Objective To study the current application and influencing factor of emergency medical service in patients with acute heart failure in our hospital.Methods 254 patients with acute heart failure who visited our hospital from January 2008 to December 2010 were selected.Data were collected by questionnaire and medical records in one week after admission to the hospital.The current application and influencing factors of emergency medical service in patients were analyzed.Results Of all the patients with acute heart failme,only 89(35％)arrived at the hospital by emergency medical service,but the rest 165(65％)relied on self-transport.Multivariate logistic analysis showed that age,sex,education level,unbearable symptoms and attribution of symptoms to cardiac origin were independent predictors of the use of emergency medical service.The effective treatment rate was higher,and the pre-hospital time was shorter in patients who used emergency medical service than those relied on self-transport.Conclusions The use rate of emergency medical service in patients with acute heart failure is low,and age,sex,education level,the characters of symptoms and cognitive factors of patients influence the use of emergency medical service in patients with acute heart failure.

Objective To investigate the application effect of intensified nursing intervention in severe pneumonia complicated with ventilator-associated pneumonia. Methods 78 senile patients admitted to hospital with severe pneumonia complicated with ventilator-associated pneumonia from November 2009 to November 2010 were chosen as the research object.They were randomly divided into the observation group and the control group with 39 cases in each group.The control group was treated with conventional and comprehensive methods of care.The observation group was taken intensified intervention on the basis of the control group.The utility time of ventilator after complication with ventilator-associated pneumonia,hospital stay time,complications and mortality rate for the two groups were compared. Results The utility time of ventilator,hospital stay time,complications and mortality rate for the two groups were compared.The observation group had a clear advantage over the control group,there was significant difference. Conclusions Nursing intervention can be targeted to enhance the improvement of the overall respiratory status in severe pneumonia complicated with ventilator-associated pneumonia.It contributes to inflammation control,and can reduce utility time of ventilator and length of hospital stay,reduce the corresponding incidence of complications and mortality rate,it is worthy of clinical application.

The concept of autoinflammatory diseases and autoimmune diseases is different but similar.With the genetic background and inflammation pathways of many autoimmune diseases elucidated,some kinds of diseases are facing a new partition.The explaination of immunological disease continuum update the concept of some diseases and benefit from the treatment.

With the improvement of the therapy and the drugs we known more results in a therapeutic ambitious goals of juvenile idiopathic arthritis.Selection of individualized sequential therapy is beneficial to the recovery of the disease.

OBJECTIVE To study the dynamic changes and clinical significance of TNF-? and IL-10 of nosocomial infection in patients with severe viral hepatitis.METHODS The study included 40 patients with severe viral hepatitis,their nosocomial infection was treated with antibiotic therapy.Serum levels of TNF-? and IL-10 were measured at baseline and 5 d,10 d and 15 d after the first antimicrobial dose.The patients were divided into 2 groups: infection be controlled group and infection be not controlled group by therapeutic efficacy.RESULTS The serum concentrations of TNF? and IL-10 were elevated in all patients when compared with the healthy control group(P

Objective To investigate the clinical characteristics of 34 systemic onset juvenile idiopathic arthritis (SoJIA) complicated with macrophage activation syndrome (MAS) and analyzed the gene PRF1,UNC13D,STX11,STXBP2 to figure out the genetic pathogenesis mechanism.Methods The clinical characteristics of 34 SoJIA complicated with MAS were analyzed retrospectively and coding sequences of PRF1,UNC13D,STX11 were amplified and tested.The Chi-square test was applied to compare the distribution of alleles and genotypes frequencies between SLE patients and healthy controls.Statistical significance was defined as P value ＜0.05.Results A total number of 34 SoJIA complicated with MAS were included.Boys accounted for 69％(23/34),and the median age was 6 years.85％(29/34) cases had genetic tests and four SNPS loci were detected:PRF1 c.1061 C＞T (rs885822); UNC13D c.659 C＞T (rs3744007); STXBP2 c.1483 T＞cC (rs10001) and STXBP2 c.1616 A＞G (rs6791).Compared with the control group,genotype and allele frequency of PRF1 rs885822 and STXBP2 rs10001 in MAS cases were statistical significantly different (rs885822:allele frequency x2=4.52,P=0.03 ; genotype frequency:x2=5.52,P=0.02.rs10001:allele frequencyx2=21.33,P=0.00; genotype frequency:x2=19.58,P=0.00).There was no statistical significant difference in genotype frequency and allele frequency of UNC13D rs3744007 and STXBP2 rs6791 between the MAS and control group (rs3744007:allele frequencyx2=1.89,P=0.17; genotype frequency:x2=1.59,P=0.45.rs6791:allele frequency x2=l.69,P=0.19; genotype frequency:x2=2.09,P=0.35).Persistent fever,progressive hepatos-plenomegaly,a sharp decline in blood cells counts,pleural effusion,markedly increased serum liver enzymes,hyperlipidemia were the main characteristics.Some children had mucosal bleeding,neurological dysfunction.More than 82％ children had upper respiratory tract infection before the occurrence of MAS.90％ of children were in remission,while three children had multiple organ failure and died.Conclusion MAS is a fatal complication caused by immune disturbance.Early detection and tre-atment is the key to improve the prognosis.The SNP PRF1 rs885822 and STXBP2 rs1001 may be concurrent with the pathogenesis of SoJIA-MAS.The SNP UNC13D rs3744007 and STXBP2 rs6791 may not participate in the pathogenesis of SoJIA-MAS.

Nosocomial infection had been the focus conc erned by society at home and abroad since the viral infection such as HIV、HBV and HCV which had seriously threaten the human health worldwide. We should strengthen t he blood products and syringe management and implement sterilization measure，wi th that safe blood starts with me. Because of that quite a few of new human viru ses continually emerged in recent years， control and prevention of nosoc omial viral infection was currently imperative, important and formidable project s and global thorny issue of public health in the 21st century too.

Objective To study the electrolyte disturbances in the sufferers during the Wen-chuan earthquake in China,and investigate their possible pathomechanism. Methods Serum concentra-tions of potassium (K), sodium (Na), chlorine (Cl), calcium (Ca), magnesium (Mg) and inorganic phosphate (P) were determined in four hundred sufferers. Their values were analyzed via statistical method. Results Significant differences of all determined six electrolytes were observed among various groups. Pearson correlation analysis showed that correlative changes among electrolytes were similar in various groups except the correlation coefficients of Na-Mg in dialysis group (r= 0.066, P = 0.546) and non-dialysis group (r=-0.433, P= 0.044). Multivariate logistic analysis revealed the highest risk factor was K+,which led to crush injury (OR= 28.037, P= 0.000) and crush syndrome (OR=6.434,P=0.000). The receiver operating characteristic (ROC) curve revealed that K+ was the most specific (specificity: 98.5%; cutoff value: 5.8 mmol/L),Ca2+ was the most sensitive (sensitivity: 81.1%; cutoff value: 1.75 mmol/L) for crush injury diagnosis. The specificity of serum K+ , Mg2+ amd P was comparative in diagnosis of crush syndrome. The sensitivity of Ca2+ was the highest,ac-counting for 75.3%. Conclusion Electrolyte disturbances of suffers occur during a natural disaster; serum electrolyte measurement contributes to correct diagnosis and severity assessment.

OBJECTIVE:To study the compatible stability of potassium sodium dehydroandrographolide succinate injection in six infusions.METHODS:The changes of potassium sodium dehydroandrographolide succinate injection in appearance,pH value,content and insoluble micrones after mixing with six infusions(0.9% NaCl solution,Compound sodium chloride injection,Glucose saline,DX 40 glucose injection,5% glucose injection in glass or plastic containers)were determined respectively.RESULTS:No significant changes were noted for the mixture within 4 h in appearance,pH value and content.Except the micrones in potassium sodium dehydroandrographolide succinate mixed with compound sodium chloride injection were up to the standard(China Pharmacopeia,2005 edition),the micrones in all the other mixtures failed to meet the standard.CONCLUSION:Potassium sodium dehydroandrographolide succinate injection can be used in combination with compound sodium chloride injection.