Objective Exploring the components of complex scenarios of healthcare surges triggered by major epidemics to provide a theorical basis for building resilience in healthcare organizations.Methods A hybrid analysis method is used to summarize macro-meso-micro multi-level and multi-source heterogeneous information,extract the elements of complex scenarios of medical surge and evaluate the rationality.Fault Tree Analysis method is used to clarify the logical relationship between various scenario elements and construct scenario reasoning paths.Results 10 scenario states,11 disaster-bearing,24 emergency management and 23 scenario results are summarized and extracted to form the key elements of complex surge scenarios.Among them,M4 expansion and coordinated scheduling of key positions,B2 conventional drug inventory emergency/insufficient core treatment drugs,B emergency medical material transportation breakage,S3 disease symptom spectrum shift to severe disease,R13 prevention and control awareness laxity,and M5 media information dissemination management are the key driving factors that promote a major turning point in the scenario.The most positive scenario result is the orderly operation of the medical service system,and the most negative scenario result is the paralysis of the medical service system.Conclusion Medical institutions need to improve emergency plans based on the complex evolution scenarios of medical surges and agile governance capabilities targeting key turning points,focus on dynamically expanding and scheduling personnel in key positions,strengthen material rotation and reserve mechanisms,maintain smooth emergency logistics channels,and improve efficient management of media and public opinion,so as to comprehensively improve overall resilience.

Objective Exploring the components of complex scenarios of healthcare surges triggered by major epidemics to provide a theorical basis for building resilience in healthcare organizations.Methods A hybrid analysis method is used to summarize macro-meso-micro multi-level and multi-source heterogeneous information,extract the elements of complex scenarios of medical surge and evaluate the rationality.Fault Tree Analysis method is used to clarify the logical relationship between various scenario elements and construct scenario reasoning paths.Results 10 scenario states,11 disaster-bearing,24 emergency management and 23 scenario results are summarized and extracted to form the key elements of complex surge scenarios.Among them,M4 expansion and coordinated scheduling of key positions,B2 conventional drug inventory emergency/insufficient core treatment drugs,B emergency medical material transportation breakage,S3 disease symptom spectrum shift to severe disease,R13 prevention and control awareness laxity,and M5 media information dissemination management are the key driving factors that promote a major turning point in the scenario.The most positive scenario result is the orderly operation of the medical service system,and the most negative scenario result is the paralysis of the medical service system.Conclusion Medical institutions need to improve emergency plans based on the complex evolution scenarios of medical surges and agile governance capabilities targeting key turning points,focus on dynamically expanding and scheduling personnel in key positions,strengthen material rotation and reserve mechanisms,maintain smooth emergency logistics channels,and improve efficient management of media and public opinion,so as to comprehensively improve overall resilience.

ObjectiveTo investigate the protective effect of N-(2R,3R,4R,5R,6R-pentahydroxyhexyl)-(N-disubstituted sodium formate)-L-methylthio-glutamate sodium (GMDTC) against cisplatin-induced acute kidney injury (AKI) in rats. Methods Specific pathogen free male adult SD rats were randomly divided into the control group, model group, low-dose group and high-dose group, with eight rats in each group. The rats in the latter three groups were injected with cisplatin at a dose of 4 mg/kg body mass through the tail vein to establish an AKI model, while the control group was not treated. Rats in the low-dose and high-dose groups were injected with injectable GMDTC at doses of 108 and 433 mg/kg body mass through the tail vein, respectively, in two hours after intoxication, while the rats in the model group were injected with an equal volume of 0.9% sodium chloride solution, once per day for five consecutive days. The 24-hours urine platinum level at day 1, 3, 5 and the level of whole blood platinum, serum platinum, urinary platinum and renal platinum at day 6 were determined using the inductively coupled plasma-mass spectrometry after GMDTC administration. Serum renal functional indicators and electrolyte level were detected, and renal histopathology was observed at day 6 after GMDTC administration. Results The levels of serum urea, serum creatinine, serum calcium ion, whole blood platinum, serum platinum and renal platinum, and the score of renal tubular injury in the model group were higher than those in the control group (all P<0.05). The 24-hours urinary platinum level at day 1, 3 and 5 after GMDTC administration in the model group was also higher than those in the control group (all P<0.05), and AKI changes were observed in histopathology. The levels of serum urea, serum creatinine, serum calcium ion, whole blood platinum, serum platinum, renal platinum, and renal tubular injury scores of rats in the low- and high-dose groups decreased compared with that in the model group (all P<0.05). The 24-hour urinary platinum levels on the first day after GMDTC administration of rats in the low- and high-dose groups increased compared with that in the model group (all P<0.05), as well as the renal histopathological changes of AKI were improved. However, there was no significant difference in the above-mentioned indicators between the low- and high-dose groups (all P>0.05). Conclusion GMDTC can promote the elimination of platinum in urine, effectively reduce the platinum level in blood and renal tissues, alleviate the pathological damage of renal tubules in rats, and improve the cisplatin-induced AKI.

Objective: Study the clinical significance of HBX gene detection, sequence analysis in peripheral blood mononuclear cell(PBMC) of chronic hepatitis B(CHB) patients with serum HBV DNA negative conversion after treatment by nucleoside analogues(NAs). Methods: Detected and analyzed the HBX gene sequence by real time PCR in PBMC of 60 patients with CHB including some with cirrhosis or hepatocellular carcinoma(HCC), all the serum HBV DNA had turned negative after treatment by NAs, and explore the clinical significance of the HBX gene. Results: HBX genes were detected in 37 cases(61.67%, 37/60). HBX positive rates of PBMC in HCC and cirrhosis patients were higher than that of CHB patients(P=0.000, P=0.010). HBX △120, HBX△129, HBX△131 truncations were detected in two HCC and one CHB cases. Two hotspot mutation including A389T/G391A, T380C had been found, and A389T/G391A double mutation in HCC patients was significantly higher than that in CHB patients(P=0.021). In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases was higher than that in HBeAg(+ ) cases(P=0.035). Conclusions In patients with serum HBV DNA negative conversion after treatment by NAs, PBMC HBX gene positive rates in cirrhosis or HCC cases are higher than that in CHB cases. A389T/G391A double mutation rate in HCC cases is significantly higher than that in CHB cases. In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases is higher than that in HBeAg(+ ) cases.