Expression and role of deleted in malignant brain tumor protein 1 in acute respiratory distress syndrome rats induced by sepsis / 中华危重病急救医学

Objective:To observe the expression of deleted in malignant brain tumor protein 1 (DMBT1) in rat acute respiratory distress syndrome (ARDS) model induced by sepsis and its relationship with ARDS related biomarkers.Methods:Forty-eight healthy male rats were randomly divided into sham operation group (Sham group) and ARDS model group, and the rats in each group were further divided into three subgroups at 6, 12 and 24 hours after operation, with 8 rats in each subgroup. The rats in the Sham group were exposed to the cecum only, and sepsis induced ARDS model was reproduced by cecal ligation and puncture (CLP) in the ARDS model group. The general performance was observed at 6, 12, 24 hours after operation. Abdominal aortic blood of rats was collected, and the levels of DMBT1, surfactant-associated protein D (SP-D), vascular endothelial growth factor (VEGF), interleukins (IL-6, IL-10) in serum were determined by enzyme-linked immunosorbent assay (ELISA). The lung tissues were collected, and the lung wet/dry weight (W/D) ratio was determined. The lung tissue pathological changes were observed under light microscope after hematoxylin-eosin (HE) staining, and the lung tissue injury score was evaluated. The expression of DMBT1 protein in lung tissue was determined by Western blotting. The relationship between the serum DMBT1 and SP-D, VEGF, IL-6, IL-10, lung tissue injury score were analyzed by Pearson correlation analysis.Results:Rats in the ARDS model group showed obvious pathological manifestations after operation. The alveolar structure destruction, inflammatory cell infiltration, and alveolar hemorrhage were observed under microscope. Compared with the Sham group, the lung tissue injury score and the lung W/D ratio at 12 hours after operation in the ARDS model group were significantly increased (lung tissue injury score: 3.35±0.13 vs. 1.16±0.07, lung W/D ratio: 5.36±0.44 vs. 4.38±0.35, both P < 0.05), and pulmonary edema was present, which suggested that the ARDS model caused by CLP was successfully reproduced. The results of ELISA and Western blotting showed that the levels of serum DMBT1, SP-D, VEGF and IL-6 in the ARDS model group increased gradually with time, while the level of IL-10 increased first and then decreased. Compared with the Sham group, the levels of DMBT1 in serum and the expressions of DMBT1 protein in lung tissue in the ARDS model group were significantly increased from 6 hours after operation [serum (ng/L) : 231.96±19.17 vs. 187.44±10.19, lung tissue (DMBT1/β-actin): 2.05±0.19 vs. 0.93±0.25, both P < 0.05], and the levels of SP-D, VEGF, IL-6 and IL-10 in serum were significantly increased from 12 hours after operation [SP-D (ng/L): 73.35±8.05 vs. 43.28±5.77, VEGF (ng/L): 89.85±8.47 vs. 43.19±5.11, IL-6 (ng/L): 36.01±2.48 vs. 17.49±1.77, IL-10 (ng/L): 84.55±8.41 vs. 39.83±5.02, all P < 0.05]. Pearson correlation analysis showed that serum DMBT1 was positively correlated with serum SP-D, VEGF, IL-6, IL-10 and lung injury score at 12 hours and 24 hours in the ARDS model group (12 hours: r values were 0.946, 0.942, 0.931, 0.936, 0.748, respectively; 24 hours: r values were 0.892, 0.945, 0.951, 0.918, 0.973, respectively; all P < 0.05). Conclusion:DMBT1 is a novel early biomarker of ARDS by affecting alveolar epithelial cell, alveolar capillary permeability and inflammatory response.

Prediction and feature selection for fatal gastrointestinal bleeding recurrence in hospital via machine learning / 中华危重病急救医学

Objective To propose a method of prediction for fatal gastrointestinal bleeding recurrence in hospital and a method of feature selection via machine learning models. Methods 728 digestive tract hemorrhage samples were extracted from the first aid database of PLA General Hospital, and 343 patients among them were diagnosed as fatal gastrointestinal bleeding recurrence in hospital. A total of 64 physiological or laboratory indicators were extracted and screened. Based on the ten-fold cross-validation, Logistic regression, AdaBoost and XGBoost were used for classification prediction and comparison. XGBoost was used to search sequence features, and the key indicators for predicting fatal gastrointestinal bleeding recurrence in hospital were screened out according to the importance of the indicators during training. Results Logistic regression, AdaBoost and XGBoost all get better F1.5 score under each feature input dimension, among which XGBoost had the best effect and the highest score, which was able to identify as many patients as possible who might have fatal gastrointestinal bleeding recurrence in hospital. Through XGBoost iteration results, the Top 30 indicators with high importance for predicting fatal gastrointestinal bleeding recurrence in hospital were ranked. The F1.5 scores of the first 12 key indicators peaked at iteration (0.893), including hemoglobin (Hb), calcium (CA), red blood cell count (RBC), mean platelet volume (MPV), mean erythrocyte hemoglobin concentration (MCH), systolic blood pressure (SBP), platelet count (PLT), magnesium (MG), lymphocyte (LYM), glucose (GLU, blood gas analysis), glucose (GLU, blood biochemistry) and diastolic blood pressure (DBP). Conclusions Logistic regression, AdaBoost and XGBoost could achieve the purpose of early warning for predicting fatal gastrointestinal bleeding recurrence in hospital, and XGBoost is the most suitable. The 12 most important indicators were screened out by sequential forward selection.

Big data in emergency and clinical decision support system / 中华危重病急救医学

Medical big data is a hot research topic in China,and it is also the main research direction in the field of emergency medicine.The current situation of the construction of the first-aid big data platform and the construction of the first-aid clinical decision support system were analyzed,the problems existing in the development of the first-aid big data research field were enumerated,to explore the theoretical methods for promoting the development of domestic first-aid big data,so as to provide references for the research in related fields.

Pilot research: construction of emergency rescue database / 中华危重病急救医学

Objective To construct a database containing multiple kinds of diseases that can provide "real world"data for first-aid clinical research. Methods Structured or non-structured information from hospital information system, laboratory information system, emergency medical system, emergency nursing system and bedside monitoring instruments of patients who visited department of emergency in PLA General Hospital from January 2014 to January 2018 were extracted. Database was created by forms, code writing, and data process. Results Emergency Rescue Database is a single center database established by PLA General Hospital. The information was collected from the patients who had visited the emergency department in PLA General Hospital since January 2014 to January 2018. The database included 530 585 patients' information of triage and 22 941 patients' information of treatment in critical rescue room, including information related to human demography, triage, medical records, vital signs, lab tests, image and biological examinations and so on. There were 12 tables (PATIENTS, TRIAGE_PATIENTS, EMG_PATIENTS_VISIT, VITAL_SIGNS, CHARTEVENTS, MEDICAL_ORDER, MEDICAL_RECORD, NURSING_RECORD, LAB_TEST_MASTER, LAB_RESULT, MEDICAL_EXAMINATION, EMG_INOUT_RECORD) that containing different kinds of patients' information. Conclusions The setup of high quality emergency databases lay solid ground for scientific researches based on data. The model of constructing Emergency Rescue Database could be the reference for other medical institutions to build multiple-diseases databases.

Analysis of diseases distribution in Medical Information Mart for Intensive Care Ⅲ database / 中华危重病急救医学

Objective To study the distribution of diseases in Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ) database in order to provide reference for clinicians and engineers who use MIMIC-Ⅲ database to solve clinical research problems. Methods The exploratory data analysis technologies were used to explore the distribution characteristics of diseases and emergencies of patients (excluding newborns) in MIMIC-Ⅲ database were explored; then, neonatal gestational age, weight, length of hospital stay in intensive care unit (ICU) were analyzed with the same method. Results In the MIMIC-Ⅲ database, 46 428 patients were admitted for the first time, and 49 214 ICU records were recorded. There were 26 076 males and 20 352 females; the median age was 60.5 (38.6, 75.6) years, and most patients were between 60 and 80 years old. The first diagnosis in the disease spectrum analysis was firstly ranked by circulatory diseases (32%), followed by injury and poisoning (14%), digestive system disease (8%), tumor (7%), respiratory disease (6%) and so on. Patients with ischemic heart disease accounted for the largest proportion of circulatory disease (42%), the proportion of these patients gradually increased with age of 60-70 years old, then decreased. However, the proportion of patients with cerebrovascular disease declined first and then increased with age, which was the main cause of death of circulatory system disease (ICU mortality was 22.5%). Injury and poisoning patients showed a significant decrease with age. Digestive system diseases were younger than the general population (most people aged between 50 to 60 years), and non-infectious enteritis and colitis were the main causes of death (ICU mortality was 18.3%). Respiratory infections were predominant in infected patients (34%), but circulatory system infections were the main cause of death (ICU mortality was 25.6%). Secondly, in the neonatal care unit, premature infants accounted for the vast majority (82%). As the gestational age increased, the duration of ICU was decreased, and the mortality was decreased. Conclusions The diseases distribution of patients can be provided by MIMIC-Ⅲ database, which helps to grasp the overview of the volume and age distribution of the target patients in advance, and carry out the next step of research. Meanwhile, it points out the important role of exploratory data analysis in electronic health records analysis.

Discussion of the implementation of MIMIC database in emergency medical study / 中华危重病急救医学

To introduce Medical Information Mart for Intensive Care (MIMIC) database and elaborate the approach of critically emergent research with big data based on the feature of MIMIC and updated studies both domestic and overseas, we put forward the feasibility and necessity of introducing medical big data to research in emergency. Then we discuss the role of MIMIC database in emergency clinical study, as well as the principles and key notes of experimental design and implementation under the medical big data circumstance. The implementation of MIMIC database in emergency medical research provides a brand new field for the early diagnosis, risk warning and prognosis of critical illness, however there are also limitations. To meet the era of big data, emergency medical database which is in accordance with our national condition is needed, which will provide new energy to the development of emergency medicine.

Study on quality and safety management standard of lifesaving access to emergency care / 中华医院管理杂志

A review of management problems found in lifesaving access to emergency care in healthcare organizations at all levels in China, and a reference international critical and emergency care systems and their quality and safety management standards were made by the authors. Based on such and special needs of such access, the paper studied the domestic lifesaving access to emergency care service workflow, and abstracted common management issues on the lifesaving access to emergency care. The study identified key elements of lifesaving access to emergency care management through case analysis, and formulated standard terms for such key elements. Hence a set of standards is developed for quality management fitting healthcare organizations at all levels in China′s lifesaving access to emergency care, serving as the guidance for their standardized management and evaluation.

Analysis of core indicators of fatal gastrointestinal rebleeding in emergency from the perspective of big data / 中华危重病急救医学

Objective To explore a method of screening the core indicators in the emergency database that can be used to evaluate the in-hospital fatal gastrointestinal rebleeding by using the big data algorithm. Methods Based on the emergency database of the Chinese PLA General Hospital, through the big data retrieval technology, all the 647 patients diagnosed as gastrointestinal bleeding in the emergency database were enrolled, except those who were admitted to the hospital for the first time and whose hemoglobin (Hb) was less than 90 g/L or did not undergo Hb test. Among them, there were 313 in the rebleeding group (fatal rebleeding in the hospital) and 334 in the non-rebleeding group (no fatal rebleeding in the hospital). General data of patients were collected, including gender, age, physical signs, blood gas, test index collection data, and the identification of gastrointestinal rebleeding. The fusion algorithm of rough set algorithm, genetic algorithm, and cellular automaton algorithm were used to calculate the key indicators that affect gastrointestinal rebleeding. Results A total of 499 indicators were calculated by machine fusion algorithm, after screening 5 times repeatedly, 24 key indicators were screened out, 3 of which were vital signs, including systolic blood pressure (SBP), diastolic blood pressure (DBP), temperature (T); 7 key indicators of blood routine, including white blood cell count (WBC), eosinophil (EOS), monocyte (MONO), Hb, hematocrit (HCT), red cell distribution width (RDW), mean corpuscular hemoglobin (MCH); 3 key indicators of coagulation, including prothrombin time (PT), plasma fibrinogen (FIB), activated partial thromboplastin time (APTT); 5 key indicators of biochemical, including myoglobin (MYO), chloride, glucose (GLU), serum albumin (ALB), total bilirubin (TBil); and 6 key indicators of blood gas, including pH, lactate (Lac), oxygen saturation (SO2), base excess (BE), bicarbonate (HCO3-), partial pressure of carbon dioxide (PaCO2). Conclusions Using big data technology, 24 core indicators for evaluating the fatal gastrointestinal rebleeding in hospitals can be screened out from the emergency database, providing new ideas and methods for clinical diagnosis of the disease.

Analysis of antimicrobial use and cost-benefit rationality in medical emergency department

Rational use of antimicrobial agents can reduce the burden of patients, reduce adverse drug reactions and effectively cure bacterial infections. In this paper the analysis is done on the antimicrobial use and cost-benefit rationality in medical emergency department. Based on the analysis of the use of antibiotics in hospital emergency department, Antimicrobial prescription accounting for 44.26% of the total prescription, involving cephalosporins, fluoroquinolones, macrolides, cephalosporins. According to the stakeholder theory, the use of antimicrobial agents involves multiple interests, too much emphasis on any party also affect the rational use of antimicrobial drugs. Pharmacy management departments need to develop a reasonable and scientific list of antimicrobial drugs, standard training people to correctly use the knowledge of antimicrobial drugs

Research on hospital drug cost control based on the perspective of pharmaceutical economy

In recent years, the continuous growth of drug costs has become one of the hot issues of society. In this paper, by using principles and methods of pharmacoeconomics, we study on the management of drug cost control in hospital. Pharmacoeconomics involves the effective allocation and rational use of drug resources, and study the economic effect, that is to carry out the study of drug resources utilization efficiency. Through the analysis of the cost-benefit analysis of drug treatment, we could find the a more cost-effective treatment. Pharmacoeconomics can be applied to the clinical diagnosis and treatment, make reasonable prescription cost effect, it could provide patients with high economic efficiency of treatment, so that drug treatment to achieve the best results

Preventive effects of ulinastatin on acute respiratory distress syndrome / 北京大学学报(医学版)

Objective:To explore the effect of ulinastatin on prevention of acute respiratory distress syn-drome (ARDS).Methods:A prospective multicentral cohort study was conducted.The patients from three intensive care units (ICUs)of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014,included 77 ARDS at-risk patients with uli-nastatin treatment and 108 ARDS at-risk patients without ulinastatin treatment (control)were eligible. Both groups received normal treatment;additionally,the intervention group received 600 000 units of uli-nastatin via intravenous infusion for 5 days.The control group received the same amount of saline via in-travenous infusion for 5 days.Venous blood human neutrophil elastase (HNE)and peptidase inhibitor 3 (PI3)levels were measured on days 1,3,and 7,respectively.Other outcomes included acute physiolo-gy and chronic health evaluation scoring Ⅱ (APACHE Ⅱ),body temperature,respiratory rate,heart rate,mean arterial pressure,white blood cell counts,PaO2 /FiO2 ,ARDS incident,mechanical ventila-tion time,ICU treatment and hospitalization duration,28 days mortality.Results:The PI3 levels showed no statistical difference on day 1,but significant differences on day 3 and day 7 between the two groups (P <0.01).HNE /PI3 ratio showed no statistical difference on day 1,but significant differences on day 3 and day 7 (P <0.05).PaO2 /FiO2 was significantly higher in ulinastatin group on day 3 and day 7 (P <0.05).The incident rate for ulinastatin group was 15.58%,lower than that for the control group (33.33%),and the difference was statistically significant (P <0.05).The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group,and the difference was statistically significant (P <0.05).There were no significant effects in other factors.Conclusion:Increased dose of ulinastatin can recover the balance of HNE and its antagonist,lower the HNE’s damage to lungs,and further reduce the ARDS incident rate.

Investigation of adjuvant treatment for difficult weaning from mechanical ventilation / 中华危重病急救医学

Objective To investigate the value of drug intervention for difficult weaning from mechanical ventilation. Methods A prospective single-blind randomized controlled trial was conducted. 120 patients with difficult weaning from mechanical ventilation encountered in Department of Critical Care Medicine of Peking University Third Hospital from January 2008 to December 2013 were included,and the patients were divided into treatment group and control group according to random number table,with 60 cases in each group. Patients received furosemide therapy in the treatment group 3 days before weaning up to 48 hours after weaning in order to control negative liquid balance. Enema was given the day before weaning to reduce abdominal pressure. On the weaning day,all of the patients received nitroglycerin and beta blocker or cedilanid to prevent or control elevation of blood pressure and heart rate in the process of weaning. All patients in treatment group received anisodamine in small dosage 2 hours before extubation.The patients in control group received conventional treatment without drug intervention. Baseline indexes of two groups were compared,including the heart rate,respiration rate(RR),mean arterial pressure(MAP),pulse blood oxygen saturation(SpO2),blood gas,hemoglobin(HG),albumin(ALB)and creatinine(Cr). The main reasons of difficulty in weaning,sedative and analgesic drug selection,presence of abdominal discomfort before weaning,interval between sputum suction before extubation,liquid balance at the beginning of the investigation and at time of weaning,24 hours and 48 hours after weaning,failures of spontaneous breathing test(SBT),length of mechanical ventilation,length of ICU stay,and total length of mechanical ventilation and total length of ICU stay during hospitalization. Results There was no statistically significant difference in the heart rate,RR,MAP,SpO2,blood gas,HG,ALB,Cr at the beginning of the investigation between the two groups. The main reasons for difficult weaning in both groups of patients were respiratory dysfunction,cardiac insufficiency,and central nervous system dysfunction. The use of propofol combined dexmedetomidine in the treatment group was more frequent than the control group〔16.7%(10/60)vs. 1.7%(1/60),χ2=8.107,P=0.004〕,and there was no statistically significant difference in the use of other combinations of sedative drugs between the two groups. Abdominal discomfort before weaning was milder in treatment group as compared with control group〔10.0%(6/60)vs. 25.0%(15/60),χ2=4.675,P=0.031〕. The interval between sputum suction before extubation in the treatment group was significantly longer than that of the control group〔hours:1(1,2)vs. 1(1,1),Z=-2.209,P= 0.027〕. SBT failure was less frequent in treatment group compared with control group〔times:0(0,1)vs. 1(1,2),Z=-6.561,P=0.000〕. Liquid balance was better in the treatment group than the control group at time of weaning,24 hours and 48 hours after weaning〔at time of weaning:-567.71 (-755.95,-226.41)vs. 1 256.76(472.48,1 796.63),Z=-9.038,P=0.000;24 hours after weaning:-5.03 (-530.28,245.09)vs. 342.28(125.36,613.25),Z=-4.711,P=0.000;48 hours after weaning:115.50(-450.26, 485.00)vs. 330.00(16.25,575.25),Z=-1.932,P=0.053〕. Compared with control group,length of mechanical ventilation〔days:1.0(1.0,2.0)vs. 2.0(2.0,3.0),Z=-6.545,P=0.000〕,ICU stay time〔days:3.0(3.0,4.0) vs. 4.0(4.0,5.0),Z=-6.545,P=0.000〕,and total length of mechanical ventilation〔days:8.0(6.0,12.0)vs. 11.0(8.0,15.0),Z=-4.091,P=0.000〕and total length of ICU stay during hospitalization〔days:12.5(9.2,19.0) vs. 17.0(12.0,29.5),Z=-2.722,P=0.000〕were all significantly shorter in the treatment group. Conclusions Adjuvant drugs therapy is helpful in patients weaning from the mechanical ventilation,and can shorten length of mechanical ventilation and ICU stay time. Propofol,combined dexmedetomidine,is helpful for weaning.

Umbilical cord mesenchymal stem cell transplantation for treatment of diabetic lower limb vascular disease / 中国组织工程研究

BACKGROUND:Compared with bone marrow and autologous peripheral blood stem cells, umbilical cord mesenchymal stem cells are characterized as more primitive, more powerful amplification and lower immunogenicity, no ethical problems, which are more important to the elderly patients with diabetes mel itus. OBJECTIVE:To evaluate the efficacy and safety of umbilical cord mesenchymal stem cells transplantation in the treatment of the elderly patients with diabetic lower limb vascular disease. METHODS:Fifty-six elderly patients with diabetic lower limb vascular disease were randomly divided into observation group and control group. The control group was treated with conventional therapy, while the observation group was treated with umbilical cord mesenchymal stem cells transplantation. RESULTS AND CONCLUSION:Observation group showed a higher efficiency than the control group, with significant difference (P<0.05). After treatment, foot skin temperature, transcutaneous oxygen pressure, and ankle brachial index were al improved in both two groups, and the ankle brachial index showed a better value in the observation group (P<0.05). There were no significant adverse reactions in the two groups. Umbilical cord mesenchymal stem cells transplantation is a simple, safe and effective therapy for the elderly patients with diabetic lower limb vascular disease, with better short-term curative effect.

Nimodipine attenuates the convulsion of pentylenetetrazoloe-induced status epilepsy with increasing expression of phosphated-ERK in the hippocampus of rats / 中华行为医学与脑科学杂志

Objective To detect the expression of extracellular-regulated kinase (ERK) and phosphatedextracellular-regulated kinase (P-ERK) in the hippocampus after pentylenetetrazoloe-induced status epilepsy and the effects of nimodipine on it.Methods Male Sprague-Dawley adult rats (200-250 g) were randomly divided into normal control group(NC,n =35),status epilepsy group (SE,n =40),nimodipine group (NIM,n =40).The rats were injected first with 40 mg/kg pentylenetetrazoloe(PTZ),followed 10 minutes later by 20 mg/kg PTZ,and subsequently,10 mg/kg PTZ ip every 10 minutes until SE occurred,apoint charactered by a loss of postural control and tonic-clonic seizures.Rats in control group received the same number of saline injections.Rats in NIM group were injected NIM(2.5 mg/kg) intraperitoneally 15 min before the injection of PTZ.Rats in every group were killed at 30 minutes,1 hour,3 hours,12 hours,24 horus,72 hours and 7 days after status epilepsy respectively and the hippocampus were dissected.The expression of ERK and P-ERK in the hippocampus were detected by Western blot.Results Nimodipine attenuated the convulsion of PTZ-induced status epilepsy.There was dynamic expression of P-ERK in SE group.In NIM group,the expression of P-ERK was markedly increased than that of SE group at 30 min,1h,3h,12h,24h,72h,and 7d (3.26 ±0.95 vs 2.56 ±0.82 at 30 min,P＜0.05).Conclusion Nimodipine attenuates the convulsion of PTZ-induced status epilepsy with increased expression of phosphated-ERK in the hippocampus of rats.

The value of early base excess monitoring on predicting prognosis in traumatic brain injury patients / 中国医师进修杂志

Objective To dynamically monitor the base excess(BE) in traumatic brain injury(TBI) patients within 3 d after admission,and to assess the impact of the early BE on prognosis.Methods Blood BE was monitored for 3 d in 56 TBI patients.Patients were classified into mild group(15 patients),moderate group (22 patients) and severe group (19 patients) according to the scores of Glasgow coma scale(GCS).Patients were classified into survival group(42 patients) and dead group(14 patients) according to prognosis.Patients were classified into high BE group (35 patients,BE≥-8 mmol/L) and low BE group (21 patients,BE ＜-8 mmol/L).The relations among BE,degree of injury and prognosis were analyzed.Results The level of BE in mild group,moderate group and severe group was increased after treatment for 1,2,3 d than that before treatment.The level of BE was consistent with the degree of injury [mild group:(-3.02 ± 0.21)mmol/L; moderate group:(-8.49 ± 1.44) mmol/L;severe group:(-9.64 ± 1.19) mmol/L].The level of BE in mild group and severe group had significant difference than that in moderate group (P＜ 0.01).The level of BE in dead group before treatment and after treatment for 1,2,3 d was significantly lower than that in survival group [(-11.97 ±2.13) mmol/L vs.(-6.29 ± 1.16) mmol/L,(-9.84 ± 1.33) mmol/L vs.(-4.89 ± 1.78)mmol/L,(-8.78 ± 2.01) mmol/L vs.(-3.61 ± 1.43) mmol/L,(-7.84 ± 1.42) mmol/L vs.(-3.10 ±0.98)mmol/L] (P ＜0.01).The scores of APACHE Ⅱ before treatment and fatality rate in low BE group were significantly higher than those in high BE group [(24.84 ± 3.68) scores vs.(16.27 ± 2.21) scores,52.4％ (11/21) vs.8.6％(3/35)] (P ＜ 0.01).The scores of GCS before treatment in low BE group was significantly higher than that in high BE group [(7.56 ± 3.09) scores vs.(10.51 ± 2.43) scores](P ＜ 0.01).Conclusion The level of early BE is a good factor on evaluating the condition and prognosis in TBI patients.

Distribution and Drug Sensitivity of Pathogens Isolated from Infected Patients in Emergency Ward / 中华医院感染学杂志

OBJECTIVE To investigate the bacterial distribution and sensitivity to antibiotics isolated from infected patients in emergency department. METHODS The antimicrobial susceptibility tests to commonly used antibiotics were performed to the specimen send by the emergency and respiratory departments in our hospital in 2007.The data were analyzed respectively. RESULTS Totally 340 strains were isolated in emergency department and 366 strains were isolated in respiratory department.The main bacteria isolated were similar in the two departments such as Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus and Escherichia coli,but their sensitivities to antibiotics were different. CONCLUSIONS Bacterial distribution of the infected patients in emergency department is similar to respiratory departments,but their sensitivities to antibiotics are different.

Effect of continuous adenosine infusion on mesentery microcirculation during cardiopulmonary resuscitation in rats with asphyxia / 解放军医学杂志

Objective To evaluate the effect of continuous adenosine infusion on mesentery microcirculation during cardiopulmonary resuscitation in rats with asphyxia. Methods Rat model of asphyxia was established in 22 healthy Wistar rats. The animals were then randomly divided into normal saline group (group A, n=10), epinephrine group (group B, n=6) and epinephrine plus adenosine group (group C, n=6). After a 3-min asphyxia without intervention, cardiopulmonary resuscitation (CPR) was started. The cardiac compression was carried out with an electric cardio-pulmonary resuscitation machine (200 times/min). Respiration was restored and maintained with a ventilator with tidal volume of 4ml, breathing rate 50times/min and FiO2 100%. After a 4-min CPR, rats in group A and group B were given normal saline and epinephrine (bolus of 90?g/kg) respectively, and in group C epinephrine (bolus of 90?g/kg) plus 70?g/kg adenosine were given. Electric defibrillation would be initiated if there was ventricular fibrillation. The reperfusion rate of mesentery arterioles and venules, diameter of blood vessels and relative blood velocity were observed. Results The reperfusion rate of mesentery arterioles and venules was significantly higher in group C than in group B (P