The West China hospital of Sichuan university has underwent four times emergency medical rescue (EMR) of earthquakes, measuring 5.7 Ms to 8.0 Ms on the Richter scale, happened at Wenchuan, Yushu, Yiliang and Lushan in recent 5 years, which gradually improved and supplemented Wenchuan experience. After Lushan earthquake, a total of 392 patients were received during 2 weeks. Among 321 hospitalized patients, there were 39 (12.15%) patients with critical injury and 14 (4.36%) patients who needed intensive care. 184 operations were performed. Based on the experiences of resource centralization, multidisciplinary cooperation, and hierarchical management, zero death, a new medical record, has been achieved among 43 patients with critical injury after centralized admission and treatment. A total of 12 medical rescue teams involving 88 healthcare workers were sent to the epicenter to join and guide EMR. Besides, rehabilitation and psychological experts came to Lushan on the first day of earthquake, and started clinical intervention of mental and physical health for people needed on the second day.
Lung cancer in never-smokers has been identified as a separate disease entity. Notably, the proportion of this distinct disease has been reported to increase in recent decades. Due to its occult onset and lack of clinical specificity, patients with this disease are always diagnosed with advanced stage. This review summarizes the current literatures about the risk factors, clinicopathological characteristics, molecular features, and prognosis of lung cancer in never-smokers, which will enhance our understanding and facilitate the precise management of this distinct disease.
Precision medicine is a novel medical modality based on genome sequencing, bioinformatics and big data science. The studies regarding tuberculosis always concentrated on the bacteria and host in the setting of precision medicine. This review mainly introduces the application of precision medicine in the diagnosis and treatment of tuberculosis. The limits of the Chinese studies with respect to precision medicine in tuberculosis are also discussed. Moreover, the article predicates its future development.
Objective To discuss the effectiveness of salmeterol in treating a case of chronic obstructive pulmonary disease (COPD). Methods Aimed at the effectiveness of salmeterol in treating COPD patients, a comprehensive search was conducted in EMbase Web (2007 to 2011) and EBSCOhost Web (2000 to 2010) to obtain and evaluate the relevant systematic reviews, meta-analysis and randomized controlled trials (RCTs), and finally to apply the best evidence in clinical practice. Results There were 2 systematic reviews, 3 meta-analyses and 172 RCTs in the initial retrieval; and 12 RCTs and 1 meta-analysis were finally included after being screened. The results indicated a significant improvement in lung function, clinical symptoms and life quality after inhalation of sameterol in COPD patients. The patient had a good effect when the above evidence was applied at the patient’s will. Conclusion The inhalation of salmeterol for COPD can significantly improve lung function, alleviate clinic symptoms and improve life quality of the patients. But there are still some side-effects which should be considered in practical applications.
The paper summarizes three revolution trends of medical service mode in the age of 5th generation mobile networks (5G), including artificial intelligence & intelligent medical service, internet of things & internet hospital, and intelligent hospital. Artificial intelligence & intelligent medical service mainly covers artificial-intelligence-assisted diagnosis, artificial-intelligence medical decision-making, and artificial-intelligence-assisted new drug research & development. Internet of things & internet hospital mainly covers internet hospitals, internet care, cloud pharmacies, and medical imaging clouds. Intelligent hospitals mainly cover intelligent clinics, intelligent wards, and intelligent management. The revolution trends count on not only techniques such as 5G, but also the support and cooperation of the government and society. The risk of information and data leak needs attention.
With the rapid development of information technology, medical reforms in various countries are moving towards informatization, and internet medical projects have been carried out gradually. Internet hospitals, as one of the manifestations of internet medical projects, have the advantages of improving the efficiency of medical services, revitalizing and effectively sinking high-quality medical resources, and therefore has become the focus of China’s next stage of medical reform. However, internet hospitals are innovative and local products of China, leading its practices lack of domestic and foreign theoretical research, as well as experience, which results in government policies and hospital management strategies are both moving forward in groping, and the construction outcomes vary. Therefore, this article aims to analyze the comprehensive dilemmas currently confronted by internet hospitals in China in different stages of construction, operation and management based on PDCA cycle, and thus, puts forward corresponding construction thinking and analysis in a targeted manner, and proposes guidance for the further development of internet hospitals.
Early diagnosis of lung cancer is difficult because of it’s lacking in distinctive clinical characteristics. With the development of CT technology for chest, the detection rate of pulmonary nodules is increasing year by year and acquires extensive attention. Therefore, the accurate clinical diagnosis to identify the character of solitary pulmonary nodules is urgently needed. However, the current clinical applications of different diagnosis have pluses and minuses. In this paper, we mainly review the diagnosis, management strategies and the existing problems of solitary pulmonary nodules based on the cancer-screening guidelines of Fleischner Society, American College of Chest Physicians, National Comprehensive Cancer Network, Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia, and Chinese Consensus on Pulmonary Nodules, and clinical research progress of pulmonary nodules.
Objective To construct small interfering RNA（siRNA） eukaryotic expression vector specific for human hnRNP K gene，and to observe its silencing effects on hnRNP K gene in A549 cells.Methods The expression vectors of pSUPER/hnRNP K siRNAa，pSUPER/hnRNP K siRNAc and pSUPER/siRNAn were constructed by gene recombination and then transfected into the A549 lung carcinoma cell line by using Lipofectamine2000（a and c respectively represented A and C fragments in hnRNP K coding sequence contained 19 nts，n represented nonsense fragment as control）.The mRNA and protein were harvested after 24 h and analyzed for the expression of hnRNP K by RT-PCR and Western blotting respectively.Results The siRNA vector targeted to hnRNP K successfully decreased hnRNP K mRNA and protein levels 24 h after transfection in A549 cells.Relative expressed doses of hnRNP K mRNA in lung cancer cells transfected by hnRNP K siRNAa and hnRNP K siRNAc respectively were 0.24±0.53 and 0.28±0.57 after 24 h，which were significantly lower than that in the control group（both Plt;0.01）.The gray scale values of hnRNP K protein were 0.23±0.11 and 0.28±0.09 respectively，which were also significantly lower than those in the control group（both Plt;0.05）.And pSUPER/hnRNP K siRNAa was the most effective one.Conclusion Eukaryotic expression vector of siRNA specific for hnRNP K is successfully constructed，which lays the basis for the function study of hnRNP K gene and its application in the treatment of lung carcinoma.
Objective To compare the long-term cost-utility of three first-generation EGFR-TKIs targeted drugs, gefitinib, icotinib, and erlotinib as first-line treatments for advanced non-small cell lung cancer (NSCLC). Methods Real-world data were collected from 1 511 patients with advanced NSCLC treated with first-generation EGFR-TKIs as first-line treatment at West China Hospital of Sichuan University from 2009 to 2019. A three-state Markov model was established to evaluate the clinical efficacy, safety and cost-utility of three first-generation EGFR-TKIs targeted drugs. The transition probability of each state was obtained by survival analysis, the direct and indirect costs were calculated by the bottom-up method, the health utility value was obtained through literature research, the incremental cost effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated, and sensitivity analyses and Monte Carlo simulations were performed. Results There was no significant difference in clinical efficacy among the three first-generation EGFR-TKIs in the treatment of NSCLC. The incidence of skin rash and liver injury caused by gefitinib was significantly higher than that caused by icotinib and erlotinib (P<0.05). The average economic burden of patients treated with icotinib was the lowest (CNY 192 535.3) (P<0.01). The cost-utility ratio of icotinib (CNY 132 985.9/QALYs) was much lower than that of gefitinib (CNY 205 005.3/QALYs) and erlotinib (CNY 172 893.1/QALYs). Conclusion Compared with the three first-generation EGFR-TKIs drugs, icotinib is the most cost-effective.
Objective To analyze the clinical and pathological features of lung cancer with metastasis, explore the regularity and characteristics of the location of metastasis, and provide reference for future clinical treatment. Methods A total of 658 patients with lung cancer treated in West China Hospital of Sichuan University from January 2008 to December 2014 were enrolled in this study. The effect of different clinical and pathological characteristics on different locations of metastasis was analyzed by χ2 test and logistic regression. Results Adenocarcinoma was the main pathological type (342 cases, 52.0%), and bone (150 cases, 22.8%) and pleura (118 cases, 18.0%) were the most common distant metastasis. Compared with patients with no corresponding metastasis, patients with age <60 years took bigger proportions in patients with bone, brain and mediastina metastasis ( P<0.05). Furthermore, logistic regression analysis showed that the younger patients were more likely to have brain metastasis (P=0.024). Besides, the elder patients were more common in those with liver metastasis (P<0.001). The proportion of males was higher in the patients with lymph node metastasis than those without lymph node metastasis (P=0.010); however, the proportion of females was higher in patients with bone or pleural metastasis than those without bone or pleural metastasis (P<0.05). There was no significant difference in gender among patients with brain, lung, liver, adrenal and mediastinal metastases (P>0.05). Conclusions Bone and pleura are the most common sites of metastasis of lung cancer. The age structure of brain metastasis tends to be younger.