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 determine the effects of the early enteric nutrition (EEN) up to scratch on the outcomes of the critical care patients with different degrees of severity of illness. Method There were 192 critically ill patients eligible for enrollment for study during the past 18 months in our ICU. They were classified by using APACHE Ⅱ scores. The aim of this retrospective analysis of the early enteric nutrition was to see if the enteric nufore, the patients were divided into two groups: up to scratch group and not up to scratch group. According to APACHE Ⅱ scores, the patients of each group were further divided into three sub-groups in terms of scores below 15, between15 and 25, and above 25, respectively. Results There were 62 patients in the group of EEN up to scratch, and 130 patients' EEN did not up to scratch. When the scores of APACHE Ⅱ were below 15, the length of hospital stay (LOS) was significantly shorter in group of EEN up to scratch in comparison with that of EEN not up to scratch (t = 6.453, P = 0.000). When the scores of APACHE Ⅱ were between15 and 25, the LOS in ICU (t = 3.966, P = 0.000), in hospital (t = 8.165,P = 0.000), The cost of medical care (t = 4.812,P= 0.000) and the mortality (x2 = 5.421,P = 0.038) were all significantly less in patients with EEN up to scratch. However, when the scores of APACHE Ⅱ were above 25, only the cost of medical care ( t = 7.364, P = 0.000) was significantly lower in patients of EEN up to scratch than that of EEN not up to scratch. Conclusions The EEN up to scratch can significantly improve the outcomes of critical patients and the clinical value of EEN up to scratch depends on the severity of illness.

Objective To explore the effects of fat on healing of porcine skin wounds so as to provide a new strategy to promote skin wound repair after injury. Methods Forty-eight full-thickness skin wounds were produced on both sides of the back in 6 male minipigs (8 wounds in each animal). These wounds were then randomly divided into 4 groups, i.e. saline control group, fat autografting group, fibroblast growth factor (bFGF) treatment group and epidermal growth factor (EGF) treatment group. On day 3, 7, 14 and 21 after wounding, the area and the volume of wounds were measured, and histological examination was performed to evaluate the speed and quality of wound healing in different groups. Results On days 3 and 7, the amount of granulation tissue and vessel density in fat treatment group were significantly more abundant compared with other groups. Wound area and volume in fat treatment wounds were markedly decreased compared with those in other groups (P

Objective To establish the equation of chest CR for the estimation of age, and evaluate the significance of forensic medicine. Methods 5 measurements were selected to carry on the independent samples, and the status were analyzed by SPSS 19.0. Results The 5 measurements and age were line-related(P<0.05); Three group regression models were formulated; In a separate test, a control sample of 30 chest CR that not involved with formulating the regression equation was correctly estimated with 73.3% to 86.7% accuracy within 3 years. Conclusion The method set up in this paper can be used to estimate the age of Chinese Han adults.

Objective To identify regular roots for medical disputes by case studies for providing evidences for hospital management..Methods 200 cases of medical malpractice were selected consecutively and categorized according to the causes,dispute focus and expert opinions.Results The main factor to trigger medical disputes is dissatisfaction of the outcome,accounting for 50.5％.48.15％ of the disputes,however,result from dissatisfaction of the therapy process which constitutes a medical malpractice.Neglect or defects in treatment,surgical operation,information notice and medical papers were highly common causes.Conclusion Medical disputes result from a variety of causes,so are the roots of medical malpractice.Medical institutions are recommended to enhance medical quality management,make sufficient doctor-patient communication,and make high quality documentation of key medical activities,in an effort to minimize medical disputes and medical malpractice.

BACKGROUND: As a kind of polypeptide, angiotensin-converting enzyme (ACE) inhibitory peptide can lower the blood pressure of human body through restraining the formation of angiotensin Ⅱ.OBJECTIVE: To investigate the influence of AGE inhibitory peptide on endothelial cell proliferation and endothelin expression in cultured human umbilical vein cells based on cellular and molecular levels in order to provide the experimental evidences for ACE inhibitory peptide to be the potential blood pressure-lowering health food.DESIGN: Repeated measures design.SETTING: School of Bioscience and Bioengineering, South China University of Technology; School of Applied Chemistry and Biological Technology,Shenzhen Polytechnic.MATERIALS: The experiment was carried out in the Institute of Applied Chemistry and Biological Technology, Shenzhen Polytechnic from September 2004 to March 2005. The AGE inhibitory peptide was provided by the Institute of Applied Chemistry and Biological Technology, Shenzhen Polytechnic. Under certain circumstance, 15 μ mol/L of the inhibitor was needed to decrease half of the AGE activity. The human umbilical vein endothelial cells of the 4th generation were cultured randomly in 7 groups with different concentrations: medium group, 150, 300 and 600 mg/L ACE inhibitory peptide groups, captopril group, norepinephrine(NE) group, and ACE inhibitory peptide+NE group.METHODS: ①The endothelial cells were cultured as recommended. The medium was M199+FBS(0.15, v/v)+penicillin(10 000 U/mL)+streptomycin (100 mg/L). After cellular fusion, the cells were carried on the passage with the ratio of 1:2. The 4th generation cells were used for experiment. ②M199(0.15, v/v) was contained in each group. ACE inhibitory peptides were added to make the final concentration 150, 300 and 600 mg/L in the 150, 300 and 600 mg/L ACE inhibitory peptide groups respectively. Captopril was added to make the final concentration 10-5 mol/L in the captopril group. NE was added to make the final concentration 100 μg/L in the NE group. ACE inhibitory peptide and NE were added to make the final concentration 300 mg/L and 100 μg/L in the ACE inhibitory peptide+NE group respectively. ③The state of cell growth was determined with cytometry. The contents of endothelial cells in the medium with different culture times were determined with radioimmunoassay. The expression of endothe lin mRNA was determined with reverse transcriptase-polymerase chain reaction. The expression of cellular endothelin protein was determined with immunohistochemical method.MAIN OUTCOME MEASURES: ①The influence of ACE inhibitory peptide on endothelial cell proliferation. ②The influence of ACE inhibitory peptide on the endothelin mRNA and endothelin protein.RESULTS: ①The influence of ACE inhibitory peptide on endothelial cell proliferation and endothelin secretion: Compared with the medium group,in the captopril and 150, 300, 600 mg/L ACE inhibitory peptide groups,the growth of endothelial cells was restrained and the endothelin content in the medium was lowered(P ＜ 0.01 or 0.05). NE could promote the growth of endothelial cells and the secretion of endothelin, but the cell density and endothelin content after treatment with ACE inhibitory peptide were similar to those in the medium group (P ＞ 0.05). ②The influence of ACE inhibitory peptide on the expressions of endothelin mRNA and protein in endothelial cells: Compared with the medium group, the expressions of endothelin mRNA and protein might be lowered in the captopril and 150,300, 600 mg/L ACE inhibitory peptide groups(P ＜ 0.01 or 0.05). The expressions of endothelin mRNA and protein could be up-regulated by NE.The gene expression after treatment with ACE inhibitory peptide was similar to that in the medium group(P ＞ 0.05).CONCLUSION: The ACE inhibitory peptides of different dosages can all restrain the growth of endothelial cells, lower the endothelin content, decrease the expression of endothelin gene and resist NE improved growth and secretion of endothelial cells in umbilical vein cell effectively.

Objective The aim of this study was to explore possible pharmacokinetic factors and develop a population pharmacokinetic model for remifentanil in adult patients.Methods Eleven healthy patients,undergoing elective major abdominal surgery,aged 25 to 86 years,received random-ly remifentanil 0.3μg·kg-1 ·min-1 (group R3),or 0.6μg·kg-1 ·min-1 (group R6).Frequent ar-terial blood samples were drawn according to predetermined time and assayed for remifentanil concen-tration.Nonlinear mixed-effects modeling (NONMEM)was used to evaluate the time courses of the measured concentrations.The covariates include age,bodyweight (WT),gender,lean body mass (LBM),body mass index (BMI)and body surface area (BSA).Results The pharmacokinetic data of remifentanil were well described using a three-compartment linear model with first-order elimination from the central compartment.Forward analysis showed that age,height and body mass index (BMI) does not affect the pharmacokinetic parameters,which are contrast with body weight,lean body mass (LBM),body surface area (BSA)and gender;further analysis demonstrated only a significant effect of body weight on remifentanil systemic clearance (CL)and volume of the central compartment (V). For typical 60 years patients,PK parameters were:V1 =7.64 L,V2 =4.81 L,V3 =4.34 L,CL1 =2.74 L/min,CL2 = 0.738 L/min,CL3 = 0.0905 L/min.Conclusion The pharmacokinetics of remifentanil is consistent with its rapid elimination by blood and tissue esterase in Chinese patients. The systemic clearance and volume of distribution of central compartment increases with body weight in the population and the range of covariates studied,which suggests that a patient with greater body weight needs a greater initial dose and maintenance infusion rate higher to obtain a stable plasma con-centrations and clinical effects.

Objective To investigate the effects of Hsp90 inhibitor 17-DMAG on proliferation and apoptosis of human colon cancer cell line HT-29.Methods HT-29 cells were treated with 17-DMAG.The cell proliferation inhibition rate was evaluated by CCK-8 assay.Apoptosis of HT-29 cells by 17-DMAG was delineated by DAPI staining assay and Annexin V PI double labeling FCM was used to determine cell apoptotic rate.Furthermore,Westen blotting analysis was used to determine caspase-3 and cleaved caspase-3 protein expression.Results 17-DMAG time-dose-dependently inhibited the proliferation of HT-29 cells.After 0.1μmol/L,0.25μmol/L,0.5μmol/L,1.0μmol/L,2.5μmol/L and 5μmol/L 17-DMAG exposured for 24 hours,the cell proliferation inhibition rate was (14.36±0.95)％,(22.17± 1.15)％,(28.45±1.16)％,(35.04±1.58)％,(46.85 ±2.44)％,(57.19 ± 2.06)％ respectively,after exposured for 48 hours,the cell proliferation inhibition rate was increased to (20.80±1.17)％,(27.55 ±0.65)％,(33.33 ±1.23)％,(46.20±4.76)％,(55.45 ±4.47)％,(61.75 ±2.72) ％ respectively,after exposure for 72 hours,the cell proliferation inhibition rate was to (29.62 ± 2.27) ％,(39.19 ± 1.74)％,(44.29 ±2.00)％,(50.66 ±2.17)％,(58.84 ±3.18)％,(70.74 ±2.65)％.DAPI staining showed that HT-29 cells treated with 17-DMAG displayed chromatin condensation and nuclear fragmentation which are typical changes of apoptosis.Annexin V PI double labeling FCM showed that when HT-29 cells were exposed to 0,0.25,0.5,1.0 and 2.5(μmoL/L) 17-DMAG for 24 hours,the total apoptotic rate for 24 hours was (2.72 ±0.57)％,(5.38 ±0.46)％,(6.88 ±0.52)％,(10.44 ±0.32)％ and (17.87 ±4.66)％ respectively.(P ＜0.05).In addition,the expression of procaspase-3 decreased,while cleaved caspase-3 increased in the presence of 17-DMAG at different concentrations for 24 hours.Conclusion 17-DMAG can time-dose-dependently inhibit proliferation and promote apoptosis of HT-29 cells in vitro.

Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

Objective To investigate the value of transrectal Doppler and contrast-enhanced ultrasonography(CETRUS)to discriminate benign and cancerous nodules in prostate. Methods Fifty-five patients with hypoechoic lesions(35 biopsy-proven benign nodules and 32 prostate cancer nodules)in the prostate underwent Color and power Doppler uhrasonography(PDUS),and the parameter of peak vascularization index(PVI)in each prostate nodule was recorded and the differences of PVI in the benign and cancerous nodules were analyzed.CETRUS was then performed on all cases.The enhancement patterns of the lesions and their surrounding peripheral zone tissues were observed.After CETRUS,lesion-specific TRUS-guided biopsy and the routine sextant biopsy were performed subsequently. Results PVI of 32 prostate cancerous nodules and 35 prostate benign nodules were (0.38±0.16),(0.24±0.19),respectively,measured by color Doppler ultrasonography.And the former was significantly higher than the latter(P=0.0023).PVI of the cancerous nodules and the benign nodules were(0.55±0.18),(0.32±0.21)(P<0.01).Malignant lesions showed significant increased peak intensity and earlier arrival time compared with their surrounding outer gland tissue,while benign lesions showed nearly equal peak intensity and time to enhancement compared with their surrounding gland tissue by CETRUS. Conclusions PVI measured by PDUS was more effective than that measured by color Doppler to discriminate benign and cancerous nodules in prostate.CETRUS could be helpful in discriminatory performance of benign and cancerous nodules in prostate.