Objective To investigate the significance of pulse indicating the continuous cardiac output (PICCO) technique in patients with post-trauma capillary leak syndrome (PTCLS). Methods Twenty traumatic patients with PTCLS received PICCO monitor from 2011 to 2014 were enrolled in this study. analyzed, The patients, with twelve males and eight females, aged from twenty three to fifty. And twenty patients in the control group, with ten males and ten females, aged from twenty one to fifty two. Twenty six patients were injuried by traffic, ten patients were injuried by crash and four patients were injuried by sword. No significant differences were found in age、gender、weight、scores of ISS、Murray and APACHEⅡof all patients. All patients were survived. The balance of fluids, Lactate, Central venous oxygen saturation (ScvO2) and the mean artery pressure (MAP) were compared at 0, 24, 48 and 72 h after entering into the ICU. The duration of ICU stay and ventilation were also compared. Results (1)No significant differences in MAP、Lac and ScvO2 were observed in two groups. (2)No significant differences in the balance of fluids when patients entered into ICU, but significant differences were found at 24, 48 and 72 h post-entering into ICU (P < 0.05). (3)Significant differences in the duration of ICU stay and ventilation between the two groups were observed (P < 0.05). Conclusion PICCO technique can provid a quantitative target for PTCLS patients, with decreasing fluid infusion, and reducing the duration of ICU stay and ventilation.

Objective To investigate the changes of the serum vascular adhesion protein-1(VAP-1)and high sensitivity C reac-tive protein(hs-CRP) in diabetic nephropathy(DN) and the effects in the development of diabetic nephropathy .Methods 40 cases of DN were enrolled as the DN group ,39 cases of type 2 diabetic mellitus were enrolled as the T2DM group ,and 46 cases of healthy persons were enrolled as the control group .The levels of the serum VAP-1 and hs-CRP were tested by ELISA ,the blood glucose (Glu) was tested by autochemistry analyzer and the concentrations of glycosylated hemoglobin A-1(GHbA-1) was tested by high performance liquid chromatography(HPLC) .All the resoults were compared with that of the control group .Results the differences of the levels of VAP-1 ,hs-CRP ,Glu ,GHbA-1 in different groups were ststisticlly significant (P<0 .05) ,the levels of VAP-1 and hs-CRP were higher in DN group than that of T2DM group and the control group ,and the level of hs CRP was higher in T2DM group than that of control group .The positive correlation was found in T2DM group between VAP-1 with hs-CRP and Glu(r=0 .568 ,0 .755 ,P<0 .05 ,0 .01) ,hs-CRP with Glu and GHbA-1(r= 0 .886 ,0 .475 ,P< 0 .01 ,0 .05) ,and Glu with GHbA-1(r=0 .471 ,P<0 .05) .In DN group ,the level of VAP-1 has positive correlation with the levels of hs-CRP ,GHbA-1 ,Glu(r= 0 .521 , 0 .830 ,0 .454 ,P<0 .05 ,0 .01 ,0 .05) ,the levels of hs-CRP has positive correlation with that of Glu (r=0 .690 ,P<0 .001) .Conclu-sion the changes of the levels of Glu and GHbA-1 in patients with T2DM could affect the increase of VAP-1 and hs CRP ,high content of VAP-1 could cause microangiopathy and renal function damage .Antagonist therapy of VAP-1 is important for the pre-vention of the DM complication .

Objective To investigate the clinical effect of combined treatment of upper gastrointestinal bleeding in emergency internal medicine. Methods A total of 102 patients with upper gastrointestinal bleeding were enrolled in the Department of Emergency Gastroenterology, Peking Binhai University Hospital from June 2014 to October 2016. The patients were randomly divided into observation group and control group, 51 cases in each group.The control group were only given omeprazole sodium, tranexamic acid injection,the observation group were given Agkistrodon hemocoagulase for injection on patients on the basis of the control group.After treatment, the clinical curative effect of two groups of patients were evaluated, the hospitalization days, the average hemostasis time, blood transfusion, bowel recovery time, abdominal pain relief time, the adverse reactions occurred of the two groups were observed.Results The total effective rate of the observation group was significantly higher than that of the control group (P< 0.05). The hemostasis time,the time of hospitalization and the average blood transfusion in the observation group were significantly lower than those in the control group (P<0.05). The recovery time of bowel and the time of pain relief in the observation group were significantly lower than in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group.Conclusion Comprehensive treatment of upper gastrointestinal bleeding with emergency internal medicine can significantly improve the clinical efficacy, shorten the time of hemostasis and recovery, and is worthy of clinical application.

A magnetic separator was used to separate magnetic bacteria based on their magnetotactic characteristics. Acidithiobacillus ferrooxidans, a bacterium that could synthesize intra-cellular nanometer magnetic particles, was investigated as an example. Strong magnetic and weak magnetic cells were separated and collected. On average, the number of the magnetic particles present in the strong magnetic cells is more than that of the weak magnetic cells. Moreover, semisolid-plate magnetophoresis showed that the magnetotaxis of strong magnetic cells was stronger than the weak magnetic cells. These results suggest that the magnetic separator can be used to isolate the magnetic bacteria, which will facilitate the research of magnetic bacteria.
Acidithiobacillus ; isolation & purification ; metabolism ; Bacteria ; isolation & purification ; metabolism ; Bacterial Physiological Phenomena ; Bacteriological Techniques ; methods ; Magnetics

ObjectiveTo investigate the influence of the number of T-junctions between central venous catheter and pressure transducer on measurement of central venous pressure (CVP) in patients.Methods A prospective controlled study was conducted. The patients with CVP monitoring in Department of Critical Care Medicine of the Fifth Center Hospital in Tianjin from February to October in 2014 were enrolled. The patients were divided into three groups according to the number of T-junction between central venous catheter and pressure transducer: without T-junction control group and 1, 2, 3 T-junctions groups. In each patient, corresponding CVP values with different number of T-junctions placed between the central venous catheter and pressure sensors were determined within a certain period, and a square-wave graphic was obtained and preserved on the monitor. The own frequency (fn) and the attenuation coefficient (D) of the system of pressure measurement were calculated after measurement of the shock wave following a square-wave to obtain the distance between two vibrations and the amplitude of the shock wave. The difference in CVP, fn and D were compared among the groups.Results A total of 20 cases were enrolled, and 150 groups of data were collected.① With the increase in the number of T-junction, CVP showed a tendency of gradual reduction. The CVP of the groups of control and 1, 2, 3 T-junctions was (7.00±1.60), (7.00±3.00), (5.00±2.00), and (4.00±1.00) mmHg (1 mmHg = 0.133 kPa), respectively. The CVP of 3 T-junctions group was significantly lower than that of the control group (F = 9.333,P = 0.015).② With an increase in the number of T-junction, fn showed a tendency of gradual increase. The fn of groups control and 1, 2, 3 T-junctions was (12.30±0.79), (16.00±0.91),(18.10±1.75), (20.90±2.69) Hz, respectively. The fn of 1, 2, 3 T-junctions group was significantly higher than that of the control group (F1 = 45.962,F2 = 45.414,F3 = 46.830, allP = 0.000); the fn of groups 2 and 3 T-junctions was significantly higher than that of 1 T-junction group (F1 = 5.827,P1 = 0.042;F2 = 15.038,P2 = 0.004), but there was no significant difference between the groups of 2 T-junctions and 3 T-junctions (F = 3.800,P = 0.087).③ With an increase of the number of T-junction, D also showed a tendency of gradual increase. The D of 1, 2, 3 T-junction group was 1.62±0.27, 1.60±0.22, 1.82±0.25, and 2.15±0.58, respectively. There were no differences among four groups.ConclusionAfter the application of T-junctions between central venous catheter and pressure transducer, CVP values will be underestimated, the reason of which is considered to be the increase in length and thinner lumen of the T-junctions.

Objective:To compare the therapeutic effect of fluid resuscitation strategy guided by pulse-indicated continuous cardiac output (PiCCO) monitoring and early goal-directed therapy (EGDT) on renal function of acute kidney injury (AKI) patients caused by septic shock.Methods:Septic shock patients with AKI admitted to the intensive care unit (ICU) of Tianjin Fifth Central Hospital and Teda International Cardiovascular Hospital from March 2017 to February 2020 were enrolled. All patients were given fluid resuscitation. Patients were divided into PiCCO-guided fluid resuscitation group [PiCCO group, intrathoracic blood volume index (ITBVI) was maintained between 850-1 000 mL/m 2] and EGDT-guided fluid resuscitation group [EGDT group, central venous pressure (CVP) was maintained between 8-12 mmHg (1 mmHg = 0.133 kPa) or CVP ≤ 15 mmHg when patients received mechanical ventilation (MV)] according to both the patient's condition and the informed consent of the patient's family. The changes of heart rate (HR), mean arterial pressure (MAP), CVP, blood lactic acid (Lac), fluid balance, urine volume and serum creatinine (SCr) at 6, 24, and 48 hours after fluid resuscitation in the two groups were observed, and the renal replacement therapy (RRT), duration of MV, length of ICU stay and 28-day mortality between the two group were compared. Results:① A total of 94 patients were enrolled, including 51 in the EGDT group and 43 in the PiCCO group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, procalcitonin (PCT), HR, MAP, CVP, Lac or SCr at ICU admission between the two groups. ② The parameters of hemodynamics, fluid balance, urine volume and SCr were improved with the time of resuscitation in the two groups, and there was no significant difference in HR, MAP or Lac between the two groups. Compared with the EGDT group, the CVP decreased significantly at 24 hours and 48 hours after fluid resuscitation in the PiCCO group (mmHg: 9.1±0.9 vs. 12.0±1.3 at 24 hours, 8.0±1.0 vs. 10.2±1.3 at 48 hours), the fluid balance significantly decreased (mL: 2 929.8±936.3 vs. 3 898.4±923.5 at 24 hours, 3 143.5±1 325.4 vs. 4 843.8±1 326.7 at 48 hours), and the condition of urine volume and SCr were better in the PiCCO group [urine volume (mL·kg -1·h -1): 1.02±0.21 vs. 0.79±0.14 at 24 hours, 1.28±0.18 vs. 0.94±0.22 at 48 hours; SCr (μmol/L): 145.7±37.6 vs. 164.3±46.4 at 24 hours, 128.4±33.6 vs. 143.5±37.7 at 48 hours), with significant differences (all P < 0.05). ③ Compared with the EGDT group, the rate of RRT in the PiCCO group was lower [11.6% (5/43) vs. 17.6% (9/51)], the duration of MV and the length of ICU stay were shorter [duration of MV (days): 4.64±1.31 vs. 6.50±2.19, length of ICU stay (days): 10.35±3.50 vs. 14.50±5.78), with significant differences (all P < 0.05). There was no significant difference in the 28-day mortality between the PiCCO group and EGDT group [14.0% (6/43) vs. 15.7% (8/51), P > 0.05]. Conclusion:Fluid resuscitation strategy guided by PiCCO in septic shock patients with AKI can reduce the amount of fluid load, improve renal function, shorten the MV duration and length of ICU stay, and shows clinical significance.

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.

Objective:To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods:According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group ( n = 12) and seawater drowning group ( n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO 2/FiO 2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. Results:① Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05].② Respiratory parameters: compared with values before drowning, PaO 2/FiO 2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO 2/FiO 2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH 2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH 2O, 1 cmH 2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO 2/FiO 2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline.③ Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured.④ Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01).⑤ HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. Conclusion:The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH 2O (1 cmH 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.

Coronavirus disease 2019 (COVID-19) epidemic is the most widespread global pandemic in the past 100 years. Person-to-person transmission of COVID-19 infection leads to the major threat of human safety and health. At 00:00 on January 24th, 2020, Tianjin City launched the first-level response to the COVID-19 epidemic. At 18:00 on the same day, Management Committee of Dongjiang Free Trade Port Zone of Tianjin received areport that there were 15 people who had fever on the Costa Crociere carrying 4 806 people from Japan back to the home port of Tianjin Dongjiang Cruise. At the same time, there are more than 140 Chinese Hubei tourists. Tianjin Municipal Committee and Government, Tianjin Customs, Binhai New Area District Committee Government, Tianjin Health Commission, Tianjin Binhai New Area Health Commission formed an emergency command center immediately to deal with the epidemic comprehensively. At 06:40 on January 25th, 2020, the medical investigation team made up by Tianjin Binhai New Area Health Commission and Tianjin East Administration of Customs boarded the cruise ship. With reference to the customs inspection and quarantine regulations, in accordance with the Diagnosis and treatment of pneumonia caused by novel coronavirus (trial version 3) for mulated by the National Health Commission of the People's Republic of China and the Novel coronavirus infected pneumonia port control and technology plan (first version) formulated by the General Administration of Customs, combined with the actual situation of cruise ships, the medical investigation team developed the inspection standards, including door-to-door inspections, temperature measurement and epidemiological investigations on all persons on board of the cruise ship. A total of 4 806 person-times were investigated in the affected area, including 3 706 tourists and 1 100 crew members. Seventeen people at high risk of COVID-19 were identified, including three Wuhan tourists. The reports of 2019 novel coronavirus (2019-nCoV) nucleic acid detection on throat swab samples for those who were identified as high risk were returned as all negative at 14:54 on the same day. At 19:30, the medical investigation team completed the investigation and evacuated the cruise ship. The temperature measurement, medical observation and resettlement of passenger were handed over to relevant personnel. After 2 weeks, the follow-up result of 2019-nCoV nucleic acid of 17 high risk people were all negative. The overall command and comprehensive coordination of the onshore command center together with the rigid principles and excellent responds ability of the on-site epidemic investigation team ensured the successful completion of the epidemic investigation work, and also provided reference for further improving the management and disposal capacity of public health emergencies at sea.