Neuromuscular blocking agents are widely used in ICU.It is an assistant treatment for nearly 25％ to 55％ patients with acute respiratory distress syndrome(ARDS).But there is controversy about the use of neuromuscular blocking agents in patients with ARDS.This review aim to discuss the use of neuromuscular blocking agents in patients with ARDS.

Objective:To reveal the effects of different doses of naloxone on moderate and severe acute head injuries by monitoring of qEEG.Methods:86 patients with moderate and severe acute head injuries (Glasgow Coma Scale 3～12,within 12 hours after injury) were selected for this study.According to the severity of injury,all patients were classified into three groups: GCS3～5,GCS6～8 and GCS9～12.Patients of each group were then randomly assigned to treatment with naloxone or control.In naloxone groups,low doses of naloxone and high doses of naloxone were administered respectively to the patients with acute brain injury of different severity for three days.Relative power of ? frequency and absolute power of 1～25 frequency were monitored with qEEG before and 30 minutes,1,2,24,48,72,120 hours after administration.Results:In GCS 9 to 12 group,relative power of ? frequency and absolute power of 1～25 frequency were significanfly different ( P 0.05).In GCS 6 to 8 group,the two parameters were improved significanfly in naloxone groups and were significantly different between low dose and high dose naloxone groups.In GCS 3 to 5 group,all parameters were not significantly different between naloxone group and control group.Conclusion:These results suggest that treatment with naloxone in patients with moderate and severe head injuries is beneficial in terms of improved qEEG and there is no significant difference between low dose and high dose naloxone in GCS 9 to 12 group,but in GCS 6 to 8 group high dose naloxone shows better efficacy than low dose naloxone.

objective:To discuss the characteristics and localizing significance of presurgical scale ambulatory electroencephalo-gram(AEEG)in patients with supratentorial tumor by comparison their electrocorticography(ECOG).Methods:124 subjects were collected in our hospital.All patients were monitored by the scalp AEEG before surgeries and ECOG during oprating.The interictal epileptiform discharges of ECOG were divided into five catalogs.Ⅰ:no spikes.Ⅱ:isolated spikes.Ⅲ:repetitive spike-wave pattern.Ⅳ:intermittent spikes,polyspikes waves burst.Ⅴ:continuous hyper-spikes and sharps.A,B,C,D and E were represented on the scalp AEEG which corresponded the above ECOG classification.Then AEEG and ECOG were analyzed.Re-sults:(1)The scalp AEEG was abnormal in 83.87% of all subjects before surgery.Ⅱ type and Ⅲ type on ECOG did not appear easily on the scalp AEEG(P

Objective To explore the effect of continuity of midwifery service model on delivery outcomes in pregnant women. Methods From January 2015 to June 2016,100 single pregnant women with full-term and cephalic presentation who accepted midwife outpatient education were selected from our hospital and divided into observation group, at the same time,100 cases of full-term and cephalic presentation accepting obstetrics regular check as control group. Both delivery methods and total labor time were compared between two groups; the rates of episiotomy, weight gain during pregnancy, postpartum hemorrhage, neonatal asphyxia and macrosomia were all observed. Results The observation group maternal weight gained, the total labor time were (12.26±0.95) kg, (445.21±246.34) min, the control group were (14.48± 1.89) kg, (642.26±258.81) min, there wwa significant difference (t=-10.534,-3.456, P < 0.01).The observation group cesarean section rate, postpartum hemorrhage rate, the rate of fetal macrosomia were 29%(29/100), 2%(2/100), 3%(3/100), the control group were 45%(45/100),10%(10/100),12%(12/100), there was significant difference (χ2=7.040, 5.674, 5.838, P<0.05). In the observation group, the rate of perineal resection were 26% (26/100) and 0 respectively, the control group were 30%(30/100) and 2% (2/100), there was no difference between the two groups (χ2=1.109, 2.020, P > 0.05). Conclusions Continuous care provided by midwife can effectively promote natural birth, reduce the incidences of macrosomia and postpartum hemorrhage, enhance the quality of obstetric services, is worth promoting in clinical application.

Objective To investigate the effect of dexamethasone(DXM)and fructose-1,6-diphosphate(FDP)on cardial troponin I(cTnI)and MB isoenzyme of creatine kinase(CK-MB),and ultrastructure of myocardial cells in rats with endotoxemia.Methods Eighty SD rats were randomly divided into 4 groups:sodium chloride group(NS group,n=8),9 g?L-1 NS 1 mL,ip;lipopolysaccharide group(LPS group,n=24),administered with endotoxin(5 mg?kg-1,ip);DXM group(n=24):received DXM(5 mg?kg-1,ip)after injection of LPS 1 h;FDP(n=24)group,received FDP(1 g?kg-1,ip)after injection LPS 1 h.Then,they were sacrificed at 6 h,12 h,24 h and 72 h after injection.CK-MB and cTnI in blood were detected with chemiluminescent techniques,and myocardial pathological damage was observed under the light and transmission electron microscope.Results Compared with control group,in LPS group,the serum cTnI and CK-MB were increased significantly from 6 h to 24 h with time going by(P

Objective:To explore the relationship between glycosylated hemoglobin (HbA1c)and carotid artery atheroscle-rosis in aged patients with normal glucose tolerance.Methods:A total of 100 aged patients with normal glucose tolerance were selected.Their bilateral carotid arteries were measured by color Doppler ultrasonography.They were grouped accord-ing to carotid intima-media thickness (C-IMT,normal,thicken and atherosclerosis)and plaque form (no plaque,hard plaque and soft plaque);blood pressure,blood lipids and HbA1c etc.were compared among groups.Results: (1)Along with CIMT rose,there was significant increase in HbA1c level [(4.98 ± 0.55)% vs.(5.51 ± 0.42)% vs.(5.92 ± 0.39)%],and there was significant difference between any two groups (P<0.01 all);(2)HbA1c level was (5.36±0.51)%,(5.89±0.44)% and (5.97±0.2)% in no plaque group,hard plaque group and soft plaque group respectively,and there was significant difference among hard plaque group,soft plaque group and no plaque group (P <0.01 all).Conclu-sion:Glycosylated hemoglobin may become an important index assessing carotid atherosclerosis in aged people.

Aim Toinvestigatetheroleofhyperglyce-mia in cerebral ischemia/reperfusion(I/R)injury with a middle cerebral artery occlusion(MCAO)rat model anditsmechanism.Methods EightyhealthymaleSD rats were randomly assigned into sham group, I/R group (normoglycemia),hyperglycemic I/R groupⅠ(HG1 )and hyperglycemic I/R groupⅡ(HG2 ).The cerebral I/R model was established by occluding the middle cerebral artery(MCA)in rats.Hyperglycemia was induced by intraperitoneal injection of 50% glu-cose solution.Neurological deficit was determined by Ludmila Belayev test;infarct size and brain edema were measured by TTC staining;mitophagy was ob-served by double immunofluorescent staining and elec-tron microscope.The expressions of autophagy-related proteins(LC3 and Beclin-1 )and apoptosis-related pro-teins(Cyt-C,AIF,caspase-9 and caspase-3 )were ex-aminedbyWesternblotfurtherly.Results Bloodglu-cose level was controlled at 4 mmol·L-1 (normoglyce-mia),10 mmol · L-1 (HG1 ) and 20 mmol · L-1 (HG2)respectively.There were no significant differ-ences between model group and HG1 group in neuro-logical deficit scores,infarct volume and edema size(P>0. 05 ).However,these indications in HG2 group were significantly increased compared with model group (P<0. 05 ).After 3 days of reperfusion,the level of mitophagy was significantly reduced accompanied with increased mitochondria damages in HG 2 group (P <0. 05 ),and the expressions of mitochondrial related ap-optotic proteins(Cyt-C,AIF,caspase-9 and caspase-3 ) were significantly increased accordingly compared to modelgroup.Conclusions Mildhyperglycemiacan not intensify the cerebal ischemic injury.In contrast, severe hyperglycemia significantly aggravates the brain ischemic injury by inhibiting the removal of injured mi-tochondria in a manner of mitophagy,thus amplifying the mitochondrial mediated cascade damage responses.

Objective To explore the diagnostic value of serum ischemia‐modified albumin (IMA) ,lipoprotein‐associated phos‐pholipase A2 (Lp‐PLA2) and cardiac troponin I (cTnI) in acute coronary syndrome (ACS) .Methods The levels of serum IMA , Lp‐PLA2 and cTnI were detected in 138 cases of ACS ,including 79 cases of acute myocardial infarction (AMI) ,59 cases of unstable angina pectoris (UAP) ,and the detection results were compared with those in 50 individuals undergoing physical examination(con‐trol group) .The levels of serum IMA ,Lp‐PLA2 and cTnI were compared among various groups .The receiver characteristic curve (ROC) was drawn to evaluate the diagnostic value of IMA ,Lp‐PLA2 and cTnI in ACS .Results The levels of serum IMA ,Lp‐PLA2 and cTnI in patients with UAP and AMI were higher than those in the healthy control group ,and there was statistical differ‐ence between them(t=7 .286 ,8 .589 ,8 .952 ,P<0 .01) .Comparing with the UAP group ,the levels of serum IMA ,Lp‐PLA2 and cTnI in the AMI group were significantly increased(t=4 .063 ,5 .987 ,2 .062 ,P<0 .05) .In the ROC curve analysis ,the area under ROC curve (AUC) of IMA ,Lp‐PLA2 and cTnI were 0 .821 ,0 .843 and 0 .852 respectively .Conclusion The levels of serum IMA , Lp‐PLA2 and cTnI can be used for monitoring and early diagnosis of ACS .

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria in PICU and to provide evidence for use of antibiotics rationally.Methods All the basic clinical features and pathogenic bacteria isolated from patients in PICU of our hospital from October 2009 to September 2012 were analyzed retrospectively.Results A total of 672 pathogenic bacterial strains were isolated (positive rate 16.7％ 672/4 020),75.1％ and 24.9％ were gram negative bacteria and gram positive bacteria,respectively.Pseudomonas aeruginosa was the most common bacteria isolated in gram negative bacteria,followed by Klebsiella pneumonia and Escherichia coli in this order.And Staphylococcus was the main strain in gram positive bacteria.Positive specimens were mainly from lower respiratory tract and bloodstream infection.Most Staphylococcus were resistant to penicillin,oxacillin and erythromycin but susceptible to vancomycin,teicoplanin and linezolid.Gram negative bacteria were resistant to ampicillin,ampicillin-sulbactam,piperacillin and cephalosporin,but susceptible to imipenem,cefoperazone-sulbactam,piperacillin-tazobactam,ciprofloxacin and amikacin.Conclusion Gram negative bacteria is the prevalent strains in PICU of our hospital,Pseudomonas aeruginosa,Klebsiella pneumonia and Escherichia coli are common bacterium isolated.Most isolates are highly drug-resistant.Analysis of pathogenic bacteria and drug-resistance surveillance are of vital importance to guide treatments for critically ill children and reduce drug-resistant bacterial strains.

Objective To investigate the clinical features of unintentional injuries in children,and to provide the theoretical basis for preventing and intervening the occurrence. Methods We collected the data of children aged from 0 to 14 years old and hospitalized in the First Affiliated Hospital of Guangxi Medical University from January 2013 to December 2015. Results There were 2286 cases of children including 1507 boys(65. 92%) and 779 girls(34. 08%). The high incidence age was 1 to 3 years with a total of 896 cases(39. 19%). The first five causes of unintentional injuries were burns/scalds 840 cases(36. 71%),fall/drop 464 cases(20. 30%),blunt force injury 290 cases(12. 68%),foreign bodies(in the esophagus,airway, etc) 253 cases(11. 07%),and sharp object injury 153 cases(6. 68%). The unintentional injuries of different age group were varied,for example,the common causes of 1 to 3 years old group were burns /scalds and for-eign bodies(in the esophagus,airway,etc),and the main injuries in 6 to 14 years old group were fall/drop and blunt force. Furthermore, the proportion of unintentional injuries in rural children was 1547 cases (67. 67%),and in the urban children was 739 cases(32. 33%). Unintentional injury with serious conse-quences included burns/scalds 55 cases(26. 96%),sharp object injury 45 cases(22. 06%),burns/scalds 26 cases (12. 75%),blast injury of 23 cases(11. 27%) and fall/drop 20 cases(9. 80%). Disable/sequel hap-pened in 204 cases(8. 92%). Ten cases died(0. 44%) including fall/drop in 4 cases,traffic accident in 3 cases(30%). Conclusion Young children aged 1 to 3 years are the most vulnerable to unintentional inju-ries. Burns/scalds and foreign bodies( in the esophagus,airway,etc) are the most common causes of injuries, and the boys are more common than girls. Moreover,the incidence rate of unintentional trauma in rural chil-dren was higher than that in the urban children. Unintentional injury complicated serious consequences are burns/scalds,sharp object injury,blast injury and fall/drop. Death cases in the majority are fall/drop and traf-fic accident. The key to reduce the occurrence of unintentional injuries is to strengthen propaganda of preven-tion knowledge about the children′s unintentional injuries.