Objective To reviewing the developmental history and to make an overall inquiry of the status quo of critical care medicine(CCM)in China,in order to make suggestions regarding the future development of this subspecialty in this country,particularly in the army forces.Methods Relevant articles regarding this subspecialty were retrieved from the published literature,and important events as well as advances in this field were reviewed to illustrate the history of establishment of intensive care unit(ICU),important events in the development,and academic advances in this subspecialty in this country and especially in the army forces.Results The review illustrated that this subspecialty of medical science had made a big stride in the past thirty years,and it has become one of the major forces in the medical arena in this country.The change in stratification of patients as a whole,further fragmentation of medical discipline,experiences obtained from participation in the care of mass casualties in multiple disasters,concerted efforts made by specialists devoted to this field of medicine,as well as strong support from the administration had given tremendous impetus to an upsurge of this subspecialty. In this army forces,this subspecialty had advanced in pace with that in the whole country.The inauguration of Military Association of CCM had further pushed forward the science and arts of CCM in the armed forces.Nevertheless,there are still many important problems in this field to be investigated.Conclusions The administration should give more support and advices for development of this important medical subspecialty in the armed forces,in order to further raise the standard of the arts and science of this branch of medical science to face any challenge in the care of serious illnesses and injuries encountered both in peace time and in combats.It is also important to propagate the perception of CCM in the medical establishments of grassroots level.

Objective To compare the clinical values of 16-slice spiral coroputed tomography(CT)and matrix metalloproteinases-9(MMP-9)in diagnosis of invasion and metastasis in human esophageal cancer.Methods Thirty-eight patients with esophageal cancer were detected with spiral CT,and their tumor tissues were detected for expression of MMP-9.Results 12 cases were diagnosed for vicinitic tissues damages by histopathological examination,while 11 cases were regarded to be damaged by CT and 13 cases were done according to MMP-9 determination;as to metastasis,there were 13 casese by histopathological examination,12 cases by CT and 16 cascs by MMP-9 determination.No statistical difference were observed in diagnosis of vicinitic tissues damages and metastasis by the three methods in positive rates,sensitivity,accuracy,specificity and diagnosis accordance rates(P＞0.05).Conclusion It is the important method for spiral CT in diagnosis of esophageal cancer,which could not be replaced by others in judgement of invasion and metastasis.

Objective To explore the clinical value of 16-slice spiral CT and its post-processing technics in diagnosis of colorectal carcinoma.Methods CT characteristics,surgery and pathological data of forty-three patients with colorectal carcinoma were analyzed retrospectively.Results The accurate diagnosis rate using 16-slice spiral CT was 100%,a total of forty-five focus were observed by CT and its post-processing pictures.It is safe to detect colorectal carcinoma using spiral CT without wounds.Further more,tumors and its growth towards enteric cavity,wall thichness,damaged surroundding tissues were all observed clearly as well as metastasize.Conclusion 16-slice spiral CT and its post-processing technics is effective in diagnosis of colorectal carcinoma,which should be used in clinical experiences.

Objective To study the clinical value of extensively whey protein hydrolyzed formula and partially whey protein hydrolyzed formula as an adjunctive therapy in treating infantile eczema.Methods Totally 59 bottle-feeding babies with infantile eczema were divided into three groups depending on different formula feeding:extensively hydrolyzed formula feeding group (eHF group,n =18),partially hydrolyzed formula feeding group (pHF group,n =22),and conventional cow's milk formula feeding group (CMF group,n =19).Meanwhile,all patients received the same drug treatment.The effective rate and remission rate were evaluated using the SCORing Atopic Dermatitis (SCORAD) index.Results After 2 weeks of treatment,the effective rate was 38.9％ and the remission rate was 50.0％ in the eHF group,which were significantly different from those in the CMF group (5.3％ and 31.6％) (x2 =12.225,P =0.002).The effective rate was 9.1％ and the remission rate was 40.9％ in the pHF group,showing no significant difference when compared with the CMF group (x2 =0.761,P =0.683).After 8 weeks of treatment,the effective rate was 55.6％ and the remission rate was 38.9％ in the eHF group,comparing to 15.8％ and 47.4％ in the CMF group,the difference was statistically significant (x2 =8.498,P =0.014).The effective rate was 31.8 ％ and the remission rate was 59.1％ in the pHF group,a trend towards higher than that of the CMF group,but the difference was not statistically significant (x2 =4.912,P =0.086).Before (F =0.773,P =0.466) and after (F =1.313,P =0.277) the treatment,the growth and development data in different groups showed no significance differences.Conclusion Both the extensively and partially whey protein hydrolyzed formula play an adjunctive role in treating infantile eczema,although the treatment effectiveness of the extensively hydrolyzed formula appears earlier than that of the partially hydrolyzed formula.

Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis'. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.

For uncontrolled hemorrhagic shock the traditional method and target of resuscitation may be harmful. The existing data supported a strategy of less aggressive interventions to those shock with uncontrolled hemorrhage until a decisive surgery begin. The choice of liquor for resuscitation remains in controversy. A combined application of crystalloid and colloid liquor seems to be reasonable and may be accepted by most physicians. It should be noted that the new resuscitation strategy may not be suitable to some kinds of trauma, such as traumatic brain injury, and its long-term effects on to the prognosis should be further evaluated.

AIM: To observe the therupeatic effects of Shemai Zhusheye vs vitamine C injection in treating dilated cardiomyopathy (DCM).　METHODS: Fifty-two patients with DCM were divided into 2 groups, 32 patients in treatment group (M 20, F 12; age 46 a± s 13 a), 20 patients in control group (M 11, F 9; age 47 a±14 a). Besides the patients in two groups were treated with conventional therapy, the patients in treatment group were given Shenmai Zhusheye 30 mL and 5% glucose injection 100 mL, iv, gtt, qd for 2 wk. The patients in control group were given vitamine C 5.0 and 5% glucose injection 100 mL, iv, gtt, qd for 2 wk. 　RESULTS: Treatment group total effective rate was 84%. Control group total effective rate was 65% (P>0.05).　CONCLUSION: Shenmai zhusheye has better effect in treating DCM. Symptom improving rate of Shenmai Zhusheye has better than vitamin C.

Objective To detect the changes of interleukin-18 (IL-18) in plasma of trauma patients and evaluate their value in early warning of organ dysfunction. Methods A prospective study was carried out in 54 trauma patients admitted in from March 2001 to September 2002, which were divided into low injury severity score(ISS) group (Group L-ISS) and high ISS group (Group H-ISS). ELISA was applied to measure the level of IL-18 of blood samples that were collected on arrival, at days 4, 7 and 14 following admission. In the meantime, IL-18 level of plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis and multiorgan dysfunction syndrome (MODS) was retrospectively analyzed so as to calculate the critical value of IL-18 in predicting organ dysfunction. Results After trauma, IL-18 concentration of plasma reached peak at days 4 and 7, and decreased gradually at day 14, which was significantly related to SIRS, sepsis and MODS, respectively. The IL-18 level was high relatively in plasma from patients with organ dysfunction. The higher IL-18 level in plasma within seven days after trauma indicated the severer organ dysfunction. Conclusion IL-18 is sensitive in early warning of organ dysfunction after trauma.

OBJECTIVETo evaluate the therapeutic effect of ulinastatin combined with thymosin α1 in the treatment of severe sepsis in rats.

METHODSNormal Wistar rats were subject to cecal ligation and puncture (CLP) to establish models of severe sepsis. The rats were then randomized into 4 groups for treatment with saline (control), ulinastatin, thymosin α1, or the combination of the latter two injected through the caudal vein or subcutaneously at 6, 24, 48 and 72 h after modeling. The mortality rate was recorded daily and the rats were executed at 24, 48, 72 and 96 h after CLP to harvest the heart, liver, spleen, lung, kidney and small intestines for pathological examination. The spleen of the rats were taken for detection of apoptosis of the spleen cells.

RESULTSThe mortality rate of the septic rats in the combined treatment group was decreased significantly (P=0.0325). The control group showed the most severe organ damage, which was moderate in single drug treatment group and the mildest in combined treatment group. Obvious spleen cell apoptosis was found in the control group, and was significantly ameliorated in the combined treatment group[(47.4∓10.9)% vs (39.3∓11.4)%, P=0.0000].

CONCLUSIONCombined treatment with ulinastatin and thymosin α1 can significantly improve the prognosis and ameliorate organ damage and spleen cell apoptosis in rats with sever sepsis.

Animals ; Apoptosis ; Drug Therapy, Combination ; Glycoproteins ; therapeutic use ; Male ; Rats ; Rats, Wistar ; Sepsis ; drug therapy ; pathology ; Spleen ; cytology ; pathology ; Thymosin ; analogs & derivatives ; therapeutic use

Objective To investigate the effect of high fluxes of hemodialysis combined with Niaoduqing granuleson in the cell-mediated immunity of elderly hemodialysis patients. Methods Fourty cases of elderly main-tenance hemodialysis patients with end-stage renal disease were randomly divided into control group and treatment group,low flux dialysis was used in both groups before the experiment,in the experiment control group adopts high flux hemodialysis,the treatment group in the control group on the basis of daily oral Niaoduqing granules 5 g, 3 times/d,observation for 3 months,compare the serum IL-2,IL-10,CD3+,CD4+,CD8+,CD4+/CD8+change of the two groups in 3 months.Results After 3 months high flux dialysis treatment,the level of IL-2 was significant-ly increased before the treatment of low flux dialysis,and the level of IL-10 was significantly reduced.The levels of IL-2 and IL-10 were significantly higher in the treatment group than in the control group after 3 months(P <0.01);The CD3+,CD4+and CD4+/CD8+levels of the two groups of high flux dialysis were significantly higher than that in the previous three months(P<0.05).The levels of IL-2,IL-10,CD3+,CD4+,CD4+/CD8+were significantly higher in the treatment group after 3 months than the control group(P<0.05).Conclusion High fluxes of hemo-dialysis can improve the immune function of elderly hemodialysis patients,while combined with Niaoduqing gran-ules is more obvious.