Objective To investigate the physiological responses of healthy youth to doing chest compression as a feedback of quality of CPR after their rapid ascent to high altitude and to evaluate the feedback in the intervention effects of CPR.Methods Prospective,single sample,before-after comparison method was used in this study.Fifteen young adults from plains natives were enrolled as trial subjects in this study.All of them received basic life support training course in advance.In Chongqing (259 m above sea level),subjects performed empiric chest compressions on the model body for 4 minutes followed by feedback compressions for 4 minutes after at least 30 minutes rest.Compression depth,rate and other compression quality parameters were measured and recorded at each turn of compressions with an AED PLUS device.Subjects performed empiric compressions based on their knowledge and experiences,and practiced feedback compressions according to the audiovisual guidance of AED PLUS device.Blood pressure,heart rate and SpO2 were taken before and after each turn of compressions.One week after arrival to Lhasa (3658 m above sea level) by flight,all subjects were asked to do the same procedure as did in Chongqing to see their physiological response to.Paired t tests or Wilcoxon matched pair rank test were used for comparisons of measurements before and after trials.Results Systolic pressures,diastolic pressures,heart rates at baseline in Lhasa were significant different from those in Chongqing,including systolic pressure (125.9 ±9.5) mmHg vs.(112.7 ±13.4) mmHg,diastolic pressure (75.3 ±7.7) mmHg vs.(64.2 ±7.3) mmHg,heart rate (86.3 ± 13.0) beat/min vs.(72.7 ± 11.6) beat/min,SpO2 (90.4 ± 1.7)％ vs.(97.8 ±0.9)％,all P ＜ 0.01.In Lhasa,empiric compressions only caused an increase in heart rate (91.1 ± 14.9) beat/min vs.(86.3 ± 13.0) beat/min,P ＜ 0.01.However,feedback compressions resulted in a significant decrease in SpO2 [(88.3 ± 3.4) ％ vs.(90.6 ± 1.9) ％,P ＜ 0.01] as well as change of systolic pressure [(130.9 ± 11.7) mmHg vs.(120.1 ± 11.9) mmHg,P ＜0.05] and heart rate [(87.9 ± 17.5) beat/min vs.(80.9 ± 11.7) beat/min,P ＜0.05].In Lhasa,the compression quality during feedback compressions was closer to guideline recommendation than that during empiric compressions.The median (interquartile range) of composite qualification rate was 43.6％ (55.9％) vs.0.6％ (5.3％) during feedback compressions and empiric compressions respectively,P ＜ 0.01.Conclusions Compression quality decreased significantly among youth after rapid ascent to high altitude.Feedback techniques for CPR could effectively guide the rescuer to improve their CPR quality,but it may be at the expense of more physical consumption.

When adult developmental dysplasia of hip (DDH) patients have developed secondary os- teoarthritis of hip (OAH) with serious clinical symptoms,total hip replacement (THR) is their first choice of treatment.The anatomic structures of the acetabulum and femur in these patients are ahnormal and special,such as small and shallow cup,small femoral head,and narrow medullary cavity at proximal femoral shaft.As a result,the THR for DDH patients is quite different from the conventional ones and is thus highly difficult.We review in this paper the clinical classification of DDH,which is important for its treatment,the difficulties we will have in THR, especially in acetabular reconstruction and femoral prosthesis placement,and also strategies to resolve them.

Objective To investigate the value of retraction phenomenon in coronal plane at threedimensional ultrasonography(3D-US) in preoperative assessment of prognostic factors in breast cancer.Methods Surgical resection specimens of 66 malignant breast lesions in 66 women who had undergone 3D-US were included.The presence of the retraction phenomenon in the coronal plane was evaluated.Pathologic prognostic factors,including tumor size,histologic grade,lymph node status,estrogen receptor (ER) and progesterone receptor (PR) status,and human epidermal growth factor receptor 2 (Cerb-B2) and p53 expression were determined.Correlation of the retraction phenomenon and prognostic factors was analyzed.Results The retraction phenomenon was correlated to the tumor size,histologic grade,and estrogen and progesterone receptor status.Compared with the breast cancer without the retraction phenomenon,the tumor foci with the retraction phenomenon were more likely to show a smaller diameter less than 2 cm (73.7％ vs 46.4％,P ＜0.05),a lower histologic grade with grade Ⅱ (88.2％ vs 42.9％,P ＜0.01),and a higher positive rate of ER and PR (86.8 ％ vs 64.3 ％,P ＜0.05;81.6 ％ vs 57.1％,P ＜0.05).The lymph node status and the expression of the CerB-2 and p53 in the two groups had no significant difference (P ＞0.05).Conclusions The retraction phenomenon in the coronal plane of three-dimensional US may be useful in the noninvasive prediction of prognostic factors of breast cancers.

Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .

Objective To investigate the epidemiological characteristics of multiple-injuries of bone and joint in the belief that a better knowledge of such injuries may help their prevention and treatment. Methods A retrospective study was done on the data of 346 patients with multiple-injuries of bone and joint who had been ad- mitted to our department from January 2001 to December 2004. On the basis of CAI's classification, the following data were statistically analyzed: gender, age, cause of injury, injured part, number of injured parts, associated injuries and mortality. Results Of the 346 injured patients, there were 278 males and 68 females, with an av- erage age of 32.8 years (9months to 89 years). Two hundred and twenty-six cases resulted from traffic accidents, 65 from crush by a heavy object, and 52 from falling. There were 159 fractures of shaft of tibia and fibula, 96 fractures of femoral shaft, 87 fractures of shaft of ulna and radius, 58 fractures of ankle and foot, 57 chest injuries, 50 knee injuries, 50 hip injuries, 49 injuries at the pelvis region, 46 wrist and hand injuries, 36 injuries of shoulder, 36 skull fractures, 33 fractures of humeral shaft, 23 spinal fractures, and 17 elbow injuries. Two hundred and forty-two patients had two parts injured, 83 had three parts, 20 had four parts, and one had six parts. The average number of injured parts was 2.3. Two hundred and five patients suffered from close injuries, and 141 from open ones. The associated injuries included skull and brain injury in 51 cases, chest injury in 23, abdomen injury in five, urine system injury in three, nerve and vessel injury in 21, shock in 78, and fat embolism in six. Five patients died. Conclusions Male young people tend to be the majority of victims of multiple-injuries of bone and joint. Traffic accidents result in most of such injuries. Since multiple-injuries mostly involve lower limbs, they are easy to diagnose while the associated close injuries involving brain, chest, abdomen and pelvic are likely to be overlooked or misdiagnosed. Strengthening safety education and technical training of first aid is important to im- provement of treatment and to decrease of disability rate and mortality.

Objective To compare the value of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ),sequential organ failure assessment (SOFA) and procalcitonin (PCT) in assessment of severe multiple trauma. Methods A retrospective study was carried out on clinical data of patients with severe multiple trauma who were admitted to ICU from July 1 st 2010 to October 31 st 2011.PCT detection,APECHE Ⅱ and SOFA scoring were routinely performed for all the patients within 24 hours,and were performed again one week later for the patients who were complicated with sepsis within one week.Results The score of APACHE Ⅱ and SOFA in septic shock group was higher than that in severe septic and septic groups (P ＜0.01 ),while PCT level among septic,severe septic and septic shock groups had no statistical difference (P ＞ 0.05).To determine the predicting accuracy of APECHE Ⅱ score,SOFA score and PCT,receiver operating characteristic curve (ROC) was constructed.The areas under the curve (AUC) for APECHE Ⅱ score,SOFA score and PCT in predicting the emergence of sepsis on admission was 0.615,0.663 and 0.160 respectively.AUC for APECHE Ⅱ score,SOFA score and PCT in predicting the occurrence of death among the severe multiple trauma patients on admission was 0.576,0.571 and 0.619 respectively.AUC for APECHE Ⅱ,SOFA and PCT in predicting the death of patients complicated with sepsis at one week after admission was 0.746,0.837 and 0.600 respectively. Conclusions Among the APACHE Ⅱ score,SOFA score and PCT,APACHE Ⅱ and SOFA score are better than PCT in assessing the infection severity of sepsis.SOFA score is the best in predicting the occurrence of sepsis,while PCT is the worst.PCT is the best in predicting the occurrence of death of severe multiple trauma patients,while SOFA score is the worst.SOFA score is better than APACHE Ⅱ score and PCT in predicting the occurrence of death of the patients complicated with sepsis.

Objective To summarize preliminary experiences on complete video-assisted thoracoscopes lobectomy for patients with non-small cell lung cancer.Methods From October 2009 to March 2012,42 patients with non-small cell lung cancer were treated with complete video-assisted thoracoscopes lobectomy.Tumors located in the left upper lobectomy in 7 cases,10 cases of left lower lobectomy,9 cases of upper right lung,4 cases of right lung,12 cases of lower right lobectomy.Preoperative cTNM stage was Ⅰ-Ⅱ (T1N0M0-T2N1M0),the size of tumor was ＜ 5 cm,no obvious lung and mediastinal lymph node enlargement or pleura hypertrophy.Results All operations were successful.There were (9.5 ± 3.2) pieces of lymph nodes removed.Nz lymph node cleaning was more than 3 groups,the average was 3.3 groups.The operation time was 100-400 (220 ± 37) min,blood loss was 120-700 (150 ± 63) ml,duration of drainage was 3-12(4.5 ± 2.1) d.The postoperative hospital stay was 9-31 (12.2 ± 5.0) d.Conclusion Video-assisted thoracoscopes lobectomy is technically feasible and safe,but the operation indications should be paid special attention.

Objective To investigate the behavioral problems and self-concept of children with oppositional defiant disorder (ODD) and the correlation between them. Methods The subjects came from a sample survey of primary and middle school students' mental status in 6 regions in Hunan province. Achenbach child behavior checklist (CBCL) was filled out by parents. The Children's self-concept scale (CSCS) was completed by children themselves. Results There were significant differences between the scores of ODD group and the normal control among all CBCL subscales except the activities scale, and the scores for the CSCS scales were all lower in patients with ODD than the control group except for the physical appearance and attributes (P<0.01). In addition, according to correlation analysis, the CBCL scores yielded small but significant correlations with the CSCS scores for children with ODD(P<0.05). Conclusion Children with ODD have generally behavioral problems, poor social competence, and lower self-concept, whose behaviors were correlated with their self-concept.

Objective To establish a arsenic cerium catalytic rate method for determination of urinary iodine,and increase the linear range of urinary iodine determination.Methods Standard series and urine samples after digestion treatment,were tested using dynamics function of spectrophotometer to record the curve of absorbance value (A) change with time (t) during arsenic cerium catalytic reaction for each measurement system,choice (A1,t1) and (A 2,t2) on this curve and calculating the reaction rate (v),v =(lgA1-lgA2)/(t2-t1).Through the determination of the standard series it could calculate regression equation of iodine concentration (C) with X:C =a ± bX,X =1 000 (v-v0),and the v0 is the reaction rate of reagent blank.Results (① C and X were positively correlated.The standard series linear range was 0-1 200 pμg/L and correlation coefficient r was higher than 0.999 1.The minimum detection limit was 3.9 μg/L (0.25 ml urine).②)Precision:5 urine samples (A,B,C,D,E) were selected within the range of 0-1 200 μg/L and the measured value were (72.3 ± 2.7),(148.2 ± 5.2),(210.5 ± 4.4),(562.7 ± 6.8),and (899.3 ± 8.0) μg/L.The relative standard deviation (RSD) was between 0.9％-3.8％.(③)Accuracy:4 samples (A,B,C,D) were measured for standard addition recovery test,recovery was between 94.2％-107.2％;urinary iodine standard material [the given values were (67.9 ± 9.0),(142.0 ± 10.0),(195.0 ± 10.0),(558.0 ± 17.0),(885.0 ± 28.0) μg/L] were determined and the results were in the range of uncertainty of the standard material.④Method contrast:with the national health standard method (method for determination of iodine in urine by arsenic cerium catalytic spectrophotometry) to determinate 120 urine samples,the results showed that there were 60 urine samples within 0-300 μg/L,60 urine samples were more than 300 μg/L.Then rate method was used to test the 120 urine samples.For the 60 samples within the scope of 0-300 μg/L,the determination results of the two methods were positively correlated (r =0.994,P ＜ 0.01);the results of the rate method were lower than those of the standard method and the difference was statistically significant (t =2.047,P ＜ 0.05).But the average deviation was only 2.1 μg/L,for the determination of urine iodine there was no practical significance;for the 60 samples higher than 300 μg/L,the determination results of the two methods were positively correlated (r =0.993,P ＜ 0.01) and the difference was not statistically significant (t =-1.092,P ＞ 0.05).Conclusions Arsenic cerium catalytic rate method has increased the linear range of urinary iodine determination.Using this method,the vast majority samples can be tested directly without dilution,thereby reducing the workload for determination of urine iodine.

Background The pathogenesis of primary open angle glaucoma(POAG) and high myopia are very complex.To construct the regulatory network of virulence genes and relevant genes that involved in pathogenicity are helpful for reveal of the pathogenesis.Objective The aim of this study was to investigate myocilin(Myoc),a gene that contributes to POAG and high myopia in eyes of BXD Recombinant Inbred(BXD RI)mice and construct the regulatory network of Myoc.Methods The affymetrix microarray system was used to detect the differential expression of Myoc in the eyes of C57BL/6J(B6),DBA/2J(D2) and BXD RI mice.Expression quantitative trait loci (eQTL) mapping was performed to construct the regulatory network of Myoc gene.Results The average expression level of the Myoc gene in the BXD strains was 10.83,and the gene exhibited expression levels ranging from 8.39 in BXD55 mice tol 1.43 in B6 mice.The eQTL mapping for the Myoc gene showed a significant likelihood ratio statistic (LRS) of 21.78.The QTL was mapped in chromosome 2,and Myoc was located on chromosome 1,indicating that the Myoc gene was a trans-acting QTL.Olfml2a was identified to be a candidate upstream gene of Myoc by analysis of bioinformatics.Genetic regulatory network analysis demonstrated that a series of genes associated with Myoc probably played roles in the pathogenesis and development of POAG and high myopia.Conclusions The genetical genomics approach provides a powerful tool for constructing pathways that contribute to complex traits,such as POAG and high myopia.