In 2013 Shanghai took the lead to carry out the specialist standardized training which is common in the international medical education. This paper first gives a picture of the general condition of the standardized training on specialists of obstetrics and gynecology in Shanghai. Then from the perspectives of strategic deployment, department management, clinical skill training and the training of examiners, the paper explores the assessment model in which both the assessment of train-ing process and the scores of the final examination are considered whereas the process assessment is given more weight. This paper is aimed to provide experience and suggestions for the further advance of the specialists standardized training in the field of obstetrics and gynecology.

Objective To observe the effect of hypertonic saline complex solution (hypertonic saline plus hydroxyethyl starch,HSH) on patients with severe cerebral trauma,high intracranial pressure and shock by the measurement of the changes of the mean arterial pressure (MAP),central venous pressure (CVP) and intracranial pressure (ICP),as well as GOS score changes followed up for 6 months,in order to determine the value of HSH treatment in severe cerebral trauma,intracranial hypertension and shock.Methods Sixty patients with severe brain injury and uncorrected hemorrhagic shock were selected,while the degree of coma was assessed by using GCS score,and shock severity was estimated by using the shock index (SI) score.The patients were randomly divided into HSH group (n =30) and mannitol group (MT group,n =30).Thirty minutes,60 min and 120 min after administration either solution,The changes of MAP,CVP and ICP were observed in two groups,and all patients were followed up for 6 months to observe the outcomes of patients.Results There were no statistically significant differences in age,gender,GCS score,SI scores,and other medication between two groups (P ＞ 0.05),and they were comparable between two groups.After resuscitation of patients in two groups,MAP and CVP were elevated,but the effect of HSH appeared sooner and higher within 30 minutes [MAP (63.1 ± 8.8) mmHg vs.(51.0-9.3) mmHg] (P ＜ 0.05);At the same time,ICP dropped more than 10％ lower [ICP (27.3 ± 5.9) mmHg vs.(32.8 ± 4.1) mmHg] (P ＜0.05),while the effect of MT appeared more slowly in hemodynamic improvement;at 120 min,the increase in MAP and reduction in ICP in HSH group were more significant than those in MT group [MAP (65.9 ± 13.2) mmHg vs.(60.4 ±7.2) mmHg] (P ＜0.01);the ICP [(22.2 ±4.7) mmHg vs.(28.1 ±6.1) mmHg] (P ＜ 0.01).Followed up for 6 months,good recovery rate in HSH group was higher and poor recovery rate was lower than those in MT group.Conclusions In patients with acute intracranial hypertension and uncorrected hemorrhagic shock,the employment of hypertonic saline plus hydroxyethyl starch solution can produce faster and more effective therapy for shock and reduce intracranial pressure,improving the long-term neurological function of patients.

A novel method based on cross sensitivity of cataluminescence (CTL) generated on the surface of a nanometer composite oxide was proposed for simultaneous determination of benzene and trimethylamine (TMA) in air. A variety of nanometer composite oxides based on Y2 O3 that showed catalytic activity to many gas molecules were synthesized. For the fabrication of the detector, nanometer composite oxide was directly coated on the ceramic rod to form a 0. 1-0. 15 mm thick layer. The ceramic rod with nanometer composite oxide was inserted into a quartz tube with an inner diameter of 10 mm. The temperature of nanometer composite oxide was controlled by the digital heater. When gas samples passed through the nanometer composite oxide in the quartz tube by the air flow, the CTL was generated during the catalytic oxidation on the surface of the nanometer composite oxide. The CTL signals were respectively recorded by two ultra weak chemiluminescence analyzers. The CTL intensity and selectivity for the determination of benzene and TMA on nano- Zr3 Y2 O9 which was characterized by TEM were bigger and better than those on other nanosized composite oxides. The optimum experimental conditions were tested. Selective determination was achieved at a wavelength of 440 nm for benzene and 540 nm for TMA. The surface temperature of the nanometer materials was about 313 ℃. The flow rate of air carrier was about 140 mL/ min. The limit of detection of this method was 0. 30 mg / m3 for benzene at 440 nm and 0. 70 mg / m3 for TMA at 540 nm. The linear range of CTL intensity versus concentration of benzene at 440 nm was 0. 8-105. 0 mg / m3 , benzene at 540 nm was 3. 0-130. 0 mg / m3 , TMA at 440 nm was 2. 5-232. 0 mg / m3 and TMA at 540 nm was 1. 2-156. 0 mg / m3 . The recovery of 5 testing standard samples by this method was 96. 8% -102. 3% for benzene and 97. 6% -103. 4%for TMA. Common coexistence matters, such as formaldehyde, ethanol, acetone, ammonia, sulfur dioxide and carbon dioxide, did not disturb the determination. The relative standard deviation (RSD) of CTL signals of a continuous 200 h detection of gas mixture of 50 mg / m3 benzene and 50 mg / m3 TMA was 2. 0% , which demonstrated the longevity and steady performance of nano-Zr3 Y2 O9 to benzene and TMA under this experimental conditions.

OBJECTIVE To apply 3M standardized chemical indicator(CI) process challenge device(PCD) to the practice of batch monitoring to guarantee sterility assurance.METHODS The standardized CI PCD and biological indicator(BI) PCD to two different sterilizers were applied with the test parameters of 132 ℃,3.5min and 8min,and 134 ℃,3.5min and 8min,respectively.RESULTS A total of 310 trials of CI PCD were obtained as negative results,with the ink moved into the accept area of the moving-front style indicator,and 240 trials of BI PCD were obtained as negative results.CONCLUSIONS Standardized CI PCD can provide further sterility assurance with more accurate monitoring and batch release capabilities.

Background and purpose: Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) can be used for magnetic resonance imaging systemic examination, especially in examing the metastatic lesions, lymph node and bone diseases, and the imaging result is similar with PET. This study aimed to evaluate the application value of magnetic resonance DWIBS and positron emission tomography with computed tomography (PET/CT) on malignant metastatic diseases. Methods: Thirty-six patients confirmed with malignant tumors accompanying metastasis by the pathology of operation or biopsy underwent both DWIBS imaging and PET/CT, chi-square test and Kappa test were used for comparing the detection results of metastasis by these 2 imaging methods. Results:Among the 36 malignant tumor patients with 238 metastatic lesions, 218 (91.6%, 218/238) lesions in DWIBS and 209 (87.8%, 209/238) lesions in PET/CT were detected, with 200 lesions detected by the two methods simultaneously, and the concordance rate was 88.7%(211/238);but there was no statistical signiifcance between this two methods (χ2=1.843, P=0.157). Kappa test showed a fair concordance rate between DWIBS and PET/CT (P=0.000).There were different significance between DWIBS and PET/CT in detecting metastatic lesions of brain and bone (P=0.005 and 0.031);But there was no signiifcant differences (P=0.309 and 1.000) in detecting metastatic lesions of lymph nodes and liver. Conclusion:DWIBS could detect metastatic lesions effectively, and there is ifne consistency with PET/CT. DWIBS is more sensitive than PET/CT in detecting metastatic lesions of brain and bone, so DWIBS could be chosed for screening metastatic lesions according to the characteristics of different primary tumors.

Objective To evaluate the effectiveness and safety of ultrasound-enhanced thrombolysis for acute ischemic stroke.Methods Fifty stroke patients with acute middle cerebral artery occlusion were randomly divided into either a ultrasound-enhanced thrombolysis group (recombinant tissue-plasminogen activator [rtPA] +2 MHz ultrasound monitoring for 2 h) or a standard thrombolysis group (rtPA alone).The demographic characteristics,vascular risk factors,blood pressure before treatment,thrombolysis in brain ischemia (TIBI) grade before thrombosis,and vascular occlusion site of the patients were collected.The primary outcome endpoint was the good outcome rate (defined as the modified Rankin Scale score 0-1) at 3 months.The secondary outcome endpoints were complete recanalization at 2 h after thrombolysis,sustained complete recanalization,symptomatic intracerebral hemorrhage,and mortalitY.Results The good outcome rate of the ultrasound-enhanced thrombolysis group at 3 months after treatment was significantly higher than that of the standard thrombolysis group (64％ vs.36％;P=0.011).The sustained complete recanalization rate (40％ vs.8％;P =0.018) and complete recanalization rate (48％ vs.12％;P =0.012) of the ultrasound-enhanced thrombolysis group were significantly higher than those of the standard thrombolysis group,but there were no significant differences in the reocclusion rate (8％ vs.12％;P =0.637),incidence of symptomatic intracerebral hemorrhage (4％ vs.4％;P=1.000),and mortality (4％ vs.4％;P=1.000) compared with the standard thrombolysis group.Conclusions Ultrasoundenhanced thrombolysis can improve the sustained complete recanalization rate,complete recanalization rate,and good outcome rate after using rtPA within 2 h,and it does not increase the risks of symptomatic cerebral hemorrhage and death.It is a safe and effective adjunctive thrombolytic therapy.

Objective To investigate the risk factors and prognosis on the post-resuscitation multiple organ dysfunction syndrome(MODS) after successful cardiopulmonary resuscitation(CPR).Methods Clinical data of 53 patients who were suffered with cardiac arrest(CA) and undergone successful CPR with return of spontaneous circulation(ROSC) were analyzed. Results There were 48 patients accompanied with MODS(90.6%),and among them,35 patients died in hospital(66.0%).All the 10 patients with CPR interval ≥6min were accompanied with MODS and they died in hospital.There were 43 patients who underwent CA immediately and of them,38 patients were accompanied with MODS.The incidence and mortality of MODS in the patients with CA-ROSC interval 0.05).Conclusion The risk factors such as ROSC interval ≥6 min,AC-ROSC interval ≥10min and the SIRS after ROSC are significantly associated with the incidence of MODS.The organic function of the patients should be evaluated promptly.

Objective To develop a Quick Cognitive Screening Scale for Elder(QCSS-E) and examine its reliability and validity.Methods In the light of rating model of MMSE and MoCA,a screening scale was developed to assess cognitive function,which contained 47 items across twelve domains.Five hundred community subjects were interviewed with the QCSS-E,then 150 subjects were retested after two weeks,and 75 subjects were assessed with MMSE and CCAS.The test-retest reliability,internal consistency reliability,empirical validity and constmct validity of QCSS-E were calculated.Results The test-retest reliability and Cronbach's α coefficient were 0.972 and 0.814 for QCSS-E total score,0.656-0.911 and 0.679-0.746 for domain scores.There were low to moderate correlation of 0.133-0.612 among domain scores,correlation domain scores with total score ranged from 0.303-0.664.QCSS-E scores decreased with increasing agc,increased with the level of education increasing,and decreased with the aggravation of brain damage.The QCSS-E was significantly correlated with MMSE(r=0.886) and CCAS (r=0.899).Factor analysis got two factors accounting for 49.4％ of variance,which were named vulnerability factor and resistance to damage factor.Conclusion The stability,internal consistency,and validity of the QCSS-E are good and meet with psychometric standard.

A management window model for patients with atrial fibrillation (AF) was established in Tilanqiao Community Health Service Center cooperated with tertiary hospitals.Patients were screened and treated in the community health service center,and a comprehensive management plan was conducted and patients were followed-up.A total of 105 patients with atrial fibrillation (97.2％) were effectively managed with an average follow-up of 10.6 months.The CHADS2 score ≥ 2 in 78 cases,including 11 cases with administration of warfarin (14.1％) and 26 cases with paroxysmal AF without transition to persistent atrial fibrillation.Compared to the data before management,the rate of taking aspirin and warfarin in managed patients was increased (all P ＜ 0.05),the international normalized ratio (INR) of patients receiving warfarin was improved (P ＜ 0.05) ; the ratio of receiving comprehensive treatment program,standardized treatment and health education were significantly increased (P ＜ 0.05) ; the awareness of the disease,treatment compliance and satisfaction of patients were improved significantly (all P ＜ 0.05).The results suggest that the management widow model is feasible and effective for management of patients with atrial fibrillation in community health service centers.

Objective To investigate the feasibility of amplitude of intraoperative nerve action potentials (NAP) for early quantitative diagnosis of peripheral nerve injury. Methods The sciatic nerve injury model were established in 16 rabbits. Intraoperative NAP were recorded after 4 weeks. According to amplitude of NAP, the injuried nerve were divided into 3 groups: NAP ＜ 100 μV in A group, 100 μV ≤NAP ＜ 500 μV in B group, NAP ≥ 500 μV in C group. Nerve specimen 1cm distal to injuried point were resected that received glycine silver stain and image analysis including number, diameter and cross section area of regenerative axons. Footprint parameter and ulcer area were measured and contrasted between each two groups. Results The number, diameter and cross section area of A group regenerative axons have significant difference with B and C group, no significant difference between B and C group; Footprint parameter and ulcer area have significant difference in each two groups. Conclusion Amplitude of intraoperative NAP can be a quantitative criteria to diagnose the degree of peripheral nerve injury that provides experiment evidence for guide intraoperative decision-making in clinical practice.