BACKGROUND: Transapical off-pump NeoChord procedure is a novel minimally invasive surgical repair of degenerative mitral regurgitation (MR). Here, we report the first four cases of NeoChord procedure in patients with mitral valve prolapse in Chinese mainland. METHODS: Four patients, aged 86, 84, 80 and 60 years, with severe MR due to posterior middle scallop prolapse (P2), underwent transapical off-pump artificial chordae implantation on April 9 and 10, 2019. The procedure was performed by left mini-thoracotomy under general anaesthesia and guided by 2D and 3D dimensional transoesophageal echocardiography (TEE). RESULTS: Mitral valve repair via NeoChord procedure was successfully performed with implantation of 3 artificial chordae in the first patient and 3, 2, and 3 artificial chordae in the following patients, respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography (TTE) showed only mild to moderate MR of these four patients and no postoperative complications were noted. There were no changes of TTE finding between one-month follow-up and pre-discharge. CONCLUSION The successful NeoChord procedures in four Chinese indicate that the valve repair using the NeoChord system for Chinese population is feasible.

BACKGROUND: Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences. METHODS: We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017. We obtained ED patient experience scores from an institutional version (IS) survey and the Press Ganey Associates-distributed survey (PGA). We compared top box scores from the two reports using frequency analysis and performed multivariable logistic regressions to identify associations between IS patient demographics and scores. RESULTS: We obtained 289 PGA and 234 IS responses. The IS reported significant, higher top box scores in doctor-specific patient questions compared to PGA (all four P-values < 0.01). Female, Christian and White patients were more likely to give top box scores (OR 3.07, OR 2.22 and OR 2.41, P-value < 0.05, respectively). CONCLUSION We found significant differences in ED patient experience scores between the IS and PGA surveys. We recommend that healthcare providers consider patient demographic variables when interpreting ED experience score reports. Multiple survey techniques and distribution methods may be adopted to best capture ED patient experiences.

BACKGROUND: Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages. METHODS: In a secondary analysis of an observational cohort study, we analyzed bystander self-efficacy for stages of BI before and after simulated SCA. Each subject participated in a singleplayer, immersive, VR SCA scenario. Subjects interacted with simulated bystanders through voice commands (“call 911”, “get an AED”). Actions taken in scenario, like performing CPR, were documented. Scenario BI actions were compared based on dichotomized comfort/discomfort. RESULTS: From June 2016 to June 2017, 119 subjects participated. Average age was 37±14 years, 44% were female and 46% reported CPR training within 2 years. During the scenario, 98% “noticed the event” and “interpreted it as a problem”, 78% “took responsibility”, and 54% “possessed the necessary skills”. Self-efficacy increased from pre- to post-scenario: noticing the event increased from 80% to 96%; interpreting as a problem increased from 86% to 97%; taking responsibility increased from 56% to 93%; possessing necessary skills increased from 47% to 63% (P<0.001). CONCLUSION Self-efficacy to respond to an SCA event increased pre- to post-scenario. Bystanders who reported feeling comfortable “taking responsibility to intervene” during an emergency were more likely to take action during a simulated emergency.

BACKGROUND: Emergency medical service system (EMSS) in China is becoming more important. However, studies on mortality of emergency departments (EDs) patients in tertiary hospitals and on the trends in mortality of ED patients all over China are stagnant. The objective of this study was to quantify and describe the trends in mortality of ED patients in China. METHODS: Nine tertiary teaching hospitals were selected from tertiary teaching hospitals in different regions. The annual numbers of ED visits and deaths of these hospitals in 2004, 2009 and 2014 were recorded and analyzed. Chi-square test was used to compare the mortality of the EDs' visits. Moreover, data on the mortality of ED patients in China from 2005 to 2015 were summarized and analyzed from the China Health and Family Planning Statistical Yearbooks (2006–2016). RESULTS: From 2004 to 2014, the overall annual mortalities in EDs increased among the tertiary hospitals (P<0.001). However, the overall annual mortality in EDs all over China decreased from 0.12% in 2005 to 0.08% in 2015. And the mortalities of EDs patients in the eastern, central and western regions of China all decreased. In addition, the average mortality of EDs patients in northern China was obviously higher than that in southern China (P<0.05). CONCLUSION The ED mortality was increased in tertiary hospitals while decreased all over China during the past decade, which may be partly caused by some critical challenges faced by China's EMSS, such as overcrowding and long length of stay in EDs of tertiary hospitals.

BACKGROUND: The study aimed to explore the clinical presentations, laboratory findings, treatments and prognosis of patients with Haff disease after eating crayfish. METHODS: Sixteen patients with Haff disease after eating crayfish were admitted to the Emergency Department of Beijing Chao-yang Hospital between June 2013 and August 2017. Clinical data was retrospectively analyzed. RESULTS: Alcohol consumption and exercise were found to be most commonly associated with the onset of rhabdomyolysis after consuming crayfish. Most patients were young adults and the symptoms mostly occurred within 24 hours of consumption of crayfish. Clinical symptoms included myalgia (100%), fatigue (87.5%), nausea (43.8%), dizziness (62.5%), chest distress (37.5%) and fever (18.8%). Also found after laboratory testing was elevations in the levels of creatine kinase (11,376±5,535 U/L), myoglobin (350±158 ng/mL), lactate dehydrogenase (6,539±3,180 U/L), alanine transaminase (174±71 U/L) and aspartate aminase (348±100 U/L). The incidence of renal dysfunction was low (6.25%), and all 16 patients had a good prognosis. CONCLUSION Patients with Haff disease exhibited typical symptoms after consuming crayfish, and laboratory findings gave highly accurate diagnostic results. The development of rhabdomyolysis was considered to be associated with alcohol consumption and exercise, but further studies are needed to demonstrate its relationship with crayfish consumption. Compared with other causes of rhabdomyolysis, rhabdomyolysis after crayfish consumption has fewer complications and better prognosis.

BACKGROUND: According to the fact that women account for the highest rate of victims of mental health loss during disasters, prioritization of their requirements is of remarkable significance. Therefore, the present study was carried out with the aim to prioritize factors related to women's mental health during an earthquake. METHODS: This study was conducted using the Delphi method in 2017. Participants consisted of experts including psychologists, counselors and psychiatrists, social medicine specialists, and psychiatric-mental health nurses with experience in service and disaster awareness, especially earthquake. They were selected using purposive and snowball sampling methods. The Delphi method was used in 2 rounds with 21 components and the final attendance of 19 participants and the collective agreement of 75%. RESULTS: Of the 21 factors related to women's mental health during the earthquake, the following components were, respectively, preferred by the participants: psychological well-being training, group relationships and support of women in emergency situations, fair treatment in the provision of rights and services to women, crisis awareness and management of behavior and difficult conditions, and social security during disasters with the total mean standard deviation (SD) of 13.4 (2.4), 13.0 (2.4), 12.7 (2.5), 12.5 (2.4), and 12.3 (2.2), respectively. CONCLUSION Training in the field of psychology and disasters, and social and cultural factors were prioritized among factors related to women's mental health during an earthquake. Therefore, the results of this study can be applied by the planners and executives of mental health, women and disasters, and the women's community itself.

BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean pre-course ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3% (P<0.01). The didactic group also showed statistically significant improvement on the physiology exam, improving from 59.3% to 70.0% (P<0.01). CONCLUSION Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically significant improvement in physiology learning when compared to standard didactic curriculum.

During the past two decades, management of blunt solid organ injuries had shifted from conventional surgery to more conservative approach, namely nonoperative management (NOM).[1] The non-operative approach mainly depends on the trauma experience of surgeons and the institution, quality of radiographic imaging and its interpretation.[2-5] If the surgeon decides to observe the patients by NOM, close monitoring of vital signs and frequent physical examinations must be done accordingly with radiological evaluations if needed.

Out-of-hospital cardiac arrest survival rates vary between 7% and 46% and are lower than those for in-hospital; cardiac arrests (IHCA).[1,2] Therefore, efforts are being made to increase survival rates for out-of-hospital cardiac arrests (OHCA). According to advanced cardiac life support (ACLS) guidelines, out-of-hospital cardiac arrest survival rates may be increased by performing cardiopulmonary resuscitation (CPR) with minimal interruptions.[3] According to the latest ACLS, does the patient need an advanced airway? If yes, use the airway that is appropriate to your skill level: King Airway System™, LMA, Combitube™, or endotracheal intubation. However, endotracheal intubation together with continuous CPR will be the basis of a permanent and safe airline management to prevent risk of aspiration, and in respiratory-induced OHCA administration as well as IHCA during long-term procedures such as percutaneous transluminal coronary angioplasty (PTCA).[3]

A six-month-old child with a history of coarctation of aorta repair admitted to our hospital with recoarctation. She underwent cardiac catheterization for stent placement via right femoral access. Reportedly, there was difficulty inserting and removing the sheath. There was no bleeding or hematoma and the distal pulse well felt at the completion of the procedure. While in recovery unit child acutely deteriorated with tachycardia, oxygen desaturation, and hypotension. She was then endotracheally intubated and started on fluid resuscitation and on vasopressors infusion. Upon arrival to the pediatric intensive care unit (PICU) child was tachycardic, pale and noted a mass on the right lower quadrant of the abdomen. Her hemoglobin dropped from 12 gm/dL to 5 gm/dL. Given the child with hemorrhagic shock, and with right lower quadrant abdominal mass, a possibility of retroperitoneal hematoma (RPH) was considered. Other possible causes of hemorrhagic shock, such as vascular access site bleeding, pleural and pericardial effusions were ruled out.