The objective of this article is to assess the dominant global economic systemand the resulting power relations from the perspective of the strategies usedworldwide against the SARS-CoV-2 pandemic. The predominantly biomedical approachhas not sufficiently taken into account the actual dimension of COVID-19 as asyndemic. While the much longer-term pandemic caused by the neoliberalism virushas not been systematically considered by public and global health scholars inthe context of COVID-19, it exhibits essential characteristics of an infectiouspathogen, and the symptoms can be described and detected according to biomedicalcriteria. Even more, the severity of leading symptoms of neoliberalism such asgrowing inequities calls for immunization campaigns and ultimately herd immunityfrom viral neoliberalism. However, achieving worldwide immunity would require ananti-neoliberal vaccine, which is extremely challenging to develop vis-à-vis thepower relations in global health. Everything revolves around how, when, and by what means this pandemic canbe ended. Several authors consider COVID-19, meanwhile, a syndemic rather than apandemic7 By analogy, the classificationof COVID-19 as a syndemic has emerged among global health scholars,810 with a main focus on theoverlap with other diseases that cause a high burden on populations. To the author'sknowledge, the COVID-19 syndemic has not yet been explicitly linked to the conceptof viral neoliberalism, which has been defined and analyzed for quite some time.This article aims to enrich the hitherto marginal scientific debate about theneoliberal syndemic among public health and global health scholars by demonstratingthe relationship between COVID-19 and the neoliberalism virus from biomedical andclinical perspectives. On one hand, the link between the two viral infections isreflected in the obvious commonalities between the two pandemics; on the other hand,it represents an attempt to make the inconsistency of some COVID-19 measurescomprehensible to non-medical professionals.Some scholars previously coined the term “neoliberal epidemics,” arguing that healthcan be best understood as the direct consequence of the unequal distribution ofpower and resources. Neoliberal economic and social policies in many places havewidened health inequalities and often imperiled past gains in people's healthstatus, and these effects depend on a set of interdependent determinants, whichspread so quickly across space and time that they would be considered as an epidemicif traceable pathogens were involved.The aim of this article, written from a  health perspective, is to sensitizeexperts from different fields of social and human sciences for the medical approachto the COVID-19 pandemic and the lessons to be drawn for pushing back other viralpandemics, such as neoliberalism, which would in turn help drive back outbreaks ofother viruses. The article is based on the analysis that the neoliberalism virus islikely to be more dangerous and more virulent in the longer term than the SevereAcute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) that has been propelling theworld for more than two years now.11 Likewise, the clinical manifestation of the virus in the formof neoliberal practice has long been present in international agencies such as theInternational Monetary Fund, World Bank, and World Trade Organization, as well asthe health-relevant specialized agencies of the United Nations (UN), including theUnited Nations International Children's Fund (UNICEF) and the World HealthOrganization.11 Viral neoliberalism is in fact a suitable metaphor for tworeasons: On one hand, neoliberalism shows the typical patterns of a contagion-basedspread causing certain symptoms, which can be described as the neoliberalismsyndrome; and secondly, it proves to be highly adaptable to changing conditions, towhich it responds with ever-new mutants.13The neoliberalism virus has been spreading and infecting governments, as well asacademia, media, and think tanks, worldwide for a much longer period of time—thatis, for decades.14 but tend to reflectindividual and subjective perceptions and correspond with everyday experiences.Unlike SARS-CoV-2, the neoliberalism virus does not spread exclusively throughdirect contact with infected persons. Transmission mostly occurs through exposure toavid economists, ubiquitous think tanks, media, and other infected sources.From a clinical perspective, the neoliberalism virus invades the human cerebrum inthe disguise of common beliefs, myths, half-truths, and fake news, which are basedon widely unproven theories of free markets and free tradeNeoliberalism is the commonly used term for the libertarian advancement of theneoclassic economic doctrine, which relies on the unlimited free play of marketforces and the withdrawal of the state from as many areas of society as possible.Neoliberal thinking places markets at the center of all economic and social life andconsiders state interventions as mostly harmful because free markets can bestregulate themselves; according to the underlying ideology, redistribution—forexample, through solidarity-based social protection systems—creates perverseincentives by punishing instead of rewarding the economy's winners. Core messagesrefer to deregulating capital and labor markets, eliminating price controls,lowering trade barriers, and reducing state influence in the economy, especiallythrough privatization and austerity. Neoliberal practice has liberalized theinternational movement of capital, limited the power of trade unions, and convertedworkforces into commodities.15 The concept—and even more so,the practice—of public goods plays, at best, a secondary role in the political andeconomic debate. In addition, the predominance of neoliberal policies has benefitedfrom and, at the same time, reinforced the belief inherent in capitalism thatsustained economic growth is the means to achieve human progress—disregarding thesocial, societal, and environmental costs and the unrestrained expense of natural,human, and other resources.The almost ubiquitous spread of neoliberalism has contributed to shifting theprevailing economic system from one of coordinated market capitalism, in whichinstitutions coordinate important economic decisions and functions such as wagesetting, bargaining, and management of social programs, toward a type of capitalismin which the state abstains as far as possible from interfering in the economicissues of individuals and society because free markets are believed to best regulateeconomics and society. Neoliberal capitalism favors the implementation of a regimethat promotes rules created by and for private owners of capital, particularlytransnational corporations. It has kept democratic governments from asserting rulesof fair competition or countervailing social interests and managed to impose rulesof competition and intellectual property tilted to protect incumbents and theprofiteers of the neoliberalism virus. Neoliberalism has not only shatteredstate-owned companies and sold off public assets, it has generally subordinatedpeople's lives to dominance by market logic and thinking.17 and austerity policies,18 as well as its “normal”performance focusing on short-term rent seeking.20 These are not only the directand indirect victims of the wars and coups to secure the interests and profits ofeconomic elites. Unemployment, impoverishment, exclusion, and environmentaldestruction in the service of—and as a consequence of a supposed increasein—economic efficiency, as the pursuit of profit maximization is euphemisticallycalled, promote the spread of chronic as well as infectious diseases and claim farmore lives than COVID-19. Understanding these connections is certainly moredemanding than reproducing figures and warnings from virologists and otherubiquitous experts with regard to the COVID-19 pandemic,21 but no less correct atall.Neoliberalism is commonly considered an economic theory. In fact, however, it hasbecome a rather toxic ideology. The neoliberalism pandemic causes millions ofpremature and preventable deaths year after year through structural adjustmentprograms in Africa22 Containing this virus isindispensable for improving people's health worldwide and therefore has to be anintrinsic core task of global health. As a serious and ultimate threat to globalhealth, viral neoliberalism is definitely a relevant yet still underestimated topicfor health security. Being key drivers of the syndemic, neoliberal logics havecontributed to a predominant focus on biomedical challenges and solutions to theCOVID-19 pandemic, while relevant environmental conditions and determinants areinsufficiently taken into account in both the health sciences and the politicaldebate on how to deal with COVID-19.20Having said this, it becomes clear that the pandemic caused by the neoliberalismvirus has been and is a public health challenge in itself.2325 The neoliberal science policyprevailing in the global research agenda tends to neutralize political debate bydemanding sound evidence instead of a self-correcting marketplace ofideas.25 The growing penetration of a neoliberal market logic andentrepreneurial practices into academia is part of a deeper, cultural–ideologicalprocess that has increasingly engulfed life sciences.26 Considerable literature isavailable on the implications of neoliberalism for pharmaceutical research,medicine, and health care.27The commercialization and privatization of health, medical, and related research,with its impact on the conduct of bioscientific knowledge-making as a key feature ofneoliberalism, has long been in the interest of scholarship.28 Rather, the neoliberal preoccupation with the individualhas laid the crucial groundwork for biomedical solutions. Disguising theprescription of biomedical solutions and the wider socioeconomic conditions ofneoliberalism is not the result of scientific research in a domination-free worldbut rather a process arising within particular socio-political contexts andrealities of global capitalism that lead to health being increasingly individualizedand medicalized.29It is not only about the overriding power of big pharma and the increasing pervasionof academia by marketization and economization leading to “neoliberaluniversities”.30 While many scholars and practitioners are aware of theessential need for more complex, multidisciplinary approaches for preventing andovercoming health crises, and while policymakers increasingly include references tothe social determination of health in their statements and declarations, this is notyet sufficiently reflected in political decision-making and practice. In the courseof the coronavirus pandemic, it became increasingly clear that the almostunchallenged dominance of virologists in the public, media, and policymaking was notbacked by adequate empirical evidence and deep comprehension in a situation wheretheories, assumptions, findings, and observations sometimes emerged as quickly asthey disappeared again.The biomedical focus tends to overestimate virological and clinical solutions and tomarginalize social and human sciences. Given the increasing evidence for theimportance of the social, political, and economic determination of health, thisreductionism is unjustified vis-à-vis the complexity of global health and can beharmful.3133 substantiallyfavored by the redistribution from public to private and for profit, which ischaracteristic of neoliberalism: In addition to basic vaccine research beingpredominantly public, private firms received massive subsidies for applied research,testing, and distribution of the same vaccines and were simultaneously rewarded withweaker regulatory controls.34Notwithstanding the immaturity of much of the short-lived evidence, the one-sidedfocus on biomedical solutions to the COVID-19 pandemic has managed to marginalizeother important and meaningful approaches to dealing with such a pandemic. Theprevailing biomedical paradigm, and particularly the massive propagation and in someplaces imposition of immature vaccines with limited efficacy, accompanied byconsiderable pressure, brought manufacturers with unimagined, state-subsidizedbillions in profits,35 and its colonial foundation36 and anchored neoliberalthinking even deeper in people's and politicians’ minds. Global vaccine inequity isone of the most outstanding consequences of neoliberal politics.37 The fact thatlow-income countries are forced to compete for the purchase of COVID-19 vaccines andrely to a large extent on the willingness of high-income countries to donate ontheir behalf38 is nothing but another expression of the neoliberal world orderimposing competition-driven markets that have long been proven to lead to structuralviolence and injustice.39At the end of the day, the production and distribution of COVID-19 vaccines suggestthat the pandemic has reinforced rather than questioned the neoliberalhegemony21 Indeed, transferring thedominant approach to fight COVID-19 and the underlying biomedical hegemony in globalhealth to the neoliberal pandemic would consistently raise the claim for aneffective vaccine against the neoliberalism virus. Here, unlike coronavirus or otherinfectious diseases, however, humanity cannot rely on Big Pharma, which definitelybelongs to the profiteers of this pandemic. The same applies tophilanthro-capitalists such as the Gates Foundations or the Wellcome Trust, whichwill have no interest in removing the basis of their prosperity. And, unlikeCOVID-19, the hitherto rather little-known discipline of virology, which hassupplanted all other disciplines since the outbreak of the coronavirus pandemic,will be able to contribute very little, at best. Rather, there is a need for amultidisciplinary approach that includes other medical disciplines and, first andforemost, a broad array of humanities and social sciences. The fact that thepandemic had enormous impact on social, economic, environmental, and other domainsof human life was not adequately reflected in COVID-19 policies.40 As a matterof fact, coercive government responses to the pandemics led to resentment, mistrust,and denial of reasonable measures.41 Likewise, disease-focusedpandemic responses may clash with local priorities, and technical solutions such astargeting the groups most at risk can have undesired effects if context is notunderstood.42Despite all these rather worrying and long-known effects of the neoliberalismpandemic, the articulation of neoliberal logics and the reconfiguring of notions ofscientific and social value in both research and  health policies remaincomparatively unexamined by public and global health scholars. This is surprisinggiven that containing the neoliberalism pandemic would be a crucial step towardimproving the public's health worldwide.43 the new mutation creates anew form of imperialism that overcomes the distinction between high- and low-incomecountries, between the Global North and the Global South, by enabling corporationsto implement a policy of extending power and dominion and to gain economic andsubsequent political control of all areas of society in all countries.If the effectiveness of immunization measures to contain the coronavirus pandemic hasalready been rather limited, close to nothing is to be expected from vaccines toprotect the world from the neoliberalism virus, and even less from its most recentmutation, the corporate world domination variant. Different from the corporateimperialism virus declared dead,44 Fake news, which was so often imputed and deplored inconnection with the COVID-19 pandemic, is systematically created and reproduced byinfluential think tanks, academia, and the media when it comes to neoliberaleconomic beliefs.45 The global context determined by post-truth rules had startedlong before this term was broadly discussed by the general public during the Trumpadministration in the United States. Harry Frankfurt described the promotion ofmyths and half-truths as a kind of intentional nonsense produced without concernwith the truth; faking things does not mean that mythmakers themselves necessarilyget them wrong.46 The impact of neoliberal managerialism, framed by theeuphemistic language about healthy competition, freedom, and individualresponsibility, tends to be even stronger and more powerful.47The neoliberalism virus has proven to be extremely efficient in both manipulatingindividuals and societies and blurring analytics. The virus has a doublestranglehold on a large part of the media, in terms of both content and the economicframework conditions.15 In fact, under the rules of the game set by neoliberalstrategists, pre-existing inequalities have increased and new ones emerged. This isnot at all surprising as the “free play of market forces” did not take place in aspace free of domination. The recently revealed irregularities that occurred in onetesting laboratory for Pfizer's COVID-19 vaccine, and particularly the downplayreaction of government bodies, again prove the dwindling control of the publicsector over transnational corporations.48 Under the rules of viralneoliberalism, politics, society, and the economy are exposed and subordinated towidely asymmetrical power relations. Lowering trade barriers, deregulating publiccontrol and labor relations, and subordinating common goods to profits tends tofavor the strongest and most powerful, but also the most ruthless and courageouscorporations compared to others, where daring and unscrupulousness are often veryclose together.Viral neoliberalism has been very successful in concealing the contradiction betweeneconomic liberalization and the extension of free markets on the one hand, and thegrowth in market power and dominance of corporate entities and monopolies on theother.49Undoubtedly, the nation state has passed its zenith. The governments of practicallyall nations have been more or less openly subverted by transnational corporations.Beyond the general openness of politicians toward economic investments of nationaland increasingly transnational corporations expecting work places and other societalbenefits, this can also be observed in the field of health care and health systems.The literature points to five specific negative impacts, namely, rising globalinequality, reduced wages and increased debt, redistribution of profits toward thefinance sector, growth of personal and financial insecurity, and the relentlesscommercialization of many areas of social and planetary life, including healthsystems.50 the 1981 market-driven health-sector reform inChile,51 various attempts to reform the British National HealthSystem,52 and many countries, particularly in the Global South.53 The manyexamples of direct involvement of transnational corporations, especially those inthe food industry, show how effective neoliberalism has become and has long been inpublic health policy.54 The increasing commercialization of medicine and theprioritization of private (profit) interests over public objectives and policies,which had already deteriorated people's health and well-being before the COVID-19outbreak, turned out to negatively affect countries’ capacity to deal with thepandemic55 and even tend to hinder effective action againstCOVID-19.56Evidence shows that neoliberal reform approaches in the health sector tend to havenegative impacts on key global health issues such as equity and fairness. Among manyothers, this applies to structural adjustment programs implemented since the 1970sin low-income countries,57 A manifesto published almosta decade ago in the Lancet shows that concern about the globallyunjust economic system being a root cause of current problems is by no means new,and that the insinuated alternative has not yet taken hold: “Our tolerance ofneoliberalism and transnational forces dedicated to ends far removed from the needsof the vast majority of people, and especially the most deprived and vulnerable, isonly deepening the crisis we face”.58The somewhat surprising new etatism observed during the initial outbreak of theCOVID-19 pandemic turned out to be short-lived. It not only failed to halt theunstoppable march of transnational corporations, rather it refrained from imposingrestrictions on them. Political decision-makers have either embraced corporateneoliberalism willingly, or they have been intimidated by the threat of corporateretaliation when trying to govern in the public interest.59 Returning to the metaphor of the viral neoliberalism, theparallels with respect to CoV-SARS-2 are striking. COVID-19 is negatively impactinga huge share of humanity, particularly the lower socioeconomic strata of the worldpopulation, and at the same time benefiting a minority of people, mainly in theGlobal North, for whom COVID-19 has brought unimagined income opportunities combinedwith relatively low individual risk.The open, tacit, or coward subordination to the interests and demands of theunrestrained spreaders of the neoliberalism virus has allowed the most influentialglobal players to become the big winners of the pandemic, which has furthercontributed to increasing extreme richness and broadening inequalities in andbetween countries.Powerful charitable organizations are increasingly shaping global health policies andstrategies. Venture philanthropies—the biggest among them the Bill and Melinda GatesFoundation and the Wellcome Trust—have become important actors and drivers in globalhealth. Private-sector billionaires have managed to implement a realphilanthro-capitalist regime contributing an ever-growing share of funding forglobal health. Along with providing enormous financial resources, venturephilanthropies use and heavily promote their own approaches. With theirbillion-dollar donations, the philanthropic foundations drive public policyworldwide. Likewise, they heavily influence academia, science, research, and healthcare supply worldwide. In applying business concepts and market based solutions tocurrent global health challenges—and due to their sheer financial power—theypermeate public policy and people's minds with neoliberal thinking andsystematically impose marketization on humanitarian aid and development cooperation.This is not surprising since charitable global health actors are closely entangledwith powerful transnational corporations, including Big Pharma, medical deviceproducers, and giants such as Google, Microsoft, and Apple.60 The Bill and Melinda GatesFoundation can claim to have made a decisive contribution to vaccine development andthus to the containment of the COVID-19 pandemic with its $50 million transfer tothe Mainz-based manufacturer BioNTech.61 On the other hand, this alsoturned out to be a financial injection into the pharmaceutical company Pfizer, whichdistributes the vaccine worldwide. The U.S. company is taking unrestrained advantageof the pandemic's plight and is selling the BioNTech vaccine at inflated prices,although public funds in the hundreds of millions have flowed or are still flowinginto its development.The declared aim of the foundations is to help the poor and disadvantaged of thisworld to a better life. However, their charity often benefits the wealthy andphilanthropists themselves. For example, the Wellcome Trust holds shares in theSwiss pharmaceutical companies Novartis and Roche, which produce promising drugs totreat severe COVID-19 infections.63 Now, the pandemic has openedup unprecedented opportunities for the vaccine-producing industry to undermine theban on direct-to-consumer advertising. Until now, this trend has generated littleattention among scholars and policymakers. General public concern and insecurityvis-à-vis a new and apparently dangerous health threat and the huge demand forreliable information meets with the need for politicians to implement and justifyeffective preventive measures. This risky mix has been grinding the wall to protectlaymen and laywomen from unproven and often premature information. Journalistseagerly took up all the news and details communicated by vaccine manufacturers andspread them in the general public. The Mainz-based company BioNTech, together withits big transnational ally Pfizer, was particularly effective among the German andother European populations.61 COVID-19-related press news issued since early 2020 aboutthe alleged or measured effectiveness of the vaccine Comirnaty were directly takenup by both policymakers and the press. The resulting positive bias toward theBioNTech vaccine among the German and other European populations65 has certainlycontributed to flush substantial profits into the coffers of BioNTech and Pfizer.Particularly worrisome is the fact that this special form of direct-to-consumeradvertising puts pressure on policymakers to disrespect scientific recommendationsor even make decisions without evidence and thereby further weakens the position ofpublic policies in relation to neoliberal managerialism and entrepreneurship.The yielding of political decision-makers to the de facto pressure of transnationalcorporations is also illustrated by another phenomenon. Direct-to-consumeradvertising of pharmaceuticals has long been criticized, with the United States andNew Zealand being the only high-income countries officially allowing medicineadvertisement to the general public.66 particularlybetween public entities and philanthropic foundations. Governments and UNorganizations are happy to get access to new sources of funding for health, butinvestments in global health have first and foremost become a business case.Vis-à-vis the sheer financial power of private donors and the dominance of businessadministration over human and social needs, charitable billionaires have been ableto increasingly set the agenda in international cooperation. The public sector inboth high-income donor and low-income recipient countries has a rather weak role toplay in PPPs. This asymmetry creates serious governance challenges, which areexacerbated by the lack of accountability posed by the structure and procedures ofphilanthro-capitalists.The market-oriented neoliberal thinking and practice in international cooperation hasmaterialized in so-called public–private partnerships (PPP), which have become anomnipresent tool in global health. There has been a veritable explosion of suchhybrid initiatives between government and non-government entities,67 and they privilegetechnological and bio-medical solutions over strengthening health systems andaddressing structural determinants of health. Hence, it is not surprising that PPPand philanthropic charity are not capable of effectively contributing to overcomingthe global structural inequality and injustice. With the enormous resources investedaccording to the PPPs’ priorities in global health rather than in real needs,philanthropic foundations and PPPs threaten to undermine the efforts of the globalcommunity to improve global health results because they leave, at best, the barriersto achieving health for all untouched, namely, the inequitable distribution ofsocial determinants of health, especially poverty and social exclusion. A sadexample from recent history is the world's inability to confront the COVID-19pandemic by ensuring an equitable distribution of vaccines to poor countries. Thisis particularly striking because the global community has specifically created aninitiative called COVID-19 Vaccines Global Access (COVAX) to ensure global supply.However, COVAX as a kind of super-PPP amplifies governance, accountability, andprofit-driven challenges of philanthropy-supported initiatives and demonstrates theextent to which PPPs have become a default solution to fighting global healthproblems.68 Notwithstanding this blatant failure and the fact thatsuper-PPPs meet all the criteria of a super-spreader of the neoliberalism virus,philanthropy is successfully delivering a form of compensatory moral fig-leaf tocover up the enormous inequalities not only in global vaccine access.20PPPs were initially adopted as mechanisms to address the financial gap in health caredelivery; however, they have increasingly become vehicles to open up health marketsto the private sector. Global health PPP focus on selected disease silos andpredominantly on infectious diseases,59 At the same time, the socioeconomic gap within countrieshas widened.69 In addition, the perversity of an extreme concentration ofglobal wealth is reflected in the fact that the number of billionaires has doubledin the past decade; today, 2,200 billionaires accumulate more wealth than 60 percentof the world population.70The inequitable global distribution of COVID-19 vaccines has highlighted with unusualclarity the extent to which the symptoms of the neoliberal virus are shaping today'sworld. While overall global wealth has significantly grown, the share of low-incomecountries that are home to 8 percent of the world's population has remained below 1percent, and in 26 countries, mostly in Sub-Saharan Africa, per capita wealth hasstagnated or even declined.No doubt, this blatant injustice is a symptom of the neoliberalism disease, which haslong since proven its chronic progressive course. It is still an open questionwhether human resilience can be sufficiently improved by, for example, training thehuman immune system or stimulating antigen-specific T cell or other immunologicresponses. Transferring the approaches taken to fight the SARS-CoV-2 pandemic,developing a new type of vaccines is definitely required for protecting the worldpopulation from ever more detrimental effects of viral neoliberalism. Achieving herdimmunity by a mix of measures, including vaccination, is certainly the only way toeliminate the neoliberalism virus. This is of course an extremely demandingundertaking in view of the unequal distribution of financial resources and power, akind of updated form of David vs. Goliath.Sustainability might be a promising approach for pushing back viral neoliberalism.The fear of irreversible damage to the earth and deterioration in the quality oflife worldwide have become global concerns. There is growing awareness of theexisting productive systems and consumption patterns threatening the continuity ofthe existing living conditions. The inequitable and undemocratic nature of thecurrent economic system is unsustainable because it endangers the planet'spossibilities for supporting and reproducing life. To enable sustainable living, itis ultimately inevitable to impose political limits on corporate power, because evenbroader and stronger mass protest movements will be unavailing as long asgovernments refrain from tackling and shackling the corporate miscreants.


Background. Congenital absence of the portal vein (CAPV) is an extremely rare malformation that is caused by aberrant venous development during embryogenesis and is usually associated with congenital portosystemic shunts (CPSS). This hemodynamic allows mesenteric blood to bypass the liver metabolism and causes an imbalance between vasodilators and vasoconstrictors in the pulmonary circulation, which, again, might lead to the development of secondary portopulmonary hypertension (PoPH). Establishing the exact morphology of the splanchnic venous system is important when evaluating possible therapeutic options (differentiating type I and II CAPV), because some variants enable the closure of the shunt, and this represents a potential cure for pulmonary arterial hypertension (PAH). Once PoPH is diagnosed, complex care in a specialized expert centre is necessary. If possible, CPSS closure is recommended. For long-term successful patient management, specific targeted PAH therapy administration is crucial. Significant morbidity and mortality in these patients may result not only from PAH itself but also due to specific PoPH complications, such as compression of the left main coronary artery by pulmonary artery aneurysm. Case Report. We report on two patients with PoPH due to CAPV and CPSS (without any liver disease) who presented as severe PAH and who, before admission to our expert centre, were misdiagnosed as idiopathic PAH. The case reports also represent our experience with respect to the long-term follow-up and PAH-specific medical treatment of these patients, as well as the possible  complications of these rare and complex patients. Congenital absence of the portal vein (CAPV) is a rare malformation that is caused by aberrant venous development during embryogenesis. CAPV is usually also associated with the presence of a congenital portosystemic shunt (CPSS), where the blood carried by the superior mesenteric vein and the splenic vein bypasses the liver and is drained directly into the systemic venous circulation. This abnormal mesenteric drainage causes the loss of physiologic hepatic clearance, and this—again, due to a long-term significant imbalance in the vasoactive substances involved in normal pulmonary vascular integrity—may result in the development of secondary pulmonary arterial hypertension (PAH) ,2.The first case of CAPV was reported by John Abernethy in 1793 based on the post-mortem examination of a 10-month-old female, which showed the termination of the portal vein in the inferior vena cava at the insertion level of the renal veins and multiple other congenital anomalies, including dextrocardia, transposition of the great vessels and polysplenia [Type I—end-to -side anastomosis with a complete portosystemic shunt exhibiting no visible portal flow in the liver due to the absence of intrahepatic portal veins. The malformation is female-predominant and associated with other congenital abnormalities, such as cardiac defects.Type II—side-to side-anastomosis with hypoplastic intrahepatic portal veins, and the liver is perfused with portal blood in the presence of a partial shunt  .Various classifications for the evaluation of extrahepatic portosystemic shunts have been proposed. The most practical and most frequently used in the literature is the classification by Morgan and Superina, who divided CPSS in two types based on whether or not the hepatic parenchyma is perfused with blood from the mesenteric venous system :Type I—eAdditionally, type I is subdivided into two further types depending on the anatomy of the portal vein. In type Ia, the splenic vein and the superior mesenteric vein drain separately into the inferior vena cava or the left renal vein, while in type Ib, a confluence of the superior mesenteric and splenic veins is present, but it does not supply the liver ,6.According to this classification, CAPV associated with extrahepatic portocaval shunts can be referred to as an Abernethy type I malformation. To provide an accurate assessment of the patency of the intrahepatic veins, an angiography with the occlusion of the shunt should be performed so as to confirm the assumed absence of intrahepatic veins or presence of remnant hypoplastic hepatic branches ,8.To our best knowledge, only 182 cases of patients with Abernethy type I malformations have previously been reported in the literature .A 41-year-old male with a history of frequent respiratory infections during childhood was under long-term observation for idiopathic PAH. This diagnosis was established at the age of 4 by right heart catheterization (RHC), when the mean pulmonary artery pressure (mPAP) was 41 mmHg. Congenital heart defect was excluded, and pulmonary arteriopathy with medial hypertrophy and intimal thickening upon lung biopsy was histologically confirmed.The patient was clinically stable for 19 years, with no dyspnoea during physical activities (New Your Heart Association (NYHA) class I). After this period, he was re-evaluated due to the occurrence of shortness of breath on exertion and significant fatigue. On an electrocardiogram (ECG), a previously documented incomplete right bundle branch block was observed, and transthoracic echocardiography showed preserved systolic function of the dilated right ventricle, without tricuspid regurgitation. An invasive haemodynamic assessment confirmed the presence of severe PAH (mPAP 59 mmHg), pulmonary capillary wedge pressure (PCWP) of 8 mmHg and pulmonary vascular resistance (PVR) of 7.2 Wood units (WU), with no vasoreactivity . Due to During the next nine years, the further progression of dyspnoea and reduction in exercise capacity continued. At the age of 31, the patient was admitted to our department due to decreased physical function (NYHA class III), with peripheral oedema, severe hoarseness and abdominal discomfort. An abdominal ultrasound showed fibrotic liver remodelling without a nodular lesion and mild ascites. On Doppler imaging, blood flow was present only in the dilated hepatic veins, with no portal flow in the liver. Computed tomography confirmed the intrahepatic absence of the portal vein, with a confluence of the superior mesenteric vein and splenic vein, which were draining directly into the inferior vena cava through a CPSS. Other indirect signs suggestive of CPSS were a slightly higher level of ammonium in the blood and an electroencephalogram (EEG) pattern of encephalopathy. Throughout the years, no liver nodules were observed on ultrasound. Esophagogastroduodenoscopy showed no signs of portal hypertension . The blood level of the liver enzymes was in the normal range. Echocardiography showed a dilated right ventricle a with miIn the light of these results, the diagnosis was reclassified as PoPH due to CAPV, with severe secondary PAH. The atypical clinical symptom, hoarseness, was diagnosed as a result of laryngeal nerve paresis due to the dilated pulmonary artery. According to the guidelines already available at that time, PAH-specific therapy with phosphodiesterase-5 inhibitor sildenafil was initiated with concomitant therapy for right heart failure, including diuretics and spironolactone.During the further follow-up, clinical improvement was observed after the specific therapy had been started . The patOn the other hand, despite good clinical results, the dilatation of the pulmonary artery progressed. This was manifested by computed coronary angiogram, which revealed compression of the left main coronary artery (LMCA) and the proximal left anterior descending artery by severely dilated pulmonary artery . HoweverAfter 11 years of specific PAH treatment with a stable clinical condition, the patient was admitted to a regional hospital with a history of fever lasting for 3 days, shivering and a cough associated with angina. In the laboratory results, a high level of troponin and inflammatory markers  were present. In the regional hospital, several paroxysms of ventricular tachycardia and ventricular fibrillation occurred, with a need for defibrillation.The patient was transferred to our heart centre on suspicion of acute coronary syndrome associated with severe pneumonia. Upon admission to the intensive care unit, he was orthopneic, cyanotic, hypotensive and on vasopressors and inotropic support, with a need for repeated electric cardioversion due to runs of ventricular tachycardia. Coronarography revealed critical ostial stenosis of the LMCA artery due to extraluminal compression by the extremely dilated pulmonary artery , withoutA 44-year-old woman with a previous long-term history of splenomegaly and mild thrombocytopenia was first admitted to a regional hospital as a 26-year-old after several syncope episodes provoked by exertion. On physical examination, a mild diastolic murmur above the pulmonary valve and accentuated second heart sound were present. An echocardiogram revealed the D-shape of the left ventricle with ventricular sept flattering and an enlarged right ventricle a with miDuring the next five-year follow-up period, the slow progression of dyspnoea and intermittently, mildly increased liver function, observed upon blood test, , occurred, accompanied by discrete peripheral oedema. An abdominal ultrasound revealed massive fibrotic changes in the portal vein, with no blood flow, normal liver parenchyma and splenomegaly. The subsequent computed tomography (CT) angiography diagnosed the agenesis of the portal vein, with a huge portosystemic shunt from the dilated splenic vein to the left renal vein . No liveThe diagnosis was re-classified as PoPH due to CAPV. The patient received consultation at a foreign surgical centre specializing in congenital vascular malformations and surgical reconstruction. Neither transcatheter shunt closure nor liver transplant were recommended. Afterwards, according to guidelines, PAH-specific therapy with selective treatment for the type A endothelin receptor antagonist (ERA), ambrisentan, was initiated.Within the next 3 months, clinical improvement was demonstrated, with increased exercise capacity, NTproBNP normalization and a mild reduction in the size of the right ventricle and PAH . This faDuring the further follow-up period, after 10 years of specific PAH treatment, a mild deterioration in the exercise capacity (NYHA II), elevation of the NTproBNP blood levels and progression of RV dilatation were observed . A combiCAPV was a rare condition in the past, but with advances in imaging techniques, the number of patients with detected CAPV has increased. The age at diagnosis is variable and ranges from the prenatal period to late adulthood .CAPV can cause a broad spectrum of clinical manifestations, which can result from concomitant congenital malformations or from subsequent syndromes.Patients may be asymptomatic or present with features suggestive of a portosystemic shunt, such as hyperammonaemia, hypoalbuminemia, hypergalactosemia and mild liver function test abnormalities. This may result in persistent jaundice, growth failure, mental retardation or some stage of encephalopathy, chronic liver disease or an acute hepatic decompensation and hemorrhoidal bleeding .CAPV is frequently combined with a benign or malignant hepatic neoplasm. Focal nodular hyperplasia is common, but an adenoma, hepatoblastoma or hepatocellular carcinoma may also occur ,12. A scAdditionally, CAPV is often associated with genetic cardiovascular abnormalities , gastrointestinal abnormalities  or other skeletal and visceral anomalies. No associated congenital malformation was detected in our patients.Significant morbidity and mortality may result from PoPH and hepatopulmonary syndrome. Although more publications dedicated to CPSS have been published lately, the vast majority are single case reports or cross-sectional studies without follow-up and a combination of patients with different types of CPSS ,13,14,15PoPH is a severe but well-known complication of portal hypertension among patients with or without underlying chronic liver disease. PoPH is defined as PAH  in patients with portal hypertension , and it is a subset of group 1 pulmonary hypertension .According to the published studies, PoPH occurs in 2–6% of patients with a pathologic or surgical portosystemic shunts . On the Histologically, the pulmonary vasculature in patients with PoPH shows plexiform lesions, medial hypertrophy, intimal fibrosis, adventitial proliferation and evidence of microthrombi, similar to idiopathic PAH. While the hemodynamic profile of patients with PoPH is better than that of patients with idiopathic PAH, their overall mortality is comparable or worse .The underlying mechanisms of the development of PoPH continue to be an area of active research. Postulated mechanisms of the development of PoPH include increased pulmonary blood flow and altered vascular compliance, leading to increased shear stress due to splanchnic vasodilatation and the formation of portosystemic shunts, which is a mechanical component.As mentioned above, the presence of congenital portosystemic shunts, even in the absence of advanced liver disease and an increased portal pressure gradient, enable the shunting of the vasoactive substances by bypassing the liver metabolism and causing an imbalance between the pulmonary vasodilators and vasoconstrictors. The imbalance between these vasoactive substances in the pulmonary vasculature  results in the injury of the pulmonary vessels, vasoconstriction and A subsequent increase in pulmonary vascular resistance .Permanent vascular remodelling mediated through bone morphogenic protein 9 (BMP9), bone morphogenic protein receptor 2 (BMPR2) and Toll-like receptors (TLRs) activated by bacterial lipopolysaccharides (LSP) is under active research .In our work, we reported two cases of CAPV that presented as PAH without severe liver diseases, which were initially misdiagnosed as idiopathic PAH due to the lack of information on the aetiology and pathophysiology of PAH. Portal vein malformations and CPSS should be included and considered in the differential diagnosis of PAH, especially in paediatric or young patients. Here, we present an algorithm recommended for the diagnosis and follow-up of patients with CPSS and PAH .Establishing the presence or absence of the intrahepatic vein is important when evaluating possible therapeutic options. The surgical or percutaneous closure of the shunt is possible only for Abernethy type II extrahepatic CPSS . Unlike In cases of CAPV and PAH, liver transplantation is still considered as a primary option and should be accounted for early in the disease course so as to anticipate the development of severe PAH, pulmonary vascular remodelling and subsequent right ventricular dysfunction at the time of transplantation . Our patTo prevent the progression of PAH, it is important to initiate an early and effective treatment with a specific pharmacotherapy for PAH that includes prostacycline analogues, phosphodiesterase-5 inhibitors and endothelin receptor antagonists .In patients with already existing severe PAH, the regular evaluation of possible complications is crucial. PAH is an important cause of pulmonary artery dilatation, and this may be a reliable indicator of PAH. When the pulmonary artery diameter exceeds 40 mm, it is defined as a pulmonary artery aneurysm .The extrinsic compression of LMCA by a pulmonary artery aneurysm is extremely rare but represents an important cause of sudden cardiac death in patients with PAH. In a recent study, a prevalence of 8.2% among patients with PAH was reported . LMCA coAortocoronary bypass and unprotected LMCA stenting are the currently available revascularization strategies. However, in asymptomatic patients, as in our cases, no clear recommendations exist. Some authors have described an improvement in compression after the intensification of a specific PAH therapy .Considering the high surgical risk in the context of severe PAH, LMCA stenting is usually favoured as the revascularization strategy of choice . The larPortal vein malformations and CPSS should be included and considered in the differential diagnosis of PAH, especially in paediatric or young patients. Congenital portosystemic malformations represent an important and potentially treatable cause of PAH and, therefore, a careful assessment of the anatomy and testing of the portal vein hemodynamic should be performed before the possibility of a correction is declined. For CAPV, the options for corrective interventions are limited, and the patients are candidates for a liver transplant.Even though recent years have seen the publishing of complex studies dedicated to CPSS, the natural course and prognosis of patients with CAPV remains unclear. The wide range of ages at diagnosis suggests that CAPV is not a fatal condition, and the comorbidities determine its course. A regular lifelong follow-up, including laboratory tests, image screening, echocardiography and the examination of respiratory functions, is recommended in order to provide the early detection and treatment of possible complications.We define the PoPH as one of the major complications of CAPV, and once it is diagnosed, it is crucial for patients to undergo management and complex care in a specialized expert centre, where specific, targeted therapy can be administrated.


Deepwater Horizon (DWH) oil spill. This anticipated multidecadal restoration was made possible by dedicated settlement monies, distributed over the past decade as governed by the RESTORE Act of 2012 and other legal vehicles, which are today approaching one-half spent or committed. Thus, in our view, it is important to take stock of progress and, looking forward, to make recommendations regarding strategies for evaluation and management.In 2020, the National Academies of Sciences, Engineering, and Medicine (NASEM) Gulf Research Program created the Committee on Long-Term Environmental Trends in the Gulf of Mexico. Our committee was tasked to consider the synthesis of additive, synergistic, and antagonistic cumulative effects resulting from ecosystem restoration following the 2010 It is timely to examine the collective effects of coastal restoration across the five US states because the spatial and temporal coordination of restoration throughout a geographic region can substantially increase the return on investment . By the Synergistic and antagonistic interactions are a basic and cross-cutting concept addressed throughout our recent report . Ecologi4A robust consideration of restoration-related changes must also include the impacts of acute events  and long-term environmental trends  on the valuable resources along the dynamic, spatially variable coastline of the US Gulf of Mexico (GoM). Yet, while the US West and East Coasts have hosted environmental synthesis centers since 1995 and 2011, respectively, the Gulf Coast does not have a scientific body performing similar functions. Here we argue that the time for synthesis of data and products from GoM restoration projects is now and the need is urgent.1)understanding and accounting for synergistic and antagonistic effects of restoration;2)incorporating long-term trends and acute events in background environmental conditions; and3)evaluating the spatial and temporal scale of restoration effects relative to other environmental changes.One way to synthesize and evaluate large-scale restoration involves applying the concept of cumulative effects. The cumulative effects of restoration are the collective additive, synergistic, antagonistic, or null effects of all restoration activities that occur within a setting defined by common or connected characteristics of hydrology, geomorphology, ecology, ecological function, and biodiversity. There remain three critical challenges to the measurement of effects that must be addressed to encompass the full cumulative effects of large-scale restoration:In ecosystem restoration practice, inherent constraints make carefully designed experiments the exception, not the norm, and this tradition appears to have continued across the GoM since settlement-funded restoration began. The GoM itself or individual estuaries, bays, and watersheds are the experimental units for restoration effects and cannot be replicated to support a formal experimental design. Restoration since the spill has proceeded partially in a coordinated fashion but also has occurred in an ad hoc manner due to the manifold participants including five US states, multiple federal agencies, and two new organizations . Eighteen funding streams empowered by the settlements , synergistic (interactions are greater than the sum of the parts), antagonistic (interactions are less than the sum of the parts), or null in effect. Any of these interactions may be viewed as positive or negative, depending on the objectives, values, and perspectives of assessors. Understanding the potential end results of these interactions and how they can enhance restoration, both through positive synergies and by avoiding negative antagonistic interactions, should be a desirable goal for all restoration funders.Although understanding remains incomplete and worthy of pursuit, some evidence exists for each of these types of interactions among and between human-constructed ecosystem restoration projects . EcosystIncomplete understanding poses a vulnerability for effective planning and engineering. Activities may blunt or, conversely, augment the expected gains from restoration. This has the potential to either reduce the cost effectiveness of restoration projects if unexpected antagonistic effects occur or to generate larger returns than expected if unexpected synergistic effects occur. Syntheses of cumulative effects focused on certain types of restoration method , or of two or more methods used in proximity to one another, therefore have the potential to directly inform advances in future ecosystem-restoration applications. A spatial example is that effects driven by localized environmental conditions that may not be replicated elsewhere may lead to a false indication of the value of restoration. A temporal example is when effects occur in the short run but disappear over longer durations . The true expected outcomes of restoration may be confused with the activities implemented or with preliminary initial outputs .Acute events and long-term environmental changes could have profound effects on the individual impacts and cumulative effects of restoration projects in the GoM. As well as inherent evolution of the system, anthropogenically exacerbated nonstationarity affects the physical and biological components of the ecosystem in wide-ranging ways  or hot moments (periods) (HSHM) . CombineSynthesis in ecology aims to discover new knowledge by bringing information together and has been defined for estuarine and coastal science as “the inferential process whereby new models are developed from analysis of multiple data sets to explain observed patterns across a range of time and space scales” . Why is 18Our review found that management of recoveries in Chesapeake, Tampa, and Galveston Bays, led by recognized regional entities, implemented essential elements of a lines-of-evidence approach to synthesis, though not using this terminology , 21–23. 21Using multiple lines of evidence helps to compensate for the inability to use traditional experimental designs, lack of reference conditions, lack of replication, difficulties in establishing causality, and often the shortage of appropriate data . AdoptioSynthesis and evaluation outcomes of interest to researchers, policymakers, or other stakeholders may be typical environmental and restoration endpoints such as ecosystem processes  or the type or biodiversity of restored systems . Alternatively, they may be focused on ecosystem services from specific organisms  or performance targets . While they may also understandably be focused on political or community units , the use of ecological boundaries for studies is encouraged, particularly where estuaries or watersheds are bistate. The use of ecological boundaries for analysis tends to produce greater fidelity and utility than environmental analyses conducted according to jurisdictional boundaries. Given all of these needs, the lack of an entity charged with conducting environmental synthesis across the GoM region is counterproductive to the cost-effective and impactful implementation of settlement monies through the restoration of productive ecosystems.


Lipid membranes are abundant in living organisms, where they constitute a surrounding shell for cells and their organelles. There are many circumstances in which the deformations of lipid membranes are involved in living cells: fusion and fission, membrane-mediated interaction between membrane inclusions, lipid–protein interaction, formation of pores, etc. In all of these cases, elastic parameters of lipid membranes are important for the description of membrane deformations, as these parameters determine energy barriers and characteristic times of membrane-involved phenomena. Since the development of molecular dynamics (MD), a variety of in silico methods have been proposed for the determination of elastic parameters of simulated lipid membranes. These MD methods allow for the consideration of details unattainable in experimental techniques and represent a distinct scientific field, which is rapidly developing. This work provides a review of these MD approaches with a focus on theoretical aspects. Two main challenges are identified: (i) the ambiguity in the transition from the continuum description of elastic theories to the discrete representation of MD simulations, and (ii) the determination of intrinsic elastic parameters of lipid mixtures, which is complicated due to the composition–curvature coupling effect. Lipid membranes are ubiquitous in living systems. The structural unit of these membranes is a lipid molecule that can be divided into two parts: a hydrophobic hydrocarbon tail and hydrophilic head. Lipids tend to diminish the contact of their tails with water, and therefore, lipid membranes usually exist in the form of a bilayer: two layers (monolayers) of lipid molecules, the hydrophobic tails of which are hidden inside a membrane from the contact with water. The most common example of a lipid membrane is the plasma membrane, which provides an almost impermeable shell for living cells, protecting them from the external environment. Except for plasma membranes, lipid membranes also constitute a boundary of organelles: nucleus, endoplasmic reticulum (ER), Golgi apparatus, lysosomes, mitochondria, vesicles, vacuoles, etc. In addition, lipid membranes are a part of the envelope of some viruses .Experimentally, it is known that lipid membranes possess elasticity ,3,4,5,6:strain, while the strain coefficients in the elastic energy are called elastic moduli. While strain is a variable quantity, elastic moduli are fixed constants and thus represent the property of a considered membrane. However, elastic moduli are not the only property, as the elastic energy can also contain spontaneous values of strain. In the following, elastic moduli and spontaneous strain are referred to as elastic parameters of lipid membranes. In general, elastic parameters depend on lipid composition. It is known that there is a variety of different lipids that comprise the membranes of living cells . As. As83]. Another challenge concerns the determination of elastic parameters of lipid mixtures. Elastic parameters of lipid mixtures are of particular interest since cell membranes are multicomponent ,27. HoweIn conclusion, although a significant development of MD approaches for the determination of elastic parameters of lipid membranes has occurred since the advent of the MD, several problems still exist with the application of these approaches. In particular, two main challenges have been identified: (i) the ambiguity in the transition from the continuum description of elastic theories to the discrete representation of MD simulations, and (ii) the determination of intrinsic elastic parameters of lipid mixtures, which is complicated due to the composition–curvature coupling effect. Further development of the MD approaches for the determination of lipid membrane elastic parameters will contribute to obtaining new insights into the biological role of mechanical properties of lipid membranes and their lipid composition in the life cycle of living cells.


Craniocerebral injury accounts for 9%-21% of the injuries in all parts of the body, and the incidence rate ranks first in all types of trauma or only lower than limb fractures. This study mainly discusses the nursing methods of patients with severe traumatic brain injury and fractures in ambulances. This study is based on risk factors with moderate-to-higher association strength from retrospective studies. According to the regression coefficients of the logistic regression model, the risk factors were assigned, and the early warning score table of craniocerebral injury complicated with hyponatremia was established. The energy efficiency of the early warning score table was evaluated by case diagnostic test and ROC analysis. At the same time, risk grading is carried out, and the chi-square test is used to test the reliability of the grading standard, so as to identify the risk of hyponatremia in patients with craniocerebral injury early and screen out high-risk patients as the key observation objects of nurses. Based on the early warning score table of craniocerebral injury complicated with hyponatremia, different systematic nursing intervention measures were taken for low-risk patients and high-risk patients, and their application effects were evaluated. The clinical application effect of the systematic nursing intervention program was evaluated by the historical control research method, which provided a reference for the nursing in the ambulance to prevent other complications of patients with craniocerebral injury. The positive rate of prehospital operation can reach 64.44%, and the specific rate can reach 84.44%. 60% of the sample sought better metastatic care in terms of the purpose of using an ambulance. The systematic nursing intervention program has a certain effect on reducing the incidence of hyponatremia in patients with craniocerebral injury and shortening the hospitalization time of patients with craniocerebral injury. The early warning score of craniocerebral injury complicated with hyponatremia developed in this study is concise and practical and can provide a basis for clinical assessment of the risk of hyponatremia in patients with craniocerebral injury. Managers should pay attention to the accident knowledge education of nurses with different characteristics. Better knowledge of prehospital emergency care can make care in the ambulance easier and reduce the infection rate of patients. For nurses with advanced age, high education, and high professional titles, they should improve their accident knowledge training to maintain the accident knowledge level of the whole nursing team. At the same time, strengthening accident rescue drills and enhancing nurses' accident rescue experience through scenario drills will help improve nurses' accident knowledge. The opportunities of early shifts in departments, nursing rounds, and group teaching should be actively used, promoting the learning of accident knowledge through theoretical lectures, scenario reproduction, and group discussions. As a professional public health institution, emergency centers (stations) are closely related to the lives and health of the people. They are the forefront of rescuing patients and have obvious medical and social benefits. Moreover, the prehospital medical emergency in the region should be adapted to the local, social, and economic development conditions and the needs of emergency services. Therefore, to carry out research on the construction and management of the prehospital medical emergency system is to promote emergency centers (stations) to provide better quality. It is an essential process for prehospital medical emergency services that are more efficient and better suited to the actual needs of the masses.Nurses have multiple identities as nurses, educators, and psychological supporters in accident rescue, which requires accident training to take into account all aspects of accident rescue, especially psychological rescue skills which refers to providing humanitarian support to those who have suffered trauma and need support. This is related to whether the victims can reintegrate into society and rebuild their confidence in life after the disaster. Therefore, nursing managers should comprehensively plan the content of accident training, combine diversified training methods, and make full use of social and cultural support to meet the mental health needs of nursing rescue team members, by holding emotional and mental health training courses, providing desktop and on-site crisis simulation exercises to promote the improvement of various accident skills of clinical nurses. This research fills the blank of comprehensive and systematic research on prehospital medical emergency and integrates the modules of legislative guarantee, emergency mode, infrastructure construction, resource allocation, and rescue dispatch to build an interconnected and organic prehospital emergency system.The junior nurses have gradually become the main force of the nursing team, and the number of nurses with a bachelor's degree or below who graduate every year is still relatively large. Therefore, hospital administrators in this region pay special attention to the comprehensive development of low-level nurses' theoretical knowledge, skills, and management ability, which promotes the development of clinical low-level nurses' accident management ability. Nursing managers should increase the opportunities for nurses to participate in accident rescue experience, build an emergency medical service system, expand and strengthen theoretical and skill training, and establish nursing education institutions with formal training qualifications. Develop targeted accident nursing courses and disaster prevention procedures according to the characteristics of nurses, strengthen disaster nursing construction, and organize training regularly to improve nurses' accident knowledge, accident skills, accident management, and overall accident preparedness. The article firstly adopts the factor analysis method for the specific index innovation of the construction and management of the municipal emergency center, grasps the status of prehospital medical emergency construction and management in each city from a macro perspective, and then analyzes the operation status of the emergency center and the maturity of construction management. For nonemergency transportation services, in the factor analysis, the KMO value is 0.801.n = 226) and tenascin-C knockout (n = 9) C57BL/6 male adult mice underwent sham or filament punch SAH modeling. Vehicle, anti-periostin antibody, or recombinant periostin was administered randomly by intracerebroventricular injection 30 minutes after modeling. Neuroscore, SAH grade, brain water content, immunostaining, and western blot were assessed blinded 24 to 48 hours after SAH. Periostin was induced in brain capillary endothelial cells and neurons 24 hours after SAH. Anti-periostin antibodies ameliorated post-SAH neurobehavior, brain edema, and blood-brain barrier disruption associated with tenascin-C downregulation, p38 inactivation, extracellular signal-related kinase 1/2, and matrix-related [The treatment and care of patients with craniocerebral injury during hospitalization not only require the participation of medical staff but also require family members to undertake a large part of the care work. Taylor et al. believe that traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of major mechanisms, including motor vehicle crashes, falls, and assaults. He described the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths in 2013 and compared them with similar estimates in 2007. State-based administrative healthcare data were used to calculate estimates of TBI-related ED visits and hospitalizations based on primary mechanism of injury, age group, gender, and injury intent. Categories of intent to harm include unintentional , intentional (self-harm and assault/homicide), and undetermined intent. These health records are derived from the Healthcare Sample and Utilization Project's National Emergency Department Sample and National Inpatient Sample [The selected cases were patients with craniocerebral injury who were discharged from January 2018 to December 2019 in a comprehensive tertiary hospitalAll the included patients were hospitalized for more than 3 days and were diagnosed with craniocerebral injury, including concussion, skull fracture, and brain herniation, after clinical diagnosis and head CT examination. They did not include cases of isolated scalp injury, chronic subdural hematoma, and skull defect; age ≥ 15 yearsPatients with abnormal thyroid and adrenal function were excluded; patients with hypernatremia after admission were excluded. A total of 79,480 patients with severe craniocerebral injury and fractures were collectedAccording to the surgical method, the patients were divided into three groups: hematoma removal, drilling and drainage, and debridement and suture. Each group was further divided into two groups: with and withoutAccording to whether there is coinfection and high fever, they are divided into two groups: yes and no. Infections include pulmonary infection, intracranial infection, and urinary tract infection. Hyperthermia was defined as a body temperature higher than 38 degrees during hospitalization for two or more daysThe patients were divided into two groups according to whether the patients were fasted or not and whether vomiting occurredAccording to the past history of hypertension and diabetes, the patients were divided into two groups: with and withoutAccording to the admission diagnosis, concussion, cerebral contusion, skull fracture, and brain herniation were divided into two groups with and without. This study mainly explored the effects of systematic nursing interventions on hyponatremia in patients with craniocerebral injury, which belonged to a quasiexperimental study. Therefore, the estimation of the sample size of the experimental study can be taken . (1)N=UαCondition evaluation function , 8:(2)fα1, α2, α3, ⋯, αn is the weight coefficient, which is the reflection of the contribution to f under the same percentage increment.Among them, Assuming that the contribution of each index to the judgment result is the same, a total judgment function is obtained :(3)G=β1Among them,x is the relevant variable.where Due to differences in social and economic development, geographical characteristics, population density, and other factors in different regions, the development of prehospital emergency medical services is not balanced. Each region fully considers its own situation and combines the advantages and disadvantages of different models to carry out local prehospital emergency models. The choice of the national unified prehospital first aid model has not yet been formed.An analysis database was established, in which variables included call time, reaction time, basic information of patients with severe craniocerebral injury and fractures, cause of injury, injury site, injury address, prehospital index , and other research indicators .According to the ability scope of prehospital emergency work after traumatic brain injury, there are requirements of key items of prehospital emergency care for traumatic brain trauma and the characteristics of prehospital emergency treatment of guiding trauma. In this study, the main points of prehospital first aid for craniocerebral trauma were integrated into the trauma information collection table, including pulse oximetry monitoring (it measures the oxygen level in the blood), state of consciousness assessment, and pupil observation. The maintenance of airway patency, resuscitation, and prevention of brain herniation are listed in the prompt section under prehospital diagnosis. At the same time, the medical record information of craniocerebral trauma was edited into 26 medical record identification information of 4 grades (I-IV). Among them, I represents the type of craniocerebral injury, which is a single choice. II-IV represent the characteristic symptoms and signs of traumatic brain injury, divided into common options and unique options. III can make multiple choices, and IV needs to make single choice and fill in. The specific identification information is shown in Open injuries: there are wounds with skin injuries, some of which often bleed, and closed injuries are easy to be misdiagnosed and mistreated. Because open injuries have wound bleeding, more emphasis is usually placed on timely treatment.Closed injuries: usually there is no wound, and there may be no skin bleeding. Since there is no wound, closed injury combined with visceral injury is usually ignored in the early stage, which can easily lead to misdiagnosis and delayed treatment.Case Grouping. Patients with craniocerebral injury were divided into hyponatremia group and normal serum sodium group according to whether hyponatremia occurred. Hyponatremia was defined as the serum sodium ion concentration less than 135 mmol/L measured once during hospitalization, which was determined as hyponatremia.Model Establishment. Extract the multivariate logistic regression analysis results of the risk factors  established in the first part of the study as the moderately strong association. A logistic regression model (a classification model and a type of linear model) was established, and the regression coefficients of each risk factor were extracted as the score of each risk factor, and an early warning score table for craniocerebral injury complicated with hyponatremia was established.Efficacy Evaluation. Calculate the specific scores of the patients in the hyponatremia group and the normal serum sodium group according to the early warning score table. The scores are arranged in ascending order, and multiple different critical values are set between the lowest score and the highest score, draw the ROC curve, the larger the area under the ROC (receiver operator characteristic curve) curve, the better the energy efficiency .Risk Classification. Calculate the Youden index (the sum of sensitivity plus specificity minus 1) according to the sensitivity and specificity of each group. The larger the Youden index, the better the effect of the screening experiment and the greater the authenticity. Finding the score corresponding to the sensitivity and specificity when the Youden index is the largest, when it is less than this score, it is a low-risk group, and when it is greater than this score, it is a high-risk group. The medical information warning is shown in (v) Monitoring of Vital Signs. The researchers communicated with doctors and responsible nurses and closely monitored the blood pressure, pulse, and respiration, especially the state of consciousness of patients in the high-risk group. Once it is found that the disturbance of consciousness is aggravated and clinical manifestations such as apathy, irritability, and lethargy appear, be alert to the occurrence of hyponatremia, and test serum sodium ions in time.The prediction model based on the characteristics of the emergency medical service system can quantitatively reflect the severity and type of traumatic brain injury fractures, but simple indicators cannot accurately reflect the condition and prognosis. The constructed prediction model based on the baseline characteristics of patients in emergency hospital and the characteristics of emergency medical service system and blood biochemical indexes has high prognostic discrimination ability in both the training group and the test group. The sample size calculation formula when sampling survey is used and the analysis index is count data , 13:(5)α is the significance level, set at 0.05.where The Kendall harmony coefficient is calculated by SPSS 16.0 software, and the calculation formula is (6)W=12mn represents the number of nursing-sensitive indicators, and m represents the total number of experts who have been consulted [onsulted .The formula for calculating the coefficient of variation is , 17(7)CS is the standard deviation.Infectious disease dynamics models for intra- and interhost coupling :(8)dsdtE(t) is the slow time term [ime term .According to the survey results of emergency death cases in 2018, four indicators of prehospital death were selected, including the fatality rate on arrival at the scene, the in-hospital response time of the ambulance, the time of the ambulance arriving at the scene, and the disposal rate of various prehospital first aid measures. Four indicators were compared, including the 1-minute attendance rate of the first-visiting doctor, the 5-minute attendance rate of second-line or superior doctors, the 30-minute attendance rate of consulting doctors, and the treatment rate of various emergency measures in the emergency department. Six indicators were compared, including in-hospital ward deaths selected for the first doctor's order issuance rate within 5 minutes, the consultation physician's attendance rate within 30 minutes, the start rate of blood transfusion within 30 minutes, the start rate within 30 minutes of surgery, the report rate of routine blood tests within 15 minutes, and the report rate of biochemical tests within 15 minutes. The ambulance rescue process is shown in The age, gender, occupation, location of injury, time of injury, injury mechanism, method of arrival, whether or not to be transferred, time of admission, hospital level, place of death, and cause of death for patients with severe craniocerebral injury and fractures were selected as 12 factors that may affect emergency death as the research indicators, and quantify and assign values to the above variables. The names and assignments of the research factors are shown in f test, variance analysis, and multiple linear regression description. P < 0.05 was considered statistically significant difference.SPSS , “Statistical Product and Service Solutions” software, was used. The original software was called “Statistical Package for Social Sciences.” The data were imported into SPSS 16.0 software, and the statistical methods included descriptive statistics, mean, standard deviation, The frequency table was made by counting the calling time, ambulance arrival time, age, gender, cause of injury, injury site, injury area, and PHI score  of the patients with severe craniocerebral injury and fractures, and use Excel 2007 to calculate side-by-side charts to study the distribution law of trauma epidemiology [DS is the fast time item. The corresponding time variable is S.T(S), T∗(S), V(S)) of the model satisfies the following initial conditions [It is assumed that any solution (nditions :(10)TS>The basic reproduction number of virus infection in the host is defined as (11)RW=Kg(E) = 0, the model always has an infection-free equilibrium point. When R>1.Among them, Considering the following scalar reaction-diffusion formula,u, ϑ, ρ are normal numbers.in which The statistical results of the prehospital trauma assistant diagnosis and treatment system are shown in The longest time for ambulances to arrive at the scene and to the hospital in each administrative area of the city is in area C, with a median of 11.03 and 29.68 minutes, respectively. The comparison of the time between the ambulance arrival at the scene and the arrival at the hospital is shown in The distribution of injury causes in different age groups is shown in The distribution of injured sites in different age groups is shown in Regarding the care factors of nonemergency transport services, the samples have the highest degree of care about formal legality and medical safety, and the average score is close to 5 points. Relatively speaking, relatives of patients with severe craniocerebral injury and fractures care less about service attitude or service price. The nonemergency transport services care about factors as shown in On the whole, the sample's overall evaluation of the hospital's nonemergency transport services is relatively low, with an average score of 7.11 points. On the whole, they showed high satisfaction with out-of-hospital nonemergency transport services, with an average score of 8.06. At the same time, for the level of medical care and ambulance equipment, they all showed a high satisfaction attitude, and the average score was higher than the overall evaluation score. Relatively speaking, the sample's satisfaction with the car-use process and the charging price is relatively low, with an average score of 8.02 and 6.59 points, which is lower than the overall evaluation of 8.06 points. However, the above analysis found that the sample cares the least about the charging price, and the sample as a whole shows a high evaluation of the nonemergency medical transfer service, indicating that the satisfaction of the lower charging price does not affect the overall satisfaction. Satisfaction with lower charged prices may simply be related to consumers' psychological expectations. The evaluation of transshipment services is shown in Nearly 70% of the respondents have used an ambulance only once, and only 6.8% have used it three or more times. In terms of the purpose of using ambulances, 60% of the samples sought better treatment for transfer; 60% of the respondents learned the contact information of the transfer agency through the introduction of hospital staff. In addition, 40% of the relatives of patients with severe traumatic brain injury and fractures could not correctly judge the qualifications of the ambulance used. They mainly rely on body markings, medical staff's dress/professional level, and consultation with hospital staff to judge the qualifications and sources of the ambulances they use. The purpose of using an ambulance is shown in The KMO (Kaiser-Meyer-Olkin) test statistic is an indicator used to compare simple and partial correlation coefficients between variables. For the nonemergency transport service, the KMO value was 0.801 > 0.7 in factor analysis, and it passed the Barth's sphericity test. And it can be seen from the above that the factor loading coefficient values corresponding to each item are all higher than 0.7, and the lowest is 0.740. Therefore, it shows that the nonemergency transport service evaluation data involved in this study has a high level of structural validity, and the research samples can be used for subsequent analysis and research. The construct validity test is shown in Under the vast majority of indicators, the peak value of the good condition in the bar graph is decreasing, and the peak value of the aggravating condition is increasing, so it can be qualitatively explained that the treatment time in the emergency department is prolonged, and the overall condition is aggravated. The analysis of the risk degree of pulse beat is shown in The accident readiness intervention plan of clinical nurses developed based on accident rescue theory has applicability and has positive significance for improving the accident readiness of clinical nurses. Learning from the international advanced rescue experience, contacting the current clinical nurse training practice, comprehensive multimedia teaching materials and various teaching methods to actively carry out the theory, knowledge and skill training of accident nursing can promote the improvement of the accident rescue ability of local nurses.The accident nursing teaching curriculum in China is relatively scattered, the nurses lack the opportunity to receive systematic accident nursing education, and the disaster relief skills and accident management ability are insufficient. In addition, in the implementation of accident rescue, Chinese clinical nurses still have insufficient accident rescue knowledge reserve, lack of core competence of accident nursing, low professional development ability of accident nursing, need to improve the level of knowledge, belief, and practice in response to accident events, and strong demand for accident nursing training. Cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in patients with craniocerebral injury, in addition to the central nervous system damage caused by the disease itself, lead to a decrease in serum sodium ion concentration. Insufficient intake (such as fasting and eating disorders) or improper absorption (such as vomiting and diarrhea), use of dehydrating diuretics, etc. may also cause a decrease in serum sodium ion concentration. The two main causes of hyponatremia in patients with traumatic brain injury are cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The pathogenesis of CSWS: central nervous system lesions or surgery, trauma, and other factors stimulate the hypothalamus and other parts, which can lead to increased secretion of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and lead to increased glomerular filtration rate, increased salt and water excretion, and cerebral salt wasting syndrome (CSWS). After cerebral contusion and laceration, there will be ischemia and hypoxia in the brain tissue. The brain cells are directly damaged, and a large amount of calcium ions flow back into the cells, causing metabolic disorders of membrane phospholipids, reducing the generation of adenosine triphosphate and enhancing the lipid peroxidation reaction of brain cell membranes, which indirectly stimulate the hypothalamus, further triggering hyponatremia. Patients with craniocerebral injury have a large loss of sodium ions and insufficient intake due to disturbance of consciousness, nausea, vomiting, surgical trauma, use of dehydrating diuretics, and other reasons. Hyperthermia will make the loss of sodium ions more serious, and the risk of hyponatremia will also increase.Healthy China is inseparable from medical support, but also needs the assistance of nursing. Nursing has gradually become a key force in promoting Healthy China. At present, the accident preparedness and emergency response ability of Chinese nurses still need to be improved. The domestic research on learning from the international advanced accident rescue experience is still limited, which shows that the research related to accident nursing in China has not yet been fully integrated with the international standards, and the theoretical guidance and disaster rescue skills need to be improved.Accident readiness is one of the main indicators to measure the accident nursing ability of nurses. The level of accident readiness of clinical nurses and how to effectively improve the accident readiness of clinical nurses are still unclear. Therefore, on the basis of reviewing domestic and foreign researches on accident nursing and rescue, this study is based on the current situation of accident nursing and rescue in this region. Based on the accident rescue theory, the clinical nurses' accident preparedness intervention plan was developed, and the application effect of the intervention plan in the accident preparedness of clinical nurses in China was discussed by organizing and implementing relevant training, so as to provide a practical basis for the accident rescue training of clinical nurses, in order to further improve the quality of clinical nurse accident rescue.Understanding the current level of nurses' accident readiness and analyzing the factors that affect nurses' accident readiness will help nursing managers to formulate strategies to improve nurses' accident readiness. In terms of disaster response skills, the multimedia teaching provided by Skype online teaching emphasizes that the curriculum setting of disaster response skills should be based on students' needs assessment, combining theory with practice. Early warning stage: nurses must master the characteristics of accident events, prepare disaster response resources and equipment, and respond to the evacuation system as soon as possible. Disaster classification phase: nursing students should use professional judgment to quickly classify casualties into categories such as immediate medical care, delayed care, nonurgent or minor, and fatal. First-aid knowledge and skills: nursing students should be proficient in rescue skills such as cardiopulmonary resuscitation, shock treatment, bleeding control, and splinting. Online teaching promotes the reflection and interaction of nursing students in their learning, practicing disaster relief skills through virtual disaster scenes, experiencing various rescue roles, and also improving teamwork and communication skills in postdisaster management. Online training, disaster drills, training drills, and interactive forums provided by Skype teaching mode are the most effective teaching methods. Nurses should master the knowledge and skills of postdisaster management through online courses, including ethical and moral principles, postdisaster psychological rehabilitation, advanced life support, disaster relief supplies, elimination of secondary injuries, and joint multiteam organization and collaborative management. Online courses based on Skype can ensure the relevance and timeliness of teaching content, help students to form their own knowledge system, and develop the accident management ability of nursing students.Taking the theoretical knowledge and skills of accident rescue as the main training content, the training methods such as theoretical training, simulation teaching, and situational drills are integrated. Under the guidance of clinical nursing experts, the training outline, training materials, and training videos were compiled, and an accident readiness intervention plan suitable for Chinese clinical nurses was developed. It adopts a combination of training courses, centralized learning in departments, simulated onsite drills, and self-study. Among them, theoretical lectures mainly teach the theoretical construction, implementation methods, and medical system of accident rescue in Israel; special lectures teach the specific implementation rules and management of accident rescue. Multimedia teaching uses the combination of audiovisual and video to reproduce the disaster scene, which makes the rescue process more step-by-step and detailed and strengthens the training effect. Group discussion is to divide nurses into groups, set up relevant accident scenarios, and discuss according to their own accident rescue knowledge so that the theoretical knowledge of accident rescue can be effectively applied to specific cases.Regardless of whether there is disaster relief experience, it has a significant positive effect on training, and the training effect of nurses without disaster relief experience is better than that of nurses with disaster relief experience. Nursing managers should strengthen accident rescue drills, help clinical nurses improve accident skills in practice, and set up different disaster rescue skill training courses according to the characteristics of nurses in different departments to ensure that nurses of different natures can effectively improve accident skills through different channels.The accident preparation degree of nurses directly affects the quality of accident rescue. The results of the first part of this study also show that the training experience of clinical nurses is one of the main factors affecting their accident readiness. Nurses with sufficient accident knowledge can provide theoretical guidance for disaster rescue, and skilled disaster rescue skills are the key factors to ensure the quality of accident rescue. In addition, nurses' accident management ability is related to the smooth development of postdisaster reconstruction. Therefore, developing an accident readiness intervention program to improve the accident readiness of clinical nurses is essential to improve the quality of accident care. Learning from the international advanced rescue experience, contacting the current clinical nurse training practice, comprehensive multimedia teaching materials and various teaching methods to actively carry out the theory, and knowledge and skill training of accident nursing can promote the improvement of the accident rescue ability of local nurses. This study only retrospectively analyzed the medical records of patients with craniocerebral injury in one hospital. The sample size is small, and there may be selection bias; further large samples and multicenter cohort studies are needed to verify the results of this study. In the future work, systematic problems and countermeasures will be analyzed for each module of the ambulance medical emergency system, and the optimal allocation of prehospital medical resources and the optimal layout of emergency stations will be explored to improve the scientific feasibility of the research results.