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Objective:To investigate the status of the knowledge of cardiopulmonary resuscitation (CPR) in community medical staff, and analyze the factors influencing their levels of CPR knowledge and skills, and to provide a basis for improving community CPR training programs.Methods:From January to March 2022, we conducted a survey for the knowledge of CPR among community medical staff in Beijing through WeChat using a self-made questionnaire based on the 2016 National Consensus on Cardiopulmonary Resuscitation in China and the 2020 American Heart Association CPR guidelines. The questionnaire mainly focused on the basic information and CPR knowledge (full score, 17 points) and practice of medical workers. R4.0.3 software was used to perform multiple linear regression analysis.Results:A total of 990 medical personnel from 51 communities effectively responded to the survey. The mean CPR knowledge score was (10.27±2.87) points. The regression analysis showed that the CPR score was significantly lower in groups of male, non-31-40-year-olds, technical degrees, only 0-1 trainings in two years, not ever practicing CPR, and not ever using an automated external defibrillator (AED), suggesting that sex, age, educational attainment, training frequency, whether having the experience of CPR and AED practice or not were independent factors influencing the CPR score of community medical staff.Conclusions:The CPR competency of community medical staff needs to be improved, especially for those with technical degrees and non-31-40-year-olds. The training frequency should be increased based on the Ebbinghaus' forgetting curve, and stratified training is recommended for different populations. Those without practical experience should receive more CPR training with real-time feedback devices and high-fidelity simulation to improve their CPR skills.
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Objective:To investigate the clinical value of bronchoscopic narrow band imaging combined with serum heat shock protein family 70 (HSP70) and netrin-1 (Ntn1) in the diagnosis of bronchogenic carcinoma.Methods:A retrospective cohort study was conducted. A total of 96 patients with suspected central lung cancer combined with airway obstruction admitted to Shanxi Province Cancer Hospital from January 2021 to January 2022 were retrospectively analyzed. Bronchoscopy and narrow band imaging were performed in all patients. Serum HSP70 and Ntn1 levels were measured by using enzyme-linked immunosorbent assay (ELISA). Pathological biopsy was taken as the gold standard. Receiver operating characteristic (ROC) curves were used to analyze the value of bronchoscopic narrow band imaging combined with serum HSP70 and Ntn1 in the diagnosis of bronchogenic carcinoma.Results:There were 70 males and 26 females in 96 suspected patients, with the age of (46±5) years. According to the pathological results, 72 were diagnosed with central lung cancer, including 43 cases of squamous cell carcinoma, 24 cases of adenocarcinoma, 3 cases of small cell carcinoma, 2 undifferentiated cases,and 24 cases of benign lesions in lung. The sensitivity, specificity, and accuracy of bronchoscopic narrow band imaging in the diagnosis of bronchogenic carcinoma were 90.3%, 79.2% and 87.5%, respectively. The serum HSP70 and Ntn1 levels in patients with lung cancer were higher than those in benign patients (all P < 0.05). ROC curves showed that the optimal cut-off values of HSP70 and Ntn1 in the diagnosis of bronchogenic carcinoma were 10.08 ng/ml and 562.82 pg/ml, respectively. The sensitivity, specificity, and accuracy of serum markers (HSP70 + Ntn1) in the detection of bronchogenic carcinoma were 93.1%, 58.3% and 84.4%, respectively. The sensitivity, specificity, and accuracy of bronchoscopic narrow band imaging combined with serum markers in the diagnosis of bronchogenic carcinoma were 98.6%, 87.5% and 95.8%, respectively; and the diagnostic accuracy of the combined method was higher than that of a single detection method such as bronchoscopic narrow band imaging or serum indexes ( χ2 values were 4.36, 7.07, all P < 0.05). Conclusions:Bronchoscopic narrow band imaging has a good diagnostic value for bronchogenic carcinoma, and the combination of serum HSP70 and Ntn1 can further improve the clinical diagnostic efficacy.
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Objective:To investigate the expressions of Yes-associated protein 1 (YAP1), YTH domain-containing family protein 2 (YTHDF2) and microRNA-888-3p (miR-888-3p) in patients undergoing radical resection for lung cancer, and their predictive value for short-term prognosis of patients.Methods:A total of 420 lung cancer patients who underwent radical resection for lung cancer in Shanxi Province Cancer Hospital from May 2015 to May 2022 were selected and divided into a modeling set (280 cases) and a validation set (140 cases) in a ratio of 2∶1 by using the computer-generated random number method. The paracancerous normal lung tissues removed by surgery (>5 cm from the edge of the cancer tissues) were used as the control. The relative expressions of YAP1 and YTHDF2 proteins in cancer tissues and paracancerous tissues of the modeling set was detected by Western blotting, and the relative expression of miR-888-3p was detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). The patients were followed up for 1 year to analyze the prognosis, and the patients in the modeling set who had recurrence, metastasis or cancer-caused death were considered as the poor prognosis group, and the rest of the patients were considered as the good prognosis group. The relative expressions of YAP1 protein, YTHDF2 protein, miR-888-3p and general information of the patients in the two groups were compared; the Cox proportional hazards model was used to analyze the influencing factors of the short-term prognosis of radical resection for lung cancer in the modeling set; a Nomogram prediction model was constructed for the short-term prognosis of radical resection for lung cancer, and its efficacy was verified.Results:The relative expression of miR-888-3p in the modeling set of cancer tissues and paracancerous tissues was 0.49±0.08 and 0.16±0.05, and the difference was statistically significant ( t = 58.53, P < 0.001); the relative expression of YAP1 protein was 0.48±0.06 and 0.12±0.03, and the difference was statistically significant ( t = 89.80, P < 0.001); the relative expression of YTHDF2 protein was 0.23±0.04 and 0.59±0.07, and the difference was statistically significant ( t = 74.72, P < 0.001). After 1 year of follow-up in the modeling set, 32 cases were lost, and 81 (32.66%) of the remaining 248 cases had a poor prognosis (poor prognosis group), while 167 cases (67.34%) were in the good prognosis group. Compared with the good prognosis group, the relative expressions of YAP1 protein and miR-888-3p in cancer tissues was elevated in the poor prognosis group (both P < 0.05), and the relative expression of YTHDF2 protein was decreased ( P < 0.05); the proportions of patients with smoking, coronary artery disease, TNM stage Ⅲ-Ⅳ, maximum tumor diameter ≥ 5 cm, and undifferentiated/lowly differentiated tissues were high in the poor prognosis group, the physical status (PS) score was elevated, and the proportion of patients with regular postoperative radiotherapy was reduced (all P < 0.05). The results of multivariate Cox regression analysis showed that the proportion of patients with smoking ( HR = 2.098, 95% CI 1.143-3.852, P = 0.009), TNM stage ( HR = 2.421, 95% CI 1.350-4.341, P = 0.002), maximum tumor diameter ( HR = 1.883, 95% CI 1.036-3.424, P = 0.011), degree of tissue differentiation ( HR = 3.133, 95% CI 1.590-6.173, P < 0.001), regular postoperative radiotherapy ( HR = 0.417, 95% CI 0.219-0.797, P = 0.003), YAP1 ( HR = 7.043, 95% CI 2.842-17.452, P < 0.001), YTHDF2 ( HR = 0.560, 95% CI 0.418-0.752, P < 0.001), and miR-888-3p ( HR = 4.100, 95% CI 1.789-9.394, P < 0.001) were the independent influencing factors for the short-term prognosis of radical resection for lung cancer. A Nomogram prediction model was constructed, and internal validation showed that the consistency index of the model was 0.822 (95% CI 0.774-0.870); the result of receiver operator characteristic curve showed that the sensitivity of the Nomogram prediction model for predicting the short-term prognosis of radical resection for lung cancer in the modeling set was 97.5% (95% CI 86.8%-99.9%), and the specificity was 82.4% (95% CI 73.0%-89.6%), and the area under the curve (AUC) was 0.943 (95% CI 0.889-0.976); the sensitivity of predicting the short-term prognosis of radical resection for lung cancer in the validation set was 91.53% (95% CI 81.3%-97.2%), and the specificity was 81.5% (95% CI 71.3%-89.2%), and the AUC was 0.922 (95% CI 0.865-0.961). Conclusions:YAP1, YTHDF2 and miR-888-3p are all influencing factors for short-term prognosis of radical resection for lung cancer, and the Nomogram prediction model constructed based on these factors has good predictive efficacy for the short-term prognosis of radical resection for lung cancer.
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Objective:To understand the cognition and training status of basic life support among medical staff in Linfen, Shanxi Province, and to provide reference for the development of targeted training strategies and programs.Methods:A questionnaire survey was conducted among medical staff in 12 county hospitals in Linfen, Shanxi Province by convenience sampling method. The survey included the general characteristics of departments and medical staff, previous basic life support training assessment and cognitive status.Results:A total of 839 medical staff were included, 756 (90.1%) completed the survey, 183 (24.2%) were doctors and 573 (75.8%) were nurses. Most personnel lacked awareness of environmental safety, emergency response system start-up, adequate compression, airway management, and electrical defibrillation.Conclusions:The cognitive status of basic life support of medical staff in Linfen county is not optimistic. It is necessary to construct an applicable precision training course and retraining assessment system to improve the cognitive level and practical operation ability.
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Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.
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Objective:To investigate the current situation of telephone cardiopulmonary resuscitation (T-CPR) in China, and analyze the reasons for the low implementation rate of T-CPR.Methods:This was a multicenter cross-sectional survey. Twenty cities were selected from six geographical regions of China by convenient sampling method. Anonymous online electronic questionnaires were sent to emergency medical service staffs in each city. All respondents were divided into the routine T-CPR group and control group. Student's t test and Chi-square test were used to analyze the difference between groups. Multivariate logistic regression was used to analyze the influencing factors of T-CPR. Results:⑴A total of 1 191 questionnaires were collected. 80.94% of respondents knew T-CPR. Nine hundred and sixty respondents, who knew T-CPR and completed the questionnaires, were included in the study, and were divided into the routine T-CPR group ( n=401) and control group ( n=559). Nine hundred and thirty-nine (97.81%) responders believed that T-CPR should be implemented for cardiac arrest patients that could be confirmed by telephone.⑵Four hundred and one (41.77%) responders routinely implemented T-CPR. Among them, 237 (24.68%) responders always did and 164 (17.08%) responders often did. ⑶Multivariate logistic regression analysis showed that male ( OR=1.787, 95% CI: 1.235-2.587, P=0.002), age ( OR=1.025, 95% CI: 1.004-1.047, P=0.020), clinical medicine background ( OR=2.926, 95% CI: 1.387-6.171, P =0.005), dispatcher ( OR=5.305, 95% CI: 3.463-8.126, P<0.01), using medical priority dispatch system (MPDS) system ( OR=1.941, 95% CI: 1.418-2.656, P<0.01), and T-CPR policy or procedure ( OR=3.879, 95% CI: 2.652-5.674, P<0.01) were favorable factors for T-CPR. ⑷The top three reasons for implementing T-CPR in the routine T-CPR group were that they had received T-CPR training (67.08%), believed that T-CPR could improve survival rate (63.59%), and had standard T-CPR process (63.09%). The top three reasons for not implementing T-CPR in the control group were that worrying about bystander compliance (42.04%), worrying about the quality of bystander cardiopulmonary resuscitation (CPR) (38.28%), and worrying about medical dispute (36.14%). Conclusions:The awareness and implementation of T-CPR among emergency medical service staffs need to be improved. The implementation of T-CPR depend on telephone dispatchers with clinical medicine background, clear T-CPR policy, standardized operation procedure, and professional assistant tools. To improve the public's awareness of cardiac arrest and cardiopulmonary resuscitation, and to improve the supporting legal system are also conducive to the implementation of T-CPR.
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Cardiopulmonary resuscitation is an important part of standardized residency training. There are certain flaws in the various commonly used training and assessment mode. In the exploration of the new mode, "step-by-step" training helps to learn skills step by step. "Low intensity and high frequency" training not only focuses on key points and difficulties, and lightens the burden of the teachers and residents, but also can improve the training effect through repeated reinforcement. Combining different training methods organically to establish a "diversified" training mode can make full use of the advantages of different methods and make up for each other's shortcomings. In addition, the "veto power" should be introduced into the assessment. Scenario simulation with role play may be an effective way to train teamwork ability, but it still needs further exploration.
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Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status,and to understand the current situation of TCPR cognition of EMS personnel in China.Methods This study is a multicenter crosssectional survey.The method of multi-level convenient sampling was adopted,and the test reliability and split half reliability of the questionnaire was tested.Questionnaire survey and data collection were conducted from December 2018 to June 2019.The ethical approval number is M2018264.SPSS 20.0 was used for analysis.x2 test was used to analyze the differences between groups.Results A total of 1191 electronic questionnaires were collected.Of them,80.94％ respondents knew TCPR,97.82％ respondents thought that TCPR should be implemented in cardiac arrest,36.62％ respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR,and TCPR training courses were set up in the emergency department which recruited 25.83％ respondents.Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69％ vs 7.89％,P=0.048),of TCPR need ncluding guidance of chest compression (92.45％ vs 87.49％,P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42％ vs 74.87％,P=0.029) than those in underdeveloped areas,but there was no significant difference in other indicators (P＞0.05).Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory.Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone,TCPR content and bystander cardiopulmonary resuscitation quality monitoring.There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China.
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The emergency management training for general practitioners during job-transfer training is an important part of clinical teaching.At present,there are many problems in emergency management teaching,such as teaching contents are extensive but the class hours are limited,traditional teaching cannot meet students' needs for studying and lack of practice for emergency management skills,leading to poor teaching effects.In the teaching of emergency management of general practitioners during job-transfer training,we cultivated emergency management ability by elaborating teaching content,strengthening their clinical thinking of emergency management,carrying out a variety of training models,enhancing skill training,and stressing the evaluation of performance and so on.
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OBJECTIVE: To explore the characteristics of death distribution in emergency critical care patients and guide the distribution of emergency resources.METHODS: Clinical data of all patients who died in the emergency department of Peking University third hospital from 2013 to 2017 were collected.Age,gender composition and time of death were analyzed.Pareto diagram was used to analyze the composition of causes of death.RESULTS:(1)Elderly patients(≥60 years old)accounted for81.0% of the total number of deaths,and the age difference has statistically significant(P<0.05).(2)Pareto diagram analysis showed that respiratory diseases,sudden death,shock and nervous diseases were the main causes of death in critically ill patients.(3)Age was associated with respiratory diseases,cardiovascular diseases,shock,sudden death,nervous diseases and trauma(P<0.05).Gender was associated with respiratory diseases,sudden death and trauma(P<0.05).(4)50.8% the death cases occurred within 24 h after admission,the median time of sudden death patients is the shortest(1 h),followed by shock(24 h).The median time of death of malignant tumor was up to 5040 h.CONCLUSION: Elderly patients are the major death group in the emergency department.Respiratory,circulatory and neurological diseases are the common causes of death.And most patients die in the early stage of treatment.Therefore,it is necessary to reasonably allocate emergency medical resources according to the actual situation.
الملخص
The emergency management training for general practitioners during job-transfer training is an important part of clinical teaching. At present, there are many problems in emergency management teaching, such as teaching contents are extensive but the class hours are limited, traditional teaching cannot meet students' needs for studying and lack of practice for emergency management skills, leading to poor teaching effects. In the teaching of emergency management of general practitioners during job-transfer training, we cultivated emergency management ability by elaborating teaching content, strengthening their clinical thinking of emergency management, carrying out a variety of training models, enhancing skill training, and stressing the evaluation of performance and so on.
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Objective To study the participating farmers'interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant ( P ＜0.05 ). Conclusions The diversity of participating farmers'interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.
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Objective To compare the clinical efficacy of single utility port and multiple utility ports thoracoscopic lobectomy in the treatment of peripheral lung cancer, and to study the operation skills, relative merit and feasibility of the single utility port thoracoscopic lobectomy. Methods The clinical data was analyzed retrospectively for 223 cases with stage Ⅰ orⅡ of peripheral lung cancer who underwent thoracoscopic lobectomy from July 2011 to November 2014 in Shanxi Provincial Cancer Hospital. Among 223 cases, 78 cases received single utility port thoracoscopic lobectomy (single utility port group), 145 cases received 2 or 3 utility ports thoracoscopic lobectomy (multiple utility ports group). The clinical outcomes involved time of operation, intraoperative blood loss,chest drainage, postoperative hospital stay, stations of lymph node dissection, numbers of lymph node dissection, rate of turn to open, postoperative complications, 2-year survival rate and disease free survival rate. Results No perioperative death occurred in both groups. There was no statistical difference between single utility port group and multiple utility ports group in operation time [(157.4 ±13.6) min vs. (151.3 ±23.2) min], intraoperative blood loss [(180.77 ±59.97) ml vs.(171.31 ±77.51) ml],chest drainage [(370.26 ±146.09) ml vs. (351.17 ±159.07) ml], lymph node dissection stations (4.29±0.65 vs. 4.21±0.73), lymph node dissection number (11.50±2.30 vs. 11.04±2.29), rate of turn to open [(5.13 ％ (4/78) vs. 4.83 ％ (7/145)], incidence of postoperative complications [17.95 ％ (14/78) vs. 15.86％(23/145)], postoperative hospital stay [(8.74±0.51) d vs. (9.48±0.63) d], 2-year survival rate [96.15 ％(75/78) vs. 93.79％(136/145)] and 2-year disease free survival rate [80.77 ％ (63/78) vs. 82.07 ％ (119/145)] (all P>0.05). Conclusions The single utility port thoracoscopic lobectomy could achieve the same clinical results as the multiple utility ports. The single utility port thoracoscopic lobectomy is a safe, effective and feasible surgical procedure.
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Objective To compare the time consumed for the procedure done,satisfaction and safety of the establishment of intraosseous (IO) access and central intravenous line placement (CVL) in critically ill patients using a randomized controlled trial.Methods The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria.The IO access and CVL were established,respectively for medicine or fluid administration.The success rates at the first attempt,time required for procedure completed,satisfaction and complications were recorded.Results During the study period,24 patients were enrolled,and divided equally and randomly into IO group (n=12) and CVL group (n=12).There were no significant differences in age,gender,BMI between the two groups.The patients with shock and cardiac arrest accounted for 83.3 ％ in IO group and 58.3 ％ in CVL group,respectively.The success rates at the first attempt was 91.7 ％ in IO access group versus 66.7 ％ in CVL group (P=0.158).the time required for procedure done was significantly shorter in IO access group (74.9 ±43.7)s compared with CVL group (944.0 s±491.5 s) (P＜0.01).The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group (P==0.053).The overall satisfaction of the operators at the entire course of procedure was 3.7 + 0.7 in IO access group versus 3.9±0.3 in CVL group (P=0.377).Complications were not observed during the study period in the two groups.Conclusions The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group,and the operation was simple and practicable.During the emergency care of critical patients,if the peripheral intravenous line placement was difficult to establish,and IO access could be a choice of alternative used as a bridging procedure to rapidly establish the vascular access and win the rescue opportunity.
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Objective:Comparing the influence of colon cancer recurrence of laparoscopic and open operation to evaluate the safety and validity of operation.Methods:The cohort study includes 62 cases of laparoscopic and 83 cases of open colon cancer radical surgery from January 2010 to October 2012.The research aimed at comparing the effects of laparoscopic and open surgery for colon cancer recurrence by analyzing postoperative follow-up ending and GCC-mRNA & CEA.Results:There have no obvious differences in age,sex,BMI,tumor size,stage,grade,pathological types and resection range between laparoscopy and open group(P＞0.05).Postoperative 3-years recurrence of two groups have no difference (P＞0.05),but 1-year recurrence rate of laparoscopic was obviously lower than open operation (3.2％ vs 14.5％,P＜0.05).There have no obvious differences of postoperative overall survival rate and mortality(P＞0.05),but 1-year disease-free survival rate of laparoscopic group was obviously higher than laparotomy group (93.5％ vs 81.3％,P＜0.05).The postoperative GCC-mRNA and CEA positive rate of laparoscopic was significantly lower than laparotomy group.Univariable and Multivariable analysis reveals that laparoscopic colorectal cancer radical can obviously reduce the cancer recurrence within 1 year (P＜0.05).Addition,stage,aspirin and other amino acid drugs are independent risk factors of postoperative recurrence (P＜0.05).Conclusion:Laparoscopic colon cancer radical surgery is a safe and effective operation and can reduce short-term recurrence of colorectal cancer compared to open surgery.
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Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.
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To explore the pharmacological mechanism of glycyrrhizin with series methods of systems pharmacology, main diseases related to glycyrrhizin were obtained by text mining tool; and the target proteins of glycyrrhizin were obtained via the database of Polysearch and PubChem. Then, the target proteins interaction network of glycyrrhizin was built using the software called Cytoscape. Next, the protein groups related to glycyrrhizin were analyzed by using Gene Ontology (GO) tool, and the action pathway of its target proteins was analyzed by using enrichment method. Text mining results showed that the related diseases of glycyrrhizin included chronic hepatitis C, chronic hepatitis, hepatitis, HIV virus, liver cancer and so on. Gene ontology analysis indicated that glycyrrhizin played a role mainly through modification of proteins and chromatin. The signaling pathway enrichment results showed that the main action proteins of glycyrrhizin were related to MAPK signaling pathway, toll-like receptor signaling pathway, neurotrophic factor signaling pathway, cancer and apoptosis pathways. So we can conclude that glycyrrhizin may exert its biological functions primarily by regulating multiple pathways such as MAPK signaling pathway and Toll-like receptors signaling pathway. The pharmacological action of a drug can be rapidly and comprehensively analyzed by the ways of systems pharmacology.
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ObjectiveTo investigate the therapeutic effect and adverse effects of transcatheter arterial chemoembolization (TACE) combined with thalidomide or sorafenib in the treatment of unresectable primary liver cancer. MethodsA total of 102 patients who underwent TACE combined with thalidomide or sorafenib in 215 Hospital of Nuclear Industry of Shaanxi Province from January 2012 to August 2013 were enrolled and divided into TACE-thalidomide group (49 patients) and TACE-sorafenib group (53 patients). The short-term outcome, long-term outcome, changes in related indices, and adverse events were evaluated. The independent-samples t-test was applied for comparison of continuous data between groups, and the paired t-test was applied for comparison of continuous data within one group; the chi-square test was applied for comparison of categorical data between groups; the survival curve was used for survival analysis, and the log-rank test was applied for survival comparison. ResultsThe indices of short-term outcome, objective response rate and disease control rate, showed no significant differences between the two groups. The 2-year survival showed a significant difference between the two groups (χ2=4692, P=0.03). The log-rank test showed that overall survival time and median progression-free survival time showed significant differences between the two groups (χ2=8.267 and 6.896, P=0.004 and 0.009). After treatment, alpha-fetoprotein (AFP) and gamma-glutamyl transpeptidase (GGT) showed significant differences between the two groups (t=2.035 and 2.843, P=0.038 and 0.025). The incidence rates of nausea/vomiting, dizziness/headache, rash/desquamation, and increased blood pressure showed significant differences between the two groups (all P＜0.05). ConclusionTACE combined with thalidomide has the same short-term therapeutic effect as TACE combined with sorafenib and can improve the patient′s long-term outcome and significantly reduce the levels of AFP and GGT, but it has high incidence of nausea/vomiting and dizziness/headache.
الملخص
Objective To evaluate the effects of ethyl gallate (EG ) on sepsis-induced acute lung injury (ALI) in rats .Methods Forty-eight healthy male Wistar rats ,aged 10-12 weeks ,weighing 150-250 g ,were randomly divided into 3 groups (n=16 each) using a random number table :control group (group C) ,group ALI , and group EG .The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg .Sepsis was induced by cecal ligation and puncture (CLP) .EG 1 ml/h (50 mg·kg-1 ·h-1 ) was infused intravenously via the femoral vein for 4 h starting from 6 h after CLP in group EG .The equal volume of normal saline was given instead in group ALI . The rats were sacrificed at 10 and 24 h after CLP (T1 ,2 ) , and the lungs were removed for determination of wet/dry lung weight ratio (W/D ratio ) , superoxide dismutase (SOD ) activity , contents of malondialdehyde (MDA ) and glutathione (GSH ) , and 3-NT expression (by immuno-histochemistry ) in lung tissues .The pathological changes of the lung were examined with light microscope .Results Compared with group C ,the W/D ratio ,MDA content and 3-NT expression were significantly increased and GSH content was decreased at T1 ,2 ,the SOD activity was significantly decreased at T2 in group ALI ,and the MDA content and 3-NT expression were increased at T1 ,and the W/D ratio ,MDA content and 3-NT expression were increased and GSH content was decreased at T2 in group EG ( P<0.05) .Compared with group ALI ,the MDA content was significantly decreased at T1 ,and the W/D ratio ,MDA content and 3-NT expression were decreased ,and GSH content and SOD activity were increased at T2 in group EG ( P<0.05) .The pathological changes of the lung were obvious in group ALI , and significantly attenuated in group EG .Conclusion EG can attenuate sepsis-induced ALI by antioxidative effects in rats .
الملخص
Objective To evaluate the effect of perioperative intravenous (Ⅳ) iron sucrose therapy on reducing postsurgical blood transfusion rates in elderly patients with hip fractures.Methods From September 2011 to February 2014,200 patients aged≥65 years with hip fractures were enrolled.The iron sucrose group (n=100) received iron sucrose (600 mg,Ⅳ),while the control group (n=100) did not receive iron sucrose.Postsurgical blood transfusion rates,infection rates,mortality and length of hospital stay were evaluated.Results The difference in blood transfusion rates was significant (25.0％ vs.41.0％,P＜0.05),while differences in infection rates,mortality and length of hospital stay were not significant between the two groups.Conclusions Perioperative Ⅳ iron sucrose can reduce blood transfusion requirements in elderly patients with hip fractures.