Objective To systematically analyze and compare the casualties’ medical evacuation (ME) in Wenchuan and Yushu earthquakes, so as to provide useful references for earthquake casualties’ ME in the future. Methods The data about casualties’ ME in Wenchuan and Yushu earthquakes were collected from the field research, work statement of the Ministry of Health, official websites, and literatures. And the descriptive analysis was then performed. Results From Wenchuan to Yushu, the principle of ME tended to be “early evacuation, all evacuation”; the evacuation level was gradually simplified, the casualties were evacuated directly from the disaster area to the rear hospital through highway and railway, or air evacuation became the major method of ME; triage became less prominent, while specialist treatment was strived as early as possible. Conclusion The early establishment of appropriate evacuation principles, building of a simplified evacuation system, ensuring adequate medical transport capacity, and scientific assessment of treatment capacity at all levels are the main issues of effective and safe ME after earthquakes that require to be solved urgently.
Objective To observe the effect of You Gui Yin and MSCs interventional therapy on the early stage of avascular necrosis of the femoral head (ANFH) and its role of improving revascularization and reossification. Methods Twenty-four adult Beagle dogs weighing (10.0 ± 0.5) kg were divided into 4 groups (n=6): group A (model group), group B (You Gui Yin group), group C (MSCs intervention group), group D(You Gui Yin and MSCs intervention group). The model of ANFH at early stage was establ ished by l iquid-nitrogen cryopreservation method, and MSCs were isolated, cultured and labeled by BrdU. Three weeks after model ing, groups C and D received 1 mL MSCs with artery perfusion [(0.5-1.0) × 106/mL)], groups B and D received intragastric administration of 100 mL You Gui Yin per day, groups A and C received intragastric administration of 100 mL distilled water. Gross observation on femoral head was conducted 4 and 8 weeks after continuous treatment. Meanwhile, DSA and MRI were adopted to observe the quantity and the diameter of femoralhead blood vessel, histology and immunohistochemistry staining were performed to observe the expression of VEGF and BrdU, and the expression of VEGF mRNA was detected by real-time fluorescence quantitative RT-PCR. Results At 4 and 8 weeks after treatment, the figuration of the femoral head in group A was flat and mushroom-shaped, while it was relatively normal in groups B, C and D. DSA observation: the number and the diameter of blood vessel in groups C and D were increased, and the obstructed blood vessel was open. At 4 and 8 weeks after treatment, significant differences between group C and group D were evident in the number and the diameter of blood vessel (P lt; 0.05); compared with before treatment, the diameter of blood vessel in two groups were significantly improved (P lt; 0.05) and the number of blood vessel in group D was significantly increased (P lt; 0.05). MRI observation: compared with group A, groups B, C and D were obviously improved, especially group D, T1W showed lower signal, T2W and STIR showed no abnormal changes of signal. Histopathology and immunohistochemistry staining: compared with group A, the structure of groups B, C and D were obviously improved, the positive expression of VEGF in group D was significantly higher than that of other groups (P lt; 0.05), the positive rate of BrdU, the number of positive osteoblast and the number of positive blood vessel in group D was obviously higher than that of group C (P lt; 0.05). Real-time fluorescence quantitative RT-PCR detection: the expression of VEGF mRNA in group D was significantly higher than that of other groups (P lt; 0.05), the expression of VEGF in groups B, C and D was higher than that of group A (P lt; 0.05). Conclusion The combination of You Gui Yin and MSCs interventional treatment has significant therapeutic effects on the early-stage ANFH, can improve the blood supply of the necrotic femoral head, promote repair and prevent collapse.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
Objective To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.