The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate.

BACKGROUND: Little is known about the components and contributing factors of door-to-balloon time after implementation of Door-to-Balloon Alliance quality-improving (QI) strategies, including the impact of door-to-ECG time on door-to-balloon time. OBJECTIVE: We investigated whether modification of emergency department (ED) triage processes could improve door-to-ECG and door-to-balloon times after implementation of QI strategies. METHODS: This was a retrospective before-and-after study of a prospectively collected database. From June 2014 to October 2014, interventions were implemented in our ED, including a protocol-driven ECG initiation and moving an ECG station and technician to the triage area. The primary outcome was the percentage of patients with ST-elevation myocardial infarction (STEMI) who received ECG within 10 min of arrival; the secondary outcome was the percentage of patients with door-to-balloon times of <90 min from arrival. Patients from the year pre- and post-QI initiative were defined as the control and intervention groups, respectively. RESULTS: Enrollment comprised 214 patients with STEMI: 109 before the intervention and 105 after the intervention. We analyzed the components of the door-to-balloon process and found the door-to-ECG process was the most critical interval of delay (20.8%). Unrecognized symptoms were the most common cause of delay in the door-to-ECG process resulting in a significant impact on the door-to-balloon time. The intervention group had a higher percentage of patients with door-to-ECG times <10 min than did the control group (93.3% vs. 79.8%, p = 0.005), with a corresponding improvement in door-to-balloon times <90 min (91.1% vs. 76.2%, p = 0.007). In subgroup analysis, the intervention benefits occurred only in non-transferred or walk-in patients. After adjustment for possible co-variates, the QI interventions remained a significant contributing factor for achieving the door-to-ECG and door-to-balloon targets. CONCLUSIONS: The modification of ED triage processes through implementation of QI strategies are effective in achieving better door-to-ECG times and thus, achieving door-to-balloon times <90 min. In patients presenting with ambiguous symptoms, improved door-to ECG target achievement rates, through a protocol-driven and multidisciplinary approach allows for earlier identification of STEMI.

Screening host proteins required for bacterial adherence after H9N2 virus infection.

H9N2 subtype low pathogenic avian influenza virus (LPAIV) is distributed worldwide and causes great economic losses in the poultry industry, especially when complicated with other bacterial infections. Tissue damages caused by virus infection provide an opportunity for bacteria invasion, but this mechanism is not sufficient for low pathogenic strains. Moreover, although H9N2 virus infection was demonstrated to promote bacterial infection in several studies, its mechanism remained unclear. In this study, infection experiments in vivo and in vitro demonstrated that the adhesion of Escherichia coli (E. coli) to host cells significantly increased after H9N2 virus infection, and this increase was not caused by pathological damages. Subsequently, we constructed a late chicken embryo infection model and used proteomics techniques to analyze the expression of proteins associated with bacterial adhesion after H9N2 virus infection. A total of 279 significantly differential expressed proteins were detected through isobaric tags for relative and absolute quantitation (iTRAQ) coupled with nano-liquid chromatography-tandem mass spectrometry (nano-LC-MS/MS) analysis. The results of Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that differentially expressed proteins were enriched in host innate immunity; cell proliferation, differentiation, and apoptosis; and pathogenicity-related signaling pathways. Finally, we screened out several proteins, such as TGF-ß1, integrins, cortactin, E-cadherin, vinculin, and fibromodulin, which were probably associated with bacterial adhesion. The study analyzed the mechanism of secondary bacterial infection induced by H9N2 virus infection from a novel perspective, which provided theoretical and data support for investigating the synergistic infection mechanism between the H9N2 virus and bacteria.

[An anticaries experimental study of SD rat immunized by recombinant plasmid pEGFP-N1-Srv+ encoding the V-region of surface protein of Streptococcus mutans].

PURPOSE: An anticaries DNA vaccine pEGFP-N1-Srv+ was used to immunize rats by different immune pathways. The expression of recombinant plasmid in different tissues in vivo and the specific immune response and protection effects against dental caries were observed. METHODS: 20 SD rats were divided into 4 groups, immunized with the recombinant plasmid pEGFP-N1-SrV+ by submandibular gland-target injection(TSG), and intramuscular injection,respectively; then the expression of recombinant plasmid in different tissues were detected by immunohistochemistry technique. 24 SD rats were divided into 4 groups, immunized with recombinant plasmid pEGFP-N1-SrV+ of 100 µg, then boosted once after two weeks, through the same routes as above;then indirect ELISA technique was used to detect the specific antibodies. Keyes caries scores were used to evaluate the anticaries effects. The data was analyzed by using SPSS17.0 software package. RESULTS: (1)Recombinant plasmid was positively expressed in the muscle fibers and submandibular glands.(2)The specific salivary anti-SR IgA and serum IgG were detected, and the peak time of the antibodies level appeared 4 weeks after initial . At the 4th week, the levels of specific anti-SR antibodies were higher in the experimental group than that in the negative control group. The levels of salivary specific anti-SR IgA were significantly higher in TSG immunization group than that in the intramuscular injection group. (3)Keyes caries scores were not significantly different between the experimental groups and negative control groups. recombinant plasmid pEGFP-N1-Srv+ expressed in vivo and effectively increased specific salivary anti-SR IgA and serum IgG, and TSG immunization route significantly increased the specific salivary anti-SR IgA compared with the intramuscular immunization route;however, the recombinant plasmid pEGFP-N1-Srv+ alone can not protect the rats from dental caries. CONCLUSIONS: The recombinant plasmid pEGFP-N1-SrV+ expressed in vivo and effectively increased specific salivary anti-SR IgA and serum IgC, and TSG immunization route significantly increased the specific salivary anti-SR IgA compared with the intramuscular immunization route; however, the recombinant plasmid pEGFP-N1-Srv+ alone can not protect the rats from dental caries.