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.
【摘要】 目的 分析地市級急救中心院前急救中損傷患者臨床特點，科學地指導院前急救診斷處置及急診外科資源配置。 方法 回顧性分析2009年1-12月份自貢市急救中心出診的全部有效病例中損傷患者出診資料，分析其疾病譜、季節、月份、時刻分布特點。 結果 全年院前急救損傷患者共1 922例，排名前5位的分別為:頭部損傷，涉及身體多個部位的損傷，膝和小腿損傷，腹部、背、腰椎和骨盆損傷，髖和大腿損傷，所有分類構成比男性均多于女性；損傷季節分布以冬季較多（Plt;0.05）；分布以1、11、12月份為多；時刻分布以凌晨0:00~6:00為出診最少時段。 結論 國際疾病分類（ICD-10）為規范院前急救疾病譜提供參考，根據損傷類疾病譜可確定急診外科工作及發展重心，依據季節、月份及時刻分布特點能指導急救資源合理配置。【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.
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.
目的:通過分析2007年自貢市急救中心院前急救反應能力，探討其影響制約因素及解決方法。方法：回顧性分析2007年1～12月份自貢市急救中心院前出診的全部有效病例呼救時間、出車時間、到達現場時間及出診距離，計算出車準備時間、車輛行駛速度、應急反應時間、急救半徑。結果：全年院前出診共3336例，出車準備時間（2.06±0.93） min，車輛平均行駛速度32.17 km/h，應急反應時間（12.51±10.87） min，急救半徑（5.60±5.35） km。結論：我市急救中心目前取得一定成績，需采取多種措施進一步提高急救反應能力。
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.
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 研究自貢市急救中心院前急救流行病學特征。 方法 回顧性分析2009年度自貢市急救中心出診的院前急救數據，研究院前急救疾病譜及性別、年齡構成，并分析時刻及季節分布特點，描述院前急救轉歸。 結果 2009年度自貢市急救中心院前急救共4 588例，排前6位疾病依次為損傷、中毒和外因的某些其他后果（45.6%），循環系統疾病（15.0%），呼吸系統疾病（6.3%），神經系統疾病（6.0%），精神和行為障礙（5.6%），消化系統疾病（4.9%）；性別構成男性多于女性（Plt;0.05）；年齡構成以中老年較多，青少年兒童較少（Plt;0.05）；時刻分布規律高峰點為15點40分（Plt;0.05），季節分布以冬季較多（Plt;0.05）；患者轉歸以住院、留院觀察為主，院前死亡人數占比例為3.8%。 結論 根據院前急救流行病學規律，可以合理配置急診資源，增強應急救援能力，滿足民眾不斷增加的醫療需求。【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.
Objective To identify independent risk factors for in-hospital all-cause mortality in patients with sepsis and to integrate them into the quick Sequential Organ Failure Assessment (qSOFA) score to construct modified models, thereby improving the ability of the original qSOFA to predict mortality risk. Methods This retrospective study included adult patients who met the Sepsis-3 criteria for sepsis and were admitted to the Intensive Care Unit or Emergency Intensive Care Unit of Zigong Fourth People’ s Hospital between January 2018 and December 2023. Demographic characteristics, vital signs, comorbidities, and laboratory parameters were collected, and the Sequential Organ Failure Assessment (SOFA) and qSOFA scores were calculated. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality. Independent predictors were dichotomized according to cut-off values derived from receiver operating characteristic (ROC) curves and combined with qSOFA to construct new models. The ROC analysis with bootstrap validation was used to assess predictive performance, and comparative performance was further evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results A total of 218 patients were included. Multivariable logistic regression analysis identified blood urea nitrogen (BUN) [odds ratio (OR)=1.100, 95% confidence interval (CI) (1.040, 1.170)] and qSOFA [OR=2.610, 95%CI (1.450, 4.920)] as independent risk factors for in-hospital mortality, whereas high-density lipoprotein cholesterol (HDL-C) was an independent protective factor [OR=0.250, 95%CI (0.065, 0.841)]. After dichotomization by ROC-derived cut-off values, BUN and HDL-C were incorporated into qSOFA to generate B-qSOFA, H-qSOFA, and BH-qSOFA. Bootstrap ROC analysis showed that BH-qSOFA exhibited the highest discriminatory ability compared with all combined models as well as the conventional SOFA and qSOFA scores [area under the curve=0.803, 95%CI (0.735, 0.863)]. NRI and IDI analyses demonstrated that BH-qSOFA provided incremental prognostic improvement over qSOFA (NRI=0.969, IDI=0.165), B-qSOFA (NRI=0.644, IDI=0.054), and H-qSOFA (NRI=0.804, IDI=0.091) (all P<0.05). Conclusions Elevated BUN and qSOFA and decreased HDL-C are independent predictors of in-hospital mortality in sepsis. The BH-qSOFA model is simple and clinically practical, exhibits superior predictive performance over the original qSOFA. It may serve as a useful early instrument for prognostic risk stratification in patients with sepsis.