With the rapid development of critical care medicine (CCM) in China, there are increases in the number of intensive care units (ICUs), the scale of one center ICU and the team. Subspecialty construction of CCM is of great concerns for personnel training as well as discipline development, and is currently one of the urgent problems that need to be resolved. Experience of CCM subspecialty construction from Europe and the United States is lacking and it is necessary to propose some opinions on innovation to construct CCM subspecialties with Chinese characteristics. We believe that CCM sub-specialties construction should be based on the core knowledge (pathophysiology) and skill (organ monitoring and support). The following 7 sub-specialties can be set up: ① acute lung injury and mechanical ventilation; ② shock, hemodynamic monitoring and treatment; ③ acute kidney injury and blood purification; ④ sepsis and anti-infective therapy; ⑤ stress, sedation and analgesia; ⑥ nutrition and metabolic support; ⑦ coagulation, immune and inflammation. The core knowledge and skills of critical care medicine will constantly be updated and enriched. Therefore, sub-specialty settings should be constantly updated as well.

Objective To explore the effects of fat on healing of porcine skin wounds so as to provide a new strategy to promote skin wound repair after injury. Methods Forty-eight full-thickness skin wounds were produced on both sides of the back in 6 male minipigs (8 wounds in each animal). These wounds were then randomly divided into 4 groups, i.e. saline control group, fat autografting group, fibroblast growth factor (bFGF) treatment group and epidermal growth factor (EGF) treatment group. On day 3, 7, 14 and 21 after wounding, the area and the volume of wounds were measured, and histological examination was performed to evaluate the speed and quality of wound healing in different groups. Results On days 3 and 7, the amount of granulation tissue and vessel density in fat treatment group were significantly more abundant compared with other groups. Wound area and volume in fat treatment wounds were markedly decreased compared with those in other groups (P

Objective To establish the equation of chest CR for the estimation of age, and evaluate the significance of forensic medicine. Methods 5 measurements were selected to carry on the independent samples, and the status were analyzed by SPSS 19.0. Results The 5 measurements and age were line-related(P<0.05); Three group regression models were formulated; In a separate test, a control sample of 30 chest CR that not involved with formulating the regression equation was correctly estimated with 73.3% to 86.7% accuracy within 3 years. Conclusion The method set up in this paper can be used to estimate the age of Chinese Han adults.

Objective To determine the effects of the early enteric nutrition (EEN) up to scratch on the outcomes of the critical care patients with different degrees of severity of illness. Method There were 192 critically ill patients eligible for enrollment for study during the past 18 months in our ICU. They were classified by using APACHE Ⅱ scores. The aim of this retrospective analysis of the early enteric nutrition was to see if the enteric nufore, the patients were divided into two groups: up to scratch group and not up to scratch group. According to APACHE Ⅱ scores, the patients of each group were further divided into three sub-groups in terms of scores below 15, between15 and 25, and above 25, respectively. Results There were 62 patients in the group of EEN up to scratch, and 130 patients' EEN did not up to scratch. When the scores of APACHE Ⅱ were below 15, the length of hospital stay (LOS) was significantly shorter in group of EEN up to scratch in comparison with that of EEN not up to scratch (t = 6.453, P = 0.000). When the scores of APACHE Ⅱ were between15 and 25, the LOS in ICU (t = 3.966, P = 0.000), in hospital (t = 8.165,P = 0.000), The cost of medical care (t = 4.812,P= 0.000) and the mortality (x2 = 5.421,P = 0.038) were all significantly less in patients with EEN up to scratch. However, when the scores of APACHE Ⅱ were above 25, only the cost of medical care ( t = 7.364, P = 0.000) was significantly lower in patients of EEN up to scratch than that of EEN not up to scratch. Conclusions The EEN up to scratch can significantly improve the outcomes of critical patients and the clinical value of EEN up to scratch depends on the severity of illness.

Objective To identify regular roots for medical disputes by case studies for providing evidences for hospital management..Methods 200 cases of medical malpractice were selected consecutively and categorized according to the causes,dispute focus and expert opinions.Results The main factor to trigger medical disputes is dissatisfaction of the outcome,accounting for 50.5％.48.15％ of the disputes,however,result from dissatisfaction of the therapy process which constitutes a medical malpractice.Neglect or defects in treatment,surgical operation,information notice and medical papers were highly common causes.Conclusion Medical disputes result from a variety of causes,so are the roots of medical malpractice.Medical institutions are recommended to enhance medical quality management,make sufficient doctor-patient communication,and make high quality documentation of key medical activities,in an effort to minimize medical disputes and medical malpractice.

Objective To explore the significance and important measure of integrative treatment of multiple trauma patients with severe craniocerebral injury in emergency center. Methods One hundred and forty-eight multiple trauma patients with severe craniocerebral injury in emergency center from November 2002 to February 2006 were analysed retrospectively. Result In total 148 cases, 72 were cured and 26 dead, 7 were in status of plant man, 17 experienced severe deformity, and 26 did mild deformity. Conclusion Multiple trauma patients with severe craniocerebral injury usually experience a serious situation and rapid development. Therefore emergency doctors are required for organizing salvage of such patients, at the same time treatment and diagnosis are implemented. Firstly the most important key to successful salvage is appropriate disposal of fatal injury and early elimination of shock. Proper surgical choice, especially at the first time, inspection and protection of visceral functions, and attention to nutritional support are other vital methods to gain more successful salvage. ICU is also emphasized for its essentiality.

OBJECTIVE:To observe the curative effects of compound glycyrrhizin injection in treatment of primary sjogren syndrome(PSS).METHODS:68 patients with PSS were randomized into the treatment group and control group,and treated for 4wk with hydroxypiperaquine,bromhexine and carmellose.The treatment group also received compound glycyrrhizin injection in addition to the three agents for the control group.RESULTS:After treatment for 4wk,both groups saw some declines in IgG,IgM,IgA,ESR and RF,and improvement in indicators such as schemer test and saliva flow rate,with the treatment group showing more significant improvement than the control group(P

Objective To investigate the effects of Hsp90 inhibitor 17-DMAG on proliferation and apoptosis of human colon cancer cell line HT-29.Methods HT-29 cells were treated with 17-DMAG.The cell proliferation inhibition rate was evaluated by CCK-8 assay.Apoptosis of HT-29 cells by 17-DMAG was delineated by DAPI staining assay and Annexin V PI double labeling FCM was used to determine cell apoptotic rate.Furthermore,Westen blotting analysis was used to determine caspase-3 and cleaved caspase-3 protein expression.Results 17-DMAG time-dose-dependently inhibited the proliferation of HT-29 cells.After 0.1μmol/L,0.25μmol/L,0.5μmol/L,1.0μmol/L,2.5μmol/L and 5μmol/L 17-DMAG exposured for 24 hours,the cell proliferation inhibition rate was (14.36±0.95)％,(22.17± 1.15)％,(28.45±1.16)％,(35.04±1.58)％,(46.85 ±2.44)％,(57.19 ± 2.06)％ respectively,after exposured for 48 hours,the cell proliferation inhibition rate was increased to (20.80±1.17)％,(27.55 ±0.65)％,(33.33 ±1.23)％,(46.20±4.76)％,(55.45 ±4.47)％,(61.75 ±2.72) ％ respectively,after exposure for 72 hours,the cell proliferation inhibition rate was to (29.62 ± 2.27) ％,(39.19 ± 1.74)％,(44.29 ±2.00)％,(50.66 ±2.17)％,(58.84 ±3.18)％,(70.74 ±2.65)％.DAPI staining showed that HT-29 cells treated with 17-DMAG displayed chromatin condensation and nuclear fragmentation which are typical changes of apoptosis.Annexin V PI double labeling FCM showed that when HT-29 cells were exposed to 0,0.25,0.5,1.0 and 2.5(μmoL/L) 17-DMAG for 24 hours,the total apoptotic rate for 24 hours was (2.72 ±0.57)％,(5.38 ±0.46)％,(6.88 ±0.52)％,(10.44 ±0.32)％ and (17.87 ±4.66)％ respectively.(P ＜0.05).In addition,the expression of procaspase-3 decreased,while cleaved caspase-3 increased in the presence of 17-DMAG at different concentrations for 24 hours.Conclusion 17-DMAG can time-dose-dependently inhibit proliferation and promote apoptosis of HT-29 cells in vitro.

Objective To establish a distinct linked emergency rescue network system in Shenzhen. Methods The current status of emergency network system in Shenzhen was studied, and some related publications in the recent years were reviewed. Results The emergency network system in Shenzhen is characterized by the following aspects: there is an effective emergency dispatch system with high authorities; the network covers every corner of Shenzhen; series of laws have been issued to ensure the proper operation of network. Conclusion The medical rescue system has developed in depth. The combination of community-based, pre-hospital and hospital rescue is effective in the whole process of emergency rescue, and shortens the rescue distance. The community-based rescue is the basic part of the system that can use the medical resources efficiently.

OBJECTIVE: To study the curative effect of Sodium Ferulate( SF) on rheumatoid arthritis( RA) and its effects on the levels of serum vascular endothelial growth factor( VEGF) and tumor necrosis factor- ? ( TNF- ? ) . METHODS: A total of 43 patients with RA were randomly divided into trial group and the control group: conventional treatment was adopted in both groups, but the trial group was treated additionally with SF injection for 4 consecutive weeks. Serum levels of VEGF and TNF- ? before and after treatment were determined by the enzyme linked immunosorbent assay( ELISA) . RESULTS: The total effective rate in the trial group the control group were 91. 30% vs. 75. 00% ( P