The heterogeneity and diversity of sepsis,evaluation for the role of definitions and related guidelines,and the key evidence for the diagnosis and therapies of sepsis are being paid close attention to.Here are the discussions for the heterogeneity or diversity of sepsis effected from etiology,personality,gut-derived problem,predisposing factors or premorbid conditions,co-intervention,with comparing the positive and negative changes on some of the recommendations,suggestions,techniques,medicine,and therapies amongst different editions of International Consensus Definition for Sepsis and Septic Shock,and International Guidelines for Management of Sepsis and Septic Shock in Surviving Sepsis Campaign or other related special procedures.

Objective To investigate the status of sub-health in young and middle-aged intellectuals in Guangxi,and to provide a reference basis for improving the health status of young and middle-aged intellectuals. Method Convenient random sampling was used to select 3862 young and middle-aged intellectuals in Guangxi and the sub-health measurement scale version 1.0 (SHMS V1.0) was used to analyze the mental sub-health status. Results The total scores was (59.53±10.48) points and the score of SHMS V1.0 in the physical subscale, psychological subscale, social subscale were (59.27±13.39),(56.26±10.39),(63.49±11.92) points.The difference of the young and middle-aged intellectuals of age, occupation, gender, marriage,dwelling,work day time, breakfast, sleeping time, exercise, smoking and drinking were statistically significant (P<0.05). Conclusions The physical and psychological sub-health status of the young and middle-aged intellectuals in Guangxi is not unsatisfactory.Puting forward the nursing strategy of installing information exchange platform , forming a good living habits , creating a good atmosphere to improve the psychological sub-health status of the young and middle-aged intellectuals are of great importance.

Objective To evaluate the efficacy of percutaneous internal fixation with hollow screw for femoral neck fractures.Methods From June 2001 to June 2004,48 cases of femoral neck fractures,including 22 cases of fracture without displacement(type Garden I and II) and 26 cases of fracture displacement(type Garden III and IV),were treated by close reduction and percutaneous internal fixation with 3 hollow screws forming inverse triangle.Results The intraoperative blood loss was less than 10 ml,and the average operation time was 32.5 min(range,18-54 min).48 cases were followed up for 24-61 months(mean,38.2 months),union of fracture found in 97.9%(47/48) of cases,union time being 4-12 months(mean,6.2 months).According to Harris score of hip joint function,32 cases were excellent,11 cases good,3 cases fair,2 cases bad,the rate of excellent and good results being 89.6%(43/48).In 22 cases of fracture without displacement,there was no nonunion and ischemic necrosis of head of femur.In 26 cases of fracture displacement,the rate of nonunion and ischemic necrosis of head of femur were 3.8%(1/26) and 11.5%(3/26) respectively.Conclusions Percutaneous internal fixation with hollow screw has the advantages of ideal curative effects,simple procedure,reliable fixation and less complications.

Objective To evaluate the lateral profile changes after the functional appliance was used to put forward the mandible. Methods Thirty one cases of maloclusion (subclass Ⅰ of the class Ⅱ) were selected,in which all the mandible were in a backward position revealed by clinical examination and roentgenographic cephalometry.Functional appliance was used to put forward the mandible,and then the changes of IMPA, Z angle, H angle, soft tissue profile angle, upper lip E Line, lower lip E Line, upper lip/lower lip, and lower facial height were compared before and after treatment. Results All of the cases showed up a better improvement of the profile after the functional appliance therapy. Z angle, H angle, soft tissue profile angle, upper Lip E line, upper Lip/lower lip, lower facial height became normal or close to normal.There was a statistical significantce in the changes ( P

Objective To evaluate the recent safety and long-term curative effect of double-pool shaping trabeculectomy with adjustable sutures in glaucoma. Methods A hundred and twenty patients with glaucoma were randomly divided into two groups, in which the control group in 62 patients underwent traditional trabeculectomy and the experimental group in 58 patients underwent double-pool shaping trabeculectomy with adjustable sutures. All patients were followed up for one year. Postoprative intraocular pressure, anterior chamber depth and filtering bleb were observed. Results In the experimental group, after the demolition of adjustable sutures, 3 eyes(5.17%) suffered from I degree shallow anterior chamber. By contrast, 8 eyes suffered from I degree shallow anterior chamber, and 1 eye (total 14.52%) suffered from Ⅱ degree shallow anterior chamber in the control group (P < 0.05). Following up in one year, the functional filtering bleb and intraocular pressure got better in the experimental group than in the control group (P < 0.05). Conclusion Double-pool shaping trabeculectomy with adjustable sutures is a safe and feasible method for glaucoma, in which it can effectively reduce intraocular pressure without complications.

Objective To investigate the effects of epinephrine in sepsis-associated lung injury in rats. Methods Thirty SD rats were randomly divided into three groups(n =10 per group):control group received intravenous 0. 9% saline 2. 4 ml/( kg·h ); LPS group received intravenous LPS ( 6 mg/kg ); epi-nephrine treatment group received an infusion of epinephrine 0. 6μg/( kg·min) after LPS intravenous injec-tion . Blood samples were taken at 2 h and 6 h after LPS injection and the levels of serum tumor necrosis factor ( TNF)-α,interleukin( IL)-6 and IL-10 were detected. The rats were sacrificed at 6 h. The lung tissues and bronchoalveolar lavage fluid( BALF) were collected. Pathological changes of the lung tissues were observed under light microscope. Water content of lung,expression of TNF-α,IL-6 and IL-10 in BALF and in serum were detected. Results (1) The water content of lung in LPS group significantly increased compared with that in control group(85. 24% ± 5. 87% vs. 70. 19% ± 5. 87%) and epinephrine group(78. 00% ± 6. 41%) (P<0. 05). (2)Pathological examination showed that LPS could cause pulmonary capillary hyperemia,ede-ma,inflammatory cells infiltration. Atelectasis and alveolar edema were found in small number of lung tissue. Compared with LPS group, epinephrine ameliorated the lung pathological injury. ( 3 ) Compared with LPS group,serum levels of TNF-α and IL-6 significantly decreased ( P <0. 05 ) , whereas IL-10 increased ( P <0. 05) in epinephrine group. (4)Compared with LPS group,BALF levels of TNF-α[(78 ± 9)ng/L vs. (102 ±16)ng/L]andIL-6[(268±42)ng/Lvs.(347±50)ng/L]significantlydepressed(P<0.05),whereas BALFlevelsofIL-10[(210±23)ng/Lvs.(146±34) ng/L]elevated(P <0.05) inepinephrinegroup. Conclusion Epinephrine could reduce the acute lung injury caused by LPS. Its protective effect may be re-lated to decreasing the levels of TNF-α and IL-6,elevating IL-10 level.

Objective Near-infrared (NIR) reflectance spectroscopy was used to develop a fast quality assessment method by simultaneous material identification and moisture quantification of Radix Ginseng Rubra (RGR). Methods The sample was identified by the comparison of its spectrum with a standard NIR spectral library. Similarity measurement was used as the discriminating parameter. The moisture content of sample was quantified by a partial least square (PLS) calibration model, correlative spectrum calculation was used for wavelength selection and multiplicative signal correction (MSC) was applied for pretreatment in the calibration model. Primary reference data were obtained using the traditional loss on drying (LOD) method. Results The NIR library can distinguish RGR from the counterfeit successfully. The optimized eight-factor PLS calibration model of NIR spectra has a high correlation coefficient (R=(0.999 7).) Conclusion The proposed method is rapid, accurate and can be used routinely in the traditional Chinese materia medica manufacturers for quality control of raw materials.

Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children.Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children's medical center between May 2008 and Apr 2011.Results Eight cases were male and 7 were less than twelve months,the oldest was 2 years old,all of them were diagnosed as Pseudomonas aeruginosa spesis.Two patients had a single lesion,and the others had multiple lesions.Ecthyma gangrenosum located on the trunks in 7 cases,on anogenital areas in 5 cases,on extremities in 5 cases and on faces in 3.The lesions appeared on day 2 to day 10.On average,they developed on day 5.Seven patients developed ecthyma gangrenosum before admission,the course of the illness before admission was 6 days.Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa,blood cultures were positive in 8 cases,the others were isolated psudomonas aeruginosa from tissue of the lesion,discharge,ascites,pleural effusion,respectively.The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported.All of the patients were started empiric antibiotics therapy on admission,the initial antibiotic regimen was appropriate in 9 patients,8 needed surgical intervention,4 were treated with continuous blood purification.Ten patients survived and 2 died,the hospital stay was from 1 to 63 days,the average was 30.Conclusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis,which is helpful for early diagnosis and treatment,and then the outcome will be improved.

Objective To explore the application of the ultrasonic cardiac output monitor(USCOM) in the children with pneumonia complicated with heart failure.Methods Fourteen children with pneumonia complicated with heart failure were enrolled in the experimental group and thirty-two children with common pneumonia were enrolled in the control group.We used the USCOM to measure the cardiac output indicators,including the aortic peak velocity,heart rate,stroke volume index,cardiac index,ejection time and correcting ejection time.Results The heart rate in the experimental group was faster than that of control group[(174 ±10) beats/min vs (133 ± 14) beats/min,P ＜0.05],the aortic peak velocity in the experimental group was lower than that of control group [(1.246 ±0.234) m/s vs (1.449 ±0.300) m/s,P ＜0.05],the stroke volume index in the experimental group was lower than that of control group [(29.357 ± 6.500) ml/m2 vs (40.188 ±5.337) ml/m2,P ＜0.05],and the correcting ejection time in the experimental group was shorter than that of control group [(342.560 ± 8.219) ms vs (354.430 ± 16.500) ms,P ＜ 0.05].Conclusion The cardiac function monitoring by USCOM is accurate and convenient,and USCOM can provide the accurate evidence for the clinical application.

Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.