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 observe the effect of Yishen Paizhuo Decoction(Decoction for reinforcing the kidney and discharging the turbid)on chronic renal failure(CRF)patients.Methods The 82 CRF patients were randomized into observation group(42 cases) and control group(40 cases).In addition to the routine treatment,the observation group was administered modified Yishen Paizbuo Decoction,and the control group was given coated aldehyde oxystarch.The course of treatment was 6 months for both groups. Changes of clinical symptoms,renal functions,blood fat,and hemoglobin were observed,and the linear regression evaluation and renal survival evaluation were employed to evaluate the development of CRF.Results The improvement of observation group in renal func- tions and blood fat was remarkable with the increased renal survival rate,compared with the control group,the difference was signifi- cant(P

Background Excimer laser corneal refractive surgery is widely used because it reduces the dependency of refractive error eye to glasses.However,the adverse effects of anti-inflammatory drugs is a problem after operation.Lotemax eyedrops is a kind of steroidal anti-inflammatory drug,with a good effect on the operative eye.But its influence on intraocular pressure(IOP) after long-term topical administration is less studied.Objective This study was to investigate the influence of lotemax eyedrops on IOP after long-term topical administration in myopic eyes received excimer laser corneal refractive surgery.Methods An one-month retrospective case serial study was adopted.The case history data of 1552 eyes from 1552 Patients who received excimer laser corneal refractive surgery were collected in Tangshan Eye Hospital from 2011 January to 2012 January,including 321 eyes with laser in situ keratomileusis(LASIK),608 eyes with sub-Bowman keratomileusis (SBK) and 623 eyes with femtosecond laser for flap excimer laser in situ keratomileusis(FS-LASIK).Lotemax eyedrops was topically administered after operation 4 times per day initial and then decreased 1 time weekly for 1 month.IOP was measured in before,1 week,2 weeks,3 weeks,4 weeks after operation with non-contact tonometer.The increasing range of IOP was divided into ＜5 mmHg,5-15 mmHg and ＞ 15 mmHg after operation.Optical head parameters were measured by Heidelberg retina tomography when IOP increasing after operation.Results Within 1 month,elevated IOP was found in 47 of 1552 eyes after administration of lotemax eyedrops,including 3.12％ (10/321) in the LASIK group,3.29％ (20/608) in the SBK group and 2.73％ (17/623) in the FS-LASIK group,without significant difference among them(x2 =1.95,P＞0.05).The IOP elevated 1 week after operation and remained normal after that till drug withdrawal in all eyes.There were no significant differences in the disk area (1.65 ±0.44) mm2 vs.(1.66 ±0.44) mm2,disk volume (0.40 ±0.09)mm3 vs.(0.39±0.08) mm3 and mean nerve fiber layer thickness (0.28 ± 0.08) mm vs.(0.29 ± 0.07) mm in IOP elevation duration compared with 1 month after IOP recovery(t =0.34,0.81,0.48,P＞0.05).Conclusions Topical administration of 0.5％ lotemax eyedrops after excimer laser corneal refractive surgery leads to reversible high IOP.It is very important to monitor the IOP during use of the drug.

Objective To summarize the experience on imaging diagnosis and surgical treatment for popliteal artery entrapment syndrome (PAES). Methods From 2004 to 2010, 11 patients (12 limbs) diagnosed as PAES by CTA and MR ( A) underwent surgery. There were 11 patients with a mean age of (28 ±19) years, eight patients were male, three patients were female. Two patients were found to have bilateral involvement. Intermittent claudication was the most frequent presenting symptom. Six limbs were type Ⅰ , three limbs were type Ⅱ , three limbs were type Ⅲ , one limb was type Ⅳ. The preoperative mean ABI was 0.47 ± 0. 27. Results Popliteal artery exploration surgery or peripopliteal artery lysis was performed in 12 limbs, and this procedure was combined with a great saphenous vein bypass graft in seven limb because of arterial occlusion or aneurysm. After a median follow-up of ( 19 ± 20) months (0 month to 6 years) , the mean ABI improved to 0. 81 ±0. 30, which was significantly higher than that of preoperation( P ＜ 0.05),one patient died of pulmonary embolism one day after operation, one patient (one limb) had popliteal artery thrombosis after operation. Intermittent claudication symptoms disappeared in all other patients. Conclusions Timely imaging diagnosis and surgical intervention is very important for patients of PAES.

There is no a systemic performance metrics for clinical data management. While the CDMC in China starts to develop the quality metrics for clinical data management, it is essential to think over the performance and pursue metrics implementation of clinical data management in China. This article provides the basic concept, development and implementation of the performance metric in clinical data management.
China ; Clinical Trials as Topic ; standards ; Data Collection ; standards ; Information Storage and Retrieval ; standards

OBJECTIVETo investigate surgical methods and effects of unstable scapular fracture.

METHODSFrom October 2008 to August 2011, 14 patients with unstable scapular fracture were treated. There were 12 males and 2 females with an average age of 38.7 years (ranging, 21 to 55 years).The time from injury to hospitalization was 1 hour to 10 days (mean 3 days). Among patients,3 patients had scapular body fracture,4 patients had scapular neck and body fracture,4 patients had scapular neck and acromion fracture,2 patients had glenoid cavity and coracoid fracture, 1 patient with scapular spine and coracoid fracture. All patients were treated by operation, Hardegger classification system was applied to evaluate the function.

RESULTSAll patients were followed up for 2 to 36 months (mean 12.4 months). The healing time ranged from 6 to 8 weeks. No infection and internal fixation failure occurred. The effect result of Hardegger scoring system was excellent in 9 cases, good in 3 cases, fair in 2 cases.

CONCLUSIONSurgical treatment for unstable scapular fracture can reconstruct stability of shoulder joint, promote early rehabilitation of joint function, and maximally restore shoulder function.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Recovery of Function ; Scapula ; injuries ; physiopathology ; surgery ; Young Adult

Objective To investigate prophylaxis and therapy of early complications following relatives' partial live small bowel transplantation.Methods Four relatives' partial live small bowel transplantations were carried out.Among the 4 patients,there were 3 cases of short intestine syn- drome and one case of non-function of small bowel caused by the absence of nerve ganglion of small in- testine.More than 4 antigens of HLA were completely matched between donators and receptors.In- testines of donators were got from terminal ileum with the length of (150?10) cm.After operations, tacrolimus (FK506),mycophenolate mofetil (MMF),and methylprednisolone were used to prevent rejections.Measures such as use of anticoagulation,improving microcirculation and albumin infusion, aimed at regulating the function of blood coagulation and preventing bleeding and formation of thrombus at anastomotic stoma;famotidine and omeprazole were used to prevent irritable ulcer;use of the third generation of cephalosporins antibiotics,ganciclovir and fluconazol could prevent bacteria,vi- rus and eumycete infections;disinfection and care of easily-infected organs were emphasized;receptors were encouraged to get out of their beds to move frequently;glutamine and enteral nutrition were used early to promote recovery of intestinal function.Results Three days after operation,one patient's lung was infected with baumanii,and the infection had been under control after being treated with the third generation cephalosporins antibiotics;five days after operation,haematoma was detected on an- other patient and was cleared through the second operations growth of eumycete was found in 2 pa- tients' excretion and secretion from enteron,and their situations were improved with fluconazol;acute rejections of the 4 patients were detected 20 days after operation and reversed by the increased use of FK506 combined with methylprednisolone.Among the 4 patients,2 of them have survived for a long time,and the first patient has survived for 6 years and 8 months till now and the other one for 3 years and 2 months;furthermore,other 2 patients respectively died of infections 5 months and 35 days after the operations.Conclusion Because of special constitution of intestine,early complications of rela- tives' partial live small intestine transplantation are frequent and complicated.Therefore,prophylaxis and therapy of early complications are crucial to the success of the transplantation.

ObjectiveTo investigate the effects of medical chitin degraded membrane on post-surgical abdominal adhesions.MethodsForty adult rabbits were made to form abdominal adhesions and divided randomly into four groups including group A1 and its control group A2, group B1 and its control groups B2 with 10 animals in each group. Medical chitin degraded membrane was applied in the group A and group B to the surfaces of the positions where would be adhered. All animals were cut the belly open again on the 7th, 14th postoperative day; the adhesions about incision and appendix were graded according to the severity, and took on bioscopy.ResultsThe abdominal adhesions model was successful. The severity of adhesions and inflammatory reaction of the group A1 and group B1 was significantly milder than that of the group A2 and group B2 in every different periods ( P<0.05).ConclusionThe medical chitin degraded membrane used intraoperatively might have some efficacy in preventing post-surgical abdominal adhesions.

ObjectiveTo summarize the means of prevention and treatment for early complications (in the first month) of partial live small bowel transplantation.MethodsThrombus of anastomosis blood vessel, bleeding, infection, rejection, dysfunction of transplantated bowel were the main complications in the first month after operation, which should be paied more attention to. ResultsFour patients suffered acute rejection, respiratory tract infection, dysfunction of transplantated bowel in first month after operation. After accurately treating, all the complications were cured. The function of transplantated bowels were well. ConclusionPreventing and treating early complications accurately after partial live small bowel transplantation is important.

Objective To study the molecular biology of rifampin-depending M. Tuberculosis. Methods The seguence (a 319-bp DNA fragment) of rpoB gene were analyzed by automated DNA sequencing machine. (2) The fingerprints of genomic DNA were obtained by random amplified polymorphic DNA (RAPD) fingerprinting. (3)The protein electrophoresis of bacterium by SDS-polyacrylamide gel (SDS-PAG).(4) The cases of pulmonary tuberculosis by rifampin-depending strains were retrospectively analyzed. Results (1) rpoB gene sequenced: The point mutationrate of rifampin-depending strainswas 96.7%(29/30) and that of rifampin-residtant strains 81.1%(30/37), P