The article summarized the practice teaching experience of traumatology: strengthening the learning education of medical ethics and the knowledge of psychology,understanding the specificity and complexity in traumatology,following the rule of evidence-based medicine and establishing clinic thoughts,strengthening the training of basic skill,basic knowledge and basic theory and helping the interns transit to clinical clerkship.

OBJECTIVE:To provide reference for rational use of TCM injection in the clinic. METHODS:Retrieved from CNKI,VIP,Wanfang database and PubMed database,literatures about top 10 TCM injections in the list of report number stated in 2014 CFDA ADR monitoring report were researched in recent 30 years. By literature retrospective study,ADR/ADE induced by TCM injection were analyzed. Combining with post-marketing drug safety re-evaluation and rationality study,the security of clini-cal use of TCM injection was evaluated. RESULTS:A total of 2013 literatures were retrieved,1354 were. Most organs or systems were involved in ADR,especially cardiovascular system,respiratory system,skin and its appendants. Allergic reaction was main clinical manifestation,among which server ADR was allergic shock. Ten ADR/ADE-inducing TCM injections had the lower consis-tency with instructions in the original diseases,solvent,dosage concentration and compatibility application. Consistency rate of original diseases,solvent and dosage concentration was 78.30%,77.94% and 74.64%;81.73% of them were used individually. CON-CLUSIONS:ADR/ADE induced by TCM injection is serious. It is urgent to improve post-marketing revaluation scheme from the aspects of safety and rationality.

Due to the complexity and risk of liver anatomy and operation, laparoscopic hepatectomy is still a challengeable procedure. In order to acquire the optimal treatment effect, we need to comprehensively analyze the general condition, hepatic reserve function of patients, and the pathway selection before this surgery. Compared with open hepatectomy, the advantage of laparoscopic hepatectomy for hepatocellular carcinoma has been widely recognized. Anatomical hepatectomy, regional resection technology, and precise hepatectomy promote the all-round development of minimal invasive liver surgery. With the navigation of indocyanine green and laparoscopic ultrasound, and the support of associating liver partition and portal vein ligation for staged hepatectomy, controlled low central venous pressure and other technologic revolution, laparoscopic hepatectomy is believed to bring new breakthrough in treatment of HCC. Although the number of HCC patients who underwent laparoscopic resection of is increasing, there are still numbers of problems, referred to technology applied and promoted, at home and abroad. This article aims to discuss the pathway selection, surgical indications and contraindications, transformation of concepts, technology annotation, and the control of complications in HCC treatment.

ObjectiveTo investigate the effect ofpinacidil hyperpolarizaed arrest on p38 mitogen-activited protein kinase (p38MAPK) during myocardial ischemia-reperfusion (I/R) in isolated rat hearts.MethodsFortyeight male SD rats weighting 250-300 g were randomly divided into 6 groups( n =8 each): natural arrest group (group A) ; St.Thomas group (group B) ; pinacidil hyperpolarization arrest group (group C) ;5-hydroxydecanoate (5-HD) group (group D);HMR-1098 group(group E) and 5-HD + HMR-1098 group(group F).Langendorff reperfusion model was established and K-H solution was retrogradely perfused for 15 min.In group A the hearts were arrested naturally afar perfusion was stopped; in group B St.Thomas solution was perfused; in group C pinacidil hyperpolarization solution was perfused; in the other three groups,K-H solution was perfused to isolated rat hearts for 10 min followed by 5 min 5-HD (group D) or HMR-1098(group E) or 5-HD and HMR-1098(group F) perfusion,then hyperpolarization arrest solution was given in each group.Each hearts suffered 60 min ischemia after arrest followed by 30 min K-H solution reperfusion.Coronary flow(CF),HR,left ventricular developed pressure( LVDP),left ventricular systolic pressure(LVSP) and the maximum rate of pressure rise (dp/dtmax) were measured at the end of 15 min K-H solution perfusion and at 20 min of reperfusion.Myocardial phosphatic and nonphosphatic p38MAPK expression was determined by Western blot at 30 min of reperfusion.ResultsCompared with group C,CF,HR,LVDP,LVSP and dp/dtmax were significantly decreased at 20 min of reperfusion and phosphatic p38MAPK expression was down-regulated,non-phosphatic p38MAPK expression was up-regulated at 30 min of reperfusion in groups A,B,D,E and F (P ＜ 0.05).Compared with group E,CF,HR,LVDP,LVSP and dp/ dtmax were significantly decreased at 20 min of reperfusion and phosphatic p38MAPK expression was down-regulated,non-phosphatic p38MAPK expression was up-regulated at 30 min of reperfusion in groups D and F ( P ＜0.05).ConclusionHyperpolarized arrest induced by pinacidil can improve cardiac function following myocardial I/R injury by up-regulating phosphatic p38MAPK expression,down-regulating non-phosphatic p38 MAPK expression and mitochondrial potassium channel is more important than membranous one during the regulation of phosphatic p38MAPK expression.

BACKGROUND: Hyperbaric oxygen may induce cerebral infarction. But what kind of medicine may prevent it and what is the preventive function of the medicine are not clear yet.OBJECTIVE: To compare the preventive function of nitrates with calcium antagonists in cerebral infarction induced by hyperbaric oxygen.DESIGN: Controlled retrospective observation based on patients.SETTING: Department of Hyperbaric Oxygen, Department of Neurology,Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 192 patients receiving hyperbaric oxygen treatment in Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA, who were 127 males and 65 females, and aged 9 -78 years old. Among them, 6 patients developed into cerebral infarction.METHODS: Totally 192 patients receiving hyperbaric oxygen treatment were old, hypertensive disease, hyperlipemia, cerebral infarction(or cerebral hemorrhage), hyperviscosity in blood and diabetes as dangerous factors, prevention function of medicine was analyzed on the level of grouping different dangerous factors.INTERVENTIONS: Under the prerequisite condition of regular treatment medicine given to the 192 patients of the 3 groups, patients in nitrate group took isosorbide dinitrate or nitroglycerin orally, patients in calcium antagonist group took sibelium or Norvasc and so on orally, and patients in group without special medication did not take preventive drugs.MAIN OUTCOME MEASURES: Dangerous index was dangerous factorsto cerebral infarction.RESULTS: No one developed into cerebral infarction with grouping less than 4 dangerous factors. On the level of grouping 4 or more dangerous factors,nitrates had good preventive function, but in calcium antagonist group,33.3% patients developed into cerebral infarction. There was significant difference between them( P ＜ 0.05).CONCLUSION: Nitrates have significant preventive functions, but calcium antagonists have no such functions.

AIM: To establish the quality standard of Shajun Zhiyang Lotion (Radix Sophorae Flavescentis, Cortex Phellodendri Chinensis, Fructus Cnidii, Borneolum Syntheticum, etc.). METHODS: Cortex Phellodendri Chinensis and Fructus Cnidii and Borneolum Syntheticum were identified by TLC. The content of matrine was determined by HPLC. RESULTS: TLC identification was highly specific and the sports were clear. The linear range for matrine was in the range of 0.295 3-2.362 0 ?g and its average recovery was 100.38% and RSD was 1.5%, respectively. CONCLUSION: The quality of Shajun Zhiyang Lotion could be controlled effectively according to the quality standard.

Objective To assess the patient effective dose during SPECT/CT imaging.Methods A total of 157 patients (85 males,72 females;mean age:(60.46±13.44) years,range:24-88 years) who underwent SPECT/CT from April 2013 to September 2014 were retrospectively analyzed.They were divided into 3 groups:99Tcm-MDP bone scan group (n=113),99Tcm-MIBI parathyroid imaging group (n=23) and 99Tcm-MAA pulmonary perfusion imaging group (n=21).The injection dose (MBq) was recorded and the effective dose (mSv) was estimated according to the International Commission on Radiological Protection (ICRP) guideline.The volume-weighted computed tomography dose index (CTDIvol) and dose length product (DLP) of CT were also recorded and the effective dose (mSv) due to CT was calculated.The effective doses among different groups were statistically compared by Kruskal-Wallis rank sum test and Wilcoxon rank sum test.Results The effective dose from radiopharmaceuticals were (4.02±0.35) mSv for 99Tcm-MDP bone scan,(6.13±0.53) mSv for 99Tcm-MIBI parathyroid imaging and (1.66±0.13) mSv for 99Tcm-MAA pulmonary perfusion imaging (x2=96.853;Z =7.533,7.262 and 5.676;all P＜ 0.05).The effective dose due to CT were (3.84±1.98),(1.04±0.19),(4.05±0.47) mSv respectively (x2 =41.225,P＜0.05),and there were significant differences between 99Tcm-MIBI parathyroid imaging group and 99Tcm-MDP bone scan group,99Tcm-MAA pulmonary perfusion imaging group(Z=6.046 and 5.672,both P＜0.05).The total effective dose during SPECT/CT imaging were (7.86± 1.98),(7.21±0.81) and (5.71±0.45) mSv (x2 =28.988,P＜ 0.05).There were significant differences between 99Tcm-MAA pulmonary perfusion imaging group and 99Tcm-MDP bone scan group,99Tcm-MIBI parathyroid imaging group(Z=4.967 and 4.994,both P＜0.05).Conclusions The increase in effective dose due to spiral CT during SPECT/CT examination should be concerned.Appropriate utilization and optimization of SPECT/CT is needed.

An integrated retrieval platform for online biomedical literature citations with the functions of one-stop retrieval, automatic removal of duplications, automatic grouping, and rapid output of standard citation report, was constructed on the basis of CMCI, with the C/S structure as its model and the NET framework as its development platform, in order to solve the problems of different citation databases in our library, such as inconsistent retrieval methods, inconsistent displaying methods of retrieval outcomes, and non-standard citation description, which can thus improve the efficiency of searching and citing biomedical literature.

Objective To study the protective effect of Xingnaojing combined with alprostadil on brain after acute ischemic stroke in rats.MethodsSixty patients with acute ischemic stroke were enrolled in zhejiang xin'an international hospital from March 2014 to March 2016.They were randomly divided into control group and treatment group, 30 cases in each group.The control group received conventional treatment plus alprostadil, the treatment group in the control group based on the combination of Xingnaojing treatment.Two groups of patients after treatment, are given nursing intervention, such as routine diet guidance, nutritional support, health education.The levels of serum oxidative stress (MDA), vascular endothelial growth factor (VEGF) and vascular endothelial growth factor (VEGF) were compared between the two groups before and after treatment.The levels of cerebral blood flow (CBFV) were recorded before and after treatment Observe the adverse reactions during treatment.ResultsAfter 14 days of treatment, the NIHSS score of the treatment group was lower than that of the control group and the ADL score was higher than that of the control group.The difference between the two groups was statistically significant (P<0.05).Before treatment, the oxidative stress indexes MDA and Hcy were no significant difference between the two groups.After treatment, the oxidative stress indexes MDA and Hcy were lower than the control group(P<0.05).Before treatment, the levels of VEGF and CBFV in the two groups were no significant difference between the two groups.After treatment, the levels of VEGF and CBFV in the two groups were significantly higher than those in the control group (P<0.05).The adverse reaction rate between the 2 groups was similar, and there was no significant adverse reaction, there was no significant difference between the two groups.ConclusionXingnaojing combined with alprostadil has a certain clinical effect on acute ischemic stroke, and has a good protective effect on brain tissue after reperfusion.

Heat stroke (HS) is a life-threatening illness characterized by core body temperatures above 40 ℃ coupled with central nervous system (CNS) dysfunction, including delirium, convulsions, and/or coma. Its morbidity has increased dramatically in the past few decades. Multiple organ dysfunction syndrome (MODS) is not only the most serious complication of HS, but also the leading cause of deaths. Understanding the pathogenesis, characteristic and advancement pattern of MODS caused by HS will have a profound effect on the clinical treatment, research and mortality decrease. The pathogenesis, injury characteristic of each system and organ, and treatment methods were summarized in this review so as to deepen the clinical recognition of this disease.