With increasing demands and recognition, emergency medicine has advanced rapidly in China in recent decades. The education and training of professionals in this field are important for the further development of emergency medicine. With an attempt to investigate the way to strengthen residency training system in emergency medicine, this article reviews its potential development direction, training modes, learning materials, and quality control.
China ; Emergency Medicine ; education ; organization & administration ; Internship and Residency ; methods ; standards ; trends

ObjectiveTo investigate the development of apoptosis during ischemia/reperfusion (IR) injury and acute rejection, and to explore the significance of apoptosis in the Graft Mesenteric Lymph Node (GALT) in a rat heterotopic small bowel transplant (SBT) model.MethodsSBT was performed in F344/N rats with either freshly harvested or preserved (4 h, in ringer lactate solution at 4 ℃) syngeneic and allogeneic (Wistar/A-F344/N) grafts. Bowel and GALT samples were collected 2 h after reperfusion and on small bowel transplant postoperative days (POD) 1, 4, and 7. Histopathology assessment of the graft and GALT were prepared for hematoxylin-eosin (H&E) staining. Apoptosis was detected by the TUNEL and the electron microscope. ResultsThe number of apoptotic cells 2 h after reperfusion increased profoundly in association with preservation. After a significant decrease on POD 1, the apoptotic cells rose again between POD 3 and 7 only in allogeneic grafts. On the other hand, the apoptotic cells in allogeneic GLAT markedly increased from POD 1 to day 3; at that time point, neither histological findings of rejection nor increase in apoptotic crypt cells were present in the graft jejunum. ConclusionIR injury and acute rejection may both induce extensive apoptosis. The graft jejunum distinct second increase in apoptosis may be an early and specific sign of acute rejection. Apoptosis of GLAT cells was well correlated with and ahead of progression of acute rejection.

Objective To investigate the value of multi-slice CT in the diagnosis of gastrointestinal stromal tumor. Method CT image of 15 cases of GIST confirmed by surgical pathology were analyzed retrospectively. Re-sults The tumors originated from the stomach(n = 8), duodenum (n = 1),jejunum and ileum (n = 3), colon(n = 1), mesentery(n = 2). The main display of CT were hemorrhage,necresis and cystic change within the tumor. The en-hancement of parenchyma was clear. The enhancement of venous phase was more clear than that of arterial phase. Conclusion MSCT is a valuable examination for GIST. MSCT can precisely display the location, shape, size and en-hancement of GIST. MSCT can be worth the locating,qualitative and staging diagnosis.

Acute Disease ; Adult ; Emergency Nursing ; First Aid ; Humans ; Male ; Nitriles ; poisoning ; Young Adult

Objective To discuss the indication and efficacy for treating hypospadias with ure-throplasty of Pedicled preputial double-faced island flap(PPDIF). Methods Records of 99 children (mean age, 5.1 years; age range, 4 months-12 years)with hypospadias who underwent PPDIF oper-ation were reviewed. Of them, 56 cases were penile type of hypospadias, 24 cases of penile root type, 13 cases of scrotal type and 6 cases of perineal type according to Barcat classification. Based on Duck-ett technique, the partial preputial cortical plate remained and was displaced to gastr-penis with ure-thra. , and finally the new urethra would be covered by the cortical plate. Results During follow-up of average 2 years, 8 patients(8. 1%) developed urethral fistula, 1 (1.0 %) developed mild meatal ste-nosis, and 1(1.0 %) developed flap necrosis. The success rate for total PPDIF procedure was 89.90 % (89/99). And the success rate of simple PPDIF for cases with penile and penile root hypospadias, and PPDIF+Duplay for cases with serotal and perineal hypospadias were respectively 91.25 % (73/80) and 84.21%(16/19). respectively. Conclusions PPDIF is good for treating most hypospadias. Furth-more it make penis better shape. In the severe cases, PPDIF+Duplay prededure is recommended and the effect was affirmative.

Objective To investigate the risk factors for hospital-acquired pneumonia (HAP) in a neurological intensive care unit (NICU).Methods The patients aged ≥ 18 years admitted in NICU of Nanfang Hospital for ≥ 48 hours from May 2010 to April 2011 were enrolled.The possible risk factors,including the general information,the worst Glasgow Coma Scale (GCS) score,as well as Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores within 24 hours in NICU,whether the occurrence of HAP,whether with some underlying disease or symptoms within the time of study and using specific drug therapy or invasive procedures were investigated retrospectively.The duration of continuous medical interventions was recorded at the same time,and the continuous variables were quantified and stratified.Results A total of 243 patients were enrolled,and 50 (20.6％) of them developed HAP.Univariate analysis showed that the proportions of coma (44.0％ vs.29.0％ ;x2 =4.091,P =0.043) and APACHE Ⅱ score ≥ 15 (60.0％ vs.38.9％ ;x2 =7.232,P =0.007) in the HAP group were significantly higher than those in the non-HAP group.There were significant differences in using antacids (＜ 6 d: 38.0％ vs.19.7％ ; ≥ 6 d: 18.0％ vs.25.9％ ; x2 =7.521,P =0.023),sedatives (＜2 d: 30.0％ vs.37.3％ ; ≥2 d: 46.0％ vs.28.0％ ;x2 =6.064,P =0.048),blood products (＜3 d: 24.0％ vs.9.8％ ; ≥ 3 d: 6.0％ vs.7.3％ ; x2 =7.150,P =0.028),endotracheal intubation (＜ 5 d:24.0％ vs.10.9％ ; ≥ 5d: 26.0％ vs.15.5％ ; x2 =10.698,P =0.005),mechanical ventilation (＜ 4 d:6.0％ vs.7.8％ ; ≥ 4 d: 30.0％ vs.7.8％ ; x2=,P =0.000) and indwelling nasogastric tube (＜ 7 d:56.0％vs.37.3％ ; ≥7d: 42.0％ vs.44.6％ ;x2 =10.410,P =0.005) between the two groups.Multivariate logistic regression analysis showed that mechanical ventilation ≥ 4 d (odds ratio [OR] 6.481,95％ confidence interval [CI] 2.522-16.654; P=0.000),indwelling nasogastric tube ＜7 d (OR 12.504,95％ CI 1.614-96.869; P =0.016) and using antacids ＜ 6 d (OR 2.271,95％ CI 1.042-4.949; P =0.039) were the independent risk factors for HAP in NICU patients.Conclusions Mechanical ventilation,indwelling nasogastric tube and using antacids are the independent risk factors for HAP in NICU patients,and thus it needs to take targeted measures.

Objective To evaluate the effect of dexmedetomidine on the inflammatory responses in brain tissues in septic rats.Methods Seventy-two male Sprague-Dawley rats,aged 10 weeks,weighing 250-280 g,were randomly divided into 4 groups (n =18 each):control group (group C); sepsis group (group lipopolysaccharide (LPS)) ; distilled water group (group DW) and dexmedetomidine group (group D).Sepsis was induced by intraperitoneal injection of LPS 5 mg/kg (dissolved in normal saline 1 ml) in groups LPS,DW and DEX,while normal saline 1 ml was injected intraperitoneally in group C.Distilled water 20 μl was injected into the lateral cerebral ventricle in group DW,while dexmedetomidine 3 μg/kg (dissolved in distilled water 20μl) was injected into the lateral cerebral ventricle in group DEX.Six animals were sacrificed at 1,2 and 6 h after administration and hippocampi were removed for determination of TNF-α and IL-6 contents (by ELISA) and TLR4 mRNA expression in hippocampal tissues (by RT-PCR).Results Compared with group C,TNF-α and IL-6 contents in hippocampus tissues were significantly increased at each time point after administration in group LPS (P ＜ 0.05).Compared with group LPS,no significant change was found in TNF-α and IL-6 contents in hippocampal tissues (P ＞ 0.05),and TLR4 mRNA expression was significantly up-regulated at each time point after administration in group DW (P ＜ 0.05).Compared with group DW,TNF-α and IL-6 contents in hippocampal tissues were significantly decreased at each time point after administration,and TLR4 mRNA expression was significantly up-regulated at 2 and 6 h after administration in group DEX (P ＜ 0.05).Conclusion Dexmedetomidine can reduce inflammatory responses in brain tissues in septic rats via down-regulating TLR-4 mRNA expression.

Urinary microquantitative albumin (UALb), immunoglobulin G (UIgG) ?2-microglo-bulin (U?2m), and Tamm-Horsfall protein (THP) were measured in 36 chronic B hepatitis (CHB) and 23 liver cirrhosis (LC) patients with radioimmunoassay. 109 healthy normal subjects served as controls. The results showed that the excretion of UALb was significantly increased in 17 patients. Out of 17 patients,the excretion of UIgG in 5 and U?2m in 16 were increased and the excretion of THP in 9 patients were decreased. Compared with normal controls there was a significant difference (P

ObjectiveTo investigate the immune tolerance function and significance of allogene bone marrow injection to the small intestines transplantation of rats.MethodsInbreeding line rat F344/N and Wistar/A were selected to perform heterotopic graft of the whole small intestine. 7 days before allogene transplantation, donator bone marrow cells (BMC) were injected into thymus of acceptor (the testing group). According to the isogene and allogene rat transplant model, it was comprehended whether injecting allogene donator marrow into acceptor thymus could decrease the acute rejection after transplantation.Results3, 5 or 7 days after allogeneic rat dystopia whole small intestine transplantation, typical reject reaction appeared, but there was no reject reaction in isogenome and testing group. 3 days after allotransplantation, serum soluble interleukin-2 receptor (sIL-2R) and tumor necrotic factor-α (TNF-α) levels were significantly higher than the other groups (P<0.01). The level of serum sIL-2R and TNF-α in the allogene marrow injecting group were only slight higher on the 3rd or 5th day, and getting downtrend, and there was no significant difference compared with isogenic transplantation group.ConclusionAllogenic donator bone marrow intrathymic injecting into acceptor 7 days before small intestina transplantation, can reduce the reject reaction after the grafting. The levels of serum sIL-2R and TNF-α can be selected as a sensitive early diagnosis index of acute rejection after small intestine transplantation.

Objective To study the effects of fluoride on minichromosone maintenance(MCM)3 mRNA and the bone formation-related gene:bone sialoprotein(BSP),osteocalcin(OC),osteopontin(OP)mRNA expression on human osteoblast cells.The expression of MCM3 was tested for diagnosis and surveillance value on osteoblast treated with excess fluoride.Methods Human osteoblast cell(Saos-2)was cultured in McCoy5A medium and treated with fluoride(sodium fluoride,NaF).There were eight groups including:0(control),0.625,1.250,2.500,5.000,10.000,20.000,40.000 mg/L groups.Expression of MCM3,BSP,OC,OP mRNA were detected by real-time PCR.Dual-standard curve method was used for analysis.ALPase was determined by measuring the absorbance using a micro titer plate reader. Results Expression of MCM3 mRNA was lower in the 0.625,1.250,2.500,5.000,20.000, 40.000 mg/L groups(0.059 ± 0.003,0.027 ± 0.001,0.272 ± 0.004,0.115 ± 0.002,0.137 ± 0.004,0.754 ±0.002, all P > 0.05) and was higher in10.000 mg/L group(21.300 ± 1.200, P < 0.01 ) than control group( 1.000 ±0.020), especially 10.000 mg/L group was higher than groups treated with fluoride(all P < 0.01 ), the differences among groups were significant(F = 305.842, P < 0.01 ). Expression of BSP mRNA was significantly higher in 0.625,1.250,2.500,5.000,10.000 mg/L groups(71.80 ± 3.60,133.00 ± 7.20,85.50 ± 0.60,80.90 ± 1.20,304.00 ± 21.00)than the control group( 1.00 ± 0.04), especially 10.000 mg/L group was higher than others groups treated with fluoride(all P < 0.01 ), the differences among groups were signifieant(F = 159.531, P < 0.01 ). Expressions of OC mRNA were higher in 0.625,1.250,2.500,5.000 mg/L groups(110.00 ± 12.00,143.00 ± 2.10,90.60 ± 4.10,23.70±1.20) than control group(1.00 ± 0.01, all P < 0.01), and the differences among groups were significant (F = 158.734, P < 0.01 ). Expression of OP mRNA were higher in 0.625,1.250,2.500,5.000,10.000,20.000 mg/L groups(167.00 ± 11.20, 111.00 ± 12.10,72.50 ± 3.50,134.00 ± 14.00,42.30 ± 2.40,45.20 ± 3.30) than the control group(1.00 ± 0.04, all P < 0.05 or < 0.01 ), the differences among groups were significant(F = 60.226, P < 0.01 ).Compared with control group(4.2 ± 1.2), the ALPase activity was increased in all groups treated with fluoride (6.0 ± 0.4,5.8 ± 0.1,5.7 ± 0.4,7.7 ± 1.1,19.2 ± 2.4,8.5 ± 3.0,18.1 ± 4.2), but only 10.000 mg/L and 40.000 mg/L groups were higher than control group and other groups treated with fluoride(all P < 0.01 ), the differences among groups were signifieant(F = 7.806, P < 0.01 ). Conclusions Irregular expression of MCM3 mRNA is not suitable as a diagnostic and monitoring biomarker of osteoblasts exposed to excessive fluoride. Fluoride may affect the osteoblast-related gene expression and to promote osteogenic differentiation.