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Volume 7 ， Issue 1 ， 2020
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Abstract：In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.Keywords：2019 novel coronavirus;2019-nCoV;Respiratory disease;Pneumonia;Infectious diseases;Rapid advice guideline;Clinical practice guideline;Evidence-based medicine4|0|85Updated：2023-06-05 - Abstract：Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China’s national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.Keywords：Heat stroke;Classic;Exertional;diagnosis;Treatment;Expert consensus9|0|0Updated：2023-06-05
POSITION ARTICLE AND GUIDELINE
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Abstract：Background:Since the trauma knowledge of trauma providers correlates with the outcomes of injured patients, this study aims to assess the socio-demographic characteristics and levels of trauma knowledge of trainees in the China trauma care training (CTCT) program in addition to their post-course test results to provide support for the development of trauma care training programs and trauma systems in China.Methods:A cross-sectional study was conducted by collecting demographic information, hospital-related information and trauma knowledge of the trainees from 19 regions in China. All participants were assessed by questionnaires collecting the socio-demographic data, the trauma care knowledge levels and the information of the hospitals.Results:There were 955 males (78.9%) and 256 females (21.1%) enrolled. Among them, 854 were physicians (70.5%), 357 were registered nurses (29.5%). In addition, 64 of them also played an administrative role in the hospitals (5.3%). The score of the trainees who were members of the emergency department staff (72.59±14.13) was the highest among the scores of all the personnel surveyed, followed by those of the trainees from the intensive care unit (ICU) (71.17±12.72), trauma surgery department (67.26±13.81), orthopedics department (70.36±14.48), general surgery department (69.91±14.79) and other departments (69.93±16.91), P=0.031. The score of the professors (73.09±15.05) was higher than those of the associate professors (72.40±14.71), lecturers (70.07±14.25) and teaching assistants (67.58±15.16), P<0.0001. The score of the individuals who attended experts’ trauma lectures (72.22±14.45) was higher than that of individuals who did not attend the lectures (69.33±15.17), P=0.001. The mean scores before and after the training were 71.02±14.82 and 84.24±13.77, respectively, P<0.001. The mean score of trauma knowledge after the training of trainees from different provinces and with different educational backgrounds was higher than that before the training, with a statistically significant difference (P<0.05).Conclusions:The level of trauma knowledge of trauma care providers was associated with their department, professional position and previous participation in related academic conferences. Trauma care experience and participation in academic lectures and training program including CTCT may effectively improve individuals’ level of trauma knowledge.Keywords：Cross-sectional study;Trauma care knowledge;Educational background;Continuing medical education4|0|0Updated：2023-06-05 - Abstract：Background:Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics’ ability to manage snakebite first aid.Methods:This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants’ socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the standardized patients (SPs) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n=27), group B received a self-learning training on the SOP and checklist (n=27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n=26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.Results:The baseline measurement yielded no significant difference (H=1.647, P=0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P=0.008, P<0.001 and P<0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F=8.841, P<0.001). Both post-intervention scores of group B and group C were higher than that of group A (P<0.001 and P=0.001, respectively), but no difference was found between group B and C (P=0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62±0.61 and 4.82±0.45, respectively.Conclusions:In this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics’ cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.Keywords：Snakebite;Standard operation procedure (SOP);Checklist;Medic;Training4|0|0Updated：2023-06-05
- Abstract：Background:Stable angina is one of the most common clinical types of coronary artery disease (CAD) and associated with poor health-related quality of life (HRQL). However, few studies have evaluated the risk factors associated with HRQL in patients with newly diagnosed stable angina.Methods:A cross-sectional survey was conducted with 342 consecutive outpatients with newly diagnosed stable angina from October 2017 to January 2018 at the Second Affiliated Hospital of Army Medical University, Chongqing, China. Eight dimensions of HRQL were evaluated via the 36-item Short-Form Health Survey, including physical functioning, role limitation due to physical problems, bodily pain, general health, vitality, social functioning, role limitation due to emotional problems, and mental health. Physical and mental component summaries were calculated. Multiple stepwise regression was performed to determine the factors associated with HRQL.Results:Patients who were older, were females, did not exercise, had lower educational levels, had lower monthly incomes, had smoking/drinking habits, and had diabetes, hypertension, or hyperlipemia showed lower physical HRQL scores, while those who were older with lower educational levels and lower monthly incomes showed lower mental HRQL scores. The results of the multiple stepwise regression analyses showed that physical and mental HRQL were positively correlated with exercise and monthly income and negatively associated with age. Patients with monthly income ≥5000 Yuan showed higher HRQL scores than those with monthly income <5000 Yuan. Sleep quality and drinking were negatively associated with physical, but not mental HRQL.Conclusions:Our findings indicated that exercise and personal income level, both modifiable factors, were positively associated with physical and mental HRQL. These findings could have implications for clinical suggestions and strategies to improve HRQL in patients with stable angina.Keywords：Coronary outpatients;Exercise;Health-related quality of life;Monthly income4|0|0Updated：2023-06-05
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Abstract：Background:The purpose of this study was to compare the frequency of femoroacetabular impingement (FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis (OA).Methods:Patients who underwent a primary total hip arthroplasty (THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle (LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam (alpha angle ≥60°), pincer (LCEA ≥40°), or mixed-type pathologies.Results:Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups (P=0.33) nor did the prevalence of cam deformities (P=0.79). The LCEAs were significantly greater in veterans than in civilians (P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians (P=0.025 and P=0.004, respectively).Conclusions:These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.Keywords：Femoroacetabular impingement;Osteoarthritis;Hip;Acetabular labral tear;Hip arthroplasty4|0|1Updated：2023-06-05 -
Abstract：Background:Dietary Reference Intakes are used to guide the energy intake of the Canadian Armed Forces (CAF) field rations provided to military personnel deployed for training or operations. However, the high energy expenditures likely to occur under harsh environmental/metabolically challenging deployment conditions may not be adequately considered. This study examined the Ad libitum energy and nutrient intakes of CAF personnel (n=18) consuming field rations in a resting thermoneutral environment and during a day of standardized strenuous infantry activities at varying environmental temperatures.Methods:Dietary intake was assessed using a measured food intake/food waste method during the experimental treatment and for 6 h after treatment. Four treatments were administered in a randomized counterbalanced design: exercise (as standardized infantry activities) in the heat (30 °C), exercise in the cold (–10 °C), exercise in temperate thermoneutral (21 °C) air temperatures and a resting (sedentary) trial (21 °C).Results:The average Ad libitum consumption of field rations was 70% of the provided total energy (2776±99 kcal/8 h) during all treatments. Even with an acute challenge of increased energy expenditure and temperature stress in the simulated field conditions, participants’ energy intakes (1985±747 kcal/8 h) under hot, cold and temperate treatments did not differ from energy intake during the sedentary condition (1920±640 kcal/8 h). Participants’ energy intakes (1009±527 kcal/6 h) did not increase during the 6 h posttreatment period when the stresses of the strenuous physical activities and the harsh environmental temperatures had subsided.Conclusions:These results should be considered when planning the provision of field rations for CAF personnel expected to be engaged in strenuous physical activities with prolonged exposure to temperature extremes.Keywords：Dietary assessment;Nutrient intakes;Military personnel;Physical activity;Temperature extremes;Field rations6|0|0Updated：2023-06-05
RESEARCH
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Abstract：An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.Keywords：Clinical characteristics;Coronavirus disease 2019 (COVID-19);Origin;SARS-CoV-2;Therapy;Transmission4|0|59Updated：2023-06-05 -
Abstract：The Persian Gulf War of 1990 to 1991 involved the deployment of nearly 700,000 American troops to the Middle East. Deployment-related exposures to toxic substances such as pesticides, nerve agents, pyridostigmine bromide (PB), smoke from burning oil wells, and petrochemicals may have contributed to medical illness in as many as 250,000 of those American troops. The cluster of chronic symptoms, now referred to as Gulf War Illness (GWI), has been studied by many researchers over the past two decades. Although over $500 million has been spent on GWI research, to date, no cures or condition-specific treatments have been discovered, and the exact pathophysiology remains elusive. Using the 2007 National Institute of Health (NIH) Roadmap for Medical Research model as a reference framework, we reviewed studies of interventions involving GWI patients to assess the progress of treatment-related GWI research. All GWI clinical trial studies reviewed involved investigations of existing interventions that have shown efficacy in other diseases with analogous symptoms. After reviewing the published and ongoing registered clinical trials for cognitive-behavioral therapy, exercise therapy, acupuncture, coenzyme Q10 (CoQ10), mifepristone, and carnosine in GWI patients, we identified only four treatments (cognitive-behavioral therapy, exercise therapy, CoQ10, and mifepristone) that have progressed beyond a phase II trial. We conclude that progress in the scientific study of therapies for GWI has not followed the NIH Roadmap for Medical Research model. Establishment of a standard case definition, prioritized GWI research funding for the characterization of the pathophysiology of the condition, and rapid replication and adaptation of early phase, single site clinical trials could substantially advance research progress and treatment discovery for this condition.Keywords：Gulf war illness;Chronic multisymptom illness;Gulf War veterans;Gulf War syndrome;Persian Gulf War;Cognitive-behavioral therapy;Exercise therapy;Acupuncture;Coenzyme Q10;Mifepristone;Carnosine;Mindfulness-based stress reduction5|1|0Updated：2023-06-05
REVIEW
- Abstract：In modern warfare, therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness. Be limited to the severe circumstance in the distant battlefield, quick and effective treatment cannot be supplied that leads infections, sepsis, multiple organ dysfunction syndrome (MODS) and high mortality. To get a better therapy for combat injury, we summarized several reports that associated with the mechanisms of sepsis and MODS, those published on MMR recently. Chaudry and colleagues reported gender difference in the outcomes of trauma, shock and sepsis. The advantageous outcome in female is due to their hormone milieu. Their accumulating reports indicated estrogen as a beneficial factor for multiple system and organs, including the central nervous system, the cardiopulmonary system, the liver, the kidneys, the immune system, and leads to better survival from sepsis. Thompson et al. reviewed the underlying mechanisms in trauma induced sepsis, which can be concluded as an imbalance of immune response triggered by damage-associated molecular patterns (DAMPs) and other immune modifying agents. They also emphasize immunomodulation as a better therapeutic strategy that might be a potential benefit in regulating the host immune response. Fan et al. have revealed a crucial mechanism underlying lung epithelial and macrophage crosstalk, which involves IL-25 as a mediator. After the injury, lung epithelial secreted IL-25 promotes TNF-α production in macrophage leading to acute lung injury (ALI). In addition to a mountain of cytokines, mitochondrial dysfunction in immune cell is another critical risk factor for immune dysfunction during sepsis. Both morphology and function alterations in mitochondria are closely associated with inadequate ATP production, insufficient metabolism process and overloaded ROS production, which lead harm to immune cells and other tissues by triggering oxidative stress. All the above reports discussed mechanisms of sepsis induction after trauma and provided evidence to improve better therapy strategies targeting diverse risk factors.Keywords：Combat injury;sepsis;Multiple organ dysfunction syndrome;estrogen;Immune dysfunction;Mitochondrial function;Interleukin-256|0|1Updated：2023-06-05
EDITORIAL
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