Immunological studies of grain dust

Epidemiological investigations of grain workers have suggested the presence of biological hazards in terminal grain elevators. Immunological assessments of the involved individuals, however, have produced inconclusive results. We have recently demonstrated in vitro a potential biological mechanism which could occur in vivo upon inhaling airborne graon dust, thereby constituting a potential inflammatory insult to the respiratory tracts of grain workers. Airborne dusts of similar size distributions generated by transporting grain in terminal grain elevators have been shown to activate the alternative pathway of complement in precipitin-negative pooled normal human serum. These dusts consumed hemolytic complement in a dose-response manner as quantified by both CH100 immunodiffusion and CH50 tube methods. The proactivator of C3 was converted to the activator form in the presence of the chelator EGTA, but conversion was prevented by EDTA. Likewise, serum from guinea pigs genetically deficient in C4, thereby lacking a functional classical complement pathway, showed complement consumption by grain dusts via the alternative pathway. Relative CH50 toxicity ranking of the various dusts was found to be unrelated to the amount of endotoxin present. Of interest, aged settled dust (20-30 years) remained relatively active against the alternative complement pathway as did 15 min aqueous extracts of ground whole rye.     

群体创伤患者急救中实施全程护理的效果观察

目的探讨群体性创伤院内急救护理模式，提高群体创伤院内抢救成功率，提高患者的满意度。方法按就诊时间的顺序将患者分为两组，2006年12月-2007年7月的群体伤患者采用分工护理法，2007年8月-2008年3月的群体创伤患者采用全程护理法。即分别为分工护理组及全程护理组，分工护理组61例采用将护士分为登记组、治疗护理组、观察组、运输组，对群体患者进行抢救护理；全程护理组50例采用责任护士与辅助护士全程负责2～4例患者的接诊、抢救及安全转送工作。观察记录两组患者的抢救成功率、有效抢救时间、患者的满意度。结果全程护理组的抢救成功率、患者的满意度、抢救有效时间均显著优于分工护理组。结论在群体创伤患者急救中实施全程护理服务，可有效地提高群体创伤患者的抢救成功率，缩短有效抢救时间，提高患者的满意度，降低医疗风险。     

Trauma scissors vs. the rescue hook, exposing a simulated patient: a pilot study

The objective of this study was to compare the exposure times using trauma scissors vs. the rescue hook on a simulated patient. This was a prospectively randomized, parallel group comparison study with two arms. The control group used trauma scissors (15 cycles), and the intervention group used rescue hooks (15 cycles). The uniform and footwear were standardized for each cycle. Ten participants were trained on each instrument. For each cycle, four participants were randomly chosen, and the use of either instrument was randomized. Each participant was then queried about their preferences for either instrument and why. The rescue hook's mean time of exposure was 24 s with a SD of 7 s and a 95% confidence interval (CI) of 20-28 s. The trauma scissors' mean exposure time was 42 s with a SD of 5 s and a 95% CI of 39-45 s. The mean difference was 18 s, with a 95% CI of 13-23 s. On average, the rescue hook was 43% faster. Nine of 10 participants preferred the rescue hook, stating that it was faster, easier, smaller, and more durable. The rescue hook was found to be faster than trauma scissors when exposing a simulated patient, and it was the instrument preferred by the majority of participants.     

火车事故致群体伤的急救护理组织与管理

介绍24例突发群体伤患者的护理管理对策.具体措施包括:采用一对一护士首诊负责制、充分的人力与物力资源准备、危重患者的抢救与绿色通道的开放、成批患者的分流与管理等,保证了本组患者得到及时有效的救治.认为采取以上护理管理对策能提高医院应对群体伤的救护能力,特别是护士首诊负责制应对突发群体伤的方法,可以实现与患者有效的信息沟通及身份识别,也能有序展开抢救工作,实现快速分流,加快就诊与转运,减少各种衔接,确保患者安全.     

Insecticidal characteristics and mechanism of a promising natural insecticide against saw-toothed grain beetle

The prevention of grain storage pests is a universal concern all over the world. It is in high demand to explore novel, safe and green insecticidal techniques to address such concerns. In this work, both raw and calcined diatomite were used as a natural insecticide to remove common grain storage pests with improved lethal effect on the saw-toothed grain beetle. Interestingly, the raw diatomite showed higher insecticidal efficiency than the calcined diatomite, and its associated insecticidal properties and preparation conditions were also optimized through orthogonal tests. The optimal conditions for processing the raw diatomite insecticide were identified as follows: the diatomite dust was 500 mesh (A₃), the temperature was 25 °C (B₁), the relative humidity was 65% (C₂), the diatomite dosage was 20 g m⁻² (D₂), the influence factor order was C ≥ D > A > B. The observation of surface morphology indicated that the raw diatomite had a complete, multi hole surface morphology and good adsorption performance, whereas the structure of the calcined diatomite was uncomplete with collapsed pores, resulting in poor adsorption performance. The special pore structure and excellent adsorption capacity of diatomite make the stored grain pests lose water to lethal effect. Acute toxicity and long-term toxicity tests in mice showed that diatomite has no harmful effects on mammals. The findings from our work led to a green and effective approach in producing a highly efficient and safe storage grain insecticide.

Insecticidal mechanism of the diatomite.     

成组化分诊模式在应对突发大批伤员救治中的应用

目的 探讨成组化分诊模式应用于三级医院应对大规模成批伤员救治的效果.方法 按照成组化分诊模式建立检伤分诊小组,按照简单检伤分类及快速治疗程序对124例爆炸伤伤员进行检伤分流管理.结果 124例伤员中分流到红区救治35例,黄区30例,绿区59例,分诊合格率100％.本组中严重多发伤及复合伤34例,行清创手术118例,损害控制性手术10例,死亡1例,抢救成功率97.1％.结论 成组化分诊模式应用于三级医院应对突发大规模成批伤员救治,可以迅速建立良好的检伤救治秩序、提高分诊全程管理的效率和患者满意度.     

The grain growth mechanism of nano-CaO regenerated by nano-CaCO3 in calcium looping

The grain growth mechanism of nano-CaO-based CO₂ adsorbents in calcium looping (CaL) process was studied to figure out the main factors affecting sorption durability. First, the thermal growth characteristics of nano-CaCO₃ grains and nano-CaO grains at 750–850 °C was measured to fit the grain growth kinetic models. The activation energy data of grain growth of nano-CaCO₃ and nano-CaO were obtained as 104.8 kJ mol⁻¹ and 212.8 kJ mol⁻¹ respectively, which indicated that the grain growth of nano-CaCO₃ was easier than that of nano-CaO. Then, the grain sizes of regenerated nano-CaO undergoing 10 CaL cycles were compared with those derived from nano-CaCO₃ suffering high temperature heat-treatment under the same looping temperature and time. It was found that CaCO₃–CaO chemical conversion could accelerate the grain growth of regenerated nano-CaO. Based on these results, the grain growth mechanism of regenerated nano-CaO grain in CaL process was proposed. The thermal growth of nano-CaCO₃ grain was the key issue to influence the grain growth of regenerated nano-CaO. Therefore, shortening the high temperature residence time as well as preventing the interface contact of nano-CaCO₃ grains were good for limiting the grain growth of regenerated nano-CaO.

The sintering mechanism of nano-CaO in calcium looping was studied by decoupling three sub-steps of regeneration experimentally.     

Interface between hospital and fire authorities--a concept for management of incidents in hospitals

INTRODUCTION: Although every hospital needs a security plan for the support of immobile patients who do not possess autonomous escape capabilities, little information exists to assist in the development of practical patient evacuation methods. HYPOTHESIS: 1) In hospitals during disasters, incident leadership of the fire authorities can be supported effectively by hospital executives experienced in the management of mass casualties; and 2) As an alternative for canvas carry sheets, rescue drag sheets can be employed for emergency, elevator-independent, patient evacuation. METHODS: A hospital evacuation exercise was planned and performed to obtain experiences in incident command and to permit calculation of elevator-independent patient transport times. Performance of incident leadership was observed by means of pre-defined checklists. The effectiveness and efficiency of carrying teams with five persons each were compared to those with a rescue drag sheet employed by a single person. RESULTS: Incident command for hospitals during a disaster is enhanced considerably by pre-defined and trained executives who are placed at the immediate disposal of the fire authorities. For elevator-independent patient transport, the rescue drag sheet was superior to conventional carrying measures because of a reduced number of transport personnel required to move each patient. With this method, patient transport times averaged 54 m/min. flat and 18 seconds for one floor descent. CONCLUSION: Experiences from a hospital during an evacuation exercise provided decision criteria for changes in the disaster preparedness plan. Hospital incident leadership was assigned to executives-in-charge in close co-operation with the fire authorities. All beds were equipped with a rescue drag sheet. Both concepts may help to cope with an emergency evacuation of a hospital.     

人工血管移植修复腰椎间盘髓核摘除后髂总动脉损伤：病例分析

背景：国内外文献报道腰椎间盘手术并发腹部大血管损伤发生率较少,可一旦发生病情危急,抢救及处理不当可导致患者死亡或肢体功能障碍。 目的：探讨腰椎间盘髓核摘除致腹侧大血管损伤的发生原因、诊断及防治措施。 方法：复习1例腰椎间盘髓核摘除致髂总动脉损伤的诊断及防治措施。 结果与结论：患者L4/5椎间盘突出症行L4、L5右侧椎板减压髓核摘除导致髂总动脉损伤,通过及时诊断、采取外科干预及人工血管移植,抢救成功。大血管的损伤与手术操作、解剖、病理等因素有关,对于术中不能明确原因的椎间隙渗血伴有术中血压突然下降提示可能有大血管的损伤;准确诊断及迅速采取外科干预是抢救生命的关键。     

Rescue of the adeno-associated virus 2 genome correlates with alterations in DNA-modifying enzymes in human cells.

The adeno-associated virus 2 (AAV) genome can be rescued either from a recombinant plasmid upon transfection into human cells or from cells latently infected with AAV, following subsequent infection with adenovirus. Using human diploid fibroblasts as a model for a natural AAV infection, we observed increased efficiency of rescue of the AAV genome in these cells as they traversed their limited proliferative life span in vitro. The efficiency of rescue correlated well with the augmented nuclease activity in these cells. Furthermore, rescue of the AAV genome, either from a recombinant plasmid or from the chromosomal DNA, was more efficient in cells from a patient with Bloom's syndrome, a rare autosomal recessive disease associated with increased chromosomal breakage due to DNA ligase I deficiency, as compared with normal human diploid fibroblasts. These studies suggest that alterations in DNA-modifying enzymes may play a role in rescue of the AAV genome in human cells.     

护生面对肿瘤重症患者死亡心理体验的质性研究

目的：了解ICU实习护生面对肿瘤重症患者抢救后死亡的心理体验，帮助护生以正确的心态面对工作中出现的患者死亡并以恰当有效的方法应对。方法：采用半结构式访谈提纲对10名在ICU实习并经历患者抢救后死亡的护生进行深入访谈，在面对面谈话中收集资料并录音，通过Colaizzi分析整理资料，得出主题。结果：护生面对肿瘤患者死亡产生惊惶失措与急躁不安，震惊与恐惧，悲伤与惋惜等心理体验，并对抢救的意义产生质疑。结论：ICU护生初次面对日常工作中的患者死亡，心理上难以接受和适应，产生多重负性体验。     

Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue.

We asked if the factors that predict overall mortality following two common surgical procedures are different from those that predict adverse occurrences (complications) during the hospitalization or death after an adverse occurrence, which we refer to as "failure to rescue." We examined 5,972 Medicare patients undergoing elective cholecystectomy or transurethral prostatectomy using three outcome measures: 1) the death rate (number of deaths/number of patients); 2) the adverse occurrence rate (number of patients who developed an adverse occurrence/number of patients); and 3) the failure rate (number of deaths in patients who developed an adverse occurrence/number of patients with an adverse occurrence). The death rate was associated with both hospital and patient characteristics. The adverse occurrence rate was associated primarily with patient characteristics. In contrast, failure to rescue was associated more with hospital characteristics, and was less influenced by patient admission severity of illness as measured by the MedisGroups score. We concluded that factors associated with hospital failure to rescue are different from factors associated with adverse occurrences or death. Understanding the reasons behind variation in mortality rates across hospitals should improve our ability to use mortality statistics to help hospitals upgrade the quality of care.     

Efficiency of grain production and latent image fading in F-18 micro-autoradiography.

In 18F micro-autoradiography using a frozen section method, the grain production was measured relative to the exposure time and radioactivity. The grain production increased until 6-hr exposure, but 7-hr or longer exposure induced a characteristic of latent image fading. However, the ratios of the efficiency of grain production between two different 18F-radioactivities (11.9 and 2.3 mBq/100 microns2) were constant over experimental exposure times, thus indicating that quantitative analysis by grain counting is preserved.     

In-water resuscitation: a pilot evaluation

INTRODUCTION: The first and most important treatment for the apnoeic drowning victim is the rapid alleviation of hypoxia by artificial ventilation. Recent studies have suggested that commencing resuscitative efforts with the victim still in the water may be beneficial. The aim of this pilot study was to evaluate the feasibility and efficacy of in-water unsupported rescue breathing. METHODS: Three lifeguards were taught how to perform in-water unsupported rescue breathing. Ventilation volume, inflation duration were recorded from a modified Laerdal resuscitation manikin. The rescue duration was recorded and compared to a rescue undertaken without in-water resuscitation. RESULTS: The three lifeguards performed between seven and nine ventilations during each simulated rescue. This gave average inflation volumes for each lifeguard of 711 ml (S.D. 166), 750 ml (S.D. 108), 629 ml (S.D. 182) and average inflation duration of 0.8s (S.D. 0.3), 0.9s (S.D. 0.2) and 0.6s (S.D. 0.1). The rescue duration was increased from an average time of 1 min 10 s to 1 min 24 s by performing in-water resuscitation. CONCLUSION: This study has demonstrated the feasibility and potential efficacy of in-water unsupported rescue breathing with a victim in deep water. Furthermore, the technique was not associated with an undue prolongation of the rescue duration over a 50 m rescue. In circumstances where the trained lifeguard finds themselves with an apnoeic victim in the water, with no buoyant rescue aid available, they may consider the application of in-water, unsupported rescue breathing, especially if recovery to dry land is likely to be delayed. The effectiveness of this technique, however, remains to be proven in the open water environment.     

喉罩在抢救呼吸骤停患者中的应用

目的探讨临床更安全、更有效、更快捷地建立人工气道的方法。方法选择急救患者94例,2009年1月-2012年3月为喉罩组和2007年1月-2008年12月为气管插管组,从建立有效呼吸、循环这一过程所需时间,抢救成功率,医生对护士急救能力的认可度,患者满意率4个方面进行比较。结果喉罩组建立有效呼吸循环所需时间（16．8±54）s,抢救成功率（自主循环恢复即视为抢救成功）88％,医生对护士的急救能力的认可度100％,患者满意率100％。结论护士利用喉罩能更安全、更有效、更快捷地建立人工气道。     

Analysis of the pre-incident education and subsequent performance of emergency medical responders to the Volendam café fire.

OBJECTIVE: At this moment, in the Netherlands, rescue workers are not given any specific standardized training in disaster response or disaster management.After the café fire in Volendam, the Netherlands, on New Year's Eve 2000, around 200 rescue workers were deployed on-site. The aim of this study is to investigate the rescue workers' experiences with regard to their level of preparation for the emergency response. METHODS: In 2002, 30 members of the medical and paramedical personnel were requested to participate in a structured interview, focused on education, task perception, triage and registration. RESULTS: Twenty-seven participated. Twenty-two rescue workers received previous training in emergency medicine. During the alarm phase, 11 rescue workers had a clear perception of their tasks. Twenty-four were involved in triage and injury assessment. Three rescue workers used a protocol for triage and 15 for injury assessment. Twenty-five rescue workers gave on-scene treatment and 15 used a protocol. Eight registered their findings. CONCLUSIONS: Preparation for the emergency response lacked standardized procedures. The use of triage protocols was extremely poor, as was documentation of actions. Slightly more than half of the personnel followed treatment protocols. It is advisable that all rescue workers become familiar with the basic uniform principles and protocols regarding disaster management. A dedicated and standardized national disaster management course is needed for all rescue workers.     

Stoichiometry–grain size-specific capacitance interrelationships in nickel oxide

Nickel oxide exhibits almost the highest theoretical specific capacitance (C_s), which includes contributions from non-faradaic double layer charging and faradaic OH⁻ adsorption. However, the realistic and tangible C_s is due to the faradaic process, which can be influenced by chemical (i.e. stoichiometry) and structural (i.e. grain size) changes. Hence, it is necessary to investigate the interrelationships among chemical and structural features and charge storage capacity. Here, a non-stoichiometric nickel oxide (Ni_xO) containing Ni²⁺ and Ni³⁺ was synthesized by a sol–gel method at 620, 720 and 920 °C using Ni(NO₃)₂·6H₂O and citric acid. The grain size as estimated from X-ray diffraction increases from 55 to 194 nm with increase in the synthesis temperature. The stoichiometry measured through Ni²⁺ (or Ni³⁺) fraction from X-ray photoelectron spectroscopy also increases from 70.3 to 99.2 atom% with synthesis temperature. The C_s due to faradaic OH⁻ adsorption was estimated from cyclic voltammetry in 2 M KOH within −0.05 to +0.60 V vs. Hg/Hg₂Cl₂/KCl (sat. in water). This C_s increases from 7.5 to 92.4 F g⁻¹ with a decrease in the grain size and stoichiometry (increase in Ni³⁺) due to possibly the increased conductivity and NiOOH formation through OH⁻ adsorption. The deviation from stoichiometry at lower grain size mainly stems from nickel vacancy accommodation, according to the thermodynamic model proposed here. The interrelationships among stoichiometry, grain size and the specific capacitance of nickel oxide are investigated.

Grain size, stoichiometry and specific capacitance in NiO are interrelated.     

汶川大地震境外医疗队救援模式及流程分析

目的回顾性分析汶川大地震期间赴四川省11支境外医疗队医疗救援总体情况、工作模式及流程,以期为我国医务工作者应对未来重大突发事件的医疗救治工作提供参考。方法收集国务院和四川省抗震救灾指挥部关于国外医疗救援的信息统计数据,以及笔者直接参与境外救援医疗队的工作统计。对收集到的资料进行归纳、分析、汇总,采用EXCEL软件建立数据库,运用SPSS11.0对数据进行处理,作描述性统计分析。结果11支境外医疗队根据具体情况采取不同的工作模式,严格按照科学、规范的工作流程开展医疗救治,取得了良好的效果。结论境外医疗队严谨的工作态度,耐心细致的服务和科学的工作方法值得中国医务工作者认真学习和借鉴。