The key point of development of emergency medicine is professional training. What we need are "emergency physicians who have well-knit theory and comprehensive technique" but "the internal physicians who could do some resuscitation". This is the goal of emergency medical education. To realize the goal, we need to improve our condition of training-bases, the curriculum,the academic level of trainer and training method. Besides, we should balance the effectivness and safety of training. We believe that the "four steps" course should be the most important and most effective method of emergency medical training.

Objective To investigate the effect of different levels of positive pressure (PEEP) during one-lung ventilation on blood gas and hemodynamics in patients with thoracoscopic lung bullae resection surgery.Methods Seventy-eight patients undergoing thoracoscopic lung bullae resection surgery were divided into three groups by random number table method,26 cases in each:group Ⅰ was only given one-lung intermittent positive pressure ventilation (IPPV) after two-lung ventilation,group Ⅱ was given one-lung IPPV and PEEP 5 cmH2O (1 cmH2O =0.098 kPa) after two-lung ventilation,group Ⅲ was given one-lung IPPV and PEEP 10 cmH2O after two-lung ventilation.Blood gas and hemodynamics were recorded and compared in the supine position and lateral position two-lung ventilation,one lung ventilation 10 and 30 min among three groups.Results Oxygen saturation was maintained at 0.99-1.00 in three groups.pH value,base excess,arterial carbondioxide partial pressure (PaCO2) and HCO3-at each time point in three groups had no statistical significance (P ＞ 0.05).Arterial oxygen partial pressure (PaO2) in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min was significantly higher than that in group Ⅰ [(336.2 ± 113.2),(348.5 ± 109.7) mmHg (1 mmHg =0.133 kPa) vs.(285.0 ± 103.5) mmHg,(357.6 ± 104.0),(358.9 ±103.2) mmHg vs.(276.0 ± 107.2) mmHg] (P ＜0.05),but were within the normal range,there was no statistical difference between group Ⅱ and group Ⅲ (p ＞ 0.05).Heart rate,mean arterial pressure,left ventricular ejection time,systemic vascular resistance at each time point in three groups had no statistical significance (P ＞0.05).Stroke volume,cardiac output in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min were lower than those in supine position and lateral position two-lung ventilation and the same period in group Ⅰ (P ＜ 0.05),but were within the normal range,there were no statistical differences between group Ⅱ and group Ⅲ (p ＞ 0.05).Conclusions Two-lung ventilation after one-lung IPPV and PEEP 5 cmH2O in thoracoscopic lung bullae resection surgery can maintain satisfactory PaO2 and PaCO2,hemodynamic change is not obvious; PEEP 5 cmH2O compares with only IPPV can further improve PaO2,but PEEP 10 cmH20 can't further improve PaO2.

Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.

Objective To investigate the decomposition method of surface EMG(sEMG)signals based on Blind Source Separation and to detect the the motor unit action potential(MUAP)information.Methods Utilizing the sEMG signals recorded at low muscle contraction force(10% MVC),the methods of second order non-stationary source separation(SEONS)and FastICA were explored to analyze the sEMG signals decomposition.Results The experiment results showed that the MUAP information could be acquired by spike detection and pattern recognition after the decomposition of recorded sEMG signals using the proposed algorithm and FastICA method,but a little difference occurred due to the complexity of sEMG signals.Conclusion The non-stationary characteristic of sEMG signals is considered by the SEONS algorithm,and the proposed method can be applied in the sEMG signals decomposition.

AIM To investigate the inhibitory effect of extract of fu ng i of huaier (EFH) on neovascularization formed by human umbilical vein endotheli al cells (HUVECs) in vitro. METHODS Using MTT assay, flow cytomet ry and Matrigel assay, the effect of EFH on the proliferation and differentiatio n of HUVECs stimulated by vascular endothelial growth factor (VEGF) were evaluat ed in vitro. RESULTS EFH inhibited proliferation of HUVECs stimul ated by VEGF at the concentration of 0 1 to 10 g?L -1 . The antiproliferat itive effect occurred in a dose-dependent manner. Flow cytometry analyses revea led that EFH treatment delayed S-phase progression. A remarkable inhibition of tube formation was observed in the presence of 1 g?L -1 EFH and complete i nhibition was obtained at 10 g? L -1 EFH. CONCLUSION EFH is able to inhibit neovascularization formed by HUVECs. Its mechanism might be rela ted to S-phase progression.

Objective Emergency department overcrowding (EDO) is an increasingly international occurrence which affects the quality and access of health care across the globe.We assessed perceptions of EDO by a detailed and comprehensive surveying of current international research literatures.Methods Through PubMed and BMC electronic literatures search engines from 1974 to 2012,1587 papers of original articles,reviews and comments with key wordsemergency departmentANDcrowding OR overcrowding are selected.Results 52.6％ (835/1587) all selected literatures is original research articles.21.2％ (n =337) of these papers involved the disciplinary construction of emergency medicine,and editorial comment (included viewpoints) holds almost one fifth (302,19.0％).Most common types of study methods in all original researches is single-center cohort study (722/835,86.5％),and none of them was multi-center,randomized control clinical trial.The number of papers on EDO is 8 during 1974 and 1988,and gradually elevated to 325 during 1989 and 2002.Yet the number has climbed up to 1254 dramatically (account for 79％) during 2003 and 2012.Together,USA,Canada and Austria,these three countries generated more than three-quarters of all published literatures (81.0％).So far,the authors in 48 countries and areas gave forth initial contributions in the field of EDO.Conclusions The studies and papers about EDO are steadily increasing in recent years.But the investigation shows the research quality still remain need to improve.This systemic review on EDO studies showed that the standardized measurement of EDO has become the bottleneck of EDO study.It is very important and urgent for ED staff to establish an objective and effective EDO evaluation system.

Objective To determine efficacy of selective devascularization in management of portal hypertension. Methods The clini-cal data of 86 patients of portal hypertension in our hospital from Jan. 2010 to Aug. 2013 were retrospectively analyzed. The patients were divided into the selective group and the nonselectove devascularization group according to the different devascularization ways. The postopera-tive liver function index and complications were analyzed. Results In selective devascularization group, the surgery time was prolonged (P<0. 05), the postoperative FPP was reduced (P<0. 05), and there was no difference in bleeding volume and blood transfusion cases (P>0. 05). The postoperative peak value of ALT and AST and postoperative pomplications in the selective devascularization group were low-er than those in the nonselectove devascularization group (P<0. 05). And patients in the selective devascularization group have a shorter hospital stay compared to the nonselectove devascularization group (P<0. 05). Conclusion Selective devascularization can lower free portal pressure more effectively, reduce incidence rates of postoperative early complications, and it is worthy of clinical promotion.

Objective To investigate the expressions of extracellular matrix protein 1 (ECM1)and matrix metalloproteinase-9 (MMP-9) in hepatocellular carcinoma (HCC) and to explore their correlations with metastasis and recurrence.Methods Immunohistochemisty was employed to determine the expressions of ECM1 and MMP-9 in 120 HCC and 17 normal liver tissues.Results The positive rates of ECM1 and MMP-9 expression in HCC tissues were 73.3％ (88/120) and 65.0％ (78/120),respectively.They were significantly higher than that in normal liver tissues.The expression of ECM1 in HCC tissues was significantly correlated with vascular invasion and TNM stage.The expression of MMP-9 in HCC tissues was significantly correlated with tumor size,number of tumor nodules,differentiation of tumor and degree of cirrhosis.They were not correlated with age,gender,serum AFP level,HBsAg,Child-Pugh class and capsulated tumor.Patients with ECM1 and MMP-9 positivity had significantly poorer overall and disease-free survival rates.There was a significant positive correlation between ECM1 and MMP-9 (r=0.585,P＜0.001).Conclusion Both ECM1 and MMP-9 were significantly related to invasion and metastasis.Over-expression of both ECM1 and MMP-9 had predictive values for prognosis and recurrence of HCC after surgery.

Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.

ObjectiveInvestigate the value of partial hepatectomy combined radiofrequency ablation in the treatment of medium-term liver cancer.MethodsThe 19 cases were retrospectively analyzed which admitted by Anhui Provinical Hospital due to hepatocellular carcinoma from October 2008 to November 2011.Liver function in patients before surgery was assessed by Child-Pugh score and indocyanine green.The complications 7 days after surgery were evaluated by liver function.The short-term effect 4 weeks after surgery was evaluated by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound.The inspection per month was lined by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound 6 months after surgery.After then referral was done once every 2-3 months.ResultsAll patients had liver function damage 7 days after surgery,but there were no hepatic encephalopathy and death cases.Residual tumor and incomplete ablation accounted for 10.1％ (2/19)of all cases.For 1 year and 2 year survival rates were 83.2％ and 46.4％.The average survival time was 22.23 months and the median survival time was 24.87 months.ConclusionsPartial hepatectomy combined radiofrequency ablation has important application value in the treatment of medium-term liver cancer,expanding the indications of surgical exploration in hver cancer,especially medium-term liver cancer,and it can matimaly kill visible lesions.