Objective To investigate and analyze the cause of the illness, types and conditions combined with dysfunction of important organs and death of severe heatstroke patients in military hospitals in southern China. Methods 117 cases of heatstroke patients from Jan 1988 to Mar 2005 admitted to 8 military hospitals were retrospectively analyzed. Results 94.02% of the cases occurred during military drill; 10% of patients complained of slight discomfort before or during the drill; the incidence of thermoplegia, heat cramp and heat exhaustion were 43.26%, 42.55% and 13.86%, respectively, in severe heatstroke, and the respective death rate was 9.76%, 5% and 23%. The incidence of severe heatstroke combined with liver dysfunction was 31.9%, with central nervous impairment was 14.9%, and with MOF was 21.3%. All patients survived when no organ dysfunction occurred; the death rate in those with single organ dysfunction was 3.6%, while it was 35% in MOF patients. Conclusion An attempt to set up a predicting index of heatstroke might be beneficial for scientifically supervising the military drill for the servicemen. Reduction of the core temperature is the“the first critical point”in the treatment. Other “critical point” in the treatment may also be emphasized for those with MOF. The present therapeutic system for heat stroke as executed in the military needs to be perfected.

Terminology of persistent inflammation immunosuppression and catabolism syndrome (PICS) is developed based on the concept of multiple organ failure (MOF), which reflect that the preponderance is gradually reversed from pro-inflammation to anti-inflammation, and eventually the state of simultaneously persistent inflammation and severe immunosuppression appeared. Although the improvement of rescue technology and management increase the early survival rates of patient with critical illnesses, the long-term outcomes of most patients are not optimistic. The patients with PICS are difficult to treat or prevent, and are likely to indolent death and have a rising incidence, which is an important challenge to the intensive care unit (ICU). The paper review the understanding of PICS, summarize the specific changes of immune system in PICS, and explore the immunological markers for early recognition of PICS and judgment of immune state in order to provide new thinking for prevention and control of PICS.

Objective To investigate the functional changes of dendritic cells (DC) in elderly patients with sepsis. Method Elderly patients (n = 20), ages 75 to 86 years, treated in the department of internal medicine for cadres and the medical intensive care unit (MICU), were selected to participate in the study. Patients with ma-ligoant tumors, hematological diseases, immune diseases, or a history of receiving drugs known to interfere with immune functions were excluded. Using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definition of sepsis, the patients were categorized into four groups: non-sepsis (group A) (n = 5) ; sepsis (group B) (n = 5) ; severe sepsis (group C) (n = 5) ; and septic shock (group D) (n = 5). The peripheral blood mononuclear cells (PBMCs) of each patient were isolated and cultured with human re-combinant granuloceyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) in vitro for 10 days. The cells were examined under an inverted microscope, scanning electron microscopy, and flow cytometry. The MTT colorimetric assay was used to observe the abilities of the dendritic cells to stimulale an allogeneic T lym-phocyte response in vitro. Paired t -test was used to compare changes in the surface markers among the different groups, Results The PBMCs in the four groups of patients differentiated into cells with typical dendritic configura-tions after in vitro cuhure with combined cytokines. The CD40, CD80, CD86, and HLA-DR expressions on the cell surfaces increased after culture,with (43.2±12.5)%/(27.3±9.3)%, (31.4 ± 10.1)%/(22.5 ± 8.7)%, (39.3±15.7)%/(21.9±7.7)%, and (75.4±25.6)%/(58.7±16.7)%, respectively. The stimulation index (the abilities of the dendritic cells to stimulale the allogeneic T lymphocyte response in vitro) in the four groups of patients after culture were (23.3±7.9) in group A, (18.9±8.3) in group B,(11.4±5.1) in Group C,and (5.5 ± 3.7) in Group D. Conclusions The immune functions of the dendritic cells of elderly patients with sepsis decrease in a linear manner with the severity of their septic state.

Objective To investigate the effect of thymosin α1 on immunity,metabolism and prognosis in elderly patients with sepsis followed by persistent inflammation,immunosuppression,and catabolism syndrome (PICS).Methods In this retrospective study,68 patients diagnosed with sepsis followed by PICS in medical intensive care unit (MICU) from Jan.2014 to Dec.2016 were involved.Thirty-four patients treated with thymosin α1 for 2 weeks were allotted to the observational group;other 34 patients were to the control group.Patients' clinical information and data of laboratory test were collected in addition.We compared patients' general information,and the indexes before and after treatment,then the indexes between the two groups to analyze the effect of thymosin α 1 on immunity and metabolism;moreover,we conducted survival analysis and compared the mortality of different periods to analyze the effect of thymosin α1 on prognosis.Results The number of monocytes,the levels of CD4/CD8 and HLADR/CD14 before and after treatment in the observational group were significantly higher than those in the control group [(0.11 ± 0.31)× 109/L vs.(-0.16 ± 0.36)× 109/L,(0.20 ± 0.94) vs.(-0.22 ± 0.74) and (5.8 ±16.3)％ vs.(-3.3 ± 18.2)％ respectively],which suggested that the number of monocytes and the levels of CD4/CD8 and HLADR/CD14 were significantly increased by thymosin α1 intervention,and the difference were statistically significant(P ＜ 0.05).Kaplan-meier survival analysis showed prognosis between the two groups was not statistically significant (P ＞ 0.05).The further analysis of mortality in different periods indicated that the mortality within 28 days,90 days and 120 days and overall mortality between the two groups [8 (23.5％) vs.12 (35.3％),18(52.9％) vs.25 (73.5％),20 (58.8％) vs.27 (79.4％) and 24 (70.6％) vs.28 (82.4％) respectively],were not statistically significant(P ＞ 0.05).Conclusions Thymosin α1 can be used to regulate the immunity of elderly patients with sepsis followed by PICS,but its effect on regulating metabolism and improving prognosis needs further study.

Objective To investigate the methods and effectiveness of the physical therapy team management mode.MethodsAccording to the type of cerebral palsy and a certain ratio of beds and staff, the therapists were divided into 3 groups, and relatively fixed. They treated children with differrent types of CP and different beds by turn. The implementation of treatment was 3 years.ResultsAfter the physical therapy team management mode was executed, the therapist's theoretical knowledge and technical skill were upgraded, patient satisfaction raised, and the occurrence of accidental injury reduced.ConclusionThe physical therapy team management mode is conducive to standardize therapist behavior, improve the capacity of theory and practice of therapists and promote patient recovery.

ObjectiveTo study the effects of botulinum toxin type A (BTX-A) injection combined with functional training on the tiptoe deformation and gross motor function in children with spastic cerebral palsy (SCP). Methods60 SCP children with tiptoe deformation whose family consented to inject BTX-A were as treatment group and treated with BTX-A combined with function training, while other 46 SCP children as control group were only treated with functional training. They were assessed with Composite Spasticity Scale (CSS), the angle of ankle passive dorsiflexion motion and D and E domains of Gross Motor Function Measure (GMFM) before and 1 week, and 3 months after treatment. ResultsThe effect of BTX-A began from 24 to 72 h after injection, reached the peak from 1 to 2 weeks, maintained beyond 3 months with few side effects. There were significant differences between 2 groups in the outcome of CSS,the angle and the standing and walking value (GMFM) 1 week and 3 months after treatment (P<0.01). ConclusionBTX-A combined with functional training is more effective on reducing spasticity of the lower extremity, correcting the tiptoe deformation, increasing the range of ankle motion, improving gross motor function.

Objective To observe the effect of the body weight support training (BWST) on walking ability of children with cerebral palsy (CP). Methods 50 children with CP were divided into the BWST group （n=30） and control group（n=20）. All cases were treated with physical therapy, but the BWST group were added with BWST. The scores of D and E dimensions of the Gross Motor Function Measure Scale (GMFM) were used to assess the walking ability before and after the treatment, respectively. Results The scores of D and E dimensions of GMFM improved in both groups after treatment (P<0.01), and that of the BWST group improved more than control group （P＜0.05）. Conclusion BWST can facilitate the recovery of the walking ability after cerebral palsy.

Objective To investigate the clinical characteristics,risk factors and prognosis of patients with persistent inflammation,immune-suppression and catabolism syndrome(PICS)secondary to sepsis in medical intensive care unit(MICU)in initial stage,in order to increase the understanding of PICS and provide the reference experience for the early screening of high-risk patients.Methods A total of 298 elderly patients diagnosed as sepsis admitted into MICU from Aug.2013 to Dec.2016 were retrospectively studied.Of them,97 patients meeting inclusion criteria were ultimately enrolled and separated into the PICS group and the non-PICS group.General and clinical data and laboratory indexes at first day admitted into MICU were compared between the two groups.The indexes between the two groups were analyzed statistically by multivariate logistic regression analysis.The survival-time distributions were estimated by Kaplan-Meier model,and the difference in prognosis was compared between the two groups.Results Of 97 patients,36 patients (37.1％)met the diagnosis of PICS.The acute physiological function and chronic health evaluation Ⅱ (APACHE Ⅱ) score had a significant difference between the two groups(27.7±5.8 vs.22.9±6.0,P＜0.01).The grade of acute gastrointestinal injury(AGI)were significantly higher in the PICS group than in the non-PICS group(P ＜0.05).Platelet counts,helper T cell counts and CD4+/CD8+ ratios were significantly lower in the PICS group than in the non-PICS group[(164.39 ± 84.29) × 109/L vs.(235.16 ± 126.89) × 109/L,(238.97± 181.11)/μl vs.(385.93±308.22)/μl,(1.58 ± 1.13) vs.(2.12± 1.23),all P ＜0.05)].Multivariable logistic regression analysis revealed that APACHE Ⅱ score was an independent risk factor for PICS and its optimal cut-off value for predicting PICS was 26.5.Kaplan-Meier analysis showed that the overall survival was poorer in the PICS group than in non-PICS group in the whole observation phase.The further Kaplan-Meier analysis on survival time of subdivisions showed that the survival of patients at 90-day and 180-day after admission and in stage 1-3 during one year had significant differences between the two groups (P ＜ 0.05).While the survival of patients at 28-day after admission had no significant difference between the two groups(P＞0.05).Conclusions The elderly patients with persistent inflammation,immune-suppression,and catabolism syndrome(PICS) secondary to sepsis in medical intensive care unit(MICU)show the higher levels of APACHE Ⅱ score and AGI grade,and lower values of platelet counts,CD4+ T cell counts and CD4+/CD8+ ratio in initial stage.And APACHE Ⅱ score is an independent risk factor for PICS in elderly sepsis patients,and the optimal cut-off value of APACHE Ⅱ score for predicting PICS is 26.5.The prognosis for advanced stage and long term prognosis are poor.It is essential to use APACHE Ⅱ and so on,to timely identify and intervene PICS.

ObjectiveTo explore the effects of Botulinum toxin type A （BTX-A） on upper extremities function of children with spastic cerebral palsy. Methods27 children with spastic cerebral palsy who were treated with comprehensive rehabilitation training and BTX-A were arranged as treatment group, and other 30 children who were treated with comprehensive rehabilitation training only as control group. They were assessed with upper extremities functional test (UEFT) before and after treatment. ResultsAfter 3 months of treatment, the scores of UEFT improved more in the treatment group than in the control group (P<0.01). ConclusionBTX-A can improve upper extremities function of the children with spastic cerebral palsy.

Objective:To compare the clinical effect of transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation and posterior subtotal vertebrectomy combined with posterior internal fixation in the treatment of stage III Kümmell′s disease.Methods:A retrospective cohort study was made on clinical data of 40 patients with stage III Kümmell′s disease admitted to Zhengzhou Orthopedic Hospital from June 2015 to December 2018. There were 10 males and 30 females, at age range of 57-79 years［(67.7±6.1)years］. A total of 19 patients were treated by transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation (impaction bone graft group), and 21 patients by posterior subtotal vertebrectomy combined with posterior internal fixation (subtotal vertebrectomy group). Operation time and intraoperative blood loss were compared between the two groups. Degree of pain, lumbar dysfunction and degree of kyphosis were evaluated by visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and kyphotic Cobb angle before operation, at 1 week after operation and at the last follow-up. Bone healing time was compared between the two groups. The complications of the two groups were observed.Results:All patients were followed up for 25-64 months［(40.6±10.4)months］. Operation time and intraoperative blood loss were (130.0±10.1)minutes and (284.5±43.5)ml in impaction bone graft group, lower than those in subtotal vertebrectomy group［(253.8±33.2)minutes, (889.1±95.7)ml］(both P<0.01). There were no significant differences in VAS, JOA score or kyphotic Cobb angle between the two groups before operation, at 1 week after operation and at the last follow-up (all P>0.05). Both VAS and JOA score showed significant differences within each group at any time point (all P<0.01). In both groups, the kyphotic Cobb angle reduced significantly at 1 week after operation when compared with that before operation (all P<0.01), and the angle showed a slight increase at the last follow-up, but remained significantly lower than that before operation (all P<0.01). There were no relapse of pain or aggravation of kyphosis. Bone healing time in impaction bone graft group［4.4(4.0, 5.0)months］was significantly shorter than that in subtotal vertebrectomy group［6.4(5.2, 8.1)months］( P<0.01). There were 2 patients with delayed healing of surgical incision in impaction bone graft group, with the complication rate of 11%. There were 2 patients with dural tear and 3 patients with delayed healing of surgical incision in subtotal vertebrectomy group, with the complication rate of 24%. The complication rate was not statistically significant between the two groups ( P>0.05). No loosening or breakage of internal fixation was observed during the follow-up. Conclusions:Transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation and posterior subtotal vertebrectomy combined with posterior internal fixation are effective in the treatment of stage III Kümmell disease. However, the former can shorten the operation time, reduce the intraoperative blood loss and accelerate the healing of injured vertebral bone, suggesting a relatively minimally invasive surgical method for reconstruction and maintenance of spinal biomechanical stability.