Sepsis is one of the serious illnesses leading to high mortality in ICU.Some animal experiments and clinical trails show that target temperature management has a protective effect on target organ function in sepsis,but the optimal timing,length of targeted temperature managment continued,intervention measures,and optimal target temperature obtained in sepsis remains in the great controversy.Whether the patients with sepsis would be truly benefited from the body temperature management is still worthy issue for further study.The aim of this article reviews is to trace the recent research progress on the body temperature management in sepsis.

Objective To observe the immunohistochemical expression of lymphocyte subpopulationin in brain and spinal cord tissue,and explore the mechanism of Zuogui wan and Yougui wan on rats with experimental autoimmune encephalomyelitis(EAE).Methods Lewis rats were immunized with the myelin basic protein(MBP).120 rats were grouping randomly into normal group,EAE group,prednisone group,Zuoguiwan group and Youguiwan group after post immunization(PI).Rats in normal group and EAE group were administered normal soline,each 3 mL/d.Rats in prednisone group were administered suspension of prednisone after developed clinical signs,each 5 mg/kg.Rats in Zuoguiwan group were administered suspension of Zuoguiwan,each 2 g/kg,and rats in Youguiwan group were administered suspension of Youguiwan,each 3 g/kg.On 15th and 27th day after PI,rats were killed and the immunohistochemical staining was performed on the sections of brain and spinal cord.Results On 15th and 27th day after PI,the expression of CD4+ in brain and spinal cord tissue of EAE group were significantly higher than that in normal group(P

Objective To research the experience of cardiac death organ donation based on the transplant coordinator.Methods Survey was made in The Third Xiangya Hospital of Central South University,and potential donors,data were collected from March to October,2010.Through defining four concepts:potential DCD donors,effective DCD donor,success ratio of DCD donor,rejection ratio of DCD donors,the DCD work was quantitatively analyzed.Results There were 16 potential DCD donors and 5 effective DCD donors,and the success ratio of DCD donor was 31.3 0％ (5/16).In the 11 failure cases,there were 3 cases (27.3 ％) whose family refused to donate,3 cases (27.3 0％) whose family had no consentaneous opinions on denotation,4 cases (36.4 ％) whose organ quality did not meet the criteria because of delaying time when dealing with various kinds of disputes or coordinating with various departments,and one case (9.1 ％ ) whose donated organ was unqualified.Rejection ratio of DCD donors was 37.5 ％ (6/16).Conclusion We need to do efforts to further improve the potential DCD donors,discovery.Transplantation coordinator plays an important role in human organ donation work,whose communication skills and professional knowledge still need to be further trained.It is not enough to just rely on the medical department and Red Cross,human organ donation work needs the collaborative participation among the administrative department,the traffic department and the department of justice.

BACKGROUND: The data of epidemiological survey on rheumatic diseases such as ankylosing spondylitis (AS) are very rare in China, especially in Shenzhen. The comprehensive understanding of epidemiological situation of AS in Shenzhen can be used to draw up treatment plans by Shenzhen Health Bureau and some other health organizations.OBJECTIVE: To investigate the epidemiological features of AS.DESIGN: Randomized complete collection and cross-sectional investigation.SETTING: Shenzhen Rheumatism Institute of Guangdong Medical College. PARTICIPANTS: From December 2001 to April 2004, totally 6 684 adults aged over 16 years were selected from three regions (one region of river and lakes, one local mountain region and one inhabitant region) of Shenzhen. Among them, 5 922 adults (2 659 males and 3 263 female) were actually investigated and the investigative rate was 88.6%. Males were accounted for 44.9% and females were 55.1%, and the ratio was 1:1.23.METHODS: Step 1 and 2, the investigated individuals were questioned and their answers were recorded by the investigators. The questionnaire proceeded one by one for every individual and proceeded at homes. Step 3,the individuals with positive findings at steps 1 and 2 were examined by rheumatologic doctors. Step 4, individuals with suspected AS were subjected to human leukocyte antigen B27 (HLA-B27) assays, radiographies including plain pelvic films, plain lumbar-vertebral films and if necessary, radiographies at other areas of spinal column as well as peripheral joints.MAIN OUTCOME MEASURES: Frequencies of rheumatic complaints,prevalence rate of AS, positive frequencies of hum an HLA-B27, and comparisons with relevant data abroad.RESULTS: ① General frequency of rheumatism was 21.6%, and the highest complaint was at knee joint, then at waist, shoulder, neck and hand. In female, the frequencies of complaints at every joint mentioned above were higher than those in male (P ＜ 0.05). A total of 13 patients (4.7%) had to discontinue their work because of rheumatic diseases. ②Prevalence rate of AS was accounted for 0.37%, and the ratio between male and female was 4.5: 1. The onset of AS began at middle age in majority patients. ③ Positive frequency of HLA-B27 was 5.0%. ④ Rate of misdiagnosis, the rate of early diagnosis and the rate of long-term irrational drug-usage were 64%, 27% and 73%, respectively.CONCLUSION: In Shenzhen, the prevalence rate of AS (0.37%) is ranked higher than that in Beijing (0.26%), Shantou (0.26%), America(0.20%) and the whites of Greece (0.24%). The differences among them may be connected with the fact that in Shenzhen the young people occupy a large proportion of population.

ObjectiveTo investigate the effects of two health education models on the psychology and nutrition of patients waiting for cadaveric renal transplantation.Methods A total of 125 patients waiting for cadaveric renal transplantations were involved in our study.They were diagnosed with chronic renal failure in our hospital during September 1, 2009 to August 30, 2010.The patients were randomly divided into control group (n = 62) and observational group(n = 63).Patients in the control group received traditional health education with routine preoperative education during hospitalization.In the observational group, full-time nurses assessed the nutrition status of each patient and monitored the data. The observational patients were followed up and were given dietary guidance and knowledge of transplantation.Various kinds of education formats were adopted in observational group to provide communication opportunities between patients and surgeons in charge as well as patients who underwent transplantation.Psychological testings of patients in both groups were tested by self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after the health education.Triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC) and biochemistry index were also tested.Psychological and nutritional status of patients in the two groups was compared.ResultsThere were no significant differences in scores of the SAS, SDS, TSF, Hb, and albumin (Alb) between the two groups (all P＞0.05) before health education.After health education, SAS and SDS in observational group were lower than those in the control group (40.02 ±9.05 vs 47.05 ± 10.32,42.70 ± 10.01 vs 50.83 ± 10.12; both P＜0.01).Both TSF and Hb were elevated after education (P ＜ 0.001 or 0.05).Alb was significantly elevated in the observational group [(35.67 ±6.19)g/L vs (37.48 ±5.09)g/L, P ＜0.01].ConclusionComprehensive and various health education methods can significantly alleviate mental stress and improve nutrition of the patients waiting for kidney transplantation, which is helpful for patients facing disease positively and having a better quality of

Objective To assess the safety and efficacy of gabapentin in treatment of refractory uremic pruritus in maintenance hemodialysis (MHD)patients. Methods A randomized controlled trial was performed.Forty-nine MHD patients with severe pruritus were randomly divided into treatment group(gabapentin 100-300 mg at dialysis day before sleep)and the control group(loratadine 10 mg daily).The efficacy was assessed by visual analogue score,pruritus score and improved Duo's VAG Score after 12-week treatment,and the side effect was also observed to assess the safety. Results After treatment,the frequency,degree and area of pruritus in 25 patients of treatment group were significantly reduced,and VAS score(1.46±1.38vs 8.71±1.17,P＜0.01),VAG score(2.92±1.63 vs 8.29±0.68,P＜0.01)and the improved Duo's pruritus score(11.33±3.99 vs 30.75±4.87,P＜0.01)decreased significantly compared with that of prior treatment.The symptoms of 24 patients in control group were improved partly,which were not as good as those in treatment group(P＜0.01).The side effects of gabapentin were drowsiness and dizziness,but most symptoms were relieved or disappeared within 1 week and no patient interrupted therapy.No serious adverse events were observed. Conclusion Gabapentin is safe and effective for refractory uremic pruritus,but long-term efficacy and safety requires larger sample and long-term observation.

Objective:To observe effects of Huanglian Jiedu Decoction on expression of insulin receptor substrate 1(IRS-1)and the level of tyrosine phosphorylation in skeletal muscles to explore the molecular mechanism in improving insulin resistance.Methods:Wistar system insulin resistance model rats were developed with injection of small dose of streptozotocin into the caudal vein plus feeding by forage with high sugar and high lipids,and they were treated with Huanglian Jiedu Decoction for 10 weeks.Then blood sugar and serum insulin level were determined,and the changes of IRS-1 protein expression and tyrosine phosphorylation level in the skeletal muscles of the rat with insulin resistence after treatment of Huanglian Jiedu Decoction were detected with immuno- precipitation and Western Blot methods.Results:After treatment with Huanlian Jiedu Decoction,IRS-1 expression and IRS-1 tyrosine phosphorylation level in the muscular tissue increased as compared with those of the model group.Conclusion Huanglian Jiedu Decoction improves IRS-1 protein expression and tyrosine phosphorylation level in the skeletal muscle tissue of the rats with insulin resistance,which is possibly one of the mechanisms of decreasing blood sugar and improving sensitivity of insulin in tissues.

Objective To compare the eficacy and safety of flexible laryngeal mask (FLMA) and endotracheal tube (ETT) in children undergoing adenoidectomy and tonsillectomy. Methods Forty children with snoring disease scheduled for selective adenoidectomy and tonsillectomy surgery under intravenous compound inhalation general an-esthesia were divided randomly into either FLMA group or ETT group. MAP,HR and SpO2 were recorded before an-esthesia induction(T0 ), 1 (T1 ),3 (T2 ),5 (T3 ) min after intubation,1(T4 ),3 (T5 ) min after extubation. Param-eters for respiratory mechanics included peak airway pressure (Ppeak ), mean airway pressure (Pmean ), end tidal CO2 (PetCO2 ),and airway sealing pressure. All of the above indicators were recorded 5 min (T6 ) after intubation, 10 (T7 ),20 (T8 ) min after put in mouth gag,5 (T9 ) min after removing mouth gag. Meanwhile,chievement ratio of first time insertion,incidence of regurgitation aspiration,bucking,laryngospasm,wheezing when extubation and af-ter extubation,anesthesia time,surgery time,extubation time were recorded. Complications such as nausea and vomi-ting,pharyngeal pain,hoarseness were followed up 24 hours after surgery. Results MAP, HR during T1 , T2 , T3 , T4 ,T5 were significantly higher in group T than T0 , and those in group FLMA (P<0.05). MAP, HR were not sig-nificantly changed in group FLMA during each time. Ppeak , Pmean was significantly lower in group FLMA than that in group ETT. The extubation time was shorter and the incidence of coughing and pharyngalgia after operation was low-er in group FLMA than that in group ETT. Conclusion Compared with endotracheal intubation, on the basis of not affecting surgical operation, FLMA is an effective, safe anesthesia for adenoidectomy and tonsillectomy surgery in children, with the advantages of hemodynamic stability, mild airway trauma,and is a easy handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory me-chanics and low incidence of postoperative upper airway complications.

Aim To investigate the effect of intracerebroventricular morphine postconditioning against ischemia-reperfusion injury in rat heart and the mechanism of the central nervous system opioid receptor.Methods Forty-two Sprague-Dawley Rats were established intracerebroventricular catheter placement and myocardial ischemia/reperfusion models and randomly assigned to 7 groups:Sham group(Sham),control group(CON),intravenous control group(VCON),morphine postconditioning group(POC),intracereborventricular morphine postconditioning group(MOC).According to the dosage of intracerebroventricular morphine(3 ?g?kg-1,0.3 ?g?kg-1,0.03 ?g?kg-1),MOC group was assigned to three groups :MOC 1,MOC 2,MOC 3.Infarct size(IS),a percentage of the area at risk(AAR) was determined by triphenyltetrazolium(TTC) staining.c-fos expression in nucleus of tractus solitarius was determined by immunohistochemical method and Cardiac TroponinI(cTnI) of serum was observed at 120 min of reperfusion.Results Compared with control group,IS,IS/AAR and cTnI were significantly reduced in POC and MOC groups(P0.05).c-fos expression in nucleus of tractus solitarius were significantly reduced in MOC 2,POC(P

Objective To evaluate the effect of conventional or goal-directed fluid management on hemodynamics in patients undergoing orthopaedic arthroscopic shoulder surgery in beach chair po-sition.Methods Thirty healthy adult patients,male 1 7 cases,female 13 cases,aged 18-65 years, weight 49-68 kg,ASA Ⅰor Ⅱ,undergoing elective arthroscopic shoulder surgery,were enrolled.Pa-tients were randomly assigned to the group R(Routine group,n = 1 5 )and the group S(SVV/CI/MAP-directed,n =1 5).All patients received 10 ml/kg of hydroxyethyl starch rapidly in group R;while in group S,if SVV > 13%,patients would receive 3 ml/kg of hydroxyethyl starch in 5 min, then the changes of each index were observed;if SVV <13% and CI< 2.5 L·min-1 ·m-2 ,given dopamine 0.5~1 μg·kg-1 ·min-1 ,until CI>2.5 L·min-1 ·m-2 .At 5 min after anesthesia induc-tion,patients were placed in a 60° upright position.The hemodynamic changes were monitored by FloTrac/Vigileo system.Heart rate (HR),mean artery pressure(MAP),cardiac index(CI),stroke volume variation(SVV),stroke volume index (SVI),were recorded on pre-induction (T1 ),post-induc-tion (T2 ),immediately after in beach chair position (T3 ),5 min after in beach chair position(T4 ),30 min after in beach chair position(T5 ),and at the end of surgery(T6 ).The duration of surgery,crys-talloid requirements,colloid requirements,urinary output,the dose of vasoactive drugs and the inci-dence of hypotension were recorded.Results Compared with T1 ,MAP,CI and SVI at T3-T5 point (after in BCP to the end of the surgery)were higher in both group(P <0.05 ).Compared with T2 , SVV in group R at T3-T5 were significantly increased (P <0.05),while SVV in group S only at T3 was slightly increased (P <0.05).Compared with group R,MAP,CI and SVI at T3-T5 were signif-icantly higher respectively,while SVV were higher at T3-T5 in group R (P <0.05).Compared with group R,the colloid requirements and total requirements in group S were significantly increased(P <0.05).Compared with group R,the doses of dopamine and ephedrine,the urinary output,the inci-dence of hypotension in group S were significantly reduced(P <0.05).Conclusion SVV/CI/MAP-di-rected fluid management is safer,more effective and renders much more stable hemodynamic than the routine fluid management.