Delayed cerebral vasospasm is the leading cause of death in patients with subarachnoid hemorrhage. A good in vivo animal model of cerebral vasospasm after subarachnoid hemorrhage helps to understand the occurrence, development of this cerebral vasospasm, and the complicated and various pathophysiological mechanisms. It will provide important information for clinical interventions

Based on a retrospective review of researches on military stress home and abroad,this paper elaborates on the following4important issues:the promptness of selected literature,the advance of stress theories,the objectivity of the methods and the practicability of the results. [

Objective To study the prognostic value of initial arterial lactate level and to explore the relationship between early arterial lactate and the outcome of patients with acute paraquat poisoning by analyzing the clinical data of 235 cases.Methods A total of 235 patients with acute paraquat poisoning were admitted to the Emergency Intensive Care Unit (EICU) from January 2009 to June 2012.Demographics,clinical and laboratory findings were compared between the survivors and non-survivors.Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off points for initial arterial lactate level.Results Totally 235 patients with average age of (33.6 ± 11.5) years old (ranging from 18 to 74),89 male and 146 female.The median estimated amount of 20％ paraquat ingested was 55 mL,(ranging from 10 to 280,IQR:27 mL,77 mL),the median length of time between paraquat ingestion and the arrival at the emergency department was 4.5 h (ranging from 0.5 to 10.5,IQR:2.3 h,6.8 h).The overall mortality rate was 74.0％ (174/235) during a 28 days follow-up period,only 61 of 235 patients survived.The initial arterial lactate level was higher in non-survivors than that in survivors (2.79 ± 0.76) mmol/L vs.(1.62 ± 0.48) mmol/L,P =0.028).Correlation analyses showed that the initial arterial lactate level was associated with increased risk of 28-day mortality (r =0.26,P =0.004),and as the initial lactate increased,the survival time of non-survivors shortened (F =3.246,P =0.037).Using the ROC curve analysis,the initial arterial lactate level had an area of 0.799 (95％ CI:0.745-0.866) and the cut-off point of concentration was 2.57 mmol/L for prediction of prognosis in patients with acute paraquat poisoning (sensitivity 85.2％,specificity 79.6％,the best Youden index was 0.648).The initial arterial lactate level was higher in patients died from circulatory failure rather than from respiratory failure (5.22 ± 1.46) mmol/L vs.(1.87 ± 0.62) mmol/L,P =0.042.And the survival time of patients died from circulatory failure was shorter than that from respiratory failure (4.1 ± 1.3) d vs.(11.6 ± 3.2)d,P =0.023.With the ROC curve analysis,the initial arterial lactate level had an area of 0.882 (95％ CI:0.805-0.941) and the cut-off point of concentration was 3.65 mmol/L for prediction of prognosis of patients died from circulatory failure (sensitivity 87.6％,specificity 82.5％,the best Youden index was 0.701).Conclusions The initial arterial lactate level may be one of early indicators of prognosis in patients with acute paraquat poisoning and it had high potential in predicting the outcome of patients died from circulatory failure.

Objective: To establish an optimized culture condition f or the growth of dermal fibroblasts. Methods: Human, Yorks hire pig or SD rat fibroblasts were cultured in DMEM with fetal boven serum(P BS) at the concentrations(ml/L) of 100 (A), 50 (B), 20 (C) or 20 supplemente d with 0.025 g/L boven pituitary extract (BPE)(D). The proliferation of the cell s were examined by microscopic observation,MTT assay and BrdU analysis. Results: Human dermal fibroblasts grew better in the medium with FBS at 100 ml/L, 50 ml/L and 20 ml/L supplemented with BPE, Yorkshire pig dermal fibroblasts did in medium with FBS at 50 ml/L and 20 ml/L supplemented with BPE . SD rat dermal fibroblasts did in the medium with 20 ml/L FBS supplemented wi th BPE. Conclusion:The favarable serum concentration in me dium for human, Yorkshire pigs and SD rats dermal fibroblasts was different,but the medium with 20 ml/L FBS supplement with BPE is suitable for all 3 kinds of f ibroblasts.

Objective To evaluate the effect on postoperative urinary and sexual function of the radical operation with autonomic nerve preserving for mid low rectal cancer.[WT5”HZ]Method [WT5”BZ]Radical operation with autonomic nerve preserving was performed on 188 cases of rectal cancer. Nerves were fully preserved in 98 cases of Dukes A stage,one or both side nerves preserved in 78 cases of stage B, only S 3,4 nerve preserved in 12 cases of stage C.[WT5”HZ]Result [WT5”BZ]The postoperative voluntary micturition developed at 8 5 days for Dukes A; 9 0 days for stage B; and 16 8 days for stage C. Erection and ejaculation remained in Dukes A, in 96% and 100%;stage B, in 47 4% and 50%;stage C, in 0 and 0. The local recurrence after the operation accounted for 12 8%(24/188), among them Dukes A,B,C were 4 1%,21 9%, and 33 3% respectively.The 5 year survival rate were 77 6%,52 6% and 33 3% respectively.[WT5”HZ]Conclusion [WT5”BZ]The radical operation with autonomic nerve preserving for rectal cancer effects a better life quality not at the expense of local recurrence and reduction of 5 year survival rate.

Objective To discuss the effect nursing of patients with gynecologic tumor and diabetes mellitus during chemotherapy in order to find effective nursing measure. Methods A retrospective study was carried out in 100 patients with gynecologic tumor and diabetes mellitus during chemotherapy. The treatment process was summarized. Results No incidence of infection and complications of diabetes mellitus were seen in these patients. The adverse effect of chemotherapy was low. Conclusions Strengthening of psychological and diet nursing, prevention of infection and health education proved to be effective measures to improve the life quality and prevent anxiety of patients with gynecologic tumor and diabetes mellitus during chemotherapy.

Objective To investigate the clinical factors dominant in the efficacy of lung recruitment maneuver (RM) with high-level positive end-expiratory pressure (PEEP) under pressure control ventilation in patients with 2009 influenza A (H1N1)-associated acute respiratory distress syndrome (ARDS) by analyzing the clinical data of 24 patients treated with mechanical ventilation.Methods A retrospective study was carried out in a 16-bed capacity emergency intensive care unit (EICU) of the First Affiliated Hospital of China Medical University from October 2009 to January 2010.Twenty-four patients with influenza-associated ARDS were included.During pressure control ventilation,when SpO2 persisted lower than 88％ for more than 30 min,RM with high-level PEEP was initiated to normalize lung volume at 30 cmH2O for 60 s.The RM was responded as SpO2 increased more than 3％ within 15 min; otherwise,the increase below 3％ in SpO2 would be considered non-responded.Variations in respiratory mechanics,oxygen metabolism and hemodynamic parameters were measured before and after RM.Results Of 24 patients with influenza-associated ARDS,16 survived and 8 deceased.The median duration of mechanical ventilation (DMV) in EICU was 5.5 days (range from 3.5 to 12.0 days).During the entire study period,a total of 158 RMs with high-level PEEP were done,including 76 (48.1％) responded RMs (the responded group) and 82 (51.9％) non-responded RMs (the non-responded group).In survivor group,the ratio of effective RM was higher than in nonsurvivors group (66.2％ vs.33.3％,P ＜ 0.01).Compared with the data before RM,HR was increased (92.6 ± 11.8) vs.(73.0 ± 12.6),P =0.038 and MAP was decreased (66.1 ±9.3) mmHg vs.(73.9 ± 11.4) mmHg,P=0.049 during RM,and these difference were not statistically significant at 3 min after RM.The decrease in SpO2 after 134 procedures of RMs in 85.9％ patients,and the minimum value of SpO2 occurred at (2.1 ±0.6) min after RM.In the responded group,the maximum SpO2 were higher than that before RM by (6.9 ± 1.6) ％ occurred at (12.7 ±2.6) min after RM.Compared with the data before RM,SpO2 were increased (90.4 ± 4.4) ％ vs.(86.7 ± 7.6) ％,P =0.047) in responded group at 30 min after RM.The initial PEEP level in the responded group was lower than that of the non-responded group (8.6 ± 3.4) cmH2O vs.(11.3 ±4.2) cmH2O,P=0.028.The initial mean DMV in the responded group was also shorter than that in the non-responded group (4.1 ± 3.1) d vs.(5.8 ± 2.5) d,P =0.011.Furthermore,the initial dynamic lung-thorax compliance (Cdyn) was obviously higher in the responded group than that in the non-responded group (30.8 ±6.2) mL/cmH2O vs.(26.1 ±5.1) mL/cmH2O,P=0.038.Conclusion The lung RM with high-level PEEP may cause temporary hemodynamic changes and the initial PEEP level,DMV,and Cdyn may be potential factors influencing the efficacy of lung RM.

Objective Summarize the interventional nursing experiences for patients with coronary chronic total occlucion by transraidal approach. Methods Preoperative evaluation, careful psychological nursing, perioperative observation and prevetion complications were used for 105 patients with coronary chronic total occlusion when curred by transraidal approach intervention. Results There were 97 cases had successful operation, while 8 cases failure. There were 14 cases of perioperative hypotension, 6 cases of coronary acute occlusion, 4 cases of coronary perforation and 3 cases of no- reflow. There were no radial- as-sociated complication in any patients. Conclusions Effective and careful nursing measures can prevent complications.

Objective To evaluate the correlation between the endolymphatic hydrops in vestibule and symp‐toms ,audiovestibular functions in patients with Meniere's disease .Methods Twenty -four hours after bilateral intra-tympanic 8 times diluted gadolinium administration , three - dimensional fluid - attenuated inversion recovery MRI ,using a three-Tesla unit ,was performed in 34 patients .The extent of endolymphatic hydrops in the MRI images was assessed and compared the hydrops with age ,duration ,stage of the disease ,frequency of attacks ,pure tone audiometry ,caloric test ,electrocochleography and vestibular evoked myogenic potentials .Results Thirty -four patients showed different levels of enhancement of perilymth in the inner ears .In these patients ,obvious signs of endolymphatic hydrops were visualized ,including 8 slight hydrops ,11 mild hydrops and 15 significant hydrops . In all 34 patients ,the results of PTA were 9 dB HL to 90 dB HL ,with average of 43 .56 dB HL and there were 21 abnormal and 13 normal patients in caloric test with a diagnostic rate 61 .76% ;17 normal ,7 abnormal and 10 not elicited patients in VEMP with a diagnostic rate 50% ;22 abnormal and 12 normal patients in electrocochleography with a diagnostic rate 64 .71% .There were almost no complications in all 34 patients after bilateral intra-tympanic injec‐tion except short vertigo among 5 of them .A statistically significant correlation was found between degrees of en‐dolymphatic hydrops in vestibule and age ,stage of the disease and VEMP (P<0 .05) ,whereas no significant corre‐lation was found between the extent of endolymphatic hydrops and duration ,frequency of attacks ,pure tone audi‐ometry ,caloric test ,electrocochleography(P> 0 .05) and the correlation coefficient were 0 .494 ,0 .568 ,0 .590 , 0 .495 ,respectively .Conclusion The degree of endolymphatic hydrops in Ménière's disease has significant correlation with age ,VEMP ,stage of the disease and pure tone audiometry .No significant correlation was found between hy‐drops and duration ,frequency of attacks ,functional level scale ,caloric test and electrocochleography .

Stressors can be classified as controllable and uncontrollable events.Self-choice behavior plays an important role in the "problem-solution" process of coping when individual faces controllable stressors.As to the uncontrollable stressors there are 2 different coping modes: transformation and compensation coping.This paper reviews the research achievements in the relationship between stress and self-choice behavior.