The article analyzed the problems in Emergency Medicine and illuminated the character-istics of the teaching model based on micro-course , and pointed out that the introduction of the micro course into the emergency training was the inevitable trend of the development of teaching. Combined with the real case of emergency training, the article described the micro teaching structure and implementation plan in detail, namely with the WeChat public number as the platform for teaching, setting up the curricu-lum according to the differences of the training staff, setting up the interactive communication area, taking into account the basic theory and expanding the study, to achieve the repeatability, individuation, interac-tivity and convenience of the teaching.

Objective To analyze the clinical characteristics, diagnosis, therapy and prognosis of acute pulmonary embolism (APE) following surgery so as to advise clinicians to pay more attention to and prevent postoperative APE. Method Thirty-one APE patients following surgery treated in the recent 8 years were analyzed retrospectively. The clinical features, diagnosis, therapy and prognosis of patients were analyzed. Results (1) Post-operative APE patients accounted for 21.9% of all APR patients during that period. The mortality of patients after surgical operation was 3.2%. (2) APE following surgery often occurred in patients after operations of spine, abdomen, gynecological surgery and point replacement as well as in patients with malignant tumor. The APE following surgery often occurred in the first week after surgery. The APE after surgery for malignant tumor occurred sooner. (3) Among many clinical manifestations, dyspnea (90.3%) was the commonest one. Other manifestations included chest pain, palpitation and syncope. The typical triad of dyspnea, hemoptysis and cheat pain was rarely seen. (4) The venous thrombolysis was a absolute contra-indication for massive PE after surgery. Catheter embolectomy and fragmentation, and surgical embolectomy were the alternative treatment. Conclusions Surgery is the essential risk factor of APE. When patients present dyspnea, chest pain or syncope, clinicians should pay attention to APE. Anticoagulation and embolectomy can improve the prognosais of the patients.

Taking a national continuing education program with hand in hand mode as an example, the advantages and disadvantages of hand in hand mode and traditional mode are com-pared. Hand in hand mode realizes a door-to-door teaching, and the curriculum is more targeted. Moreover, the time and physical power of trainees are saved, so the training effect is better. The na-tional continuing medical education program withhand in hand is worthy of promotion in the teach-ing practice.

Cardiopulmonary resuscitation is an important part of standardized residency training. There are certain flaws in the various commonly used training and assessment mode. In the exploration of the new mode, "step-by-step" training helps to learn skills step by step. "Low intensity and high frequency" training not only focuses on key points and difficulties, and lightens the burden of the teachers and residents, but also can improve the training effect through repeated reinforcement. Combining different training methods organically to establish a "diversified" training mode can make full use of the advantages of different methods and make up for each other's shortcomings. In addition, the "veto power" should be introduced into the assessment. Scenario simulation with role play may be an effective way to train teamwork ability, but it still needs further exploration.

Objective: To investigate the effect of hypoxia/reoxygenation on endoplasmic reticulum stress in cultured neonatal rat cardiomyocytes. Methods: Neonatal rat cardiac myocytes in primary culture were exposed to hypoxia for 5.5 hours and subsequently reoxygenation for 2-24 hours. Western blot and RT- PCR were applied to monitor the expression change of GRP78(glucose regulated protein 78). 2-deoxy-D-glucose(2-DG) was the positive control of this study. Then Western blot and RT- PCR were used to examine the expression of GRP78. Results: Cell viability was decreased obviously after hypoxia/reoxygenation. Compared with untreated cells, the GRP78 content of the cells had increased significantly in the hypoxia/reoxygenation cells. The level of GRP78 protein and mRNA elevated from the points of 2 hours to 24 hours after reoxygenation, and increased most obviously at the point of 4 hours after reoxygenation.(4 hours: protein level 142% of the control, mRNA level 200%). 2-DG could induce the increasing expression of GRP78 in a concentration-dependent manner from 10-50 mmol/L. Conclusion: Hypoxia/reperfusion can induce endoplasmic reticulum stress in rat cardiomyocytes.

Objective To evaluate the early diagnostic value of human heart-type fatty acid- binding protein (H-FABP) of acute coronary syndrome (ACS) and compare the diagnostic accuracy of different combination regimens of cardiac markers. Methods A total of 103 consecutive patients with chest pain (within 6 h after admission to Peking University Third Hospital,emergency department) suggestive of ACS were recruited for the analysis from April,2010 to June,2011.The blood levels of H-FABP,cardiac troponin-T (cTnT) and creatine kinase-myocardial band (CK-MB) were obtained at admission. The sensitivity,specificity,positive predictive value and negative predictive value together with the sensitivity and specificity in different phases of illness at admission were analyzed and compared among H-FABP,cTnT,CK-MB and different combinations by using SPSS version 17.0 software.Results Within 6 h of onset of symptom,the overall sensitivities of H-FABP,cTnT and CK-MB were 62.5％,30.6％ and 33.3％ respectively for patients with ACS.The sensitivity of H-FABP was significantly higher than that of cTnT and CK-MB (P ＜0.01 ).There were no differences in specificity and positive predictive value.The combination of H-FABP with cTnT had the greatest negative predictive value (53.8％ ).The sensitivity of H-FABP was higher during 3 - 6 h (77.8％ ) than during 0 - 3 h (53.3 ％ ) after chest pain onset (P =0.038).Within 0 - 3 h of onset of AMI,the overall sensitivities of the combination of H-FABP with cTnT and H-FABP with CK-MB (55.6％) were significantly higher than the combinaton of cTnT with CK-MB ( 24.4％ ) ( P =0.003 ).The sensitivity of the combination of H-FABP with cTnT was higher than that of single H-FABP during 0- 3 h and 3 -6 h after onset of AMI with increment in 3.3％ and 7.4％ respectively.The combination of H-FABP with cTnT had the greatest sensitivity ( 85.2％ ) during 3 - 6 h after onset.Conclusions H-FABP is the most sensitive cardiac marker in diagnosing of ACS in the early phase within 6 h,especially during 3 -6 h after onset.The sensitivity of the combination of H-FABP with cTnT is higher than that of H-FABP alone.The combination of H-FABP with cTnT has the best diagnostic value during 3 -6 h after onset of ACS.

Objective To investigate the difference in the incidence of postextubation throat complications between severe patients treated with methylprednisolone intravenously with and without budesonide suspension inhalation immediately after postextubation.Methods 75 patients with tracheal intubation were divided into group A (n=36,patients received methylprednisolone 40 mg intravenously before extubation) and group B (n=39,patients received methylprednisolone 40 mg intravenously before extubation and budesonide suspension inhalation 1 mg immediately after extubation).Postextubation thoat complications including sore throat,hoarseness and laryngeal edema were observed in the two groups.Clinical efficacies in the two groups were analyzed.Results The incidences of sore throat,hoarseness and laryngeal edema after extubation were 50.0％ (18/ 36),55.6％ (20/36) and 5.6％ (2/36) respectively in group A and 30.8％ (12/39),35.7％ (14/ 39) and 2.6％ (1/39) respectively in group B.There were no significant differences in the incidences of sore throat,hoarseness and laryngeal edema after extubation between the two groups,but the tendencies of complication incidences were decreased in group B as compared with group A.Conclusions The application of intravenous methylprednisolone before extubation and budesonide suspension inhalation after extubation can reduce the incidences of sore throat,hoarseness and laryngeal edema after extubation.

Objective This study was designed to investigate the role of apoptosis-inducing factor on neonatal rat cardiomyocytes apoptosis induced by TNF-a,and to detect the effect of IL-10 on the apoptosis rate of cardio-myocytes apoptosis induced by TNF-α.Methods Neonatal rat cardiacmyocytes in primary culture were exposed to TNF-α( 100ng/ml)for 12 hours,18 hours,24 hours,TNF-α( 100ng/ml) for lohours pretreated by IL-10(50ng/ml) 1 hour,or IL-10(50ng/ml) for 19hours.Apoptotic cells were detected by flow cytometry and Hoechest 33258 dye; Western blot were used to determine the apoptosis-inducing factor protein expression.Results The apoptosis rate of cardiomyocytes increased in TNF-α 12 hours group than that of control[ Flow cytometry (5.08 ±0.79% ) vs ( 2.2± 0.77)% ,P <0.05],and reach the peak in TNF-α 18 hours group compared with control[ Flow cytometry(14.39± 2.31)%vs(2.2±0.77)%,P<0.01;Hoechst 33258 dyeing(18.936±2.791)% Vs(2.890± 1.326)% ,P< 0.01];also elevated in TNF-α 24 hours group vs control[Flow cytometry(4.61±0.84)% vs(2.2 ±0.77)% ,P< 0.05].AIF expression:Increased expression of AIF in the cells treated by TNF-α( 100 ng/ml) 12 hours,reached highest in TNF-α( 100 ng/ml) for 18 hours group and decreased in TNF-α( 100 ng/ml) 24 hours group compared with control;AIF expression is not decrease in TNF-α( 100 ng/ml) 18 hours pretreated by IL-10(50 ng/ml) for 1-hour group comparing with TNF-α( 100 ng/ml) 18hours group.Conclusion The study demonstrated that AIF contributed to TNF-α induced apoptosis of rat cardiomyocytes; IL-10 alleviated the apoptosis of rat cardiacmyocytes induced by TNF-α,and AIF may not its mechanism.

Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.

Objective To explore the relationship between content of fine particulate matter (PM2.5) in atmospheric and the number of emergency room (ER) visits with acute coronary syndrome (ACS).Methods Daily data of ER visits to Peking University Third Hospital for ACS was collected from December 1st,2013 to November 30th,2014.All patients were resident population of Haidian District,Beijing.The daily meteorological data and contents of air pollutants in Beijing were also collected in the same time period.Generalized Additive Model (GAM) was fitted to estimate the association between the ambient PM2.5 and the ER visits for ACS,under controlling for time trends,holiday effect,day of week effect and weather conditions.Results The annual average amount of PM2.5 was 85.44 μg/m3 over the study period.There were 619 cases with ACS as ER visits.PM2.5 was positive related with PM10,NO2 and SO2.The corresponding correlation coefficients were 0.87,0.48 and 0.67,respectively (P ＜ 0.05).But PM2.5 was negative related with mean temperature (r =-0.04,P ＜ 0.05).In the polluted model,there was positive association between PM2.5 and ER visits with ACS.When each increament in PM2.2 with 10 μg/m3,the relative risk strength of ER visits with ACS was 1.019 (95％ CI:1.000-1.038).PM2.5 concentrations had a delayed effect on the onset of ACS occurred on the next day.This lagged 1 day phenomenon showed the most significant influence of PM2.5 on ER visits for ACS.Conclusions The ambient concentrations of PM2.5 are positively associated with ER visits for ACS.And there is a lag effect.