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 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.

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.

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.

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB)is a commonly seen gastrointestinal emergency.Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB.Aims:To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Methods:Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic (ROC)curve (AUC).Results:Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived (P <0.01 ).The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0.785 (95% CI:0.743-0.828,P=0.000),0.765 (95% CI:0.693-0.837,P=0.000),0.835 (95% CI:0.703-0.966,P=0.005),respectively.The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0.812 (95%CI:0.775-0.848,P=0.000),0.870 (95%CI:0.811-0.930,P=0.000),0.784 (95% CI:0.614-0.954,P=0.017),respectively.Conclusions:Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.

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

AIM: To investigate the expression of ICAM-1 mRNA in hepatic sinusoidal cells (HSCs) during liver ischemia-reperfusion injury and its effects. METHODS: Three groups of rabbit livers experiencing ischemia for 15, 30 and 60 minutes respectively, and reperfusion for 60 minutes were conducted. The hepatic ICAM-1 mRNA expression was observed and leukocytes in hepatic sinus were counted. RESULTS: The lower expression of ICAM-1 mRNA showed in HSCs before reperfusion. Besides, leukocyte counts could no change. However, the more expression of ICAM-1 mRNA was found at the point of 60 minutes reperfusion. Furthermore, the higher expression of ICAM-1 mRNA showed in the more prolonged ischemic liver. Meanwhile, there was significant positive correlation between ICAM-1 mRNA contents and leukocyte counts. CONCLUSION: The high ICAM-1 mRNA expression induced by hepatic ischemia in HSCs increased adherence of HSCs and sequestrated more leukocytes in liver.

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.