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.

Objective To observe the immunohistochemical expression of lymphocyte subpopulationin in brain and spinal cord tissue,and explore the mechanism of Zuogui wan and Yougui wan on rats with experimental autoimmune encephalomyelitis(EAE).Methods Lewis rats were immunized with the myelin basic protein(MBP).120 rats were grouping randomly into normal group,EAE group,prednisone group,Zuoguiwan group and Youguiwan group after post immunization(PI).Rats in normal group and EAE group were administered normal soline,each 3 mL/d.Rats in prednisone group were administered suspension of prednisone after developed clinical signs,each 5 mg/kg.Rats in Zuoguiwan group were administered suspension of Zuoguiwan,each 2 g/kg,and rats in Youguiwan group were administered suspension of Youguiwan,each 3 g/kg.On 15th and 27th day after PI,rats were killed and the immunohistochemical staining was performed on the sections of brain and spinal cord.Results On 15th and 27th day after PI,the expression of CD4+ in brain and spinal cord tissue of EAE group were significantly higher than that in normal group(P

ObjectiveTo investigate the effects of two health education models on the psychology and nutrition of patients waiting for cadaveric renal transplantation.Methods A total of 125 patients waiting for cadaveric renal transplantations were involved in our study.They were diagnosed with chronic renal failure in our hospital during September 1, 2009 to August 30, 2010.The patients were randomly divided into control group (n = 62) and observational group(n = 63).Patients in the control group received traditional health education with routine preoperative education during hospitalization.In the observational group, full-time nurses assessed the nutrition status of each patient and monitored the data. The observational patients were followed up and were given dietary guidance and knowledge of transplantation.Various kinds of education formats were adopted in observational group to provide communication opportunities between patients and surgeons in charge as well as patients who underwent transplantation.Psychological testings of patients in both groups were tested by self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after the health education.Triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC) and biochemistry index were also tested.Psychological and nutritional status of patients in the two groups was compared.ResultsThere were no significant differences in scores of the SAS, SDS, TSF, Hb, and albumin (Alb) between the two groups (all P＞0.05) before health education.After health education, SAS and SDS in observational group were lower than those in the control group (40.02 ±9.05 vs 47.05 ± 10.32,42.70 ± 10.01 vs 50.83 ± 10.12; both P＜0.01).Both TSF and Hb were elevated after education (P ＜ 0.001 or 0.05).Alb was significantly elevated in the observational group [(35.67 ±6.19)g/L vs (37.48 ±5.09)g/L, P ＜0.01].ConclusionComprehensive and various health education methods can significantly alleviate mental stress and improve nutrition of the patients waiting for kidney transplantation, which is helpful for patients facing disease positively and having a better quality of

BACKGROUND: The data of epidemiological survey on rheumatic diseases such as ankylosing spondylitis (AS) are very rare in China, especially in Shenzhen. The comprehensive understanding of epidemiological situation of AS in Shenzhen can be used to draw up treatment plans by Shenzhen Health Bureau and some other health organizations.OBJECTIVE: To investigate the epidemiological features of AS.DESIGN: Randomized complete collection and cross-sectional investigation.SETTING: Shenzhen Rheumatism Institute of Guangdong Medical College. PARTICIPANTS: From December 2001 to April 2004, totally 6 684 adults aged over 16 years were selected from three regions (one region of river and lakes, one local mountain region and one inhabitant region) of Shenzhen. Among them, 5 922 adults (2 659 males and 3 263 female) were actually investigated and the investigative rate was 88.6%. Males were accounted for 44.9% and females were 55.1%, and the ratio was 1:1.23.METHODS: Step 1 and 2, the investigated individuals were questioned and their answers were recorded by the investigators. The questionnaire proceeded one by one for every individual and proceeded at homes. Step 3,the individuals with positive findings at steps 1 and 2 were examined by rheumatologic doctors. Step 4, individuals with suspected AS were subjected to human leukocyte antigen B27 (HLA-B27) assays, radiographies including plain pelvic films, plain lumbar-vertebral films and if necessary, radiographies at other areas of spinal column as well as peripheral joints.MAIN OUTCOME MEASURES: Frequencies of rheumatic complaints,prevalence rate of AS, positive frequencies of hum an HLA-B27, and comparisons with relevant data abroad.RESULTS: ① General frequency of rheumatism was 21.6%, and the highest complaint was at knee joint, then at waist, shoulder, neck and hand. In female, the frequencies of complaints at every joint mentioned above were higher than those in male (P ＜ 0.05). A total of 13 patients (4.7%) had to discontinue their work because of rheumatic diseases. ②Prevalence rate of AS was accounted for 0.37%, and the ratio between male and female was 4.5: 1. The onset of AS began at middle age in majority patients. ③ Positive frequency of HLA-B27 was 5.0%. ④ Rate of misdiagnosis, the rate of early diagnosis and the rate of long-term irrational drug-usage were 64%, 27% and 73%, respectively.CONCLUSION: In Shenzhen, the prevalence rate of AS (0.37%) is ranked higher than that in Beijing (0.26%), Shantou (0.26%), America(0.20%) and the whites of Greece (0.24%). The differences among them may be connected with the fact that in Shenzhen the young people occupy a large proportion of population.

Objective To research the experience of cardiac death organ donation based on the transplant coordinator.Methods Survey was made in The Third Xiangya Hospital of Central South University,and potential donors,data were collected from March to October,2010.Through defining four concepts:potential DCD donors,effective DCD donor,success ratio of DCD donor,rejection ratio of DCD donors,the DCD work was quantitatively analyzed.Results There were 16 potential DCD donors and 5 effective DCD donors,and the success ratio of DCD donor was 31.3 0％ (5/16).In the 11 failure cases,there were 3 cases (27.3 ％) whose family refused to donate,3 cases (27.3 0％) whose family had no consentaneous opinions on denotation,4 cases (36.4 ％) whose organ quality did not meet the criteria because of delaying time when dealing with various kinds of disputes or coordinating with various departments,and one case (9.1 ％ ) whose donated organ was unqualified.Rejection ratio of DCD donors was 37.5 ％ (6/16).Conclusion We need to do efforts to further improve the potential DCD donors,discovery.Transplantation coordinator plays an important role in human organ donation work,whose communication skills and professional knowledge still need to be further trained.It is not enough to just rely on the medical department and Red Cross,human organ donation work needs the collaborative participation among the administrative department,the traffic department and the department of justice.

Objective To assess the safety and efficacy of gabapentin in treatment of refractory uremic pruritus in maintenance hemodialysis (MHD)patients. Methods A randomized controlled trial was performed.Forty-nine MHD patients with severe pruritus were randomly divided into treatment group(gabapentin 100-300 mg at dialysis day before sleep)and the control group(loratadine 10 mg daily).The efficacy was assessed by visual analogue score,pruritus score and improved Duo's VAG Score after 12-week treatment,and the side effect was also observed to assess the safety. Results After treatment,the frequency,degree and area of pruritus in 25 patients of treatment group were significantly reduced,and VAS score(1.46±1.38vs 8.71±1.17,P＜0.01),VAG score(2.92±1.63 vs 8.29±0.68,P＜0.01)and the improved Duo's pruritus score(11.33±3.99 vs 30.75±4.87,P＜0.01)decreased significantly compared with that of prior treatment.The symptoms of 24 patients in control group were improved partly,which were not as good as those in treatment group(P＜0.01).The side effects of gabapentin were drowsiness and dizziness,but most symptoms were relieved or disappeared within 1 week and no patient interrupted therapy.No serious adverse events were observed. Conclusion Gabapentin is safe and effective for refractory uremic pruritus,but long-term efficacy and safety requires larger sample and long-term observation.

Objective To evaluate the efficacy of pressure-controlled volume-guaranteed (PCVVG) mode for lung protective ventilation in patients requiring one-lung ventilation (OLV) during thoracoscopic surgery.Methods Sixty patients,aged 50-70 yr,with body mass index of 18-26 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of esophageal cancer performed via video-assisted thoracoscope under general anesthesia,were divided into 2 groups (n=30 each) using a random number table:volume-controlled ventilation group (group V) and PCV-VG group (group P).The ventilator settings were adjusted,with a tidal volume 10 ml/kg and respiratory rate 10-12 breaths/min during two-lung ventilation,and with a tidal volume 6 ml/kg and respiratory rate 12-16 breaths/min during OLV.The inspiratory/expiratory ratio was 1 ∶ 2,pressure restriction was 35 cmH2O,and 33％ oxygen was inhaled at 2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg.Visual analog scale score was maintained ≤ 3 after operation.After admission to the operation room (T0) and at 1,3 and 7 days after operation (T1-3),forced vital capacity (FVC),forced expiratory volume in first second (FEV1),and maximal mid-expiratory flow (MMEF) were measured,arterial blood samples were collected for blood gas analysis,arterial carbon dioxide partial pressure and arterial oxygen partial pressure (PaO2) were recorded,and alveolar-arterial oxygen tension difference (PA-a O2) was calculated.Clinical Pulmonary Infection Score was assessed at T1,T2 and T3.The chest tube removal time and length of postoperative hospital stay were recorded.Results Compared with the baseline at T0,FVC,FEV1,MMEF and PaO2 were significantly decreased,and PA-aO2 was increased at T1-3 in the two groups (P＜0.05).Compared with group V,FVC,FEV1,MMEF and PaO2 were significantly increased,PA-aO2 and Clinical Pulmonary Infection Score were decreased,and the chest tube removal time and length of postoperative hospital stay were shortened at T1-3 in group P (P＜0.05).Conclusion PCV-VG mode can achieve lung protective ventilation,which is helpful in improving outcomes in the patients requiring OLV during thoracoscopic surgery.

Aim To investigate the effect of intracerebroventricular morphine postconditioning against ischemia-reperfusion injury in rat heart and the mechanism of the central nervous system opioid receptor.Methods Forty-two Sprague-Dawley Rats were established intracerebroventricular catheter placement and myocardial ischemia/reperfusion models and randomly assigned to 7 groups:Sham group(Sham),control group(CON),intravenous control group(VCON),morphine postconditioning group(POC),intracereborventricular morphine postconditioning group(MOC).According to the dosage of intracerebroventricular morphine(3 ?g?kg-1,0.3 ?g?kg-1,0.03 ?g?kg-1),MOC group was assigned to three groups :MOC 1,MOC 2,MOC 3.Infarct size(IS),a percentage of the area at risk(AAR) was determined by triphenyltetrazolium(TTC) staining.c-fos expression in nucleus of tractus solitarius was determined by immunohistochemical method and Cardiac TroponinI(cTnI) of serum was observed at 120 min of reperfusion.Results Compared with control group,IS,IS/AAR and cTnI were significantly reduced in POC and MOC groups(P0.05).c-fos expression in nucleus of tractus solitarius were significantly reduced in MOC 2,POC(P

Objective To investigate the clinical significance of CGRP level and gene sequence in congenital heart disease(CHD)with pulmonary hypertension.Methods The level of serum CGRP was tested by radioimmunoassy in 36 children with left to right shunt CHD,including 29 children with different severity of pulmonany hypertension(PH).Echo cardiography pulse wave Doppler tested the ratio of the pulmonary and systemic arterial pressure.The exon 5 in CGRP gene was directly sequenced in these patients. Results There were significant differences in serum levels of CGRP between the patients with mild PH and control group.The levels of serum CGRP were significantly decreased in patients with moderate or severe PH.There was significant negative line correlation between the levels of CGRP and pulmonary pressure.Base mutation were not found in the exon 5 in CGRP gene.Conclusion The CGRP might be involved in the pathophysiologic process of pulmonary hypertension in CHD.There is no gene expression polymorphism in encode sequence in CHD patients with pulmonary hypertension.

OBJECTIVE:To provide basis for the further implementation of the national essential medicine system in township hospitals. METHODS:By issuing questionnaires,an investigation was made on the basic information of township hospitals imple-menting“Health Ⅺ project”in Heilongjiang Province before and after the implementation of the national essential medicine system. Prescriptions of 4 days in 2008 and 2012 were extracted,statistically compared and analyzed by using random system cluster sam-pling medication rationality was evaluated. RESULTS:40 questionnaires and 3 173 prescriptions were recycled during the investiga-tion in 2009,and 40 questionnaires and 4 197 prescriptions were recycled in 2013. Compared with the township hospitals in project areas in 2008,the proportion of practice(assistant)physicians per township hospitals and the average number of beds were respec-tively increased by 1.5%and 4.6 in 2012. The average kind of prescription drugs was decreased from 2.9 kinds to 1.7 kinds,the us-age rate of infusion was decreased from 46.5%to 30.6%,antibiotics was decreased from 61.5%to 40.0%,two or more kinds anti-biotics was decreased from 18.9% to 4.8%,hormone was decreased from 11.9% to 4.2% and the rate of combined use of antibiot-ic and hormone was decreased from 9.2% to 2.8%;the drug expenditure of each outpatient service and hospitalization was respec-tively decreased 19.1% and 16.4%. There were significant differences(P<0.05). CONCLUSIONS:After the implementation of na-tional essential medicine system,the medication rationality of township hospitals in project areas has made great improvement,es-pecially on the aspects of prescription drug number,the combined usage rate of antibiotic and hormone,the usage of hormone and the drug expense burden,which reaches the policy targets;although the infusion rate and the usage of antibiotic show great im-provements,there are still some gaps between the current situation and the policy targets;the obvious decrease of the average drug expenditure of each service doesn’t make a relative decrease of the average expenditure of each medical service,which has a little increase.