Background: Isotonic crystalloids are the preferred solution for the initial clinical management of patients with multiple trauma, among which lactated Ringer's solution and normal saline are the most widely used, but both have clinical limitations. Bicarbonated Ringer's solution (BRS), which provides physiological levels of bicarbonate ions and electrolyte ions, can be used to supplement missing extracellular fluid and correct metabolic acidosis.Methods: A prospective, randomized controlled study enrolled 63 patients with traumatic hepatic rupture and hemorrhagic shock. They were randomly assigned to the Bicarbonated group (n = 33) or the Control group (n = 30), which received restrictive fluid resuscitation with sodium bicarbonate Ringer's solution or sodium lactate Ringer's solution, respectively. The levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, arterial blood lactic acid and potential of hydrogen (pH) were measured prior to, 1, 3, 24, and 72 hours following resuscitation. The primary outcomes were patient survival, shock-related complications, and comparison of the inflammatory factors.Results: The incidence of complications in the Bicarbonated group was significantly lower than in the Control group (15.15% vs 40.0%; P < .05). The intensive care unit length of stay and mechanical ventilation time in the Bicarbonated group were significantly shorter than in the Control group (all P < .01). The levels of IL-6 and TNF-α in the Bicarbonated group were significantly lower 1 hour following resuscitation than prior to resuscitation (P < .01), whereas these levels in the Control group were increased following 1h of resuscitation as compared with before resuscitation (P < .01). Following resuscitation, the levels of IL-6, TNF-α and lactate in the Bicarbonated group were significantly lower than in the Control group (P < .01). Moreover, in the Bicarbonated group, the lactic acid level decreased and the pH value increased significantly following resuscitation, whereas there was no difference in lactic acid levels and pH value between pre-and 1 hour post-resuscitation in the Control group (P > .05). Conclusion:The shock-related complications were dramatically reduced from using BRS in these patients. Additionally, the BRS was found to better inhibit the expression of inflammatory factors in their peripheral blood and could correct acidosis.

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The geological feature of the Kalpin thrust belt, Tarim Basin, China, has been a controversial issue, because of remoteness and lack of information. In this paper, Landsat Thematic Mapper (TM) data are used to discuss the structural framework of the area and its forming mechanism; the results were confirmed in the field. The PCI EASI/PACE 6.2 PC version was chosen to process the image data. The false colour composite images elaborately chosen could discriminate clearly strata of different ages and geological structures in the area. From detailed imagery interpretation, it is found that the thrust belt could be divided clearly into three parts with different deformation features from the west to the east. The west part is characterized by thrusts and folds of various sizes. The middle part consists of imbricate thrusts, transverse tear faults and some fault-related folds. The east part is expressed by the pile-up of strata sheets separated by complex thrusts and tear faults. During the Late Tertiary, the strong compression from the Tian Shan Mountains made the Kalpin Uplift thrust southward over three different structural units, thus producing entirely different structural styles within the thrust belt.

BACKGROUND:With the reform of medical education methods, a novel educational resource “micro-course” and a new educational model “flipped classroom” have attracted the attention of educators. There are few indicates about whether and how they can be applied in emergency medicine teaching in the past period. OBJECTIVE: This paper investigates the practice of the micro-course combined with the flipped classroom in emergency medicine course in West Anhui Health Vocational College. SUBJECTS and METHODS: The students from Class 2003 and Class 2004 of the Clinical Department of West Anhui Health Vocational College, Grade 2000, were assigned to the reforming group and the traditional group respectively. The education style of the micro-course combined with the flipped classroom was applied to the reforming group, and the didactic teaching style was used in the traditional group. At the end of the course, theoretical tests and questionnaires were used to test the teaching results. RESULTS: The results of theory tests in reforming group were significantly better than those in traditional group (t=3.122, P <0.01). Furthermore, the outcomes of the questionnaire investigation indicated that the students' general satisfaction to participate in micro-course combined with flipped classroom was exceed traditional group. In the refroming group, the students thought that their passion to learning, efficiency of learning, and ability of learning on their own and solving the problem were greatly enhanced comparing with traditional teaching method. CONCLUSION: Micro-course combined with flipped classroom successfully increased the outcome of emergency medicine teaching. It should provide reference for the reform of emergency medicine teaching in medical colleges and universities.