Successful Large Hospital Evacuation With 11 350 Patients Transferred in the 2021 Zhengzhou Flood.

OBJECTIVES: This is a case report of a huge hospital evacuation with 11 350 inpatients in the 2021 Zhengzhou flood in China, using a mixed methods analysis. METHODS: The qualitative part was a content analysis of semi-structured interviews of 6 key hospital staff involved in evacuation management. The evacuation experience was reviewed according to the 4 stages of disaster management: prevention, preparation, response, and recovery. RESULTS: Because of unprecedented torrential rain, the flood exceeded expectations, and there was a lack of local preventive measures. In preparation, according to the alert, the evacuation was planned to reduce the workload on inpatients and to accept the surge of medical needs by the flood. In response, the prioritization of critically ill patients and large-scale collaboration of hospital staff, rescue teams, and accepting branch made it possible to successfully transfer all 11 350 inpatients. In recovery, restoring medical services and a series of activities to improve the hospital's vulnerability were carried out. CONCLUSIONS: A hospital evacuation is one of the strategies of the business continuity plan of a hospital. For the evacuation, leadership and collaboration were important. Challenges such as prolonged roadway flooding and the infrastructure issues were needed to be addressed throughout the evacuation process.

A New Continuous Flow Microwave Radiation Process Design for Non-Isocyanate Polyurethane (NIPU).

Non-isocyanate Polyurethane (NIPU) has been known to result from a thermal-ring-opening reaction between bis-cyclic carbonate (BCC) compounds and polyamines. BCC can be obtained from carbon dioxide capture using an epoxidized compound. Microwave radiation has been found to be an alternative process to conventional heating for synthesizing NIPU on a laboratory scale. The microwave radiation process is far more efficient (>1000 times faster) than using a conventional heating reactor. Now, a flow tube reactor has been designed for a continuous and recirculating microwave radiation system for scaling up NIPU. Furthermore, the TOE (Turn Over Energy) of the microwave for a lab batch (24.61 g) reactor was 24.38 kJ/g. This decreased to 8.89 kJ/g with an increase in reaction size of up to 300 times with this new continuous microwave radiation system. This proves that synthesizing NIPU with this newly-designed continuous and recirculating microwave radiation process is not only a reliable energy-saving method, but is also convenient for scale-up, making it a green process.

Ursodeoxycholic acid ameliorates hepatic lipid metabolism in LO2 cells by regulating the AKT/mTOR/SREBP-1 signaling pathway.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease, can progress into nonalcoholic steatohepatitis (NASH), cirrhosis, and even hepatocellular carcinoma. Bile acids such as ursodeoxycholic acid (UDCA) play an essential role in the pathogenesis of NAFLD by regulating the level of sterol regulatory element-binding protein (SREBP) 1c, but the underlying regulatory mechanism remains elusive. Increased evidence indicates that the AKT/mTOR/SREBP-1 signaling pathway is a key pathway to regulate hepatic cellular lipid metabolism. UDCA may regulate the AKT/mTOR/SREBP-1 signaling pathway to ameliorate hepatic lipid metabolism. AIM: To investigate the functional mechanism of UDCA in an oleic acid (OA)-induced cellular model of NAFLD. METHODS: The cellular model of NAFLD was established using OA and treated with UDCA. First, the best concentration of UDCA was selected. For the best time-dependent assay, cells were stimulated with OA only or co-treated with OA and 2 mmol/L UDCA for 24 h, 48 h, and 72 h. Oil red O staining was used to observe the accumulation of intracellular lipids, while the intracellular contents of triglyceride, alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and aspartate aminotransferase (AST) were detected by enzymatic methods. Meanwhile, the expression levels of AKT/mTOR/SREBP-1 signaling pathway-related proteins were detected by real-time PCR and Western blot. RESULTS: In the NAFLD cell model established with LO2 cells induced using OA, lipid accumulation was obvious. UDCA significantly inhibited lipid accumulation at different concentrations (especially 2 mmol/L) and decreased cell growth ability at different time points. The biochemical parameters like ALT, AST, and GGT were significant improved by UDCA. UDCA treatment vividly repressed the activation of AKT, mTOR, and CRTC2 and the expression of nSREBP-1 in LO2 cells induced with OA. CONCLUSION: Our findings demonstrate the effect of UDCA in improving NAFLD. UDCA attenuates OA-induced hepatic steatosis mainly by regulation of AKT/mTOR/SREBP-1 signal transduction.

[Efficacy and safety of telbivudine in pregnant women to prevent perinatal transmission of hepatitis B virus].

OBJECTIVE: To evaluate the efficacy and safety of telbivudine use during the second and third trimester of pregnancy for reducing hepatitis B virus (HBV) transmission from highly viremic hepatitis B e antigen-positive (HBeAg+) mothers to their fetuses. METHODS: Pregnant women, between weeks 20 to 32 of gestation, who were HBeAg+ and had HBV DNA more than 1.0*10(7) copies/mL were enrolled in our study. The women were offered inclusion into one of two treatment arms, based upon their personal preference: telbivudine or no telbivudine. The patients in the telbivudine treatment arm were administered 600 mg/d telbivudine at least until postpartum week 4. All delivered infants in both treatment arms were administered hepatitis B immune globulin (HBIG; 200 IU) within 12 hours of delivery and recombinant HBV vaccine (20 mug) at 0, 1 and 6 months. The HBV perinatal transmission rate was determined by measuring HBsAg and HBV DNA in infants at postpartum week 28. RESULTS: A total of 220 pregnant women were enrolled in our study, 120 chose the telbivudine arm and 100 chose the control arm. All telbivudine treated subjects were registered in the Antiretroviral Pregnancy Registry. Telbivudine treatment was associated with a marked reduction in the mothers' serum HBV DNA, HBeAg and ALT levels before delivery. A striking decline of HBV DNA levels in treated mothers was observed at week 2 of treatment, which was followed by a gradual and steady decrease that continued until delivery. Thirty-seven (31%) of the telbivudine-treated mothers and none (0%) of the untreated controls had polymerase chain reaction-undetectable viremia at delivery. At week 28, 0% of the infants delivered from telbivudine-treated mothers were HBsAg+ or HBV DNA+, as compared to 8% HBsAg+ or HBV DNA+ in the untreated control arm (P = 0.002). No telbivudine discontinuations occurred from adverse events, and no congenital deformities were observed in the infants delivered to telbivudine-treated mothers. Eighty mothers discontinued telbivudine at week 4 postpartum, and there were no cases of severe hepatitis. There were no significant differences between the two treatment arms for postpartum hemorrhage, adverse events during pregnancy, cesarean section, gestational age, or infants' height/weight or Apgar scores. CONCLUSIONS: Telbivudine use during the second and third trimester of pregnancy in HBeAg+ highly viremic mothers can safely reduce perinatal HBV transmission rates. Telbivudine was well-tolerated by our patient group. Furthermore, no safety concerns were observed in either the telbivudine-treated mothers or their delivered infants in short term follow-up.

Intradural disc herniation at L5 level mimicking an intradural spinal tumor.

Intradural lumbar disc herniation is a rare complication of disc disease. The reason for the tearing of the dura matter by a herniated disc is not clearly known. Intradural disc herniations usually occur at the disc levels and are often seen at L4-L5 level but have also been reported at other intervertebral disc levels. However, intradural disc herniation at mid-vertebral levels is rare in the literature and mimics an intradural extramedullary spinal tumor lesion in radiological evaluation. Although magnetic resonance imaging (MRI) with gadolinium is useful in the diagnosis of this condition, preoperative correct diagnosis is usually difficult and the definitive diagnosis must be made during surgery. We describe here a 50-year-old female patient who presented with pain in the lower back for 6 months and a sudden exacerbation of the pain that spread to the left leg as well as numbness in both legs for 2 weeks. MRI demonstrated an intradural mass at the level of L5. Laminectomy was performed, and subsequently durotomy was also performed. An intradural disc fragment was found and completely removed. The patient recovered fully in 3 months. Intradural lumbar disc herniation must be considered in the differential diagnosis of mass lesions in the spinal canal.