stroke. Eligible studies were identified from the database of PubMed, Medline, Embase, Web of Science, CNKI, Weipu, and Wanfang. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the association. RESULTS: Four articles were included in our study, including 1926 cases and 2678 controls for -717A > G polymorphism, 652 cases and 1103 controls for -286C > T > A polymorphism. The results of meta-analysis showed that single nucleotide polymorphism (SNP) -717A > G was not significantly associated with the risk of ischemic stroke (GG vs. AA, OR = 1.12, 95% CI = 0.83-1.50, P = 0.207; GG + GA vs. AA, OR = 1.04, 95% CI = 0.93-1.17, P = 0.533; GG vs. GA + AA, OR = 1.10, 95% CI = 0.82-1.47, P = 0.220). Meta-analysis of SNP - 286C > T > A also demonstrated no statistical evidence of a significant association with the risk of ischemic stroke (AA vs. CC, OR = 0.86, 95% CI = 0.59-1.25, P = 0.348; AA vs. CC, OR = 0.92, 95% CI = 0.80-1.06, P = 0.609; AA vs. CC, OR = 0.89, 95% CI = 0.62-1.30, P = 0.374). CONCLUSIONS: This meta-analysis demonstrated little evidence to support a role of CRP gene -717A > G, -286C > T > A polymorphisms in ischemic stroke predisposition. However, to draw comprehensive and more reliable conclusions, further larger studies are needed to validate the association between CRP gene polymorphisms and ischemic stroke in various ethnic groups.

Efficient post-disaster patient transportation and transfer: experiences and lessons learned in emergency medical rescue in Aceh after the 2004 Asian tsunami.

This descriptive study aimed to present experiences and lessons learned in emergency medical rescue after the 2004 Asian tsunami in terms of transportation and transfer of patients and coordination of medical rescue forces. After the tsunami, numerous rescue institutions and international organizations rushed to Aceh province to aid in the rescue work. To coordinate various aspects of medical rescue efforts, an airport-based joint patient transfer center was developed. Within the framework of the joint transport center, rescue teams, militaries, and international institutions worked together to jointly triage, rapidly treat, and transfer patients. As members of the Chinese International Search and Rescue team, we were involved in the rescue efforts in the joint patient transfer center, and treated and transferred a total of 217 injured patients, the majority of whom were triaged as level II, followed by level III, and level I. The top three diseases were trauma/wound infection, respiratory system disease, and digestive system disease. The airport-based joint patient transfer center provided an efficient mechanism for successfully coordinating various aspects of the medical rescue efforts to transfer patients. Large-scale air transport, available health resources, and effective triage criteria also played an essential role in patient transportation and transfer.

Anti-HBc-positive/HBsAg-negative liver donors pose a higher risk of occult HBV infection but do not cause severe histological damage in liver grafts.

BACKGROUND: The use of serum anti-hepatitis B core antibody (HBc)-positive/hepatitis B surface antigen (HBsAg)-negative liver donors for patients with hepatitis B virus (HBV)-related liver disease (HBRLD) is a promising means of expanding the organ donor pool and does not increase the risk of HBV recurrence. However, whether such donors will compromise the histology of the liver grafts is unclear. METHODS: Among 84 patients who underwent transplantation for HBRLD and who did not have post-transplant HBV recurrence (non-detectable serum HBsAg and HBV DNA), 19 underwent liver biopsy (eight received anti-HBc-positive/HBsAg-negative liver grafts; 11 received anti-HBc-negative liver grafts) and were included in the study. Intrahepatic total HBV DNA and covalently closed circular DNA (cccDNA) were detected using real-time polymerase chain reaction; histological characteristics were evaluated with the Batts-Ludwig semi-quantitative scoring system. RESULT: Of the 19 recipients, nine (47.4%) were positive for intrahepatic HBV DNA; 82.5% (7/8) received grafts from anti-HBc-positive donors and 18.2% (2/11) received grafts from anti-HBc-negative donors (P=0.003). HBV cccDNA was not detectable in the liver grafts of the 19 recipients. Ten patients had mild inflammation and minimal fibrosis in the portal area: four of the eight in the anti-HBc-positive group and six of the 11 in the anti-HBc-negative group (P>0.05). CONCLUSION: Anti-HBc-positive/HBsAg-negative donors for HBRLD pose a higher risk of occult HBV infection post-liver transplant but do not cause liver damage. Thus, anti-HBc-positive grafts may be considered an effective and safe means of expanding the pool of liver donors for patients with HBRLD.

[Medical rescue of China National Earthquake Disaster Emergency Search and Rescue Team in Lushan earthquake].

OBJECTIVE: To summarize and analyze the medical mission of China National Earthquake Disaster Emergency Search and Rescue Team (CNESAR) in Lushan earthquake, to promote the medical rescue effectiveness incorporated with search and rescue. METHODS: Retrospective analysis of medical work data by CNESAR from April 21th, 2013 to April 27th during Lushan earthquake rescue, including the medical staff dispatch and the wounded case been treated. RESULTS: The reasonable medical corps was composed by 22 members, including 2 administrators, 11 doctors [covering emergency medicine, orthopedics (joints and limbs, spinal), obstetrics and gynecology, gastroenterology, cardiology, ophthalmology, anesthesiology, medical rescue, health epidemic prevention, clinical laboratory of 11 specialties], 1 ultrasound technician, 5 nurses, 1 pharmacist, 1 medical instrument engineer and 1 office worker for propaganda. There were two members having psychological consultants qualifications. The medical work were carried out in seven aspects, including medical care assurance for the CNESAR members, first aid cooperation with search and rescue on site, clinical work in refugees' camp, medical round service for scattered village people, evacuation for the wounded, mental intervention, and the sanitary and anti-epidemic work. The medical work covered 24 small towns, and medical staff established 3 medical clinics at Taiping Town, Shuangshi Town of Lushan County and Baoxing County. Medical rescue, mental intervention for the old and kids, and sanitary and anti-epidemic were performed at the above sites. The medical corps had successful evacuated 2 severe wounded patients and treated the wounded over thousands. Most of the wounded were soft tissue injuries, external injury, respiratory tract infections, diarrhea, and heat stroke. CONCLUSIONS: Compared with the rescue action in 2008 Wenchuan earthquake, the aggregation and departure of rescue team in Lushan earthquake, the traffic control order in disaster area, the self-aid and buddy aid are better, which give rise to the casualties to the lowest. The medical mission incorporated with search and rescue work showed that the medical performance manner altered with stages, the medical staff match changed with the mission, and the focus related with rescue time.

[Discussion about health assessment and epidemic prevention mode for China National Earthquake Disaster Emergency Search and Rescue Team in Lushan earthquake].

OBJECTIVE: To discuss health assessment and epidemic prevention in earthquake rescue, to establish emergency health and epidemic prevention mode for the national earthquake emergency medical rescue team scientifically, and to provide references and consultations for emergency hygiene and epidemic prevention measures in disaster medicine. METHODS AND RESULTS: China National Earthquake Disaster Emergency Search and Rescue Team gathered and evaluated environment, food, drinking water and other health related information around more than 2000 earthquake victims in Baoxing County, Shuangshi Town and Qingren Township from 20th April 2013 to 27th by using methods such as field epidemiological investigations. The national earthquake emergency medical rescue team spread comprehensive evaluation focusing on the local epidemics, find out the starting point of epidemic prevention, and then built reporting system in disaster area. The team also formulated the emergency detection system of food and drinking water and carried out health education. CONCLUSION: After the golden 72 hours, by comprehensive evaluation the establishment of early response in disaster area and spreading epidemic prevention, this team achieved the full coverage of three in the earthquake area, the resettlement of residents and families in that area and gradually formed a disaster medical rescue hygiene and epidemic prevention mode.

[Clinical application of alendronate for osteoporosis/osteopenia secondary to hyperthyroidism].

OBJECTIVE: To evaluate the efficacy and safety of alendronate for the treatment of osteoporosis/osteopenia secondary to hyperthyroidism. METHODS: From April 2008 to November 2009, 27 patients with hyperthyroidism with osteoporosis/ osteopenia measured by dual energy X-ray absorptiometry (DXA) were included in this study, and then they were randomly divided into two groups (group A and group B) by simple random sampling. Group A consisted of 14 patients treated with antithyroid drug and caltrate D, the antithyroid drug change with thyroid function, and caltrate D 600 mg per day. Group B consisted of 13 patients treated with antithyroid drug, caltrate D and alendronate, antithyroid drug and caltrate D the same as group A, and alendronate 70 mg weekly. Meanwhile, 21 healthy voluntary adults were chosen as control group. And compared with the control group which was treated with nothing. Followed-up for one year, the bone mineral density (including T-score, Z-score, BMD) in lumbar spine (LS), femoral neck (FN) and distal radius (DR) and general information, were compared before and after treatment. RESULTS: BMD at FN and DR were significantly higher at 12 months after treatment than at the baseline in group A (P = 0.000); T-score, Z-score, and BMD at the LS, FN and DR were all significantly higher at 12 months after treatment than at the baseline in group B (P < 0.05), but these data could not arrive to normal level. In group A, the percentage increased in BMD at the LS, FN, and DR were (4.34 +/- 10.5)%, (3.21 +/- 1.38)%, (1.95 +/- 0.44)%, respectively, at 12 months after treatment. In group B, the percentage increased in BMD at the LS, FN, and DR were (6.10 +/- 8.12)%, (4.10 +/- 5.64)%, (3.10 +/- 3.23)%, respectively, at 12 months after treatment. There was significant difference in the rate of increase between two groups (P < 0.05). AKP decreased, weight, BMI increased, and thyroid function decreased, after treatment than those before in both of the two groups. (P < 0.05). CONCLUSION: Alendronate can significantly increase BMD in treating patients with hyperthyroidism and osteoporosis/osteopenia. Compared with anti-thyroid drugs alone, treatment with alendronate can obtain more clinical effect and also very safety.

Post-disaster medical rescue strategy in tropical regions.

BACKGROUND: Earthquakes, floods, droughts, storms, mudslides, landslides, and forest wild fires are serious threats to human lives and properties. The present study aimed to study the environmental characteristics and pathogenic traits, recapitulate experiences, and augment applications of medical reliefs in tropical regions. METHODS: Analysis was made on work and projects of emergency medical rescue, based on information and data collected from 3 emergency medical rescue missions of China International Search and Rescue Team to overseas earthquakes and tsunamis aftermaths in tropical disaster regions - Indonesia-Aceh, Indonesia-Yogyakarta, and Haiti-Port au Prince. RESULTS: Shock, infection and heat stroke were frequently encountered in addition to outbreaks of infectious diseases, skin diseases, and diarrhea during post-disaster emergency medical rescue in tropical regions. CONCLUSIONS: High temperature, high humidity, and proliferation of microorganisms and parasites are the characteristics of tropical climate that impose strict requirements on the preparation of rescue work including selective team members suitable for a particular rescue mission and the provisioning of medical equipment and life support materials. The overseas rescue mission itself needs a scientific, efficient, simple workflow for providing efficient emergency medical assistance. Since shock and infection are major tasks in post-disaster treatment of severely injured victims in tropical regions, the prevention and diagnosis of hyperthermia, insect-borne infectious diseases, tropic skin diseases, infectious diarrhea, and pest harms of disaster victims and rescue team staff should be emphasized during the rescue operations.