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 evaluate the effect of the application of fast track surgery theory, in endoscopic neurosurgery. Methods 198 patients of neuroendoscopic endonasal tranasphenoidal surgery for pituitary edenomas were divided into the experiment group and the control. The fast track surgery theory was applied in the experiment group while traditional methods in the control group. Psychological effect of preoperative bowel preparation, the postoperative recovery time of bowel function, analgesia effect, incidence of complications, postoperative nutrional state and hospital day were compared between the two groups. Results The experiment groups were less anxious than the control(P <0. 01 ). The postoperative recovery time of bowel function and Postoperative hospital day wore fewer than the control ( P < 0. 01). Postoperative pain was eased effectively. Condusions The fast track sugery theory can be applied in endoscopic neurosurgery to reduce the level of preoperative anxiety,increasing patient's comfort and improve the nutritional status,help recovery of patients.

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 explore the influnce on the endothelin-1 (ET-1) and clinical application value of continuous blood purification (CBP) on the treatment of severe craniocerebral injury with the neurogenic pulmonary edema (NPE).Methods All data about sixty patients with NPE were prospectively studied.These 60 patients were randomly (random number) divided into control group (n =30) and treatment group (n =30).In control group,patients were rapidly given with lowering intracranial pressure,mechanical ventilation,calming,antibiotic therapy and so on.In the treatment group,patients received CBP integrated with routine treatment.On admission and 72 h posttreatment,ET-1,static lung compliance and oxygenation index were observed.Time of mechanical ventilation support,incidence rates of multipal organ dysfunction syndrome (MODS) were compared between two groups.The paired t-test was used for the amount data within the group.Chi-square was used for the constitute ratio and incidence ratio of the each relevant information.P ＜ 0.05 was considered statistically significant.Results Compared to the control group,the level of ET-1 was decreased significantly in the treatment group [(48 ± 10) ng/L vs.(85 ± 14) ng/L] after 72 h post-treatment,while static lung compliance [(60.9 ± 2.3) mL/cmH2O vs.(31.4 ±4.8) mL/cmH2O] and oxygenation index [(317 ± 11) mmHg vs.(192 ± 14) mmHg] increased significantly (P ＜ 0.05).In treatment group and control group,the time of respirator intervention were [(6.0 ± 2.1) d vs.(11 ± 3.2) d],and the statistical significance was shown (P ＜ 0.05).Compared to the control group [56.7％ (17/30)],incidence rate of MODS [20.0％ (6/30)] was lower in treatment group (P ＜ 0.05).Conclusions CBP combined with routine treatment,which can remove ET-1 effectively,improve oxygenation,reduce the time of mechanical ventilation support and incidence rate of MODS.

Objective To explore the value of gemstone spectral imaging (GSI)in quantitative evaluation of Lauren classification of gastric cancer.Methods Fifty-two patients with gastric cancer confirmed by gastroscopy underwent contrast-enhanced spectral CT imaging preoperatively.The monoergic and iodine-based images were obtained by GSI Viewer software,CT value and iodine concentration (IC)of the lesions were measured,and normalized iodine concentration (NIC)was calculated.With the reference of postoperative pathology,data were analyzed by LSD method of one-way analysis of variance.Results The IC,NIC,spectrum curve slope of 40-70 keV,40-140 keV and 70-140 keV energy range of intestinal type,mixed type and diffuse type carcinoma in the arterial phase were 12.86±6.80 (100 μg/mL),0.13±0.06 ,2.50±1.26 ,0.99±0.51 ,0.34±0.20 ,18.54±6.49 (100 μg/mL),0.19±0.07, 3.56±1.24,1.42±0.50,0.50±0.18 and 24.52±9.68 (100 μg/mL),0.24±0.09,4.73±1.76,1.90±0.73,0.68±0.29,respectively. The values of intestinal type were all significantly lower than those of diffuse type (P <0.05).Comparison between intestinal-mixed type and mixed-diffuse type,the other parameters were no significant differences except IC between intestinal-mixed type (P=0.037).Conclusion The slope of spectrum curve,iodine concentration,and normalized iodine concentration could be helpful for preoperative evaluation of Lauren classification of gastric cancer.

[Objective]This study was designed to investigate the effects of small volume resuscitation with different fluids on the lung of endotoxie rats.[Methods]Thirty SD rats weighting 180-250 g were divided randomly into 5 groups(n=6):Group C[lipopolysaccharide(LPS)negative control group],Group E(LPS+4 mL/kg physiologic saline),Group HSS(LPS+4 mL/kg 75 g/L hypertonic saline solution),Group HES(LPS+4 mL/kg hydroxyethyl starch 130/0.4),Group HSH(LPS+4 mL/kg 75 g/L hypertonic sodium chloride hydroxyethyl starch 40).Resuscitation was administrated 30 min after LPS injected.Pathological examination and score were made under optical microscope.Dry/wet ratios were observed.Levels of total protein of bronchoalveolar lavage fluid(BALF)were measured.Thibabituric acid(TBA)was used to measure tissue malonaldehyde(MDA)levels.Xanthine oxidase(XO)was employed to measure the tissue activity of superoxide dismutase(SOD).[Results]Compared with group C,in the other 4 groups,pathological changes were server.Levels of total protein of BALF were higher(P＜0.05).Pathological score of group E was significantly higher(P＜0.01).Dry/wet ratio of group E was lower(P＜0.05).Tissue activity of SOD of group E was lower(P＜0.01).Levels of tissue MDA in group E and HSS were significantly higher.Compared with group E,in group HSS,HES and HSH,pathological changes were slighter(P＜0.01).Pathological scores and tissue MDA levels were lower(P＜0.01).Dry/wet ratios were higher(P＜0.05).Tissue activity of SOD were higher(P＜0.01),levels of total protein of BALF were lower(P＜0.05,P＜0.01).[Conclusion]Small volume resuscitation with HSS,HES,and HSH had protective effects on the lung of endotoxie rats.HES and HSH had better effect on decreasing the capillary permeability of the lung of endotoxic rats lung compared with HSS.