Objective To study the clinical significance of end-tidal carbon dioxide partial pressure (PetCO2 ) during cardiopulmonary resuscitation (CPR) and seek the fixed value according which to decide if we should and when to give up.Methods This was a prospective,observational study.A total of 124 patients with cardiac arrest in or out-of-hospital from may 2003 to March 2009 in emergency department of our hospital were selected.All of them had definite etiological factors.Changes of PetCO2 in 124 cardiac arrest patients during CPR were tracked.Results The gender,age,rescue time in seventy-one patients with the return of spontaneous circulation (ROSC) after endotracheal intubation have a significant difference with that in fifty-three patients without ROSC (P ＜0.01 ).The PetCO2 of the survival were higher than that of patients without ROSC or with ROSC,but finally died (P ＜0.01 ).A fixed point 14.4 mmHg of PetCO2 after 20 minutes' CPR can be used as a reference value to guide CPR or predict prognosis.Conclusions Monitoring PetCO2 during CPR has a predictive value on the success of resuscitation.

Objective To investigate whether endoscopic nasobiliary drainage (ENBD) after endoscopic stone extraction could reduce post-operative complications.Methods Retrospective analysis of 697 patients with extrahepatic duct stones undergoing ERCP treatment was pedormed.They were assigned to ENBD group (n =538) and control group (n =159).Post-operative complications including pancreatitis,cholangitis and bleeding were observed and compared.Results There were no significant differences in incidence of pancreatitis and bleeding between 2 groups.Incidence of cholangitis in ENBD group was significantly lower than that in control group (1.3％ vs.3.8％,P ＜ 0.05).Conclusion ENBD after endoscopic stone extraction could reduce the incidence of postoperative cholangitis.

Objective To evaluate diagnostic value of diffusion tensor imaging(DTI)in ringlike- enhanced lesions.Methods Nine abscesses,12 glioblastomas,10 metastases confirmed clinically or pathologically underwent conventional MRI and DTI.Average diffusion coefficient(ADC)value,fractional anisotropy(FA)value and maps were calculated in the central portion and peripheral edema of the lesions. Results On DTI,the abscesses displayed as hyperintense signal with hypointense or isointense signal of edema;but glioblastomas and metastases all showed as hypointense signal with isointense or hypointense signal of edema.On ADC map,the abscesses showed as hypointense signal,the mean ADC value was (0.66?0.07)x10~(-3)mm~2/s,The mean ADC value were(2.50?0.11)x10~(-3)mm~2/s and(2.37?0.52)x10~(-3)mm~2/s for the glioblastomas and metastases,respectively,all demonstrated as hyperintense signal with slightly hyperintense signal of edema.The difference between abscess and necrotic tumors was statistically significant(F=108.80,P

This paper is to build a finite element model of brain with a real brain shapeon which simulation studies of electrical impedance tomography EIT in the brain is based. A curve of a real brain shape is simulated with the curve-fitting methods and EIT in the brain is finished with finite-element methods and Equipotential Lines Back-Projection algorithm.The locationarea and amplitude of the change of the resistivity are reconstructed accurately. But the image quality has to be further improved.This paper provides a basis for clinical applications of EIT in brain.

BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased.
OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements.
METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus<6 mm (18 patients were varus instability and 7 patients were valgus instability) when finished operation of standard osteotomy and soft tissue balancing. The bone cement knee prostheses in 23 cases were purchased from Smith&Nephew. The stem implant was not used in al cases. Cement or autografts were used in 11 valgus knees to fil the bone defects.
RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.

Objective To explore the relationship between muscle fatigue and pain in lumbar muscle fatigue induced test. Methods From July to October, 21 healthy female volunteers were subjected to the fatigue induced test. Their root mean square (RMS) and median frequency (MF) of the surface electromyography were collected, their fatigue were assessed with Borg Fatigue Scale and Visual Analogue Scale (VAS), and their maximal voluntary contraction (MVC) and pressure pain threshold (PPT) were measured, before, during and after ex-periment. They were divided into pain or no-pain groups according to the symptom, and the differences before and after test were compared. Results There was significant difference in the scores of Borg Fatigue Scale and VAS, MVC, RMS, and MF after test (Z>6.064, P<0.001). There was significant difference between two groups in all the data before test, and there was significant difference between two groups in the difference before and after test of the VAS score (t=-4.112, P=0.001) and RMS (t>2.385, P<0.05) in some points. Receiver operating characteristic curve analysis showed that the optimal cut-off point of VAS score difference was 3.45 in predicting the pain onset, with sensi-tivity of 100％and specificity of 81.8％. Conclusion For the fatigue induced test, the fatigue VAS score difference may predict the induced pain, and RMS difference associate with the occurrence of pain. No significant is observed of the Borg Fatigue Scale and PPT.

Objective To introduce the therapeutic measure of preventing the first web contracture after hand crush injury in early stage. Methods Three types were divided according to the traumatic condition in 57 cases: closed injury, open injury and with blood vessel of thumb or fingers injury, and used different method such as closing injury postpone, opening the first web by kischner wire or mini-external fixation splint and covered by local or island flap to cure each type in primary and early stage, after 6 months, measured the width and angle of the first web. Results Forty-one cases were followed-up after 3 months - 2 years,abduction and opposition of the thumbs were fine, the average of width and angle of the first web were (5.89 ± 0.58)cm and (87.85 ± 6.03)°. Conclusion The key points of preventing the first web contracture after crush injury are opening the first web that being covered by local flap and to use splint in primary stage.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To have a conclusion on how to nurse the patients underwent transluminal stent-assisted angioplasty of vertebrobasilar artery stenosis. Methods The nursing processes for 27 cases of transluminal stent-assisted angioplasty of vertebrabasilar artery stenosis from June 2002 to July 2006 were reviewed and summarized. Results 25 patients were succeeded in the placement of stent and the nursing effects were satisfied. Conclusions It can reduce the complications and be helpful for the patients' rehabilitation, if an exact evaluation of individual risk factor and a care of the patients' blood pressure are given before the operation, and a close observation of the change on the patients' blood pressure and nervous system given after the operation.

Objective Discussion on the teaching method of improving the quality of clinical nursing practice through the insights and realizations in Japan. Methods From the aspects of the arrangement of practice, the pre-practice education, the process of practice and the appraisement after the practice, retrospectively summarized the advanced training realization in Japan Oita University Hospital for half a year, and comparetively analyzed with the present situation of clinical nursing education in China. Results In Japan, the pre-practice education were put in place; the clinical comprehensive practice abilities were emphasized in the training process; the two-way evaluation of students and teachers were also emphasized after the practice. Conclusions In China, to increase the training of Nurse-Patient simulated scene before the clinical practice ; to choose suitable cases with complete 1 to 1 teaching according to nursing procedure, and to try to organize the practical seminars in the afternoon.