Coagulopathy is very common in patients in intensive care unit (ICU) and often indicates organ dysfunction or underlying diseases.The application of traditional methods assessing the patients' coagulation status in ICU is limited because they can not reflect the whole process of coagulation.Thromboelastography (TEG),a point-of-care (POC) assay of coagulation,fibrinolysis and platelet function,developed in recent years has been widely used in organ transplant and cardiovascular surgery and so on.However,there is no standard for the use of TEG in ICU.The development and application of TEG in sepsis,multiple trauma,guiding blood transfusion,extracorporeal membrane oxygenation (ECMO),and anticoagulation monitoring were addressed in this review,and its value and application prospect in ICU were analyzed.

Objective To systemically review the efficacy and safety of heparin for treatment of sepsis.Methods Database search of IM/MEDLINE,Cochrane Library,SCIE,CBM,CNKI,VIP Data,WanFang Data (from January 2000 to June 2012) was conducted.The quality of included randomized controlled trials (RCTs) about heparin for treatment of sepsis was assessed,and relevant data were extracted according to the inclusion and exclusion criteria.Then meta analysis was performed using RevMan 5.1.Results 17 trials with 1 167 participants were included.The results of meta-analysis showed:compared with the control group,heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio (OR) =0.59,95％ confidence interval (95％CI) 0.45-0.77,P=0.0001] ; heparin did not deteriorate coagulation disorders,but corrected sepsis-induced platelet (PLT) count reduction [mean difference (MD) =13.94,95％ CI 10.15 to 17.72,P＜0.000 01],while it had no significant effect on the activated partial thromboplastin time (APTT) and prothrombin time (PT,APTT:MD=-3.18,95％CI-6.88 to 0.53,P=0.09; PT:MD=-0.68,95％ CI-1.48 to 0.12,P=0.09).There was no significant difference between the two groups in the incidence of bleeding either.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of heparin group was significantly lower than that of the control group (MD=-2.58,95％CI-3.29 to-1.87,P＜0.000 01),and the incidence of multiple organ dysfunction syndrome (MODS) was significantly lower than that of the control group (OR=0.32,95％CI 0.17 to 0.61,P=0.000 6).In addition,heparin could shorten intensive care unit (ICU) stay (MD=-4.43,95％CI-6.79 to-2.07,P=0.000 2),whereas it showed no significant effect on the total length of hospital stay.Conclusions Heparin can ameliorate sepsis,and has high degree of safety and lower hospital expense.Due to limitation of the quality of included studies,larger sample and well-designed RCTs are needed to further support this conclusion.

Objective To investigate the effects of volatile organic compounds escaped from alkyd dope on neurotransmitter content in the brain of mice.Methods 56 BALB/c mice were randomly divided into 7 groups,8 in each and exposed to volatile organic compounds(30 mg/m3)escaped from alkyd dope by dynamic inhalation exposure.The neurotransmitters(cholines,monoamines,amino acids)in the brain were determined during the period of exposure and comeback.Results Compared with the control,DA,5-HT,NE and Glu significantly decreased and Gly,GABA significantly increased during the period of exposure,however NE still kept significant decrease during the period of comeback.Conclusion Volatile organic compounds escaped from alkyd dope may cause neurochemical change in mice.

The cultivation of communication skill of anesthesiology medical students has already become a request as time developing.Not only it accommodates the request of medical model and society development to cultivate the communication skill of anesthesiology medical students from the aspect of strengthening their self-confidence and pride,global consciousness and international view,catholicity and humanity as well as cognitive ability,but also embodies the requirement of anesthesiology anthropo-culture.So there should be pertinent measures to cultivate the communication skill of anesthesiology medical students.

Objective To report the experience in diagnosing gastroenteric tuberculosis under en-doscopies, and arose enough attention to avoid missed or mis-diagnosis. Methods Biopsy is taken when lesions, such as gastroenteric mucosal protrusions, nodule, erythema and ulcer are found under endoscopies. Results In 7 cases studied, 2 of them are the gastric tuberculosis (1 ulceration, 1 proliferation) , the rest, colonic tuberculosis (4 proliferation and 1 mixed). Distribution of lesions: gastric antrum 2, each one in terminal ileum, ileocecal valve, terminal ileum plus ileocecum, terminal ileum plus pan colon, and ascending colon. Endoscopic diagnosis: colonic tuberculosis with infiltrative tuberculosis in both lungs 1; colonic malignant tumors 2, mucosal protrusions and ulcerative lesions with undefined nature 4. Caseous necrotic granu-lomas are found in all cases on pathological examination. Conclusion The various appearances of gastroenteral tuberculosis under endoscopies are hard in differentiating from those of colonic carcer, inflammatory bowel diseases ( Crohn' s disease etc. ) , gastric benign or malignant ulceration. The definite diagnosis of gastroenteral tuberculosis is greatly depended on pathological results.

Objective To investigate the protective effect of short-term moderate exercise on ischemic/reperfused myocardium and its correlation to the activation of protein kinase C(PKC).Methods Fourty Wistar rats were randomly divided into 4 groups(n=10 respectively): control group(CON group),exercise group(EXE group),exercise + PKC inhibitor group(E+C group) and PKC inhibitor group(CHE group).The occurrence of arrhythmia,the recovery of cardiac function,and infarct size were observed by using the Langendorff-ischemia/reperfusion model in isolated rat heart in vitro.Results Recovery rate of LVDP(on the 30th and 60th minute of reperfusion) and RPP(on the 20th,30th and 60 minute of reperfusion) of EXE group were higher than those of CON and E+C groups(P

Liver has great ability in regeneration,and liver regeneration is closely related to the prognosis of patients who received liver surgeries.The mechanisms of liver regeneration include biochemical theory and hemodynamic theory.Portal perfusion with moderate pressure is an important factor for starting liver regeneration.Hepatic artery buffer response,fluid shear stress and gasotransmitter play important roles in the liver regeneration.Learning the mechanisms of hemodynamic signal is of great importance for the treatment of liver diseases.

Forty-five patients with burn area exceeding 30% TBSA were studied prospectively. Among these 45 patients, 13 developed multiple organ failure (MSOF). Blood superoxide, dismutase (SOD) activity and plasma malondialdehyde (MDA) levels were sequentially determined to assess the role of excessive release of oxygen radicals and lipid peroxidase injury in the mechanism of pathogenesis of postburn MSOF. The results showed that the anti-oxidation capacity of the body was markedly depressed and lipid peroxidase injury markedly increased after a severe burn injury. These changes were not only related to hypovolemic shock after the injury, but also the severity of the burn injury and infection.

Objective To observe the effects of laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder and the effects on postoperative rehabilitation of patients. Methods 78 cases of patients with polypoid lesions of gallbladder treated in our hospital from August 2011 to November 2014 were selected as the study object. According to the order of medical treatment and hospital admission , the patients were numbered and randomly divided into laparoscopy group and combined group , with 39 cases in each group. The laparoscopy group were treated by laparoscopic cholecystectomy while the combined group were treated by laparoscopy combined with choledochoscopy gallbladder-protection surgery. The operation indicators , recovery of gastrointestinal function and incidence of postoperative complications in the two groups were observed. After discharge , the 2 groups of patients were followed up for 1 year. The improvement of postoperative digestive tract symptoms and rehabilitation of patients was observed. Results The intraoperative bleeding volume, postoperative fasting time, defecation time and hospitalization time of the combined group [(20.13 ± 7.48) mL, (0.51 ± 0.98) d, (1.20 ± 0.84) d, (1.98 ± 1.54)d] were less than those of the laparoscopy group (P <0.05); The incidence rate of complications in the combined group (10.26%) was lower than that in the laparoscopy group (33.33%) (P < 0.05); Immediately at the end of operation and 1 week after operation, VAS scores of the combined group [(4.23 ± 0.41), (2.46 ± 0.17) ] were lower than those in the laparoscopy group (P < 0.05); At the last follow-up, KPS score of the combined group increased to (89.98 ± 1.24), which was higher than that in the laparoscopy group (P < 0.05); GradeⅠpostoperative recovery in the combined group accounted for 87.18% which was higher than that in the laparoscopy group (64.10%). There was no case of grade III and the proportion was lower than that in the laparoscopy group (15.38%). The differences in proportions of grade I and III between the two groups were statistically significant (P < 0.05). Conclusion To adopt laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder , the curative effect is certain and the minimally invasive advantage is obvious. The long-term recovery effect is good and the safety is high.

Objective: To explore the relation among new graduates’ career maturity, work value,adaptation status and work performance. Methods: Chinese Student Career Maturity Inventory and Work Value Inventory for College Students were used to test 257 new employees’ career maturity and work value. Job Satisfaction, Role Ambiguity, Role Conflict and Turnover Intention Scales were administered to the employees 3 months later to assess the adaptation status. Their job performance data were collected at the same time with adaptation status, and were collected again after 1 year. Results: ①Sub-factors of career maturity and work value can predict adaptation status, including job satisfaciotn, turnover intention, role ambiguity and role conflict; ②Work value dimension of Reputation, performance after 3 months of joining the company, role ambiguity can significantly predict performance after one year. Conclusion: Newly graduated employees’ work value, career maturity can be predicted by adaptation status and job performance. Further follow-up studies are need for the influence of long-term work.