OBJECTIVE To study the alteration of microbial population distribution in intensive care unit (ICU) for the reference to clinical drug administration. METHODS The distributed features of 413 strains of infection germs detected among the patients of ICU were statistically analyzed during the years of 2002 to 2005. RESULTS The main germs of 413 strains were Pseudomonas aeruginosa(87 strains), Acinetobacter baumannii(48 strains), Stenotrophomonas maltophilia(34 strains), Staphylococcus epidermidis(30 strains), S. aureus (20 strains) and Escherichia coli (19 strains). The first 3 species were P. aeruginosa (21.07%), A. baumannii(11.62%) and Sten. maltophilia (8.23%). CONCLUSIONS Most pathogens in ICU are Gram-negative bacteria and the proportion of Sten. maltophilia increases gradually. It is a very important clinical value to inspect the bacterial distribution and antibiotics should be used rationally.

Objective A stable rat model of heat stroke was established to investigate heat stroke-induced changes of the intestinal epithelial tight junction (TJ) barrier permeability, and to investigate the mechanism by observing the changes of TJ protein (occludin) expression and TJ morphology. Methods SD rats were randomly divided into two groups(n = 10): heat stroke group and normal control group. Stable model of heat stroke was established. Anesthetized rats were exposed to 42 ℃ in a ventilated chamber for 50min, after heat exposure, the rats were placed in room temperature(26 ℃ ) for 2 h. Then the rats were sacrificed and samples were taken. The effect of heat stroke on intestinal epithelial barrier permeability was observed through changes of plasma FD4 and endotoxin concentration, cytokines concentration was detected as inflammatory indicators. The general and micro pathology was observed by light microscope (hematoxylin and eosin-staining, HE staining) and transmission electron microscope (TEM). Occludin expression was investigated by Western bloting and immunochemistry. Results At 2 h after heat exposure, intestinal epithelial barrier permeability( FD4 and endotoxin concentration), and cytokines levels of heat stroke group were significantly higher than normal control group(P ＜ 0. 05 ). In morphology, by observing the light micrographs of HE jejunal tissue, the sloughing of epithelium off the basement membrane at the villus tips of the heat stroke group compared with the normal controlgroup. In many visual fields (VF)( ≥6VF/slice), this phenomenon was not universal. Under TEM, TJ of normal enterocytes was integrated with the compact zonal structure. At 2 h after heat exposure, TJ of heat stroke group was broken with widen intercellular space, and the density of TJ was decreased. In immunochemistry assay, the positive signal was distributed along the cell membrane in normal small intestinal tissue, while the signal was obviously decreased in heat stroke group.The results of Western bloting showed that occludin expresion of heat stroke group was significantly lower than normal control group(P ＜0.05). Conclusion Heat stroke decreased occludin expression, opened the intestinal epithelial TJ, which destroyed intestinal epithelial tight junction barrier, induced high intestinal epithelial barrier permeability, produced endotoxemia and systemic inflammatory response syndrome (SIRS).

Objective To study the therapeutic action of SHENFU (ginseng-aconite) injection on post-operation of liver transplantation. Methods From Jan. 2004 to Mar. 2005, 30 cases underwent orthotopic liver allotransplantation were divided into two groups randomly. The patients in control group received routine transfusion, while the patients in SHENFU injection group, besides the routine transfusion, received SHENFU injection as well. Results 120 minutes after the SHENFU treatment, the mean arterial pressure (MAP) of the patients was raised from 53.21?8.52mmHg to 75.62?7.58mmHg, meanwhile the heart rate (HR) declined from 115.3?13.2/min to 90.1?7.2/min. At the same time, the contents of lactic acid, IL-6, IL-8 and TNF-? in the patients also declined from 9.82?3.96mmol/L, 89.02?43.75pg/ml, 58.24?33.61 pg/ml and 42.33?28.15pg/ml to 4.31?2.11mmol/L, 30.08?25.12pg/ml, 29.83?20.05pg/ml and 24.52?15.61pg/ml, respectively. Compared with the control group, there existed significant differences (P

Objective To study the curative effect of continuous renal replacement therapy (CRRT) to the patients with acute renal failure after liver transplantation. Methods From Mar. 2004 to Jan. 2005, the continuous renal replacement therapy was applied to 7 patients with acute renal failure after liver transplantation. The average time of CRRT was 36.1h. The volume of fluid displacer during CRRT was 2-4L/h and the volume of blood flow was 150～250ml/min. Normal heparin was used as anticoagulant. Results For the 7 patients, 4 improved, 2 died. The contents of blood urea nitrogen (BUN) and blood Cr of all the 7 patients have obviously declined(P0.05). The haemodynamic variables were stabilized during CRRT and no obvious side-effect related to CRRT was found. Conclusions CRRT improved the prognosis to the patients with acute renal failure after liver transplantation, showed a favorable tolerance, and may be applied as a emergency measure to the patients with acute renal failure.

Objective To investigate the etiopathogenesis of exertional heat stroke(EHS)induced by military training of those patients admitted in military hospitals,and analyze the influence of EHS as a predisposing factor on prognosis.Methods Eighteen patients with EHS were admitted in 6 military hospitals from Sep.1995 to Aug.2007,their clinical data were retrospectively analyzed.All cases were evaluated according to Minard's EHS predisposing factors including the individual's physiologic limitations,environmental conditions and the organizational predisposing factors.According to the final treatment outcome,18 cases of EHS were divided into fatal group(Group F)and survival group(Group S).The significance of deviation on the predisposing factors,and of the differences on the accumulated predisposing factors between the two groups,was analyzed.Results All the 18 cases of EHS occurred after military training,and complicated with multiple organ dysfunction syndrome(MODS).Hyposthenia,excessive physical efficiency training,incorrect disease classification to the patients,and inappropriate diagnosis and treatment were found to be the strong predictors to a grave prognosis.The effect of accumulated predisposing factors of EHS in group F was significantly higher than that in group S(10.0?1.41 vs 5.64?1.96,P

Objective To analyze the possible effective intervention for heat stroke(HS)associated with multiple organ dysfunction syndrome(MODS)as a result of cross-country training.Methods All the data of causes of HS,clinical manifestations,laboratory findings,clinical interventions and outcome were collected and analyzed in five cases of HS associated with MODS.Results Four patients survived and one died of severe DIC and MODS.The levels of creatin kinase and myoglobulin in survived patients lowered gradually 4-5 days after effective treatments.No sequela was found in survived patients.Conclusions The therapeutic principle for the patients of HS associated with MODS is early commencement of hypothermia,fluid expansion,anticoagulation,blood purification and deep-sedation.

ObjectiveTo investigate the effect of continuous renal replacement therapy (CRRT) on the elderly patients with acute renal function failure.Methods11 elderly patients with acute renal function failure were treated with continuous renal replacement therapy. The average time of CRRT was 24.8 h. The ultrafiltration rate during CRRT was 2～4 L/h and blood flow rate was 150～250 ml/min. Normal heparin was used as anticoagulant.ResultsAmong 11 patients, 7 were mend, 3 died. The blood urea nitrogen (BUN) and creatinine (Cr) levels of all patients obviously declined (P<0.01). The haemodynamic variables of all patients were stabilized during CRRT and no obvious side-effect related to CRRT was found.ConclusionThe treatment of CRRT can improve the sufferer prognosis to the elderly patients with acute renal function failure, not restricted by age, and is the effective means to the elderly patients with acute renal function failure.

Objective To evaluate the value of selecting and locating coronary artery severe stenosis by the segmental longitudinal strain imaging diastolic indexes (LSI-DI).Methods 94 subjects with left ventricular ejection function (LVEF) ≥50％ and without regional wall motion abnormalities (RWMA) were divided into A group (coronary artery sever stenosis),B group (coronary artery light or mid stenosis) and C group (normal control) using coronary angiography.Some indexes were measured such as early diastolic mitral annulus velocity of septum (e),diastolic peak flow velocity of mitral valve (E,A) and E/e ratio.Using two-dimensional speckle tracking,indexes were measured such as segmental peak systolic longitudinal strain (PSLS),segmental longitudinal strain imaging diastolic indexes (LSI-DI) and global peak systolic longitudinal strain (GPSLS),global longitudinal strain imaging diastolic indexes (GLSI-DI).Compared these indexes among the three groups,the most valuabe segments were obtained and the optimal values were found out by ROC curve.Results There were no significant differences about GPSLS among the three groups.Coronary artery severe stenosis group were significantly lower than the other two groups on GLSI-DI (P ＜0.05);GLSI-DI of B group was lower than that of normal control group but the difference was not significant(P ＞0.05).The optimal cutoff values of LSI-DI were 45.5％ in the middle anteroseptal segment for detecting left anterior descending (LAD) artery severe stenosis (sensitivity 81.8％,specificity 84.2％),44.8％ in the basal anterolateral segment for detecting left circumflex (LCX) artery stenosis (sensitivity 87.3％,specificity 85.3％),and 48.3 ％ in the basal inferior segment for detecting right coronary (RCA) artery stenosis (sensitivity 79.6％,specificity 86.9 ％).Conclusions Patients with coronary artery severe stenosis can be screened by LSI-DI among patients with LVEF ≥50％ and without RWMA through conventional echocardiography.The middle anteroseptal segment,the basal anterolateral segment and the basal inferior segment can better locate the branches of coronary artery severe stenosis and the cutoff values were separately 45.5 ％,44.8 ％ and 48.3 ％.

Objective To explore the efficacy of low dosage of olanzapine combined with fluoxetine in the treatment of depression.Methods A 8-week study was conducted in 130 patients met the diagnostic criteria for de- pression.Subjects were randomly assigned to two groups:fluoxetine(20mg/d)alone and olanzapine(2.5～5 mg/d) plus fluoxetine(20mg/d).They were evaluated with Hamilton depression scale(HAMD).Hamilton anxiety scale (HAMA)at baseline,the 1 week,2 weeks,4 weeks and 8 weeks subsequently.Results(1)There were significant differences in the total scores and reduction rates of HAMD between two groups in every interview.(2)The combi- nation group had greater reduction in depressive and anxiety symptoms than that in fluoxetine group.(3)The re- sponse rate in combination group was higher than that of fluoxetine group in 1 week,2 weeks and 4 weeks.There were no significant differences in response and remission rate between combination group and fluoxetine group.Con- clusion The combination of olanzapine with fluoxetine demonstrated a rapid,effective antidepressant action.

Objective To observe the curative effect of low melocular weight heparin(LMWH) on the hypercoagulability in acute Kawasaki disease(KD).Methods Forty-six patients were diagnosed KD.Twenty-two cases out of all KD patients whose serum concentration of whether platelet(PLT) or fibrinogen(FIB) was significantly increased or who were found thrombus in their coronary artery by ultrasonic Doppler were treated with LMWH by subcutaneous injection once every day for 7-10 days.All the patients were divided into 2 groups accor-ding to whether using LMWH or not:H group(using LMWH) and NH group(no using LMWH).It were detected before and after treatment that included thrombin time(TT),activated partial thromboplastin time(APTT),international normalized ratio(INR),FIB,plasma mucosity,erythrocyte sedimentation rate(ESR),hematocrit(HCT) and situation of haemorrhage.Results 1.Before treatment,PLT and FIB of patients in H group were significantly higher than those in NH group(Pa