Shock is the hypoperfusion or blood flow distribution abnormality and leads to systemic tissue hypoperfusion and organ dysfunction.Cardiac output and tissue perfusion pressure are major factors affecting tissue and organ peffusion.Continuous assessment of hemodynamic parameters is crucial for the diagnosis and treatment of shock.The pulse indicator continuous cardiac output technology combines hemodynamic monitoring and volumetric measures to assess a variety of hemodynamic parameters including cardiac output,afterload and volume,which is a kind of low-risk,convenient,accurate,and continuous technology.

Extracorporeal membrane oxygenation (ECMO) is a technology of cardiopulmonary life-support,where blood is drained from the venous vascular to an oxygenator,circulated outside the body by a mechanical pump,and then reinfused into the circulation.Recently,the application of ECMO in China is increasing gradually.Effective prevention and treatment of complications of ECMO is an important factor for the success of this technology.The aim of this paper is to discuss cardiac stun during ECMO support.

Sepsis is a group of clinical syndrome in response to overwhelming inflammation,which is a major problem associated with high morbidity and mortality among critically ill patients.Recently,an abundance of basic and clinical findings suggest that stem cell can be attributed to anti-inflammatory,tissue healing and immunomodulatory,which may provide a promising idea in the treatment of sepsis.

Septic shock remains a major cause of morbidity and mortality in intensive care unit(ICU). Abun-dant fluid resuscitation is one of the most common therapies for septic shock patients;but some fundamental questions about its efficacy and safety remain. In this paper,recent insight derived from clinical trials in terms of fluid type,dose, rate and toxicity are discussed.

Objective To evaluate the value of using the color Doppler ultrasound in the treatment of pseudoaneurysm with thrombin intratumoral injection.Methods Intratumoral injection of thrombin was given under the guidance of color Doppler to 7 cases of femoral artery pseudoaneurysm after cardiac catheterization,then we observed thrombus formation time and the dosage of thrombin.After the treatment of 10 minutes,1 day,5 days,15 days,we reviewed pseudoaneurysm with the color Doppler ultrasound.Results Thrombosis in the pseudoaneurysm was fast with only 2 to 4 minutes,and thrombin dosage was 200 to 500U,with an average of 280 U,and the cure rate was 100%,but one case was accompanied by acute allergic reaction and ipsilateral deep venous thrombosis.Conclusion The color Doppler ultrasound-guided thrombin intratumoral injection treatment of pseudoaneurysm is a simple,safe and effective method,with few complications,so it can be used as the first choice treatment for pseudoaneurysm.

Objective To study the characteristics of the central part of the nociceptive system in acute myelitis (AM) with contact heat evoked potentials (CHEPs) and to document the potentials in patients with AM.Methods Twenty patients with AM were recruited in this study as an experimental group,and twenty healthy subjects were chosen as a control group.A heat foil was used to elicit pain and CHEPs.Thermal stimuli were applied at 54.5 ℃ at five sites:the dorsum of the hand,the proximal volar surface of the forearm,the skin of the leg 5 cm proximal to the medial malleolus,and at the C7 and T12 acupuncture locations.The latency and waveform of the evoked potentials were recorded.The conduction velocity of the A8 fibers of the peripheral nerves and of the spinal part of the spinothalamic tract were analyzed.The somatosensory evoked potential (SEP) and sensory conduction velocity (SCV) of the limbs were also examined,and the results were compared with the CHEP results.The results were compared between the two groups.Results The N 550 latencies of the CHEP on the dorsum of the hand,the inside of the leg,and at C7 and T12 were prolonged significantly in the patients with AM compared to the healthy controls.There were no significant differences in the nerve conduction velocity of the Aδ fibers and the velocity or amplitude of sensory nerve conduction in the limbs between the groups.The conduction velocities of the spinothalamic tract were significantly reduced in the patients with AM compared to the control group,while the peak latencies of N13 and the interpeak latencies of N9-N13 and N13-N20 in the AM patients were significantly prolonged compared to the healthy persons.In the patients with AM,CHEP abnormality in the lower limbs (17/20,85％) was significantly higher than in the upper limbs,total CHEP abnormality and CHEP abnormality in the lower limbs were significantly greater than SEP abnormality.Conclusion Persons with AM have abnormalities in the central part of the nociceptive system.When used with MRI and other electrophysiological examinations,CHEP may contribute to diagnosing AM.It could be helpful in the differential diagnosis of AM from motor neuron diseases and peripheral nerve lesions.It is of great potential value in clinical practice.

Objective To observe the effects of low frequency electrical nerve stimulation on sensory and motor functioning in patients with hemiplegia and hemianesthesia caused by acute cerebral infarction.Methods Sixty-one acute cerebral infarction patients with both hemiplegia and hemianesthesia were randomly divided into a treatment group and a control group.Thirty patients in the control group received conventional treatment.Thirty-one patients in the treatment group were treated with low frequency electrical stimulation of the peripheral nerves of the affected extremities in addition to the conventional treatment.Sensory function,motor function and performance in the activities of daily living(ADL)were evaluated before and 14 days after treatment.Results Sensory function,motor function and ADL performance in both groups improved significantly over the 14 days.Furthermore,the difference between the two groups after treatment was significant.Conclusion Low frequency electrical nerve stimulation can improve sensory function,motor function and ADL performance in acute cerebral infarction patients with both hemiplegia and hemianesthesia.

ve To explore the sanitary quality of swimming pool water of public places. Methods The sanitary quality of swimming pool water of 7 public places was monitored, and the sanitory facilities equiped in swim-ming pools were investigated in Jiangyin. Results The pH values, the levels of turbidity and urea in swimming pool water all accorded with the related sanitary standards, and their related qualified rates were 93.9% , 98.5% and 98.5% respectively. For water temperature and residual chlorine, the qualified rates were lower, 3.0% and 19.7% respectively. Both the levels of turbidity and urea were positively correlated with the openning durations of swimming pools (P

Patients with respiratory crisis occupied a large numbers in extracorporeal membrane oxy-genation(ECMO) group. ECMO is able to give a plenty amount of gas exchange for body essential metabolic needs by ECMO oxygenator whoever the lungs are of function or not. The key indications for respiratory ECMO are that the patient had no response to all medical treatment except ECMO,and the origin cause of the disease is potentially recoverable. Besides the contraindications and accessibility, ECMO has no special settings among the different ages or cause of diseases. The VV-ECMO is preferred for respiratory support. VA-ECMO should be considered if cardiovascular failure exists. ECMO may offer a powerful respiratory support to patient with critically ill conditions until recovery. The outcomes are influenced by some factors including the reversibility and the cause of diseases.

Acute respiratory distress syndrome(ARDS) is a critical illness in children with high mortality.Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for the severe ARDS,and is usually used in ARDS patient who does not respond to conventional respiratory support including mechanical ventilation.The principle of ECMO is to afford a cardiopulmonary bypass support and gives enough blood oxygen delivery.The effectiveness of ECMO on ARDS is influenced by the severity and causes of the sickness because of its respiratory support character.The reported survival rate of the ECMO children with ARDS ranged from 40％ to 78％.The traumatic procedure,need anticoagulation,noted complication and treatment cost are the important factors that restrain ECMO at the rescue role.