Objective To compare the therapeutic effect and safety of naloxone ,flumazenil and naloxone combined wiht flumazenil in treating acute diazepam poisoning and to find out ideal therapeutic treatment.Methods 45 patients were divided into three groups at random: naloxone group (n=15), flumazenil group (n=15) and naloxone combined with flumazenil group (n=15). Besides given the same routine therapy to each group, naloxone group received 0.4mg naloxone through intravenation and 1.2mg naloxone through intravenous drip; flumazenil group received 0.1mg flumazenil through intravenation and 0.9mg flumazenil through intravenous drip; naloxone combined with flumazenil group received 0.4mg naloxone and 0.1mg flumazenil through intravenation and 1.2mg naloxone and 0.9mg flumazenil through intravenous drip. Each patient's consciousness status was graded after given drug treatment 0, 5,15,60,90,180 minute. Testing the BR, SR, CK, CK-MB of every patient and recording to the Bp, HR, RR, SpO 2 and the rhythm of the heart continuously. Results At the point of 5 minute, the therapeutic efficiency of the group with combined drug use was higher than that of the naloxone group ( P

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Objective To investigate the effect of morphine preconditioning on mitochondrial permeability transition pore (MPTP) and its protective mechanism after myocardial ischemia-reperfusion injury. Methods A rat model of ischemia-reperfusion injury was established. Forty rats were injected with 2-3[H] DOG and then divided into 4 groups randomly: a sham operation (S) group, an ischemia-reperfusion injury (IR) group, a morphine preconditioning (Mp+IR) group, and a cyclosporine A preconditioning (CsA+IR) group. We monitored the concentrations of serum creatine kinase-Mb (CK-Mb) and cardiac troponin I (cTnI), and measured myocardial mitochondrial 2-3[H] DOG, cytochrome c content, Ca2+ concentration ([Ca2+]m), the velocity of Ca2+ intake and reaction half time of mitochondrial permeability transition pore (MPTP t1/2) in the 4 groups. Results The concentrations of serum CK-Mb and cTnI decreased more in the Mp+IR group and the CsA+IR group than those of the IR group. The concentrations of 2-3[H]DOG and [Ca2+]m in the IR group were evidently higher but the level of cytochrome c was lower than those of the sham operation group. The concentrations of 2-3[H] DOG and [Ca2+]m in the Mp+IR group decreased whereas the concentration of cytochrome c increased compared with those in the IR group. Mitochondrial 2-3[H]DOG content was positively correlated with the concentration of calcium (r=0.797, P<0.01). The 2-3[H]DOG and [Ca2+]m content were negatively correlated with cytochrome c in the IR group (r=-0.805 and r=-0.648, respectively, P<0.01). MPTP t1/2 in the IR group was shortened evidently, and that in the Mp+IR and CsA+IR group was significantly lengthened. Conclusion Morphine preconditioning may have myocardial protective effect through unburdening the calcium overload and lengthening the MPTP t1/2.

Objective To analyze the literature of snakebite and tetanus infection at home and abroad, and understand the situation of tetanus in snakebite patients.Methods The retrieval of China CNKI database, Wanfang database, VIP database and MEDLINE, Web of Science Embase and Science Direct database was performed with “snake bite” and “tetanus” as the key words, and the retrieval time from January 1953 to October 2017.Results A total of 98 articles was retrieved, which clearly records the snakebite patient data with tetanus has collected 8 literatures, Chinese 6 literatures, English 2 articles;a total of 16 patients, including 11 cases of Chinese, 4 in Nigeria, 1 in Thailand;the bite sites were limbs;9 patients with blood circulation the snake wound, 7 cases of mixed snakebite;snake bite patients with tetanus before;1 patients were injected with Tetanus Antitoxin, 13 patients were treated with Chinese herbal medicine on the wound, 2 patients were untreated.Prognosis analysis showed that in 16 cases, 12 cases were cured, 4 cases died, and the death of the patients had the history of herbal.Conclusions The prevention of tetanus infection should be strengthened in patients with extremities trauma, external application of herbs, blood based drugs, or mixed venomous snake bites.

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.

Department of Emergency Medicine, The Second Xiangya Hospital of Central South University tried to establish the emergency and difficult disease ward since 2013, which specially treated patients with difficult complex involving multiple disciplines.After four years of operation, we obtained the ideal effects.The related information is as follows.(1) The necessity to establish the emergency and difficult disease ward:The necessity of the emergency rescue task is heavy, and difficult disease patients in the emergency department retention time is long, affects both the normal turnover of beds, also increased the economic burden of patients.(2) The feasibility to establish the emergency and difficult disease ward:The patient has the needs, and with the support of our hospital, we have the ability to do it well.(3) The exploration to establish the emergency and diffict disease ward:we defined the standard of treatment for patients with difficult problems, and established the diagnosis and treatment procedures of patients with difficult problems.(4) The results to establish the emergency and difficult ward:① In four years, patients with difficult diseases are effectively disposed of.② The levels of diagnosis and treatment of difficult diseases have been improved.③ Scientific research ability has been effectively improved.

Objective: To predict the in-hospital incidence of acute respiratory distress syndrome (ARDS) in COVID-19 patients by developing a predictive nomogram. Methods: Patients with COVID-19 admitted to Changsha Public Health Centre between 30 January 2020, and 22 February 2020 were enrolled in this study. Clinical characteristics and laboratory variables were analyzed and compared between patients with or without ARDS. Clinical characteristics and laboratory variables that were risk factors of ARDS were screened by the least absolute shrinkage and selection operator binary logistic regression. Based on risk factors, a prediction model was established by logistic regression and the final nomogram prognostic model was performed. The calibration curve was applied to evaluate the consistency between the nomogram and the ideal observation. Results: A total of 113 patients, including 99 non-ARDS patients and 14 ARDS patients were included in this study. Eight variables including hypertension, chronic obstructive pulmonary disease, cough, lactate dehydrogenase, creatine kinase, white blood count, body temperature, and heart rate were included in the model. The area under receiver operating characteristic curve, specificity, sensitivity, and accuracy of the full model were 0.969, 1.000, 0.857, and 0.875, respectively. The calibration curve also showed good agreement between the predicted and observed values in the model. Conclusions: The nomogram can be used to predict the in-hospital incidence of ARDS in COVID-19 patients.

Objective    To explore the effects of PKD1 gene on mouse aortic smooth muscle (MOVAS) cells autophagy. Methods    The shRNA and over-expression lentiviral vectors for the target gene of PKD1 were constructed. MOVAS cells were infected by a number of successful packaging shRNA (PKD1 knockdown) or ETS-1 (PKD1 over-expressing) lentiviral vectors, and qPCR was used to test interference and over-expressing effects. Then qPCR and Western blotting were used to detect the expression levels of autophagy markers including Atg5, Beclin1 and LC3 in control group, shPKD1 group and ETS-1 group. Results    Compared with the control group, PKD1 mRNA level was decreased in the shPKD1 group (P<0.05); ETS-1 and PKD1 mRNA levels were increased in the ETS-1 group (P<0.05). In contrast with the control group, the mRNA levels of autophagy markers including Atg5 (P<0.05) and Beclin1 (P<0.01) were obviously decreased in the shPKD1 group, but they were obviously increased in the ETS-1 group (P<0.001). Protein levels of Atg5, Beclin1 and LC3 were significantly decreased in the shPKD1 group (P<0.05), but they were increased obviously in the ETS-1 group (P<0.05) in contrast with the control group. Conclusion    PKD1 gene is involved in MOVAS cells autophagy, low expression of PKD1 gene can inhibit autophagy and high expression of PKD1 promotes autophagy in vascular smooth muscle cells.

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and novel coronavirus pneumonia(COVID-19). Methods: This study was a retrospective study. A total of 7 patients with Heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups, but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 2/7, P=0.001; 12/12 vs. 4/7, P<0.001). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001; 0/12 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of small pulmonary veins was also higher (3/7 vs. 0, P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there are more disease with rounded morphology in COVID-19 (9/12 vs. 2/7, P=0.048) . Conclusions More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.