Interim Singapore guidelines for basic and advanced life support for paediatric patients with suspected or confirmed COVID-19

The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.     

Pain management in mice using methanol extracts of three plants belongs to family Amaranthaceae

ObjectiveTo investigate the analgesic activity of methanolic extract of Amaranthus viridis (A. viridis), Amaranthus caudatus (A. caudatus) and Amaranthus spinosus (A. spinosus).MethodsIn this study, the analgesic activity of methanol extracts of all three plants at doses of 200 and 400 mg/kg were investigated by acetic acid-induced writhings test, hot plate test and tail immersion test for mice.ResultsIt was found that all the three plants showed significant pain management effect (P<0.01) at a dose of 400 mg/kg, but showed a less significant effect at a dose of 20 mg/kg in the entire tests used for evaluation of analgesic activities (P<0.05).ConclusionsMethanol extracts of A. viridis, A. caudatus and A. spinosus show potent analgesic activities, and this study provides the scientific proof for their traditional claims.     

Hepatocellular carcinoma in patients with chronic hepatitis C virus infection without cirrhosis

AIM:To investigate and characterise patients with chronic hepatitis C virus(HCV) infection presenting with hepatocellular carcinoma(HCC) in the absence of cirrhosis.METHODS:Patients with chronic hepatitis C infection without cirrhosis presenting with HCC over a 2-year period were identified.The clinical case notes,blood test results and histological specimens were reviewed to identify whether additional risk factors for the development of HCC were present.RESULTS:Six patients(five male,one female) with chro...     

Lean techniques for the improvement of patients’ flow in emergency department

BACKGROUND:

Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called “lean” management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process.

METHODS:

It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared.

RESULTS:

Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05).

CONCLUSION:

The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.KEYWORDS: Lean, Triage, Waiting time, Patient flow, Emergency department     

少年教养人员人格类型及其与自尊、成就动机、应对方式的调查

目的:选取人格、自尊与成就动机、应对方式作为相关变量,分析少年教养人员不同人格类型的自尊与成就动机、应对方式的特点。方法:调查对象为河南省某少年教养管理所2004-10/2005-02在押的少年教养人员97名,均为男性。运用艾森克人格问卷、自尊量表、成就动机量表和简易应对方式量表测评不同人格类型少年教养人员的自尊、成就动机及应对方式。其中①艾森克人格问卷由88项问题,4个分量表组成,分别为精神质、内外向、神经质、掩饰,每题按自己的实际情况回答“是”和“否”。②自尊量表共10题,4级评分(“非常符合”到“很不符合”),总分范围10～40分,分值越高,自尊程度越高。③成就动机量表由30项问题,2个分量表组成,分别为追求成功动机,避免失败动机,得分越高,追求成功的动机越高,得分越低,成就动机越弱,个体越倾向于避免失败。④简易应对方式量表包括积极应对方式和消极应对方式2个分量表,采用多级评分,“不采用、偶尔采用、有时采用、经常采用”,相应评分0,1,2,3分。结果:共发放问卷97份,有效问卷88份。①少年教养人员人格精神质、神经质和掩饰性得分与相应常模比较,差异具有显著性意义[(9.44±3.78),(6.65±4.36)分;(14.49±4.22),(11.43±4.31)分;(8.69±4.24),(12.47±3.81)分,P<0.01]。②自尊与成就动机、积极应对呈正相关,与避免失败、消极应对呈负相关;成就动机与内外向呈正相关,与稳定性呈负相关;积极应对与自尊、成就动机呈正相关;消极应对与内外向、稳定性、避免失败呈正相关,与自尊呈负相关,差异具有显著性意义(P<0.05)。③通过Q型聚类分析得出3种人格类型:冲动型37名、敌对型32名和稳定型19名。不同人格类型被试精神质、稳定性、掩饰性、自尊和成就动机比较,差异具有显著性意义(P<0.01);应对方式比较,差异无显著性意义(P>0.05)。结论:少年教养人员具有高精神质、低掩饰性和神经质偏高的人格特质;具有冲动型、敌对型和稳定型3种人格类型。不同人格类型具有不同的自尊、成就动机和应对方式。     

老年人大脑听觉皮质脑磁图对刺激声频率和强度的反应

目的:观察不同刺激声频率和强度对老年人脑磁图的影响,为老年人大脑听觉皮质脑磁图的测试提供理论依据。方法:选取32例2002-01/2005-01在河北省人民医院耳鼻咽喉科门诊就诊的健康受试者,年龄60～80岁。以306通道全头型脑磁图仪测试听阈上30dB的0.5,2,4kHz纯音,以及听阈上30dB和50dB的2kHz纯音所诱发的双侧大脑半球听觉皮质脑磁场M100,并与其MRI解剖影像信息叠加整合,得到大脑听觉皮质磁源性影像。分析比较相同强度3种不同频率纯音和同一频率不同强度纯音所诱发M100的潜伏期、波幅及其等电流偶极在X,Y,Z坐标轴的三维定位。结果:32例受试者均进入结果分析。①0.5,2和4kHz三种频率纯音声刺激所诱发的老年人大脑听觉皮质磁反应波M100潜伏期和波幅相同诱发侧别之间比较其差异有显著意义(P<0.01),其中又以处于语言频率的2kHz所诱发的M100潜伏期最短[同侧(110.3±8.9)ms;对侧(102.8±8.5)ms],波幅最大[同侧(16.7±4.2)nA;对侧(18.4±6.4)nA];而高频的4kHz所诱发的M100潜伏期最长[同侧(132.5±12.6)ms;对侧(120.7±10.1)ms],波幅最低[同侧(6.7±2.6)nA;对侧(8.6±3.7)nA]。②听阈上50dB的2kHz纯音较30dB的2kHz纯音诱发的老年人大脑听觉皮质M100潜伏期显著缩短[同侧(100.6±6.2),(110.3±6.5)ms;对侧(92.5±4.3),(102.8±5.6)ms;P均<0.01],波幅显著增加[同侧(22.3±4.4),(16.7±3.8)nA;对侧(26.5±6.4),(18.4±4.5)nA;P均<0.01]。两种强度2kHz纯音诱发的M100等电流偶极的位置在X,Y,Z轴均无显著变化(P>0.05)。结论:①老年人大脑听觉皮质的老化性退行性变是以感受较高频率声音的听觉皮质区域最早开始而且其退行性变的程度也最重。②增加刺激声强度仅能激活大脑听觉皮质更多数量的神经细胞,却不能改变大脑听觉皮质各种频率刺激声激活的区域和范围。③老年人大脑听觉皮质脑磁图的测试需要注意所选择的刺激声频率要包括各种频率的声音信息,测试较高频率刺激声诱发的脑磁图时声音强度不可过低。     

移植骨骨矿物元素的动态代谢变化

目的:观察移植骨在移植后骨矿物元素的动态变化。方法:实验于2005-03/11在广东医学院生理学教研室完成。①5个月龄SD大鼠16只,于颅顶骨正中用直径8.4mm的圆形钻取下全层骨片,将其修为直径4mm骨片(去除软组织)植入缺损的正中部位,②标准固体饲料饲养,饲料经电感耦合等离子体发射光谱仪测定,每克饲料的无机盐含量为:钙:16.35mg,镁:2.90mg,锌:41.56μg,磷:4.60mg,硫:2.48mg,钴:1.58μg,锰:44.40μg。术后8周随机抽取6只大鼠用空气栓塞法处死,取出移植骨和邻旁正常骨,用原子分光光度计测定锌,铜,铁,钙,镁和锰的含量。术后12周将剩下7只大鼠同法处理。结果:13只大鼠进入结果分析,其余3只因伤口处有化脓现象而舍去。①术后8周移植骨骨矿物元素铜、钙、镁、锰均比邻旁正常骨降低[移植骨铜、钙、镁、锰依次为:(29.33±6.77)μg/g,(18.13±5.06)ng/g,(490.85±76.72),(58.06±10.60)μg/g,邻旁正常骨铜、钙、镁、锰依次为:(50.44±6.60)μg/g,(37.22±1.10)ng/g,(901.01±145.86),(82.10±17.66)μg/g,P<0.01或0.05];锌、铁则无明显变化(P>0.05)。②术后12周移植骨与邻旁正常骨相比,上述骨矿物元素含量均无统计学意义(P>0.05)。结论:移植骨经过12周生长后,骨矿物元素代谢渐趋于正常,与邻旁正常骨已无明显差异,表明钙,铜,锰,镁等骨矿物元素代谢参与了移植骨的生长过程,提示给接受骨移植者补充必需的骨矿物元素将有助于移植骨的生长。     

Toll-like receptor 9 triggers an innate immune response to helper-dependent adenoviral vectors.

A major obstacle to the clinical application of systemic adenoviral gene replacement therapy is the host innate immune response. Although recent studies have attempted to characterize the cellular basis for this response to systemically administered helper-dependent adenoviral vector (HD-Ad), the underlying molecular components of the innate immune repertoire required to recognize the viral vector have yet to be identified. Here, we show that primary macrophages can sense HD-Ad vectors via the Toll-like Receptor 9 (TLR9) and respond by increasing pro-inflammatory cytokine secretion. Moreover, TLR9 sensing is involved in the rapid innate immune response to HD-Ad in vivo. TLR9 deficiency attenuates the innate immune response to HD-Ad, whereas TLR9 blockade reduces the acute inflammatory response after intravenous injection of the vector. Moreover, HD-Ad upregulates TLR9 gene expression independent of TLR9 function, suggesting that additional innate signaling pathways work cooperatively with TLR9. The identification of the components of the innate immune response to adenovirus will facilitate the development of combinatorial therapy directed at increasing the maximal tolerated dose of systemically delivered adenoviral vectors.