Objective: To investigate the cochlear function of the patients suffering from obstructive sleep apnea-hypopnea syndrome(OSAHS) by using ABR.Methods: 40 patients with OSAHS(80 ears) admitted from February 2004 to September 2004 were divided into two subgroups: mild OSAHS group(11 cases) and moderate and severe OSAHS group(29 cases)according to the value of AHI.Each group was tested by Auditory brainstem response(ABR).The latencies of wave Ⅰ、Ⅲ、Ⅴand the interpeak latency intervals of waveⅠ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ were measured.The obtained results of the two subgroups were respectively compared with the normal values.Results: The latencies of waveⅠ、Ⅲ、Ⅴ and the interpeak latency intervals of wave Ⅰ-Ⅲ、Ⅰ-Ⅴin the moderate and severe OSAHS subgroup were prolonged compared with the normal control values,and the difference was significant statistically.The latencies of waveⅠ、Ⅲ in the moderate and severe OSAHS subgroup were significantly prolonged compared with those in the mild OSAHS subgroup.But there was no statistical change in the latencies of wave Ⅰ、Ⅲ、Ⅴand the interpeak latency intervals of waveⅠ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴin the mild OSAHS subgroup as compared with the normal control values.Conclusion: Cochlear function can be impaired in patients with moderate and severe OSAHS,and ABR can be taken as a monitor index to observe whether OSAHS affects cochlear function or not.

Objective To investigate the clinical efficacy of atorvastatin in patients with lacunar infarctions (LI) and influence on cerebrovascular reactivity(CVR). Methods 60 patients with LI were randomly divided into observation group and control group. The patients of control group were given aspirin treatment, patients of observation group were given atorvastatin combination with aspirin therapy. The breath-holding index(BHI) before and after treatment was calculated. After continuous treatment for 3 months the clinical efficacy was evaluated. Results The total effective rate of the observation group was 90. 0% ,it was significantly higher than that of the control group(73.3% ),compared with the control group the difference was significant( x2 = 10. 428 ,P < 0. 05). The bilateral BHI of observation group significantly increased, compared with per-treatment and control group the difference was significant ( t =9. 455,6. 135 ,all P < 0. 05 ) ,but the bilateral BHI of control group had no significant difference compared with pertreatment ( P ＞ 0. 05 ). Conclusion Atorvastatin could effectively improve CVR in patients with LI. Therefore, atorvastatin had great significance for the prevention of stroke.

Objective On the basis of previous researches,the paper confirmed the weight of indicators to build emergency physicians'competency models for their different career stages.Methods Using the method of analytic hierarchy process (AHP)to establish evaluation hierarchy for emergency physicians'different career stage and construct the pair wise comparison judgment matrix,checking consistency and judgment matrix at the same time.Results Achieved the construction of competency models for three different stages of emergency physicians,primary,intermediate and advanced included.Conelusion The models can dynamically clarify the career stages of emergency physicians,supporting personalized training and management of the physicians.

Objective To build a competency-based indicator system for emergency physicians in their career stages.Methods We conducted expert consultations which were guided by Delphi method,and analyze the data collected from the experts using professional statistic software such as Excel and SPSS.Results The evaluating indicator system for emergency specialists at primary,intermediate and senior level was constructed base on experts' view.Conclusion The indicators illustrate the required competencies of emergency specialists in different stages comprehensively,which help to evaluate and classify the career stages of emergency physicians effectively.

ObjectiveTo explore the value of 64-slice CT perfusion imaging(CTPI) in the early diagnosis of radiation-induced lung injury ( RILI ).MethodsForty-eight patients with upper esophageal cancer resection underwent CTPI before and after radiotherapy,and the TNF-α and TGF-β1 were measured from patient's peripheral blood.Serum cytokine,conventional CT appearances and CTPI parameters (rrBF,rrBV,rrPS) in patients with RILI (Group A) and non-RILI (Group B) were compared and analyzed.A randomized block design t-test was used for comparison of serum cytokines and perfusion values between the two groups.The Chi-square ( x2 ) test was used for comparison of detection rate between conventional CT and CTPI.ResultsRILI occurred in 18 of 48 cases ( 18/48,Group A).In Group A,TNF-α and TGF-β1 preand pos-radiation were (36.1 ± 15.0),(30.4 ±t 14.9) ng/L and (17.5 ±9.8),(14.3 ±7.6) μg/L,respectively,and there were no statistically significant differences (t =1.14,1.I0,P =0.264,0.279).At half-dose time point of radiation,there were no significant differences for TNF-α and TGF-β1 pre- and posradiation [ ( 30.4 ± 14.9),( 28.9 ± 14.7 ) ng/L and ( 14.3 ± 7.6),( 14.4 ± 6.0 ) μg/L,respectively ]between Group A and B ( t =0.33,1.23 ; P =0.746,0.227).The rrBF,rrBV and rrPS of post-radiation from Group A were significantly higher than those of pre-radiation ( t =5.67,5.97,6.11,P =0.000,0.000,0.000),the rrBF and rrBV of post-irradiation from Group B were significantly higher than those of pre-irradiation (t =6.52,7.84,P =0.000,0.000).There was no significant difference for rrPS in Group B pre- and post-radiation (t =1.36,P =0.178 ).There were significant differences for all perfusion values detected from radiation lung fields between Group A and B ( t =2.32,2.18,6.04,P =0.025,0.034,0.000).Taking rrPS =1.28 as a threshold value on ROC,the sensitivity and specificity of CTPI for diagnosis of RILI were 77.8％,93.3％,respectively,which were much higher than those ( 11.1％,90.0％,respectively) of conventional CT (x2=13.61,P=0.000).ConclusionCTPI parameters may reflect the hemodynamic changes of post-radiation lung and have potential values for the early diagnosis of RILI.

Objective To explore the titre of serum anti-phospholipase A2 receptor antibodies (anti-PLA2 R antibodies) detected by the enzyme-linked immunosorbent assay (ELISA) to provide a more specific serological index for clinical diagnosis and disease judgment of membranous nephropathy (MN).Methods Thirty-four cases of MN confirmed by kidney biopsy ,32 inpatients with autoimmune diseases ,nephrotic syndrome and renal insufficiency in the nephrology department of our hospital and 12 persons un-dergoing physical examination were selected.The serum was collected for detecting anti-PLA2 R antibodies level.Then its diagnostic performance for diagnosing MM was analyzed by combining with serum TP ,ALB ,IgG ,IgA ,IgM ,C3 and C4 indicators.Results The medians of anti-PLA2 R antibodies titres in the MN group ,disease control group and healthy control group were 22.1 ,2.0 ,2.0 RU/mL respectively ,which had statistical difference between the MN group and other two groups (P<0.05).Seventeen cases of anti-PLA2R antibodies positive were in the MN group(positive rate50% )and 17 cases were negative,the disease control group and healthy control group all were negative.Its specificity and positive predictive value were 100% ,TP ,ALB and IgG had statistical difference between the MN group with the disease control group and healthy control group (P<0.05);the relative coefficients of anti-PLA2 R antibodies with TP ,ALB and IgG ,IgA ,IgM ,C3 and C4 were in turn -0.382 ,-0.344 ,-0.502 ,-0.295 ,0.062 , 0.005 and 0.241 respectively ,anti-PLA2R antibodies were negatively correlated with TP ,ALB ,IgG and IgA(P<0.01) ,positively correlated with C4(P<0.05) and had no relation with IgM and C3(P>0.05).Conclusion Anti-PLA2 R antibodies have higher specificity for the diagnosis of MN and can serve as the necessary and specific serologic detection indicator in the patients unable to conduct renal biopsy.Quantitative detection helps to condition judgment.

Objective To investigate the value of detections of anti‐nuclear antibody (ANA) combined with anti‐cardiolipin anti‐body (ACA) ,anti‐sperm antibody (AsAb) and anti‐beta 2 glycoprotein I (β2 GPI) antibody in the diagnosis of female infertility dis‐ease .Methods A total of 187 female cases of infertility (infertility group) were detected serum ANA and AsAb by the indirect im‐munofluorescence assay ,and ACA andβ2 GPI antibody by the enzyme linked immunosorbent assay (ELISA) .ANA ,ACA ,AsAb andβ2 GPI antibody also were detected in 80 females cases of normal fertility (normal group) .Results Among 187 cases of female infer‐tility ,ANA positive rate was 18 .1% (34/187) and which in the normal group was 2 .5% (2/80) .The ACA positive rate was 22 .3%(43/187) in the infertility group and 5 .0% (4/80) in the normal group ;the AsAb positive rate was 18 .7% (35/187) in the infertil‐ity group and 3 .8% (3/80) in the normal group ;theβ2 GPI positive rate was 20 .3% (38/187) in the infertility group and 3 .8% (3/80) in the normal group;the differences between the two groups had statistical significance (P<0 .05) .Conclusion Infertility is closely correlated with the in vivo existence of ANA ,ACA ,AsAb andβ2 GPI antibody ,the joint detection is conducive to find the e‐tiology of infertility and improve the clinical diagnosis rate .

Objective To explore the impact of enteral nutrition (EN)support on patients with advanced cancer.Methods 83 cases with advanced cancer were selected,the patients were randomly divided into two groups, 42 cases in the observation group,41 cases in the control group.The observation group was given EN support com-bined with parenteral nutrition (PN)support,while the control group was only given the PN support.Immune function CD +4 ,CD +4 /CD +8 ,IgA,IgG,nutrition indicators [serum albumin (ALB),transferrin (TF)and 24h urea nitrogen (24hUP)]before and 10d after surgery as well as complications were compared.Results The differences of CD +4 , CD +4 /CD +8 ,IgA,IgG,ALB,TF and 24h UP between the two groups before surgery were not statistically significant (P >0.05);10d after surgery,CD +4 ,CD +4 /CD +8 ,IgA,IgG levels in the control group were (52.4 ±4.4)%,(1.8 ± 0.3)%,(2.7 ±0.3)g/L and (11.4 ±2.1)g/L,which in the observation group were (55.9 ±5.6)%,(2.1 ± 0.5)%,(2.9 ±0.5)g/L and (12.9 ±2.3)g/L,CD +4 /CD +8 ,IgA,IgG were significantly higher in the observation group(t =2.408,2.521,2.332,2.359,all P <0.05);10d after surgery,ALB,TF and 24h UP in observation group were (36.6 ±2.3)g/L,(2.9 ±0.2)g/L,and (0.7 ±0.3)g/L,which were (32.4 ±1.5)g/L,(2.2 ±0.1)g/L,and (0.4 ±0.1)g/L in the control group,the differences were statistically significant (t =7.493,15.34,4.648,P <0.05).The incidence rate of complications in the observation group was 9.5% (4 /42),which in the control group was 26.8%(11 /41),the difference was statistically significant (χ2 =4.196,P <0.05).Conclusion EN support for patients with advanced cancer is benefit for immune function improvment and nutrition improvement,and can reduce the risk of complications.

Objective To evaluate the effect of palliative care in the treatment of pain and life quality in later period tumor patients.Methods 103 patients with advanced tumors in our hospital were selected and divided into group A(51 patients) and group B(52 patients) based on the methods of treatment.The patients in group A were given conventional treatment,and the patients in group B were given palliative care program on the basis of the treat-ment in group A.The effects of the groups A and B were observed and compared.Results The pain levels of group A and B before treatment had no statistically significant difference (P>0.05).The pain level score of group B after treatment was (26.41 ±3.55)points,which was lower than (32.56 ±7.12)points in group A,and the difference was statistically significant (t=6.430,P<0.05).The difference in life quality of the two groups before treatment was not significant (P>0.05).After treatment,the life quality score of group B was (66.85 ±6.75)points,which was higher than (53.39 ±6.74)points in group A,and the difference was statistically significant (P<0.05).Conclusion It is effective for palliative care to treat the patients with advanced tumors on their pain management and quality of life, which is worthy of clinical application.