Personnel resource is very important for the development of emergency department and emergency medicine.In recent years a series of researches for the standardized training of emergency residents have been progressed in the Emergency Depart- ment of West China Hospital.It goes through three phases.The idea of the training changes from“general physician”to“emer- gency specialist”.And the training is designed,practised and assessed with standardization.

Adolescent ; Adult ; Benzene ; toxicity ; China ; Female ; Humans ; Leukemia ; chemically induced ; diagnosis ; Male ; Middle Aged ; Occupational Exposure ; Young Adult

BACKGROUND:To explore the methods for secondary limb revascularization after endovascular repair is one of the most urgent research topics.
OBJECTIVE:To investigate the biological mechanism about the transplantation of autologous peripheral blood stem cel s to lead and perfect the effect of ischemic tissue for secondary revascularization.
METHODS:Forty-two patients with critical low limb ischemia were selected and treated with endovascular repair as first revascularization and transplantation of autologous peripheral blood stem cel s as secondary revascularization. The secondary revascularization was carried out at 3 months after the first blood flow remodeling. The patients receiving secondary revascularization were fol owed for 4 years.
RESULTS AND CONCLUSION:After transplantation of autologous peripheral blood stem cel s, the patients complained that the rest pain of the lower leg was relieved obviously and intermittent claudication distance was significantly lengthened. Limb salvage rate was 100%. Skin temperature index was 1.6±0.3, transcutaneous oxygen pressure was (5.00±1.26) kPa, ankle-brachium index was 0.9±0.2, photoplethysmograpy index was 0.8±0.1, saturation of blood oxygen was (79.4±20.4)%, and digital subtraction angiography score was (1.3±0.2)
points. After transplantation, local blood flow indicators of the low limbs were positively correlated to local symptom indicators of the limbs (0.6

20% lymphocytes)was documented in all patients who underwent bronchoalveolar lavage(BAL).In addition,inversion of the CD4/CD8 ratio(mean value:0.64?0.21)was observed in the patients.Non-specific IgM and IgG antibodies to antigens were documented in 13/14(92.9%)of BAL patients.Ten patients were cured by glucocorticoid,others by anti-infective therapy.We rechecked the HRCT which displayed the shade of lung in 12 patients(85.7%)vanishing completely,2 patients'(14.3%)partly.Conclusion There is no specificity in the clinical manifestations,change of mageology,pulmonary function and the immunologic test.However,compared with other methods,we find the test of BAL is more valuable to the diagnosis.It is critical to avoid the antigen,and we find the curative effect of the glucocorticoid is significant.

Objective To observe the effect of buprenorphine transdermal patch combined with gabapentin in patients with diabetic peripheral neuralgia (DPN).Methods Sixty patients were divided randomly into experimental (A) and control (B) groups.Patients in group A were treated with buprenorphine transdermal patch combined gabapentin.Patients in group B were orally administered pregabalin only.The period of treatment was 8 weeks.The analgesic effect [visual analogue scale (VAS) scores] , sleep scores, daily doses of gabapentin, and adverse reactions were evaluated before treatment, and the 2nd weeks, 4th weeks and 8th weeks after treatment.Results The VAS scores of group A were significantly lower than group B at 4th weeks and 8th weeks after treatment [(2.8 ± 1.6) points vs (3.8 ± 1.5) points,(2.6 ± 0.5) points vs (3.5 ± 1.6) points, P ＜ 0.05].The sleep scores of group A were significantly higher than group B (P ＜ 0.01).The daily doses of gabapentin were significantly lower [(853.0 ± 349.8) mg vs (1575.8 ± 351.0) mg, (845.1 ± 342.7) mg vs (1434.2 ± 440.8) mg, (826.9 ± 298.5) mg vs (1389.8 ±356.6)mg, P ＜ 0.05].The incidence of adverse reactions was significantly lower in group A (10.7％ vs 25.9％ , 10.7％ vs 29.6％ , P ＜ 0.05).Conclusions The combination of buprenorphine transdermal patch and gabapentin is effective and safe for the patients with DPN.

Objective To investigate the effect of N-nitro-L-arginine (NO2Arg) on the development of morphine tolerance and dependence.Methods Forty male SD rats weighing (180 ? 18)g were randomly divided into 5 groups for the study of morphine physical dependence and tolerance : group Ⅰ normal saline; group Ⅱ morphine; group Ⅲ morphine + 1 mg?kg-1 NO2Arg; group Ⅳ morphine + 5 mg?kg-1 NO2 Arg ; group Ⅴ morphine +20 mg?kg-1 NO2Arg. Twenty-four male Kunming mice weighing (20.0 ? 2.3)g were randomly divided into 3 groups for the study of psychological dependence: group Ⅵ morphine; group Ⅶ dihydro etorphine; group Ⅷ normal saline. The morphine physical dependence was induced by dose increment. The degree of morphine tolerance was assessed by the pain threshold to heat radiation using tail-flick test. The degree of morphine physical dependence was determined by evaluating the abstinence syndrome precipitated by 4 mg?kg -1 naloxone. The psychological dependence of mice was evaluated by conditioned place preference. Results Consecutive injection of NO2Arg inhibited the development of morphine tolerance in a dose-dependent manner. 5 mg?kg-1 NO2 Arg suppressed most abstinent symptoms of morphine dependent rats. The duration when morphine and dihydro etorphine psychologically dependent mice stayed in the preferred compartment increased significantly from (6.1? 2.0)min and (8.0?0.7)min to (9.3?1. l)min and (9.5 ? 1.2) min by 4 mg?kg-1 NO2 Arg. Conclusion NO2 Arg can inhibit the development of morphine tolerance and dependence and reverse the existing psychological dependence.

Objective To compare the specificity and sensitivity of antibodies against SSA and SSB,anti-M3 receptor polypeptide antibodies,anti-α-fodrin(IgG)antibodies in primary SjSgren's syndrome (pSS).Methods One hundred and ten pSS patients(mean age was 49.2±14.8.mean disease duration was 5.6±4.6),80 systemic lupus erythmatosis(SLE)patients(mean age was 25.5 4-4.6,mean disease duration was 2.5±1.2)and 80 rheumatoid arthritis(RA)patients(mean age was 44.6±3.5.mean disease duration was 4.2±1.1)were studied.Enzyme-linked immunosorbent assay was used to measure these antibodies.Results The seropositive rates of anti-SSA,anti-SSB antibodies,anti-M3 receptor polypeptide antibodies and anti-α-fodrin(IgG)antibodies were 45.5%,30.9%,78.2%and 77.3%,respectivelv in pSS.They were much higher than those in RA and SLE patients(P<0.05).Specificities of SSA、SSB antibodies,anti-M3 receptor antibodies and anti-α-fodrin IgG were 83.8%,97.7%.92.0%and 90.O% respectively.With the combination of these antibodies in the diagnosis of pSS.the Sellsitivity can be increased at least to 88.2%and the specificity was not decreased significantly.Conclusion Combination of these antibodies can significantly improve the sensitivity of these antibodies in the diagnosis of pSS.Anti-SSA and SSB antibodies,anti-M3 receptor antibodies and anti-α-fodrin(IgG)antibodies are specific antibodies for the diagnosis of pSS.

Aquaporins (AQP), abundant in diversity, are the member of the major intrinsic proteins (MIPs) family with extraordinary ability to transport water, and thus, play important roles in modulation of water relations in plants. The recent advances in classification, structural characteristics, and physiological functions during plant growth and development as well as the various regulation modes of the activity and the effects of several abiotic stresses (water stress and salt stress) and phytohormones (ABA, GA and ethylene) on the gene expression of AQP were reviewed.

Objective To study the value of tubal catheterization and hydrotubation using hysteroscopy in the assessment of tubal patency after laparoscopic operations for ectopic pregnancy.Methods Hysteroscopic tubal catheterization and hydrotubation was carried out for evaluating tubal patency in 56 cases of ectopic pregnancy at 2~24 months after laparoscopic salpingectomy or salpingotomy. Results Of 15 cases of salpingectomy,unilateral complete tubal unobstructedness was achieved in 9 cases(60.0%).Of 41 cases of linear salpingotomy,bilateral tubal unobstructedness was found in 18 cases(43.9%) and unilateral in 18 cases(43.9%).A follow-up observation for 4~25 months(mean,10.8 months) in 37 women with childbearing demand showed normal intrauterine pregnancy in 20 cases(54.0%),intrauterine pregnancy after in vitro fertilization(IVF) in 3 cases,and recurrent ectopic pregnancy in 1 case(2.3%).Conclusions Hysteroscopic tubal catheterization and hydrotubation is a direct and accurate procedure for evaluating tubal patency after laparoscopic operations for ectopic pregnancy.It may be taken as a guide in evaluating the possibility of normal intrauterine pregnancy.

Objective To investigate the safety and effectiveness of high intensity focused ultrasound (HIFU ) in the treat‐ment of uterine fibroid (<4 cm) .Methods Retrospectively studied 79 single fibroid (<4 cm) patients that treated with HIFU in our hospital from January 2011 to February 2013 .Evaluated the improvement of post‐treatment ,shrinkage of fibroid volume and HIFU‐related adverse reaction .Results All the 79 patients were successfully cured by HIFU treatment .The shrinkage rate of fi‐broid was 79 .0% (four point spacing 57 .9% ,92 .1% ) after 2‐year treatment ;Symptom severity score (SSS) and uterine fibroid symptom and quality of life score (UFS‐QOL) were significantly improved ;and there was no adverse reaction .Conclusion HIFU can be safely used in the treatment of small uterine fibroids (diameter<4 cm ) .