Personnel resource is very important for the development of emergency department and emergency medicine.In recent years a series of researches for the standardized training of emergency residents have been progressed in the Emergency Depart- ment of West China Hospital.It goes through three phases.The idea of the training changes from“general physician”to“emer- gency specialist”.And the training is designed,practised and assessed with standardization.

Adolescent ; Adult ; Benzene ; toxicity ; China ; Female ; Humans ; Leukemia ; chemically induced ; diagnosis ; Male ; Middle Aged ; Occupational Exposure ; Young Adult

Objective To observe the effect of buprenorphine transdermal patch combined with gabapentin in patients with diabetic peripheral neuralgia (DPN).Methods Sixty patients were divided randomly into experimental (A) and control (B) groups.Patients in group A were treated with buprenorphine transdermal patch combined gabapentin.Patients in group B were orally administered pregabalin only.The period of treatment was 8 weeks.The analgesic effect [visual analogue scale (VAS) scores] , sleep scores, daily doses of gabapentin, and adverse reactions were evaluated before treatment, and the 2nd weeks, 4th weeks and 8th weeks after treatment.Results The VAS scores of group A were significantly lower than group B at 4th weeks and 8th weeks after treatment [(2.8 ± 1.6) points vs (3.8 ± 1.5) points,(2.6 ± 0.5) points vs (3.5 ± 1.6) points, P ＜ 0.05].The sleep scores of group A were significantly higher than group B (P ＜ 0.01).The daily doses of gabapentin were significantly lower [(853.0 ± 349.8) mg vs (1575.8 ± 351.0) mg, (845.1 ± 342.7) mg vs (1434.2 ± 440.8) mg, (826.9 ± 298.5) mg vs (1389.8 ±356.6)mg, P ＜ 0.05].The incidence of adverse reactions was significantly lower in group A (10.7％ vs 25.9％ , 10.7％ vs 29.6％ , P ＜ 0.05).Conclusions The combination of buprenorphine transdermal patch and gabapentin is effective and safe for the patients with DPN.

BACKGROUND:To explore the methods for secondary limb revascularization after endovascular repair is one of the most urgent research topics.
OBJECTIVE:To investigate the biological mechanism about the transplantation of autologous peripheral blood stem cel s to lead and perfect the effect of ischemic tissue for secondary revascularization.
METHODS:Forty-two patients with critical low limb ischemia were selected and treated with endovascular repair as first revascularization and transplantation of autologous peripheral blood stem cel s as secondary revascularization. The secondary revascularization was carried out at 3 months after the first blood flow remodeling. The patients receiving secondary revascularization were fol owed for 4 years.
RESULTS AND CONCLUSION:After transplantation of autologous peripheral blood stem cel s, the patients complained that the rest pain of the lower leg was relieved obviously and intermittent claudication distance was significantly lengthened. Limb salvage rate was 100%. Skin temperature index was 1.6±0.3, transcutaneous oxygen pressure was (5.00±1.26) kPa, ankle-brachium index was 0.9±0.2, photoplethysmograpy index was 0.8±0.1, saturation of blood oxygen was (79.4±20.4)%, and digital subtraction angiography score was (1.3±0.2)
points. After transplantation, local blood flow indicators of the low limbs were positively correlated to local symptom indicators of the limbs (0.6

Objective To investigate the therapeutic effect on allergic rhinitis(AR)with plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior under endoscope.Methods 98 cases with AR were included in this study,which were randomly divided into 2 groups.The treating group was treated with plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior under endoscope,the control group was treated with microwave.Results The total and significantly effective rates were 94% and 78% in the treating group,68.8% and 39.6% in the control group.The therapeutic effect of the treating group were obviously higher than that in the control group(P＜0.01).Conclusion The therapy of plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior in the AR treatment under endoscope had the advantage of little bleeding,no serious adverse effect and com plication,significantly effective and fine clinical application.

Objective To compare the specificity and sensitivity of antibodies against SSA and SSB,anti-M3 receptor polypeptide antibodies,anti-α-fodrin(IgG)antibodies in primary SjSgren's syndrome (pSS).Methods One hundred and ten pSS patients(mean age was 49.2±14.8.mean disease duration was 5.6±4.6),80 systemic lupus erythmatosis(SLE)patients(mean age was 25.5 4-4.6,mean disease duration was 2.5±1.2)and 80 rheumatoid arthritis(RA)patients(mean age was 44.6±3.5.mean disease duration was 4.2±1.1)were studied.Enzyme-linked immunosorbent assay was used to measure these antibodies.Results The seropositive rates of anti-SSA,anti-SSB antibodies,anti-M3 receptor polypeptide antibodies and anti-α-fodrin(IgG)antibodies were 45.5%,30.9%,78.2%and 77.3%,respectivelv in pSS.They were much higher than those in RA and SLE patients(P<0.05).Specificities of SSA、SSB antibodies,anti-M3 receptor antibodies and anti-α-fodrin IgG were 83.8%,97.7%.92.0%and 90.O% respectively.With the combination of these antibodies in the diagnosis of pSS.the Sellsitivity can be increased at least to 88.2%and the specificity was not decreased significantly.Conclusion Combination of these antibodies can significantly improve the sensitivity of these antibodies in the diagnosis of pSS.Anti-SSA and SSB antibodies,anti-M3 receptor antibodies and anti-α-fodrin(IgG)antibodies are specific antibodies for the diagnosis of pSS.

20% lymphocytes)was documented in all patients who underwent bronchoalveolar lavage(BAL).In addition,inversion of the CD4/CD8 ratio(mean value:0.64?0.21)was observed in the patients.Non-specific IgM and IgG antibodies to antigens were documented in 13/14(92.9%)of BAL patients.Ten patients were cured by glucocorticoid,others by anti-infective therapy.We rechecked the HRCT which displayed the shade of lung in 12 patients(85.7%)vanishing completely,2 patients'(14.3%)partly.Conclusion There is no specificity in the clinical manifestations,change of mageology,pulmonary function and the immunologic test.However,compared with other methods,we find the test of BAL is more valuable to the diagnosis.It is critical to avoid the antigen,and we find the curative effect of the glucocorticoid is significant.

Objective The purpose of this study was to investigate the efficacy and safety of bortezomib +doxorubicin + dexamethasone (PAD) regimen in the treatment of patients with multiple myeloma (MM) . Methods Thirty-eight patients with MM in our hospital were selected and randomly divided into observation group and control group with 19 cases in each. The observation group was treated with PAD regimen and the control group was treated with VAD regimen (vincristine+doxorubicin+dexamethasone) . Clinical efficacy and adverse reaction were compared between the two groups. Results The effective rate and total effective rate of the observation group were 52.63%and 78.95%respectively, which were significantly higher than those of the control group ( <0.05 and <0.05) . There was no statistical difference in the incidence of adverse events between the two groups ( >0.05) . Conclusion PAD regimen could improve the clinical effect of treating patients with MM, and the adverse reactions can be tolerated. It is safe and worthy of clinical application.

Objective To investigate the safety and effectiveness of high intensity focused ultrasound (HIFU ) in the treat‐ment of uterine fibroid (<4 cm) .Methods Retrospectively studied 79 single fibroid (<4 cm) patients that treated with HIFU in our hospital from January 2011 to February 2013 .Evaluated the improvement of post‐treatment ,shrinkage of fibroid volume and HIFU‐related adverse reaction .Results All the 79 patients were successfully cured by HIFU treatment .The shrinkage rate of fi‐broid was 79 .0% (four point spacing 57 .9% ,92 .1% ) after 2‐year treatment ;Symptom severity score (SSS) and uterine fibroid symptom and quality of life score (UFS‐QOL) were significantly improved ;and there was no adverse reaction .Conclusion HIFU can be safely used in the treatment of small uterine fibroids (diameter<4 cm ) .

Objective To investigate the effect of N-nitro-L-arginine (NO2Arg) on the development of morphine tolerance and dependence.Methods Forty male SD rats weighing (180 ? 18)g were randomly divided into 5 groups for the study of morphine physical dependence and tolerance : group Ⅰ normal saline; group Ⅱ morphine; group Ⅲ morphine + 1 mg?kg-1 NO2Arg; group Ⅳ morphine + 5 mg?kg-1 NO2 Arg ; group Ⅴ morphine +20 mg?kg-1 NO2Arg. Twenty-four male Kunming mice weighing (20.0 ? 2.3)g were randomly divided into 3 groups for the study of psychological dependence: group Ⅵ morphine; group Ⅶ dihydro etorphine; group Ⅷ normal saline. The morphine physical dependence was induced by dose increment. The degree of morphine tolerance was assessed by the pain threshold to heat radiation using tail-flick test. The degree of morphine physical dependence was determined by evaluating the abstinence syndrome precipitated by 4 mg?kg -1 naloxone. The psychological dependence of mice was evaluated by conditioned place preference. Results Consecutive injection of NO2Arg inhibited the development of morphine tolerance in a dose-dependent manner. 5 mg?kg-1 NO2 Arg suppressed most abstinent symptoms of morphine dependent rats. The duration when morphine and dihydro etorphine psychologically dependent mice stayed in the preferred compartment increased significantly from (6.1? 2.0)min and (8.0?0.7)min to (9.3?1. l)min and (9.5 ? 1.2) min by 4 mg?kg-1 NO2 Arg. Conclusion NO2 Arg can inhibit the development of morphine tolerance and dependence and reverse the existing psychological dependence.