The predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting.

OBJECTIVES: We aimed to explore the predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting. METHODS: Trauma patients admitted to Shenzhen University General Hospital from July 2018 to December 2022 were included in this study. They were divided into the massive transfusion group and the non-massive transfusion group according to the blood transfusion volume within 24 h. Basic information about patients was collected. Glasgow Coma Scale (GCS), focused assessment with sonography for trauma (FAST), and injury severity score (ISS) were performed. The receiving operating characteristic (ROC) curve was used to compare the predictive value of four trauma transfusion scores for early massive blood transfusion in the pre-hospital setting. RESULTS: A total of 475 patients were enrolled, 43 received massive blood transfusions and 29 died within 24 h. The sensitivity and specificity of the four trauma hemorrhage scores in predicting the need for massive blood transfusions in trauma patients at their recommended cutoff points were all high. Among the four scores, the area under the ROC curve was larger for the assessment of blood consumption (ABC) score (0.864) and smaller for the trauma-induced coagulopathy clinical score (TICCS) score (0.795, p > 0.05). CONCLUSIONS: All four pre-hospital trauma hemorrhage scores have a high predictive value in assessing massive blood transfusion in trauma patients.

Construction of a 5G-based, three-dimensional, and efficiently connected emergency medical management system.

Background: Shenzhen is unique in its need for ad hoc responses to emergencies. The need for emergency medicine also demonstrates a trend of sustained growth. Objective: A three-dimensional and efficiently connected emergency medical management model using fifth generation mobile communication technology (5G) was established to improve the efficiency and level of management in emergency medicine. Method: A mixed-frequency band private network collaborative emergency treatment mode was built under daily emergency scenarios using 5G. The efficiency of a three-dimensional telemedicine treatment mode was tested using prehospital emergency medicine. Also, the feasibility of quickly establishing a temporary network information system using unmanned aerial vehicle (UAV) and/or high-throughput communication satellites under disaster-caused power outages and network interruptions was examined. A monitoring system was constructed for suspected cases using 5G amid public health emergencies, which raised the Emergency Department's efficiency and security in responding to the pandemic. Results: The three-dimensional rescue system supported by 5G showed that the radius of the emergency medical rescue services expanded from 5 to 60 km, and the cross-district emergency reaction time reduced from 1 h to <20 min. Thus, it was feasible to construct a communication network expeditiously with devices carried by UAV under disastrous scenarios. The system developed based on 5G could be used in managing suspected cases of public emergencies. Among the 134 suspected cases in the early stage of the pandemic, no nosocomial infection was detected. Conclusion: A three-dimensional, efficiently connected emergency medical management system based on 5G was constructed, following which the emergency rescue radius quickly expanded and the emergency response time reduced. Thus, with the aid of new technology, an emergency information network system was built expeditiously under specific scenarios, such as a natural disaster, and the level of management under public health emergencies advances. The confidentiality of patient information is a critical issue regarding the application of new technology.

Application of telemedicine system on the management of general patient in quarantine.

To limit the epidemic of COVID-19, most countries and regions have adopted the policy of quarantine, providing an opportunity for the development of telemedicine. This study aims to develop a telemedicine system within a quarantined district and validate its effectiveness and safety in managing a variety of diseases within the population. Appling the private network and specialized set, telemedicine system and service process were constructed in the quarantine district. Based on the patients' conditions, the staffs supplied kinds of medical service for the patients in the quarantine district. The basic characteristics and results of patients in the quarantine area who used telemedicine system during January to September 2022 were statistically analyzed. Within this period, 2410 cases were included in this study, among which, 1803 patients directly saw a doctor by the Internet hospital in the Internet hospital of telemedicine system, 607 patients used telemedicine system, 166 patients achieved referral to a specific hospital via telemedicine system, and 162 cases made further consultation, with no infection cases in the quarantine zone and no death cases. The six most occurred diseases were respiratory disease (20.6%), ophthalmology and otorhinolaryngology (12.9%), cardiovascular diseases (12.7%), digestive system disease (12.5%), dermatological diseases (10.6%), and metabolic and endocrine diseases (7.6%). The top three referred cases were obstetric diseases (19.3%), others (12.0%) and respiratory disease (10.2%). There were statistically significant differences between the diseases of the cases using telemedicine system with and without referral (P < 0.001). It is feasible, effective and efficient to construct and use telemedicine system in quarantine area. It is an approach to manage many patients by indirectly contact. With the solution of follow-up related problems and the application of novel technologies, telemedicine may usher in greater development.

Unmanned aerial vehicle based intelligent triage system in mass-casualty incidents using 5G and artificial intelligence.

BACKGROUND: Rapid on-site triage is critical after mass-casualty incidents (MCIs) and other mass injury events. Unmanned aerial vehicles (UAVs) have been used in MCIs to search and rescue wounded individuals, but they mainly depend on the UAV operator's experience. We used UAVs and artificial intelligence (AI) to provide a new technique for the triage of MCIs and more efficient solutions for emergency rescue. METHODS: This was a preliminary experimental study. We developed an intelligent triage system based on two AI algorithms, namely OpenPose and YOLO. Volunteers were recruited to simulate the MCI scene and triage, combined with UAV and Fifth Generation (5G) Mobile Communication Technology real-time transmission technique, to achieve triage in the simulated MCI scene. RESULTS: Seven postures were designed and recognized to achieve brief but meaningful triage in MCIs. Eight volunteers participated in the MCI simulation scenario. The results of simulation scenarios showed that the proposed method was feasible in tasks of triage for MCIs. CONCLUSION: The proposed technique may provide an alternative technique for the triage of MCIs and is an innovative method in emergency rescue.

Hydrophilic metal-organic frameworks integrated uricase for wearable detection of sweat uric acid.

The chemistry of the metal-organic frameworks (MOFs) coating may affect the biological functionality of the encapsulated biomacromolecules in harsh environment. Enzymes encapsulated in hydrophilic MAF-7 can retain high activity in harsh environment. We conducted this study to prepare a non-invasive wearable uircase@MAF-7-based electrochemical sensor that can achieve accurate and sensitive detection of UA levels in sweat by integrating a flexible microfluidic chip and wireless electronic readout device. The flexible microfluidic chip enabled an easy and effective collection of sweat samples. MAF-7 protected enzyme activity by encapsulating uricase. The uricase@MAF-7-based electrochemical sensor enabled the highly sensitive detection of UA in the concentration range of 2 µM-70 µM with a detection limit of as low as 0.34 µM. Additionally, we evaluated the utility of the sensor for monitoring UA levels in real sweat samples by means of a high purine dietary challenge. This personalized wearable sweat sensing device has a potential to be used for monitoring disease-related metabolites in daily life.

Hybrid micelles enhance tumour therapy by remodelling biodistribution and improving intracellular drug release.

PEGylated micelles have been widely used for tumour therapy. Although PEGylation can prolong the blood circulation time, there is only less than 5% of administered micelles that can be transported to tumour sites and over 95% are cleared by the reticuloendothelial system (RES). Besides, the limited intracellular drug release also restricts their efficacy. To improve the therapeutic efficacy of PEGylated micelles, a safe, simple and efficient hybrid micellar system, composed of poly(aminoethyl ethylene phosphate)-poly(L-lactic acid) (PAEEP-PLLA) and poly(ethylene glycol)-poly(L-lactic acid) (PEG-PLLA), was developed. The hybrid micelles significantly prolonged the blood circulation time by decreasing the plasma protein adsorption and reducing the clearance by the RES. The deposition of the hybrid micelles in the liver and spleen was reduced, and the tumour accumulation was greatly improved. In addition, the intracellular drug release of the hybrid micelles was obviously increased due to the easy degradation of PAEEP in the endo/lysosomes. The tumour growth inhibition efficiency of the hybrid micelles was much higher than that of the PEG-PLLA micelles (84.5% vs. 44.5%). Furthermore, the hybrid micelles exhibited low hemolysis and reduced deposition in normal organs, which revealed their excellent bio-safety. Therefore, we established a promising hybrid micelle system for efficient anti-tumour therapy.

Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis.

BACKGROUND: Lung cancer is a major cause of death among patients, and non-small cell lung cancer (NSCLC) accounts for more than 80% of all lung cancers in many countries. AIM: To evaluate the clinical benefit (CB) of COX-2 inhibitors in patients with advanced NSCLC using systematic review. METHODS: We searched the six electronic databases up until December 9, 2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC. Overall survival (OS), progression free survival (PFS), 1-year survival rate (SR), overall response rate (ORR), CB, complete response (CR), partial response (PR), stable disease (SD), and toxicities were measured with more than one outcome as their endpoints. Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using Egger's linear regression test. Data analysis was performed using R software. RESULTS: The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS, progression free survival, 1-year SR, CB, CR, and SD. However, there was a difference in overall response rate for patients with advanced NSCLC. In a subgroup analysis, significantly increased ORR results were found for celecoxib, rofecoxib, first-line treatment, and PR. For adverse events, the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia, thrombocytopenia, and cardiovascular events. CONCLUSION: COX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.

[Strategy research and analysis on 10 590 cases of invalid ambulance attendance in prehospital emergency care in Nanshan District of Shenzhen from 2014 to 2018].

OBJECTIVE: To provide a scientific basis for reducing the rate of invalid ambulance attendance and the establishment of grades dispatch system through a retrospective analysis of the invalid ambulance attendance in prehospital emergency care. METHODS: The data of the invalid ambulance attendance was collected in Huazhong University of Science and Technology Union Shenzhen Hospital (the only tertiary hospital of in Nanshan District) from 2014 to 2018, and the reasons of the invalid ambulance attendance, the time period during the invalid ambulance attendance occurred (every 3 hours was divided into one time period), and the reasons of ambulance calling were statistically analyzed. RESULTS: (1) The invalid ambulance attendance rates showed a fluctuating decrease trend year by year from 2014 to 2018, the rates were 31.22% (2 515/8 055), 26.94% (2 147/7 970), 29.80% (2 398/8 046), 25.69% (1 844/7 177) and 21.89% (1 686/7 703), respectively. The total invalid ambulance attendance rate was 27.19% (10 590/38 951) in the five years. (2) The top three reasons for the invalid ambulance attendance were cancelled calls, departure before the ambulance arrived, and going to hospital by themselves, accounting for 36.87%, 25.08%, and 17.03%, respectively. The constituent ratios of the causes of invalid ambulance attendance in each year were different with statistical significance (χ2 = 217.626, P < 0.001). (3) The top three time period of invalid ambulance attendance occurred at 21:00-23:59, 18:00-20:59 and 09:00-11:59, accounting for 16.86%, 14.95% and 13.54%, respectively. There was no statistical significance in the distribution of time period in each year (χ2 = 32.571, P = 0.252). (4) The top five reasons for ambulance calling of invalid ambulance attendance were fainting/syncope, trauma, alcoholism, traffic accident injuries, and brawls, accounting for 20.13%, 15.67%, 9.97%, 8.64%, and 6.45%, respectively, and there was statistically significant difference in the distribution of the reason for ambulance calls in each year (χ2 = 194.213, P < 0.001). CONCLUSIONS: The invalid ambulance attendance rate is high in Nanshan District of Shenzhen. Improving the professional level and triage ability of the dispatchers, improving the system construction of prehospital emergency care system and increasing social education are conducive to reduce invalid ambulance attendance rate.

Linked PNPLA3 polymorphisms confer susceptibility to nonalcoholic steatohepatitis and decreased viral load in chronic hepatitis B.

AIM: To investigate the association of PNPLA3 polymorphisms with concurrent chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD). METHODS: A cohort of Han patients with biopsy-proven CHB, with or without NAFLD (CHB group, n = 51; CHB + NAFLD group, n = 57), and normal controls (normal group, n = 47) were recruited from Northern (Tianjin), Central (Shanghai), and Southern (Zhangzhou) China. Their PNPLA3 polymorphisms were genotyped by gene sequencing. The association between PNPLA3 polymorphisms and susceptibility to NAFLD, and clinical characteristics of NAFLD were evaluated on the basis of physical indices, liver function tests, glycolipid metabolism, and histopathologic scoring. The association of PNPLA3 polymorphisms and hepatitis B virus (HBV) load was determined by the serum level of HBV DNA. RESULTS: After adjusting for age, sex, and body mass index, we found that four linked single nucleotide polymorphisms (SNPs) of PNPLA3, including the rs738409 G allele (CHB + NAFLD group vs CHB group: odds ratio [OR] = 2.77, 95% confidence interval [CI]: 1.18-6.54; P = 0.02), rs3747206 T allele (CHB + NAFLD group vs CHB group: OR = 2.77, 95%CI: 1.18-6.54; P = 0.02), rs4823173 A allele (CHB + NAFLD group vs CHB group: OR = 2.73, 95%CI: 1.16-6.44; P = 0.02), and rs2072906 G allele (CHB + NAFLD group vs CHB group: OR = 3.05, 95%CI: 1.28-7.26; P = 0.01), conferred high risk to NAFLD in CHB patients. In patients with both CHB and NAFLD, these genotypes of PNPLA3 polymorphisms were associated with increased susceptibility to nonalcoholic steatohepatitis (NASH) (NAFLD activity score ≥ 3; P = 0.01-0.03) and liver fibrosis (> 1 Metavir grading; P = 0.01-0.04). As compared to those with C/C and C/G at rs738409, C/C and C/T at rs3747206, G/G and G/A at rs4823173, and A/A and A/G at rs2072906, patients in the CHB + NAFLD group with G/G at rs738409, T/T at rs3747206, A/A at rs4823173, and G/G at rs2072906 showed significantly lower serum levels of HBV DNA (P < 0.01-0.05). CONCLUSION: Four linked SNPs of PNPLA3 (rs738409, rs3747206, rs4823173, and rs2072906) are correlated with susceptibility to NAFLD, NASH, liver fibrosis, and HBV dynamics in CHB patients.