Objective To investigate the related index of early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.Methods 13 cases of the acute-on-chronic liver failure caused by chronic hepatitis B were collected in our department,39 cases of chronic hepatitis B were randomly paired to analyze the difference index.ROC curve analysis was conducted for the different data,then to choose the data whose AUC (area under the curve)is >0.8 to accumulate points,while the cutoff value in the light of Youden index was indentified.Each accu-mulating points data would score 1 point if it is≥cutoff value,otherwise,it would score 0 points.ROC curve analysis was conducted for the total accumulating points,the cutoff value of the total accumulating points according to Youden index was indentified,the sensitivity and specificity were calculated.Results The data of which AUC are >0.8 include glutamic-pyruvic transaminase (ALT)/Upper Limit Of Normal (ULN),neutrophil count (N),alkaline phosphatase (AKP)/ULN,glutamic-oxalacetic transaminease(AST)/ULN,direct bilirubin/total bilirubin(Dbil/Tbil),total bile acid(TBA),whose AUC were respectively 0.869,0.874,0.897,0.917,0.919 and 0.978,while their cutoff value were respectively 18.57,3.1 ×109/L,0.99,22.21,44.41%and 140.20μmol/L.The cutoff value of total accumula-ting points of the six data was 4 points,AUC was 0.987,Youden index was 0.949,and their sensitivity for ealier diag-nosis for the acute -on -chronic liver failure caused by chronic hepatitis B was 100%,specificity was 94.87%. Conclusion The accumulating points of the six data aboved (ALT/ULN,N,AKP/ULN,AST/ULN,Dbil/Tbil,TBA) will help the early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.

Objective To study the practicability of measurement of abdominal wall tension (AWT) for noninvasive monitoring of intra-abdominal pressure in ICU patients.Methods Patients with indwelling urethral catheter admitted to ICU from April 2011 to March 2013 were enrolled for a prospective study.Exclusion criteria were patients with muscular relaxants,abdominal operation in three months,acute peritonitis,abdominal mass,acute injury of urinary bladder,acute cystitis,neurogenic bladder,intrapelvis hematoma,and pelvic fracture.The AWT (N/mm) and urinary bladder pressure (UBP) (mm Hg) of all patients were measured.Statistical analysis was performed by SPSS 13.0 statistical software.The correlation of AWT and UBP were analyzed using linear regression analysis.The effects of respiration and body position on AWT were analyzed using the Paired-samples t test,and the effects of gender and body mass index (BMI) on basic level of AWT (IAP ＜ 12 mm Hg) were analyzed using the One-way ANOVA.Results A total of 51 patients were recruited in study.A significantly linear correlation between AWT and UBP were observed (R =0.986,P ＜ 0.01),the regression equation was Y =1.369 + 9.57X (P ＜ 0.01).Under the supine-flat positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.65 ± 0.52) N/mm and (1.45 ± 0.54) N/mm,respectively,and under body straight up 30° supine positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.25 ± 0.30) N/mm and (1.07 ± 0.35) N/mm,respectively.There were significant differences in intra-abdominal pressure between different respiratory phases and body positions (P ＜ 0.01).Basic levels of AWT in male and female were (1.09 ± 0.29) N/mm and (1.01 ± 0.34) N/mm.The basic levels of AWT in patients with BMI ＜ 18.5,18.5 ≤ BMI ≤25 and BMI ＞ 25 were (0.91 ± 0.30) N/mm,(1.02 ±0.35) N/mm and (1.16 ±0.28) N/mm respectively,but gender and BMI had no significant effects on basic level of AWT (P =0.457 and 0.313,respectively).Conclusions There was a significantly linear correlation between AWT and UBP,and respiratory phase and body position had significant effects on AWT,but gender and BMI had no significant impacts on basic level of AWT.AWT could be served as a simple,easy,and accurate method to monitor the IAP in critical ill patients.

Objective To study the changes of trans-diaphragmatic pressure (Ptra) and its correlation with esophageal pressure (Peso) through ARDS piglet model.Methods Five piglets were enrolled in the study.Peso,gastric pressure (Pgas) and intra-thoracic pressure (Pint) was monitored through balloon inserted.The data before ARDS serve as control.ARDS was produced in the piglets through saline lavage.The pressure were observed and the Ptra were calculated.The pressure changes and correlation between Ptra and Peso were analyzed as well.Linear regression with the coefficient of determination and t-test were used as appropriate.Significance was assumed for P ＜ 0.05.Results Peso,Pgas and Pint before ARDS were 7.3 ± 1.9,25.5 ± 2.4,- 1.23 ± 0.21 cmH2O,Ptra was 18.2 ± 1.6 cmH2O.While after ARDS,the data were 4.7 ± 1.4,31.1 ± 3.1 and - 1.79 ± 0.28 cmH2O,and Ptra was 26.4 ± 2.1 cmH2 O,and all these changes were obviously ( P ＜ 0.05 ).The correlation between Pint and Peso,Pint and Ptra (A) and Ptra ( B ) were 0.93 ± 0.025,0.88 ± 0.023 and 0.87 ± 0.37 before ARDS.After ARDS,the correlation changed to be 0.82 ±0.21,0.81 ±0.20 and 0.78 ±0.31.Although a bit decreased,the correlation was still positive (P ＜ 0.01 ).Conclusions There existed good correlations between Peso and Ptra as well as between Pint and Peso before or after ARDS.Ptra was increased obviously after ARDS,which could lead to respiratory muscle fatigue.

The "exterior-interior relationship between lung and large intestine" is one of the theories of traditional Chinese medicine, which is scientific in modern medicine. The ancients discovered the specific connection between the lung and large intestine, and constructed the theory of "exterior-interior relationship between lung and large intestine" through the Yin-Yang theory and the meridian attachment. The theory of "exterior-interior relationship between lung and large intestine" has been of great significance in the critical care field since the first study on intestinal tract and acute respiratory distress syndrome (ARDS) was carried out in the emergency medicine in 1980s. This article analyzes the consistence of lung and large intestine in early embryonic development, explains the close connection between the lung and large intestine through the intestinal flora translocation theory in sepsis, and reviews the immunoregulation mechanism of helper T cell 17 (Th17) in intestine and lung, and the possible molecular mechanism of immune response, so as to provide physicians with further exploration of the traditional theory of "exterior-interior relationship between lung and the large intestine".

Objective To explore the role of clinical pharmacists in the treatment of drug poisoning by analyzing the clinical pharmacist's participation in the treatment of a patient with sodium valproate poisoning. Methods Clinical pharmacists measured the plasma concentration of sodium valproate to inform the doctor to diagnose illnesses. At the initial stage when the concentration is high, to eliminate the free drug by continuous venous-venous hemodialysis-filtration (CVVHDF). Then, the combined drug was cleared by hemoperfusion (HP). Results The blood concentration dropped by half at the first CVVHDF and decreased obviously after two HPs. After stable observation in five days’ course of disease, the blood concentration was maintained at a low level and the patient was cured and discharged. Conclusion The implementation of the blood purification program under the monitoring of the blood drug concentration with the participation of pharmacists is helpful for the rescue of drug overdose and is worthy of promotion.