To compare clinical and radiographic outcomes of hook plate fixation and coracoclavicular ligament reconstruction in the treatment of acute unstable acromioclavicular joint dislocation.

Fiftypatients with acute unstable dislocation of the acromioclavicular joint were enrolled in the study and divided into two groups according to the treatment modality, ie, internal fixation with a hook plate group (Group I, 20 cases) and coracoclavicular ligament reconstruction group (Group II, 30 cases). The clinical outcomes were evaluated using Constant- Murley score (CMS) and visual analog scale (VAS) and the radiographic outcomes assessed based on coracoclaviculardistance (CCD).

The mean CMS score was(94.4±6.97) points and (95.87±3.50) points in Groups I and II, respectively, with no statistical difference. The mean VAS scores at the final follow-up was (0.85±0.93) points and (0.87±0.82) points in Groups I and II, respectively, with no statistical difference. The acromioclavicular joints were well reduced in both groups. CCDwas improved from preoperative (15.91±5.29)mm to postoperative (6.94±2.90)mm in Group I, with an improvement of (263.00±181.45)%, and from preoperative (15.10±6.43)mm to postoperative (5.54±2.10)mm in Group II, with an improvement of (293.67±116.39)%. The improvement in Group I was not significantly superior to that in Group II(P>0.05) Subluxation was observed in both groups, with higher incidence in Group II(26.7%) than that in Group I(15%). However, erosions of the acromion undersurface and osteoarthritis of acromioclavicular were only observed in group I, with an incurrence of 80% and 25%, respectively. Furthermore, coracoclavicular ligament ossification shown more frequently in group I (35%) than group II (13.3%).

For acute unstable acromioclavicular joint dislocation, hook plate fixation and coracoclavicular ligament reconstruction can attain comparable satisfactory clinical and radiographicoutcomes. Hook plate should be moved earlier to avoid the complication. Subluxation is the major complication of ligament reconstruction.

To investigate the effectiveness of percutaneous dilational tracheostomy (PDT) in airway positioning for emergency and critically ill patients.

A review was done on clinical data of 153 critically ill patients admitted into the Department of Emergency and ICU, First Hospital Affiliated to the General Hospital of the PLA from July 2004 to July 2014. All patients were treated with tracheotomy. There were 34 males and 22 females in PDT group, while 48 males and 49 females in conventional tracheal incision operation tracheotomy(OT) group(OT group). The time-effectiveness and safety of PDT and OT were compared in clinical application of tracheotomy from aspects of operation time, low oxygen from the continuous time, hypotension rate, postoperative bleeding, wound healing.

Operation time of PDT and OT groups was(6.0±2.2) min and(17.6±5.5) min, respectively(P<0.001). Continuous time of low oxygen in PDT and OT groups were(10.8±2.8)min and(37.6±6.1)min, respectively(P<0.001). Hypotension rate in PDT and OT groups was 25% and 24.7%, respectively(P>0.05). Postoperative bleeding in PDT and OT groups was (4.0±0.7) mL and (5.3±1.4) mL, respectively (P<0.001). Wound healing time in PDT and OT groups were (4.4±1.3) d and(7.8±2.5) d, respectively(P<0.001).

PDT is better than OT in airway positioning for emergency and critically ill patients.

To explore emergency green channels for the treatment effects of patients with the acute brain injury.

100 cases of acute craniocerebral injury patients in our hospital were randomly divided into observation group and control group, 50 cases in each group: control group for the conventional first aid mode; observation group to adopt green channel fast treatment. Rescue effect was compared between two groups.

In the observation group, average stay time in emergency room(16.0±3.5) min, average special examination time(17.9±2.6) min, average time from emergency to the operating room(7.2±1.1) min, and average time from admission to the operation(41.7±8.9) min were significantly shorter than those of the control group [average stay time in emergency room(23.0±5.1) min, average special examination time(25.9±3.1) min, average time from emergency to the operating room(8.3±1.8) min, and average time from admission to the operation(56.9.7±11.0) min], with statistical significance(P<0.05). 41 patients in the observation group(82%) were successfully treated, in which 4 cases(8%) had complications; in the control group 30 cases(60%) were successfully treated, in which 13 cases(26%) had complications, with statistically significant difference(P<0.05). Treatment success rate in the observation group was higher than that of the control group.

Implement emergency green channels can significantly shorten the reaction time of acute brain injury patients, and thus improve the success rate.

To guide the improvement and construction of Emergency Medical Service System, and investigate the epidemiological information of patients in pre-hospital emergency care in Huaihua city and probe the patients, characteristic.

The data were exported from the computer databases of Huaihua city, emergency medical center between 9-21, 2013 and 9-20, 2016.The thorough records of data from 12 744 aid patients were conducted to statistical analysis.The 7 033 male and 5 711 female between 1 month to 94 years old in that, the average ages is 51.8±22.6 . Specificly analyse different results of treatment [Pre-hospital care non-death, pre-hospital death (Pre-hospital cardiac death and Pre-hospital non-cardiac death)], that patients accepted pre-hospital emergency care of the time of deployment, arrival, spot, returning, drawing-out, and rescuing radius, quarterly distribution, types of diseases, the distribution of sexs and ages; this analyses the situation of ages of the different types of diseases about Pre-hospital medical care patients.

(1) The scheduling time, running time, returning time and service radius about patients receiving pre-hospital care in the death group were less than those of the non-death group, and the rescue time and total time of the former were more than those of the latter respectively (P<0.01 or P<0.05). The scheduling time of Patients receiving pre-hospital care didn’t have significant difference between the sudden cardiac death groups and the non- sudden cardiac death groups respectively(P>0.05), but running time, returning time, total time and service radius of the sudden cardiac death groups were more than those of the non- sudden cardiac death groups, and returning time of the former was less than that of Pre-hospital care group of non-sudden cardiac death (P<0.01 or P<0.05). (2)The patients, amount in Pre-hospital medical care group, the non-death group, the death group, the non- sudden cardiac death group and the sudden cardiac death group were common in the first season of the year. (3)In 12 744 cases of pre-hospital medical care patients group, the patients, amount of trauma was at most, the percentage of the trauma group to the pre-hospital medical care group was 32.99%(4 204/12 744), whose age grades was by far among 21~50, which the patients, amount of traffic accident was at the most, and the others with a high incidence of the disease in sequence were circulatory system, nervous system, digestive system, poisoning group and respiratory system, whose age grades in circulatory system, nervous system, digestive system, respiratory system was by far above 51, the patients, age grades in poisoning group was patients by far among 21~50, which the patients, amount of acute alcoholism was at the most, the percentage of the acute alcoholism group to the poisoning group was 76.52%. (4)In 657 cases of aid death patients group, the death amount of trauma and poisoning group ranked at the 1th, 5th respectively, whose age grades was by far among 21~50.The death amount of diseases of circulatory system, nervous system, respiratory system and digestive system ranked at the 2th, 3th, 4th, 6th respectively, those patient’ age grades was by far above 51, in the further analysis, the amount of patients with pre-hospital of sudden cardiac death was at most in the death amount of diseases in circulatory system.(5) The total amount, the death amount and the sudden cardiac death amount of cases of male patients were more than those of female patients. (6) The percentage of the death group to the pre-hospital medical care group cases was 5.15%(657/12 744), and the percentage of the sudden cardiac death group to the pre-hospital medical care group cases was 1.11%(141/12 744), and the percentage of the sudden cardiac death patients group to the death group was 21.46%(141/657).

Trauma, especially in traffic accident injury, is the main cause of death of pre-hospital care in Huaihua city in recent years. The measures benefit to reduce icidence, mrtality in pre-hospital emergency medical care in the local aera by strengthening emergency first aid network construction, the rational preparation schedule settings, or the evidence for the existence of sudden cardiac death risk factors in patients with increased vigilance, making preventions plans for a particular season, disease and people, promoting the knowledge and skills of pre-hospital popularity, focusiong on cardio-cerebral vascular disease and respiratory disease prevention and control, improving the masses of the common early identification of critical capacity and other targeted initiatives.

To evaluate the accuracy and reliability of ECG remote mobile monitoring system in remote dynamic monitoring, early warning of abnormal electrical activity and long-range records.

A prospective study was conducted on 60 cases patients needing electrocardiogram (ECG) or dynamic ECG examination continuously selected from Qilu Hospital of Shandong University from October to December 2014. All patients were examined with ECG RHMS and dynamic ECG monitor simultaneously for 24 hours. The stability of ECG RHMS dynamically sending ECG records was evaluated by collecting the baseline drift, maximum and average value of ECG and compared with the ordinary static 12-lead electrocardiogram. The waveform amplitude and duration of leads (Ⅰ, Ⅱ, Ⅲ, aVR, aVL, aVF, V1, V5) in ECG detection results of various recording methods were recorded in the same patient and at the same time. The image quality was evaluated by comparing ECG RHMS with ordinary static 12-lead electrocardiogram and dynamic electrocardiogram. The abnormal electrical activity in real-time ECG fragments automatically sent by ECG RHMS remote mobile monitoring system was counted and classified to compare with dynamic electrocardiogram of the same patient and at the same time. The long range (22 h or higher) of ECG RHMS was recorded and classified to compare with the dynamic electrocardiogram of the same patient.

There were 34 males and 26 females, aged 16-96 years, average (58±14.5)years. According to ECG RHMS monitoring system, the limit of the electrocardiogram drift rate was for 5.0% (3/60), the average deviation for (0.10±0.64) mm and the maximum displacement for 2 mm, with no statistically significant difference compared with dynamic electrocardiogram (P>0.05). The reliability of remote mobile ECG RHMS monitoring system for real-time sending segments of ECG graphics was 97.75% (2 820/2 885), with no statistical significance in comparison with ordinary static 12-lead electrocardiogram (P>0.05). The wave amplitudes, time limits and degrees of ST segment deviation differences collected by remote mobile ECG RHMS monitoring system showed no statistical difference compared with the same patient, the same time points and same lead dynamic electrocardiogram (P>0.05). The records of all kinds of abnormal electrical activity in segments of electrocardiogram and long-range electrocardiogram sent by the remote mobile ECG RHMS monitoring system had no differences in comparison with the dynamic electrocardiograms of same patient at the same time (P>0.05).

Remote mobile RHMS ECG monitoring system can be more sensitive to find abnormal ECG activity and warn in time to accurately and quickly sending records and hence provide effective security in real-time monitoring, early prevention and early intervention for high-risk persons with abnormal electrical activity, as is beneficial to reduce harm of arrhythmia to patients and is worthy of extensive application in clinical work.