With increasing demands and recognition, emergency medicine has advanced rapidly in China in recent decades. The education and training of professionals in this field are important for the further development of emergency medicine. With an attempt to investigate the way to strengthen residency training system in emergency medicine, this article reviews its potential development direction, training modes, learning materials, and quality control.
China ; Emergency Medicine ; education ; organization & administration ; Internship and Residency ; methods ; standards ; trends

Objective To explore the relation between clinical-pathological features,Siewert classification and prognosis of esophagogastric junction (EGJ) carcinoma,and to assess the applicability of the new edition of American Joint Committee of Cancer (AJCC) staging guideline on EGJ adenocarcinoma in China.Methods From 2002 to 2012,the clinical data,pathological features,treatment and prognosis of 218 patients with EGJ malignant tumor were retrospectively analyzed.The patients were typed according to Siewert classification criteria and each case was staged according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma and gastric cancer.Kaplan-Meier method and Log-rank test were performed for survival analysis.Results According to the Siewert classification,type Ⅰ was rare (nine cases,4.1％),type Ⅱ was the most common type (150 cases,68.8％) and followed by type Ⅲ (59 cases,27.1％).There was no significant difference in survival curve among the three types (P＞0.05).The survival curve was drawn according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma.In T staging,the prognosis of patients at T4b was better than that of patients at T4a,the prognosis of patients at ⅡB was better than that of patients at ⅡA.The survival curve of patients at Ⅲ C obviously crossed with that of patients at Ⅳ,which was not in conformity with clinical results.The survival curve was drawn according to 7th edition of AJCC staging criteria for gastric cancer.In T staging,the survival curve of patients at Tis was overlapped with that of patients at T1a.The survival rate of patients at ⅡB could not be accurately predicted by the overall staging.In general,the survival of patients with EGJ carcinoma was better predicted according to 7th edition of AJCC staging criteria for gastric cancer than 7th edition for esophagus adenocarcinoma.Conclusions Neither 7th edition of AJCC staging criteria for esophagus adenocarcinoma nor for gastric cancer could accurately predict its prognosis.In our country,EGJ malignant tumor was similar to gastric cancer and had specific clinical-pathological features.It is necessary to research and establish EGJ carcinoma staging criteria instead of applying the current staging criteria for esophagus adenocarcinoma or gastric cancer.

Objective To explore the histopathological features of 850 patients with esophageal malignant tumor in 10 years.Methods From January 2002 to January 2012, 850 patients diagnosed with esophageal malignant tumor were enrolled.Tumor location, general type, pathological type and TNM stage were retrospectively analyzed.All the data were described as case number and percentage.Results Among the 850 cases of esophageal malignant tumor, 33 lesions (3.9％) located in the neck segment of esophagus, 119 lesions (14.0％) located in the upper segment, 44 lesions (5.2 ％) located in the upper-middle segment, 409 lesions (48.1％) located in the middle segment, 123 lesions (14.5 ％) located in the middle-lower segment, 122 lesions (14.4％) located in the lower segment.Among the 724 eases clearly diagnosed as esophageal malignant tumor by general type, the most cases were ulcer type (305 cases, 42.1％), followed by medulla type (260 cases, 35.9％), fungating type (80 cases, 11.0％) and constrictive type (70 cases, 9.7％), and the least cases were intraluminal type (nine cases, 1.2％).Among the 850 cases of esophageal malignant tumor, squamous cell carcinoma (794 cases, 93.4 ％) was the most common cytological type, followed by small cell carcinoma (19 eases, 2.2％), and the least common cytological type was adenocarcinoma (seven cases, 0.8 ％).Among the 724 cases with clear TNM staging, case number of Tis, T1, T2, T3 and T4 stage was eight (1.1％), six (0.8％), 271 (37.4％), 278 (38.4％) and 161 (22.2％), respectively.Among the 122 cases of distal esophageal carcinomas (104 cases with clear TNM staging), most cases were squamous cell carcinoma (112 cases, 91.8 ％), the others cases were adenocarcinoma (three cases, 2.5 ％), small cell carcinoma (three cases, 2.5 ％), basaloid squamous cell, adenosquamous, neuroendocrine carcinomas and carcinosarcoma (one case in each type, 0.8％).Conclusions Esophageal carcinoma was mostly located in the middle segment of in which squamous cell carcinoma was predominant while adenocarcinoma was less common.Esophageal cancer located at lower segment of esophagus is with a wide range of pathological spectrum, squamous cell carcinoma was still dominant, however, esophageal adenocarcinoma is rare.

Aged ; Endocarditis ; etiology ; therapy ; Humans ; Kidney Transplantation ; adverse effects ; Male

Objective To evaluate the surgical characteristics and clinical effect of percutaneous reduction with kirachner wire assisted by a small lateral incision approach for poking reduction and allngraft bone transplantation in treating compressive intra-articular calcaneal fractures. Methods A retrospective analysis was performed among 17 patients with compressive intra-articular calcaneal fractures (Sanders Ⅱ to Ⅲ ) treated by percutaneous reduction with kirachner wire assisted by a small lateral incision approach for poking reduction and allograft bone transplanta-tion. Results All the patients were followed-up for an average time of 13.5 months. The wound of 15 feet achieved primary healing, the acute rejection was found in 2 patients. The Bohler's angle was (9.58±5.25)° and Gissane an-gle was (101.15±13.83)° preoperation and was (33.55±4.17)° and (113.25±12.17)° immediate postopera-tion, showing statistically significant differences pre-and postoperation(P < 0.05). By the lately follow-up, the Bohler angle was (31.65±7.72)° and Gissane angle was (111.15±8.68)°, also showing statistically significant differ-ences when compared to preoperation (P < 0.05), there was no statistically significant differences (P > 0.05) when compared with normal X-ray. Conclusion That percutaneous reduction with kirschner wire assisted by a small lateral incision approach for poking reduction and allograft bone transplantation in treating the compressive intra-articular cal-caneal fractures (Sanders Ⅱ to Ⅲ) is minimally invasive, less complication, and it enables satisfactory recoastruc-tion of bone defects and allows metanatomic reduction and functional recovery, also maintaining restoration of calcane-al height and anatomic reduction of the posterior facet.

To study time and dose related changes after gamma knife radiosurgery (GKR) in rat brain, right caudate nucleuses of rats were irradiated by OUR XGD gamma units. The maximum dosages of 20,50,75 and 160Gy were given using a 4 mm collimator. HE, Nissl, Luxol fast blue staining and immunohistochemistry were utilized to observe histological changes.Histological changes in the right caudate nucleuses such as microvessel injury, which appeared as telangiectasia, vasodilatation, vessel wall thickening and edema, and astrocyte changes, which appeared as hypertrophy and proliferation, were observed at various time points after GKR. These findings demonstrate time dependent and dosage dependent changes are found in normal cerebral tissue after GKR. These results provide an explanation of the process taking place during the latent period before delayed radiation necrosis develops.

Objective: To establish a HPLC method for the determination of ginsenoside Re、Rg1 in Yianhuisheng Oral Liquor(Radix Ginseng Rubra, Radix Aconiti Lateralis Preparata, Scorpio etc.) Methods: RP-HPLC was used to quantitative analysis. The Synchropak C 4 column (250mm?4.6mm, 5?m) was used, and mobile phase was composed of acetonitrile-0.05% H 3PO 4(18∶82). Detection wavelength was at 203nm, the flow rate was 1.0 mL?min -1 , the injection volume of sample was 10?L and of reference 8?L. Results: The linear response range from 0.432 ～3.456?g of Re(r=0.9992, n=5), 0.360～2.88?g of Rg1(r=0.9998, n=5), respectively. The recovery of Re: 97.0%, RSD=1.4%, the recovery of Rg1: 96.8%, RSD:=1.1%, respectively. Conclusion: The method was proved to be simple, rapid, accurate and reproducible, and suitable for content determination of the oral liquor.

Objective To develop the Chinese version of the 35-item Medical Outcomes Study HIV Health Survey (MOS-HIV) and to assess the reliability and validity of MOS-HIV among HIV-infected individuals.Methods Between April and July of 2007,a croas-sectional survey of 758 HIV-infected individuals was conducted.Responses to the MOS- HIV were analyzed for its reliability and validity.Results Pearson's correlation coefficients of items for test-retest relia- bility ranged from 0.46-0.92,all internal consistency reliability coefficients exceeded 0.69,and all items were more strongly correlated with hypothesized scale than any other scale.Eight scales of MOS-HIV were significantly associated with CD_4 cell counts.Conclusions The Chinese version of MOS-HIV offers good reliability and validity and can be used as a tool to assess the quality of life of HIV infected individuals in China,thus providing evidence for further studying AIDS related quality of life in this country.

Objective To compare the efficacy and safety of venlafaxine and paroxetine in the treatment of comorbidity of depressionwith anxiety disorder. Methods 86 cases simultaneously conformed to depression and anxiety disorder accepted venlafaxine (group A) orparoxetine (group B) for 8 weeks. They were assessed with Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale forAnxiety (HAMA) before and 1, 2, 8 weeks after treatment. Results There was no significant difference in the scores of HAMD and HAMAbetween both groups before treatment, and there was since 1 week after treatment (P<0.05). 45.4% were clinically cured and 75.0% improvedin group A, which was 33.3% and 66.6% in group B 8 weeks after treatment (P<0.05). Conclusion Venlafaxine is more efficaciousthan paroxetine on anxiety and depression comorbidity.

Adolescent ; Humans ; Leukemia, Myeloid, Acute ; etiology ; pathology ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; pathology