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 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 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.

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 analyze the risk factors of mucous plug caused byMycoplasma pneumoniae pneumonia (MPP) in children and guide clinical therapy to decrease the incidence of sequela caused by airway inlfammatory obstruc-tion.Methods We conducted a retrospective study of the clinical data of 116 children with MPP who received ifber broncho-scope from January 2012 to January 2014 admitted to the respiratory department of the Children's Hospital of Hebei provience. Based on the airway mucosal lesions seen through the bronchoscope, the subjects were divided into the mucous plug group (n=67) and the control group (n=49). Gender, age of onset, febrile course, pleural effusion, white blood cell counts, neutrophil ratio, C reactive protein (CRP), serum lactate dehydrogenase level (LDH), initial time of received macrolides and ifber bronchoscope were compared between the two groups. If the Results of single factor analysis showedP<0.05, the indicators were analyzed by the logistic regression analysis. The receiver operator characteristic (ROC) curve was drawn to evaluate the predictability of logistic regression model.Results The Results of single factor analysis showed that age of onset, febrile course, CRP, serum LDH, pleural effusion cases in the mucous plug group were higher than those in control group (P<0.05). The Results of the logis-tic regression analysis showed that older than three years (OR=7.45), febrile course more than 10 days (OR=4.01), the level of CRP and LDH higher than 40 mg/L (OR=5.41) and 350 U/L (OR=3.63) were respectively the risk factors of mucous plug caused by MPP in children. The area under the ROC curve is 0.846 (95%CI: 0.773-0.919,P=0.000).Conclusions MPP children with age older than three years, or with febrile course more than 10 days, or with the level of CRP and LDH higher than 40 mg/L and 350 U/L has the possibility of forming a mucous plug.

ObjectiveTo evaluate the uncertainty for the determination of ethanol in human blood by auto-headspace gas chromatography (HS-GC) with internal standard curve method.Methods Each source of uncertainty, arising from the procedure of testing, was analyzed and conifrmed according to the guidelines of the uncertainty in measurement . After each uncertainty component was quantized, the combined standard uncertainty and the expanded uncertainty of the result were calculated.Results The relative uncertainty brought from the measurement repeatability, standard solution of the ethanol, the sample of blood, internal standard solution of the tert-butyl alcohol, the calibration cure, gas chromatography were 3.4%,0.71%,0.61%,0.41%,1.1% and 1.3% respectively; the relative expanded uncertainty of ethanol in blood was 3.9%.Conclusion The measurement uncertainty of the concentration of ethanol was came primarily from the measurement repeatability of sample, HS-GC and standard curve of ethanol.

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 discuss the effect of the quality control circle(QCC)activities in reducing the incidence of cold in reflux-enema of children.Methods The QCC team was built,reducing the incidence of cold in reflux-enema of children was named as the theme,to grasp the present situation,set the goal,fix the methods and carry out countermeasures.Results Through the development of QCC,making the standards of reflux-enema,the incidence rate of cold reduced from 25.0％(7/28) down to 3.6％(1/28),the nurses' abilities of technical operation and communication improved significantly.Conclusions Application of QCC in reflux-enema of children is practical.It can effectively improve the nurses' awareness of participating in the implementation management and nursing management system.By making the standardization of reflux-enema,nurses can improve the quality and effect of the reflux-enema and ensure the quality and safety of nursing.