ObjectiveTo investigate the status quo of emergency resources in all township hospitals in a county of Aba Autonomous Region. MethodWe set up a uniform electronic version questionnaire between April 15th and 18th, 2015. The leaders of township hospitals filled in their information and uploaded the data including emergency medical services, human resources, medical device and technology application situation. Then, the data were statistically analyzed. ResultsFor these township hospitals, the service population was 2 206.05±846.95, the service radius was (25.5±14.3) km. The number of registered doctors per 1 000 people of resident population was 1.52, the number of registered nurses per 1 000 people of resident population was 0.47, and the number of hospital beds per 1 000 people of resident population was 1.69. The staff in all township hospitals included 74 doctors and 23 nurses. The constitution of positional titles and academic qualifications of doctors and nurses in these township hospitals was not significantly different (P>0.05). All township hospitals had a total of six ambulances, one of which was ambulance for rescue and monitoring, and the others were ordinary ambulances. The devices equipped in the ambulances and hospitals were not sufficient, and most doctors and nurses could only perform surrounding vein puncture, and debridement and suture surgery. They could not recue critically ill patients alone. ConclusionsFor these township hospitals, the service radius is too long, the number of doctors and nurses is too small, and the ability of service is insufficient. In order to meet the demand of emergency resources in ethnic areas as far as possible, we should increase investment and promote medical devices, increase the number of doctors and nurses, improve the personnel structure, and strengthen professional training.
Objective To compare the prognostic value of different types of simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute pulmonary embolism (APE), so as to select the best scoring system for clinical application. Methods We retrospectively collected the data of consecutive patients with APE in the Fourth People’s Hospital of Zigong City from January 1st, 2014 to January 1st, 2019. The endpoint was 1-month all-cause mortality. We tried to modify sPESI by replacing arterial oxyhaemoglobin saturation with arterial partial pressure of oxygen / fraction of inspired oxygen (new scoring system named psPESI), and modify sPESI by replacing arterial oxyhaemoglobin saturation with saturation of pulse oxygen / fraction of inspired oxygen (new scoring system named ssPESI), and analyzed the area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration and decision curve. Results A total of 280 patients (109 with low-risk APE, 155 with intermediate-risk APE, and 16 with high-risk APE) were enrolled in the study. Of these patients, 165 (58.93%) were male, and the 1-month all-cause mortality rate was 10.71% (30/280). The AUCs of sPESI, psPESI and ssPESI were 0.756, 0.822 and 0.807, respectively, and the AUC of ssPESI was higher than that of sPESI (P=0.038) but not lower than that of psPESI (P=0.388). Comparing ssPESI with sPESI, the NRI was 0.928 (P<0.001) and the IDI was 0.084 (P<0.001); comparing ssPESI with psPESI, the NRI was 0.041 (P=0.227) and the IDI was –0.028 (P=0.060). The psPESI (Hosmer-Lemeshow test χ2=12.591, P=0.182) and ssPESI (Hosmer-Lemeshow test χ2=4.204, P=0.897) were well-calibrated in the internal validation cohort and obtained more net benefits within wide threshold probabilities than sPESI. Conclusion Since the saturation of pulse oxygen is non-invasive and easy to obtain, and the predictive ability of ssPESI is similar to that of psPESI, it is recommended that ssPESI be used as a new scoring system to evaluate the prognosis of APE.
目的:通过分析2007年自贡市急救中心院前急救反应能力，探讨其影响制约因素及解决方法。方法：回顾性分析2007年1～12月份自贡市急救中心院前出诊的全部有效病例呼救时间、出车时间、到达现场时间及出诊距离，计算出车准备时间、车辆行驶速度、应急反应时间、急救半径。结果：全年院前出诊共3336例，出车准备时间（2.06±0.93） min，车辆平均行驶速度32.17 km/h，应急反应时间（12.51±10.87） min，急救半径（5.60±5.35） km。结论：我市急救中心目前取得一定成绩，需采取多种措施进一步提高急救反应能力。
Objective To investigate the expressions of insulin like growth factor binding protein -3 （ IGFBP-3 ） in serum and bronchoalveolar lavagae fluids （ BALF ） of patients with non-small cell lung cancer ， and explore the clinical significance in dignosis and prognosis of lung cancer.Methods The bronchoalveolar lavagae fluids （ BALF ） were collected by bronchoscopy in 80 cases with non-small cell lung cancer and 14 healthy subjects.The expression of IGFBP-3 in serum and BALF were detected by immunoradioassay.Results The expression of IGFBP-3 in serum and BALF of lung cancer group were significantly lower than that of health group（Plt;0.05）.IGFBP-3 levels were significantly lower in those patients with lymphoid node metastasis or metastasis or TNMⅢ-TNMⅣ than those without metastasis or TNMⅠ-TNMⅡ（Plt;0.05）.In lung cancer group，the levels of the IGFBP-3 in serum and BALF had a significantly positive correlation（r=0.415，r=0.355，Plt;0.01）.Conclusion The IGFBP-3 may play an important role in the development of non-small cell lung cancer and is valuable in dignosis and prognosis of lung cancer.
【摘要】 目的 分析地市级急救中心院前急救中损伤患者临床特点，科学地指导院前急救诊断处置及急诊外科资源配置。 方法 回顾性分析2009年1-12月份自贡市急救中心出诊的全部有效病例中损伤患者出诊资料，分析其疾病谱、季节、月份、时刻分布特点。 结果 全年院前急救损伤患者共1 922例，排名前5位的分别为:头部损伤，涉及身体多个部位的损伤，膝和小腿损伤，腹部、背、腰椎和骨盆损伤，髋和大腿损伤，所有分类构成比男性均多于女性；损伤季节分布以冬季较多（Plt;0.05）；分布以1、11、12月份为多；时刻分布以凌晨0:00~6:00为出诊最少时段。 结论 国际疾病分类（ICD-10）为规范院前急救疾病谱提供参考，根据损伤类疾病谱可确定急诊外科工作及发展重心，依据季节、月份及时刻分布特点能指导急救资源合理配置。【Abstract】 Objective To provide scientific guidance of assistances for patients sustaining injuries and of effective resource allocation of emergency surgery by analyzing the pre-hospital features of injuries in urgent rescue centers at the local or city level. Methods All cases of injuries in pre-hospital emergency care during the year of 2009 were studied. The spectrum of diseases, and the seasons, the months, and the time points of the diseases were analyzed. Results There were totally 1 922 patients of pre-hospital emergency care in the whole year. Based on the International Classification of Diseases 10th Revision (ICD-10), top five classifications were injuries to the head, injuries involving multiple body regions, injuries to the knee and lower leg, injuries to the abdomen, lower back, lumbar spine and pelvis, and injuries to the hip and thigh. For all kinds of injuries, the number of male patients was more than that of the female. The cases in winter were more than those in other seasons (Plt;0.05). The cases in January, November and December were more than those in other months. The cases between 0:00 am and 6:00 am were less than those at other time points. Conclusion ICD-10 could provide reference for standardizing the spectrum of diseases in pre-hospital care. The focus of emergency surgery may be guided by the spectrum of injuries. The features of the season, the month, and time point of diseases can offer practical help for resource allocation in pre-hospital care.
【摘要】 目的 研究自贡市急救中心院前急救流行病学特征。 方法 回顾性分析2009年度自贡市急救中心出诊的院前急救数据，研究院前急救疾病谱及性别、年龄构成，并分析时刻及季节分布特点，描述院前急救转归。 结果 2009年度自贡市急救中心院前急救共4 588例，排前6位疾病依次为损伤、中毒和外因的某些其他后果（45.6%），循环系统疾病（15.0%），呼吸系统疾病（6.3%），神经系统疾病（6.0%），精神和行为障碍（5.6%），消化系统疾病（4.9%）；性别构成男性多于女性（Plt;0.05）；年龄构成以中老年较多，青少年儿童较少（Plt;0.05）；时刻分布规律高峰点为15点40分（Plt;0.05），季节分布以冬季较多（Plt;0.05）；患者转归以住院、留院观察为主，院前死亡人数占比例为3.8%。 结论 根据院前急救流行病学规律，可以合理配置急诊资源，增强应急救援能力，满足民众不断增加的医疗需求。【Abstract】 Objective To research on the epidemiological characteristics of the prehospital cases in Zigong emergency rescue center. Methods We retrospectively analyzed the database of prehospital cases in Zigong emergency rescue center in 2009, and reviewed the prehospital disease spectrum, gender composition, age structure, the circadian and seasonal distribution, and the outcomes of these cases. Results A total of 4 588 prehospital victims in Zigong emergency rescue center were enrolled. In the study, six leading diseases were injury, poisoning and certain other consequences due to external causes (45.6%), diseases of the circulatory system (15.0%), diseases of the respiratory system (6.3%), diseases of the nervous system (6.0%), mental and behavioral disorders (5.6%), and diseases of the digestive system (4.9%). Male patients were more than female patients (Plt;0.05). The proportion of the aged and the middle-aged was significantly larger than that of young population in the same districts (Plt;0.05), and the occurrence of prehospital care usually peaked at 15:40 (Plt;0.05). Prehospital care had a higher incidence in winter (Plt;0.05), and the outcome of prehospital cases was mainly in hospital and in observation ward. The proportion of deaths was 3.8%. Conclusion We can allocate emergency resources reasonably in prehospital care, and promote the ability of rescuing in order to meet people′s medical demands on the basis of the epidemiological study in our city.
The body of patient undergoing cardiopulmonary resuscitation after cardiac arrest experiences a process of ischemia, hypoxia, and reperfusion injury. This state of intense stress response is accompanied with hemodynamic instability, systemic hypoperfusion, and subsequent multiple organ dysfunction, and is life-threatening. Pulmonary vascular endothelial injury after cardiopulmonary resuscitation is a pathological manifestation of lung injury in multiple organ injury. Possible mechanisms include inflammatory response, neutrophil infiltration, microcirculatory disorder, tissue oxygen uptake and utilization disorder, etc. Neutrophils can directly damage or indirectly damage lung vascular endothelial cells through activation and migration activities. They also activate the body to produce large amounts of oxygen free radicals and release a series of damaging cytokines that further impaire the lung tissue.
ObjectiveTo establish a predictive model of surgical site infection (SSI) following colorectal surgery using machine learning.MethodsMachine learning algorithm was used to analyze and model with the colorectal data set from Duke Infection Control Outreach Network Surveillance Network. The whole data set was divided into two parts, with 80% as the training data set and 20% as the testing data set. In order to improve the training effect, the whole data set was divided into two parts again, with 90% as the training data set and 10% as the testing data set. The predictive result of the model was compared with the actual infected cases, and the sensitivity, specificity, positive predictive value, and negative predictive value of the model were calculated, the area under receiver operating characteristic (ROC) curve was used to evaluate the predictive capacity of the model, odds ratio (OR) was calculated to tested the validity of evaluation with a significance level of 0.05.ResultsThere were 7 285 patients in the whole data set registered from January 15th, 2015 to June 16th, 2016, among whom 234 were SSI cases, with an incidence of SSI of 3.21%. The predictive model was established by random forest algorithm, which was trained by 90% of the whole data set and tested by 10% of that. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 76.9%, 59.2%, 3.3%, and 99.3%, respectively, and the area under ROC curve was 0.767 [OR=4.84, 95% confidence interval (1.32, 17.74), P=0.02].ConclusionThe predictive model of SSI following colorectal surgery established by random forest algorithm has the potential to realize semi-automatic monitoring of SSIs, but more data training should be needed to improve the predictive capacity of the model before clinical application.
Objective To explore the effectiveness of fixation of atlas translaminar screws in the treatment of atlatoaxial instability. Methods A retrospective analysis was made on the clinical data of 32 patients with atlatoaxial instability treated with atlantoaxial trans-pedicle screws between March 2007 and August 2009. Of them, 7 patients underwent atlas translaminar screws combined with axis transpedicle screws fixation because of fracture types, anatomic variation, and intraoperative reason, including 5 males and 2 females with an average age of 48.2 years (range, 35-69 years). A total of 9 translaminar screws were inserted. Injury was caused by traffic accident in 4 cases, falling from height in 2 cases, and crushing in 1 case. Two cases had simple odontoid fracture (Anderson type II), and 5 cases had odontoid fracture combined with other injuries (massa lateralis atlantis fracture in 2, atlantoaxial dislocation in 1, and Hangman fracture in 2). The interval between injury and operation was 4-9 days (mean, 6 days). The preoperative Japanese Orthopaedic Association (JOA) score was 8.29 ± 1.60. Results The X-ray films showed good position of the screws. Healing of incision by first intention was obtained, and no patient had injuries of the spinal cord injury, nerve root, and vertebral artery. Seven cases were followed up 9-26 months (mean, 14 months). Good bone fusion was observed at 8 months on average (range, 6-11 months). No loosening, displacement, and breakage of internal fixation, re-dislocation and instability of atlantoaxial joint, or penetrating of pedicle screw into the spinal canal and the spinal cord occurred. The JOA score was significantly improved to 15.29 ± 1.38 at 6 months after operation (t=32.078, P=0.000). Conclusion Atlas translaminar screws fixation has the advantages of firm fixation, simple operating techniques, and relative safety, so it may be a remedial measure of atlatoaxial instability．