Objective To investigate the applicative effect of cardiopulmonary resuscitation in pre-hospital care of emergency pa-tients with cardiac arrest and provide the basis for pre-hospital care of cardiac arrest.Methods Selected 93 cases of cardiac arrest in January 2011 to May 2013 occurred out of Hainan Province Nongken Sanya Hospital,including 51 cases of cardiopulmonary resusci-tation of pre hospital rescue as the study group,42 cases of the application of artificial compression cardiopulmonary resuscitation as control group.Compared blood oxygen saturation,oxygen and carbon dioxide partial pressure and blood pressure changes,CPR time,spontaneous breathing recovery time and the recovery of the function of two groups.Used chemiluminescence method to detect NSE,NT-proBNP,cTnI and H-FABP.Results The two groups of patients with blood oxygen saturation,oxygen and carbon diox-ide partial pressure showed no statistical difference(P>0.05);the DBP and SBP levels of the study group were significantly higher than the control group(P<0.05);the study group CPR time and spontaneous circulationtime were significantly higher than that in control group(P<0.05).Two groups of intraoperative heart rate,respiration,blood pressure and oxygen saturation had no signifi-cant difference(P>0.05).Study group of patients with spontaneous breathing recovery,the restoration of spontaneous circulation, survival is greater than 24 h and rehabilitation discharge rates were significantly higher than the control group(P<0.05).There was no significant difference in the serum levels of NSE,NT-proBNP,cTnI immediately,H-FABP recovery in spontaneous circula-tion(P>0.05);after 24 h,NSE,NT-proBNP,cTnI,H-FABP levels in study group were significantly lower than those in the control group(P<0.01).Conclusion The application of cardiopulmonary resuscitation in patients with cardiac arrest before salvage can ef-fectively shorten the recovery time of CPR patients and spontaneous circulation time,reduce the damage to heart,brain,lung and other organs,improve the success rate of cardiopulmonary resuscitation,worthy of clinical application.

Objective To investigate the clinical significance of changes of serum insulin-like growth factor-Ⅱ(IGF-Ⅱ),carbohydrate antigen 19-9(CA19-9)and alpha fetoprotein(AFP)levels after intervention and percutaneous ethanol injection therapy in patients with primary hepatic cancer.Methods Serum levels of IGF-Ⅱ,CA19-9 and AFP(with RIA)were repeatedly determined in 57 patients with primary hepatic cancer before intervention therapy,1 month after intervention and percutaneous ethanol injection therapy and 6 months after intervention and percutaneous ethanol injection therapy as well as in 42 controls.Results Before intervention therapy,serum leveh of IGF-Ⅱ,CA19-9 and AFP in the patients were significantly higher than those in the controls(P＜0.01).One month after intervention and percutaneous ethanol injection therapy,all the serum levels were near to normal.Six months later,the levels in the patients without recurrence remained normal.However,the levels in the 10 patients with recurrence returned to those before intervention therapy again.Conclusion Changes of serum IGF-Ⅱ,CA19-9 and AFP levels are closely related to the tumor burden and may reflect the presence of recurrence.

Objective To evaluate the efficacy of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) in treating primary hepatocellular carcinoma(HCC).Methods From March 2004 to March 2006,137 patients with primary HCC underwent TACE alone(n=87) and TACE+RFA(n=50),respectively,after the interventional treatment,all patients periodically received CT reexaminations and alpha fetoprotein(AFP) measurement.The therapeutic efficacy,AFP level and survival rate between two groups were compared with each other.Results In TACE group the effective rate(CR+PR) was 34.5%,AFP decreasing amplitude was 54.2%,and 2 years survival rate was 43.7%.While in TACE+RFA group,the effective rate(CR+PR) was 70.0%,AFP decreasing amplitude was 78.0%,and 2 years survival rate was 62.0%,there were significant differences between two groups(P

1%. During the latent TB screening, agreement between tests was low (Kappa=0.07, P<0.01), but T-SPOT. TB is not affected by BCG vaccination, indicated its better specificity for screening latent TB than that of TST.

Objective To study the status of professional commitment and its effect on self-esteem of non-medical undergraduates in medical colleges. Methods Totally 410 non-medical under-graduates and 403 medical undergraduate were investigated by professional commitment of undergrad-uate scales and self-esteem questionnaire of undergraduates. T test,chi-square test,ANOVA,corre-lation analysis and multiple regression analysis were employed to do statical analysis,with P<0.05 be-ing statistical differences. Results Non-medical undergraduates’scores of professional commitment (85.11 ±11.60)and self-esteem (2.57 ±0.37)were lower than those (93.82 ±11.43)and (2.62 ± 0.35) of medical undergraduates. There were statistical differences in non-medical undergraduates’ professional commitment concerning the variables of professional consistency (t=5.657,P=0.000)and grades (F=8.528,P=0.000). Professional commitment of non-medical undergraduates was positively correlated with self-esteem. There was linear regression relationship between the variables of emotion-al commitment (P=0.005),normative commitment (P=0.006)and self-esteem. Conclusions Non-medical undergraduates' professional commitment and self-esteem levels are lower than those of medical undergraduates. The professional commitment could produce obvious effects on self-esteem.

Objective To analysis the victim's help-seeking behavior of domestic violence. Methods Using a multi-stage sampling strategy,306 victims of domestic violence were randomly selected and face-to-face interviewed. A self-designed help-seeking questionnaire of domestic violence was administered. Results 33.7%victims felt nowhere to seek help. The three leading helpers they seek were the other family member (34.6%),neighbor and friend( 17.0% ) and community office ( 12.5% ) ,and the community office had highest prevalence of effect (71. 1% ). The prevalence of seeking help from other family member and Women's Federation were highest in urban victims (P＜0.01) ,and seeking help from community office was highest in rural victims (P＜0.01). The three leading helpers were other family member (27.3%) ,community office ( 15.8% ) and neighbor and friend ( 10.9% ) by male victims, and other family member ( 38.0% ), neighbor and friend ( 20.0% ) and community office ( 10.8% ) by female victims. The prevalence of seeking help from neighbor and friend was higher in female than in male ( 20.0% vs 10.9%, x2 = 3. 980, P＜ 0.05 ). Adult victims seek help from other family member were less than children and the elderly (31.6% vs 42.0% and 46.9%, x2 =5.993, P＜0.05),and the elderly seek help from community office were more than adults and children (28.1% vs 12. 1% and 4.0%, x2 =9.930, P＜0.01 ). The victims with higher level of education were with higher prevalence of feeling nowhere to seek help (47.8%). Seeking help from other family member and community office were most in victims with lower level of education( 38.5% and 24.0% ,respectively) and were least in victims with higher level of education ( 17.4% and 0,respectively, P ＜ 0.05, P ＜ 0. 01 ). Conclusion Help-seeking behaviors of victims of domestic violence are varied by geographic settings,age,gender and education levels.

Objective To investigate the best operative approach in the treatment of myasthenia gravis (MG) by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery (VATS). Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time, postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb's movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time,and incisional infection in VATS group [(77.5 ± 18.0) ml, ( 100.8 ± 11.8) ml,( 2.3 ± 0.5 ) d, 0 ] were superior to those in trans-sternal group[ (97.4 ± 14.3 ) ml, ( 175.8 ± 18.3 ) ml, ( 3.1 ±0.7 ) d, 6.2% ( 2/32 ) ] and median stemotomy group [ ( 130.1 ± 24.0) ml, ( 379.0 ± 45.6 ) ml, (4.2 ± 0.6) d,13.8% (9/65)] (P ＜0.05),and median sternotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb's movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group (P ＜0.05).Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is more advantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for primary hospitals without advanced technology and equipments.

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Purpose: To investigate the clinical effect of miniature needle-knives in treatment of calcanodynia.Methods: Of 96 calcanodynia patients, 64 were treated with a needle-knife and 32, by local block therapy. The curative effects were evaluated. Results: The effective rate was 96.8% in the needle-knife group and the 78.1%in the local blockage group. There was a significant difference in curative effect between the two groups (P＜0.01). Conclusion: Needle-knife lysis has a marked effect on calcanodynia.

BACKGROUND: Property of artificial liver reactor is generally evaluated by using an enclosed experimental device, which is constructed through simulating bioartificial liver supporting system. Moreover, the enclosed experimental device is also comprehensively evaluated biological function of hepatocytes and biological response efficiency. In addition, it is significance for primarily evaluating the properties of polysulfone membrane hollow fiber reactor to optimize bioartificial liver supporting system. OBJECTIVE: To construct polysulfone membrane bioreactor experimental system, understand the effects on plasma of patients with severe hepatitis, and observe the feasibility of hollow fiber reactor regarded as bioartificial liver reactor. DESIGN: Repeated measurement.SETTING: General Infectious Disease Institute, Southwest Hospital, the Third Military Medical University of Chinese PLA. MATERIALS: Seven Chinese mini-pigs with 1-7 days old and of either gender were provided by Experimental Animal Center, the Third Military Medical University (certification: F99017). The animal disposal accorded to the ethical standard. Tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) kits were purchased from Jingmei Bioengineering Company, China; polysulfone membrane hollow fiber reactor by Shanghai Dehong Biomaterial Institute, China; Cellco culture-circular artificial capillary culture system by Spectrum Company, USA; seven plasma exponents were taken from admission patients with chronic severe hepatitis during plasma exchange. All patients provided the informed consent, and the animal experiment was conducted with confirmed consent by the local ethics committee.METHODS: This study was performed at the General Infectious Disease Institute, Southwest Hospital, the Third Military Medical University of Chinese PLA from January 2004 to July 2005. ① Experimental procedure: The experimental pigs underwent ablactation at 12 hours before experiment, and then hepatocytes were separated after cleaning their fur. An enclosed system was composed of polysulfone membrane hollow fiber reactor and Cellco culture-circular artificial capillary culture system, which were connected with oxygen-carbon dioxide diffusion tube and media holding pond. Interface of external cavity was blocked with clean rubber tampon. The separated hepatocytes underwent spheroid culture by using magnetic stirring method, and then they were inoculated in the external cavity of polysulfone membrane hollow fiber reactor. Next, 200 mL plasma from severe hepatitis patients was added in media holding pond and circled from internal cavity of reactor to media holding pond at the speed of 80 mL/min. ② Experimental evaluation: 2 mL liquid circulation separately collected from internal cavity of reactor at 0, 2, 4 and 6 hours after circulation was used to measure level of ammonia in supernatant by using glutamic dehydrogenase-violet method. In addition, content of total bilirubin was detected by using automatic biochemistry analyzer, prothrombin time by using automatic blood coagulometer, and TNF-α and TGF-β1 were detected according to the kits. MAIN OUTCOME MEASURES: Effects of polysulfone membrane bioreactor on ammonia, bilirubin, prothrombin time, TNF-α and TGF-β1 in plasma of patients with severe hepatitis.RESULTS: ① Measurement of ammonia, total bilirubin and prothrombin time in patients with severe hepatitis: Level of ammonia decreased persistently, in particularly, the decrease was obvious from 0 to 2 hours, and then, it was decreased slowly. While, level of total bilirubin was also decreased persistently, and it was significantly lower at 6 hours than that at 0 hour (P < 0.05). Moreover, prothrombin time was decreased persistently, and it was significantly lower at 6 hours than that at 0 hour (P < 0.05). ② Measurement of TNF-α and TGF-β1 in patients with severe hepatitis: Contents of both TNF-α and TGF-β1 decreased persistently, and they were significantly lower at 6 hours than those at 0 hour (P < 0.05). CONCLUSION:Polysulfone membrane bioreactor experimental system can clear noxious substance of small molecules in plasma of patients with severe hepatitis, supply beneficial components, and decrease levels of cytokines. Therefore, it can be regarded as the bioartificial liver reactor.