Objective To study the effect of sand storm on the activity of saliva lysozyme of middle school students and pupils.Methods 452 subjects aged 8-17 years,living in the areas where the sand storm happened frequently and infrequently,were selected with the stratified sampling and cluster sampling methods in May 2007.The activity of saliva lysozyme in saliva was measured by turbidimetric method.Results Compared with the areas where the sand storm happened frequently,in the infrequent areas,the activity of lysozyme of the boys in 12,14,16 ～17 age groups and of the girls in 12 and 14 age groups significantly decreased(P﹤0.05 or P﹤0.01).The activity of saliva lysozyme of the areas where the sand storm happened frequently was concerned with gender,age,time of daily outdoor activity during the sand storm.Conclusion Sand storm can cause the activity of saliva lysozyme decrease in the middle school students and pupils.

The anatomy of the trunks and branches of anterior inferior cerebellar artery(AICA) was studied and its surgical importance especially in the operation for acoustic neuroma(AN), was discussed.15 fresh adult cadavers were perfused with ABS via internal carotid artery and vertebral artery and then dissected under operation microscope in detail. AICA was constantly present in all specimens. The incidence of labyrinthine artery(LA), recurrent perforating artery(RPA), subarcuate artery(SA),and cerebellar subarcuate artery (Cer.SA) was 100%,86.7%,80% and 16.7%, respectively. 97.1% of LA entering the internal auditory meatus (IAM) were located under the facial vestibulocochlear nerve complex, 56.7% of RPA passed between it ,and 75% of SA was located posteroinferiorly to it .60.7% of the loop of AICA was situated close to the IAM, and 53.6% of them lay between the Ⅶ and Ⅷ cranial nerves. These data may be helpful in microneurosurgical operation and radiography.

The Lazarus phenomenon is defined as delayed ROSC,or ROSC after failure of CPR and cessation of all the emergency medical care,including the cessation of chest compression,mechanical ventilation,and venous fluid resuscitation.It was first reported in 1982 and 53 cases of Lazarus phenomenon have been reported in the medical literature so far.Even though Lazarus phenomenon is rare and the pathophysiological mechanisms are poorly understood,several possible mechanisms are still proposed,which could be rational to explain this phenomenon,such as auto-PEEP,hyperkalemia,alkalosis,delayed action of drugs,etc.In most cases,it was reported that ROSC occurred within 10 minutes after cessation of medical effort.Therefore,before the announcement of death of patient,it is mandatory to monitor those patients for at least 10 minutes after the cessation of CPR.However,more explicit studies seem to be necessary to gain a better understanding of this phenomenon.

Objective Respiratory variations in the pulse oximetry plethysmographic waveform amplitude (△POP) have been popularly studied as a dynamic indicators for fluid responsiveness assessment.The authors hypothesized that △POP can indicate fluid responsiveness in septic shock patient in emergency department.Methods A prospective study of 28 patients with septic shock was carried out in Emergency Room and Emergency Intensive Care Unit from 1 October,2010 to 30 September,2011.Hemodynamic data including cardiac index,stroke volume Variation (SVV) and △POP were recorded before and after volume expansion treatment.Fluid responsiveness was defined as an increase in cardiac index of 15％ or greater.Results Changes in △POP after volume expansion were greater in responders than that in non-responders (P ＜ 0.01).There was a significant relation between △POP and SVV before volume expansion (r =0.900,P ＜ 0.0001).Conclusions △POPcan indicate fluid responsiveness non-invasively in septic shock patient in emergency department.This marker has potential clinical application with high sensitivity and reliability.

Objective To study the mechanism of glycerol in treatment of trigeminal neuralgia. Methods After chronic constriction injury was produced to the infraorbital nerve and the model of trigeminal neuralgia in rats was successfully established, the trigeminal ganglion and preganglionic rootlets were exposed through infratemporal fossa approach. In the experimental group, pure glycerol was instilled into the preganglionic rootlets, while in the control group physiologic saline instead. The electrophysiologic response and the results of the electron microscopy were observed at different time points after glycerol injection. Results The latency of sensory evoked potential in the experimental group was longer than that in control group. Under the electron microscope, demyelination and degeneration were very similar in two groups, but disruption of neuraxon was only observed in the experimental group. Neuraxon regeneration occurred 10 weeks later. Conclusion Retrogasserian glycerol rhizotomy in treatment of trigeminal neuralgia was through disruption of myelinated nerve fiber that is reversible.

ObjectiveTo evaluate the efficacy of hypertonic saline (HS) treatment in cardiopulmonary resuscitation (CPR) in animal models of cardiac arrest (CA).Methods PubMed and EMBASE data were retrieved from January 1st, 1966 to September 30th, 2014, and Wanfang data and CNKI were searched from January 1st, 1990 to September 30th, 2014 for randomized controlled trials (RCTs) regarding CPR intervention of CA animal models with HS. HS was intravenously infused at the initiation of CPR in HS group, without limiting its dosage or concentration. The same volume of normal saline (NS) was given in NS group. Meta-analysis concerning the rate of restoration of spontaneous circulation (ROSC), the serum sodium concentration before CA and during CPR, and related hemodynamic parameters, including mean arterial pressure (MAP) and coronary perfusion pressure (CPP) at the immediate beginning of CPR and 90 minutes after ROSC was conducted by RevMan 5.3 software.Results A total of 8 RCTs were included. Meta-analysis showed that compared with NS group, the rate of ROSC [relative risk (RR) = 1.23, 95% confidence interval (95%CI) = 1.05-1.43,P = 0.010], serum sodium concentration during CPR [weight mean difference (WMD) =17.44, 95%CI = 12.57-22.31,P< 0.01], and the level of MAP at 90 minutes after ROSC (WMD = 4.81, 95%CI =1.58-8.03,P = 0.003) were significantly improved in HS group. There was no significant statistic difference in other hemodynamic parameters, including serum sodium concentration before CA (WMD = 0.78, 95%CI = -0.26-1.82,P =0.14), MAP (WMD = 5.43, 95%CI = -0.74-11.59,P = 0.08) and CPP at the immediate beginning of CPR (WMD =6.82, 95%CI = -5.54-19.19,P = 0.28), and CPP at 90 minutes after ROSC (WMD = -0.77, 95%CI = -10.33-8.80, P = 0.88) between two groups. It was showed by funnel chart that bias was not significant in the published articles. Conclusion This systematic review indicates that HS infusion is followed by an improved ROSC rate, serum sodium concentration during CPR, and MAP at 90 minutes after ROSC in animal models of CA.

As one of the cornerstones of modern cardiopulmonary resuscitation (CPR), ventilation received controversy and challenges in the past two decades. From 2000 to 2015, the changes in CPR guidelines of American Heart Association (AHA) showed that the position of ventilation declined gradually as compared to chest compressions. Chest compressions only CPR has been strongly advocated in recent years, especially in witnessed cardiogenic cardiac arrest (CA). Passive oxygenation and cardiocerebral resuscitation (CCR) also showed good effect in the early stage of cardiogenic CA. However, clinical validation in a larger context is still needed. An impedance threshold device (ITD) transiently blocks air from entering the lungs during recoil, decreases the intrathoracic pressure, facilitates venous return to the chest and increases coronary blood flow. However, the relevant research findings are not consistent, and the guidelines do not recommend routine use of ITD. Positive-pressure ventilation, which can increases intrathoracic pressure, affects the coronary perfusion pressure (CPP) and cerebral perfusion, is thought to be not only useless, but also has adverse effects within the first few minutes of CPR. This view is accepted by many scholars, however, ventilation is essential in late-start CPR, prolonged CPR and non-cardiogenic CA. Mechanical ventilation, especially special ventilation modes for CPR showed some prospects. Positive-pressure ventilation remains the gold standard in CPR in clinical practice at present. It was shown by existing research that hyperventilation significantly reduce the success rate of resuscitation, thus a consensus had been reached about avoiding hyperventilation. Currently, the number of studies on ventilation during CPR is very limited, and many of the conclusions are not consistent among studies. Therefore, more high-quality studies are needed in future to further clarify the application of ventilation during CPR.

Cardiopulmonary resuscitation is the most comonly used method facing cardiac arrest.The 2010 CPR guidelines emphasized high quality chest compressions and recommended continuous compression for 2 minutes after defibrillation to minimize interruptions in compressions.However,starting chest compressions immediately after a defibrillation shock may be harmful,if the heart is providing spontaneous beats and being subjected to external compressions at the same time.So it is very important to recognize ROSC during CPR,the methods of which include touching the pulse,amplitude spectral area,partial pressure end-tidal carbon dioxide,coronary perfusion pressure,central venous oxygen saturation,chest compression fraction,regional cerebral oxygen saturation,photoplethysmography,conjunctival oxygen tension,transthoracic-impedance plethysmography and echocardiography.This paper gives a review of the ROSC prognosis and recognition methods during CPR.

Objective To study the risk factors associated with death of patients suffered from acute exacerbation of interstitial pneumonia (AE-IP) with very high mortality and very difficult to handle so as to find the most suitable treatment strategy for these patients.Methods The data of 26 patients with AE-IP admitted to Emergency Intensive Care Unit in Peking Union Medical College Hospital from September 2010 to September 2013 were restrospectively analyzed.Comparison of general condition of patients,treatment strategy and response to non-invasive ventilation of patients was made between survival group and death group.Results There was no significant difference in general condition of patients between death group and survival group.But compared with idiopathic pulmonary fibrosis (IPF),connective tissue disease-related interstitial pneumonia had a tendency to accounting for higher proportion in the survival group.The rats of endotracheal intubation and invasive ventilation were significantly increased in death group (14％ vs.84％,P ＜ 0.05).There was significant improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours in the survival group (176 ± i10 vs.218 ±64,P ＜0.05) while the death group had no significant improvement.Conclusions In patients with AE-IP,connective tissue disease associated interstitial pneumonia might have better outcome than IPF.AE-IP patients have a very high mortality rate once patients intubated,thus the decision of intubation in such patients needs to be very cautious.The patients with negligible improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours may have a poor prognosis.

Objective To study risk factors associated with predisposition to Lm -ABM in adult patients and to evaluate the clinical features,management and out in this cohort of patients because Listeria monocytogenes (Lm) is the third most common cause of acute community acquired bacterial meningitis (Ac-ABM),after Streptococcus pneumoniae and Neisseria meningitides aetiologies.Methods A descriptive,prospective study carried out in a tertiary grade medical center emergency department in Beijing over a 10 -year period.During the study period,15 patients of Lm- ABM were included.Comparison of episodes of Lm - ABM versus other aetiologies was made.Results Fifteen episodes of Lm - ABM were identified in327 adult Ac - ABM patients.Three cohorts of individuals were vulnerable to Lm - ABM:the elderly ( RR=3.14; 95％ CI 1.84-5.35),the immunocompromised (RR =3.34; 95％ CI2.08-5.38),and pregnant women ( RR 12.48 ; 95％ CI 3.29 ～ 47.39 ).The classic triad of fever,neck stiffness,and altered mental status was present in 40％ (6 of 15) Lm - ABM patients.Similarly,40％ patients had at least one of cerebrospinal fluid (CSF) samples with features met the criteria of typical bacterial meningitis.The coverage of empirical antimicrobial therapy was microbiologically inadequate for 13 ( 86.7％ ) patients.The mortality rate was 33.3％ (5 of 15),and 7 (46.7％ ) of 15 patients led to an unfavorable outcome ( GOS ＜ 4),both of which were significantly higher than those in other aetiologies of Ac - ABM ( P =0.015P =0.009 respectively). Conclusions Our study showed the elderly,the immunocompromised patients,and pregnant women predisposed to Ac - ABM most likely to be Listeria monocytogenes aetiology.In contrast with similar previous reports, the current study showed that patients with meningitis due to Listeria monocytogenes did not present with atypical clinical features.A high proportion of patients received empirical antimicrobial therapy that did not cover Listeria monocytogenes.Lm - ABM is still a serious disease that leads to high morbidity and mortality rates.With these important caveats in mind,our findings have implications for clinical practice and food safety policy makers.