Severe sepsis and septic shock is a clinical syndrome with sequential organ dysfunction or tissue hypoperfusion induce by sepsis.Although early,adequately and rapidly initial resuscitation plays pivotal role in the management,but infusion of albumin,plasma,red blood cell,platelet,gamma globulin and other blood products and the immunological support with ulinastatin combined with thymosin,blood purification and anti CD14 monoclonal antibody therapy also play an important role.

Objective To study the clinical value of exposure of recurrent laryngeal nerve in thyroid operation for the prevention of recurrent laryngeal nerve injury. Methods A total of 90 patients received thyroid operation in our hospital from April 2012 to August 2014 were enrolled and randomly divided into observation group(n=45) and control group(n=45) according to whether the recurrent laryngeal nerve were exposed during operation. The patients in observation group received thyroid operation with recurrent laryngeal nerve exposure, and the patients in control group received conventional thyroid operation. Then recurrent laryngeal nerve injury situation and operation situa-tion were compared. Results Recurrent laryngeal nerve injury symptoms were less in the observation group (2. 22%) compared with that of the control group (15. 56%) with a statistically singnificant difference(P<0. 05). The operation time of observation group (54. 45 ± 6. 62) min was longer than that of the control group (41. 29 ± 5. 82) min with a statistically singnificant difference (P<0. 05). The recovery time of observation group (5. 85 ± 0. 85) d was shorter than that of the control group (8. 02 ± 1. 12) d, with a statistically singnificant differ-ence (P<0. 05). There was no significant difference in bleeding volume during operation,postoperative drainage volume and drainage dura-tion between two groups(P>0. 05). Conclusion Exposure of recurrent laryngeal nerve in thyroid operation is helpful to prevent recurrent laryngeal nerve injury,which reduce the damage recovery time,although it will extend the operation time,does not increase bleeding and drainage volume.

Objective To compare the efficacy and safety of prourokinase,reteplase and urokinase on the patients with acute ST -segment elvation myocardial infarction.Methods According to random number table,the eligible patients with acute ST -segment elvation myocardial infarction were randomly divided into prourokinase group (50mg,n =34),reteplase group (36mg,n =42)and urokinase group (1 500 000IU,n =32).The patency of infarct related coronary artery was estimated by coronary angiography at 90min after administration of thrombolytic agents.The adverse reaction was also observed including bleeding and the major adverse cardiac events(MACEs).Results The patency of culprit vessel in the prourokinase group was 76.50% (≥TIMI 2 flow),which in the reteplase group was 83.30% (≥TIMI 2 flow),and which in the urokinase group was 53.10% (≥TIMI 2 flow),respctively.Both of prourokinase group and reteplase group were higher in the patency than theurokinase group(χ2 =8.27,P =0.004). The MACEs and bleeding adverse reaction(prourokinase group 17.65%,reteplase group 28.57%,urokinase group 42.19%)showed that security of prourokinase group was securer than reteplase group and urokinase group(χ2 =6.36,P =0.012).Conclusion Both of prourokinase and reteplase are effective for the patients with acute myocardial infarction with ST -segment elvation,and prourokinase is safer.

Objective To characterize composition and antibiotic resistance of the pathogens isolated from patients' deep sputum with ventilator-associated pneumonia(VAP) in PICU of our hospital,and give support to the administration of antibiotics early and reasonably in clinic.Methods The study was conducted during the period of January 2009 to December 2013 at PICU of the Children's Hospital of Zhejiang University School of Medicine.One hundred and twenty-one cases of children who conformed to the diagnostic criteria of VAP after treated with ventilator were the object,the endotracheal aspirates were collected and transported to microbiology laboratory within 15 minutes.The pathogens were routinely analyzed and identified with WITEK60 and used Kirby-Bauer method for drug sensitive test,and identified with the special drug-resistant bacteria.Results Among 121 VAP diagnosed patients,127 pathogenic strains isolated from sputum specimen.Gram negative,Gram positive bacteria and fungi accounted for 64.57％ (82/127),29.92％ (38/127)and 5.51％ (7/127) respectively.Acinetobacter baumannii (25.61％,21/127),Escherichia coli (20.27％,17/127),Stenotrophomonas maltophilia (20.27 ％,17/127),Klebsiella pneumoniae (16.22％,12/127) and Pseudomonas aeruginosa (9.46％,11/127) were frequently identified isolates among Gram negative bacteria.The resistant rate of Gram negative bacteria in β lactam antibiotics was 77.62％.Ten strains of Staphylococcus epidermis and 6 strains of Staphylococcus aureus were identified isolates among Gram positive bacteria.Except the sensitive to vancomycin and linezolid,Gram positive bacteria were resistance to cephalosporin and aminoglycosides.All fungi were sensitive to the anti-microbial agents.Conclusion The Gram negative bacteria were more prevalent than Gram positive bacteria and fungi in VAP and show high drug resistance.It is pivotal to administer anti-microbial agents early and reasonably for VAP children.To emphasize surveillance to the antibiotic resistance and grasp the characteristics of the drug resistance are much important to VAP therapy.

To apply preventive T-shaped enterostomy in protective defunctioning stoma.Technique of enterostomy closure was only made in abdominal wall rather than abdominal cavity.A total of 78 patients undergoing protective ostomy from January 2005 to April 2012 were divided into two groups of routine enterostomy (group A,n =52) and protective T-shaped enterostomy (group B,n =26).The length of operation and average hospital stay in group A with stoma closure were(98 ± 16) min and (15.3 ± 5.2)days while those of group B (52 ± 9) min and (9.5 ± 2.3) days.The inter-group differences were statistically significant respectively (P ＜ 0.05).Therefore protective T-shaped enterostomy,showing advantages in operative skills,operative trauma and postoperative recovery time,is an effective technique and its application should be further promoted.

Object To investigate the stability of baicalin in different conditions Methods The stability of baicalin in water with different pH values, methanol, ethanol, chloroform and in the mouse lung homogenate, mouse liver homogenate, mouse plasma and bovine serum was investigated by the classical isothermal method Results The experiments showed the baicalin was stable in acidic water and these organic solutions, but unstable in basic water and these biological media Conclusion The stability of baicalin in different media was different, which should be considered in practice

Objective: In order to provide an effective reference to the study on its preparation, the stability in vitro of andrographolide was investigated. Methods: Andrographolide was dissolved in phosphate buffer solutions of different pH values; classical isothermal method was employed; the content of andrographolide was determined by RP HPLC; then the stability of the drug in different biological media and organic solvents at 37?C was investigated. Results: The stability of andrographolide was different at different pH values and was best in the condition of pH=3～5. In biological media, it was most stable in bovine serum and the next was in mice homogenate. Conclusion: In different conditions, the stability of andrographolide was different. It provided a reference to the study on andrographolide and its preparation.

OBJECTIVE To report malignant hematologic patients suffered in fungal infections treated with voriconazole(VOR),compare them with other similar patients treated with aluphotericin B liposome(L-AMB) as control,and then review the references.METHODS Fifty patients were treated with VOR and 57 patients were treated with L-AMB.According to the clinical performance and the changes in the CT,we could find the difference of between them.RESULTS Forty cases were effective in VOR group and most of them were in good tolerance.In the control group,37 cases were effective,most of them were in poor tolerance,and some of them stopped the treatment.CONCLUSIONS Instead of L-AMB,VOR can be a useful drug in the treatment of hematologic malignancies patients suffered in fungal infections.

Objective To investigate the change of serum CD62p of coronary heart disease (CHD) patients after different doses of clopidogrel administration.Methods One hundred and ninety-one patients with CHD were selected as our subjects.Of which,95 cases were with SAP and 66 cases were with non ST segment elevation acute coronary syndrome (NST-ACS).SAP patients were randomly given clopidogrel at dose of 75 mg/d or 150 mg/d and served as A and B groups.NST-ACS patients were randomly given 300 mg clopidogrel,then randomly divided into C and D groups with sequentially taking clopidogrel at dose of 75 mg/d or 150 mg/d respectively.Thirty healthy peoples were served as E group without drug intervention.Concentrations of serum CD62p were detected by Elisa before taking clopidogrel,24 h and the fifty day of after taking clopidogrel.Results (1) Before taking clopidogrel,the serum concentrations of CD62p in CHD patients were higher (A group:(7.62 ± 2.99) ng/L,B group:(8.48 ± 3.13) ng/L,C group:(9.50 ± 3.32) ng/L,D group:(10.22 ± 5.14) ng/L than that of healthy control group ((5.49 ± 1.99) ng/L,P ＜ 0.05).The Serum CD62p levels in SAP patients were lower than that of NST-ACS patients (P ＜ 0.05).(2)The serum concentrations of CD62p in A and B groups at before taking clopidogrel were (7.62 ±2.99) ng/L and (8.48 ±3.13) ng/L respectively,higher than that four days after taking clopidogrel ((6.79 ± 2.51) ng/L,(6.37 ± 1.80) ng/L;t =2.390,4.520;P ＜0.05 or P ＜0.01).There was no statistical significant difference between A and B groups(P ＞0.05).(3) In C and D groups,the serum CD62p at before taking clopidogrel were (9.50 ±3.32) ng/L and (10.22 ±5.14) ng/L,higher than that after taking clopidogrel for four days ((8.21 ± 2.62) ng/L,(8.17 ± 2.37) ng/L; t =2.084,2.157 ; P ＜ 0.05).No significant difference was seen between C and D groups (P ＞ 0.05).Conclusion The serum CD62p in patients with CHD was higher than that in the healthy control.Clopidogrel administration can decrease serum CD62p in CHD patients.

Objective To study on bioactive chemical compounds against ultraviolet irradiation in antarctic ice microalgae.Methods Four kinds of Antarctic ice microalgae were cultured under the conditions of low temperature,illumination,UV-A and UV-B irradiation.The chemical compounds were extracted by methanol and analyzed by spectrophotometer and HPLC/MS.The molecular structures were elucidated according to these data.The chemical compounds were irradated by sunshine to observe the speed of degradation and to estimate the bioactivity.Results There were five active compounds in Chlorophyceae L-4 and 7 active compounds in Diatom HF-9,in which 6 compounds belong to MAAs(mycosporine-like amino acids) and were of more bioactivity against ultraviolet irradiation.Conclusion MAAs from of Antarctic ice microalgae play an important role in resisting ultraviolet irradiation.