Ascent schedules,acute altitude illness,and altitude acclimatization:Observations on the Yushu Earthquake

During the Yushu Earthquake on April 14,2010,a large number of rescuers from sea level or lowlands ascended to the quake areas very rapidly or rapidly less than 24 h. However,Yushu Earthquake is the highest quake in the world at altitudes between 3 750 m and 4 878 m where is a serious hypoxic environment. A high incidence of acute altitude illness was found in the unacclimatized rescuers;the mountain rescue operation changed as "rescue the rescuers". Lesson from the Yushu Earthquake is that the occurrence of acute altitude illness may be closely related to the ascent schedules. This prompted us to study the relationship between ascent rate and the incidence and severity of acute altitude illness;five different groups were compared. The first group was 42 sea level male young soldiers who ascended to quake area very rapidly within 8 h at 4 000 m;the second group was 48 sea level male young soldiers who ascended to 4 000 m rapidly less than 18 h;the third group was 66 acclimatized medical workers from 2 261 m who ascended to 4 000 m rapidly within 12 h;the fourth group was 56 Tibetan medical workers from 2 800 m who ascended to 4 000 m rapidly within 8 h;the fifth group was 50 male sea level workers who ascended to 4 000 m gradually over a period of 4 d. The results showed that the sea level rescuers ascended to 4 000 m very rapidly or rapidly had the highest incidence of acute mountain sickness (AMS) with the greatest AMS scores and the lowest arterial oxygen saturation (SaO2);the sea level workers ascended to 4 000 m gradually had moderate incidence of AMS with moderate AMS scores and SaO2 values;whereas the acclimatized and adapted rescuers had the lowest incidence of AMS,lowest AMS scores and higher SaO2;especially none AMS occurred in Tibetan rescuers. AMS score is inversely related to the ascent rate (r=-0.24,p< 0.001). Additionally,acute altitude illness is significantly influenced by altitude acclimatization. The ascent rate is inversely re- lated to the period of altitude acclimatization whereas the time of perfect recovered from AMS is positively correlated to the time taken to acclimatize. Generally,the best means of preventing acute altitude illness is slow and gradual ascent to high altitude,as this allows time for establishing altitude acclimatization and tolerance to the hypoxic environment. However,during an emergency circumstance,such as mountain rescue operation,the rescuers must rapidly ascend to high altitude,so a series of preventive strategies including pre-acclimatization,using some prophylactic drugs and oxygen supplementary are sorely necessary.

Pancreatic encephalopathy in 24 patients with severe acute pancreatitis

BACKGROUND: Pancreatic encephalopathy (PE), an un- familiar complication of severe acute pancreatitis ( SAP) , is difficult to diagnose and treat, and it has a high mortality. The aim of this study was to investigate the manifestation, classification, mechanism and therapy of PE. METHODS: Of 132 patients with SAP treated at our hospi- tal from March 1994 to March 2004, 24 patients complicated by PE were analyzed retrospectively. RESULTS: The causes of SAP were mostly biliary and alco- holic. Twenty-four patients (18.2%) were complicated by PE within 3 hours-38 days ( average 6. 6 days) [ 21 (87. 5%) within 2 weeks, and 3(12.5%) after 2 weeks]. Eleven pa- tients were male and 13 female, with an average of 47 years (range 25-72 years). Excitement or restrain was the main manifestation. Nine patients (37.5%) received surgery and 15 (62.5%) conservative treatment, with a mortality of 11.1 % (1/9) and 66.7% (10/15), respectively. CONCLUSIONS: PE occurs 2 weeks after SAP and is part of multiple organ failure (MOF). Some patients have PE in the late stage of SAP because of lack of VitB1 and nutri- tion. But PE can be prevented by prescribing adequate nu- trition and VitB1 in the early stage of SAP.

Facilitating and hindering factors of community nurses'emergency and critical care treatment abilities:A qualitative study

BACKGROUND This study adopts a descriptive phenomenological approach to investigate the facilitators and barriers of community nurses'abilities in managing critical and emergency conditions.With the transition of healthcare systems to the community,the evolution of nursing practices,and the attention from policies and practices,community nurses play a crucial role in the management of critical and emergency conditions.However,there is still a lack of comprehensive understanding regarding the factors that promote or hinder their capabilities in this area.AIM To understand the facilitators and barriers of community nurses in managing critical and emergency conditions,exploring the fundamental reasons and driving forces influencing their treatment capabilities.METHODS This study utilized the destination sampling method between May 2023 and July 2023.It employed a descriptive phenomenological approach within qualitative research methodologies.Through objective sampling,17 community nurses from 7 communities in Changning District,Shanghai,were selected as the study subjects.Semi-structured interviews were conducted to gather data,which were subsequently organized and analyzed using Colaizzi's seven-step analysis method,leading to the extraction of final themes.RESULTS The barrier factors identified from the interviews encompassed three topics:resource allocation,professional factors,and personal literacy.The facilitators comprised three themes:professionalism,management attention,and training and continuing education.We identified that the root causes of the barriers included the lack of practical treatment experience among community nurses,insufficient awareness of self-directed learning,and limited knowledge and technical proficiency.The professional quality of community nurses and management attention serve as motivation for them to enhance their treatment abilities.CONCLUSION To enhance the capability of community nurses in treating acute and critical patients,it is recommended to bolster training specifically tailored to acute and critical care,raise awareness of first aid practices,and elevate knowledge and skill levels.

A successful mountain rescue operation in Yushu Earthquake

On April 14, 2010, an earthquake reaching 7.1 Richter scale struck Jiegu Town of Yushu. More than 2 698 people were confirmed dead, and 12 135 were injured, of which 1 434 were severely injured. Rescue operation was carried out soon after the disaster; however, the rescue teams face great challenges of altitude hypoxia, freezing temperature and very bad weather. Thus, 1 434 severe injuries were rapidly transported airlifted to hospitals in Xining and neighboring provinces for effective treatment. The extremity trauma （49.9 % ） was the most common patteru of injuries. Asphyxia （40.8 % ） was by far the most important reason for death. A high incidence of acute altitude illness in the lowland rescuers was a special medical problem during the highest earthquake in Yushu. We have learned more lessons from Yushu Earthquake.

A necklace of pearl in high altitude medicine and hypoxic physiology in Yushu Earthquake

During Yushu Earthquake,a large number of rescuers flocked to the mountainous quake areas. Under such a very specific circumstance,a high incidence of acute altitude illness was observed in rescuers who rapidly traveled from near sea level to an altitude of 4 000 m. It is evident that acute altitude illness leads to a significant human and economic toll,and also seriously influences the mountain rescue operation. So what does this teach us about mountain rescue in Yushu? Professor Wu Tianyi and many other authors collected shining points of the experiences and drew the lessons from the Yushu Earthquake into this special issue in Engineering Sciences which is like to thread pearl beads for a necklace. What readers learn from this special issue will have implications for the health and well-being of all high altitude populations all over the world.

Analysis of severe human adenovirus infection outbreak in Guangdong Province,southern China in 2019

During 2018–2019,a severe human adenovirus(HAdV)infection outbreak occurred in southern China.Here,we screened 18 respiratory pathogens in 1704 children(≤14 years old)hospitalized with acute respiratory illness in Guangzhou,China,in 2019.In total,151 patients had positive HAdV test results;34.4%(52/151)of them exhibited severe illness.HAdV infection occurred throughout the year,with a peak in summer.The median patient age was 3.0(interquartile range:1.1–5.0)years.Patients with severe HAdV infection exhibited increases in12 clinical indexes(P≤0.019)and decreases in four indexes(P≤0.007),compared with patients exhibiting nonsevere infection.No significant differences were found in age or sex distribution according to HAdV infection severity(P>0.05);however,the distributions of comorbid disease and HAdV co-infection differed according to HAdV infection severity(P<0.05).The main epidemic types were HAdV-3(47.0%,71/151)and HAdV-7(46.4%,70/151).However,the severe illness rate was significantly higher in patients with HAdV-7(51.4%)than in patients with HAdV-3(19.7%)and other types of HAdV(20%)(P<0.001).Sequencing analysis of genomes/capsid genes of 13 HAdV-7 isolates revealed high similarity to previous Chinese isolates.A representative HAdV-7isolate exhibited a similar proliferation curve to the curve described for the epidemic HAdV-3 strain Guangzhou01(accession no.DQ099432)(P>0.05);the HAdV-7 isolate exhibited stronger virulence and infectivity,compared with HAdV-3(P<0.001).Overall,comorbid disease,HAdV co-infection,and high virulence and infectivity of HAdV-7 were critical risk factors for severe HAdV infection;these data can facilitate treatment,control,and prevention of HAdV infection.