Primary Medical Units Research Articles

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

BackgroundTo demonstrate the technical feasibility of percutaneous nephrolithotomy (PCNL) guided by 5G-powered robot-assisted teleultrasound diagnosis system (RTDS) in a complex kidney-stone (CKS) cohort and present our preliminary outcomes. PCNL is highly skill-required, which hinders it popularization in primary medical units of remote regions. We designed an innovative tele-assistance approach to make PCNL easy to be operated by inexperienced surgeons.MethodsThis was a prospective proof-of-concept study (IDEAL phase 1) on intraoperative tele-assistance provided by online urological experts via a 5G-powered RTDS. Total 15 CKS patients accepted this technology. Online experts manipulated a simulated probe to assist unskilled local operators by driving a patient-side robot-probe to guide and monitor the steps of access establishment and finding residual stones.ResultsMedian total delay was 177ms despite one-way network-connecting distance > 5,800 km. No perceptible delay of audio-visual communication, driving robot-arm or dynamic ultrasound images was fed back. Successful tele-assistance was obtained in all cases. The first-puncture access-success rate was 78.6% with a one-session SF rate of 71.3% and without complications of grade III-V.ConclusionsThe current technology based on 5G-powered RTDS can provide high-quality intraoperative tele-assistance, which has preliminarily shown satisfactory outcomes and reliable safety. It will break down a personal competence-based barrier to endow PCNL with more popular utilization.Trial registrationThe study was approved by ethics committee of the Xinjiang Kezhou People’s Hospital and ethics committee of the First Affiliated Hospital of Nanjing Medical University and was registered on http://www.chictr.org.cn (ChiCTR2200065849, 16/11/2022).

Rapid vertical flow technique for the highly sensitive detection of Brucella antibodies with Prussian blue nanoparticle labeling and nanozyme-catalyzed signal amplification.

Brucellosis is a chronic infectious disease caused by Brucella, which is characterized by inflammation of reproductive organs and fetal membranes, abortion, infertility, and local inflammatory lesions of various tissues. Due to the widespread prevalence and spread of brucellosis, it has not only caused huge losses to animal husbandry, but also brought serious impacts on human health and safety. Therefore, rapid and accurate diagnosis is of great significance for the effective control of brucellosis. Therefore, we have developed a rapid vertical flow technique (RVFT) using Prussian blue nanoparticles (PBNPs) as a marker material for the detection of brucellosis antibodies. Lipopolysaccharide (LPS) was purified and used to detect brucellosis antibodies to improve the sensitivity of this technique. To enhance the sensitivity of serum antibody detection, a single multifunctional compound buffer was created using whole blood as a biological sample while retaining the advantages of typical lateral flow immunoassays. After signal amplification, standard Brucella-positive serum (containing Brucella antibody at 4000 IU mL-1) could be detected in this system even at a dilution factor of 1 × 10-2. The detection limit was 40 IU mL-1, which is ten times that before signal amplification. This RVFT displayed good specificity and no cross-reactivity. This RVFT effectively avoided the false negative phenomenon of lateral flow immunoassays, was easy to operate, had a short reaction time, has good repeatability, and could elicit results that were visible to the naked eye for 2 ~ 3min without any equipment. Since this method is very important for controlling the prevalence of brucellosis, it holds great promise for application in primary medical units and veterinary brucellosis detection.

P05.03.B Application of rapid cytology in intraoperative diagnosis of primary central nervous system lymphoma

Abstract Background To assesment the value of rapid cytological diagnosis in primary central nervous system lymphoma (PCNSL) surgery. Material and Methods A total of 213 PCNSL specimens from the First Affiliated Hospital of Fujian Medical University between 2012 to 2022 were included, 1-2mm3 was taken from the tissues diagnosed for intraoperative pathology and made into cell smears, rapid cytological diagnosis was performed after 95% ethanol fixation and H&E staining, most of the remaining tissues were diagnosed by frozen section. With the results of paraffin section pathological diagnosis as the control standard, compared the accuracy of rapid cytology and frozen tissue section and their combined diagnosis. Results Cytological smears can reveal microscopic structures within the cells under a microscope, furthermore, it can avoid the formation of artifacts or deformation of cells when frozen due to excessive water in brain tissue. Compared with paraffin section pathological diagnosis, the diagnostic accuracy of rapid cytology was 151cases (70.89%) , that of frozen tissue section was 175 cases (82.16%) , and that of the combination of the two methods was 187 cases (87.79%) . There were 26 cases (12.21%) in which neither method could give a definite conclusion intraoperatively and only depended on the results of paraffin tissue sections. Conclusion Rapid cytology alone is less accurate in diagnosing PCNSL than frozen sections alone. However, the combination of the two diagnosis can improve the accuracy of intraoperative diagnosis of PCNSL and correct some errors that may occur when only relying on frozen section diagnosis. It is especially suitable for stereotactic biopsy surgery or cases with very little tissue, as well as primary medical units without frozen section machine and other equipment.

Diagnosis of imported malaria cases in Shaanxi, 2015-2019

Objective To provide the basis for malaria surveillance to prevent re-transmission after malaria elimination by analyzing the treatment and diagnosis of imported malaria cases in Shaanxi Province during 2015-2019. Methods Data on imported malaria cases in Shannxi Province from 2015 to 2019 were collected and sorted through the National Infectious Diseases Information Reporting Management System (IDIRMS) and the Parasitic Diseases Information Reporting Management System (PDIRMS). The diagnostic methods, primary medical units, laboratory testing institutions and diagnostic timeliness of imported malaria cases were described and analyzed by Chi-square test, Fisher’s exact test and rank-sum test. Results A total of 409 imported malaria cases were reported during 2015-2019 in Shaanxi Province, and all of which were diagnosed with laboratory tests. The rate of utilization RDT increased from 48.56%(36/74) in 2015 to 82.83%(82/99) in 2019. The main primary medical unitswere found to be prefecture level medical (67.97%, 278/409) and county level medical (10.27%, 42/409). There was a significant difference in the upward trend of the correct rate of initial diagnosis of the cases ( χ 2 =15.677, P <0.001). The main laboratory testing institution was prefecture level medical(69.44%, 284/409) while the main reported institution was prefecture level medical (66.99%, 274/409).The median time from onset to diagnosis of malaria cases was 4 days, in which the median time from onset to first visit was 2 day. There was a significant difference in the time from first visit to diagnosis ( χ 2 =25.627, P <0.001), and the interquartile interval of malaria cases was shortened from the longest 4 days in 2015 to the shortest 1 days in 2019. There was a significant difference in the time from first visit to diagnosis among different species of malaria ( χ 2 =9.115, P =0.028), and P. malariae cases (7 days) were the longest than the other species malaria cases. Conclusion To strengthen the health education of key population to improve the awareness of medical treatment, continuously improve the diagnostic awareness and capabilities of medical institutions, and to play the role of sentinel hospitals in the surveillance of preventing re-transmission after malaria elimination. 摘要:目的 分析2015—2019年陕西省输人性疟疾病例诊断的情况,为消除疟疾后防止再传播的监测工作提供依 据。 方法 数据来源于传染病报告信息管理系统和寄生虫病防治信息管理系统,收集整理2015—2019年陕西省报告 的所有疟疾病例信息,对其诊断方式、初诊机构、实验室检测机构、诊断及时性等情况采用 χ 2 检验、Fisher确切概率或秩 和检验进行统计分析。 结果 2015—2019年陕西省共报告输人性疟疾病例409例,均为实验室确诊病例,快速诊断试 剂(RDT)使用率由2015年的48.56%(36/74)提高到2019年的82.83%(82/99)。病例的初诊机构主要为地市级医疗机构 (67.97%,278/409)和县级医疗机构（10.27%, 42/409)。病例的初诊诊断正确率呈上升的趋势,差异有统计学意义( χ 2 =15.677, P <0.001)。实验室检测主要为市级医疗机构(69.44%)。病例的报告机构主要为地市级医疗机构(66.99%)。病 例从发病到确诊时间中位数为4 d,其中发病-初诊时间中位数为2 d,初诊-确诊时间差异有统计学意义( χ 2 =25.627, P <001),其四分位数间距由2015年最长的4 d缩短为2019年的1 d。不同虫种的疟疾病例初诊-确诊时间差异有统计学 意义( χ 2 =9.115, P =0.028),以三日疟的初诊-确诊的中位数最长,为7 d。 结论 加强重点人群的健康教育以提高其就诊 意识,持续提高医疗机构的诊断意识和水平,发挥医疗机构在消除疟疾后防止再传播监测工作中的哨点作用。

Rapid detection of Pseudomonas aeruginosa by cross priming amplification

Pseudomonas aeruginosa (PA) is an opportunistic pathogen of humans and animals and a common source of nosocomial infections especially of the respiratory tract. Pseudomonas aeruginosa is also a major bacterial disease of poultry and in particular, eggs and newly hatched chicks. In this study, we developed a simple, accurate and rapid molecular detection method using cross priming amplification (CPA) with a nucleic acid test strip to detect P. aeruginosa. The assay efficiently amplified the target gene within 45 min at 62°C only using a simple water bath. The detection limit of the method was 1.18×102 copies μL−1 for plasmid DNA and 4.4 CFU mL−1 for bacteria in pure culture, and was 100 times more sensitive than conventional PCR. We screened 83 clinical samples from yellow-feather broiler breeder chickens and hospitalized/treated dogs and cats using CPA, PCR and traditional culture methods. The positive-sample ratios were 15.3% (13/83) by CPA, 13.3% (11/83) by PCR and 12.1% (10/83) by the culture method. The established CPA method has significant advantages for detecting P. aeruginosa. The method is easy to use and possesses high specificity and sensitivity without the requirements of complicated experimental equipment. The PA-CPA assay is especially fit for outdoor and primary medical units and is an ideal system for the rapid detection and monitoring of P. aeruginosa.

Characteristics and requirements of hypertensive patients willing to use digital health tools in the Chinese community: a multicentre cross-sectional survey

BackgroundDigital health tools (WeChat or mobile health apps) provide opportunities for new methods of hypertension management for hypertensive patients. However, the willingness of these patients to use social media and mobile health apps for hypertension management remains unclear. This study explored the characteristics and requirements of patients willing to use digital health (WDH) tools to manage hypertension.MethodsFrom February to March 2018, we administered questionnaires to 1089 patients with hypertension at eight Chinese primary medical units. We assessed independent risk factors of WDH and requirement among WDH patients.ResultsOverall, 43% (465/1089) of participants were WDH patients, who were younger (58 ± 12 vs 61 ± 13 years) and had a greater proportion of employed individuals (31% vs 14%) and higher education levels (65% vs 52%) than the non-WDH patients (all P < 0.0001). After adjusting for other risk factors, higher education (OR: 0.52; 95% CI: 0.34–0.79), good medicine adherence (OR: 1.5; 95% CI: 1.0–2.3) and blood pressure self-monitoring (OR: 1.6; 95% CI: 1.2–2.3) remained significantly associated with WDH (all P < 0.05). WDH patients responded that digital health tools should try to provide a platform for blood pressure monitoring (42%), medication reminders (41%), hypertension knowledge (39%) and doctor-patient communication (32%).ConclusionOur survey suggested that among hypertensive patients, willingness to use digital health tools was significantly associated with education, medicine adherence and blood pressure self-monitoring. Digital health tool developers and researchers should pay particular attention to recruiting older, less educated and unemployed patients with less willingness and who are less technologically savvy and research the requirements of WDH patients (blood pressure monitoring, medication reminders, and knowledge education) in the future.

Evaluation and design of public health information management system for primary health care units based on medical and health information

ObjectiveThe objective is to understand the role of information management systems in the public health perspective of primary care units more accurately. MethodsA public health information management system for primary medical units, which is based on electronic health records, virtual private network technology, real-time data storage, and other technologies, is designed on the premise of economical and straightforward operation. Besides, Xinhua Community Health Service Center Around the Wulong Street, Longsha District, Qiqihar City is selected as the experimental unit of the public health information management system, and the work efficiency of the system in the public health perspective of the primary medical unit is evaluated after 12 months of system operation. ResultsThe public health information management system of primary medical units has following comprehensive management functions: health record management, child health, maternal health, health of the elderly, health of patients with chronic diseases, health of severe psychiatric patients, health education, infectious diseases and public emergencies, health events, health supervision, and management information. In addition, after 12 months of information management system operates in the grassroots units, the results show that patients and doctors have a very high satisfaction rate with the system. The system not only cultivates the excellent health and disease prevention awareness of residents but also improves the efficiency of primary care institutions, as well as reducing the number of patients seeking medical cares. ConclusionThe public health information management system of primary health care units based on medical and health information design is rich in functions with prominent work efficiency, which significantly improves the public health of grass-roots medical units. The research is useful and significant for follow-up studies on public health care systems.

A novel, rapid and simple method for detecting brucellosis based on rapid vertical flow technology.

To prevent the spread of brucellosis, a simple and rapid vertical flow technology (RVFT) for the detection of antibodies targeting brucellosis was developed. In this study, Brucella sp. lipopolysaccharide was purified and used to detect brucellosis antibodies. Sheep IgG was used as a negative control. Colloidal gold-labeled recombinant staphylococcus aureus protein A was sprayed on a fibreglass membrane to prepare immunogold pads. Rapid vertical flow technology was used to detect Brucella in 1668 Sheep, 2743 bovine, 674 red deer and 420 human samples. The results indicated that the accuracy of this assay can reach 98%. The established RVFT uses a single multifunctional buffer that can be used to detect antibodies in serum, plasma, whole blood and other biological samples while preserving the advantages of lateral-flow immunoassays. This technology would be of great use in primary medical units and veterinary stations, and it is of great significance for the control of epidemic diseases.

Establishment and application of isothermal multiple-self-matching-initiated amplification (IMSA) in detecting Type II heat-labile enterotoxin of Escherichia coli.

Enterotoxigenic Escherichia coli (ETEC) constitutes a major cause of diarrhea in young children and animals, particularly in poor regions of the world, as well the traveler’s diarrhea in adult individuals. Type II heat-labile enterotoxin (LT-II) from ETEC can cause profuse watery diarrhea, posing a potential threat to public health and animal husbandry. In the present study, isothermal multiple-self-matching-initiated amplification (IMSA) was established to rapidly detect LT-II producing ETEC. The specificity and sensitivity were assessed, and clinical samples were tested. The established IMSA method had good specificity for the detection of LT-II gene with a limit of detection of 25 CFU/mL, i.e. 2 times higher than that of real-time PCR and other two isothermal amplifications (loop-mediated isothermal amplification, LAMP and cross-primer isothermal amplification, CPA). Meanwhile, in 103 clinical Escherichia coli strains isolated from diarrhea samples, 9 strains with LT-II+ gene were detected (8.73%), corroborating real-time PCR, LAMP and CPA data. Therefore, the IMSA technology applied for the detection of LT-II producing ETEC has a good application prospect for screening clinical samples in primary medical units or common laboratories.

Medical service as a part of everyday life of workers of the ferrous metallurgy enterprises in the first half of 1950s.

The aim of the study is to analyze medical aid given to the workers of ferrous metallurgy enterprises in the first half of the 1950s. Primary medical unit provided medical aid for workers of the ferrous metallurgical enterprises. Because of the lack of medical unit at the metallurgical plant or because there was no medical institutions in the organizational structure of the medical unit, local medical institutions provided the workers with medical care. During the first half of the 1950s, was the problem of the lack of medical staff in the medical institutions caused by insufficient material and household support. It did not allow implementing the shop principle of medical service of metallurgists. At the enterprises, individual shops did not have a factory’s sectorial doctor, or the number of workers assigned to a factory’s sectorial doctor exceeded the norm. Because the local hospitals, which controlled the health post at the ferrous metallurgy enterprises of the Zaporizhzhya region, were placed at a considerable distance, ‘the shop principle’ was not implemented there at all. The personnel problem also affected the formation of queues, which were a characteristic feature of the medical care provided to the workers. Work overload of physicians led to a quick examination of the patients, resulting in mistakes in the diagnosis. Contrary to accepted laws aimed at improving the quality of diagnosis, the periodic medical examinations of workers were not always carried out qualitatively, and the medical examination was carried out in a number of plants partly. In the first half of the 1950s the enterprises of the ferrous metallurgy of Zaporizhzhya region had a problem that the medical institutions were on a far distance and the percentage of patients needed medical help reduced. Lack of hospital beds had caused the untimely hospitalization of patients that prevented recovery of their. Many of the medical institutions were located in the old or non-specialized buildings with limited space, stove heating and primitive food units, without household premises and sewage. Characteristic of the medical services of metallurgists were depreciation of the material fund of medical institutions, lack of medicines, medical equipment. Not all medical institutions were provided with ambulances. There were cases of refusal to leave for a challenge or untimely provision of emergency care. It was concluded that the level of medical services given to the metallurgists in the first half of the 1950s was insufficient, despite the fact that they were workers of one of the leading branches of the Soviet economy.

ACTUAL ISSUES OF TUBERCULOSIS IN ADOLESCENTS EXPOSED TO TUBERCULOSIS INFECTION

The article characterizes respiratory tuberculosis in adolescents exposed to tuberculous infection. Exposure to tuberculosis in the family or when contacting close relatives makes the biggest contribution into development of the disease unless the patient is isolated from those exposed. Advanced and severe forms of tuberculosis with bacillary excretion are detected, compromising the life quality of adolescents. The main causes of late diagnostics are poor performance of TB services, primary medical units, low level of health education aimed at the increase of motivation to have planned medical examinations in the general population and to take relevant sanitary and hygienic measures in the sites of infection. Adolescents from the sites with bacillary excretion, and, first of all, if multiple or extensive drug resistant tuberculosis is detected, are to be considered a high priority group facing the risk to develop the disease with more frequent monitoring and deeper examination. In primary medical units, should any sings typical of tuberculosis be presented, it is sensible to add skin tests (Mantoux test and test with tuberculous recombinant allergen) to the minimum diagnostic procedures. Organizational, methodical and health education activities in the sites of infection are to be improved.