Objective To study the influence of pre-hospital emergency professional technology for nerve function,disability rate and mortality in the critically injured patients.Methods One hundred critically injured patients were selected as pre-hospital group,100 critically injured patients who immediately went to hospital emergency department were selected as hospital group.The Glasgow coma score,shock index,trauma index,mortality were compared between the 2 groups.Resuts There was no statistical difference in Glasgow coma score at 12 h after treatment between the 2 groups (P ＞ 0.05),Glasgow coma score at 24 h after treatment in pre-hospital group was significantly higher than that in hospital group [(13.9 ± 3.6) scores vs.(11.9 ± 4.8) scores],there was statistical difference (P ＜ 0.05).The trauma index at 12,24 h after treatment in pre-hospital group were significantly lower than those in hospital group (12.1 ± 5.1 vs.14.6 ± 4.8,11.9 ± 4.6 vs.14.3 ± 3.8),there were statistical differences (P ＜ 0.05).There were no statistical differences in shock index at 12 and 24 h after treatment and mortality (P ＞0.05).Conclusion Pre-hospital emergency professional technology has important the role for the treatment of critically injured patients.

Objective To investigate clinical effect of Miccoli surgical thyroid bilateral subtotal resection for Graves disease,to provide a reference for clinical treatment.Methods 80 patients with Graves disease were selected, they were divided into the observation group and the control group according to the surgical approach.44 patients in control group were taken small incision under direct vision routine bilateral subtotal thyroid treatment,36 patients in the observation group took Miccoli surgical.Surgical success rate,surgical index were compared between two groups. Results The patients of the two groups were operated smoothly,the success rate was 100.00% in the observation group,the incision length,blood loss,operative time were (3.04 ±0.64)cm,(32.25 ±3.29)mL,(81.19 ±6.68)min respectively,which were significantly less than those of the control group,the differences were statistically significant (t =5.214,P =0.004;t =14.514,P =0.000;t =6.514,P =0.001).The VAS score,length of stay,incidence rate of complication in the observation group were (1.93 ±0.43),(3.82 ±0.79)d,5.26%,which were significantly better than those in the control group,the differences were statistically significant (t =5.697,P =0.003;t =4.654,P =0.009;χ2 =11.214,P =0.000).The hospitalization cost of the observation group was (9 043.65 ±565.76)Yuan, which was significantly higher than the control group,the difference was statistically significant (P <0.05).The cut rating of the observation group was (8.35 ±2.15)points,which was significantly higher than the control group,the difference was statistically significant (t =8.364,P =0.001 ).The hyperthyroidism relapse during follow -up,the incidence of thyroid dysfunction between the two groups had no significant difference (χ2 =0.568,P =0.311;χ2 =0.604,P =0.294).Conclusion Miccoli improved surgical incision and under direct vision thyroid bilateral subtotal resection both have similar clinical effects for Graves disease,Miccoli surgery has smaller trauma,more satisfaction incision,but under direct vision small incisions has lower treatment costs.

[Objective]To establish effective and reliable complete spinal cord transection models in rats,and to investigate the effects of micromanipulation used in surgical procedure of transected spinal cord treated with human umbilical cord blood stem cells(UCBSCs) grafts in rats.[Method]Human UCBSCs were obtained from umbilical cord blood of term deliveries.Sixty Sprague-Dawley(SD) female rats were divided randomly into group A(control group),group B(spinal cord transection and PBS injection),group C(spinal cord transection and UCBSCs transplantation) and group D(spinal cord transection and UCBSCs transplantation by using micromanipulation).All groups were operated,and 1 ?l UCBSCs(6?109/L ~7?109/L) were injected into the both ends of the completely transected spinal cord at the groups C and D by two different surgical procedures respectively.From 1 week to 8 week post-operation,a behavioral testing was performed weekly upon each hindlimb for all animals according to the BBB scoring system.At the 8th week,all animals were sacrificed and the spinal cords were taken out for morphological observation.[Result]No changes were observed at group A pre-and post-operation.After 2 weeks post-operation,the hindlimb motor function of groups C and D began to recover.After 3 weeks post-operation,the group D showed more improvement than group C,and the difference between groups D and C were significant in the BBB scores(P

Objective: To strengthen the education of ethics,honor and humiliation,and humanities for the working staff in community healthcare service,so as to better serve the community residents.Method: To strengthen the education of ethics,honor and humiliation,and humanities for the working staff in community healthcare service,and check the outcome.Conclusion: It is necessary to recognize the humanistic function of community healthcare service,strengthen practice and the ability of healthcare service to improve residents' trust and satisfaction of community healthcare service.

Objective To investigate the feasibility of the functional pulmonary lobectomy (FPLT) by studying the blood-gas and morphology of the FPLT model. Methods 18 healthy dogs were divided into three groups randomly: Group A (n=6): the target bronchus and lung bubbles were filled with emulsion of iodine oil and pingyangmycin(PYM)and then target bronchus was occluded with polymethylmethacrylate(PMMA).Group B (n=6): the target bronchus was only occluded with PMMA and Group C (n=6): the target pulmonary lobe was resected. Artery blood gas were measured at the time of pre-operation and post-operation immediately and then 1st, 2nd, 3rd and 4th week after operation respectively. Chest radiolography and histology and bacterial culture of tissue of target lung lobe were made after 4 weeks. Results There was a significant difference in artery blood-gas among 3 groups pre-operation compared with post-operation immediately (P0.05) compared with 1st, 2nd, 3rd and 4th week after operation. It showed atelectasis radiologically and fibrosis of target lung lobe histologically and no bacterium grew in target tissue the 4th week after operation. There were 3 cases of lung atelectasises but no pulmonary fibrosis in group B. Conclusion FPLT may be obtained after the target bronchus and lung bubbles were filled with emulsion of iodine oil and PYM and then target bronchus were occluded.FPLT is a minimal invasive, safe and effective procedure and might partially replace the surgical pulmonary lobectomy in future.

BACKGROUND:Acute myocardial infarction with acute onset is dangerous, but the aided diagnosis for hyperacute disease mainly depends on electrocardiogram. The advantages of tissue Doppler strain imaging were utilized to help early diagnosis of acute myocardial infarction.
OBJECTIVE:To observe left ventricular transmural peak radial strain and strain time-to-peak of subendocardiac muscle, midmyocardium and subepicardiac muscle using tissue Doppler strain imaging in dogs before and after acute myocardial infarction, and to assess its mechanical characteristics.
METHODS:A total of 16 Beagle dog models of acute myocardial ischemia were established by ligating left anterior descending coronary artery. The two-dimensional apical short-axis views of the left ventricle in five complete cardiac cycles were acquired and stored in TDI-Q workstation before and after acute myocardial ischemia. Transmural peak radial strain and strain time-to-peak of segment, subendocardiac muscle, midmyocardium and subepicardiac muscle at infarct region and baseline were observed.
RESULTS AND CONCLUSION:Peak radial strains at infarct and subendocardiac muscle, midmyocardium and subepicardiac muscle were decreased compared with the baseline (P<0.05). Peak strain gradient disappeared in each layer of infarct myocardium. Strain time-to-peak of the whole segment and infarct myocardium at different layers was significantly postponed (P<0.05). There was a positive correlation of peak radial strain between subendocardium and segment as wel as between medium and segment at baseline (r=0.617, P<0.01;r=0.556, P<0.01). This relationship disappeared at infarct region (r=0.338, P>0.05;r=0.218, P>0.05). Results indicated that after acute myocardial infarction, peak strain gradient disappeared at different layers at infarct region. Acute myocardial ischemia induces peak radial strain decrease at subendocardium, medium, subepicardium and strain time-to-peak at infarct region was significantly postponed, which reflected abnormal cardiac structure and dysfunction, resulted in uncoordinated cardiac motion and asynchronous heart movement. This may be an important mechanical mechanism triggering heart failure.

Objective To observe left ventricular transmural peak radial strain and strain time-to-peak of peri-infarct different layers myocardium using tissue Doppler strain imaging, to assess its mechanical pattern during acute myocardial ischemia.Methods Left anterior descending coronary artery (LAD) were ligated in experimental open-chest Beagle dog models (n = 9),the two-dimensional apical short-axis views of left ventricle in three complete cardiac cycles were acquired and stored in TDI-Q workstation at baseline(the control group of peri-infarc myocardium) and during acute myocardial ischemia respectively.Sampling volume was uesd to measure the peak radial strain and the strain time-to-peak consesquently on the derived M -mode tissue Doppler velocity images at peri-infarct myocardium before and after ischemic segments and different layers(subendocardium, medium, subepicardium).Statistical analies was performed using student's t- test or Pearson's correlations.Results Peak radial strain decreased at peri-infarct subendoeardium (P<0.05) with no significant difference between those at baseline and at peri-infarct medium (P >0.05), the peak radial strain increasd at peri-infarct subepieardium (P < 0.05) ,and the strain time-to-peak at different layers of peri-infarct myoeardium was significantly postponed (P< 0.05).There was a good correlationship of peak radial strain between subendocardium and segment as well as between the medium and segment (r = 0.617, P<0.01 ; r = 0.556, P<0.01).This correlationship disappeared at peri-infarct myocardial segment (r = 0.287, P > 0.05, r = 0.243, P > 0.05).Conclusions The left ventricular transmural mechanical remodeling at peri-infarct myocardium is the integrant of result of mechanical interactions between ischemic and nonischemic myocardium,which might be one of the trigger the structural and fundational remodeling processes involving in the pathophysiological foundation of ischemie cardiomyopathy.

BACKGROUND: Basso, beattie and bresnahan (BBB) score and tilt table test are associated with the height of spinal cord injury degree in study of spinal cord models. OBJECTIVE: To establish modified complete spinal cord transected rat models, and to observe effects of BBB score and tilt table test on function following human umbilical cord blood mesenchymal stem cell transplantation. DESIGN, TIME AND SETTING: The observation control experiments were performed at the Key Laboratory of Tissue Construction and Detection of Guangdong Province from April 2007 to July 2008. MATERIALS: Cord blood was collected from healthy puerperants after full-term delivery. Fifty SPF healthy adult female Sprague Dawley rats were randomly divided into group A (sham operation) (n=10), group B (spinal cord transection and phosphate buffered saline, PBS injection) (n=20), group C (spinal cord transection and hMSCs transplantation) (n=20). METHODS: Human umbilical cord blood stem cells were harvested and cultured in vitro. After incising rat dural sac, arachnoid membrane, spinal cord, bilateral wall and ventral dura mater of spinal cord were completely incised in the dural mate of spinal cord to establish complete spinal cord transected rat models. Vertebral plates were only opened in the group A. Rats in the group C were injected with human umbilical cord blood mesenchymal stem cells (6?109 -7?109L-1) at two broken ends of fractured spinal cord. Phosphate buffer saline was injected into rats in the group B. MAIN OUTCOME MEASURES: At 12 weeks after surgery, a behavioral testing was performed every 2 weeks upon each hindlimb for all animals by using the BBB scoring system and tilt table test. RESULTS: No significant difference in hindlimb motor function was detected in the group A. From the second weeks after surgery, motor function of hindlimbs was gradually recovered in the groups B and C. BBB scoring system and tilt table test showed a consistent increasing tendency in a positive correlation. From the fourth week after surgery, significant difference in tilt table test was detected between rats with BBB score

Pancreatic necrosis (IPN) is a serious complication of acute pancreatitis (AP), with a mortality reported to be as great as 32.0%. At present, it is considered that patients with proven or suspected infected necrotizing pancreatitis, invasive intervention (i.e. percutaneous catheter drainage, endoscopic transluminal drainage/ necrosectomy, minimally invasive or open necrosectomy) should be delayed where possible until at least 4 weeks after initial presentation to allow the collection to become 'walled-off'. With the development of endoscopic technology, endoscopic transmural (stomach or duodenum) drainage and necrosectomy has been recommended as one of the preferred methods for walled-off necrosis. This article introduces the diagnosis and evaluation of the walled-off necrosis ; the indications, operation procedures, postoperative evaluation and management of postoperative complications of endoscopic transmural drainage and necrosectomy. At last, the research progress of endoscopic drainage and debridement in recent years was introduced.

Objective To analyze the clinical characteristics of patients with acute pancreatitis (AP) in Jiangxi Province.Methods From 2007 to 2012,the data of 2 625 hospitalized patients diagnosed as AP were retrospectively analyzed.The changes of composition in gender,age and etiology during 2007-2009 time period and 2010-2012 time period were compared.Mann Whitney U test was performed for non-normal distribution measurement data analysis and x2 test was for count data analysis.Results Among the 2 625 patients with AP,from 2007 to 2009 there were 1 028 cases and 1 597 cases in the period 2010 to 2012.The ages of the patients in these two period were 50(38,61) and 50 (40,63) years old,respectively.There was statistically significant difference in the age distribution between these two period (U=783 635.5,P＜0.05).Biliary factor was the most common cause of AP in the two time period 2007 to 2009 and 2010 to 2012,which accounted for 55.9％ (575/1 028) and 62.9％ (1 005/1 597),respectively,and the difference was statistically significant (x2=12.778,P＜ 0.01).Alcoholic AP accounted for 1.9％ (19/1 028) and 7.3％ (117/1 597),respectively,hyperlipidemic AP were 14.0％ (144/1 028) and 17.7％ (283/1 597),and idiopathic AP were 22.0％ (226/1 028) and 5.9％ (94/1 597),all the differences were statistically significant (x2 =38.204,6.330 and 151.416,all P＜0.05).In male patients,biliary AP accounted for 52.4％ (732/1 398),which was lower than that of female patients (69.1％,848/1 227),and the difference was statistically significant (x2 ＝76.524,P＜0.01).Alcoholic AP and hyperlipidemic AP accounted for 9.0％ (126/1 398) and 21.4％ (299/1 398) in male patients,which were significantly higher than those of female patients (0.8％,10/1 227; 10.4％,128/1 227),and the differences were statistically significant (x2 89.396 and 57.585,both P＜0.01).Biliary AP accounted for 79.9％ (631/790) in elderly group,which was higher than that of non elderly group (51.7％,949/1 835),and the difference was statistically significant (x2＝182.720,P＜0.01).In elderly group hyperlipidemic AP and alcoholic AP accounted for 2.5％ (20/790) and 1.3％ (10/790),which were significantly lower than those of non-elderly group (22.2％,407/1 835; 6.9％,126/1 835),and the differences were statistically significant (x2 =156.524 and 35.262,both P＜0.01).Conclusions The middle-aged and elderly people are the vulnerable population of AP.Biliary factor is the most common cause of AP,especially in the female and elderly.The proportions of hyperlipidemic AP and alcoholic AP both significantly increase,in the male higher than that of the female and in the non-elderly higher than that of the elderly.The proportion of idiopathic AP significantly decreases.