The Surviving Sepsis Guidelines were first published in 2004,with revisions in 2008 and 2012.In January 2017,the fourth revision of the Surviving Sepsis Guidelines was presented at the 46th annual SCCM meeting and published online in Critical Care Medicine.The updated guideline was generated by 55 international experts and providing 93 recommendations on early management of sepsis and septic shock.There are numerous major advances in the revision of the guidelines.Among the various topics covered,initial resuscitation and antibiotic therapy are the domains in which the most important changes and advances were made.

Objective To study the effectiveness of comprehensive rehabilitative therapy with paraplegic spinal cord injury (SCI) patients. Methods Forty patients with SCI-caused paraplegia were divided randomly into a rehabilitation group and a control group. The routine treatment was administered to both groups, and comprehensive rehabilitative therapy was also administered to patients in the rehabilitation group as an addition. Functional assessments and somatosensory evoked potential (SEP) tests were performed with the two groups pre-treatment and 30 days post-treatment. Results The rehabilitation group achieved, on average, greater improvement in their physical functions , as demonstrated by their much higher scores in terms of the Barthel index than those of the control group ( P

Nitric oxide ( NO ) , cyclic guanosine 3′, 5′-monophosphate ( cGMP ) and cGMP-dependent protein kinase( PKG) play an important role in a variety of tissue cells. This paper reviews the related literatures about the NO-cGMP-PKG pathway and the cardiovascular diseases since the close relationship between them by summarizing the founction of the NO-cGMP-PKG pathway and the affection on the cardiovascular diseases by the NO-cGMP-PKG pathway,aiming to find a new research direction of the pathogenesis of cardiovascular disea-ses.

Objective To explore ultrasonographic diagnosis of severe fetal limb deformity in early pregnancy.Methods A total of 5 843 cases of pregnant women were screened and 147 cases of suspected fetal malformation were sellected.The routine ul-trasound examination results were recorded as control group,and continuous order tracking ultrasonic method inspection results were recorded as observation group.The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value was compared.Results The clinical results obtained in multiparous or limb malformation fetus were 40 cases,accounting for 27.21%. In the observation group on limb loss and other detection rate of 100% (14/14)and 65.00% (13/20),significantly higher than those in control group 50.00% (7/14)and 5.00% (1/20).But in the observation group on finger deformity examination showed no advantage.Observation accuracy,sensitivity and negative predictive value was 91.84%,70.00%,89.92%,which were higher than those in the control group(78.91%,22.50%,77.54%).The differences were statistically significant (P <0.05).Conclusion The application of continuous order tracking ultrasonic method to check the first trimester fetal limb deformity with high accuracy,pro-vided sufficient time for prenatal diagnosis of fetal treatment and late.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Alopecia ; physiopathology ; therapy ; Female ; Hair ; growth & development ; Humans

AIM: To compare the dissolution of asperosaponin Ⅵ between the ultra-micro powder and the fine powder of Radix Dipsaci.METHODS : The real contents,in vitro release and releasing rate of asperosaponin Ⅵ were determined by HPLC for the ultra-micro powder and the fine powder.RESULTS: In the ultra- micro powder and the ordinary powder,the real content of asperosaponin Ⅵ were 4.87%,4.74%,respectively; in vitro release in 1 h were 48.2 mg/g,47.5 mg/g,respectively; releasing rate parameter T_(0.9) were 0.23 min,10.41 min,respectively.CONCLUSION: The ultra- micro porphyrization could not influent the real content and in vitro release of asperosaponin Ⅵ in Radix Dipsaci.But it could improve the releasing rate of asperosaponin Ⅵ.

This article summarizes specific ethical doctrines from the traditional ancient Indian medicine, analyzes the characteristics of its ethical thought, absorbs its reasonable essence, pays great attention to the dual function of medical technique and medical ethics in current medical activities, highlights the importance of cooperation under the modern medical service condition, and emphasizes the application of etiquette in medical activities.

Objective To OxplorO thO OffOct of lactobacillus vaginal capsulO in thO trOatmOnt of sOnilO vaginitis.Methods From January 2017 to FObruary 2018, 100 OldOrly patiOnts with vaginitis in thO SOcond POoplO＇s Hospital of Haining wOrO sOlOctOd in thO study. ThOy wOrO randomly dividOd into obsOrvation group and control group according to thO digital tablO, with 50 casOs in Oach group. ThO obsOrvation group was trOatOd by lactobacillus vagina capsulO, and thO control group was trOatOd by compound mOtronidazolO suppository. ThO clinical OffOcts of thO two groups wOrO comparOd.Results ThO total OffOctivO ratO of thO obsOrvation group (96.00% ) was significantly highOr than that of thO control group(76.00% ),thO diffOrOncO was statistically significant(χ2 =12.547,P<0.05).ThOrO was no statistically significant diffOrOncO in vaginal pH bOforO trOatmOnt bOtwOOn thO two groups[(6.89 ± 1.32) vs. (6.91 ± 1.26),t=0.102,P>0.05],and thOrO wOrO statistically significant diffOrOncOs in vaginal pH of thO two groups bOforO and aftOr trOatmOnt(t=8.204,5.112,all P<0.05),thO vaginal pH of thO obsOrvation group aftOr trOat-mOnt was significantly lowOr than that of thO control group, thO diffOrOncO was statistically significant[(4.49 ± 0.11) vs.(5.76 ± 0.37),t=5.024,P<0.05].In thO obsOrvation group, only 1 casO had rOcurrOncO at 2 months aftOr trOatmOnt, and no rOcurrOncO was obsOrvOd at 3 months and 6 months aftOr trOatmOnt, thO rOcurrOncO ratO was 2.00%. In thO control group, thOrO wOrO 2 casOs,4 casOs,6 casOs had rOcurrOncO at 2 months,3 months and 6 months aftOr trOatmOnt, and thO rOcurrOncO ratO was 24.00%. ThO rOcurrOncO ratO of thO obsOrvation group was significantly lowOr than that of thO control group (χ2 =25.634,P <0.05).Conclusion Lactobacillus vaginal capsulO in thO trOatmOnt of sOnilO vaginitis has curativO OffOct is distinct, thO rOcurrOncO ratO is low, also thO usO procOss is vOry simplO, has high clinical application valuO.

Objective To study the role of Ginsenoside Re and Rb3 on mice with viral myocarditis (VMC) and explore the mechanisms. Methods BALB/C mice were infected by coxsackievirus B3 ( CVB3) to establish VMC model. The mice were divided into control group,virus group and Ginsenoside Re and Rb3 treatment group(treatment group). On day 5,day 10,day 20 after infection,the level of serum crea-tine phosphokinase-MB( CK-MB) was detected. Then myocardial sections stained with Masson′s trichrome were used to observe the distribution of mice myocardial collagen fibers, quantify collagen volume fraction (CVF),and detect the levels of superoxide dismutase(SOD). Results (1)The level of CK-MB peaked on day 5,and decreased afterwards[day 5:(463. 68 ± 47. 62) U/L; day 10:(588. 81 ± 56. 09) U/L; day 20:(340. 48 ± 58. 22) U/L,respectively]. While the levels of CK-MB in treatment group were lower than those in virus group[day 5:(378. 69 ± 56. 02) U/L;day 10:(452. 56 ± 67. 78) U/L; day 20:(327. 13 ± 47. 20) U/L,respectively] in the same point. There were significant differences between groups on day 5 and day 10 (P<0. 01). (2) In viral group,the blue staining degree gradually increased with time in myocardial sections stained with Masson′s trichrome,especially in myocardial necrosis area. Compared with treatment group,CVF increased significantly in virus group on day 10 and day 20 ( day 10:6. 52% ± 2. 34% vs. 8. 94% ± 1. 67%;day 20:7. 00% ± 1. 53% vs. 10. 46% ± 1. 74%,P<0. 01). The levels of SOD in myocardial sections in virus group were lower than those of control group[day 5:(48. 83 ± 17. 74) U/L;day 10:(61. 41 ± 14. 58) U/L;day 20:(66. 26 ± 18. 97) U/L,respectively,P<0. 05],but in treatment group,the level of SOD could beimprovedsignificantly[day5:(72. 07 ±24. 85)U/L;day10:(83. 22 ±19. 52)U/L;day20:(92. 00 ± 20. 46) U/L, respectively, P < 0. 05]. Conclusion Because of the inhibition of oxygen radicals and oxidative stress, Ginsenoside Re and Rb3 can protect myocardial tissue. Ginsenoside Re and Rb3 can effectively reduce the extent of myocardial fibrosis. The mechanism may be related with the reduced peroxide level in vivo.

As a major adhesion molecule of endothelial junction, vascular endothelial cadherin (VE-cadherin) plays a very important role for the maintenance of vascular homeostasis. It regulates infiltration of vascular endothelia on contents in plasma such as eukocytes and lipid, as well as cellular proliferation and apoptosis. It plays an important role by involving in angiogenesis in the multiple links of the process of atherosclerosis, This article reviews the recent progress in research on the effects and mechanisms of VE-cadherin in the occurrence and developmaent of atherosclerosis in recent years.