Establishment and implementation effect of rapid response medical team for extracorporeal cardiopulmonary resuscitation in emergency department / 中华急诊医学杂志

Objective:To retrospectively analyze the establishment and implementation effect of ECPR rapid response medical team in emergency department, and to explore a more efficient rescue mode.Methods:A total of 41 patients who started ECPR in the emergency room of a tertiary hospital in Beijing from November 2017 to September 2022 were selected as subjects. The 14 patients treated by the ECPR rapid response medical team in the emergency department were set as the experimental group, and the 27 patients treated by the ECPR team of the MDT mode led by the cardiac surgeon were set as the control group. The ECPR start-up time, pipeline pre-filling time, ECPR start-up to ECMO successful operation time, complication rate and treatment success rate were compared between the two groups.Results:There was no significant difference in the outcome between the two groups (all P>0.05), but the total time (min) of ECPR implementation by the rapid response medical team in the emergency department was shorter (20.86 ± 10.86 vs. 23.04 ± 11.40), the incidence of complications was lower, and the success rate of treatment was higher (28.57 % vs. 25.93 %). Conclusion:Establishing a mature ECPR rapid response team dominated by emergency medical care helps improve the rescue coordination and work efficiency, thereby providing the emergency protection and management of full -chain for the treatment of critical condition.

Establishment and Application of Early Risk Stratification Method for Acute Abdominal Pain in Adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians' clinical experience. The aim of this study was to establish an early risk stratification method (ERSM) for addressing adults with acute abdominal pain, which would guide physicians to take appropriate and timely measures following the established health-care policies.</p><p><b>METHODS</b>In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study. Measurement data and numeration data were compared with analysis of variance and Chi-square test, respectively. Multiple regression analysis calculated odd ratio (OR) value. P and OR values showed the impacts of factors. ERSM was established by clinical experts and statistical experts according to Youden index. In Cohort 2, data from 305 patients with acute abdominal pain were enrolled to validate the accuracy of the ERSM. Then, ERSM was prospectively used in clinical practice.</p><p><b>RESULTS</b>The ERSM was established based on the scores of the patient's clinical characteristics: right lower abdominal pain + 3 × diffuse abdominal pain + 3 × cutting abdominal pain + 3 × pain frequency + 3 × pain duration + fever + 2 × vomiting + 5 × stop defecation + 3 × history of abdominal surgery + hypertension history + diabetes history + hyperlipidemia history + pulse + 2 × skin yellowing + 2 × sclera yellowing + 2 × double lung rale + 10 × unconsciousness + 2 × right lower abdominal tenderness + 5 × diffuse abdominal tenderness + 4 × peritoneal irritation + 4 × bowel sounds abnormal + 10 × suspicious diagnosis + white blood cell count + hematocrit + glucose + 2 × blood urea nitrogen + 3 × creatine + 4 × serum albumin + alanine aminotransferase + total bilirubin + 3 × conjugated bilirubin + amylase. When the score was <18, the patient did not need hospitalization. A score of ≥18 and <38 indicated that the patient should be under observation or hospitalized. A score of ≥38 and <50 indicated the need for an emergent operation. A score of ≥50 indicated the need for admission to the Intensive Care Unit. The area under the receiver operating characteristic curve of the ERSM in Cohorts 1 and 2 were 0.979 and 0.988, respectively.</p><p><b>CONCLUSIONS</b>This ERSM was an accurate and reliable method for making an early determination of the severity of acute abdominal pain. There was the strong correlation between scores of ERSM and health-care decision-making.</p>

Progress in effects of rhein on drug transporters and metabolic enzymes / 药物评价研究

Drug transporters and drag metabolic enzymes are crucial factors in the process of drug treatment.Rhein,as the main active component of traditional Chinese medicine rhubarb,has a wide range of pharmacological activities.Previous studies have shown that rhein is closely related to drug transporters and metabolic enzymes,and can directly activate or inhibit the functions of a variety of transporters and their protein expression.Furthermore,rhein can inhibit the function and protein expression of cytochrome P450 (CYP450),a drug metabolizing enzyme.Thus,when rhein is combined with other drugs,the drug-drug interaction (DDI) may occur based on pharmacokinetic.This paper focuses on the distribution of drug transporters,metabolic enzymes,and the effects of rhein on transporters and metabolic enzymes.

Biocompatibility of novel bionic scaffold with nanostructure / 中国组织工程研究

BACKGROUND:Pore diameter,size and porosity of biomaterials are important for cell attachment,infiltration and growth.OBJECTIVE:To primarily evaluate the biocompatibility of novel bionic scaffold of poly(3-hydroxybutyrate-co-3-hydroxyvalerate)/sol gel bioactive glass (PHBV/SGBG) with nanostructure in vitro.DESIGN,TIME AND SETTING:Cell-material experiment was performed at the Central Laboratory of Third Hospital of Sun Yat-sen University from March to September 2006.MATERIALS:PHBV/SGBG was provided by the Institute of Materials Science and Engineering,South China University of Technology;bone marrow stroma cells (MSCs) were prepared by our team.METHODS:The standard concentration of PHBV/SGBG extracting solution should be 10 mL/ cm2 of the ratio of culture solution to material surface.PHBV/SGBG was immersed into the complete culture solution and incubated in 5% CO2 at 37 ℃ for 2-3 days.The extracting solution was drawn and stored under sterile condition.In addition,PHBV/SGBG extracting solution of 8,4,2,1,0.5,0.25 and 0.125 times of standard concentration was prepared.MAIN OUTCOME MEASURES:PHBV/SGBG ultrastructure was observed by scanning electron microscopy;PHBV/SGBG porosity was measured by routine measurement.MTT methods were used as a quantitative assessment for cytotoxicity of the biomaterials.Adherence and spreading of MSCs on the surface of specimen was observed using direct contact cultivation.RESULTS:The PHBV/SGBG was porous,with connecting pores under electron microscopy.Nanometer SGBG particles were imbedded or encapsulated in pore wall of PHBV,with the porosity ＞90%.The toxicity gradation of the novel bionic scaffold ranked from grade 0 to 1 at 1,3,5 days of culture.MSCs slightly attached and grew on the surface of the biomaterials,and proliferated rapidly.Obvious cell processes stretched into the micro-pores structure.CONCLUSION:The novel bionic scaffold of PHBV/SGBG has excellent cellular affinity,possibly due to the porous structure,with no cytotoxicity to MSCs.