To the Editor： As we have known, Emergency Medicine is an interdisciplinary subject and has many hot spots for research. However, many researchers often worry that their research is too narrowed or not so cutting edg...To the Editor： As we have known, Emergency Medicine is an interdisciplinary subject and has many hot spots for research. However, many researchers often worry that their research is too narrowed or not so cutting edge as to be accepted by journals with high impact thctor （IFs）. Why？ One reason perhaps lies in the fact that many of them have difficulty in following the fronts and hot spots in internal Emergency Medicine research.展开更多
Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising fro...Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.展开更多
Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide re...Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.展开更多
Background Some studies found that cholinesterase （ChE） can be an independent risk factor for patients with multiple organ dysfunction syndrome. To assess aged patients with systemic inflammatory response syndrome ...Background Some studies found that cholinesterase （ChE） can be an independent risk factor for patients with multiple organ dysfunction syndrome. To assess aged patients with systemic inflammatory response syndrome （SIRS） early and predict their prognosis, the predictive value of ChE for the prognosis of aged patients with SIRS was analyzed. Methods From September 2009 to September 2010, all aged patients with SIRS in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed if they met inclusion criteria： patients aged 〉65 years and met American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria for SIRS. Serum ChE, albumin, D-dimer, lactic acid and C-reactive protein （CRP） were measured, and the Acute Physiology and Chronic Health Evaluation （APACHE） II and Glasgow Coma Scale （GCS） scores were evaluated within the first 24 hours in the ICU. Fisher＇s exact test was used for comparison of the primary disease between the deceased group and surviving group. For comparison of study variables between the two groups, the Student＇s t test or Mann-Whitney U test was used. Multivariate significance was tested with binary Logistic regression analysis. Results The clinical data of 124 aged patients with SIRS were collected and analyzed. Sixty-six patients （46 male, 20 female, mean age （78.70±8.08） years） who died were included in the deceased group and 58 patients （34 male, 24 female, mean age （76.02±6.57） years） who survived were included in the surviving group. There were no significant differences in age, gender, APACHE II score and GCS score between the deceased group and surviving group （all P 〉0.05）, but there were significant differences in lactic acid （P=0.011）, D-dimer （P=0.011）, albumin （P=0.007）, CRP （P=0.008）, and ChE （P 〈0.0001）. The correlation analysis showed that the APACHE II score and CRP were not correlated with ChE （both P 〈0.05）. D-dimer and albumin were correlated with ChE （Spearman＇s rho correlation coefficients were -0.206 and 0.324, the corresponding P values were 0.022 and 〈0.0001）. Multiple Logistic regression analysis showed that age, gender, lactic acid, D-dimer, albumin, CRP, APACHE II score, and GCS score were not independent risk factors for prognosis of aged patients with SIRS, but that ChE was （P 〈0.0001）. The receiver operating characteristic curve of ChE had an area under the curve of 0.797 （standard error=0.04; P 〈0.0001）, and a ChE of 103.00 U/L was the cut-off value with sensitivity=0.793, specificity=0.742. Conclusion Serum ChE might be a predictive marker for the prognosis of aged patients with SIRS, with low serum ChE levels indicating poor prognosis.展开更多
Background Improvement of clinical symptoms following hyperbaric oxygen （HBO） treatment of neuropsychiatric disorders arising from traumatic brain injury was proved by our previous study. This study was aim to obtai...Background Improvement of clinical symptoms following hyperbaric oxygen （HBO） treatment of neuropsychiatric disorders arising from traumatic brain injury was proved by our previous study. This study was aim to obtain the evidence of other changes. Methods Three hundred and ten patients with neuropsychiatric disorders arising from traumatic brain injury were treated twice with hyperbaric oxygen. Cerebral single photon emissions computed tomography （SPECT） images and computed tomography scans （CT） before and after hyperbaric oxygen treatment, were compared. Results Before treatment, the proportion of abnormal cerebral changes detected by SPECT was 81.3% but only 15.2% by CT. After HBO treatment, 70.3% of SPECT scans showed no abnormalities and these patients were clinically improved. Treatment improved regional cerebral blood flow. Conclusion SPECT was much more sensitive than CT in the diagnosis of neuropsychiatric disorders following hyperbaric oxygen treatment of neuropsychiatric disorders arising from traumatic brain injury.展开更多
To the Editor: Out-of-hospital cardiac arrest (OHCA) is a major public health challenge. Early initiation, good quality cardiopulmonary resuscitation (CPR), and the use of an automated external defibrillator (AED) hav...To the Editor: Out-of-hospital cardiac arrest (OHCA) is a major public health challenge. Early initiation, good quality cardiopulmonary resuscitation (CPR), and the use of an automated external defibrillator (AED) have been reported to significantly improve the survival and long-term outcomes in survivors of OHCA.展开更多
Emergency department （ED） overcrowding is a worldwide problem which is common in daily practiceand after disasters.During dally practice, it is more so in large hospitals. ED overcrowding may cause a series of adver...Emergency department （ED） overcrowding is a worldwide problem which is common in daily practiceand after disasters.During dally practice, it is more so in large hospitals. ED overcrowding may cause a series of adverse outcomes such as prolonged waiting time for treatment, an increase in ambulance diversion and a reduction in working efficiency.4 Therefore, it is urgently necessary to clearly define ED overcrowding and search for effective ways to solve the problem.展开更多
Background Plasma galectin-3, a mediator of fibrogenesis and inflammation, its potential to associate with type 2 diabetes （T2DM） is poorly investigated. Here, we explored its interaction with the serum galectin-3 a...Background Plasma galectin-3, a mediator of fibrogenesis and inflammation, its potential to associate with type 2 diabetes （T2DM） is poorly investigated. Here, we explored its interaction with the serum galectin-3 and vascular complications. Methods We conducted a population-based cross-sectional survey in Zhejiang, China involving 165 men and 119 women （age range, 43-84 years）, investigating the relationship between serum galectin-3 and vascular disease in patients with T2DM. Results Serum galectin-3 was higher in subjects with T2DM than that in control participants （27.4 vs. 17.6 ng/ml, P 〈0.001）. Compared with subjects with galectin-3 values in the lowest quartile, those with values in the highest quartile had an increased likelihood of vascular complications （4th quartile odds ratio （OR） 2.52, 95% confidence interval （CI）, 1.25- 4.07）. Increased risk of micro- or macrovascular complications corrrelated with serum galectin-3 concentration （ORs 11.4 and 8.5, respectively）. An increased number of vascular complications was associated with high serum galectin-3 levels （P 〈0.05）. Patients with serum galectin-3 levels 〉25 ng/ml had an elevated risk of diabetes relative to patients with levels 〈10 ng/ml （OR for any vascular complication 2.64, for heart failure 3.97, for nephropathy 4.09, for peripheral arterial disease （PAD） 4.18; all P 〈0.05）. Complication risk was higher in patients with neurogenic, stroke, or retinopathy complications, but this difference was not significant after risk factor adjustment. Serum galectin-3 levels correlated with diabetes duration, C-reactive protein （CRP） levels, and albuminuria. Conclusion High galectin-3 values were associated with increased odds of developing heart failure, nephropathy, and peripheral arterial disease in patients with T2DM.展开更多
Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and paralle...Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.展开更多
To the Editor:Out-of-hospital cardiac arrest(OHCA)is a serious threat to people's lives and safety.The annual incidence of OHCA in North America is approximately 55/100,000,and it is approximately 59/100,000 in As...To the Editor:Out-of-hospital cardiac arrest(OHCA)is a serious threat to people's lives and safety.The annual incidence of OHCA in North America is approximately 55/100,000,and it is approximately 59/100,000 in Asia.[1,2]How can the success rate of resuscitation be improved in patients with cardiac arrest?The American Heart Association(AHA)and the European Resuscitation Council have put forward their own cardiopulmonary resuscitation(CPR)guidelines,which are constantly updated with the latest research evidence.CPR training is also an important part of the guidelines.[3,4]Chinese colleagues also try to improve the success rate of rescuing patients with cardiac arrest based on the experience of their international counterparts and combine it with Chinese characteristics.CPR training is in full swing,which includes the training of first responders and medical staff.展开更多
文摘To the Editor： As we have known, Emergency Medicine is an interdisciplinary subject and has many hot spots for research. However, many researchers often worry that their research is too narrowed or not so cutting edge as to be accepted by journals with high impact thctor （IFs）. Why？ One reason perhaps lies in the fact that many of them have difficulty in following the fronts and hot spots in internal Emergency Medicine research.
文摘Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.
文摘Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
文摘Background Some studies found that cholinesterase （ChE） can be an independent risk factor for patients with multiple organ dysfunction syndrome. To assess aged patients with systemic inflammatory response syndrome （SIRS） early and predict their prognosis, the predictive value of ChE for the prognosis of aged patients with SIRS was analyzed. Methods From September 2009 to September 2010, all aged patients with SIRS in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed if they met inclusion criteria： patients aged 〉65 years and met American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria for SIRS. Serum ChE, albumin, D-dimer, lactic acid and C-reactive protein （CRP） were measured, and the Acute Physiology and Chronic Health Evaluation （APACHE） II and Glasgow Coma Scale （GCS） scores were evaluated within the first 24 hours in the ICU. Fisher＇s exact test was used for comparison of the primary disease between the deceased group and surviving group. For comparison of study variables between the two groups, the Student＇s t test or Mann-Whitney U test was used. Multivariate significance was tested with binary Logistic regression analysis. Results The clinical data of 124 aged patients with SIRS were collected and analyzed. Sixty-six patients （46 male, 20 female, mean age （78.70±8.08） years） who died were included in the deceased group and 58 patients （34 male, 24 female, mean age （76.02±6.57） years） who survived were included in the surviving group. There were no significant differences in age, gender, APACHE II score and GCS score between the deceased group and surviving group （all P 〉0.05）, but there were significant differences in lactic acid （P=0.011）, D-dimer （P=0.011）, albumin （P=0.007）, CRP （P=0.008）, and ChE （P 〈0.0001）. The correlation analysis showed that the APACHE II score and CRP were not correlated with ChE （both P 〈0.05）. D-dimer and albumin were correlated with ChE （Spearman＇s rho correlation coefficients were -0.206 and 0.324, the corresponding P values were 0.022 and 〈0.0001）. Multiple Logistic regression analysis showed that age, gender, lactic acid, D-dimer, albumin, CRP, APACHE II score, and GCS score were not independent risk factors for prognosis of aged patients with SIRS, but that ChE was （P 〈0.0001）. The receiver operating characteristic curve of ChE had an area under the curve of 0.797 （standard error=0.04; P 〈0.0001）, and a ChE of 103.00 U/L was the cut-off value with sensitivity=0.793, specificity=0.742. Conclusion Serum ChE might be a predictive marker for the prognosis of aged patients with SIRS, with low serum ChE levels indicating poor prognosis.
文摘Background Improvement of clinical symptoms following hyperbaric oxygen （HBO） treatment of neuropsychiatric disorders arising from traumatic brain injury was proved by our previous study. This study was aim to obtain the evidence of other changes. Methods Three hundred and ten patients with neuropsychiatric disorders arising from traumatic brain injury were treated twice with hyperbaric oxygen. Cerebral single photon emissions computed tomography （SPECT） images and computed tomography scans （CT） before and after hyperbaric oxygen treatment, were compared. Results Before treatment, the proportion of abnormal cerebral changes detected by SPECT was 81.3% but only 15.2% by CT. After HBO treatment, 70.3% of SPECT scans showed no abnormalities and these patients were clinically improved. Treatment improved regional cerebral blood flow. Conclusion SPECT was much more sensitive than CT in the diagnosis of neuropsychiatric disorders following hyperbaric oxygen treatment of neuropsychiatric disorders arising from traumatic brain injury.
基金National Natural Science Foundation of China(No.81871455)the Beijing Municipal Science and Technology Project(No.Z191100004419003)。
文摘To the Editor: Out-of-hospital cardiac arrest (OHCA) is a major public health challenge. Early initiation, good quality cardiopulmonary resuscitation (CPR), and the use of an automated external defibrillator (AED) have been reported to significantly improve the survival and long-term outcomes in survivors of OHCA.
文摘Emergency department （ED） overcrowding is a worldwide problem which is common in daily practiceand after disasters.During dally practice, it is more so in large hospitals. ED overcrowding may cause a series of adverse outcomes such as prolonged waiting time for treatment, an increase in ambulance diversion and a reduction in working efficiency.4 Therefore, it is urgently necessary to clearly define ED overcrowding and search for effective ways to solve the problem.
文摘Background Plasma galectin-3, a mediator of fibrogenesis and inflammation, its potential to associate with type 2 diabetes （T2DM） is poorly investigated. Here, we explored its interaction with the serum galectin-3 and vascular complications. Methods We conducted a population-based cross-sectional survey in Zhejiang, China involving 165 men and 119 women （age range, 43-84 years）, investigating the relationship between serum galectin-3 and vascular disease in patients with T2DM. Results Serum galectin-3 was higher in subjects with T2DM than that in control participants （27.4 vs. 17.6 ng/ml, P 〈0.001）. Compared with subjects with galectin-3 values in the lowest quartile, those with values in the highest quartile had an increased likelihood of vascular complications （4th quartile odds ratio （OR） 2.52, 95% confidence interval （CI）, 1.25- 4.07）. Increased risk of micro- or macrovascular complications corrrelated with serum galectin-3 concentration （ORs 11.4 and 8.5, respectively）. An increased number of vascular complications was associated with high serum galectin-3 levels （P 〈0.05）. Patients with serum galectin-3 levels 〉25 ng/ml had an elevated risk of diabetes relative to patients with levels 〈10 ng/ml （OR for any vascular complication 2.64, for heart failure 3.97, for nephropathy 4.09, for peripheral arterial disease （PAD） 4.18; all P 〈0.05）. Complication risk was higher in patients with neurogenic, stroke, or retinopathy complications, but this difference was not significant after risk factor adjustment. Serum galectin-3 levels correlated with diabetes duration, C-reactive protein （CRP） levels, and albuminuria. Conclusion High galectin-3 values were associated with increased odds of developing heart failure, nephropathy, and peripheral arterial disease in patients with T2DM.
文摘Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.
基金National Natural Science Foundation of China(No.81871455)。
文摘To the Editor:Out-of-hospital cardiac arrest(OHCA)is a serious threat to people's lives and safety.The annual incidence of OHCA in North America is approximately 55/100,000,and it is approximately 59/100,000 in Asia.[1,2]How can the success rate of resuscitation be improved in patients with cardiac arrest?The American Heart Association(AHA)and the European Resuscitation Council have put forward their own cardiopulmonary resuscitation(CPR)guidelines,which are constantly updated with the latest research evidence.CPR training is also an important part of the guidelines.[3,4]Chinese colleagues also try to improve the success rate of rescuing patients with cardiac arrest based on the experience of their international counterparts and combine it with Chinese characteristics.CPR training is in full swing,which includes the training of first responders and medical staff.
