Objective To explore the improvement of cardiopulmonary resuscitation (CPR) efficiency by rescue team through the clinical access to pre-hospital care.Methods Mter establishment of clinical approaches to cardiac arrest,the training program of first line personnel of rescue teams in the Hangzhou Emergency Center was carried out with practice on simulated patients and scenario.A total of 45 eligible teams were randomly enrolled for study by observing the performance of some essential resuscitation techniques before and after training.Result The efficiency of resuscitation performed by rescue team for cardiac arrest was generally not good enough before training evidenced by the shortage of application of ECG monitoring,endotracheal intubations and establishing intravenous line which were only 8 (17.8％),5(11.1％),6 (13.3 ％),respectively,and the interruption time of chest compression during the first three minutes was (102.13 ± 13.68) seconds and the successfully artificial respiration ratios by assistant members was (0.37 ± 0.09),and ratios of ECG forensics and written inform consent were 8 (17.8％) and 6 (13.3％) respectively,CPR and forensics done simultaneously was only 2 (4.4％).The efficiency of rescue for cardiac arrest was obviously improved after training by the clinical approaches proved by the increase in application of ECG monitoring,endotracheal intubations,intravenous line set up reached to 45 (100％),43 (95.6％),43 (95.6％),respectively,and the interruption time of chest compression during the first three minutes was shorten to (69.7 ± 7.7) seconds and the successfully artificial respiration ratios done by assistant members was (0.57 ±0.12) after training.The ratios of on-site ECG forensics and written inform consent were 40 (88.9％) and 43 (95.6％),respectively,and CPR and evidence obtained simultaneously was up to 36 (80.0％).The efficiency of work done by teams was obviously improved and the risk of miserable events was controlled.Conclusions The clinical approaches to cardiac arrest in prehosptial care is the efficient strategy to rescue the patient with cardiac arrest and it is worthy to popularize at present.

Objective To study the clinical effect of peritoneal and abdominal indwelling tube by ultrasound for patients with severe acute pancreatitis.Methods Sixty-eight patients with severe acute pancreatitis from January 2010 to December 2013 were analyzed retrospectively.The patients were divided into experiment group (48 cases) and control group (20 cases).The patients in control group were given the common drugs treatment,and the patients in experiment group were given the common drugs and the peritoneal and abdominal indwelling tube by ultrasound.The clinical effects and complication were compared.Results The total efficacy rate in experiment group was 93.75％(45/48),in control group was 35.00％(7/20),and there was significant difference (P ＜ 0.05).Seven patients in experiment group occurred complication,after the symptomatic treatment 6 patients recovered and 1 patient died of multiple organ failure;7 patients in control group occurred complication,after the symptomatic treatment 3 patients recovered and 4 patitents died of infection recurrence.The complication rate in experiment group was 14.58％(7/48),in control group was 35.00％ (7/20),and there was significant difference (P ＜ 0.05).Conclusion Peritoneal and abdominal indwelling tube by ultrasound could improve clinical efficacy and decrease complication rate for patients with severe acute pancreatitis.

Objective To study on the difference of plasma renin activity ( PRA),angiotensin Ⅱ (Ang Ⅱ ),and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO),and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR).Methods The plasma aldosterone,Ang Ⅱ and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA,n =111 ),aldosterone-producing adenoma (APA,n=l18),PHEO (n=98) and EH (n=86).ARR was calculated.Results Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [ 374 (294,465 ) pmol/L and 629 (449,997) pmol/L] and PA group [471 (346,632) pmol/L and 673(499,825) pmol/L] were higher than those in EH group [ 277 (224,332) pmol/L and 427 (341,501 ) pmol/L ] (P ＜ 0.01 ).They were also higher in APA group [576 (416,731 ) pmol/L and 726 (554,906 )pmol/L ] than those in IHA group [399(313,504) pmol/L and 609(485,776)pmol/L ] (P ＜0.01).Ang Ⅱ levels in both positions were lower in PA group [43.2(26.4,74.4) ng/L and 60.1(38.5,103.6) ng/L] than in EH group [56.7 (43.3,78.9) ng/L and 84.3(61.3,108.4) ng/L] or PHEO group [54.3(29.9,101.5) ng/L and 102.8 (49.9,167.0) ng/L] (all P values ＜ 0.01 ),and there was no difference between IHA and APA group (P ＞ 0.05 ).The PRA level in both positions of each group were PHEO group [ 0.3 (0.2,1.0) μg ·L-1 · h-1 and 1.4(0.6,3.4) μg · L-1 · h-1] ＞EH group [0.2(0.1,0.4)μg · L-1 · h-1 and 0.6(0.4,1.0)μg· L-1 ·h-1] (P＜0.01) ＞PAgroup [0.1(0.1,0.1)μg· L-1 · h-1 and 0.2(0.1,0.3)μg·L-1 · h-1] (P＜0.01),and APA group [0.1(0.1,0.1)μg · L-1 · h-1 and0.1(0.1,0.3)μg · L-1 ·h - 1 ] ＜ IHA group [ 0.1 ( 0.1,0.2 ) μg · L - 1 · h - 1 and 0.2 (0.1,0.3 ) μg · L-1 · h - 1 ] ( supine P ＜0.01 ; upright P ＜ 0.05 ).APA was divided into 2 types with renin-Ang Ⅱ -responsive APA ( n =26) and unresponsive APA (n =92).The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang Ⅱ-responsive APA than in unresponsive APA patients.ARR in upright was higher in PA group ( P ＜ 0.01 ) but lower in PHEO group ( P ＜ 0.05 ) compared with EH.ARR was higher in APA than in IHA (P ＜0.01 ).The sensitivity and specificity of ARR as 40 (aldosterone unit:ng/dl;PRA unit:μg · L-1 · h-1; its value should multiply 27.7 when transferred to pmol/L,simili) were 93％ and 76％,respectively.Conclusion The levels of PRA,Ang Ⅱ and aldosterone from patients with EH,PA and PHEO are significant different.ARR as 40 in upright position could be used for PA screening cutoff point.

Objective To investigate the expression of urinary galectin-3 binding protein(Gal-3BP)and V-set containing immunoglobulin domain 4(VSIG4)in urine from patient with systemic lupus erythematosus(SLE)and its relationship with disease activity and kidney injury.Methods A total of 105 SLE patients(SLE group)and 50 normal patients(control group)admitted to Danzhou People's Hospital were selected as the study objects.According to SLEDAI score,105 SLE patients were divided into mild active group(SLEDAI≤9 points,n=51),moderate active group(14 point≥SLEDAI≥10 points,n=29)and severe active group(SLEDAI ≥ 15 points,n=25).According to the degree of renal function impairment,they were divided into normal renal function group,mild renal function impairment group and moderate and severe renal function impairment group.Enzyme linked immunosorbent assay was used to detect the expressions of Gal-3BP and VSIG4.Multiple Logistic regression was applied to analyze the risk factors of kidney injury in SLE patients,and ROC curve was drawn to analyze the value of urinary Gal-3BP and VSIG4 levels in predicting kidney injury in SLE patients.Results The urinary Gal-3BP(251.38±46.75 ng/ml)and VSIG4(13.40±4.27 ng/ml)levels in the SLE group were higher than those in the control group(117.50±18.24 ng/ml,2.73±0.85ng/ml),and the differences were statistically significant(t=19.315,15.681,all P＜0.001).The higher the activity level of SLE patients,the higher the urinary Gal-3BP and VSIG4 levels,with severe activity group＞moderate activity group＞mild activity group,and the differences were statistically significant(F=23.416,17.380,all P＜0.001).The urinary Gal-3BP and VSIG4 levels in the moderate to severe renal function group and mild renal function group were higher than those in the normal renal function group(t=24.580,18.163,20.864,15.947),and the urinary Gal-3BP and VSIG4 levels in the moderate to severe renal function group were higher than those in the mild renal function group(t=19.837,11.215),and the differences were statistically significant(all P＜0.001),respectively.Multiple logistic regression analysis showed that elevated levels of urinary Gal-3BP(OR=3.472,95％CI:2.685～11.463)and VSIG4(OR=2.376,95％CI:1.842～9.105)were risk factors for renal injury in SLE patients(all P＜0.05).ROC curve analysis showed that the combination of Gal-3BP and VSIG4 had the highest area under the curve(95％confidence interval)[AUC(95％CI)]for predicting renal injury in SLE patients[0.909(0.846～0.973)],with an accuracy of 88.6％.Correlation analysis showed that the urinary Gal-3BP level was positively correlated with VSIG4 level(r=0.813,P＜0.05),and the levels of urinary Gal-3BP and VSIG4 were positively correlated with SCr,BUN,24-hour urine protein,anti-dsDNA antibodies,and SLEDAI scores(r=0.358～0.702,all P＜0.05),while urinary Gal-3BP and VS1G4 levels were negatively correlated with hemoglobin and eGFR in SLE patients(r=-0.479～-0.670,all P＜0.05).Conclusion Urinary Gal-3BP and VSIG4 levels are elevated in SLE patients,and their high expressions are related to disease activity and renal injury.The combination of the two have good value in predicting renal injury in SLE patients.

Objective To prepare an influenza A(H1N1) split-virus vaccine and observe its safe-ty and effectiveness. Methods According to the process for preparing seasonal flu split-virus vaccine two batches of vaccine were prepared with the flu A (H1N1) vaccine virus strain recommended by WHO. The pilot products were tested against the requirements of flu split-virus vaccine. Results The quality of the pi-lot vaccine has been tested by National Control Laboratory and conformed to the requirements. Nine hundred and sixty volunteers received one dose of vaccine containing either 15 μg or 30 μg of hemagglutinin. The re-suits indicated the both seroconversion rate and protection rate were higher the 70%. The GMT of HIAb of the volunteers who received 1 dose of 15 μg increased significantly by 15, 39, 37 and 25 times compared to those before vaccination in the age groups of 3-11, 12-17, 18-59 and ≥60, respectively. And 26, 72, 68 and 36 times rise were found in the postvaccinated volunteers of 30 μg group. The total adverse reaction rates of 15 μg and 30 μg dose group were 29.38% and 43.75%, respectively. The grade 2 adverse reaction rates of 15 μg and 30 μg dose group were 6.25% and 15.42%, and the grade 3 adverse reaction rates of 15 μg and 30 μg dose group were 0.83% and 1.46%, respectively. No serious adverse reactions were found. Conclusion The influenza A (H1N1) split-virus vaccine prepared according to the requirements of season-al flu vaccine is safe and effective.

Objective To compare the changes of antrum and fundus cross‐sectional area ( CSA ) measured by bedside ultrasonography on gastric insufflation during anesthesia induction in non‐obese female patients and analyze the relationships between these changes as well as postoperative nausea and vomiting ( PONV ) . Methods Fourty‐six patients scheduled for elective gynecological laparoscopic operations were enrolled in the study . T he patients w ho appeared the comet‐tail artifacts were defined as gastric insufflation positive group( GI+ group) ,w hile the ones without comet‐tail artifacts were defined as gastric insufflation negative group( GI‐ group) . Blood oxygen saturation ( SPO 2 ) ,end‐expiratory partial pressure of CO 2 ( PET CO2 ) ,tidal volume( T V ) were recorded after 180 seconds ventilation in both groups . T he longitudinal and anteroposterior diameters of gastric antrum and fundus were measured before and after facemask ventilation respectively and the corresponding CSA were calculated . T he cutoff values of prediction of gastric insufflation were determined according to the ROC curve and the corresponding sensitivity and specificity were calculated . PONV of the two groups were also recorded . Results T he analysis was based on the remaining 41 data sets actually . T here were 13 patients in GI‐group and 28 ones in GI+ group . Compared with GI‐group ,the changes of T V and fundus CSA in GI+ group had significantly differences( P ＜0 .05) ; w hile compared with before mask ventilation ,the changes of antrum and fundus CSA in both groups had significantly differences ( P ＜0 .05).T he areas of antrum and fundus CSA under the ROC curve (95% CI) were 0 .67 and 0 .80 ,with cut‐off value 3 .19 cm2 and 24 .90 cm2 ,sensitivity 0 .93 and 0 .93 and specificity 0 .39 and 0 .69 ,respectively .T he incidence of PONV in GI+ group was higher than that in GI‐group( P ＜0 .05). Conclusions Changes of fundus CSA by ultrasonography might be superior to antrum CSA in gastric insufflation caused by 20 cm H2 O peak airway pressure of facemask ventilation during anesthesia induction . Gastric insufflation caused by positive pressure ventilation is related with PONV for young female patients undergoing gynecological laparoscopic operation .

Objective To evaluate the effect of facemask ventilation with different pressures on perioperative complications in the patients undergoing gynecological laparoscopic surgery. Methods Seven-ty-five American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-60 yr, with body mass index of 18-24 kg∕m2 , scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 3 groups ( n=25 each) using a random number table method: 10 cmH2 O group ( group P10) , 15 cmH2 O group ( group P15) and 20 cmH2 O group ( group P20) . The pres-sure for facemask ventilation was 10, 15 and 20 cmH2 O during induction of anesthesia in group P10, group P15 and group P20, respectively. Before facemask ventilation ( T0 ) and at 180 s of facemask ventilation ( T1 ) , longitudinal and anteroposterior diameters of the antral area in the supine position were measured u-sing ultrasonography, the antral cross-sectional area was calculated, and the development of serious flatu-lence was recorded. The development of hypoxemia, tidal volume and end-tidal pressure of carbon dioxide in each group were recorded at T1 . The operation time and occurrence of postoperative flatulence and nausea and vomiting were recorded. Results Compared with group P10, the incidence of serious flatulence and postoperative flatulence and nausea and vomiting was significantly increased, and the incidence of hypox-emia was decreased in group P15 and group P20, and tidal volume was increased at T1 in group P20 ( P<0. 05) . Compared with group P15, the incidence of serious flatulence was significantly increased ( P<0. 05) , and no significant change was found in the incidence of hypoxemia and postoperative flatulence and nausea and vomiting in group P20 ( P>0. 05) . There was no significant difference in the end-tidal pressure of carbon dioxide at T1 or antral cross-sectional area at T0 and T1 among the three groups ( P>0. 05) . Con-clusion Pressure of 10-15 cmH2 O for facemask ventilation is optimal during induction of general anesthe-sia and can ensure adequate oxygen supply and reduce perioperative complications in the patients undergoing gynecological laparoscopic surgery.

Objective? To explore the application effect of online learning platform on the training of family caregivers of disabled elderly people. Methods? From September 2017 to March 2018, the family caregivers of 90 disabled elderly people in a district of Changsha were selected by convenience sampling method, and divided into control group and observation group by random number table method, with 45 cases in each group. During the study period, the caregivers of the control group received general health education. The caregivers in the intervention group received online training on the self-developed online learning platform under the guidance of the researchers for months. Before and after the training, the family caregivers were investigated using the Family Caregivers Care Ability Scale and the Care Knowledge Assessment Questionnaire. Results? Before the training, there was no statistically significant difference in average score of care knowledge, and the total score and the five dimensions' scores of the Family Caregivers Care Ability Scale between the two groups (P ＞ 0.05). After training, the score of the care knowledge in the intervention group was (82.2±15.2), which was higher than that in the control group (64.2±17.2), and the difference was statistically significant (t=5.260,P＜ 0.01). After training, the score of Family Caregivers Care Ability Scale in the intervention group was (13.90±4.52), which was lower than that in the control group (16.57±3.25), and the difference was statistically significant (t=3.217,P＜ 0.01). The scores of the four dimension of the scale, including adjusting the role of caregiver, meeting need and providing assistance, dealing with personal mood, adjusting life in order to meet the needs to take care of elderly in the intervention gorup were lower than those in the control group, and the differences were statistically significant (P＜ 0.05). Conclusions? The training based on the online care knowledge and skill system for disability elderly can improve the family caregivers of nursing knowledge level and ability to take care of the elderly.

Neuromyelitis optica spectrum disorders (NMOSD) are a severe autoimmune inflammatory demyelinating disease of the central nervous system. NMOSD complicated with immune thrombocytopenia (ITP) is rare. This paper reports a case of NMOSD who was misdiagnosed as multiple sclerosis for many years, and then developed thrombocytopenia. ITP was diagnosed by perfect examination. After immunosuppression and thrombopoiesis therapy, the platelets returned to normal. The review of the case and literatures can help to improve the understanding of this kind of disease, timely diagnose and treat patients, and avoid serious complications.