Pathophisiology of Budd-Chiari syndrome is complex and complicated; therefore during the treatment of BCS,both the conditions of inferior vena cava and hepatic veins should be carefully considered. Along with the continuous development of the minimal invasive,reliable efficacy and comparative safety of the interventional therapy,more and more patients are willing to adopt this technology. However,there are still many difficulties that can't be overcomed in the performance. The surgeons,especially the vascular surgeons,should entirely present their knowledge and skill into fulfillment and simultaneously combine with the consideration of the situations of our country to formulate the scientific,reasonable,feasible,safe and efficient treatment plan.

Objective:To study the mechanism and clinical significance of the precordial ST segment deviations in acute inferiorwall myocardial infarction (AIMI) involving adjacent area. Methods: Characteristics of electrocardiogram were analyzed in118 patients with AIMI. Results: (1)The magnitude of ST segment elevation of inferior wall leads (Ⅱ, Ⅲ and aVF) wassignificantly negatively correlated with that of precordial leads (P＜0.01). (2)The changed magnitude of ST segment oflead V2 (0.63±1.82 mm) and V2/aVF ratio (0.84±1.61) in 16 cases associated with right ventricular infarction weresignificantly higher than those of only inferior wall myocardial infarction group (V2:0.35±1.65 mm,V2/aVF ratio:0.29±1.28)(P＞0.05 and P＞0.05). (3)The magnitude of ST segment fall of lead V2(-1.20±1.52 mm) and V2/aVFratio (-0.33±1.15) in 38 cases associated with lateral-posterior wall in farction were higher than those of only inferiorwall infarction group (P＜0.05). (4)If the cases associated with right ventricular and lateral-posterior wall infarction werenot included, the ST segment correlation coefficient between inferior and precordial leads would significantly increase inAIMI (r =-0.797, P＜0.01). Conclusion:The directions of ST segment deviations of precordial leads elevate in casesassociated with right ventricular infarction and fall in eases associated with lateral-posterior wall infarction in AIMI.

The abdomen is an indispensable site of cardiopulmonary resuscitation,and combination with the chest for sustaining artificial circulation is the future research direction for precision medicine.This paper elaborates on the importance of abdomen in cardiopulmonary resuscitation,and analyzes the resuscitation mechanism of the chest,abdomen and thoracic abdominal combination for heart and lung recovery.The respective advantages and complementary points of chest and abdomen compression for cardiopulmonary resuscitation were also discussed.

Objective To investigate clinical features of patients with severe acut respiratory syndrome (SARS) and fever-clinic patients in SARS prevalence days. Methods Clinical data of 45 SARS patients, 150 medical observation patients and 1200 home observation patients from fever-clinic were analyzed retrospectively. Results All the 45 SARS patients had the medical history of close contact with SARS, and their body temperatures were higher than the fever-clinic patients' ones. Leucopenia and lymphopenia in SARS patients were more common than those in the home observation patients, but were similar with those in the medical observation patients. All the SARS patients' chest radiographs showed large area of interstitial infiltration or shadows, and 46 7% patients developed rapidly in a short time. Conlusion Epidemic history and chest radiograph findings may be the major evidences to diagnose SARS, while the fever symptom and blood routine examination may be helpful to screen SARS.

Objective To explore the prognosis value of serum hydrogen sulfide (H2S) concentration and acute physiology and chronic health evaluation HI (APACHE Ⅲ) scores in critically ill patients. Methods The serum H2S levels were measured in 72 cases and 12 controls by spectrophotometry. The APACHE Ⅲ scores of the patients were assessed. The relationship between serum H2S concentration and APACHE H scores and prognosis were analyzed. Results The average serum H2S concentration of the 72 cases was (45. 6 ±17.2) μmol/L The concentration in the survival group was(41. 1 ± 14. 7) μmol/L,and which was significantly lower than in the dead group(62. 8 ±15. 5)μmol/L,(P<0. 01). The average APACHE I score was(43. 6 ±26. 0)of the 72 cases. The APACHE Ⅲ score was(37. 7 ±22. 2) in the survival group,and which was significantly lower than in the dead group (65. 0 ±29. 6) (P <0. 01). The higher of the serum H2S concentration or APACHE Ⅲ scores,the higher mortality of the patients(P <0. 01). Conclusions Serum H2S levels and APACHE Ⅲ scores of critically ill patients have a role in judging the condition and prognosis of the patients.

OBJECTIVE Learned through the seeing about the infection management of the Japanese Oita Medical University affiliated hospital and analyzed our hospital infection management′s status,to understand the dynamic management of hospital infection.Moreover these suggested that we attach importance to the management of hospital infection and constantly explore new ways of hospital infection management.METHODS According to the comparative presentation of these two hospitals′ awareness and practices of infection management from China and Japan,this paper probed into the direction of our hospital infection management development.RESULTS Hospitals in every country of the world have attached great importance to their infection management,but their specific practices were different.CONCLUSIONS By comparing inspection,every hospital should maintain the individualized characteristics and learn from each others′ strong points to offset their own weakness in order to gain continuous improvement of hospital infection management.

To promote the technical training and scientific popularization of cardiopulmonary resuscitation (CPR) in China, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association combined with the Science Popularization Branch of the Chinese Medical Association wrote "2018 National consensus on cardiopulmonary resuscitation training in China". The formation was based on the general outline about "2016 National consensus on cardiopulmonary resuscitation in China", and to implement the important strategies included the "three pre" policy, prevention, precognition, and pre-warning, before the cardiac arrest (CA); the "three modernization" methods, standardized, diversified and individualized, during the CA; and the "three life" strategies, the rebirth, the extra and the extended, after the CA; and also combined with the concrete National conditions and clinical practice of China area. The document summarized the evidence of published science about CPR training till now, and recommend the establishment of "the CPR Training Triangle" according to the Chinese National conditions. The bases of the triangle were system, training and person, the core of which was CPR science. The main contents were: (1) The "three training" policy for CPR training: the cultivation of a sound system, which included professional credibility, extensive mobilization and continuous driving force, and the participation of the whole people and continuous improvement; the cultivation of scientific guidelines, which included scientific content, methods and thinking; and the cultivation of a healthy culture, which included the enhancement of civic quality, education of rescue scientifically, and advocate of healthy life. (2) The "three training" program of CPR training: training professional skills, which included standard, multiple, and individual skills; training multidimensional, which included time, space, and human; and training flexible, including problem, time, and innovation oriented. (3) The "three party" direction of CPR training, the application for achievement translation, which included scientific translations, skill propagators, and cultural advocates; the precision disseminators, which included accurate communication sources, channels, and dissemination of the audience; and theoretical innovation guides, which included scientific, popular science and communication theory. That integrated the wisdom of scholars, melt the thought of genius, and created the act of envoy for Chinese and foreign CPR training. The training program should be suitable for different trainee, no matter who is trainer or trainee. The release of the expert consensus on the 2018 CPR training will make the National CPR education into the new training era with definite direction, clear target and fully standard of China.
Cardiopulmonary Resuscitation ; China ; Consensus ; Heart Arrest ; Humans

Objective To evaluate the diagnostic significance of ECG and coronary arteriography (CAG) in coronary heart disease in different age groups. Methods totally 216 cases of suspected or CAG-confirmed coronary heart disease were retrospectively analyzed. The non-elderly group included patients aged 45-59 years, and the elderly one was older than 60. Patients in each group were further divided into subgroup A and B with or without the pain in heart front area, respectively, accompanied by ST-T change in ECG. Comparative analysis of CAG and ECG changes was done between different age groups, and between subgroup A and B. The history of pain in heart front area, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), platelet count (PLT), and fibrinogen (Fg) were also analyzed for clinical diagnosis. Results In the non-elderly, positive CAG was 88.8% in subgroup A while 56.3% in group B ( P0.05). TC, LDL-C, and Fg were significantly higher in subgroup A than in subgroup B for the elderly group. But in non-elderly, TC, TG, LDL-C, and Fg in subgroup A were significantly higher than those in subgroup B(all P0.05). The history of pain in heart front area was longer in the elderly, and also in this age group, more patients showed multivessel involvement. Conclusions ST-T change of ECG accompanied by classical pain in heart front area is more valuable than single ST-T change in the diagnosis of coronary heart disease, especially among non-elderly patients. ST-T change could not be used simply as a tool to diagnose coronary heart disease. The diagnosis should be made generally considering the typical symptom of the pain in heart front area, clinical history, TC, TG, LDL-C, and Fg. CAG could increase the positive diagnostic rate of coronary heart disease and decrease the rate of misdiagnosis as well.

Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.

Objective:To observe the effect of "Qishen Yiqi Droplet" on serum concentrations of high sensitivity C reactive protein(hs-CRP),plasminogen activator inhibitor-1(PAI-1),endothelin-1(ET-1)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention (PCI).Methods:A total of 100 consecutive ACS patients ready to receive PCI therapy in our hospital from june 2007 to August 2008 were randomly assigned into two groups:Qishen group,n=50,with Qishen Yiqi Droplet 5.0 g three timee a day+conventional therapy after PCI;and Control group,n=50 with conventional therapy after PCI.The concentrations of hs-CRP,PAI-1 and ET-1were detected and compared 24 hours before PCI,and 24 hours,4weeks after PCI between two groups respectively.Results:There were no obvious differences of hs-CRP,PAI-1 and ET-1 24 hours after PCI in two groups.The levels of hs-CRP,PAI-1,ET-1 were lower in Qishen group than in Control group 4 weeks after PCI (0.219±0.143)ng/dl vs.(0.366±0.132)ng/dl,P<0.001,(104.252±26.038)ng/dl vs.(118.419±28.849)ng/ml,P<0.05,and (37.411±12.977)ng/dl vs.(45.755±12.305)pg/ml,P<0.01,respectively.Conclusion:Qishen Yiqi Droplet could decrease the levels of hs-CRP,PAI-1 and ET-1 in ACS patients who underwent PCI,and it might have the protective role in preventing the neointimal hyperplasia and thrombogenesis after stent implantation.