Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

AIM To observe the effects of rhIL 10 on psoriatic models and immune function in mice. METHODS The anti psoriatic effect of rhIL 10 was studied by using the models of vaginal epithelium and tail scales of mouse. ConA induced proliferation and production of IL 2 and IFN ? by T lymphocytes, LPS induced production of IL 1 and TNF ? by the peritoneal macrophages and the activity of NK cells, LPS induced proliferation of B lymphocyte were determined. RESULTS The result showed that rhIL 10 (5, 20 and 80 ?g?kg -1 ?d -1 ,sc) could significantly inhibit the mitosis of vaginal epithelial cells in mice treated with estrogen. No abnormal changes of nucleolus and organelle were found under electronic microscope. rhIL 10 facilitates development of granular cell layers in mice tail scales. There were for 2 to 3 granular cell layers and bigger granular cells in scales under electronic microscope. CONCLUSION The anti psoriatic effect of rhIL 10 is related to inhibiting hyperplasia of epidermal cells and promoting the formation of granular cells and possessing anti inflammatory and immunomodulatory activity.

AIM To observe the long-term toxicities of reteplase(Ret). METHODS Rat was administrated by injection of vein on 14 consecutive days to macaca fasicular. RESULTS Ret 8.0 MIU?kg -1 to macaca fasicular did not show any toxicity. In 25.0 MIU?kg -1 and 80.0 MIU?kg -1 of doses, RBC, HGB and HCT of blood have significantly decreased. Feces of hidden blood test also showed positive response in some animals, meanwhile, Ret could reduce the content of plasma total protein. But these changes could have recovery in restoration period. In addition, in 8.0?25.0?80.0 MIU?kg -1 doses, Ret could significantly lengthen bleeding time and clotting time. The obvious toxic changes of coefficient and pathology in Ret 8.0?25.0?80.0 MIU?kg -1 groups were not found. CONCLUSION 8.0 MIU?kg -1 is a safety dosage by injection of vein. 25.0,80.0 MIU?kg -1 doses have certain toxic actions, such as anemia and bleeding, but these toxic effects were reversible.

Objective:To further improve the department information system, and to establish a multi-parameter critical care medicine database, which can provide data for the analysis and research of big data in critical care medicine, and provide references for other medical institutions to establish relevant databases.Methods:On the premise of fully understanding the needs of clinical and scientific research, based on a Critical Care Medicine Clinical Information System, the department of critical care medicine of the First Medical Center of Chinese PLA General Hospital integrated the patients' case data in hospital information system (HIS), electronic medical records (EMR), monitoring information system (Monitor), laboratory information system (LIS), and radiation information system (RIS), to establish a rudimentary critical care database. On this basis, the related data were analyzed and verified. Further, this database was gradually improved in both its content and structure by referring to Medical Information Mart for Intensive CareⅢ (MIMIC-Ⅲ) database.Results:During the operation of Critical Care Medicine Clinical Information System from September 2017 to February 2020, the database collected diagnosis and treatment data of 2 207 critically ill patients, including data before the patient entering the intensive care unit (ICU) and all data during the ICU, such as demographic data, vital signs, medical treatment, the records of intake and output, sampling time, laboratory examination results, surgical treatment, and a variety of commonly used clinical scoring and diagnosis data. The data in the database were stored in different tables according to different contents, and the tables were connected to each other through the primary key. The data could be analyzed statistically through the information system and has been applied for certain clinical studies, combining clinical practices with scientific studies.Conclusions:The critical care medicine database based on the Critical Care Medicine Clinical Information System can help medical institutions to carry out standardized treatment and clinical research of critically ill patients. With further improvement of the function, the database can be better applied to the data analysis of Chinese critical patients.

Objective To investigate the effect of Gexia Zhuyu decoction combined with diosmin on coagulation mechanism in patients with great saphenous varicose vein surgery.Methods A total of 60 patients who received great saphenous varicose vein surgery in Shaoxing Hospital of Traditional Chinese Medicine from January 2019 to April 2022 were selected and divided into control group and observation group according to random number table method,with 30 patients in each group.Control group was treated with diosmin,and observation group was treated with diosmin + Gexia Zhuyu decoction.Coagulation indexes,vascular endothelial function and inflammatory factor levels were compared between two groups.Results After treatment,Krüppel-like factor 2,activated partial thromboplastin time,thrombin time,prothrombin time,nitric oxide,and interleukin(IL)-10 in observation group were significantly higher than those in control group,while plasminogen activator inhibitor type 1,von Willebrand factor,endothelin 1,hypersensitive C-reactive protein,IL-2 and IL-6 were significantly lower than those in control group(P<0.05).Conclusion Gexia Zhuyu decoction combined with diosmin can improve the hypercoagulable state and vascular endothelial function in patients with great saphenous varicose vein surgery,and reduce the level of inflammatory factors in the body,which is worth popularizing.