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Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy

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《医学前沿（英文）》 2013年 第7卷 第3期   页码 386-388 doi: 10.1007/s11684-013-0278-y

摘要：

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

关键词： thoracic trauma     differential diagnosis     critical care     pneumothorax     pneumomediastinum     CT scan     pitfalls     lung and airways physiology    

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Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

《医学前沿（英文）》 2023年 第17卷 第4期   页码 675-684 doi: 10.1007/s11684-022-0970-x

摘要： This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015−2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ≥15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%×nosocomial infection management + 17.97%×compliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

关键词： critical care medicine     quality control     evaluation     exploratory factor analysis (EFA) model    

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Socialized care services for the aged population: System construction and support measures

《工程管理前沿（英文）》 2023年 第10卷 第2期   页码 339-353 doi: 10.1007/s42524-022-0208-2

摘要： Given the aging society, an increase in social demand, information- and communication technology-driven culture, and government policy support emerges to enable the development of the socialized care services system for the aged (SCSSA). The development of the SCSSA would be a significant step toward addressing China’s aging population. However, the construction of the SCSSA challenges the theories and methods of traditional elderly care service system construction. Specifically, the implementation path for such elderly care service policies is unclear, the necessary technological support is insufficient, and the mechanism for integrating intelligent information technology remains underexplored. Thus, this paper focuses on the needs of the elderly, grounded in the context of the changing elderly care service policies in China, and proposes a research paradigm that integrates system construction and support measure embedding. We then construct the original SCSSA, which includes “material + spirit + medical treatment + healthcare” and propose a method of optimization and iteration. Finally, we build the research framework of systematic support measures from the perspectives of policy reconstruction, institutional embeddedness, and technical support. Our work provides theoretical support and practical guidance for the construction and dynamic optimization of the SCSSA, thus making a significant contribution that will help China effectively cope with its aging society.

关键词： socialized     care service for the elderly     system construction     support measure    

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Advancing pediatric care before birth

《医学前沿（英文）》 2023年 第17卷 第2期   页码 352-354 doi: 10.1007/s11684-022-0974-6

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Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai

《医学前沿（英文）》 2022年 第16卷 第1期   页码 126-138 doi: 10.1007/s11684-021-0897-7

摘要： This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43±8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95±5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (<7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP)<130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c)<2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (<140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

关键词： type 2 diabetes     quality of care     macrovascular complication     microvascular complication     treatment pattern     epidemiology    

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Determination and occurrence of endocrine disrupting compounds, pharmaceuticals and personal care products

Yong YU,Laosheng WU

《环境科学与工程前沿（英文）》 2015年 第9卷 第3期   页码 475-481 doi: 10.1007/s11783-014-0640-6

摘要： Endocrine disrupting compounds (EDCs), pharmaceuticals and personal care products (PPCPs) have attracted much attention due to widespread contamination in aquatic environment. In this study, we determined 13 EDCs and PPCPs in fish blood, bile and muscle by using gas chromatography-mass spectrometry (GC-MS). The limits of quantitation (LOQ) were in the ranges of 0.23–2.54, 0.22–2.36 ng·mL , and 0.24–2.57 ng·g dry weight (dw) for fish blood, bile and muscle, respectively. Recoveries of target compounds spiked into sample matrices and passed through the entire analytical procedure ranged from 65% to 95%, from 60% to 92% and from 62% to 91% for blood, bile and muscle, respectively. The methods were applied to the analysis of fish from a lake in California. Target compounds were relatively low in bile, and only bisphenol A (BPA) and diclofenac were measurable near the LOQ. Seven of 13 compounds were detected in blood, with total concentrations up to 39 ng·mL . Only BPA was frequently found in muscle, with mean concentration of 7.26 ng·g dw. The estimated daily intake of BPA through fish consumption for U.S. resident was significantly lower than the tolerable daily intake recommended by the European Food Safety Authority. This study showed that the exposure to the bisphenol A from fish diet is unlikely to pose a health risk.

关键词： endocrine disrupting compounds (EDCs)     pharmaceuticals and personal care products (PPCPs)     fish     bisphenol A (BPA)     risk assessment    

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Primary health care for all by 2020: The systematic reform of the medical and health system in China

《医学前沿（英文）》 2010年 第4卷 第1期   页码 3-7 doi: 10.1007/s11684-010-0024-7

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Arthrogryposis multiplex congenita: classification, diagnosis, perioperative care, and anesthesia

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《医学前沿（英文）》 2017年 第11卷 第1期   页码 48-52 doi: 10.1007/s11684-017-0500-4

摘要：

Arthrogryposis multiplex congenita (AMC) is a rare disorder characterized by non-progressive, multiple contractures. In addition to affected extremities, patients may also present microstomia, decreased temporomandibular joint mobility. Although the etiology of AMC is unclear, any factor that decreases fetal movement is responsible for AMC. Thus, accurate diagnosis and classification are crucial to the appropriate treatment of AMC. The development of ultrasound technology has enabled prenatal diagnosis. Very early treatment is favorable, and multidisciplinary treatment is necessary to improve the function of AMC patients. Most patients require surgery to release contracture and reconstruct joints. However, perioperative care is challenging, and difficult airway is the first concern of anesthesiologists. Postoperative pulmonary complications are common and regional anesthesia is recommended for postoperative analgesia. This review on AMC is intended for anesthesiologists. Thus, we discuss the treatment and perioperative management of patients undergoing surgery, as well as the diagnosis and classification of AMC.

关键词： arthrogryposis     amyoplasia     distal arthrogryposis     anesthesia    

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Screening of indicator pharmaceuticals and personal care products in landfill leachates: a case study

《环境科学与工程前沿（英文）》 2023年 第17卷 第9期 doi: 10.1007/s11783-023-1716-y

摘要：

● A systematic framework was developed to identify i-PPCPs for landfill leachate.

关键词： Landfill leachates     PPCPs     Indicator     Screening criteria     Source-specificity    

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我国老年智慧康养平台建设路径研究

侯汉坡,位鹤,王颍超,于今,邱贵兴

《中国工程科学》 2022年 第24卷 第2期   页码 170-178 doi: 10.15302/J-SSCAE-2022.02.023

摘要：

我国正处于老年人口数量较多、老龄化速度加快、应对人口老龄化任务繁重的阶段，利用现代化技术建立老年智慧康养平台是解决我国养老问题的有效途径。本文阐述了建设老年智慧康养平台的背景以及相关概念与发展现状，以杭州市西湖区老年智慧康养平台为案例，深入分析了老年智慧康养平台的建设模型与发展面临的问题，进而总结了我国老年智慧康养平台的共性特征。研究提出了我国老年智慧康养平台的建设路径：以科技手段助力实现健康中国为建设目标，以全国康养信息和数据的互联互通为建设基础，构建“社区嵌入型”智慧康养服务综合体来调动服务资源，开展远程健康数据监测和健康管理来强化信息支撑，发挥地域优势并促进本土康养产业升级。为此建议，推动康养产业及科技转化，健全老年人精神需求保障机制，完善老年人能力评估体系，构建智慧康养标准体系，协调城乡智慧康养产业发展。

关键词： 老龄化     健康中国     社区居家养老     智慧健康养老     养老服务     康养平台    

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Determination of 27 pharmaceuticals and personal care products (PPCPs) in water: The benefit of isotope

Xueqi Fan, Jie Gao, Wenchao Li, Jun Huang, Gang Yu

《环境科学与工程前沿（英文）》 2020年 第14卷 第1期 doi: 10.1007/s11783-019-1187-3

摘要： • Isotope dilution method was developed for the determination of 27 PPCPs in water. • The established method was successfully applied to different types of water samples. • The correction effect of corresponding 27 ILSs over 70 d was investigated. • Benefit of isotopic dilution method was illustrated for three examples. Pharmaceuticals and personal care products (PPCPs) are a unique group of emerging and non-persistent contaminants. In this study, 27 PPCPs in various water samples were extracted by solid phase extraction (SPE), and determined by isotope dilution method using liquid chromatography coupled to tandem triple quadruple mass spectrometer (LC-MS/MS). A total of 27 isotopically labeled standards (ILSs) were applied to correct the concentration of PPCPs in spiked ultrapure water, drinking water, river, effluent and influent sewage. The corrected recoveries were 73%–122% with the relative standard deviation (RSD)<16%, except for acetaminophen. The matrix effect for all kinds of water samples was<22% and the method quantitation limits (MQLs) were 0.45–8.6 ng/L. The developed method was successfully applied on environmental water samples. The SPE extracts of spiked ultrapure water, drinking water, river and wastewater effluent were stored for 70 days, and the ILSs-corrected recoveries of 27 PPCPs were obtained to evaluate the correction ability of ILSs in the presence of variety interferences. The recoveries of 27 PPCPs over 70 days were within the scope of 72%–140% with the recovery variation<37% in all cases. The isotope dilution method seems to be of benefit when the extract has to be stored for long time before the instrument analysis.

关键词： Pharmaceuticals and personal care products (PPCPs)     Isotopically labeled standard (ILSs)     Water     Solid-phase extraction (SPE)     LC-MS/MS    

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efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care

Feng Zhu, Zhijian Yao, Wenliang Ji, Deye Liu, Hao Zhang, Aimin Li, Zongli Huo, Qing Zhou

《环境科学与工程前沿（英文）》 2020年 第14卷 第3期 doi: 10.1007/s11783-020-1228-y

摘要： A hydrophilic resin (GCHM) was facile synthesis and characterized. Average absolute recovery of GCHM (75.6%) performs better than Oasis® HLB. Detection limits of method (SPE-UPLC-MS/MS) ranged between 0.03 and 0.6 ng/L. 22 PPCPs were determined in environmental waters ranging from 0.5 to 1590 ng/L. In this study, a hydrophilic resin named GCHM was fabricated based on poly(N-vinyl pyrrolidone-co-divinylbenzene), characterized, and applied as a solid-phase extraction (SPE) material. Up to 44 pharmaceuticals and personal care products (PPCPs) belonging to 10 classes were recovered in environmental water samples. Different variables affecting extraction, such as adsorbent amount, sample pH, and loading speed, were optimized. Under optimal conditions, the average absolute recovery of 44 PPCPs was 75.6% using GCHM, indicating a better performance than the commercial Oasis® HLB. SPE with home-made hydrophilic polymeric sorbent followed by ultra-performance liquid chromatography and tandem mass spectrometry was validated, and the method achieved good linearity (r2>0.991, for all analytes). In addition, the method detection limits of target compounds ranged from 0.03 to 0.6 ng/L. The developed method was applied to determine PPCPs in 10 environmental water samples taken from the Yangtze River, Huaihe River, and Taihu Lake, 1 groundwater sample from Changzhou in Jiangsu Province, 1 wastewater sample from Xiamen and 2 seawater samples from the Jiulong River in Fujian Province, China. In these samples, 22 compounds were determined at levels ranging from 0.5 to 1590 ng/L.

关键词： Hydrophilic resin     Solid phase extraction     Pharmaceuticals and personal care product     Ultra-performance liquid chromatography and tandem mass spectrometry     Environmental water    

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PAC在人工流产术后计划生育关爱中的应用

钟慧玲

《中国工程科学》 2014年 第16卷 第5期   页码 31-33

摘要：

文本研究人流后关爱（PAC）在人工流产术后计划生育关爱中的应用。选择2011年1月—2013年1月，武汉市蔡甸区计划生育服务站门诊进行人工流产的260 名病例为分析对象，根据其先后序号按照奇偶顺序分为关爱PAC组和对照组，每组130 例，对PAC组进行流产后关爱指导，而对照组只进行常规处理。一年后，共收回有效问卷248 份，其中关爱组126 份，对照组122 份。PAC组避孕知识和人流后保健知识掌握优良率均高于对照组，生活质量评分有明显优势，而重复流产率明显较低，育龄妇女满意率较高。其差异均有统计学意义（P<0.05）。高价值的PAC关爱，对于减少重复流产的概率和提高生活质量有着积极重要的意义。

关键词： 人工流产     流产后关爱     计划生育关爱     效果分析    

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Recent advances in pharmaceuticals and personal care products in the surface water and sediments in China

Wentao Zhao, Ying Guo, Shuguang Lu, Pingping Yan, Qian Sui

《环境科学与工程前沿（英文）》 2016年 第10卷 第6期 doi: 10.1007/s11783-016-0868-4

摘要： Recent publications on PPCPs in surface water environment in China were reviewed. Antibiotics received more attention than other PPCPs in surface water environment. Uneven attention has been focused across different study areas in China. Sulfamethoxazole showed the most significant environmental risk in surface water. Higher risks were posed by PPCPs in sediments than in surface water. Pharmaceuticals and personal care products (PPCPs) have been regarded as an emerging problem in the surface water environment in the past few decades. In China, although related studies were initiated several years ago, an increasing number of studies on this topic have been conducted in recent years. These studies have expanded knowledge of their occurrence, behavior and associated risk in the surface water environment in China. This review compiles the most recent literature related to the studies of PPCPs in the surface water environment in China. It includes PPCP occurrence in surface water and sediments, their geographical distribution, and outcomes of the associated risk assessment. It shows that antibiotics have received much more attention in both surface water and sediments than other PPCPs. Compared to other countries; most antibiotics in the collected sediments in China showed higher contamination levels. Many more study areas have been covered in recent years; however, attention has been given to only specific areas. Environmental risk assessment based on risk quotients indicated that sulfamethoxazole presents the most significant environmental risk to relevant aquatic organisms; followed by ofloxacin, ciprofloxacin, enrofloxacin, 17α-ethynylestradiol, ibuprofen and diclofenac. Despite limited research on the environmental risk assessment of PPCPs in sediments, higher risks posed by PPCPs in the sediments rather than surface water were identified highlighting the need for further risk assessment of PPCPs in sediment samples.

关键词： Surface water     Sediment     Antibiotics     Geographical distribution     Risk assessment    

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Heterogeneous length-of-stay modeling of post-acute care residents in the nursing home with competing

《工程管理前沿（英文）》   页码 577-591 doi: 10.1007/s42524-022-0203-7

摘要： Post-acute care (PAC) residents in nursing homes (NHs) are recently hospitalized patients with medically complex diagnoses, ranging from severe orthopedic injuries to cardiovascular diseases. A major role of NHs is to maximize restoration of PAC residents during their NH stays with desirable discharge outcomes, such as higher community discharge likelihood and lower re/hospitalization risk. Accurate prediction of the PAC residents’ length-of-stay (LOS) with multiple discharge dispositions (e.g., community discharge and re/hospitalization) will allow NH management groups to stratify NH residents based on their individualized risk in realizing personalized and resident-centered NH care delivery. Due to the highly heterogeneous health conditions of PAC residents and their multiple types of correlated discharge dispositions, developing an accurate prediction model becomes challenging. Existing predictive analytics methods, such as distribution-/regression-based methods and machine learning methods, either fail to incorporate varied individual characteristics comprehensively or ignore multiple discharge dispositions. In this work, a data-driven predictive analytics approach is considered to jointly predict the individualized re/hospitalization risk and community discharge likelihood over time in the presence of varied residents’ characteristics. A sampling algorithm is further developed to generate accurate predictive samples for a heterogeneous population of PAC residents in an NH and facilitate facility-level performance evaluation. A real case study using large-scale NH data is provided to demonstrate the superior prediction performance of the proposed work at individual and facility levels through comprehensive comparison with a large number of existing prediction methods as benchmarks. The developed analytics tools will allow NH management groups to identify the most at-risk residents by providing them with more proactive and focused care to improve resident outcomes.

关键词： nursing home     predictive analytics     individualized prediction     competing risks     health outcomes    

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标题 作者 时间 类型 操作

Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy

null

期刊论文

Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

期刊论文

Socialized care services for the aged population: System construction and support measures

期刊论文

Advancing pediatric care before birth

期刊论文

Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai

期刊论文

Determination and occurrence of endocrine disrupting compounds, pharmaceuticals and personal care products

Yong YU,Laosheng WU

期刊论文

Primary health care for all by 2020: The systematic reform of the medical and health system in China

期刊论文

Arthrogryposis multiplex congenita: classification, diagnosis, perioperative care, and anesthesia

null

期刊论文

Screening of indicator pharmaceuticals and personal care products in landfill leachates: a case study

期刊论文

我国老年智慧康养平台建设路径研究

侯汉坡,位鹤,王颍超,于今,邱贵兴

期刊论文

Determination of 27 pharmaceuticals and personal care products (PPCPs) in water: The benefit of isotope

Xueqi Fan, Jie Gao, Wenchao Li, Jun Huang, Gang Yu

期刊论文

efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care

Feng Zhu, Zhijian Yao, Wenliang Ji, Deye Liu, Hao Zhang, Aimin Li, Zongli Huo, Qing Zhou

期刊论文

PAC在人工流产术后计划生育关爱中的应用

钟慧玲

期刊论文

Recent advances in pharmaceuticals and personal care products in the surface water and sediments in China

Wentao Zhao, Ying Guo, Shuguang Lu, Pingping Yan, Qian Sui

期刊论文

Heterogeneous length-of-stay modeling of post-acute care residents in the nursing home with competing

期刊论文