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.

To treat residual or recurrent stones after operation on hepatolithiasis conveniently and effectively, a subcutaneous permanent tunnel to bile duct (SPTBD) was established in 564 cases of hepatolithiasis by using an afferent jejunum or a well-functioned gallbladder in order to provide a postoperative way to remove residual or recurrent stones through cholangioscopy. We found that by cutting SPTBD open to remove residual or recurrent stones through cholangioscopy in 96 out of 238 followed-up cases, all the patients got good clinical effects without death or complications. The results suggest that it is a good method to establish a SPTBD during operation in patient with hepatolithiasis. It is a simple and effective way to cut SPTBD open to remove residual or recurrent stones after operation.

Objective To summarize the clinical effects of cholecystocholangiostomy (STHG) in the treatment of hepatocholangiolithiasis and hepatic portal bile duct stenosis. Methods The early complications, clinical effects, and functions of gallbladder in a total of 135 patients, admitted since 1994 were for STHG were retrospectively analyzed. Results No early complications were observed after the operation. The contraction and concenration function of the gallblader remained basically normal. The color of gallbladder mucosa was normal,and no edema or erosion was found under choledochoscopy. Conclusions This operation not only maintained the normal physiological functions of the gallbladder and Oddi sphincter, but also the physiological flow of the bile, farthermere it prevented reflux of intestinal juice and reflax chdangitis. Because the anastomotic stoma was large, concentrated bile within the gallbladder could freely get access to the intrahepatic biliary tract, the concentration of bile acid in the intrahepatic bile duct was markedly elevated, so that the solubility of bilirubin crystal, was increased and recurrence of calculus formation eould be retarded. There fore, STHG should be considered to be an optimal operation in dealing with hepatocholangiolithiasis and biliary stenosis.

Objective To study relationship between hepatocellular apoptosis and glycogen contents during cold preservation-reperfusion of liver and its mechanism. Methods Rat liver models with different contents of glycogen were established and the rats were divided into 4 groups (A, B, C and D). During cold reservation-reperfusion of liver, the changes in hepatocellular apoptosis and tissue SOD, GSH and MDA were observed in the groups. Results After cold preservation for 9 h in each group, 60?min reperfusion could result in obvious apoptosis in livers. There was difference in the numbers of apoptotic hepatocytes among all the groups. At the same time, there also were significant difference in the levels of SOD, GSH and MDA in liver tissue among the four groups.Conclusion Intracellular abundant glycogen may significantly depress hepatocellular apoptosis during hepatic cold preservation-reperfusion by decressing oxygen free radicals.

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 investigate the effect of intracellular glycogen on mitochondrial respiratory function of the ischemic reperfusion hepatocytes and its values.Methods During liver ischemia-reperfusion in the 21 rabbits,the tissue ATP content,hepatic enzymological change,respiratory control ratio(RCR) and P/O ratio of hepatocellular mitonchondria were observed in liver glycogen content significantly different three groups.Results Rabbit liver tissue with the higher content of glycogen has shown the higher mitonchondrial ATP content,also showed the higher RCR and P/O ratio of hepatocellular mitonchondria and the slighter injury of liver function.Conclusion Intracellular abundant glycogen may significantly improve respiratory functon of mitochondria,which can play an important role in keeping the hepatocellular function well during liver ischemia-reperfusion.

The main causes of early mortality after the earthquake are traumatic shock, hemorrhage and dehydration, and the ratios of shock and hemorrhage are high in patients with abdominal injuries. Prompt triage is very important to persons with abdominal injuries who were rescued in 48 hours after the earthquake. Primary triage should be carried out in the rescue field, and then followed by the secondary triage in the hospital. We improved the efficiency and accuracy of triage by following the principle of "5 steps, 3 categories and 1 indication". Nineteen persons with identified abdominal injuries and unstable vital signs received operation. The false positive rate was 5% (1/19), and the successful rate of the operation was 95% (18/19). During the process of rescue, the lives of the injured persons should be put in the first place. The operation should be performed under the principle of simpleness, rapidity and safeness.

BACKGROUND:Nano-hydroxyapatite/polyamide artificial bone has good biocompatibility and strong tissue binding force, which exerts a significant role in the recovery of neurological function. OBJECTIVE: To investigate the clinical effect of nano-hydroxyapatite/polyamide artificial bone in anterior cervical fusion. METHODS: Ninety patients with cervical spondylosis and traumatic dislocation of the cervical spine were randomized into observation group and control group. Patients in the two groups underwent nano-hydroxyapatite/polyamide artificial bone and autologous iliac bone implantation, respectively. Surgical condition, Japanese Orthopaedic Association score, vertebral height loss and bone fusion rate were compared and analyzed at different time after implantation. RESULTS AND CONCLUSION:There were no significant differences in surgical time, out of bed time, postoperative hospitalization time between the two groups (P > 0.05), but the intraoperative blood loss was significantly lower in the observation group than the control group (P < 0.05). Japanese Orthopaedic Association scores were significantly increased in the two groups at 3 and 6 months after operation and at last folow-up than before (P < 0.05), but there was no difference in the Japanese Orthopaedic Association score between the two groups (P> 0.05). The vertebral height loss and bone fusion rate had no difference between the two groups at 6 months after operation and at the last folow-up (P > 0.05). No adverse effects occurred in the two groups. These findings indicate that nano-hydroxyapatite/polyamide artificial bone has good clinical effects in anterior cervical fusion, and the treatment effect is equivalent to autologous iliac bone graft.

Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

Objective To investigate the therapeutic effectiveness of endoscopic self-expandable metal stent implantation for hilar cholangiocarcinoma. Methods The clinical data of 73 patients with hilar cholangiocar-cinoma who had received endoscopic metal stent implantation at the General Hospital of PLA Chengdu Command from July 2004 to July 2009 were retrospectively analyzed. The success rate of stent implantation, effective rate of jaundice release, duration of patency of the stent, survival time and postoperative complications were analyzed. Results Among the patients, 70 were successfully implanted with the stents. Unilateral metal stents were implan-ted in 62 patients, bilateral metal stents in three patients, and metal + plastic stents in five patients. The effective rate of jaundice release was 87% (61/70), the median duration of patency of the stent was 190 days, and the median survival time was 246 hours. Seven patients had complications of cholangitis, three had pancreatitis and two had bleeding. Conclusions The advantages of endoscopic metal stent implantation include minimal trauma and good efficacy in alleviating jaundice. It is the option of choice for the treatment of malignant biliary obstruction in patients with inoperable hilar cholangiocarcinoma.