The early mortality of sepsis patients has been largely decreased since the publication of the Surviving Sepsis Campaign guidelines.However, the poor long-term prognosis, high 3-year mortality, impaired mental and physical functions, and tremendous financial burden constitute a new challenge to the treatment of sepsis.Persistent inflammation immuno-suppression catabolism syndrome (PICS) is known to be a definite factor affecting the long-term prognosis of sepsis.This article presents a systematic review of the concept, pathogenesis and treatment strategies of PICS, hoping to provide a new approach to the diagnosis and management of sepsis.

Critical care medicine is an emerging unique specialty developed from the later 20th century,since then,it has been enriched with theoretical and practical experiences and becomes the most active subject in the field of clinical medicine.Critical care medicine of the PLA has attained significant achievements in the treatment and research of severe trauma,sepsis,severe heat stroke,multiple organ failure and severe acute pancreatitis.Besides,it stands in the leading position in the organ function maintenance of critically ill patients,continuous hemofiltration and nutrition support in China.Furthermore,critical care medicine plays an important role in the rescue of critically ill patients,medical support and disaster relief.As the relationship between battle wound rescue system and critical care medicine has been increasingly close,transition in the form of war in the new period brings new tasks to battle wound treatment constantly.Combined with the characteristics of information-oriented war condition in the future,developing the PLA critical care medicine and advancing the level of battle wound treatment in the new period point out the direction for the future work of critical care medicine.

Patients with SAP have a hypermetabolic and hypercatabolic state.Nutritional support for patients with SAP is needed.EN by the jejunal route does not stimulate pancreatic secretions and is safe.At present,the beneficeal effects of EN towards improving the nutritional condition,protecting gut barrier function,reducing translocation of bacteria and endotoxins,modulating the inflammatory response,and decreasing the cost have been observed.Therefore,the EN rather than PN should be used by the jejunal route to provide nutritional support for patients with SAP.

In recent years,some investigations show that gut barrier dysfunction induced by severe acute pancreatitis was an important factor to determine the prognosis. Consequently, pathogenesis, monitoring standard was and treament of pancreatitis associated gut barrier dysfunction are becoming hot spots.

Objective:To investigate the distribution of infection pathogens and their drug resistance in acute severe pancreatitis patients. Methods:Retrospective analysis was made on all pathogenic bacteria and their drug resistance of infection among 78 patients with acute severe pancreatitis patients. Results:Among 78 patients with acute severe pancreatitis 75 patients were cured,3 patients were dead.Of 286 clinical isolates,Gram negative organisms accounted for 61.19%,Gram positive ones 32.17%,fungi(6.64%).They resisted to antibiotics at high degrees.Among 92 strains of gram positive organism,60 were drug-resistance;also 172 strains of gram negative organism,above half were drug-resistance. Conclusion:Patients with acute severe pancreatitis are at high risk of infection.Due to drug-resistance are at high degrees in infection pathogens,effective drainage should be adopted to accelerate treating the infection besides selecting correct antibiotics according to the antibiotic sensitive essay results.

Increased catabolism, including reduced protein synthesis rates and increased protein degration rates, is common in patient with trauma and sepsis. There has been a long time search in how to reverse the increased catabolism. Besides nutritional support, people hope manipulation of anti catabolism hormone might reverse or at least ameliorate catabolism. Recent researches indicate that the GH IGF IGFBP axis plays a crucial part in regulating the metabolism of muscle protein on both basal and stress condition. This article aims to review the changes in GH IGF IGFBP axis and its clinical significance associated with trauma and sepsis.

Objective To clone and analyze rat albumin gene. Methods Total RNA was prepared from rat hepatocytes. cDNA fragment encoding rat albumin was amplified by RT-PCR, and then was cloned into pGEM-T vector. Inserted rat gene was sequenced by ABI PRISM 377DNA Sequencer. Meanwhile, the albumin mRNA expression was observed in hepatocytes treated with 1ng/ml and 1g/ml LPS. Results Rat albumin gene was successfully cloned. The expression of albumin mRNA was inhibited by LPS, and the inhibition was dose dependent. Conclusion The cloned rat albumin gene was composed of 401 base pairs and had 100% nucleotide homology with that reported in Genbank. The albumin expression was decreased in hepatocytes treated with LPS. A stable method of semi-quantitative analysis of rat albumin mRNA was established.

Objective: To determine the related factors of vitamin metabolism after trauma and sepsis.Methods: The control group consisted of 20 healthy volunteers and 20 trauma or sepsis patients were selected into trauma-sepsis group.Body weight,body temperature,hct,wbc account and Apache Ⅱ scores were registered and plasma vitamins were measured,and the relationships among them were assessed with linear regression. Results: In these patients,plasma vitamin A,vitamin E and vitamin C were significantly lower than those in healthy volunteers,and plasma vltamin A,E and C were correlated with Apache Ⅱ score obviously. Conclusion: There were vltamin A,E and C deficiencies in trauma and sepsis patients,and the vitamin deficiencies were correlated with the severity of illness.

Objective To study the effects of vitamins A, E, and C with TPN on antioxidation in peritoneal sepsis. Methods The rat model of intraperitoneal infection was established by cecal ligation and puncture (CLP). Health male SD rats were divided into control group (CLP+TPN), treatment group (CLP + TPN + Vitamin A, E, C), and delayed-treatment group ( CLP + TPN + delayed use of Vitamin A, E, C). Levels of the vitamins, MDA, and GSH in plasma and liver were measured. Results Vitamins A, E, C and GSH in the control group were lower than those in the normal control, and MDA was higher. Vitamins A, E, C and GSH in plasma and the liver in the treatment group and delayed-treatment group were higher than those in the control group, but delayed-treatment group was lower than treatment group. MDA in the treatment group and delayed-treatment group was lower than that in control group, but delayed-treatment group was higher than treatment group. Conclusion Vitamins A, E, C with TPN may effectively ameliorate the oxidative injuries in peritoneal sepsis.

Vitamin E is an important nutrient to protect the integrity of body structure, metabolized mainly in liver. Recommended dietary allowance of vitamin E is 10 mg/d. As an important antioxidant, vitamin E can inhibit aggregation of blood platelet, prevent DNA damage and enhance immune function. As present, vitamin E is widely used for treating arteriosclerosis, preventing a few kinds of cancer and supporting treatment of trauma and infection.