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.

ObjectiveTo observe the clinical effectiveness of midnight-noon ebb-low acupuncture by hour-prescription of points combined with western medicine for patients of Parkinson's disease with restless legs syndrome. MethodsSixty cases of Parkinson's disease with restless legs syndrome were divided into a control group and a treatment group randomly， with 30 cases in each group. The control group was given conventional western medicine treatment， and the treatment group was given the treatment of the control group with midnight-noon ebb-low acupuncture by hour-prescription of points based on Daling （PC 7）， Zhongzhu （TE 3）， Yanglingquan （GB 34）， Zusanli （ST 36）， and Sanyinjiao （SP 6） with perpendicular insertion， and Baihui （GV 20） with oblique insertion to the back，all of them used the manipulation of neutral reinforcement and reduction； Dudu （SP 2） and Taibai （SP 3） acupoints were inserted in accordance with the direction of the meridian travelling when the patients inhaled， and the needle was removed when exhaled； the time of acupuncture manipulation selected as Si time （9 AM-11 AM）， the needle stay for 30 mins each time， once a day， 5 times a week， a total of 4 weeks of treatment. The international restless legs severity scale （IRLSS）， Pittsburgh sleep quality index （PSQI）， Parkinson's disease quality of life questionnaire （PDQ-39）， and the International Movement Disorder Society unified Parkinson's disease rating scale part Ⅰ （MDS-UPDRS Ⅰ） were compared before and after the treatment， and the clinical effectiveness of the two groups were compared after the treatment. ResultsIRLSS scores， PSQI scores， PDQ-39 scores and MDS-UPDRS Ⅰ scores decreased in both groups after treatment compared to those before treatment （P＜0.05 or P＜0.01）. After treatment， the total effective rate in the treatment group （83.3%， 25/30） was higher than that in the control group （60%， 18/30） （P＜0.05）. ConclusionAdding midnight-noon ebb-low acupuncture with hour-prescription of points on conventional western medicine treatment for Parkinson's disease with restless legs syndrome can significantly improve patients' clinical symptoms， sleep quality， quality of life， and enhance clinical effectiveness.

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 relationship between mild cognitive impairment and quality of life in hemodialysis patients with diabetic nephropathy.Methods One hundred and twenty-five hemodialysis patients with diabetic nephropathy were selected in Affiliated Hospital of North China University of Science and Technology from December 2014 to December 2016,and were divided into two groups according to mild cognitive impairment,including 73 patients without mild cognitive impairment as control group,and 52 patients with mild cognitive impairment as observation group.Patients received Montreal cognitive assessment scale and kidney disease quality of life scale.Patients received clinical index detection.Results Montreal cognitive assessment scale(visual space and execution(3.0±0.7) points,naming(2.4±0.3) points,attention(4.3±0.7) points,language(2.1±0.4) points,abstraction(1.1±0.2) points,delayed recall(1.6±0.3) points,orientation(5.4±0.5) points) score,kidney disease quality of life scale(physical(70.3±3.5) points,physical constraints due to work and life(14.6±2.8) points,pain(56.4±7.1) points,general health(36.2±3.4) points,emotional status(51.3±2.6) points,social function(52.7±3.4) points,mental status(43.2±3.6) points,emotional constraints due to work and life(41.3±2.8) points,symptoms(73.6±2.1) points,work status(20.3±1.6) points,cognitive function(72.7±1.8) points,nephropathy effect(49.1±3.2) points,sexual function(53.2±4.0) points,burden of nephropathy(21.3±2.6) points,sleep quality(70.1±1.5) points,social quality(43.3±1.9) points,social support(71.2±2.3) points) score in observation group were lower than control group((4.4±0.8) points,(3.0±0.0) points,(5.4±0.5) points,(2.7±0.3) points,(1.8±0.4) points,(3.4±0.6) points,(6.0±0.0) points),((78.6±4.1) points,(25.7±3.6) points,(69.8±4.2) points,(41.0±2.7) points,(58.5±3.0) points,(61.2±3.8) points,(53.4±2.8) points,(46.5±2.4) points,(82.9±3.2) points,(24.2±2.7) points,(81.6±2.3) points,(65.3±4.0) points,(62.8±3.9) points,(35.7±2.8) points,(79.3±2.0) points,(59.7±2.4) points,(82.4±2.6) points)(t=7.667,5.502,5.558,5.857,9.364,14.250,4.112,4.038,10.603,5.321,4.326,4.403,4.613,5.361,4.262,4.315,4.923,4.224,6.265,4.804,6.712,4.316,6.787,4.573,all P<0.05).Conclusion Hemodialysis patients with diabetic nephropathy has mild cognitive impairment,while quality of life is low.

Objective To investigate the relationship between vitiligo and thyroid diseases .Methods Chemiluminescence was used to detect serum levels of free triiodothyronine (FT3) ,free thyroxine(FT4) ,thyrotropic stimulating hormone(TSH) ,anti‐thy‐roglobulin antibody(TG‐Ab) and anti‐thyroperoxidase antibody(TPO‐Ab) in 289 vitiligo patients and 128 healthy subjects .All re‐sults were statistically analyzed .Results The abnormal rates of FT3 ,TG‐Ab and TPO‐Ab in vitiligo patients were higher than healthy subjects (P<0 .05) ,which might be correlated with the age and gender of vilitigo patients .Conclusion Levels of thyroid function and autoantibody might be abnormal in vilitigo patients ,which could be more obvious in male and adolescent patients .It could be advantageous to screen thyroid function and antibody levels in patients with vitiligo .

Objective To describe the clinical application of microvascular anastomotic device in head and neck reconstruction.Methods From July,2013 to November,2013,microvascular free flaps were transferred to reconstruct the defects simultaneously after tumor resection of head and neck region in 12 cases in Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology.Microvascular anastomotic coupling devices (MACD) were used in vascular anastomosis.The clinical data were collected and analyzed,including the selection of free flap,diameter of donor and recipient vessels,type of MACD,time of anastomosis,instant patency of anastomosis.The flap was monitored closely after operation and the final survival rate was calculated.Results Twelve microvascular free flaps were done in this series,including 6 fibula flaps,4 forearm flaps and 2 anterolateral thigh flaps.Totally 17 MACD were used by end-to-end anastomosis in this series,including 5 arterial anastomosis and 12 venous anastomosis.The anastomose time using MACD was from 4 to 10 minutes,with a median time 6.8 minutes.The instant patency rate of anastomosis was 100％.There were some blood leakages near the anastomotic stoma in 1 arterial anastomosis using MACD.It was resolved successfully by changing a new MACD.Conclusion Our primary clinical experience showed that the MACD was well suited to the microvascular reconstruction of head and neck defect.The feasibility and reliability was confirmed by our clinical cases.It should be recommended as a safe,fast and reliable adjuvant anastomotic instrument for free tissue transfer.

Objective To investigate the relationship between disease severity and enzyme-linked immunosorbent assay (ELISA) index values of anti-desmoglein (Dsg) 1 and-Dsg3 antibodies in 56 patients with pemphigus,and to characterize fluctuations in anti-Dsg1 and-Dsg3 antibodies in different forms of pemphigus.Methods Fifty-six patients with pemphigus (including 36 cases of pemphigus vulgaris (PV) and 20 cases of pemphigus foliaceus (PF)) were enrolled in this study.Blood samples were obtained from these patients before treatment and at the following four time points:when the condition was relieved and the taper of glucocorticoids began,the dose of glucocorticoids was tapered to half of their initial dose,the maintenance treatment started,and when the duration of maintenance treatment reached two years.ELISA was performed to determine the levels of anti-Dsg1 and-Dsg3 antibodies in these serum samples.Spearman correlation analysis was carried out to assess the relationship between disease severity and ELISA index values,and independent sample's t test to compare the levels of anti-Dsg antibodies among these time points.Results The severity of pemphigus was correlated with anti-Dsg antibody ELISA index values.Both anti-Dsg1 and anti-Dsg3 ELISA index values were significantly reduced at the remission of pemphigus compared with those before treatment (all P ＜ 0.01).At the end of the two-year maintenance treatment,10 (50％) patients with PF and 7 (19.4％) patients with PV became negative for anti-Dsg1 ELISA,whereas only 1 (2.7％) patient with PV became negative for anti-Dsg3 ELISA.Conclusions Anti-Dsg antibody ELISA index value is correlated with disease severity in patients with pemphigus,which may serve as a useful marker for assessing disease severity and activity as well as evaluating therapeutic efficacy.

Porcine reproductive and respiratory syndrome virus (PRRSV) non-structural protein 7 (Nsp7) plays an important role in the induction of host humoral immune response and could serve as an ideal antigen for serological genotyping assay for PRRSV based on the significant difference in immunoreactivities of North American (NA) and European (EU) PRRSV Nsp7. In this study, Nsp7 of NA and EU PRRSVwas separately expressed and purified using prokaryotic expression system. The purified recombinant Nsp7 proteins reacted with serum antibodies against corresponding genotype PRRSV in Western blotting. However, nonspecific reaction of whole recombinant Nsp7 with antibodies against another genotype PRRSV was observed, indicating that whole NA PRRSV Nsp7 and EU PRRSV Nsp7 have similar antigenic epitopes and recombinant proteins could not be used for genotyping of antibodies against PRRSV. Based on the analysis of similar antigenic epitopes at the hydrophilic region of NA PRRSV Nsp7 and EU PRRSV Nsp7 by bioinformatics assessment, partial Nsp7 gene region deleted sequences encoding similar antigenic epitopes was constructed by fusion PCR. The recombinant truncated Nsp7 (NA-deltaNsp7 and EU-deltaNsp7, about 43 kDa) was expressed and the molecular weight was about 43 kDa. The results of Western blotting showed that NA-deltaNSP7 and EU-deltaNSP7 could be specifically recognized by positive serum to NA or EU PRRSV individually and nonspecific reaction was eliminated. This study provided a basis for further development of serological genotyping assay for North American and European genotype PRRSV infection.
Animals ; Genotype ; Porcine respiratory and reproductive syndrome virus ; classification ; genetics ; immunology ; Recombinant Proteins ; biosynthesis ; immunology ; Swine ; Viral Nonstructural Proteins ; biosynthesis ; immunology

ObjectiveTo investigate the relationship of lymphotoxin β receptor (LTβR) and classical nuclear factor-κB (NF-κB) activation pathway in the pathogenesis and progress of cystitis and bladder cancer.MethodsThe LTβR and P65 mRNA expression were detected by Real-time quantitative PCR in 108 cases of fresh bladder tissue specimens (75 cases of bladder cancer,10 cases of inflammation and 23 normal bladder mucosa cases grouped by the tissue classification ),and protein expression were analyzed by immunohistochemistry assay in 118 cases of paraffin-embedded biopsy specimens (73 cases of bladder cancer,30 cases of cysitis and 15 normal bladder mucosa cases).The correlation analysis between the expressions of LTβR and P65 with clinical pathological data was then performed.Differences between LTβR and P65 mRNA and protein expression level were compared in different groups of bladder tissues using Kruskal-Wallis H test and the Chi-square test.Results( 1 )The mRNA expressions of LTβR and NF-κB/P65were higher in bladder cancer than those in normal group ( LTβR:29.4 ( 14.2 - 46.7 ) × 10 - 3/1.2 ( 0.3 -7.0) ×10-3,Z=-5.508; P65:9.7 (2.7 -21.1) ×10-3/1.0(0.8 ～1.8) ×10-3,Z=-5.030,P＜0.05 ).There were significantly differences between bladder cancer with different histological grades ( LTβR:18.2(2.1-31.3) × 10-3/ 28.4(16.6-36.2) × 10-3/47.9(34.3 -70.5) ×10-3,x2K-W=20.378;P65:4.9(1.3 - 12.0) × 10-3/7.4(3.0-21.9) × 10-3/17.0(10.0 ～28.3)× 10-3 ,x2K-W2 =15.219,P all ＜0.05) and lymph node metastasis (LTβR:27.2(9.7-40.1) ×10-3/39.4(26.7 -52.6) ×10-3,Z=-2.552; P65:7.4(2.3-15.6) ×10-3/13.4(6.7-23.3) ×10-3,Z=-2.026,P＜0.05).(2)The positive rates of LTβR and phosphorylated P65 ( p-P65 ) protein in cancer were higber than those of normal group (LTβR:69.8％/13.3％,x2 =16.600 ; p-P65:56.2％/6.7％,x2 =12.220,P ＜ 0.05 ).Upregulation of LTβR and p-P65 were associated with the histological grade (LTβR:56.3％/70.0％/90.4％,x2 =7.055; p-P65:40.6％ /60.0％/76.2％,x2 =6.679,P ＜0.05) and with lymph node metastasis (LTβR:58.3％/92.0％,x2 =8.849; p-P65:52.1％/64.0％,x2 =5.088,P ＜0.05).(3)There was a positive correlation between LTβR and P65 expression ( mRNA:r =0.654,P ＜ 0.05,protein:r =0.399,P ＜ 0.05 )in the bladder cancer and cystitis (r =0.521,P＜0.05).ConclusionsThe activation of LTβR and P65 was associated with progression and metastasis of bladder cancer.The activation of classical NF-κB pathway by LTβR may be achieved by P65.