ObjectiveTo observe the effect of Jidesheng snake medicine on patients with bites by unknown poisonous insects. Methods69 cases with bites by unknown poisonous insects were randomly divided into the experimental group (35 cases)and the control group (34 cases).The experimental group used Jidesheng snake medicine for external application,the control group used povidone iodine.The treatment effect within one week was compared,including cure rate,total effective rate,satisfaction degree of patients and incidence rate of complication. ResultsAfter treatment,the cure rate and total effective rate of the experimental group was 71.43％ and 97.14％,higher than 61.76％ and 85.29％ of the control group.The incidence rate of complications was 2.86％ in the experimental group,lower than 8.82％ of the control group.The satisfaction degree of patients in the experimental group was 91.43％,significantly higher than 85.29％ of the control group. ConclusionsApplication of Jidesheng snake medicine in treatment of bites by unknown poisonous insects is more effective,and the incidence rate of complication was lower.It is worthy of clinical application.

Objective To observe the cyclooxygenase-2(COX-2) expression of gastric tumor tissue ,and to study the relationship between cagA + Helicobacter pylori(Hp cagA+ ) infection and COX-2 .Methods 42 specimens of gastric cancer tissue (including gastric carcinoma ,paracancerous hyperplastic tissue and paracancerous normal gastric mucosa ) in our hospitals from January 2010 to August 2011 were collected and detected the Hp cagA expression by PCR .Results The COX-2 protein positive rate in the gas-tric tcancer tissue was significantly higher than that in the paracancerous hyperplastic tissue and normal gastric mucosa (P<0 .01) . Among 42 cases of gastric cancer specimens ,Hp cagA+ was in 25 cases ,Hp cagA - was in 17 cases .The COX-2 protein positive rate was 88 .0% (22/25) in the Hp cagA+ group and 35 .3% (6/17) in the Hp cagA - group .The COX-2 protein positive rate in the Hp cagA+ gastric tissue was significantly higher than that in the Hp cagA - gastric tissue(P<0 .01) .Conclusion Abnormal ex-pression of COX-2 exists in gastric tcancer tissue ,cagA+ Helicobacter pylori infection may promote the occurrence and development of gastric cancer by regulating the expression level of COX-2 .

Objective To investigate the diagnosis and surgical treatment of peripheral solitary pulmonary nodule (SPN).Methods From January 2007 to October 2012,the clinical data of 69 cases of SPN treated were analyzed prospectively.And postoperative pathologic examination results as the gold standard to determine spiral CT enhanced check the accuracy and consistency test (Kappa test).Results Twenty-eight cases were diagnosed as malignant SPN by preoperative CT,25 cases were diagnosed as malignant SPN by postoperative pathology.The accuracy of CT judgment SPN benign and malignancy was 89.3％ (25/28),the Kappa value was 0.503.All patients were followed up for 6-12 (9.6 ± 1.4) months.There was no recurrence or enlargement.Conclusions Enhanced spiral CT scan is more economical and practical way for identifying benign and malignant SPN.Malignant SPN diagnosed by CT should be considered having surgery and auxiliary thoracoscopy combined with intraoperative rapid freezing to determine the surgical approach.

Emergency specialist training in our country is still in its infancy and perfecting stage. The United States has perfect emergency specialist training system. From training target, access system, program personnel, training content and assessment and evaluation, this study explores the difference of the emergency physician training program of the University of Michigan and the emer-gency physician training rules of Beijing University. The emergency specialist training program in the United States has a strict elimination mechanism and a more rigorous training system for the training parties, making the training plan can be implemented and worth learning from.

Objective To investigate the feasibility,advantage and clinical effect of video-assisted thoracoscopic in the treatment of sharp injury hemopneumothorax.Methods 53 cases in our hospital of sharp injury hemopneumothorax who need operation treatment were divided into the observation group (VATS group) and the control group(Open group),which were treated by Video-assisted thoracoscopic surgery and the traditional thoracotomy surgery respectively.The clinical effects,such as operative time,intraoperative blood loss,hospital stays,postoperative chest lead flow and so on were compared.Results The operation time,bleeding volume,length of hospital stay,postoperative chest lead flow and pleural drainage days have significant difference (all P ＜ 0.05).Conclusion VATS has shorter operative time,less intraoperative blood loss and quicker recovery after operation,which is a better and safer treatment of sharp injury hemopneumothorax and deserves further clinical application.

OBJECTIVE:To establish the Evaluation Criteria on Rational Use of Human Serum Albumin(HSA)in our hospi-tal,and to provide refereuce for rational use of HSA. METHODS:Referring to drug utilization evaluation(DUE)criteria of WHO and developed countries,based on the guideline of HSA use,Human Serum Albumin,Non-protein Colloid and Crystalloid Solu-tion Guidelines of USA University Hospital Consortium,Blood Products Prescription Evaluation Guideline of Beijing area,etc., Evaluation Criteria on Rational Use of HAS was established through experts discussion,and the use of HAS in 420 patients of our hospital were evaluated. RESULTS:The Evaluation Criteria on Rational Use of HSA mainly included indication,contraindication, usage and dosage,drug combination,incompatibility,etc. 414 patients (98.57%) detected serum albumin concentration before treatment;167 patients(39.76%)were in line with the indication;56 patients(13.33%)had contraindication in using HSA;352 patients(83.81%)met the criteria in usage and dosage,duration of treatment;there were 17 cases(4.05%)of unreasonable drug combination and 3 cases(0.71%)of incompatibility. CONCLUSIONS:The established criteria has strong practicability,and some problems and insufficiencies can be found in the clinical practice,is conducive to promote rational drug use in the clinic.

Objective To discuss the clinical efficacy of video-assisted thoracoscopic surgery(VATS)for bilateral bullous lung disease operation.Methods VATS procedures were performed on 120 patients with bilateral ballous lung disease.56 patients were operated in one-stage with traditional incision surgery.Results 120 patients were cured.The mean duration of chest drainage after surgery was 4.7 days.Postoperative complications occurred in 14 cases,including pulmonary edema,pneumothorax again respiratory failure and so on.The mean postoperative hospital stay was 14.5 days.The patients were followed up 1 to 60 months.Conclusion VATS is an effective and preferred method for bilateral bullous lung disease.compared with conventional open techniques for bilateral bullous lung disease,the advantages of VATS include shorter hospital stays,less postoperative pain and earlier return to work.

Objective To prepare the Fe3O4 loaded polymer microspheres(Fe3O4/PLGA),and to investigate the influence of Fe3O4/PLGA combined with high-intensity focused ultrasound (HIFU) on rabbits bearing breast tumor.Methods Double emulsion method were utilized to prepare the Fe3O4/PLGA.14 days after implantation of VX2 tumor in breast,32 rabbits were randomly divided into four equal groups.In group Ⅱ,Ⅲ,and Ⅳ,the rabbits received a percutaneous injection of 0.5 ml saline,PLGA,and Fe3O4/PLGA microcapsules solution into breast tumor at 3,6,9,12 dots,about 3 mm around the tumor respectively,and massaged for 1 min before receiving HIFU ablation,while HIFU group received HIFU ablation only.HIFU ablation parameters were the same:ablated-dot mode,acoustic power 150 W,exposure duration 5 s.After HIFU ablation,the volume of coagulative necrosis was calculated,HE staining,TEM and immunohistochemical examination of PCNA were performed to detect the structure changes of the targeted tissue caused by HIFU ablation.Results The volume of coagulative necrosis caused by HIFU ablation was substantially larger and the positive index of PCNA was lower in the necrotic region after the injection of Fe3O4/PLGA microcapsules compared to the group without injection agents,the group of saline and the group of pure PLGA microspheres under the same irritation(P ＜0.05).Pathological examination demonstrated the targeted tissue was destroyed severely,Fe3O4 nanoparticles were seen depositing in residual tumor cells under TEM.Conclusions The self-made Fe3O4/PLGA microspheres can effectively enhanced the biomedical effect of HIFU surgery on rabbits bearing VX2 breast tumor.

ObjectiveTo study the optimal power of self-made polymeric microcapsules with liquid perfluorocarbon enhancing high intensity focused ultrasound (HIFU) ablation of normal bovine in vitro and the treatment efficacy of HIFU ablation of normal rabbit liver in vivo.Methods The experiment was divided into two parts:the first part was HIFU ablation of bovine in vitro:The bovine was injected different drugs before HIFU ablation to find the optimal power and treatment time.It was divided into four groups:①HIFU + 0.9％ NaCl(NACL) group; (② HIFU + poly( lactic-co-glycolic acid) (PLGA) group; ③ HIFU + perfluorohexane(PFH) group; ④ HIFU + PLGA + PFH group; The second part was HIFU ablation of normal rabbit liver.Similarly,It was also divided into four groups as above.Each group was undergone HIFU ablation with same parameters after ear vein injection of drug.Then the ultrasonographic changes and its value,and the actual situation of liver damage in target areas of each group were observed and compared before and after the ablation area.ResultsIn experiments of vitro bovine,gray scale changes and coagulation necrosis could be seen in the liver in group 2,3,4 with HIFU power of 150 W and treatment time of 2 s.In experiment of normal rabbit liver,the average gray-scale of group 3 and 4 were larger than that in group 1 and 2,the difference was statistically significant (P ＜0.001),and its gray change area gradually reduced with time elapsed.While there was no statistically significant difference between group 3 and 4 ( P ＞0.05).In pathological specimens,there was no significant liver damage in group 1 and 2.There was hemorrhagic necrosis and white coagulation necrosis in group 3 and 4.Conclusions The polymeric microcapsules with liquid perfluorocarbon can effectively enhance the efficacy of HIFU ablation and be used as a good synergist for HIFU.

Objective To investigate the correlation between the expression of adhesion molecule CD146 and the vulnerability of carotid atherosclerotic plaque.Methods The plaque samples were collected from 40 patients who underwent the carotid endarterectomy and were divided into the stable plaque group and the instable plaque group by ultrasound imaging.Five carotid artery samples were taken from the healthy donors as the control.Immunohistochemistry was applied to test the CD146 expression in all samples.Results Higher expression of CD146 was observed in the atherosclerotic plaques than in the healthy control.Moreover,statistical difference was found in the expression of CD146 in the plaques between the instable plaque group and the stable plaque group (0.31 ± 0.19 vs 0.17 ± 0.07,P ＜ 0.05).The expression of CD146 was positively correlated with the necrotic area (r =0.471 8,P =0.019 9) and the matrix metalloproteinase (MMP)-9 expression in the plaques (r =0.535 6,P =0.000 9).Conclusion The CD146 expression is correlated with the vulnerability of carotid atherosclerotic plaque.