Objective To assess the impact of a regional rapid response system (RRS) implemented in a Chinese Joint Commission International Hospital on the timely treatment of patients with serious adverse events (SAEs). Methods Clinical SAEs, activation periods, reasons for RSS activation, and patient outcomes were assessed using SAE response sheets at admission to the hospital and over 31 months of follow-up. Results We found that 192 events were called by medical staff and 6 were called by auxiliary staff. Reasons for the 385 RRS activations included: unconsciousness (133; 34.5%), and airway obstruction and absent carotid pulse (49 each; 12.7%). The average arrival time of the medical emergency team was 2.4 ± 0.1 minutes. There were 123 (62.1%) RRS activations during daytime working hours (8:00–17:00); CPR was performed in 86 (43.4%) cases. Outcomes of RRS were: vital signs stabilized in 82 (41.4%) patients and 61 (30.8%) patients were transferred to ICU. Conclusion Our experience showed that the regional RRS has led to better integrated multidisciplinary cooperation and reduced time for treating patients with SAEs, resulting in success of the RRS.
In the 2020 World Health Organization classification of female genital tumours, endocervical adenocarcinomas (ECAs) are subclassified into human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) groups on the basis of their distinct aetiologies and clinical behaviours. The aim of this study was to investigate programmed death-ligand 1 (PD-L1) expression and its prognostic value in HPVI ECA and HPVA ECA, and compare these between the two entities.A total of 93 ECAs accessioned between 2013 and 2020 were selected for further analysis, including 48 usual-type HPVA ECAs and 45 HPVI ECAs. Then, we evaluated PD-L1 expression in whole tissue sections of these cases by using the tumour proportion score (TPS) and the combined positive score (CPS). Heterogeneous PD-L1 expression was observed in both HPVI ECAs and usual-type HPVA ECAs. However, no significant difference in PD-L1 expression was seen among different histological types of ECA when either the CPS or the TPS was used. Gastric-type ECA (GEA) was associated with higher clinical stage (P = 0.001), worse progression-free survival (PFS) (P = 0.008) and worse overall survival (OS) (P = 0.02) than usual-type HPVA ECA and non-GEA HPVI ECA. When the TPS was used, PD-L1-positive GEA was associated with significantly worse PFS (P = 0.03) and OS (P = 0.015) than PD-L1-negative GEA.Our data show frequent PD-L1 expression in HPVI ECAs, supporting the potential role of the programmed cell death protein 1/PD-L1 pathway as a therapeutic target for these tumours. Our data also support PD-L1 as a negative prognostic marker associated with a potentially unfavourable outcome for GEAs.
Hemodialysis (HD) is an incomplete renal substitutive therapy to interchange blood and dialyzate between semipermeable membrane so as to clean metabolic wastes and toxic products, maintain electrolyte and acid-base balance, and eliminate excessive moisture from body. Because of double affliction of the pain itself and treatment induced complication, most of Maintenance Hemodialysis (MHD) patients are bothered by influenced sleep quality and other symptom distress. In the study, we set out to investigate the intervention effect of herb foot-bath therapy to improve sleep quality and symptom distress for them. It was an experimental study in two stages including preliminary screening survey and herb foot-bath intervention. 142 MHD patients from Xiangya Hospital of Central South University and the Third Hospital of Central South University in accordance with inclusive criteria were randomly divided into control and intervention group. Patients in intervention group were intervened by regular herb foot-bath for 4 w. Pittsburgh Sleep Quality Index (PSQI) and Dialysis Symptom Index (DSI) were applied to quantify sleep quality and symptom distress of MHD patients. The data were analysis by SPSS19.0. The results showed that a majority of MHD patients were undergoing somnipathy and most of them experienced several symptoms at the same time with high scores of PSQI and DSI. Sleep quality was positively correlated with the symptom burden. To some extent, it was found that herb foot-bath therapy can effectively improve sleep quality of MHD patients and mitigate their symptom distress.
Older adults have been reported to be a population with high-risk of death in the COVID-19 outbreak. Rapid detection of high-risk patients is crucial to reduce mortality in this population. The aim of this study was to evaluate the prognositc accuracy of the Modified Early Warning Score (MEWS) for in-hospital mortality in older adults with COVID-19.A retrospective cohort study was conducted in Wuhan Hankou Hospital in China from 1 January 2020 to 29 February 2020. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of MEWS, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Function Assessment (SOFA), quick Sequential Organ Function Assessment (qSOFA), Pneumonia Severity Index (PSI), Combination of Confusion, Urea, Respiratory Rate, Blood Pressure, and Age ≥65 (CURB-65), and the Systemic Inflammatory Response Syndrome Criteria (SIRS) for in-hospital mortality. Logistic regression models were performed to detect the high-risk older adults with COVID-19.Among the 235 patients included in this study, 37 (15.74%) died and 131 (55.74%) were male, with an average age of 70.61 years (SD 8.02). ROC analysis suggested that the capacity of MEWS in predicting in-hospital mortality was as good as the APACHE II, SOFA, PSI and qSOFA (Difference in AUROC: MEWS vs. APACHE II, -0.025 (95% CI [-0.075 to 0.026]); MEWS vs. SOFA, -0.013 (95% CI [-0.049 to 0.024]); MEWS vs. PSI, -0.015 (95% CI [-0.065 to 0.035]); MEWS vs. qSOFA, 0.024 (95% CI [-0.029 to 0.076]), all P > 0.05), but was significantly higher than SIRS and CURB-65 (Difference in AUROC: MEWS vs. SIRS, 0.218 (95% CI [0.156-0.279]); MEWS vs. CURB-65, 0.064 (95% CI [0.002-0.125]), all P < 0.05). Logistic regression models implied that the male patients (≥75 years) had higher risk of death than the other older adults (estimated coefficients: 1.16, P = 0.044). Our analysis further suggests that the cut-off points of the MEWS score for the male patients (≥75 years) subpopulation and the other elderly patients should be 2.5 and 3.5, respectively.MEWS is an efficient tool for rapid assessment of elderly COVID-19 patients. MEWS has promising performance in predicting in-hospital mortality and identifying the high-risk group in elderly patients with COVID-19.
Abstract Background: To study the pharmacodynamic effect of Jintiange capsules (JTG) on collagenase-induced osteoarthritis (OA) in rats; Based on the chondrocytes model, to explore the mechanism of treating OA with JTG-containing serum. Methods: 1. 60 Sprague-dawley (SD) rats were used to establish OA model by type II collagenase. Knee joint diameter, lower limb load and pain threshold were measured. Then ELISA detection, micro-CT scanning and crocus solid green staining were performed. 2. Chondrocytes were extracted from SD rats. The effect of JTG on the migration of chondrocytes induced by il-1β was evaluated by Scratch Test. Chondrocytes were divided into control group, model group and JTG Group. RNA sequencing, nucleic acid sequence analysis, KEGG pathway enrichment analysis and qRT-PCR were performed after administration. Results: 1. Micro CT and safranine fast green staining showed that the number of bone trabeculae in JTG group increased significantly, arranged neatly. 2. The containing serum of JTG significantly increased the scratch healing rate of chondrocytes. GO and KEGG showed that the above differential genes were mainly enriched in immune system processes and TNF signaling pathways. RT-qPCRresults indicated that the TNF pathway and immune system regulation related genes were key pathways and genes in the treatment of OA. Conclusion: JTG effectively blocks the progression of articular cartilage through the TNF pathway and genes involved in immune system regulation.
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