Objective To analyze the status of misdiagnosis of exertional heat stroke (EHS), its causes and influence on prognosis. Methods The clinical data of patients with EHS in 9 military hospitals from January 2012 to December 2018 were analyzed retrospectively. According to the time of diagnosis (from onset to the establishment of preliminary or suspected diagnosis), the patients were divided into ≤0.5 h, 0.5-1 h, 1-3 h, 3-6 h and >6 h groups. The number of organs involved and the clinical outcome (death or survival) of patients in each group were recorded, and the relationship between delayed diagnosis and prognostic indexes was analyzed. Through the analysis of misdiagnosis-related medical records, the distribution characteristics and possible causes of misdiagnosis were found. Results Among 122 EHS patients, 23 died, with a total fatality of 18.9%. The diagnosis time showed a skewed distribution, and the median (quartile interval) was 1.5(2.63) h. The correlation analysis between the time of diagnosis and the time of initiation of cooling showed a positive correlation (r=0.871, P<0.05). The number of involved organs increased with the delay of diagnosis, and it was significantly higher in patients diagnosed more than 6 h than that in patients diagnosed in the early stage (within 0.5 h, P<0.05). The risk of death also increased significantly with the delay of diagnosis, and the fatality rate of patients diagnosed more than 6 h was significantly higher than that of patients diagnosed in the early stage (within 0.5 h, P<0.05). The composition ratio of misdiagnosis varied with time. The misdiagnosis rate within 0.5 hours of onset was 87.7%. The diagnosis was mainly based on symptomatic description (64.5%), followed by misdiagnosis as nervous system disease (24.3%). The main causes for the delay in diagnosis were the lack of typical clinical manifestations in the early stage of the disease and the lack of understanding of the disease in the on-site emergency medical personnel. Conclusions The misdiagnosis rate would be high in the early stage of EHS, and it may be significantly related to organ injury and prognosis. The main cause of misdiagnosis in the early stage of EHS might be the lack of understanding of the disease in the on-site emergency medical personnel, which suggests an urgent need to improve the EHS recognition by on-site emergency medical personnel.

Objective To establish the training objective systems for undergraduates in mili-tary clinical medicine in order to promote the educational reform of military medicine, and to improve the quality of talents training in military medical universities. Methods Literature analysis was made to determine the initial military clinical medical undergraduate training objectives, and a questionnaire was given to experts, on-the-job military doctors, medical graduates to know the real requirements of military doctors' position. A total of 455 valid questionnaires were collected. Then the questionnaire results were discussed and summarized by the method of expert discussion. Finally,. Delphi method was used to determine the ultimate training objective system. Results The ultimate training objective system of military undergraduate clinical medicine contains two aspects, eight fields and sixty-one standards objective systems. Conclusion Organically fusing military medical knowledge, ability and professional quality requirement into two levels and eight modules and clearly understanding the standards and requirements of each module are significantly systematic, advanced and operable, which has important reference value and guiding significance to both the military medical colleges and uni-versities and the local universities.

The effects of pretreatment methods of Jerusalem artichoke tubers on microbial lipids fermentation with an oleaginous yeast strain Rhodosporidium toruloides Y4 were investigated in shaking flask culture.The yeast strain accumulated substantial amount of lipids using either purple-or white-skinned Jerusalem artichoke tubers as sole carbon and energy source.When cells were cultured on the extracted juice or the acidhydrolysate,cellular lipid content reached 40%(w/w),while cultured on the pulp,the white-skinned tubershadhigher lipid productivity,yielding 12.1 g lipids per100 g dried tubers.Major fatty acid constituents of microbial lipids were those contained 16-and 18-carbon atoms based on GC analysis,which is quite similar to traditional vegetable oil.Microbial lipids prepared from Jerusalem artichoke can be applied to biodiesel production.

Objective To investigate the traffic capacity of ambulances in Beijing,and to explore factors and methods to resolve this problem.Method A survey on all the ambulances on-duty in Beijing from 17th August to 17th September 2006 was conducted by questionnaires.Results The average speed of ambulances in Beijing was 32.07 km/h.There were statistically significant differences in terms of the areas and time, respectively.Conclusions The traffic jam of Beijing was serious.The traffic capacity of ambulances was far from being ideal,which restricted the operation of 120 ambulances.It is difficult to satisfy the needs of Beijing 2008 Olympic games and it is time for the relevant authorities to search for appropriate methods and solve this problem.

ObjectiveTo investigate the biomechanical characteristics of different types of fixation with bioactive cervical fusion cage made of hydroxyapatite and poly L-lactic acid in cervical spinal fusion.MethodsIliac crest bone,bioactive cervical fusion cage and bioactive cervical fusion cage with plate fixation were used for anterior interbody implants after anterior discectomy across C5-6 in six fresh human cervical spine specimens respectively,and the range of motion of the cervical vertebrae interbody fusion were measured through the motional stability test.Results After discectomy,Bioactive Cervical Fusion Cage with plate fixation exhibited a significant increase in stability and a decrease of range of motion in angular motion than others in all motional directions ( P ＜ 0.005 ). Bioactive cervical fusion cage exhibited a decrease in stability and an increase of range of motion (6.25 ± 0.29) in angular motion than the intact spine (5.76 ± 0.40) in extension,but the difference was not significantly ( P ＞ 0.05 ).Bioactive cervical fusion cage exhibited a decrease in angular motion than iliac crest bone and a significant increase in stability in all motional directions except extension (P ＜ 0.005).ConclusionsBioactive cervical fusion cage' s biomechanical performance was excellent and bioactive cervical fusion cage with plate fixation was excellent in stability in all motional direction,and could remain initial stability of cervical vertebrae.

Objective:To study the metabolism of pedunculoside treated with rat intestinal bacteria in vitro. Methods:Pedunculo-side and rat intestinal bacteria were incubated in vitro for 0, 4, 8, 24 and 48 hours under anaerobic condition. After extracted repeat-edly by ethyl acetate, the metabolites in the incubation media were qualitatively and quantitatively analyzed by HPLC. Results:Totally 90. 8% of pedunculoside was transformed to M2 after incubated with rat intestinal bacteria in vitro for 48 hours, and a detailed compari-son of HPLC profiles between M2 and rotundic acid showed M2 was rotundic acid. Conclusion: Pedunculoside can be metabolized to rotundic acid by rat intestinal bacteria in vitro.

Objective:To examine the feasibility of using cerebral state index(CSI)for monitoring the sedation depth during target-controlled infusion(TCI)with propofol and remifentanil.Methods:Forty-four consenting ASAⅠorⅡpatients(aged 18-60 years)undergoing elective surgery under general anesthesia were randomly divided into 4 groups(n=11 each)according to the target effect-site concentrations of remifentanil administered by TCI during induction of anesthesia.The target effect-site concentrations of remifentanil of R_0,R_2,R_4,and R_6 groups were 0,2 ng?ml~(-1),4 ng?ml~(-1),and 6 ng?ml~(-1),respectively. Anesthesia was induced by TCI with remifentanil and propofol.CSI and bispectral index(BIS)were used to measure the sedation depth.The initial effect-site propofol concentration(PCe)was 1.5?g?ml~(-1),which was increased by 0.5?g?ml~(-1) every 4 min.The modified OAA/S score(5=alert,1=does not respond to prodding),loss of eyelash reflex(LOR eyelash)and loss of response to electric tetanie stimulation(LOR tetanic)were compared against CSI,BIS and PCe(calculated effect-site propofol concentration).Correlation coefficients were calculated between CSI and other parameters.Results:The 4 groups were comparable with respect to the ages and bodyweights.CSI and BIS values were higher but PCe value were lower at LOR eyelash and LOR tetanic in R_2,R_4,and R_6 than those in the R_0 group(P

Objective To investigate and evaluate the iodine nutritional status of school-age children in Yi county of Heibei Province,and to provide scientific basis for the development of control measures to iodine deficiency disorders.Methods Retrospectinely analyzed school-age children urinary iodine monitoring results of Yi County of Hebei Province from 1998 to 2011.One township was selected randomly in each of the five directions (east,west,south,north and center) from 1998 to 2011.One elementary school was randomly chosen in each of the five townships.And at least 20 urine samples of 8-10 years old children were randomly collected in each school selected.Urinary iodine contents were determined through arsenic cerium catalytic spectrophotometric method.Urinary iodine determination standard according to The Standard of Iodine Deficiency Disorders Elinination (GB 16006-2008) and The Iodine Deficiency Disorders Elinination Guide.Results A total of 1725 children urinary samples were collected from 1998 to 2011,urinary median was 243.26 μg/L,each of the median urinary iodine was higher than 100 μg/L.The ratio of urinary iodine less than 100 μg/L was ＜ 50％ over the years,and less than 50 μg/L was ＜ 20％.Overall,the highest value of urinary iodine stayed at approximately 200 μg/L,showing positively skewed distribution that was skewed to the right.Urinary iodine level was compared among different ages,gender and ethnicity,and the difference was not statistically significant(P ＞ 0.05).Conclusions In recent years,the iodine intake of school-age children of Yi County can meet the body needs,and the iodine nutrition is at an appropriate level.

Objective To investigate the risk factors associated with the death of pediatric septic shock,for improving prognosis and decreasing mortality.Methods Sixty-four patients in intensive care unit diagnosed as septic shock were enrolled from Apr.2002 to Apr.2008.The factors such as age,sex,C-reacted protein,WBC,platelet count,blood glucose,procalcitonin(PCT),serum lactic acid,pediatric critical illness score(PCIS),ventilator using and complication of multiple organ dysfuction syndrome(MODS) were researched,these research factors were analyzed by univariate analysis,then to be analyzed by Logistic regression.Results The mortality was 59.38%(38/64 cases).Twenty patients with severe septic shock were all died.Thirty-four patients had breath failure and 26 cases had MODS,the mortality were 62.50%,76.92%,100.00% in patients complicated with 2,3,4 organs dysfunction.In the univariate analysis,variables significantly associated with death in septic shock were PCT,lactic acid,PCIS,MODS.In the Logistic regression,variables significantly associa-ted with death were PCT,lactic acid,PCIS and MODS.Conclusions The mortality of septic shock was high,and decreased PCIS,elevated serum lactic acid level and PCT,and multiple organ dysfuction are the risk factors associated with the death of septic shock.

Objective To discuss the operative procedures and clinical result of posteromedial and posterolateral approaches in treatment of posterior condylar tibial plateau fractures. Methods From January 2006 to June 2008, 21 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 12 males and 9 females. The age ranged from 28 to 68 years, with a mean of 39.5 years. Of the patients, 13 had resulted from a traffic accident and 8 had caused by a fall. As for the state of posterior condylar tibial plateau fractures, 7 patients had a medial condylar.fracture, 8 patients had a lateral condylar fracture and 6 patients had a bilateral condylar fracture. Results A follow-up lasted 12-24 months (mean 16.2 months ) in 21 patients. There was no infection, no varus or valgus of the knee, no nerve injuries and loosening or breakage of the screw. All cases had attained bone union. According to the Rasmussen functional scoring, the results were excellent in 12, good in 7 and fair in 2. The excellent and good rate of clinical results was 90.5%. Radiologic results were graded with the Rasmussen score to evaluate the reduction of fracture. There were excellent in 13, good in 7 and fair in 1. The excellent and good rate of clinical results was 95.2%. Conclusion Posteromedial and posterolateral approaches can facilitate the reduction and fixation for posterior condylar tibial plateau fractures. It has many advantages such as good exposure, less invasion and the excellent clinical results.