Spesis/severe sepsis remains a serious problem in pediatric intensive care unit.The mortality of sepsis/severe sepsis is still very high.The waterfall cascade reaction of cell factors is the main reason leading to the continued deterioration of the condition.Continuous blood purification technology can not only remove inflammatory mediators by adsorption and filtration function,but also improve the immune function,even reduce the mortality rate.But there is a controversial topic on the selection of the appropriate dose.This review not only introduces the effects of high-volume hemofiltration and low-volume hemofiltration from different aspects,but also analyses the influencing factors of different effects.

OBJECTIVE To study the 16 genotypes of ?-lactamase in multidrug-resistant Acinetobacter baumannii isolated from inpatients,to know the state of multidrug resistance of A.baumannii in Urumqi.METHODS Bacterial strains were identified by system of API,and antibiotic susceptibility test was detected by K-B and microdilution according CLSI.PCR was used to determine the genotypes of ?-lactamase and compare with that in GenBank.RESULTS The antibiotic resistance rates to cefataxime and tetracycline of the isolates were the highest,(100%).Resistance rate to cefoperazone/sulbactam was the lowest(5 TEM(25%)strains and 10 OXA-23 strains(50%)from 20 strains multidrug resistant A.baumannii).CONCLUSIONS There is a high percentage of multidrug resistance production of A.baumannii in Urumqi.The ?-lactamase is focused on TEM and OXA-23;it is deserved to make further augmentation of epidemiology surveillance on ?-lactamase.

Reform of the property right system in medical institutions is an important part of Chinas health reform. It is closely related to the reform of the health investment system, the operating mechanism of medical institutions, regional health planning, the structural readjustment of health services, and the health management system. For this reason, the paper offers an account of the motive, objective, major forms, place and functions of the reform of the property right system in medical institutions as well as some other issues worthy of attention.

Good standardized training of resident physicians is indispensable for high quality medical personnel building.This paper gives a brief introduction to the experiences of endocrinology fellowship trainings in three top hospitals in USA.On the basis of current simation in China,a new and improve the quality'is proposed,and a new approach is explored,which is a valuable reference for the endocrine resident trainings in China.

Phase Ⅱ metabolic enzymes play pivotal role in the biotransform and metabolism of exogenous substances, which might influence its ability of metabolism and detoxification to exogenous carcinogens.Polymorphism have been demonstrated in various phase Ⅱ metabolic enzymes and etiology studies showed that individuals exposed to the same environment could develop different susceptibility to tumorigenesis due to different metabolic enzyme polymorphism. Here, we summarized the effects of phase Ⅱ metabolic enzyme polymorphism on the risk of cancer.

Background The effectiveness of medical tissue adhesive for the reparation of operative incision has been recognized,but its influence to ocular surface microenvironment is not quite clear.Objective This study was to appraise the safety and efficacy of α-cyanoacrylate,a medical issue adhesive,for the reparation of the conjunctival and skin laceration.Methods Twenty healthy New Zealand rabbits were randomly divided into suturing group and medical glue group.Routine ophthalmic examination,the level of tear secretion and breakup time of tear film (BUT) were tested before operation.The upper bulbar conjunctiva of each right eye was cut apart about 1.0 cm after surface anesthesia and the skin of back was incised about 2.5 cm length after local anesthesia.The conjunctival and skin lacerations were adhered with compound medical adhesive in the medical glue group,and continuous suture was done to repair the conjunctival laceration and interrupted suture to the skin laceration with 5-0 chorda serica chirurgicalis in the suture group.The routine ophthalmic examination,level of tear secretion,BUT and the states of wound healing were examined 1 day,2 days and 7 days postoperatively.Pathologic examination of the corresponding tissues was also carried out 1 week after the animals were sacrificed.The data were analyzed by SPSS 13.0 statistical software.This experiment followed the Administration of the Care and Use of Experimental Animals of Shanghai City.Results The conjunctival and skin lacerations healed well both in the suture group and the medical glue group.The levels of tear secretion 1 day and 2 days postoperatively in the medical glue group were (12.70±2.21)mm and (12.70±2.00)mm respectively,showing a significant lowness in comparison with (14.90±2.38)mm and (14.90±2.33)mm of the suture group (q =-4.02,P =0.03;q =-4.02,P =0.03).Compared with the baseline,the difference of the levels of tear secretion in the medical glue group was not statistically significant in various time points after operation (P=1.00,1.00,0.51).The BUT values at 2 days and 7 days postoperatively in the medical glue group were (4.50 ± 1.18) seconds and (4.10±0.88) seconds respectively,being significantly longer than (3.30 ± 1.06) seconds and (3.00±1.25) seconds in the suture group (q=4.37,P=0.02;q=4.19,P=0.03).Compared with the baseline,there was not statistically significant difference at each time point postoperatively in the medical glue group (P =0.28,0.59,0.21).However,BUT at each time point after operation in the suture group was significantly shorter than that of the baseline (P=0.01,0.01,0.00).Pathological examination showed that all the conjunctival and skin lacerations healed well.Trivial collagen hyperplasy was seen in the eyes of the suture group and infiltration of a few of inflammatory cells was found in the medical glue group.In the pathological result of the skin test,there was conspicuous scar and severe collagen hyperplasy in the suture group,but in the medical glue group,the skin structure was almost normal.Conclusions α-Cyanoacrylate is safe and effective for the repair of the conjunctival incision with little affection to ocular surface microenvironment.

66 patients with sick sinus syndrome were enrolled in this study. All patients meeting the indications for dual chamber pacing were randomly divided into two groups: right atrial appendage(RAA) pacing group was made up of 36 patients and low atrial septal(LAS) pacing group was made up of 30 patients. Follow-up was 12 months. The incidence of atrial fibrillation(AF) was lower in LAS group(3. 3% ) compared with the RAA group(19. 4% );P wave dispersion in RAA group was significantly higher than that in the LAS group (P < 0. 01). After 3 months of the operation, left atrial volume index(LAVI) in RAA group was significantly larger than that in the LAS group. In LAS group compared with the RAA group P wave dispersion and LAVI were significantly lower after operation in sick sinus syndrome. LAS pacing was superior to RAA pacing in preventing new atrial fibrillation.

Objective To explore the effect of radiofrequency catheter ablation( RFCA) on cardiac reverse remode-ling and improvement of life quality in cardiomyopathy patients with paroxysmal atrial fibrillation( PAF) . Methods 95 cardiomyopathy patients with PAF were enrolled in our study and divided into two groups. RFCA group:62 patients received circumferential pulmonary vein isolation, ( left ventricular end-diastolic ) LVEDD ≥55 mm (male), LVEDD ≥50 mm (female); Drug group:33 patients were treated with drug for controlling heart rate ( resting heart rate around 60~80 bpm, heart rate during daily activity <100 bpm) . 72 hours after admission or 6 months after surgery in RFCA group, when the heart rate returned to normal or 6 months after treatment in Drug group, Short-Form36(SF-36) was used to evaluate the quality of living in the patients respectively; transthoracic echocardiography was performed in sinus rhythm;LAD, LVEDD and LVEF of the patients were measured. Results in RFCA group, LAD and LVEDD of 62 patients reduced and LVEF increased in 6 months after surgery statisti-cally significant(P<0. 05). In Drug group, 6 months after treatment, LAD and LVEDD of 33 patients increased ( P<0. 05 ) , without significant change in LVEF. There was no statistical significance in psychological health, physical function and general health perceptions, but there was significant improvement in social function and phys-ical function,affective state, physical role and energy in both RFCA group and drug group (P<0. 05), and it was more obvious in RFCA group(P<0. 05). Conclusion RFCA can reverse cardiac structural remodeling via sinus rhythm maintenance and improve the quality of life in cardiomyopathy patients with PAF.

Objective To evaluate the radiofrequency catheter ablation for type I atrial flutter through application of Holo catheter labelling with anatomic imaging localization to ablate the isthmus of IVC TA during complete double way block.Methods Eleven cases with type I atrial flutter undergone Holo catheter labelling technique and consecution with conduction time change of coronary venous sinus orifice withright atrial lower lateral wall pace excitation ,were performed with radiofrequency catheter ablation for the isthmus outcoming with complete double way conduction block. Results All together 11 cases with 4 of atrial flutter and 7 of sinus rhythm were undergone radiofrequency catheter ablation resulting with double way conduction block of the isthmus accompanied by prolongation of right atrial conduction time 56.0?2.3ms and 53.0?4.6ms respectively.The right atrial excitation consecution during coronary venous sinus orifice and right atrial lower lateral wall pace excitation appeared to be in clockwise and counter clockwise of single direction. No recurrence occurred during 3-34 months follow up with only one showing atrial fibrollation.Conclusions The application of Holo catheter labelling technique with anatomic imaging localization to achrieve the double way conduction block by radiofrequency catheter ablation of TVC TA isthmus, is a reliable method for treating atrial flutter.

Resting energy expenditure is the main indicator to assess energy consu mpit on of ap tine ts. The ne eryg expenditure of critically ill children can be influenced by many factors.Different ts atse of diseases are followed by different values of resting energy expenditure.Right now,indirect calorimetry is the “golden standard” of measurement of energy metabolism.Indirect calorimetry can be used to accurately grasp energy expenditure of patients.And it is beneficial to optimization of nutrition support,also for individualized nutri-tion therapy.