Objective To assess the feasibility,safety,and effectiveness of early rapid icy normal saline infusion to attain mild hypothermia in cardiac arrest patients. Methods A single-center prospective randomized controlled trial was conducted. From March 2011 to October 2013,patients who had recovery of spontaneous circulation (ROSC)after cardiopulmonary resuscitation (CPR)in Beijing Daxing District People's Hospital were randomly divided into two groups. In icy normal saline group,patients received a rapid infusion of 1 000 mL of 4 ℃ normal saline intravenously to attain a mild hypothermia. In the control group,the patients were treated with ice bag on head,and axillary temperature was monitored. For all patients,rectal temperature was measured and recorded immediately and 1 hour later . The occurrence of pulmonary edema on initial chest X-ray at 6 hours ,occurrence of tremor within 48 hours,ventricular fibrillation recurring within 48 hours,and consciousness or death within 14 days were recorded. Results A total of 45 patients were enrolled,including 23 patients in icy normal saline group and 22 in control group. The patients in icy normal saline group had a rectal temperature descended from(36.7±0.9)℃to(34.9±0.7)℃1 hour later,while the patients in control group had a rectal temperature risen from(36.5±1.0)℃to(37.9±0.9)℃1 hour later. There was significant difference in rectal temperature between two groups (t=2.228,P=0.031). The number of patients who successfully awaken within 14 days in ice normal saline group was significantly larger than that in control group (13 cases vs. 7 cases,χ2=65.710,P=0.021). There was no statistical difference in the occurrence of acute pulmonary edema (4 cases vs . 6 cases),tremor (2 cases vs . 0 case),ventricular fibrillation recurrence (4 cases vs. 5 cases)and death within 14 days (11 cases vs. 12 cases,all P>0.05). Conclusions The study shows that early rapid i.v. infusion of 4℃normal saline is feasible,safe and effective for cerebral resuscitation.

Objective To explore the correlation between global end diastolic volume index(GEDI)and central venous pressure(CVP)of severe sepsis patients during fluid resuscitation by pulse induced continuous cardiac output(PiCCO )test. Methods Sixty-four severe sepsis patients had been treated by fluid resuscitation strictly in accordance with the guidelines for treatment of sepsis in 2008. During the treatment,GEDI and corresponding CVP data were measured and recorded to observe the correctness of volume reaction under different CVP ranges,and the relativity between GEDI and CVP was analyzed. Results In the whole process of monitoring circulatory blood volume,no significant correlation between CVP and GEDI(r=-0.012,P>0.05)was found in severe patients with severe sepsis. When the CVP was in 0-8 mm Hg(1 mm Hg=0.133 kPa)or greater than 12 mm Hg,there was no correlation with the GEDI(r=-0.009,-0.020,respectively,both P>0.05). When the CVP was in 8-12 mm Hg at the 6 hours resuscitation target required by the guidelines,there was an obvious positive correlation between CVP and GEDI(r=0.653,P<0.01). Conclusion CVP is not suitable to be an exclusive target indicator for fluid resuscitation volume.

The Economists Intelligence Unit pointed out that the global ranking of Chinese people's death quality index falls behind and once again causes people's attention and discussion of death and related legal issues.Palliative Care can make people go to death as far as possible with dignity,ready and calm.So it is gradually being concerned,and the importance of legislation related to it is also becoming increasing.Palliative Care has emerged in our country,but because of the lack of legislative regulation,relatives of patients and medical staff are at risk being accounted for legal liability.Through the analysis of the legitimacy and feasibility of palliative care,this paper put forward some suggestions of relevant legislation and current corresponding countermeasures;it should clarify the legal validity of living will signed by patients,strengthen the supervision in the implementation process and exempt responsibility of relevant personal.

Three kinds of PEGylated gold nanoparticles (PEG-Au NPs) with different surface charges are prepared by assembly of thiolated polyethylene glycol (HS-PEG) with different terminal groups including methoxy, amino or carboxyl on gold nanoparticle surface through sulfur-gold covalent bond, respectively.The experimental results of cell co-culturing and tail intravenous injection in mouse indicate that the biological behaviors of PEG-Au NPs are affected significantly by their surface charges.The cellular internalization amounts of PEG-Au NPs are following the order, positive charge ＞ neutral charge ＞ negative charge.The PEG-Au NPs are gradually transferred to liver and spleen from main organs through the circulation of blood after tail intravenous injection in mouse.The negatively charged PEG-Au NPs have the slowest hepatic clearance rate while the positively charged PEG-Au NPs can cause the strongest response of immune system in mice.

Objective To compare the scores from the simpliifed COMFORT scale with those from the bispectral index (BIS) and analyze the variation among different evaluators in children in an intensive care unit, and to investigate the reliability;validity of simpliifed COMFORT scale. Methods Twenty children between 3 and 16 years of ages on mechanical ventilation and sedation were simultaneously classiifed based on the BIS and the simpliifed COMFORT scale evaluated by 4 independent evalua-tors. The Kappa test was performed and the correlation between the two methods (Pearson correlation) was tested. Results In to-tal, 70 observations were performed on 20 patients. Based on the Kappa coefifcient, the agreement among evaluators ranged from 0.62 to 0.77 (P<0.001). There was a correlation between the BIS and the simpliifed COMFORT scale (r=0.53-0.61,P<0.01). Conclusions Due to the strong consistency between the independent evaluators and the correlation between the two methods, the reliability and validity of simpliifed COMFORT scale are preferable and simpliifed COMFORT scale is useful in classifying the level of sedation in children on mechanical ventilation.

【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.