Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective To investigate the protective effect of Shenxi Dan,a recipe for cooling blood,activating blood and inducing resuscitation,on multiple organ damage of rats with endotoxic shock.Methods The SD rats were randomly divided into normal group,model group and Shenxi Dan group.Except for the normal group,the rats in the other groups were given intraperitoneal injection of D-galactosamine (GalN) and intravenous injection of lipopolysaccharide (LPS) to induce endotoxic shock.The changes in mean arterial pressure (MAP) during the entire process were monitored.Serum samples and liver and lung tissues were collected after infusion for 0 h,2 h,6 h,respectively,and then the amount of whole blood cells,serum contents of total bilirubin (TB),lactate dehydrogenase (LDH),aspartate aminotransferase (AST),and alanine aminotransferase (ALT) were detected.Meanwhile,the pathological changes in lung and liver tissues after hematoxylin-eosin (HE) staining were observed under light microscope.Results Compared with the model group,the decrease degree of the blood pressure was mild,platelet count(plt) was not decreased obviously,while the increase of serum TB,LDH,AST,ALT contents was significantly inferior,and inflammatory pathological changes of lung and liver tissues significantly were much relieved in Shenxi Dan group.Conclusion Shenxi Dan can improve lung and liver function of endotoxic shock rats,reduce the pathological damage,and improve microcirculation,which is helpful to clinical treatment of endotoxic shock.

ObjectiveTo investigate the effects of heme oxygenase- 1 ( HO- 1 ) on pancreas and liver in severe acute pancreatitis(SAP) rats, and explore its probable mechanism. MethodsA total of 40 male SD rats were randomLy divided into 4 groups: control group(n = 10) ; SAP group(n = 10) ; HO-1 stimulation group (75 μg/kg hemin was injected intraperitoneally at 30 minutes after model establishment, n = 10 ) ; HO-1 inhibition group(20 μg/kg ZnPP was injected intraperitoneally at 30 minutes after model establishment, n = 10). Sodium Cholate (3％) was retrogradedly injected into the pancreatic duct to produce the SAP model. To observe the histopathological changes of pancreas, liver tissues were observed and serum, pancrease and liver tissues concentration of HO-1, IL-10 and TNF-α in different groups were observed 24 h after the SAP model establishment. ResultsCompared with those in SAP model group, the pathological scores were lower in HO-1 stimuLation group[ (7.50 ±0.58) vs (10.50 ±0. 71) ; ( 1.20 ±0.42) vs (1.70 ±0.48) ]( P ＜ 0.05 ), and the serum, pancreas and liver tissues HO- 1 [ (0.97 ± 0.02) ng/mL, (0.78 ± 0.09) ng/mL,(0.73 ±0.05) ng/mL]and IL-10[(101.72 ±2.63) ng/mL, (63.58 +1.02) pg/mL, (169.40 ±3.06) pg/mL ]concentrations were significantly elevated in HO- 1 stimuLation group ( P ＜ 0.05 ), while the serum, pancreas and liver tissues TNF-α [ (22.85 ± 1.74) pg/mL, (26.50 ± 1.3) pg/mL, (35.88 ±0.98 ) pg/mL]concentrations were significantly decreased in HO-1 stimuLation group (P ＜ 0.05 ). Compared with those in SAP model group, the pathological scores were higher in HO-1 inhibition group (P ＜0.05 ), and the serum, pancreas and liver tissues HO-1 and IL-10 concentrations were significantly decreased( P ＜0.05 ), while the serum, pancreas and liver tissues TNF-α concentrations were significantly elevated (P ＜ 0.05 ). CondusionThe results of the study demonstrated that HO- 1 over- expression has protective effects on the pancreas and liver in SAP. UP-regulated IL-10 expression and down-reguLated TNF-α expression might be served as a potential mechanism.

Objective To investigate the variation of procalcitonin(PCT) in blood and tissue level of acute pancreatitis rats and probe its significant. Methods One hundred and two male Wistar rats were randomly divided into control group ( n = 6 ), lipopolysaccharide group ( LPS, n = 24 ), acute edematous pancreatitis (AEP) group ( n = 24), acute necrotizing pancreatitis (ANP) group ( n = 24), AN P + LPS group ( n = 24). Subcutaneous injection of cerulein was used for AEP induction, while ANP model was induced by retrograde injection of sodium taurocholate into the biliary and pancreatic duct. The rats were sacrificed at 3,6, 18 and 24 hours after model induction. Pancreatic tissue was harvested and the pathological scores were assessed. Levels of PCT in serum, liver, lung, spleen, pancreas, small intestine, large intestine tissue was harvested and tissue levels of PCT were determined. Results AEP and ANP models were established successfully. At 6 h, the serum levels of PCT in control group, LPS group, AEP group, ANP group and ANP +LPS group were (0.0144 ±0.0082) ng/ml, (0. 1722 ±0.0449) ng/ml,(0.4751 ±0.0572) ng/ml, (0.7070 ±0. 1040) ng/ml and ( 1. 1960 ±0.8644) ng/ml, respectively; and the difference was statistically significant (P < 0.05 ). PCT could be detected in liver, lung, spleen, pancreas, small intestine and large intestine tissue of normal rats. PCT levels in liver and pancreas of ANP group were not statistically different, but the PCT levels in lung, spleen, and large intestine tissue significantly decreased, and the corresponding values were (5.63 ±0.62) ng/ml vs. (6.85 ±0.46) mg/ml, (4.73 ±1.27) mg/ml vs. (6.88 ±0.37) ng/ml, (1.08 ±0.52) ng/ml vs. (4.12 ± 1.02) ng/ml (P <0.01 ). However, the PCT levels in small intestine significantly increased, which were (2.51 ±0.90) ng/ml vs (0.98 ±0. 12) ng/ml (P<0. 01). Conclusions Serum PCT level was associated with the severity of AP and infection; the changes of PCT levels in different tissues may be related with the changes of organ's function.

Objective To investigate the etiology of acute recurrent pancreatitis (ACP) and de-termine how to further enhance its level of treatment.Methods The clinical data of 33 patients with ACP treated in Ruijin Hospital from 2003 to 2007 were retrospectively analyzed.Results Of the 33 patients with an average age of 55 (22-86), 18 (55%) were male and 15 (45%) female.ACP occurred once in 26 patients, twice in 4 and 3 times in 3.The disease appeared whithin 1 year in 29 patients, 1-2 years in 2, 2-3 years in 1 and 3 years in 1 after being dischared from hospital.For its etiology, it was of biliary origin in 29 patients, hyperlipidemia in 1, pancreatic tumor in 1 and unknow reasons in 2.Twenty-four patients were treated with operation or endoscopy.Two patients died and the mortali-ty was 9.1%.Conclusion ACP is mainly due to biliary origin in China.Operative intervention at an appropriate opportunity can effectively reduce the recurrence of biliary-origin pancreatitis.

Objective To investigate the feasibility and effect of recanalization of inferior vena cava with percutaneous transluminal angioplasty(PTA)by Inoue-balloon. Methods Eighty-nine patients with Budd-chiari syndrome(BCS)were treated with PTA by Inoue-balloon. Results After PTA, the median(interquartile range)diameter of hepatic segment inferior vena cava increased from 0.00(0.20 ～ 0.00) cm to 1.90(2.00 ～ 1.47)cm; (P