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 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.

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.

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.

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.

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

BACKGROUND:Anterior cervical plate can maximize the intervertebral space height,expand intervertebral foramen,restore cervical physiological antecurvature,prevent instability due to implant micromovement,and increase graft fusion.However,the selection of entire autologous bone or Ti-mesh bone graft remains uncertain in application of anterior cervical plate.OBJECTIVE:To compare the complications of three different intervertebral fusion methods in anterior cervical decompression surgery.METHODS:A total of 92 cases of cervical spondylotic myelopathy were treated by anterior cervical decompression and three different intervertebral fusion methods.They were followed up for at least 3 months.Of them,6 underwent bone grafting alone,21 underwent autogenous bone graft with cervical plate-screw fixation,and 65 underwent pyramesh with anterior cervical plate-screw fixation.Complications were observed in all cases.RESULTS AND CONCLUSLON:A total of 2 of 6 autogenous bone grafting cases suffered from graft bone dislocation,1 suffered from pseudoarthrosis formation,and 1 suffered from donated ilium.Six of 21 autogenous bone graft with cervical plate-screw fixation suffered from loss of intervertebral height,and 3 suffered from pain of donated ilium.Eleven of 65 pyramesh with anterior cervical plate-screw fixation suffered from titanium mesh subsidence,1 case suffered from breakage of fixation screw.Simple autogenous bone grafting surgery was rarely used due to long duration of external fixation and too much complications.Autogenous bone grafting with anterior cervical plate-screw fixation surgery has shortage of grafted bone absorption and pain of donated ilium.Pyramesh with anterior cervical plate-screw fixation surgery overcomes the shortage of donated iliac pain,but remains the shortage of titanium mesh subsidence and lose of intervertebral height.

Background and purpose:Ca2+plays a very important role in the maintenance of cell biological functions. The storage, release and uptake capacity of Ca2+ is controlled by endoplasmic reticulum (ER). Ca2+ homeo-stasis is essential for cellular energy metabolism and proper protein folding. This study aimed to investigate the effect of cytoplasmic Ca2+ on cisplatin induced ER stress-mediated autophagy in ovarian carcinoma SKOV3 and its underlying mechanism.Methods:The ovarian cancer SKOV3 was used as a study object. The experiment consisted of three parts:① To explore the possible relationship between cisplatin-induced ER stress and autophagy, SKOV3 cells were treated with cisplatin for 0, 6, 12 and 24 h, respectively;② To explore the possible relationship between ER stress induced Ca2+ effux and autophagy, SKOV3 cells were treated with cisplatin for 0, 9 and 12 h, respectively, and TG was used as a positive control;③ To explore the effects of blocking calcium effux on autophagy, SKOV3 cells were divided into control group, cisplatin group, TG group, BAPTA-AM group, cisplatin combined with BAPTA-AM group and TG com-bined with BAPTA-AM group. Western blot was used to detect the protein levels of GRP78 and LC3. Fluo-4 calcium lfuorescent probe was used to examine cytoplasmic Ca2+ levels. Confocal microscopy was used to detect LC3 level by immunolfurescence staining.Results:Compared to control group (0.679±0.011), GRP78 was signiifcantly accumulated at 6, 12 and 24 h after cisplatin treatment and reached the maximum value at 6 h (1.393±0.004,P=0.000). Similarly, compared to control group (0.038±0.000), LC3 puncta were clearly seen after cisplatin treatment and reached the maxi-mum value at 12 h (0.072±0.002,P=0.000). Using confocal microscopy, we found that cisplatin and TG increased LC3 punctate accumulation and cytoplasmic Ca2+ levels in a time-dependent manner. Immunolfuorescent method showed that treatment with cisplatin combined with BAPTA-AM or TG combined with BAPTA-AM increased LC3 punctate accumulation induced by cisplatin or TG. The results of Western blot showed that cisplatin combined with BAPTA-AM (0.071±0.001) or TG combined with BAPTA-AM (0.065±0.001) signiifcantly increased LC3Ⅱ/LC3Ⅰ ratio induced by cisplatin (0.039±0.000,P=0.000) or TG (0.035±0.001,P=0.000).Conclusion:Cisplatin induces intracellular ER stress and autophagy in SKOV3 cells, accompanied by increased cytoplasmic Ca2+ levels. Chelating cytoplasmic Ca2+enhanc-es cisplatin-induced autophagy.

Objective To investigate the clinical efficacy of the laparoscopic radical resection and the conventional laparotomy for colorectal cancer. Methods The clinical data of 106 patients with colorectal cancer treated by surgery from March 2011 to January 2016 were retrospectively analyzed, including 55 patients receiving laparoscopic surgery (laparoscopic group) and 51 patients treated by traditional surgery (conventional laparotomy group). The clinical effects of both groups were compared. Results The operation time in conventional laparotomy group was shorter than that in laparoscopic group [(141.2 ±40.6) min vs. (192.0±32.5) min, t=7.136, P<0.05]. The blood loss of the laparoscopic operation group was lower than that of conventional laparotomy group [(81.2 ±16.5) ml vs. (168.0 ±36.2) ml, t= 16.077, P< 0.05]. The recovery time of gastrointestinal function and hospital stay time in laparoscopic surgery group were significantly shorter than those in the laparotomy group (t= 12.236, t= 9.524, all P< 0.05). There were no statistical differences in the number of captured lymph nodes, complications and the length of bowel resection between two groups (all P>0.05). There were no severe complications and death case in both groups. Patients were followed up for 10-60 months, and there were no significant differences on recurrence and metastasis between two groups (P> 0.05). Conclusion Compared with the conventional laparotomy, laparoscopic radical resection is an effective method for the treatment of colorectal cancer with small trauma, less bleeding and fast recovery, which is worthy of clinical application.

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.