Using information on the Emergency Department of the Sino-Japanese Friendship Hospital-reconstructed in January of 2002-as primary data, the authors provide a general view of the model for the building, management and development of emergency departments in China in the 21" century. There are two aspects to the issue. One concerns the composition of the hardware architecture of the emergency department, including emergency medical service system(EMSS), modified layout and facilities, medico-technical departments with a complete range of functions, rational emergency medical service procedures as well as pie-hospital first aid and facilities for long-distance network medical treatment. The other concerns the composition of the software architecture of the emergency department, including the transformation of the employment system of emergency medical personnel, the change of emergency service concepts, the personnel performance and financial control of the emergency department, and the development of an emergency department culture.

Objective To evaluate the lung protection of flurbiprofen axetil combined with protective mechanical ventilation in the patients undergoing thoracic surgery.Methods Sixty patients of both sexes,aged 25-64 yr,with body mass index of 18-29 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of esophageal cancer under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:conventional mechanical ventilation (group CMV),flurbiprofen axetil combined with conventional mechanical ventilation group (group F+CMV),protective mechanical ventilation group (group PMV),and flurbiprofen axetil combined with protective mechanical ventilation group (group F+PMV).Volume-controlled ventilation was performed in the 4 groups.Conventional mechanical ventilation mode was as follows:tidal volume (VT) 10 ml/kg and respiratory rate (RR) 10-12 breaths/min during two-lung ventilation (TLV);VT 8 ml/kg and RR 15-18 breaths/min during one-lung ventilation (OLV).Protective mechanical ventilation mode was as follows:VT 6 ml/kg,positive end-expiratory pressure 5 cmH2O,RR 15-18 breaths/min (during OLV) or 10-12 breaths/min (during TLV),inspiratory/expiratory ratio 1:2,fraction of inspired oxygen 100％,oxygen flow rate 1-2 L/min.The end-tidal pressure of carbon dioxide was maintained at 3545 mmHg in the 4 groups.Flurbiprofen axetil 2 mg/kg was injected intravenously at 15 min before skin incision,and the patient-controlled intravenous analgesia (PCIA) was used after surgery.PCIA solution contained sufentanil 100 μg and flurbiprofen axetil 2 mg/kg in 100 ml of normal saline.The PCIA pump was set up with a 0.5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h,and visual analogue scale score was maintained ≤ 3.Before induction of anesthesia (T0),at 15 min of TLV (T1),at 1 and 2 h of OLV (T2),at 2 h after OLV (T3),at the end of surgery (T4),and at 24hafter surgery (T5),blood samples were taken from the radial artery for determination of arterial oxygen partial pressure,and oxygenation index was calculated.The occurrence of abnormal pulmonary function was recorded during and after surgery.The parameters of pneumodynamics were recorded at T1-4.Central venous blood samples were taken at T0,4,5 to measure the concentrations of tumor necrosis factor-alpha,interleukin6 (IL-6),and IL-8 in serum.Results Compared with group CMV,arterial oxygen partial pressure,oxygenation index,and dynamic lung compliance were significantly increased,the peak airway pressure,airway plateau pressure and concentrations of tumor necrosis factor-alpha,IL-6,and IL-8 in serum were significantly decreased,and the incidence of abnormal pulmonary function after surgery was significantly decreased in the other 3 groups,especially in group F+PMV (P＜0.05).Conclusion Flurbiprofen axetil used before and after surgery has lung protection,and it produces better efficacy when combined with protective mechanical ventilation in the patients undergoing thoracic surgery.

Objective To investigate the effects of methylprednisolone on lung function and inflammation during one-lung ventilation in patients undergoing pulmonary lobectomy.Methods Sixty patients (46 males, 10 females, aged 18-60 years, ASA grade Ⅰ or Ⅱ) scheduled for pulmonary lobectomy were randomly divided into two groups (n=30 each) using a random number table: the control group (group C) and the methylprednisolone group (group M).Patients in group M were treated with methylprednisolone before induction of anesthesia within 30 min, whereas patients in group G received equal volume of normal saline at the same time.The heart rate (HR), mean arterial pressure (MAP), peak airway pressure (Ppeak), plateau airway pressure (Pplat), and dynamic lung compliance (Cdyn) were recorded at the momment before OLV (T1), 30 min after OLV (T2), 1 h after OLV (T3), 10 min after resuming two-lung ventilation (T4) and the end of the surgery (T5).The arterial blood gas analysis were performed at the above time points in order to determined the oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), then the oxygenation index (OI), alveolar to arterial difference of oxygen tension (A-aDO2) and respiratory index (RI) of each patient was evaluated.The concentration of serum TNF-α, IL-6 and IL-10 were determined by ELISA at T0, T4, 6 h (T5) and 24 h (T6) after surgery using venous blood samples.The incidence of pulmonary complications at 72 h after operation were also recorded.Results Compared with T0, the MAP and Cdyn was decreased, whereas the Ppeak and Pplat was increased significantly in both group at T1, T2 (P＜0.05), the OI was decreased and the A-aDO2, RI was increased significantly at T1-T4 (P＜0.05), and the concentration of serum TNF-α, IL-6 and IL-10 at T4-T6 was increased significantly in both group (P＜0.05).Compared with group C, the Cdyn was increased, the Ppeak and Pplat were decreased significantly in group G at T1, T2 (P＜0.05), the concentration of serum TNF-α and IL-6 were decreased, and IL-10 was increased significantly in group G at T4-T6 (P＜0.05).The incidence of postoperative pulmonary complications had no statistically signifcant differences between the two groups.Conclusion Methylprednisolone can significantly improve the pneumodynamics and lung compliance, alleviates the inflammatory responses, but have no significant effect on intrapulmonary oxygenation and gas exchange during one-lung ventilationin patients undergoing pulmonary lobectomy.

The Doha Declaration has entrusted to the members of WHO the right to use the compulsory licensing for drug patents in the face of global public health crises.Although the basic compulsory licensing system for drug patents has been established in China, the efficiency of its implementation is low, the responsibility of its executive departments is unclear, the related rules are not fully understood by pharmaceutical enterprises, it is thus necessary to improve and perfect the relevant legal provisions and systems in order to effectively improve the accessibility of drugs.

Objective To evaluate the effect of flurbiprofen axetil pretreatment on the level of central β-endorphin in a rat model of incisional pain.Methods Fifty-four SPF male healthy Sprague-Dawley rats,aged 6-7 weeks,weighing 180-230 g,were divided into 3 groups (n=18 each) using a random number table:control group (group C),incisional pain group (group Ⅰ) and flurbiprofen axetil pretreatnent group (group FA).At 30 min before the model of incisional pain was established,fat emulsion 1 ml was injected via the caudal vein in group Ⅰ,and flurbiprofen axetil 6 mg/kg (diluted to 1 ml in fat emulsion) was injected via the caudal vein in group FA.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before establishment of the model and 1,6 and 12 h after establishment of the model (T1-3).The rats were sacrificed after measurement of pain threshold at T1-3,and the lumbar enlargement segment of the spinal cord and hypothalamic arcuate nucleus specimens were obtained for determination of β-endorphin content (by enzyme-linked immunosorbent assay) and β-endorphin expression (by immunohistochemistry).Results Compared with group C,the MWT was significantly decreased at T1-3 in I and FA groups,the content and expression of β-endorphin in the spinal cord were significantly decreased at T2,3,and the content and expression of β-endorphin in the hypothalamic arcuate nucleus were increased at T1 in group Ⅰ,and the content and expression of β-endorphin in the spinal cord and hypothalamic arcuate nucleus were significantly increased at T1-3 in group FA (P＜0.05).Compared with group Ⅰ,the MWT was significantly increased,and the content and expression of β-endorphin in the spinal cord and hypothalamic arcuate nucleus were increased at T1-3 in group FA (P＜0.05).Conclusion The mechanism by which flurbiprofen axetil pretreatment produces analgesic effect may be related to the increased level of central β-endorphine in a rat modal of incisional pain.

Objective To investigate the protective effects of creatine phosphate pretreatment on circulato ry function in prone position in elder patients with general anesthesia.Methods Forty patients in ASA physical status Ⅰ or Ⅱ of male and female,aged 60 to 75 years undergoing percutaneous nephrolithotripsy in prone position,were randomly divided into two groups (n =20 each):the control group (gToup N) and the creatine phosphate group (group P).In the group P,creatine phosphate sodium (30 mg·kg-1 in 50 mL normal saline) was continuous infused at a speed of 100 mL· h-1,while only normal saline 50 mL in the group N at the same time.HR,MAP,CO,SV,CVP,Pulse Pressure Variation (PVV) and Systemic Circulation Resistance (SVR) were monitored and recorded at 1 min before prone position (T0) and 1 min (T1),3 min (T2),5 min (T3),10 min (T4) after prone position.The requirement for vasoactive agents were also recorded.Results Compared with T0,HR began to increase significantly at T1 in the group N(P ＜ 0.05),while MAP,CO and SV began to decrease at T1 to T3,and CVP,PVV and SVR began to increase significantly at the same time in the group N (P ＜ 0.05).Compared with the group N,MAP,CO and SV were decreased,PPV,CVP and SVR were increased significantly at T1 to T2 in the group P (P ＜ 0.05).The requirement for vasoactive agents in the group P was obviously lower than that in the group N (P ＜ 0.05).Conclusion Creatine phosphate pretreatment can stabilize the hemodynamic change effectively,and prevent the adverse cardiovascular events caused by prone position in elder patients with general anesthesia.

Objective To study the distinct clinical phenotype of chronic airway diseases by hierarchical cluster analysis and two-step cluster analysis.Methods A population sample of adult patients in Donghuamen community,Dongcheng district and Qinghe community,Haidian district,Beijing from April 2012 to January 2015,who had wheeze within the last 12 months,underwent detailed investigation,including a clinical questionnaire,pulmonary function tests,total serum IgE levels,blood eosinophil level and a peak flow diary.Nine variables were chosen as evaluating parameters,including pre-salbutamol forced expired volume in one second(FEV1)/forced vital capacity (FVC) ratio,pre-salbutamol FEV1,percentage of post-salbutamol change in FEV1,residual capacity,diffusing capacity of the lung for carbon monoxide/alveolar volume adjusted for haemoglobin level,peak expiratory flow (PEF) variability,serum IgE level,cumulative tobacco cigarette consumption (pack-years) and respiratory symptoms (cough and expectoration).Subjects' different clinical phenotype by hierarchical cluster analysis and two-step cluster analysis was identified.Results (1) Four clusters were identified by hierarchical cluster analysis.Cluster 1 was chronic bronchitis in smokers with normal pulmonary function.Cluster 2 was chronic bronchitis or mild chronic obstructive pulmonary disease (COPD) patients with mild airflow limitation.Cluster 3 included COPD patients with heavy smoking,poor quality of life and severe airflow limitation.Cluster 4 recognized atopic patients with mild airflow limitation,elevated serum IgE and clinical features of asthma.Significant differences were revealed regarding pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1％ pred,postsalbutamol change in FEV1 ％,maximal mid-expiratory flow curve (MMEF)％ pred,carbon monoxide diffusing capacity per liter of alveolar(DLCO)/(VA)％ pred,residual volume(RV)％ pred,total serum IgE level,smoking history (pack-years),St.George' s respiratory questionnaire (SGRQ) score,acute exacerbation in the past one year,PEF variability and allergic dermatitis (P ＜ 0.05).(2) Four clusters were also identified by two-step cluster analysis as followings,cluster 1,COPD patients with moderate to severe airflow limitation;cluster 2,asthma and COPD patients with heavy smoking,airflow limitation and increased airways reversibility;cluster 3,patients having less smoking and normal pulmonary function with wheezing but no chronic cough;cluster 4,chronic bronchitis patients with normal pulmonary function and chronic cough.Significant differences were revealed regarding gender distribution,respiratory symptoms,pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1 ％ pred,post-salbutamol change in FEV1 ％,MMEF％ pred,DLCO/VA％ pred,RV％ pred,PEF variability,total serum IgE level,cumulative tobacco cigarette consumption (pack-years),and SGRQ score (P ＜ 0.05).Conclusion By different cluster analyses,distinct clinical phenotypes of chronic airway diseases are identified.Thus,individualized treatments may guide doctors to provide based on different phenotypes.

Objective To evaluate the effects of flurbiprofen axetil administered at different time points on oxygenation in the patients undergoing one-lung ventilation (OLV).Methods Ninety patients of both sexes,aged 45-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective thoracoscope-assisted pulmonary lobectomy,were assigned into 3 groups (n =30 each) using a random number table:control group (group C),preoperative administration group (group F1) and intraoperative administration group (group F2).Flurbiprofen axetil (10 mg/ml) and fat emulsion 10 ml were injected intravenously at 15 min before operation in F1 and C groups,respectively.Flurbiprofen axetil 10 ml was intravenously injected immediately after the beginning of OLV in group F2.At 15 min before operation (T1),15 and 30 min of OLV (T2,3),and 15 min after restoration of two-lung ventilation (T4),airway peak pressure (Ppeak) and dynamic lung compliance (Cdyn) were recorded,arterial blood samples were collected for blood gas analysis.The arterial oxygen partial pressure (PaO2) was recorded,and the oxygenation index (OI) and intrapulmonary shunt (Qs/Qt) were calculated.The concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-K-PGF1α) in serum were measured by enzyme-linked immunosorbent assay,and TXB2/6-K-PGF1α ratio was calculated.The development of interrupting OLV due to SpO2＜90％ and postoperative dyspnea,pulmonary infection,atelectasis and length of hospital stay were recorded.Results Compared with group C,PaO2 and OI were significantly increased,and Qs/Qt was decreased at T2,3,the serum concentrations of TXB2 and 6-K-PGF1α were decreased,and TXB2/6-K-PGF1α ratio was increased at T2-4,the incidence of interrupting OLV was decreased (P＜0.05),and no significant change was found in the parameters mentioned above in group F2 (P＞0.05).Compared with group F1,PaO2 and OI were significantly decreased at T2,3,Qs/Qt was increased at T2,and the serum concentrations of TXB2 and 6-K-PGF1α were increased,and TXB2/6-K-PGF1α ratio was decreased at T2-4 in group F2 (P＜0.05).There was no significant difference in the incidence of postoperative dyspnea,pulmonary infection and atelectasis and length of hospital stay between the three groups (P＞0.05).Conclusion Flurbiprofen axetil injected at 15 min before operation can significantly improve oxygenation and prevent the development of hyoxemia in the patients undergoing OLV,however,flurbiprofen axetil administered immediately after the beginning of OLV has no such effect.

Objective To observe the hemodynamic change and stress reaction of target-con-trolled infusion (TCI)of propofol guided by Narcotrend for anesthetic induction in renal transplanta-tion patients.Methods Forty patients (25 males,1 5 females,aged 21-38 years,ASA grade Ⅲ orⅣ)undergoing related living donor kidney transplantation were randomly divided into two groups:group A and group B (n =20).Group A was induced using TCI system with propofol under the moni-toring of Narcotrend.Group B was induced with propofol manually.HR,MAP,Narcotrend index (NTI),blood glucose (Glu)and plasma cortisol (Cor)were measured before induction (T0 ),before tracheal intubation (T1 ),and 1 (T2 ),3 (T3 ),and 5 (T4 )minutes afterwards.Results HR and MAP at T1 were lower than those at T0 (P < 0.05 )in two groups,they were significantly lower in group B than in group A at corresponding points(P <0.05).HR and MAP in group B increased sig-nificantly (P <0.05)and were significantly higher than those in group A (P <0.05)at T2 and T3 . There was no obvious difference in Glu and Cor between T0 and T2-T4 in group A.Glu and Cor at T2-T4 were obviously higher than those at T0 (P <0.05)in group B and those at corresponding points in group A (P <0.05).Conclusion TCI of propofol guided by Narcotrend in renal transplantation pa-tients can better control the depth of anesthesia,attenuate the stress reaction caused by tracheal intu-bation,and keep hemodynamic smooth during anesthesia induction.

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position.Methods Sixty patients of both sexes,aged 60-75 yr,of American Society of Anesthesiologists physieal status Ⅱ or Ⅲ,scheduled for elective lumbar surgery in the prone position under general anesthesia,were divided into 2 groups (n =30 each) using a random number table:conventional fluid therapy group (group C) and goal-directed fluid therapy group (group G).The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G.Mean arterial pressure was maintained at 60-110 mmHg,central venous pressure at 6-12 emH2O and urine volume more than 0.5 ml · kg-1 · h 1 using conventional fluid therapy in group C.In group G,goal-directed fluid therapy was performed under the guidance of stroke volume variation,and cardiac index was maintained at 2.5-4.0 L · min-1 · m 2.The requirement for crystalloid and colloid solution,total volume of fluid infu sed,blood loss,urine volume and requirement for vasoaetive agents were recorded during operation.After anesthesia induction,at 1 h after turning to the prone position and at the end of operation,blood samples were collected fromn the left radial artery for blood gas analysis,and the blood lactate concentration was recorded.The volume of drainage within 3 dlays after operation,perioperative blood transfusion,early postoperative cardiovascular and pulmonary complications,development of oliguria and anuria,emergence time and length of hospital stay were recorded.Results Compared with group C,the requirement for crystalloid solution,total volume of fluid infused,urine volume and requirement for vasoactive agents were significantly decreased during operation,the requirement for colloid solution was increased during operation,the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation,the length of hospital stay was shortened,and the incidence of postoperative cardiovascular and pulnonary eomplications was decreased in group G (P＜0.05).Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position.