The emergent and severe diseases always shows the characteristics of acute course, severe condition, rapid changes, and many complications. The common treatments based on syndrome differentiation usually lacked dynamics and promptness. The treatment of emergent and severe diseases emphasized the importance of early interventions, which can reverse the acute trend of the diseases and improve the outcomes. This article discuessed in five parts, including the meaning and significance of trend identification, the physiological and pathological trend of the human body, the influence factors of diseases' trend, how to carry out a trend identification and intervention strategies of trend identification. It elaborated the theory about the trend identification in the emergent and severe diseases.

Objective To build a scientific,rational and practical evaluation index system for medical tutors.Methods Evaluation framework was initially constructed on the basis of literature analysis.Two rounds questionnaires investigation were conducted soon using Delphi method and the data were analyzed using descriptive analysis,independent samples of non-parametric test (Kreskas-Wallis test),expert reliability analysis,analytic hierarchy process and other methods.Results The results of two rounds of expert questionnaires showed that both recovery rate and acceptance rate of the questionnaires were more than 90％ and overall expert coefficient was 0.8957.The coordinate coefficient of the second-class index was 0.181,x2 =27.148,P ＜ 0.001,and that of the third-class index was 0.157,x2 =127.03,P ＜ 0.001.Experts' opinions were highly consistent.Conclusions Evaluation index system including three first-class indexes,seven second-class indexes and twenty-eight third-class indexes was established for medical tutors.The evaluation index system is of great importance in safeguarding postgraduate culturing quality and strengthening teaching staff construction.

Objective To explore the characteristics of uhrasonography of hepatobiliary cystadenoma. Methods The ultrasonographic characteristics of 5 cases with hepatobiliary cystadenoma were retrospectively analysed, and compared with the operation and pathology. Results The ultrasonography of 5 cases was multilocular cystic mass,which seems to be,but not indeed communicating with the biliary tree,in which irregular septation was demonstrated in two-dimensional structure and also with perforator vessels along in color Doppler flow imagineg. And in some cases small papillary tuft and small loci of calcification was noted on the septation. Conclusions Muhilocular cystic mass,locating along the biliary tree, however not communicating with the the biliary tree, is an important diagnostic basis of biliary cystadenoma. And it should be distinguished with other cystic tumor in the liver.

Objective To observe the clinical efficacy of Chuankezhi acupoint injection combined with nursing health care education for treatment of patients with chronic obstructive pulmonary disease (COPD) at stable stage complicated with spleen kidney deficiency syndrome.Methods A prospective study was conducted. 118 patients with stable COPD and spleen kidney yang deficiency syndrome admitted to Hangzhou Third People's Hospital and Zhejiang Xinhua Hospital from February to April 2014 were enrolled, and they were divided into an experimental group (60 cases) and a control group (58 cases) according to the random number table. Both groups were given conventional treatment [including oxygen therapy, bronchodilators, corticosteroids, rehabilitation therapy in accord with the Global Initiative COPD (GOLD)]. Simultaneously, in the experimental group, Chuankezhi acupoint injection was additionally given, once daily for 12 weeks, and appropriate corresponding health education was mentioned. The lung function, quality of life and prognoses of the patients were regularly followed up for 9 months and compared between the two groups.Results After 12 weeks, one second forced expiratory volume (FEV1), FEV1/forced vital capacity (FVC) and maximum voluntary ventilation (MVV) per minute in the experimental group were significantly higher than those in control group [FEV1 (L): 1.57±0.42 vs. 1.35±0.35, FEV1/FVC: (58.62±4.56)% vs. (50.36±4.35)%, MVV (L/min): 60.62±7.56 vs. 56.95±6.33, allP < 0.05]. The quality of life evaluation form for COPD (QLICD-COPD) was used to evaluate the physical function, psychological function, social function and specific modules scores, showing that the above items in the experimental group were significantly higher than those in control group (total score: 74.69±8.92 vs. 68.62±8.95, physical function score: 74.16±8.55 vs. 66.31±7.15, mental function score: 78.69±9.79 vs. 72.64±8.45, social function score: 75.45±6.75 vs. 70.36±6.12, specific modules score: 67.52±6.33 vs. 61.36±6.17, allP < 0.05); Barthel index score was also significantly higher than that in the control group (75.41±9.24 vs. 68.43±7.95,P < 0.05). Within 9 months of follow-up, the incidence of acute exacerbation of COPD in the experimental group was significantly lower than that in the control group [5.00% (3/60) vs. 17.24% (10/58),P < 0.05]. The re-admission rate was also significantly less in patients in experimental group compared with that of control group [1.67% (1/60) vs. 12.07% (7/58),P < 0.05]. Conclusion Chuankezhi acupoint injection with health education for treatment of patients with COPD at stable stage and spleen kidney yang deficiency syndrome has good clinical efficacy, worthy to be applied more widely.

By equality in the healthcare retorm we mean equal access to healthcare protection.Future reiorm should establish a fair value concept and make great efforts to solve the serious lack of fairness in the current healthcare system.Efficiency in the healthcare refers to not only higher revenue income of medical institutes but also to utmostly meet the citizens" needs for medical service.For the sake of the most cost - effective distribution of the insufficient budgets and medical resources,medical services have to be diversified for an improved efficiency. In the framework of the healthcare reform,relations between equality and efficiency is the unity of opposites,and top priority shall be given to equality while maintain efficiency.

Plant active components characterized of many different structures and activities on multiple targets, have made them to be the important sources of inhibitors on HIV-1. For finding leading compounds with new structure against HIV-1, three key HIV-1 replicative enzymes (reverse transcriptase, protease and integrase) were used as screening models. The in vitro activities of 45 plant derived components isolated from Schisandraceae, Rutaceae and Ranunculaceae were reported. Within twelve triterpene components isolated, eight compounds were found to inhibit HIV-1 protease, in these eight active compounds, kadsuranic acid A (7) and nigranoic acid (8), inhibited both HIV-1 protease and integrase; Among fifteen lignans, meso-dihydroguaiaretic acid (15) and kadsurarin (16) were active on HIV-1 reverse transcriptase, and 4, 4-di(4-hydroxy-3-methoxyphenly)-2, 3-dimethylbutanol (13) active on HIV-1 integrase. All of the six alkaloids, seven flavones, and five others compounds were not active or only with low activities against HIV-1 replicative enzymes. Further studies of the triterpene components showing strong inhibitory activities on HIV-1 were warranted.

Around the features of low power and high integration of portable electronic medical equipment design, the primary low power MCU series from the current semiconductor manufacturers were compared. The analysis results showed that the 32-bit MCUs based on the low cost and high energy efficient ARM Cortex-M architectures, have comprehensive advantages on power level, operational performance and integrated peripherals obviously.
Electronics, Medical ; instrumentation ; Equipment Design

Objective To analyze the timing and frequency of spontaneous gasping during cardiopulmonary resuscitation in a rat model,and evaluate its value bearing some relation to duration of cardiac arrest (CA ) in predicting the severity of post-resuscitation myocardial dysfunction.Methods Twenty-seven healthy Sprague-Dawley rats were randomly (random number)divided into 3 groups according to different durations of CA:CA 4 min (n=9),CA 6 min (n=9)and CA 8 min (n=9).CA of rats was electrically induced and untreated for 4,6 or 8 min respectively in the corresponding groups,and then cardiopulmonary resuscitation (CPR)was initiated and continued for 8 min in all animals.The emergence timing and frequency of spontaneous gasping during cardiopulmonary resuscitation and resuscitation outcomes were documented.Myocardial function such as cardiac output,ejection fraction and Tei index was measured by echocardiography prior to CA and at 1 h,2 h and 4 h post-resuscitation.Results The earliest appearance of gasping with highest frequency was observed in the CA 4 min group during CPR.Gasping appeared later with decreased frequency observed following longer duration of CA.There were statistically significant differences in the timing and frequency of gasping among the 3 groups.In the CA 4 min group with frequent gasping,all animals were successfully resuscitated with 8-min CPR with the least number of defibrillation,which was significantly better than that in the CA 8 min group.During the evaluation of post-resuscitation myocardial function,cardiac output,ejection fraction and myocardial work index (Tei index) were better in the CA 4 min group with frequent gasping,worse in the CA 6 min group and worst in the CA 8 min group, showing statistically significant differences in cardiac function among the 3 groups. Conclusions The spontaneous gasping appeared sooner with higher frequency during cardiopulmonary resuscitation indicated shorter duration of CA,and predicted better success of resuscitation and post-resuscitation myocardial function.

Objective To study the effects of hyperbaric oxygen (HBO) preconditioning (PC) on motor function and mitochondrial apoptosis after spinal cord injury (SCI) in rats.Methods Thirty-six healthy,male Wistar rats were randomly divided into 3 groups (each n =12):a control (CON) group,an SCI model group and an HBO-PC group.The SCI group and the HBO-PC group after 7 sessions of HBO-PC treatment were subjected to SCI modeling using Allen's method.The CON group was not given any special treatment.Two weeks after the modeling,Basso,Beattie,and Bresnahan BBB scale was used to rate the rats' locomotor function,and the T8 segment of the rats' spinal cords was removed.After extracting total RNA from the spinal cord tissue,real-time quantitative PCR was used to detect the mRNA expression levels ofcaspase-3,cytochrome C (CYC),Bak,Bax,Bcl-x and Bcl-2 in the spinal cord tissue.Results Two weeks after modeling,compared with the CON group,the average BBB locomotion score of the SCI model group had decreased.In contrast,caspase-3,CYC,Bak and Bax mRNA expressions had increased significantly.Compared with the CON group,the average BBB locomotion score of the HBO-PC group had decreased,caspase-3 expression had increased,and Bax mRNA expression had decreased,but the differences in the changes between the two groups were not statistically significant.Bak mRNA expression increased and CYC expression decreased,and the difference between the two groups was statistically significant.Compared with the SCI model group,the average BBB locomotion score of the HBO-PC group increased while caspase-3,CYC,Bak and Bax mRNA expressions decreased,but none of these differences between the two groups was statistically significant.Bak mRNA expression increased and CYC mRNA expression decreased,and those differences between the two groups were statistically significant.Bcl-x and Bcl-2 mRNA expression in the CON,HBO-PC and SCI model groups were significantly different.Conclusion HBO-PC can reduce the loss of motor function after SCI,at least in rats.The mechanism may be related to reducing neuron mitochondrial apoptosis.

The concept and methods of evidence-based medicine(EBM)has been evolved to impact almost all fields of health care and policy since it first appeared in 1992.but in the field of dentistry or stomatology,many problems remain to be solved in carrying out EBM.The necessity and feasibility of implementing evidence-based dentistry education in China were discussed in this paper for chnical evidence-based decision making and clinical research.The contenk teaching approach and accreditation tools for EBM in dental education were also proposed.