Objective: By analyzing the psychological state of patients during pre-hospital care,proper psychological support is provided for better rescue,reduce patients′ suffering and and incidence of medical conflicts.Methods: Follow-ups with patients of pre-hospital care,discussion of medical cases,and practical experiences are reviewed,and combine psychological knowledge and pre-hospital care.Results: When psychological support is given during pre-hospital care,patients′ pain was greatly reduced with satisfaction increased.Conclusion: The psychological support is given during pre-hospital care is necessary,and benefits both doctors and patients.

China faces opportunities and challenges as well when it participates in global environment and health governance. Major opportunities are as follows:(1) The convergence between global environment and health governance’s future trend and China’s environment and health strategies is a strongest incentive to push China to par-ticipate in global environment and health governance;(2) China can benefit from this participation in term of more access to international resources; ( 3 ) Global environmental and health issues are the areas that can best illustrate China’s international image as a responsible member; ( 4 ) Since global environmental and health governance is still young, early participation will give China a louder voice in its decision-making. The challenges that China faces are as follows:(1) Huge pressure from domestic environment and health challenges forces China to be primarily inward-looking and makes it very hard for the country to keep a high profile in global environment and health governance. China also faces the increasing international pressure. ( 2 ) The lack of global environment and health governance strategy prevents China from effectively participating in global environment and health governance. (3)“The Grand Health Outlook”hasn’t been fully established yet in China, leaving much room for improvement. (4) Intellectual sup-port is inadequate. (5) Some countries have too high expectations of China in terms of its contribution to global envi-ronmental and health governance. In order to effectively participate in this field, China should undertake coordinated planning on both the international and domestic scenes, and take some specific policies both at national and interna-tional level.

Since 1949 , the linkage of environment and health in China has been mainly reflected in the is-sues, knowledge, policy and laws, organizations and the interactions between domestic and external factors, featuring the increasing expansion and complexity. The weak and inefficient environment and health governance institutions and the poor environment and health problems coping ability are the two major challenges that face the current environ-ment and health governance in China.

Based on the global governance prospective, this paper examines the linkage of global environment and health and the structural features in terms of the policy and institutions system level, the future challenges are al-so analyzed as well. From the institutional perspective, the linkage of global environmental and health is mainly re-flected in laws, norms, governance models, actors and institutions. The current global environment and health gov-ernance structure presents three characteristics: it experiences a rapid formation; it remains fragmented, loose and fragile, thus it has much room for future development;and it is held on dominating advantage in science, engineering and technology, funds, diplomatic skills and other aspects for the developed countries. There is also a potential con-flict between environment and health which may be from their different values or from different understanding of the relationship between them. Therefore, the future global environment and health governance faces challenges like po-liticization and national security considerations.

ObjectiveTo explore the value of MRI in diagnosis of chronic injury of the elbow in young athletes,and to discuss the optimization of imaging sequences.MethodsA total of 34 athletes (40 elbows) aged 6-16 years underwent MR examination on axial,sagittal and coronal planes.The characteristics of MRI were analyzed.ResultsThe anatomy of parenchyma and bones in elbow joint were displayed clearly by using axial TIW,sag T1W,T2W,sag STIR and PDW sequences.The thickening of periosteum and arthroedema were displayed well with sagittal T2W and STIR sequence,while bone marrow,ligament injury and synovitis were displayed well with PDW sequence.ConclusionMRI can display clearly the injury of bones and muscles in young athletes with chronic injury of the elbow.Optimization of imaging sequences is of importance in the depicting and diagnosis of chronic injury of bone and muscles.

Objective To investigate the effects and adverse events of Yiaisanjie soup combined with sustained release fluorouracil in treating pancreatic cancer.Methods From January 2012 to December 2015,the clinical data of 62 cases with pancreatic cancer in Deqing County People's Hospital were retrospectively analyzed,which were divided into combination group and control group.The combination group underwent the implantation of sustained release fluorouracil panicles under CT guidance and took Yiaisanjie soup once a day for at least 5 cycles of 3-week administration and then 1-week no administration.The control group was treated only by sustained fluorouracil panicle implantations.The blood samples at fasting were collected before and 1 week after treatment to detect serum tumor markers.The adverse events were recorded.The therapeutic effect for solid tumors was evaluated according to response evaluation criteria in solid tumors(RECIST).Results Before treatment,CEA,CA125,CA242,CA19-9 in 2 groups had no statistical differences.After treatment,these tumor markers obviously decreased in both groups compared with before treatment.Compared with the control group,the CEA,CA125,CA242,CA50 and CA19-9 in combination group decreased at a more significant degree,and the difference was statistical significant (P ＜ 0.05).The incidence of Ⅱ and Ⅲ degree thrombocytopenia,nausea,vomiting and diarrhea was significantly lower in the combination group than in the control group (12.12％ vs 34.48％,18.18％ vs 48.28％,9.09％ vs 41.38％,all P＜0.05).There were 10 cases with partial remission (PR),17 cases with stable disease (SD) and 6 cases with progressive disease (PD),and the total effective rate was 81.8％ (27/33) in the combination group.There were 5 cases with PR,15 cases with SD and 9 cases and PD,and the total effective rate was 69.0％ (20/29) in the control group.The difference was not statistically significant (x2 =1.390,P =0.119).Conclusions The therapeutic effect of Yiaisanjie soup combined with sustained release fluorouracil in treatment of pancreatic cancer is not obvious,but the combination can significantly reduce serum tumor markers and reduce the incidence of side effects.

Objective:To induce long-term survival of cardiac allograft in rats by adenovirus-mediated gene transfer of CEMQIg gene, and to investigate the potential mechanisms involved in the induction of transplantation tolerance. Methods: The donor cardiac allograft from DA rats was heterotopically transplanted into the abdomen of LEW recipient rats, and recombinant adenoviruses containing EGFP gene or CD40Ig gene at a dose of 5 x ICf pfu were administered via portal vein, respectively, during the operation. The graft survival was monitored by daily palpation. The expression of CD4QIg fusion protein in the recipients was detected via EIISA. The tolerant mechanism was investigated via MLR, IL-2 reverse experiment and analyzing the expression of Thl/Th2 type cytokines in the recipients.Results: Compared with the untreated recipients, the mean survival time(MST) of the cardiac allograft was not prolonged in the recipients treated with AdEGFP adenovirus, whereas MST were prolonged significantly to 142.8 ?26.8 d in the recipients administered with AdCD40Ig adenovirus. The expression of CD40Ig fusion protein remained a long time but the levels gradually decreased. The results of MLR indicated that the induced tolerance in the recipients was donor-specific. The results of IL-2 reverse experiment demonstrated that the tolerance mechanisms were involved clonal anergy at the early stage of the established tolerance. The expression pattern of Thl/Th2 type cytokines did not indicate the polarization of Thl/Th2 type cytokines in the experimental models. Conclusion: A single injection of the defined dose of adenovirus containing CD40Ig gene via portal vein during operation is enough to induce long-term survival of cardiac allograft in rats.

Objective To investigate the relationship between acute myocardial ischemia and abnormal motions of left ventricular wall using tissue velocity imaging (TVI) combined with dipyridamole stress echocardiography and evaluate the significance of the new technology in detecting myocardial ischemia. Methods Several grades of constriction on left circumflex coronary artery(LCX) were produced in 13 open-chest canine models. Dipyridamole was added in two steps,first 0.56 mg/kg,then 0.28 mg/kg after four minutes. Views of apical four chambers,two chambers and left ventricular long axis were observed and analyzed. Results In basal condition,the systolic peak velocity(SPV) on different part of wall was various and decreased from cardiac base to apex on each view of long axis. When flow of LCX was decreased 25% and large dosage of dipyridamole was added,the decreasing tendency along the long axis was destructed and SPV of corresponding blood-supply area decreased sharply compared with that of basal condition( P

To study the relationship between plasma procalcitonin(PCT) level and intestinal mucosal injury in patients with liver cirrhosis(LC), plasma PCT levels in 78 patients with LC were determined by immunoluminometric assay, endotoxin(ET)and the indicator of intestinal mucosal injury-diamine oxidase(DAO)activity were measured by fluorometric assay, TNF-? and IL-6 were measured by ELISA. The results showed that plasma levels of all these factors in LC patients were significantly higher than those of normal controls, and they were also higher in spontaneous bacterial peritonitis (SBP) group than those in non SBP group(P

Clinical medical postgraduate education is an important part of higher education in China.We analyzed the current status,major problems existed,direction of the reform and the prospect in the training system.Unifying cultivation criterion,diversifying form of academic degree system,making selection standard strict for advisors and decreasing the proportion of research work for doctors were considered as the effective measures to address these issues.