Objective 18 patients of brain stem tumors in results were analyze retrospective by Stereotactic Conformal Radiotherapy.Methods From March 2000～March 2005.18 patients with brain stem tumors were treated by SCRT.The patients age were 6～67 years old,midian age were 28 years.The dose was 45～60Gy/5～7week.Results The symptoms had been improved in 15/18 cases at the end of the radiotherapy.The 1-3 and 5 year survival rates were 57.6%,42.6% and 30.4%.The complication occurrence rate was 13.13%.Conclusions The Stereotactic Conformal Radiotherapy is a main therapy mean to brain stem tumors.That can improved survival rates and life quality of the patients with brain stem tumors.

OBJECTIVE: To analyze the oil content and fatty acid constituents of Fructus Quisqualis.METHODS: The fatty oil of Fructus Quisqualis was extracted by supercritical fluid extraction (SFE) .The content of oil and compositions of fatty acid were determined by gravimetric analysis and GC - MS respectively .RESULTS:The oil content of Fructus Quisqualis was 27.70% .Among the fatty acids, oleic acid, linoleic acid and palmitic acid were dominant.The unsaturated fatty acids accounted for 63.93% of the total fatty acids, and the major saturated fatty acid was palmitic acid .CONCLUSION: The oil of Fruclus Quisqualis is of highquality,and the analytic results provide scientific basis for exploitation and utilisation of the oil of Fructus Quisqualis.

Objective To observe the clinical efficacy of acupuncture in treating functional dyspepsia. Method Sixty-eight patients with functional dyspepsia were randomized into an acupuncture group and a control group. The acupuncture group was intervened by matrix needling, once a day, 8 d as a course, with a 2-day interval between two courses, for successive 4 weeks. The control group was prescribed with Motilium at 10 mg, 3 times a day, for successive 4 weeks. Result The total effective rate was 91.4% in the acupuncture group versus 87.9% in the control group, and the difference was statistically insignificant (P>0.05); there was a significant difference in abdominal pain score between the two groups (P<0.05), indicating that the acupuncture group should be superior to the control in releasing abdominal pain. Conclusion The overall efficacies in treating functional dyspepsia are equivalent between the acupuncture group and control group, but the acupuncture group is better than the control in releasing pain. Therefore, compared to medicine, acupuncture has advantage in treating functional dyspepsia.

ObjectiveTo observe the infection of continuous aspiration of subglottic secretion(CASS) for patients with ventilator associated pneumonia (VAP).MethodsOne hundred and fifty VAPpatients under mechanical ventilation whose basical information were recorded were divided into two groupsby random digits table method:control group(70 cases) and CASS group(80 cases).Conventional VAPprevention was taken in control group and CASS group,while CASS therapy was added to CASS group.ResultsSex,age,acute physiology and chronic health evaluation Ⅱ score,recent antibiotics usage,airpressure,time in ICU,hospital stay and mortality rate of two groups had no statistical significance(P ＞0.05 ).The time of ventilator treatment of CASS group was obviously shorter than that of control group [ (5.2 ±1.4) d vs.(7.8 ± 1.2) d,P =0.02 ],and VAP incidence was lower than that of control group [ 22.5％ (18/80)vs.32.9％(23/70),P =0.04 ].ConclusionCASS could reduce the incidence of VAP and short the time ofventilator treatment.

Objective To explore cephalosporinase from nosocomial Klebsiella pneumoniae infection and their drug-resistant characteristics among the ICU patients so as to provide an instruction for rational clinical medication.Methods 67 samples were identified with VITEK-60 automated system.The strains producing AmpC β-lactamases were screened with cefoxitin disk diffusion method recommended by the CLSI,and confirmed by cefoxitin three-dimensional test.AmpC β-lactamase genotype was differentiated by PCR-sequencing and susceptibility tests which were done with the Kirby-Bauer method recommended by the CLSI.Results In the 67 isolates of Klebsiella pneumoniae,11 strains(16.4％) were found to produce AmpC β-lactamases.The drug-resistant genotype for all the 11 AmpC-positive strains was DHA-1.AmpC-producing strains developed multi-drug resistance,especially for broadspectrum β-lactam antibiotics and enzyme inhibitors.β-lactamases-producing strains were more resistant than non-producing ones.Conclusion Klebsiella pneumoniae in ICU patients has a higher proportion of producing AmpC β-lactamase strains,which are all of DHA-1 genotype and have multi-drug resistance.

Objective To observe the expression levels of 8 - hydroxy-deoxyguanosine (8-OHdG) in patients with different glucose metabolism and its relationship with islet dysfunction.Methods Based on the 75 g oral glucose tolerance test (OGTT), the patients were divided into 3 groups: normal glucose tolerance (NGT) group (30 patients), isolated impaired glucose tolerance (IGT) group (28 patients), type 2 diabetes mellitus (T2DM) group (28 patients), and 30 healthy subjects were selected as the healthy control group (healthy control, HC) . The triglyceride (TG) and total cholesterol (TC), glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), insulin resistance index, insulin and c-peptide area under the curve (AUC) were detected, and compared between groups, and the correlation between 8-OHdG and these indexes was analyzed. Results There was no difference in FBG values between NGT group and HC group, the indicators of patients in other groups were higher than HC group,the difference was statistically significant (P<0.01). The values of FBG, 8-OHdG, HbA1C and HOMA-IR of patients in IGT group were higher than NGT group, the difference was statistically significant (P<0.01) . The values of FBG ,8-OHdG, HbA1C and HOMA-IR in T2DM group were higher than IGT group. There were no differences in insulin AUC between NGT group, IGT group and T2DM group (P> 0.05) . 8-OHdG was correlated with FBG, HbA1c, HOMA-IR, C peptide AUC, insulin AUC, and the correlation coefficients were 0.704, 0.713, 0.665, 0.825 and 0.653, respectively, the differences were statistically significant. Conclusions 8-OHdG levels can reflect the status of islet dysfunction,and can be used as an indicator of islet function for diabetic patients.

Objective To observe the pathogens and drug-resistance of ventilator-associated pneumonia (VAP) patients in emergency intensive care unit (EICU) for rational antibiotic therapy and the prevention of VAP. Method The sputum culture results and drug-resistance of pathogens of VAP patients in EICU from 2007 to 2009 were collected. Results One hundred and two mechanical ventilation patients were selected. VAP was occurred in 70 patients (68.6%). One hundred and fifty-seven pathogens had been examined,including 92 Gram-negative bacilli (58.6%),35 Gram-positive cocci (22.3%) and 30 fungus (19.1%). Pseudomonas aeruginosa and meticillin-resistant-staphylococcus aureus was 22 strains (14.0%)respectively, stenotrop homonas maltophilia was 21 strains (13.4%) and acinetobacter baumanii was 17 strains (10.8%). Fifty-nine patients (84.3%) had suffered from multiple pathogen infection, with 31 cases having 2 pathogens and 28 cases having 3 pathogens. Conclusions Pseudomonas aeruginosaa,methicillinresistant staphylococcus, stenotrophomonas maltophilia and acinetobacter baumanii are main pathogens of VAP in EICU patients,and candida albicans is still the main pathogens in fungal infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe.

Angiotensin converting enzyme 2 (ACE2) is a new member of renin-angiotensin system found recently. It counterbalances the effects of angiotensin converting enzyme (ACE), hydrolyzes angiotensin Ⅱ to generate angiotensin-(1-7) and hydrolyzes angiotensin Ⅰ to produce angiotensin-(1-9). Angiotensin-(1-9) can be hydrolyzed by ACE to form angiotensin-(1-7), and angiotensin-(1-7) counteracts the effects of angiotensin Ⅱ in many aspects. Bradykinin or atrial natriuretic factor or substance P are not the substrates of ACE2, and ACE2 hydrolyzes the metabolites of bradykinin such as des-Arg~9-BK and des-Arg~(10)-kallidin, and also the dynorphin A, one of the opium peptides. ACE2 is not inhibited by angiotensin-converting enzyme inhibitor (ACEI). Recent studies demonstrate that ACE2 is a functional receptor of SARS coronavirus. To elucidate the mechanisms of cardiovascular diseases and other disease such as SARS, further investigations in ACE2 are needed.

With the rapid development of critical care medicine (CCM) in China, there are increases in the number of intensive care units (ICUs), the scale of one center ICU and the team. Subspecialty construction of CCM is of great concerns for personnel training as well as discipline development, and is currently one of the urgent problems that need to be resolved. Experience of CCM subspecialty construction from Europe and the United States is lacking and it is necessary to propose some opinions on innovation to construct CCM subspecialties with Chinese characteristics. We believe that CCM sub-specialties construction should be based on the core knowledge (pathophysiology) and skill (organ monitoring and support). The following 7 sub-specialties can be set up: ① acute lung injury and mechanical ventilation; ② shock, hemodynamic monitoring and treatment; ③ acute kidney injury and blood purification; ④ sepsis and anti-infective therapy; ⑤ stress, sedation and analgesia; ⑥ nutrition and metabolic support; ⑦ coagulation, immune and inflammation. The core knowledge and skills of critical care medicine will constantly be updated and enriched. Therefore, sub-specialty settings should be constantly updated as well.

OBJECTIVE To analyze the risk factors of respiratory tract infection by Stenotrophomonas maltophilia and its resistance to common antibiotics so as to guide clinical prevention and treatment.METHODS Thirty two patients of respiratory tract infection by S.maltophilia were examined.RESULTS Among them,the ratio of susceptivity of S.maltophilia to compound sulfamethoxazole was 87.5%,to levofloxacin was 78.1%,and to ticarcillin/clavulanic acid was 81.2%,but the ratio of resistance of S.maltophilia to imipenem was 100.0%,and it was also high to aminoglycosides and cephalosporins.CONCLUSIONS The old age,serious underlying diseases,many kinds of antibiotics used,infection in hospital and the use of glucocorticoids are the main risk factors of the respiratory tract infection by multiresistant S.maltophilia.