Sepsis is one of the serious illnesses leading to high mortality in ICU.Some animal experiments and clinical trails show that target temperature management has a protective effect on target organ function in sepsis,but the optimal timing,length of targeted temperature managment continued,intervention measures,and optimal target temperature obtained in sepsis remains in the great controversy.Whether the patients with sepsis would be truly benefited from the body temperature management is still worthy issue for further study.The aim of this article reviews is to trace the recent research progress on the body temperature management in sepsis.

Duraphat fluoride varnish is a topical coating material applied to tooth surfaces composed of fluoride compound,film-forming material and volatile solvent and containing 5％ sodium fluoride (22,600 ppm Fluoride).Many studies have shown the effectiveness of Duraphat fluoride varnishes in inhibiting caries,reducing tooth mineralization and releasing hypersensitive dentine.This article aims to review the research on clinical application of Duraphat fluoride varnish

OBJECTIVE:To discuss the economic efficiency of different antimicrobials in treatment of lower respiratory tract infections(LRTI) METHODS:50 cases of LRTI collected from this hospital were divided into two groups:A,pefloxacin;B,ceftazidime Evaluation was carried out with pharmacoeconomic cost-effectiveness analysis RESULTS:The total costs were 957 60 yuans and 1 596 00 yuans and the effective rates were 84% and 92% in group A and B respectively An increase of 1%effective rate in group A saved 79 80 yuans in comparison with that in group B CONCLUSION:The therapeutic scheme of pefloxacin seems to be the best one for treating LRTI

Journal Club education method is widely used in resident training in foreign countries.Its function in neurosurgery clinical training is gradually focused on.This method will promote the mastery of new concept,new method and new technique by the residents,help them to form good reading habit and improve their ability to solve actual clinical problems.The application of Journal Club education method in neurosurgery clinical training in our country may have positive influence on the standardized training of clinicians and the spreading of evidenced-based medicine.

BACKGROUND:Interstitial fluid flow around the osteocytes caused by a series of physiological activities plays an important role in the osteocyte metabolism and signal transduction.
OBJECTIVE:To review and summarize the research progress of bone structures and physiological functions, then further il ustrate how the mechanical loads make an impact on bone tissue.
METHODS:A computer-based search was conducted in PubMed database for articles related to the bone microstructure, metabolism and osteocyte signal transduction published from January 2009 to December 2015. The keywords were“osteocyte, mechanical load, permeability, lacunar-canalicular system, interstitial fluid flow, mechanotransduction, signaling pathways”in English. Data were screened firstly, dated articles or literatures with wrong research methods were excluded, and total y 40 eligible articles were enrol ed.
RESULTS AND CONCLUSION:Bone tissue can quickly adapt to the change of mechanical environment to guarantee enough osteocytes in the functional bone area indicating that osteocytes regulate the bone absorption and formation by responding to stress, which is closely related to osteocyte physiological characters. Osteocytes exist in mineralized matrix, and the special microstructures make it possible to receive mechanical loads and transform the mechanical signals into chemical signals aimed at regulating the bone absorption or formation.So the interstitial fluid flow in the lacuna-canalicular system occures, namely load-induced fluid flow, when the mechanical load is distributed on the bone. This fluid flow affects the bone tissue through two mechanisms:regulating osteocyte metabolism and participating in the mechanotransduction. In conclusion, the mechanical load plays a vital role in maintaining health bone and regulating bone adaptation.

Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty.Methods 80 children (aged 2 -6,weight 10 -25kg,ASAⅠ -Ⅱ)with high ligation of hernia sac were divided into two groups according to the random number table method:group S -sevoflurane combined with inguinal region block under laryngeal airway ventilation;group K -ketamine combined with caudal block.Group S was inhalated with 6% -8% sevoflurane for foundation anesthesia,and then followed with vein induction:fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interop-eration.Group K was adopted the intramuscular ketamine (5mg/kg)for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move,choking cough,etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0 ),1min after skin cutting (T1 ),5min after skin cutting (T2 ),the end of operation (T3 )and awaken time (T4 ).The body movement was observed intraoperation,the number of SpO2≤95% and awaken restlessness,the recovery time and residence time in anesthesia recovery room were recorded.Results The values of MAP in group S at time points of T1 ,T2 ,T3 were (77.6 ±6.2)mmHg,(77.8 ±6.4)mmHg,(76.5 ±4.7)mmHg respectively,and the values of MAP in group K at time points of T1 ,T2 ,T3 were (86.9 ±8.1)mmHg,(88.1 ±5.3)mmHg,(86.4 ±6.5)mmHg respectively.The t values at time points of T1 ,T2 ,T3 were 5.766,7.893,7.806 respectively when the group S compared with group K(P <0.0001),the group S was superior to group K.The values of HR in group S at time points of T1 ,T2 ,T3 were (121.3 ± 9.6)times/min,(121.9 ±8.4)times/min,(120.3 ±7.8)times/min respectively,and the values of HR in group K at time points of T1 ,T2 ,T3 were (138.6 ±9.4)times/min,(136.5 ±7.5)times/min,(128.7 ±6.9)times/min respec-tively.The t values at time points of T1 ,T2 ,T3 were 8.144,8.200,5.101 respectively(P <0.0001),the group S was superior to group K.The MAP and HR were more smoothly in group S than in group K.The recovery time in group S and K was (7.5 ±3.4)min and (16.7 ±5.5)min respectively(t =8.99,P <0.0001),it was shorter in group S than in group K.The residence time in anesthesia recovery room was (15.4 ±4.2)min and (23.7 ±6.3)min respectively (t =6.93,P <0.0001),it was shorter in group S than in group K.Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2 =10.32,P <0.001);Cases of SpO2 ≤95% was 4 and 12 respec-tively in group S and group K(χ2 =10.32,P <0.001),the occurrence of body movements and SpO2 ≤95% cases was lower in group S than in group K.Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction,faster recovery,the hemodynamics was more stable,adverse reactions was fewer and so on,it can be safely used in pediatric anesthesia.

Objective To explore the anesthesia effect and influence of combined spinal epidural anesthesia (CSEA)with head -up of 10°on maternal hemodynamics during cesarean section.Methods 120 pregnant women undergoing cesarean section were selected,and were randomly divided into group A,B and C,40 cases in each group. Three groups were all given CSEA,yet pregnant women in group A were taken supine position,group B was taken head-up of 10°,and group C was taken head -up of 20°.Hemodynamic parameters of three groups of the following time points were compared,including before anesthesia(T0 ),5min after anesthesia(T1 ),skin incision(T2 ),fetal disen-gagement immediately(T3 ),and operation at the end(T4 ),also anesthesia effect was recorded,and usage of ephedrine and local anesthetic was noted,and adverse reactions were compared.Results Compared with T0 ,group A's hemody-namics in T1 decreased,including systolic blood pressure (SBP),diastolic blood pressure (DBP),and increased in T2 and T3 ,yet there were no statistical differences on hemodynamics in three groups in T4 .Compared with group B and C,there were statistical differences on hemodynamics in T1 ,T2 and T3 in group A(t =3.63 -7.25,P <0.05 or P <0.01),yet there were no statistical differences on hemodynamics in group B and C(t =0.00 -0.93,all P >0.05). Anesthesia block scores in group A,B and C were (2.0 ±0.3)points,(2.5 ±0.2)points,(2.6 ±0.2)points,and scores of B and C were higher than that in group A(t =3.92,4.01,all P <0.05).Cases and total usage of ephedrine in group A were higher than those of group B and C(χ2 =31.43,50.61,t =16.27,20.17,all P <0.01).Cases of adjusting surgical position,and addition of local anesthetic in group C were significantly higher than those of group B (χ2 =23.85,28.47,all P <0.01).Conclusion It has better anesthetic effect of taking CSEA by head -up of 10°, and maternal hemodynamics are more stable,can better meet operation's requirements,also with easier operation,so it is superior to supine position and head -up of 20°.

Objective To determine if thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension. Methods Eighteen patients with congenital heart disease complicated by pulmonary hypertension were studied. Age ranged from 14 to 31 yr and body weight from 35 to 57 kg. The patients were premedicated with intramuscular pethidine 1 mg? kg-1 and scopolamine 0.3 mg. Swan-Ganz catheter was inserted through internal jugular vein. The patients were randomized to receive thiopental 2 mg?kg-1 , propofol 1 mg?kg-1 or ketamine 1 mg?kg-1 administered slowly via Swan-Ganz catheter for induction of anesthesia. MAP, high arterial pressure (RPA), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) and pulmonary vascular resistance (PVR) were measured before induction of the intravenous anesthetics. Results PVR unchanged significantly after ketamine , thiopental and propofol as compared with the baseline value. MAP was significantly decreased after injection of thiopental and propofol. Conclusion Thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension.

Ojective To investigate therapeutic results of conservative operation with laparoscopy for all kinds of patients with tube pregnancy. Methods 62 patients with tube pregnancy were performed the conservative surgery, fenestration on the position of tube pregnancy or take out embryos from the tube crevice combined with injection of MTX under laparoscopy. Results all of 61 patients' tube were retained successfully. no complications occurred, urine HCG recovered to normal levels two weeks after operation. Only one patient continue to pregnancy and completely recovered after intramuscular injection MTX. 18 patients were carried out HSG 1～4 months after operations. 15 patients' tube among them were unobstructed. Opening rate was 88.3%. Within postopeative four years, 12 patients were repregnant. Pregnancy rate was 66.7%. Conclusions Tube pregnancy conservative treatments under laparoscopy not only is safe and minimal invasion, but also had less complications, therefore it is a more suitable method for retaining the fertile females' tubes.

Objective To investigate the possibility of differentiation of multipotent adult progenitor cells from human bone marrow(hMAPCs) into hepatocytes with hepatocyte growth factor (HGF) and fibroblast growth factor-4 (FGF-4) in vitro to find a new cell source for liver tissue engineering. Methods (1) Harvest of the hMAPCs: The bone marrow mononuclear cells were obtained from bone marrow obtained from volunteers by gradient centrifuging. The adherent mononuclear cells were cultured. The mesenchymal stem cells(MSCs) were isolated and collected by magnetic activated cell sorting(MACS) through depletion selection by the use of CD45 and GlyA microbeads. (2) The hMAPCs were induced to differentiate with HGF(20ng/ml) +FGF-4(10ng/ml). L-02 human hepatocytes (cell lines) were used as the control, with undifferentiated hMAPCs serving as the contrast. (3)The expression of albumin (ALB), alpha fetoprotein (AFP), cytokeratin-18(CK-18), cytokeratin-19(CK-19) was detected with immunocytochemistry to identify the characters of the differentiated cells at different time, and to determine the ratio of positive cells. (4) ALB expression of the differentiated cells at different time was detected by Western blot on day 21 and 25. Results (1) The result of immunocytochemistry: The differentiated hMAPCs expressed the late markers (ALB, CK-18) of hepatocyte at all the time but did not express CK-19. The differentiated hMAPCs expressed AFP on day 7. (2) The result of Western blot assay: the differentiated cells expressed the late markers (ALB) of hepatocyte on day 21 and 35. Conclusions hMAPCs can differentiate into hepatocyte-like cells under specific inducing conditions.