ObjectiveTo investigate the correlation between procalcitonin (PCT), C-reactive protein (CRP) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score, and to investigate the value in assessment of PCT and CRP in prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit (ICU) of Changzheng Hospital Affiliated to the Second Military Medical University from January 2011 to June 2014 were retrospectively analyzed. 201 sepsis patients who received PCT and CRP tests, and evaluation of APACHEⅡ score and SOFA score were enrolled. The values of PCT, CRP, APACHEⅡ score and SOFA score between survivals (n = 136) and non-survivals (n = 65) were compared. The values of PCT and CRP among groups with different APACHEⅡ scores and SOFA scores were compared. The relationships between PCT, CRP and APACHEⅡ score and SOFA score were analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was plotted to assess the prognostic value of PCT and CRP for prognosis of patients with sepsis.Results Compared with survival group, the values of PCT [μg/L: 11.03 (19.17) vs. 1.39 (2.61), Z= -4.572,P< 0.001], APACHEⅡ score (19.16±5.32 vs. 10.01±3.88,t = -13.807,P< 0.001) and SOFA score (9.66±4.28 vs. 4.27±3.19,t = -9.993,P< 0.001) in non-survival group were significantly increased, but the value of CRP was not significantly different between non-survival group and survival group [mg/L: 75.22 (110.94) vs. 56.93 (100.75),Z = -0.731,P = 0.665]. The values of PCT were significantly correlated with APACHEⅡ score and SOFA score (r1 = 0.373,r2 = 0.392, bothP< 0.001), but the values of CRP were not significantly correlated with APACHEⅡscore and SOFA score (r1 = -0.073,P1 = 0.411;r2 = -0.106,P2 = 0.282). The values of PCT rose significantly as the APACHEⅡ score and SOFA score became higher, but the value of CRP was not significantly increased. When APACHEⅡ score was 0-10, 11-20, and> 20, the value of PCT was 1.45 (2.62), 1.96 (9.04), and 7.41 (28.9)μg/L, respectively, and the value of CRP was 57.50 (83.40), 59.00 (119.70), and 77.60 (120.00) mg/L, respectively. When SOFA score was 0-5, 6-10, and> 10, the value of PCT was respectively 1.43 (3.09), 3.41 (9.75), and 5.43 (29.60)μg/L, and the value of CRP was 49.30 (86.20), 76.00 (108.70), and 75.60 (118.10) mg/L, respectively. There was significant difference in PCT between any two groups with different APACHEⅡ and SOFA scores (P< 0.05 orP<0.01), but no significant differences in CRP were found. The area under the ROC curve (AUC) of PCT for prognosis was significantly greater than that of CRP [0.872 (95% confidence interval 0.811-0.943) vs. 0.512 (95% confidence interval 0.427-0.612),P< 0.001]. When the cut-off value of PCT was 3.36μg/L, the sensitivity was 66.8%, and the specificity was 45.4%. When the cut-off value of CRP was 44.50 mg/L, the sensitivity was 82.2%, and the specificity was 80.3%.Conclusions Compared with CRP, PCT was more significantly correlated with APACHEⅡ score and SOFA score. PCT can be a better indicator for evaluation of degree of severity, and also prognosis in sepsis patients.

The medicine of critical disease is a clinical discipline that gradually sprang up in the late 1960s.Yet at present controversy still exists as to whether the discipline should be regarded as a separate one and it has not been ranked among the separate disciplines listed by the State Educational Committee. The authors, however, give an account of the customers and the cunent situation of disciplinary development of the discipline of critical disease from the petspective of a discipline. They also offer an account of the organizational structure and the form of staff of ICUs,pointing out that ICUs have 3 subjects structurally and are divided into CategoriesⅠ,Ⅱand Ⅲ. Except for ICUs in a few hospitals that are up to the level of Category Ⅱl, ICU s in most hospitals in China are lower than or just up to the level of Category Ⅰ. Then the authors give an introduction to the three forms of ICU management: open, semi-open and closed.

The medicine of critical disease is a clinical discipline that gradually sprang up in the late 1960s. Yet at present controversy still hats as to whether the discipline should be regarded as a separate one and it has not been ranked among the separate disciplines listed by the State Educational Committee. The authors, however, give an account of the customers and the current situation of disciplinary development of the discipline of critical disease ho the perspective of a discighne. They also offer an account of the organizational structure and the form of staff of ICUs, pointing out that ICUs have 3 subjects structurally and are divided into CategoriesⅠ,Ⅱ and Ⅲ. Except for ICUs in a few hospitals that are up to the level of Category n, ICUs in most hospitels in China are lower than or just up to the level of CategoryⅠ. ho the authorss give an introduction to the ho formsn of ICU management open, semi-opened-cpc ana closed.

To evaluate availability of permissive hypercapnia (PHC) in patients with severe acute respiratory distress syndrome (ARDS). Method: To observe the influence of different tidal volumes (V_T) on pulmonary mechanics and hymodynamies in 10 patients with severe ARDS. Result : PHC was induced by decreasing VT from 10-12 ml/kg(routine V_T) to 6-8 ml/kg (small V_T). Arterial oxygen pressure and saturation remained unchanged, but pulmonary venous mixture increased(P

Objective To study the role of changes of oropharyngeal microflora in pathogenesis of post-traumatic ventilator-associated pneumonia (VAP). Methods Forty-five patients with post-traumatic VAP treated with intubation and mechanical ventilation were involved in the study.Microbiologic cultures and drug-sensitivity test of oropharyngeal secretions,subglottic secretions,sputum from deep airway and gastric fluid samples were performed at days 1,3,7 and 14 after mechanical ventilation.The stool samples were collected to detect the coccus and bacillus ratio and the fungus.The concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions were compared. Results The main pathogens for VAP patients were gram-negative bacilli.The study showed an increase in aspects of the positive rate of etiology cultures of subglottic secretions,sputum and gastric fluid samples,the concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions and the number of ESBL + and multi-resistant bacteria,along with the prolonged mechanical ventilation. Conclusions The changes of oropharyngeal microflora are closely associated with the development of VAP.The enterobacteria in the gastric cavity always reversely colonize in the oropharynx and the retrograde stomach-pharynx-lower respiratory tract infection is a major infection route of VAP.

Objective To study the effects of broad-spectrum antibiotics, including the third generation Cephalosporin and Carbapenems, on intestinal enterococci in septic rats. Methods Ninety-one SD rats were randomly divided into normal control group, scald group, scald group with 3 days of ceftriaxone treatment, scald group with 9 days of ceftriaxone treatment, scald group with 3 days of imipenem treatment, scald group with 9 days of imipenem treatment, and sepsis group, sepsis group with 3 days of ceftriaxone treatment, sepsis group with 9 days of ceftriaxone treatment, and sepsis group with 3 days of imipenem treatment, sepsis group with 9 days of imipenem treatment. All the animal were subjected to 30% TBSA Ⅲ degree scald injury on their back, followed by endotoxin challenge with a dose of 20mg/kg 24 hours after the burn injury. The animals were treated with intraperitoneal injection of ceftriaxone (60mg/kg, q12h) or imipenem (60mg/kg, q12h) 24h after the second hit with endotoxin. At the end of the treatment, intestinal enterococci in colon were cultured. The number and variety of the bacteria were also determined. Results The number of enterococci in the gut of the septic rats was significantly increased after the second hit with endotoxin, exceeding that of the rats in normal control group and scald group(P

Objective To study the effects of broad-spectrum antibiotics, including the third generation Cephalosporin and Carbapenems, on intestinal commensal bacilli in rats with sepsis. Methods Ninety-one SD rats were randomly divided into normal control group, scald group, scald group with 3 days of ceftriaxone treatment, scald group with 9 days of ceftriaxone treatment, scald group with 3 days of imipenem treatment, scald group with 9 days of imipenem treatment, and sepsis group, sepsis group with 3 days of ceftriaxone treatment, sepsis group with 9 days of ceftriaxone treatment, and sepsis group with 3 days of imipenem treatment, sepsis group with 9 days of imipenem treatment. All the animal were subjected to 30% Ⅲdegree scald injury on their back, followed by endotoxin challenge with a dose of 20mg/kg 24 hours after the burn injury. The animals were treated with intraperitoneal injection of ceftriaxone (60mg/kg, q12h) or imipenem (60mg/kg, q12h) 24h after the second hit with endotoxin. At the end of the treatment, bacilli in the colon were cultured. The number and variety of the bacteria were also determined. Results The antibiotics obviously reduced the number of colibacilli(P

Objective To analyze 137 cases of clinical invasive fungal infection (IFI), and to sum up clinical experiences in the treatment of early anti-fungal. Methods 137 patients with 91 males and 46 females, who suffered from invasive fungal infection in ICU from January 1, 2000 to June 30, 2006, were enrolled in this study. The age ranged from 17 to 82 years. Among 137 patients with IFI, the respective incidence of infection of Candida albicans, Candida glabirate, Candida tropicalis and Candida parapsilosis was 47.4%, 26.3%, 20.4% and 3.6%. The sputum, urine, blood and other excreta were collected for examination three days after admission and then every three days. Results Out of the 137 patients, 42 patients were complicated with hemorrhage (30.7%), 53 patients developed candida rash in the chest, abdomen and extremity (38.7%), and 49 patients developed organ dysfunction (35.8%). The chest films revealed that infiltration caused by IFI mainly occurred in the apex of lung in some patients. 137 patients were treated with fluconazole at first, and among them, 64 patients were cured. The cure rate was 46.7%. 39 patients out of 61 patients treated with Amphotericin B(AmB) or lipid AmB were cured. The cure rate was 63.9%. 11 patients were treated with voriconazole and 6 patients were cured. The cure rate was 54.5%. 28 patients failed to respond to the above therapy and died.The mortality was 20.4%. Conclusion The clinical symptons of IFI included hemorrhage, candida rash, organ dysfunction, and infiltration in apex of lung. Fluconazole and amphotericin B(AmB) or lipid AmB still have a good curative effect on invasive fungal infection.

Cuiru oral liquid (COL ) for the promotion of lactation is prepared from an aqueous extract of Angelica sinensis, Astragalus membranaceus (Fisch.) Bge., Rehmbnnia glutinosa Libosch.,et al. Its formulatiou and processing were briefly desctibed, and the quality standard and stability of the finished product were studied. Results showed that the formu lation processing and stability of COL were suitable for clinical trial. Moreover, its pharmacology was briefly described.

Objective To observe apoptosis and proliferation of intestinal epithelial cells and to explore the mechanism of protective effects of rhubarb monomers on intestinal epithelial cells in septic rats.Methods Eighty male Sprague-Dawley (SD) rats (230-250 g) under anesthesia and sedation were subjected to cecal ligation and perforation (CLP).After surgical preparation,rats were randomly (ramdom number) divided into 8 groups (n =10 each):a sham group (A) [normal saline (NS) gavage];a sepsis group (B) (NS gavage);group C (ip dexamethasone 0.5 mg/kg immediately after CLP) (C);and rhubarb monomer 100 mg/kg in NS treated groups including:rhein group (D),emodin group (E),3,8-dihydroxy-1-methyl-anthraquinone-2-carboxylic acid group (F),1-O-caffeoyl-2-(4-hydroxy-O-cinnamoyl)-D-glucose group (G),and 3,8-dihydroxy-1-methyl-anthraquione group (H).Animals were sacrificed 24 hrs after treatment.Intestinal histopathology,apoptosis (TUNEL) and proliferation of intestinal epithelial cells (proliferating cell nuclear antigen,PCNA) were measured.Multiple comparisons were carried out with one-way analysis of variance (ANOVA).Results Histopathology revealed injury to the intestinal mucosal villi induced by sepsis in group B compared with group A.The injury was significantly ameliorated in groups C,D,E,F,G,and H compared with group B.The apoptosis index in group B was significantly higher than that in group A (P ＜ 0.05) and the apoptosis index in groups C,D,E,F,G,and H was significantly lower than that in group B (P ＜ 0.05).The PCNA positive index in group B was significantly lower than that in group A (P ＜ 0.05),but was significantly higher in groups C,D,E,F,G,and H than that in group B (P ＜ 0.05).Conclusion Rhubarb monomers can promote the proliferation of mucosal cells and prevent apoptosis of intestinal mucosal cells.In addition,rhubarb monomers may play a role in protecting the intestinal barrier function.