Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis.

BACKGROUND: The effects of corticosteroids on clinical outcomes of patients with sepsis remains controversial. We aimed to further determine the effectiveness of corticosteroids in reducing mortality in adult patients with severe sepsis by comparison with placebo. METHODS: Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all controlled studies that compared corticosteroids and placebo in adult patients with severe sepsis. The primary outcome was the mortality 28-day mortality and the secondary outcomes were mortality at longest follow up, occurrence, and reoccurrence of septic shock. RESULTS: A total of 19 trials involving 7035 patients were pooled in our final analyses. No significant heterogeneity was found in any of the outcome measures. Compared with placebo, corticosteroids were associated with a lower 28-day mortality (RR 0.91, 95% CI 0.85-0.98, Z = 2.57, P = 0.01) both in patients having sepsis and in those who developed septic shock (RR 0.92, 95% CI 0.85-0.99, Z = 2.19, P = 0.03), while no significant difference was found in mortality with the longest follow up in patients either having sepsis (RR 0.94, 95% CI 0.89-1.00, Z = 1.93, P = 0.05), or occurrence (RR 0.83, 95% CI 0.56-1.24, Z = 0.90, P = 0.37) or reoccurrence of septic shock (RR 1.08, 95% CI 1.00-1.16, Z = 1.89, P = 0.06). CONCLUSIONS: Corticosteroids were effective in reducing the 28-day mortality in patients with severe sepsis and in those with septic shock.

[Medical societies in modern China-China Medical Missionary Association].

In modern times, the development and exchange of scientific research were promoted greatly by establishments of scientific societies in the west. In the second half of the 17(th) century, medical societies such as the Berlin Royal Society of Medicine, the Paris Surgical Society, the Edinburgh Medical Society and the London Medical Society appeared in sequence, which promoted the progress of European medicine greatly by means of medical conferences and journals. At the end of the 19(th) century, in order to promote medical missions and education, western missionaries drew lessons from the medical society system and founded the China Medical Missionary Association (CMMA). The association was dedicated to work in four fields: terminology standardization, missionary hospitals, medical education and study on endemic disease. CMMA accelerated the development of medical missions and the spread of western medicine. As members of CMMA must be of religious orders, many scholars were not qualified to join in, which resulted in limitation of academic research and exchange. With the return of overseas students, Chinese scholars majoring in western medicine enhanced the awareness of medical knowledge. As a result, western medical societies were established one by one, including the Shanghai Medical Association, the Chinese Pharmaceutical Association, the Chinese Medical Association and the Society of Chinese Medicines of the Republic of China. Established in 1915, the Chinese Medical Association had members who also belonged to the CMMA, so the Chinese Medical Association made reference to the CMMA for its organization, function, operating mechanism, journals, etc..

[The invention and evolution of the stethoscope].

There is a record of direct auscultation in the Hippocratic Corpus and this auscultation method has been used for more than 2000 years. In 1816, the first monaural stethoscope was invented by a French physician Dr. Rene Laennec, who also wrote books introducing how to use the stethoscope and auscultation. This instrument has been improved by several doctors and in 1851,the one improved by George Cammann, an American doctor, was the model of today's stethoscope. The electrical stethoscope was produced by the 3M(TM) Littmann Company in 1999, after which the audio files could be saved. In 2000, the vibration response imaging system was introduced into medicine. In 2006, a noise-free active stethoscope was displayed in the Acoustics Conference held in Honolulu, USA. This kind of stethoscope could be used in noisy or bumpy circumstances. These new pieces of equipment made the stethoscope's application field even broader.

[The experimental results of GVHD following orthotropic liver transplantation].

OBJECTIVE: To analyze experimental results of Graft-versus-host disease (GVHD) after liver transplantation. METHODS: 13 cases of GVHD out of the 1013 liver transplantation between 2002-2008 were analysed. Routine blood test, liver function and microorganisms test were done in all of the 13 cases, bone marrow test was done in 5 cases, liver pathological test was done in 5 cases, cytokines were analyzed in 4 cases, chimerism test was done in 6 cases. RESULTS: Leukocytes were reduced to various degree in all 13 cases, and were extremely low in 8 cases. Hematopoiesis was repressed in 4 cases. Normal liver function was found in 9 cases. Bacterium were found in blood, bile, wound secrete juice, excrement, phlegm of 10 cases. The pathological characteristics was in accordance with GVHD in 5 cases. The levels of IL-1 alpha, IL-1 beta, IL-2, IL-4 were low or undetectable. IL-10 was decreased in 4 cases but increased in 1 case. MCP-1, VEGF, IL-6, EGF, IL-8 were increasing or remained at high level during GVHD. TNF alpha was slightly increased. IFN gamma was only slightly changed before GVHD. CONCLUSION: Chimerism is a reliable but not unique evidence of GVHD.

[Comparison between transmission of modern western medicine in China and Japan].

In the middle period of the 16th century, western medicine had been introduced successively into China and Japan by the medium of Catholic missionaries. The transmission mode of western medicine in the two countries differed dramatically from each other due to the political, economic and social cultural differences of that time. In China, the transmission of western medicine focused on the theory first and transferred to the practical use later; while in Japan, it began with clinical treatment, then rose from the technology to the theory. As a result, the cognition to the western medical knowledge and medical system as well as the transplanting and localization in China and Japan were significantly different. The local western medical groups emerged earlier in Japan than in China, and the attitude toward western medicine was also more positive and a national health system was quickly established. The corresponding situation in China obviously lagged behind the one in Japan, and China learned from the successful experiences of Japan for a time.

[Bernard's outlook on life and its influence on modern physiology].

In the later half of the 19th century, the main stream in physiology was mechanical reductionism. Bernard, however, advocated organic, holistic outlook on life, and put forward the idea of inner environment of organism. His thinking and methodology exerted significant influence on the development of physiology in early 20th century.