The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety.

Parkinson's disease(PD)and restless legs syndrome(RLS)are relatively common movement disorders.There has been much debate over whether an etiological link exists between these two diseases and whether they share common pathophysiological mechanisms.PD and RLS may co-occur and respond well to dopaminergic agents, suggesting there is underlying dopamine dysfunction in both conditions.Despite the overlapping clinical features, the mechanisms underlying idiopathic RLS and RLS associated with PD may differ.In this article, we review studies related to the epidemiology, pathophysiology and genetics of PD with concurrent RLS, in order to provide evidence for exploring the link between RLS and PD.

Objective　To evaluate the differences of clinical and sleep characteristics and related factors between patients with Parkinson’s disease (PD) with restless leg syndrome (RLS) and idiopathic restless leg syndrome (iRLS).Methods　One hundred and twenty-five patients with PD and 137 patients with iRLS from 2015 to 2020 were collected.PD patients were divided into PD with RLS group (PD-RLS) and PD without RLS group (PD-NRLS).The general condition,clinical features,subjective and objective sleep examination of the three groups were compared and analyzed.Results　The prevalence of comorbid RLS in PD patients was 27.2%.The score of UPDRS-Ⅲ score in patients with PD-RLS was higher than that in PD-NRLS.The objective sleep quality of patients with PD-RLS was worse than that of patients with iRLS.Age and comorbid PD were the risk factors of poor sleep quality in patients with RLS.IRLS-RS and HAMD scores are risk factors for poor subjective sleep quality in patients with RLS.Conclusion　Objective sleep disorders are more likely to occur in patients with PD-RLS than in patients with iRLS.While subjective sleep disorders in patients with iRLS are more severe.Which may be related to the clinical heterogeneity of RLS complicated with PD.

Objective　To understand the relationship between elective motivation and sleep emotional characteristics of students in sleep medicine course.Methods　The study used Wenjuanxing to investigate data,including demographic data,motivation to elect the Sleep Medicine Course,Pittsburgh Sleep Quality Index (PSQI),Insomnia Severity Index (ISI),Epworth Sleep Score (ESS),Morningness/Eveningness Questionnaire (MEQ),Self-Rating Depression Scale (SDS),Self-Rating Anxiety Scale (SAS) and Fatigue Severity Scale (FSS).Results　From 2017 to 2019,410 students selected the Sleep Medicine Course,in which 70.3% were interested in the course and 27.4% had the demands to resolve sleep problems.The percentage of PSQI≥6 is 28.85%，ESS ≥9 is 6.15%,ISI≥8 is 29.49%,SAS≥508 is 9.1%,SDS≥53 is 25%，the score of FSS is 35.9±12.5.Students were separated to three different groups by cluster analysis.The characteristic of first group was depression (14%),the second group was anxiety and fatigue (63%),and the third was poor sleep quality,sleepiness,anxiety,fatigue,and depression (23%).Conclusions　The motivation of taking Sleep Medicine Courses may be related to the high level of anxiety.Sleep problems are prone to comorbid anxiety and depression and affect daytime function.

Neck myoclonus is part of sleep-related dyskinesia characterized by sudden myoclonus during night sleep. Myoclonus causes pronounced brief rotation or flexion of the head. As a single event, neck myoclon ususually occurs during rapid eye movement (REM) sleep, and it lasts longer than 0.5-1.0 s. At present, neck myoclonus is rarely reported. A 28-year-old male whose clinical manifestation was repeated head swing during sleep was admitted to Tangdu Hospital. Video-polysomnography showed that all the events occurred during REM sleep, and some of them were accompanied by micro-arousal reaction and leg movement. Small does of clonazepam could relieve symptoms.

Objective　To explore the therapeutic effects of comorbid different insomnia symptoms on continuous positive airway pressure （CPAP） in patients with obstructive sleep apnea （OSA）. Methods　A total of 202 patients with CPAP in the Department of Neurology of Tangdu Hospital of Air Force military Medical University from 2011 to 2016 were collected. Age，sex，height，weight and past history were collected，as well as the results of Epworth sleepiness scale，polysomnography of diagnostic night and CPAP titration night. The differences of the above indexes between the group of difficulty maintaining sleep and other insomnia groups were analyzed. Results　There were 101 patients co-morbid insomnia and sleep apnea （48.95±11.75 years old）. There were 101 patients with OSA only （48.39±11.23 years old）. Compared with other insomnia groups，there were significant differences in proportion of Stage No rapid eye movement 2（NREM 3），proportion of Stage NREM 3，Apnea-hypopnea index（AHI），mean pulse oxygen saturation and oxygen desaturation index in the group of difficulty maintaining sleep after treatment. Conclusion　Therapeutic efficacy of patients with comorbid OSA and different insomnia symptoms on CPAP treatment are different. Individualized therapy for insomnia symptoms combined with OSA therapy is benefit for the rehabilitation of these patients.

Objective To examine the effect of low temperature on trehalose and trehalase levels in Culex pipiens pallens. Methods The fourth instar larvae and female adult mosquitoes of Cx. pipiens pallens were exposed at 4 ℃ for 0, 1, 3, 6, 12, 18, 24 h and 0, 1, 3, 6, 12, 18, 24, 36, 48, 72 h, respectively. Then, the trehalose and trehalase contents were detected by enzyme-linked immunosorbent assay (ELISA) in mosquitoes. Results The contents of trehalose and trehalase significantly increased in the larval and female adult mosquitoes post-exposure to low temperature. The changing trend of trehalose levels was consistent in the larval and female adult mosquitoes, and the highest levels were (2.458 8 ± 0.379 2) mg/g and (2.825 7 ± 0.211 1) mg/g 3 h post-exposure to low temperature, respectively. The trehalose and trehalase levels fluctuated greatly within the first 6 h post-exposure to low temperature. Following adaptation for a period of time, the trehalose and trehalase levels remained at a relatively high level. Conclusion Low temperature may induce the production of trehalose and trehalase in Cx. pipiens pallens, and the trehalose and trehalase may play an important role in the improvement of the cold resistance.

Objective To assess the epidemiology and clinical characteristics of sleep disorders in a single center in northwest China.Methods Using the International Classification of Sleep Disorders, 3rd Edition, all consecutive patients which were suspected as sleep disorders in Tangdu Hospital between January 2007 and December 2016, were included retrospectively.Results The average age of 8 037 patients was (46.59±15.83) years with male-female ratio 1∶1.24.Chronic insomnia was found in 3 848 (47.9%) patients, obstructive sleep apnea was found in 2 648 (32.9%) patients, narcolepsy was found in 294 (3.7%) patients, Kleine-Levin syndrome was found in 11 (0.1%) patients, circadian rhythm sleep-wake disorders were found in 14 (0.2%) patients, rapid eye movement behavior disorder was found in 193 (2.4%) patients, restless legs syndrome was found in 139 (1.7%) patients, periodic limb movement disorder was found in 109 (1.4%) patients, and other possible sleep disorders were found in 478 (5.9%) patients, respectively.Chronic insomnia and obstructive sleep apnea combided with somatic diseases.Conclusions Patients diagnosed by polysomnography in our single center suggested consultation rate of sleep disorders was increasing in past ten years, of which chronic insomnia and obstructive sleep apnea were dominant and comorbided with somatic diseases.

Accidents ; Humans ; Hydrogen Sulfide ; poisoning ; Vegetables

BACKGROUNDNovel influenza A viruses of avian-origin may be the precursors of pandemic strains. This descriptive study aims to introduce a novel avian-origin influenza A (H10N8) virus which can infect humans and cause severe diseases.

METHODSCollecting clinical data of three cases of human infection with a novel reassortment avian influenza A (H10N8) virus in Nanchang, Jiangxi Province, China.

RESULTSThree cases of human infection with a new reassortment avian influenza A(H10N8) virus were described, of which two were fatal cases, and one was severe case. These cases presented with severe pneumonia that progressed to acute respiratory distress syndrome (ARDS) and intractable respiratory failure.

CONCLUSIONThis novel reassortment avian influenza A (H10N8) virus in China resulted in fatal human infections, and should be added to concerns in clinical practice.

Aged ; Antiviral Agents ; therapeutic use ; Female ; Fluoroquinolones ; therapeutic use ; Humans ; Imipenem ; therapeutic use ; Influenza A Virus, H10N8 Subtype ; drug effects ; pathogenicity ; Influenza, Human ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged ; Oseltamivir ; therapeutic use