Objective To investigate the clinical value of combining early urine paraquat early clearance rate (UPCR) with severity index of paraquat poisoning (SIPP) in predicting the prognosis for paraquat poisoning patients.Methods In this retrospective research,a total of 425 cases diagnosed with acute paraquat poisoning from March 2014 to March 2016 in Emergency Intensive Care Unit,First Affiliated Hospital of China Medical University were enrolled.The general data of patients,the results of rapid qualitative test of paraquat in blood and urine,the concentration of paraquat in blood / urine,the poisoning time,the concentration of blood lactic acid and the APACHE Ⅱ score were collected.The early UPCR and SIPP were measured at different time intervals,and the ratio of 6-SIPP and 12 h-UPCR were calculated.These patients were divided into death groups and survival groups according to the 28-day mortality.The relationship between these factors and the mortality were analyzed.Results Of all the 425 patients,268 cases (63.1％) died,157 cases (36.9％) survived;the blood concentration of paraquat,the lactate concentration,SIPP values and the APACHE Ⅱ scores were significant difference between the two groups (P ＜ 0.05).The mortality of 2-6 hour paraquat rapid qualitative test result positive patients was higher (96.4％) than that of the negative patients (3.6％) (P ＜ 0.05);the mortality of 12-24 hour paraquat rapid qualitative test result negative patients was lower (11.5％) than that of the positive patients (88.5％) (P＜0.05).The 2-6 hour SIPP value was 19.8 ±6.7 in death group,which was higher than that in survival group (4.9±3.1) (P＜0.05);the 2-6 hour UPCR value was (41.7±9.3) indeath group,which was lower than that in survival group (86.3 ± 15.8) (P ＜ 0.05).There was no significant difference in the 2-6 hour UPCR value and 12-24 hour UPCR value between two groups (P ＞0.05).The 6 h-SIPP/12 h-UPCR value was (41.94 ±5.9) in death group,which was higher than that in survival group (5.27 ± 3.6) (P ＜ 0.05).Conclusion The combined use of early UPCR and SIPP values is an effective indicator of the prognosis of patients with acute paraquat poisoning and is helpful for the early stratification.We should pay more attention to the patients whose rapid qualitative blood test is positive because of their high mortality risk;for the patients whose 12 h urinequalitative test was negative,the hemoperfusion therapy might be stopped because the toxin was completely excluded,and the medical resources can be saved reasonably.The UPCR might indicate the excretion of toxins,and SIPP might indicate the severity of poising.

Objective To investigate the joint value of early peak temperature and 48 h-△sequential organ failure assessment (SOFA) score in predicting the prognosis for patients with sepsis in emergency department.Methods Two hundred and thirty-one patients with sepsis admitted from January 2013 to January 2015 in Emergency Intensive Care Unit of the First Affiliated Hospital of China Medical University were enrolled.Clinical features,early peak temperature,SOFA scores,the length of stay in EICU and the mortality in 28 days were studied.The patients were divided into two groups according to the 48 h-△SOFA.Each group were divided into three subgroups according to the early peak temperature.For example,hypothermia subgroup had temperature below 36 ℃,normothermia subgroup had temperature between 36 ℃ and 38 ℃,and hyperthermia subgroup had temperature above 38 ℃.The relationship between peak temperature plus 48 h-△SOFA and the length of stay in EICU as well as mortality were analyzed.Results Of 231 patients,in 48 h-△SOFA＞0 group (n =142) 27 (19.0％) patients died,and in 48 h-△SOFA≤0 group (n =89) 33 (37.1％) patients died (P ＜ 0.05).Hypothermia subgroup had a higher odds ratio value in predicting nonsurvival in 48 h-△SOFA≤0 group (OR =4.51,95％CI:1.33-2.17,P =0.01).Hyperthermia subgroup had a longer stay in EICU than hypothermia subgroup and normothermia subgroup (P ＜ 0.05).Conclusion The combination of the early peak temperature and 48h-△SOFA score is an effective indicator to evaluate the prognosis and to stratify patients with sepsis in emergency department.More attention should be paid to the patients with an early peak temperature ＜ 36 ℃ and 48 h-△SOFA ≤0 because of higher mortality.The condition of patients should be reassessed and try to make a more rational treatment for the patients with an early peak temperature ＞38 ℃ and 48 h-△SOFA ＞0 because of its longer stay in EICU.

Objective To compare the efficacy of video-assisted thoracoscopy plus minithoracotomy(VAMT) and limited axillary thoracotomy(LAT) for the treatment of lung cancer.Methods 85 consecutive lung cancer patients were treated by either VAMT or LAT.The operative time,blood loss during operation,postoperative chest drainage time,and hospital stay time and postoperative complication were compared between the two groups.Results There was no death in two groups.The operative time and blood loss during operation were significant less in VAMT than inLAT(t =6.514,2.413,all P ＜0.05).But postoperative chest drainage time,and hospital stay time and postoperative complication were no significant difference between the two groups (t =0.490,0.338,all P ＞ 0.05).Conclusion VAMT is a safe and less traumatic procedure in the treatment of lung cancer,which is worthy of promotion and application.

Objective:In order to improve the quality of standardized residency training in a tertiary hospital in Beijing, and to establish a multi-dimensional evaluation system based on post competency and professional accomplishment.Methods:The residents trained in our hospital were evaluated by questionnaires sent by third parties from the five aspects of evaluation by patients, peers, nurses, superiors and themselves. In this paper, SPSS 24.0 software was used to analyze the reliability and validity of the multidimensional evaluation scale. The evaluation results were analyzed by ANOVA and Pearson correlation analysis.Results:The hospital met the requirements for the post competency and professional accomplishment of the residents, and the overall level was good. However, the teamwork ability of some residents, especially the medical communication still needs to be improved.Conclusion:This study has enabled residents to pay more attention to the development of daily post competencies and professional accomplishment behaviors. It has provided an example basis for the further development of standardized residency training in the hospital, and carried out preliminary exploration for the design of training modules.

The angiogenesis inhibitor endostatin is a 20 000 C terminal fragment of collagen ⅩⅧ.Endostatin inhibits endothelial cell migration in vitro and appears to be highly effective in murine in vivo studies. Endostatin is a specific and the most effective antiangiogenisis till now. The molecular mechanisms behind the inhibition of angiogenesis have not yet been elucidated.The structure and functional roles in angiogenesis of wllagen ⅩⅧ/endostatin were reviewed.

Objective To investigate the operative treatment of displaced intra-articular fractures of the calcaneus using a small lateral incision approach.Methods Thirty-one patients with 32 intra-articular calcaneal fractures,were treated with open reduction and internal fixation through a small lateral incision approach from October 2004 to April 2006.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.According to Sanders classification,there were 21 typeⅡfractures and 11 typeⅢfractures.The first change of dressing was done on the second day after operation.The residual blood clots in the wounds were cleaned as much as possible when the drainage sheet was removed.The operated foot was bandaged with pressure dressing of cotton pad.Results After an average follow-up of 10.5 months(range,3 to 18 months),no soft tissue com- plications were found,and all had acceptable reduction.The preoperative X-ray film showed that B(?)hler angle was 6.84??9.36?,Gissane angle was 106.04??12.03?.The postoperative X-ray film demonstrated that B(?)hler angle was 32.06?+6.87?,Gissane angle was 115.81??9.48?,and the difference was statistically significant(P＜0.01).According to the AOFAS evaluation system for Ankle-Hindfoot,two feet scored 60-70 points,nine feet 70-80 points,16 feet 80-90 points and five feet 90-100 points.Condusion The small lateral incision approach is a good option for management of calcaneus fractures,because it causes minimal soft tissue damage,provides excellent exposure,and leads to convenience for later removal of internal fixators and subtalar arthrodesis.

Objective To observe the effects of interleukin-1 ?(IL-1?) on spontaneous electrical activity of neurons in paravenrticular nuclei,and discuss the possible mechanism.MethodsExtracellular recording technique was employed to observe the effects of IL-1? on spontaneous electrical activity of neurons in paravenricular nuclei in rat hypothalamic slices,and the influence of losartan on the electrical activity induced by IL-1? was examined.ResultsAfter exposure to IL-1?(1?10-7 mol/L),the discharge frequency was significantly increased in 46 of the 59 discharge units(78%) of neurons(P

Objective To evaluate the application of Doppler tissue imaging (DTI) in assessment of cardiac function after percutaneous coronary intervention (PCI) for myocardial infarction (MI) for long term follow-up. Methods 86 patients with MI were divided in PCI group (45 cases) and conventional therapy group (41 cases). All the patients received two-dimensional echocardiography (2DE) and DTI measurements. The left ventricular ejection fraction (LVEF), peak E, peak A wave velocities and peak E versus peak A (E/A) of 2DE were recorded, as well as the velocity of systolic wave(s), early diastolic filling wave(e), late filling wave(a) and wave e versus wave a (e/a ) of DTI. Results The LVEF and the average velocity of systolic wave (s) of mitral annulus was increased after PCI (P<0.05). S wave was related to LVEF, but the sensitivity of s wave is better than that of LVEF. There was no difference in the pulse Doppler trans mitral flow velocity E/A before and after PCI (P>0.05) , but the average velocity of mitral annulus (e/a ) was remarkably increased after PCI (P<0.01).Conclusion The left ventricular systolic and diastolic function in MI patients be improved after PCI. DTI is a sensitive method to detect the cardiac function after MI and PCI.

Archen,a kind of Anthraquinone,is one of active ingredients of Chinese herb Rhubarb.The researches showed that archen has ideal therapeutic effects on diseases of circulatory system,digestive system，nervous system and tumor. The paper reviewed related researches on pharmacology of archen from year 2004 to 2008 and made a summary of the researching development of it.

Objective To evaluate the therapeutic efficacy of peritoneal dialysis(PD) for acute renal failure(ARF) subsequent to cardiac surgical procedures in adults.Method Clinical data of 125 consecutive adult patients,admitted from Feb.1997 to Nov.2007,with ARF subsequent to cardiac surgery and undergone PD,were analyzed retrospectively.The levels of creatinine(Cr),blood urea nitrogen(BUN),albumin and kalium ion([K+]) were compared before and after PD.Results Of 8451 consecutive adult patients undergone operations on heart,358 cases(4.2%) experienced ARF,and 125 cases(1.5%) required PD.In 117 patients performed PD,[K+] declined to normal level within one day,BUN and Cr were 10.5?3.6mmol/L and 129.3?41.6?mol/L at the third day after PD respectively,significantly lower than those before PD(P