Objective To evaluate preventive and therapeutic effects of low dose of unfractioned heparin on severe sepsis. Methods 52 Patients with severe sepsis hospitalized in Intensive Care Units were randomly divided into control group and heparin group. On the basis of conventional therapy, patients with sepsis were given low dose of unfractioned heparin or isovolume physiologic saline by continuous intravenous drip infusion over 5 days. Acute Physiologic and Chronic Healthy Evaluation (APACHE-Ⅱ) score, blood platelet count(BPC), prothrombin time(PT), activated partial thromboplastin time(aPTT), thrombin time(TT), plasma fibrinogen(FDP) and D-dimer levels were assessed on admission, 3rd, 5th day after intervention. Incidence of disseminated intravascular coagulation(DIC) and 28-day mortality between heparin group and control group were compared. Results There were no significant difference in APACHE-Ⅱ, BPC, PT, aPTT, TT, and FDP levels, incidence of DIC, and 28-day mortality between heparin group and control group. D-dimer levels in both groups decreased along with time. D-dimer levels on 5th day after treatment in heparin group was markedly decreased than that of control group(740?135?g/L vs 853?179?g/L, P

Objective To study the effects of enteral immunonutrition on immune function in patients with multiple trauma. Method A total of 32 patients with multiple trauma admitted to general ICU in ChangZheng hospital, Shanghai from March 2007 to May 2008 were randomly (random number) divided into two groups,enteral immunonutrition group (EIN group, n = 16)and the general formula enteral nutrition group (EN group, n = 16).Two groups of patients on the third day after injury began to accept the EIN and the general formula EN which respectively support at least 14 days. The patients peripheral blood lymphocyte count (TLC), immunoglobulin (IgG,IgM, IgA) ,and T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) were detected on the day of the group formation, the seventh and the fortteenth day of the nutritional support. Results TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in EIN Group on the 7th and 14th day than that on the first day ( P ＜0.05), and extended with the EIN and sustained increase. All immunization indicators of EN group on the 7th day were no significant changes compared with the day of the group formation, and on the 14 th day TLC, IgG, IgM,IgA, CD4 and CD4/CD8 ratio were significantly higher than that on the day of the group formation ( P ＜ 0.05),but were significantly lower than that in the EIN group on the 14th day ( P ＜ 0.05). Conclusions Compared with the general formula EN, EIN is more helpful to restore and increase the humoral and cellular immune function in early post-multitraumatic phase.

Objective To evaluate the value of bypass graft in the treatment of critical lower limb ischemia with distal single outflow artery.Methods Forty-nine lower limbs in 42 patients with single outflow artery were collected and underwent arterial bypass graft.The operation methods included femoropopliteal artificial graft to single outflow artery with autograftand popliteal artery to calf vessel and so on.The results were analyzed finally.Results All of 42 patients,postoperative grafts occlusion occured in 1 case,the occlusion rate was 2.4％(1/42) and the success rate was 97.6％(41/42),1 case died of respiratory failure 4 d postoperatively,the mortality was 2.4％(1/42).The patency rate of graft was 100.0％(41/41) on discharge.Healing rate of foot ulcer was 33.3％ (11/33).Conclusions It's difficult to reconstruct blood flow for critical ischemic limb with single outflow artery,but good result is still expected by distal lower limb bypass graft.Distal bypass can provide a better nutritional support for the healing of foot ulcer and result in a lower limb salvage or lowering of amputation level.

Objective To probe the different expression of psychomotor in different model of pretreatment and the influence of pretreatment context on the expression of psychomotor.And to compare dopaminergic and non-dopaminergic neuron activity in midbrain after different pretreatment.Methods Rats were pretreated by escalated high-dose morphine( HD group) ,fixed low-dose morphine( LD group) and saline as control(S group).After withdrawal, rats were challenged by morphine in non-drug used environment.Locomotor behavior and stereotypy behavior were monitored as the index of compulsive drug-seeking motivation.By double labeling immunohistochemistry of tyrosine hydroxylase (TH) and Fos protein, the plasticity of neuronal activity in ventral tegmental area and substantia nigra of rats response to morphine challenge were disclose after pretreated with morphine or saline.Results After 10 mg/kg morphine challenge in non-drug used environment,the locomotor behavior and the stereotypy behavior of HD group were both significant higher than that of S group ( Locomotor behavior and Stereotypy behavior,HD group: 26907 ± 2003 and 129.6 ± 6.5; S group: 14962 ± 1888 and 89.9 ± 10.9, all P ＜ 0.01 ).The results of immunohistochemistry showed that Fos protein expressed in the SNr and in lateral SNr was significantly higher in the HD group compared to S groups ( Fos expression in SNr and lateral SNr,HD group: 29.14 ±5.27 and 9.83 ± 2.84; S group: 17.29 ± 1.51 and 2.06 ±0.45; all P＜0.05 ).Conclusion The sensitization behavior expression of the rat pretreated by escalated high-dose morphine is not modulated by drug using enviroment compared with fixed low-dose morphine pretreatment.The neuroplasticity of SNr,especially lateral SNr might be one of the mechanisms underlying the uncontroled sensitization behavior expression.

Objective To investigate the risk factors to acute lung injury based on multiple trauma to provide a theoretical basis for early intervention .Methods The emergency surgical patients with multiple trauma in our hospital from March 2006 to March 2011 were selected .The patients meeting the diagnostic criteria for acute lung injury were taken as the study group and the others as the control group .All patients were enrolled for evaluating the injury severity score (ISS) ,acute physiology and chronic health Ⅱ(APACHE Ⅱ) score and recording smoking ,alcohol abuse ,diabetes mellitus ,number of organ damage ,gastrointestinal bleeding , pulmonary contusion ,diffuse intravascular coagulation (DIC ) ,vomiting ,traumatic shock ,time to correct shock ,blood transfusion . The polymorphism of rs3788853 ,rs13306087 ,rs12709426 of angiotensin-converting enzyme(ACE) gene were analyzed .Results In the study group and the control group ,there were statistical differences in 6 influencing factors of the ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,time to correct shock>6 h(P<0 .05);the gene and genotype frequencies of ACE between the two groups had no statistical difference (P>0 .05);the 6 kinds of influencing factors were risk to acute lung injury based on multi-ple trauma by Logistic regression analysis .Conclusion The ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,long time to correct shock are the risk factors to acute lung injury based on multiple trauma .

Objective To investigate the protective effect of prostaglandin E1 (PGE1) on platelet during cardiopulmonary bypass (CPB).Methods A total of 24 patients undergoing cardiac valve replacement were randomly divided into the experimental group (n=12) and the control group (n=12).The levels of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1?(6-K-PGF1?) in serum were measured at different intervals during and after CPB. The ultrastructure of platelets was also observed by transmission electron microscope.Results The levels of TXB2 and 6-K-PGF1? during CPB were significantly higher than those before CPB in the both groups(P

Objective:To explore the expression of CD23,CD19 on peripheral blood lymphocytes as well as its association with serum total IgE levels and nasal allergic symptoms in patients with allergic rhinitis(AR). Method:Symptom scores were evaluated in 46 AR patients,expression of CD23,CD19 on peripheral blood lymphocytes were measured by flow cytometry,and serum total IgE levels were determined by immune chemiluminescence. Thirty two healthy individuals were enrolled as controls.Result:The percentage of CD23~+,CD19~+ and CD23~+/CD19~+,on peripheral blood lymphocytes in AR patients were 11.6±1.9,22.8±3.3,10.2±1.7,respectively.Higher frequencies of CD23~+,CD19~+,and CD23~+/CD19~+ were found in AR patients compared with controls (P＜0.05).There were positive correlations between expression rates of CD23~+,CD19~+,CD23~+/CD19~+ and levels of serum total IgE,nasal allergi symptom scores,respectively.CD23~+ /CD19~+ demonstrated greater correlations with serum total IgE and nasal allergic symptom(r=0.65 and 0.49,P＜0.05)than CD23~+ and CD19~+ did.Correlation between CD23~+/CD19~+ and nasal allergic symptom scores was greater than the corresponding correlations of serum total IgE(r=0.33,P＜0.05).Conclusion:CD23 and CD19 are important factors that associated with serum total IgE in the pathogenesis of AR,Analysis on the expression of CD23~+/CD19~+ on peripheral blood lymphocytes is helpful for evaluating the severity of AR.

We created the multi-media network-based teaching platform in emergency and critical care medicine teaching and unified the advantages of the network technique,multimedia technique and information commons,to build up a new place for all kinds of persons to learn the emergency and critical care medicine in any time or any places,and to build up a teaching re-source library of emergency and critical care medicine by the digital image processing technique, streaming media technique and database technique.

Objective: To observe the clinical effect of FU's subcutaneous needling on acute lumbar sprain. Method: One hundred acute lumbar sprain cases were randomly allocated into a treatment group and control group, 50 cases in each. FU's subcutaneous needling on tenderness were employed in the treatment group, whereas voltaren was administered to the cases in the control group. The changes in symptoms and signs were then observed in the two groups. Results: The total effective rates in the treatment group and control group were 94.0% and 70.0% respectively, showing a statistical difference (P<0.01). Conclusion: FU's subcutaneous needling is better than voltaren for acute lumbar sprain.

【Objective】 To investigate the effect of Kaixin Capsule (KC) on gene expression of myocardial immune inflammatory factor in dogs after resuscitation and to search for an effective way to counteract the progress of systemic inflammatory response syndrome (SIRS) after cardiopulmonary resuscitation. 【Methods】 Fifteen hybrid dogs were randomly divided into three groups, 5 dogs each: pseudo-operation group (group A), model group (group B) and KC group (group C). The dog model of cardiac arrest and resuscitation was established; the dogs were executed and the heart was isolated 180 min after the recovery of autonomic circulation. Myocardial total RNA was extracted and the mRNA expression of objective gene was detected by reverse transcription polymerase chain reaction (RT-PCR). 【Results】 mRNA expression of Toll-like receptor (TLR_4) and tumor necrosis factor ?(TNF-?) in group B differed from that ingroup A (P