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Objective:To analyze the epidemiological characteristics and influencing factors of venous thrombosis in elderly patients with severe trauma.Methods:A retrospective study was conducted to collect and statistically analyze general information[sex, age, body mass index(BMI)], causes of trauma, injury severity score(ISS), Glasgow coma score(GCS), coagulation function[prothrombin time(PT), international normalized ratio(INR), D-dimer], B-type natriuretic peptide(BNP), liver function(alanine aminotransferase, aspartate aminotransferase), creatinine, Caprini score, surgical approach, immobilization mode, days of hospitalization, and treatment cost.Results:Totally 179 elderly patients with severe trauma were enrolled, including 130 men(72.6%), aged(67.6±6.4)years.The BMI, ISS and GCS scores of elderly patients with severe trauma were(22.9±3.4)kg/m 2, 28.4±10.5 and 10.2±4.6, respectively.The Caprini score was 11.7±4.0.Of these patients, 32(17.9%)had VTE events.Compared with the VTE negative group, the VTE positive group was older( t=-2.214, P=0.028), with a higher Caprini score( t=-2.684, P=0.008)and more lower limb fractures( P=0.008)and pelvic fractures( P=0.001). There were no significant differences in coagulation function, liver function, atrial natriuretic peptide levels, creatinine levels and surgical approaches between the VTE negative group and the VTE positive group(all P<0.05). No significant difference was found in the proportion of patients receiving surgical treatment between the two groups( P=0.563). In the VTE positive group, 18.8% had no fracture, 50.0% had one fracture, and 31.2% had two or more fractures, and the difference was statistically significant compared with the VTE negative group( P=0.029). However, VTE events had no significant effect on the average length of stay and hospitalization costs in elderly trauma patients(all P<0.05). Conclusions:For elderly patients with severe trauma, VTE is more likely to occur with increased age, a high Caprini score, multiple fracture sites and pelvic fracture.In addition, pelvic fracture is an independent risk factor for VTE in very old trauma patients.Attention should be paid to prevention and treatment to achieve steady improvement in the overall prognosis of trauma in these patients.
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Objective:To explore the morbidity, clinical features and mortality of unilateral pulmonary edema (PE) in the intensive care unit (ICU).Methods:Clinical data of PE patients in ICU between January 2018 and January 2021 were retrospectively collected. All patients were divided into the bilateral PE and unilateral PE groups according to imaging manifestations. Etilogy, clinical performance, cardiac ultrasound parameters, complications, treatment and prognosis were compared between the two groups. Binary logistic regression analysis was used to screen out the risk factors of death.Results:Of the 314 PE patients, 14 (4.5%) were unilateral PE patients , and 11 (78.5%) were right-sided unilateral PE. There were no differences in age, gender, heart rate, respiratory rate and left ventricular eject fraction between the unilateral and bilateral PE groups. Compared with the bilateral PE group, systolic and diastolic blood pressure were significantly lower in the unilateral PE group [128 (102.7-138) mmHg vs. 135 (116-166) mmHg, 72 (54-88.2) mmHg vs. 82 (69-97.7)mmHg, respectively]. The incidence of cardiac arrest and hospital mortality were higher in the unilateral PE group [28.6% vs. 8.0%, 42.9% vs. 10%, all P<0.05]. Binary logistic regression analysis showed that age, unilateral PE, and use of vasoactive agent were associated with poor prognosis. Odds ratio of unilateral PE and use of vasoactive agent were 17.78 and 11.67, respectively. Conclusions:Unilateral PE is not rare, which is an independent risk factors for mortality and should be promptly recognized to avoid delays in treatment.
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Objective To observe the effect of different temperatures on endoplasmic reticulum stress, calcium overload, mitochondria and cell damage in pulmonary microvascular endothelial cells (PMVEC) induced by heat stress, and clarify the mechanism of endothelial cell injury in the process of heat stress to provide experimental basis for clinical prevention and treatment of heat stree. Methods Heat stress model of PMVEC cell was set up. Control group cells were incubated at 37℃, 5%CO2, while heat stress group cells were incubated at 39℃, 41℃, 43℃ for 2h, respectively, then further incubated at 37℃, 5%CO2 for 6h. Pretreatment of cells with 20μmol/L BAPTA-AM or 50μmol/L CsA before heat stress at 43℃. The protein levels of p-PERK, PERK p-eIF2a, eIF2a, ATF4 and GRP78 were analyzed by Western blotting. Intracellular Ca2+, mitochondrial membrane potential and the changes in mitochondrial permeability transition pore were investigated by flow cytometry. The change of caspase-3 was detected by Caspase Assay Kit. Millicell-ERS Volt-Ohm Meter and Accessories was used for determining the changes of transepithelium electrical resistance (TER). Results Compared with the control group, with the increase of heat stress temperature (41-43℃), the phosphorylation of p-PERK and p-eIF2a protein and the expressions of ATF4 and GRP78 proteins were gradually activated, intracellular Ca2+ increased, MPTP pore was opened, mitochondrial membrane potential decreased, cell permeability increased and apoptosis occurred, and it was the most obvious in the 43℃ heat stress group, and the difference was statistically significant (P<0.05). Pretreatment with Ca2+ inhibitors promoted the recovery of the MPTP hole, mitochondrial membrane potential and cell permeability, and reduced the occurrence of apoptosis. While pretreatment with the mitochondrial protective agent did not reduce the release of Ca2+, but it could promote the recovery of cell permeability and reduce the occurrence of apoptosis. Conclusion Heat stress activates endoplasmic reticulum stress response, induces intracellular Ca2+ overload mediated cell and mitochondrial damages in PMVEC cells, which may be one of the important mechanisms of endothelial cell injury induced by heat stress.
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Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.
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Objective: To investigate the nutritious effects of IGF, HGF and Gln on intestinal mucosal precursor cells in vitro.Methods: Different combinations of IGF,HGF and Gln were used to observe their effects on the expansion and development of the cultured intestinal mucosal precursor cells.Results: The combination of IGF,HGF and Gln could markedly promote the expansion of cultured intestinal mucosal precursor cells.Although IGF or HGF alone could promote the expansion of intestinal mucosal precursor cells, they had little effects on the development.On the contrary,Gln alone can promote the development of intestinal mucosal precursor cells,but it had little effects on their expansion.Conclusion: IGF,HGF or Gln alone has little effects on the expansion and development of the intestinal mucosal precursor cells.When they are used together,they can efficiently provide the essential stimuli for the expansion of the cultured intestinal mucosal precursor cells in vitro and enable the recombination of the different cells and formation of intestinal mucosa-like structure in vitro.
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Objectives:To study the alterations of NF-?B activation in PBMC, in order to clarify the signal transcription of NF-?B concerned in the mechanism of inflammatory reaction in severe burns. To evaluate the alterations of expression of NF-?B dependent proinflammatory cytokines mRNA. Thereby, to observe the regulating effects of NAC on NF-?B, and verify the medial effects of upstream signal molecules on cytokines expression. Methods:Sprague Dawley rats were randomly assigned to each group. A 30% TBSA full-thickness scald was performed by immersing in 100℃ water for 12 seconds. PBMC were isolated at different time point after scalding. From isolated PBMC, the total RNA was isolated and the nuclear protein purified by Trizol reagents. The NF-?B proteins were measured through EMSA. Message RNA expression of proinflammatory cytokines and Th2 cytokines were assayed by RT-PCR. Results:Lots of NF-?B proteins were sequester in nucleus in all burn groups. mRNA expression of proinflammatory cytokines were also enhanced and related to the activity of NF-?B protein in nucleus. NAC could decrease the activity of NF-?B protein in nucleus. NAC had also significantly inhibitory effects on the production of proinflammatory cytokines. However, all of Th2 cytokines measured in this study were enhanced too. Conclusions:NF-?B might be the second signal molecule from cytosol to nucleus and mediate the proinflammatory cytokines transcription in PBMC after burns. In signal transduction levels, enhancing scavengers of oxygen free radicals in PBMC may modulate the activity of NF-?B which mediate the expression of proinflammtory cytokines.
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<p><b>OBJECTIVE</b>To investigate the relationship between the presence of the TNF2 allele and plasma concentrations of tumor necrosis factor-alpha (TNF alpha) and soluble TNF receptor (sTNF-R) with the development of acute severe pancreatitis (ASP) and severe sepsis.</p><p><b>METHODS</b>Genomic DNA was prepared from peripheral blood leukocytes. The TNF1 and TNF2 biallelic polymorphisms were identified by analyzing NcoI-digested DNA fragments obtained from PCR products. Plasma levels of TNF alpha and sTNF-R were measured by EASIA.</p><p><b>RESULTS</b>The overall TNF2 allele frequency in ASP patients was comparable to that found in healthy volunteers (29.2% vs. 29.3%, P > 0.05). Severe sepsis occurred in 26 of 72 patients. Patients with severe sepsis showed a significantly higher prevalence of TNF2 than those without (46.2% vs. 19.6%, P < 0.05). Plasma TNF alpha, sTNF-R I, and sTNF-R II levels were (36 +/- 31) pg/ml, (5.4 +/- 3.5) ng/ml, and (11.2 +/- 7.8) ng/ml, respectively, in patients with severe sepsis, and (31 +/- 25) pg/ml, (4.6 +/- 3.8) ng/ml, and (8.8 +/- 6.6) ng/ml in non-severe sepsis subjects. Differences in TNF levels were not statistically significant between patients with ASP and control group (P > 0.05). Moreover, there was no correlation between TNF2 allele frequency and TNFalpha levels [(37 +/- 31) pg/ml vs. (31 +/- 25) pg/ml in TNF2 group and TNF1 group, respectively, P > 0.05].</p><p><b>CONCLUSIONS</b>Our results suggest that there is no relationship between ASP and the TNF2 allele, but that the TNF2 allele is associated with a susceptibility to severe sepsis as a result of ASP.</p>
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Adult , Female , Humans , Male , Middle Aged , Acute Disease , Pancreatitis , Genetics , Polymorphism, Genetic , Receptors, Tumor Necrosis Factor , Blood , Sepsis , Genetics , Tumor Necrosis Factor-alpha , GeneticsABSTRACT
Objectives:To observe the effects of Dantrium and nimodipine on myocardial function in severely burned rabbits. Methods: Full thickness scald burn covering 30% TBSA was produced on rabbits. LVSP, ?dp/dt max ,BPs, BPd, BPm were recorded through a MPA Ⅳ Biological Signal Analysis System before and after burn constantly. All burn animals were resuscitated with lactate Ringer's solution according to the Parkland formula. Dantrium and nimodipine were administered respectively. Results: The myocardial contractility and relaxation were depressed after burn trauma, with a short phase of enhancement immediately after scalding. LVSP,?dp/dt max , BPs and BPm were increased after intravenous injection of Dantrium. The effect of nimodipine was not same as Dantrium. LVSP,?dp/dt max ,were enhanced after infusing nimodipine slowly. Conclusions: The rabbits myocardial function was depressed after severely burn. Dantrium and nimodipine could both improve the myocardial function. Dantrium ○R was suitable for treating the animal with burn shock and myocardial malfunction.
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Objectives:To study the alterations of calcium ion and NF ?B activation in cultured PBMC after stimulation of post burn plasma, and to investigate the roles of signal transduction pathway in the mechanisms of SIRS after burn. Methods:PBMC were stimulated with post burn plasma in vitro . The calcium ion concentration were measured by fura 2. The NF ?B protein were measured by EMSA. Results:Lots of NF ?B proteins were sequester in nucleus in all burn plasma groups. Dantrium and Nimodipine could decrease the activity of NF ?B protein in nucleus, and have significant inhibitory effects on the production of interleukin 6 and NO. Conclusions:In signal transduction levels, calcium ion may modulate the activity of NF ?B which mediate the expression of most proinflammtory cytokines.
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SNP may play an important role in the mechanism of sepsis. Detection SNP of the patients with sepsis may be the key point to the individualization treatment in near future.
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Objectives: To study the alteration of total plasma antioxidant capacity(TAC), NO and IL 6 in severely burned rats, and evaluate the relationship between TAC and NO or IL 6 production. Methods: Full thickness scald burn covering 30%TBSA was produced on SD rats. At different time the blood were collected for isolating the plasma. The TAC and NO were measured according to the protocols of kits. The IL 6 was measured by radioimmunoassay. Results:TAC decreased significantly after burns, following by the increasing production of NO and IL 6. The lowest TAC level and highest production of NO and IL 6 appeared at 6 h after burns. The correlation analysis showed that TAC and NO or IL 6 had negative correlation( r=-0.839, r =-0.783). Conclusions: The low TAC level might be the cause of the high production of inflammatory mediate such as NO and IL 6. It hints that enhancing TAC level might inhibit the production of NO and inflammatory cytokines.
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Objective: Using MB-80 Microbiology Kinetic Rapid Reader, the methods were established to quantitatively measure the body fluid content of bacterial endotoxin and fungus in infectious patients. Methods: The blood samples were collected from Gram negative bacterial infection and deep mycosis patients and healthy volunteers. After pre-treatment, the plasma samples were measured using MB-80 system through kinetic turbidimetric limulus test method. The system computer could calculate the content of endotoxin and fungus during 1 hour detection. Results: The detection methods of endotoxin and fungus using MB-80 were simple and rapid. The process of pre-treatment was standardized and the results had good repeatability. The normal ranges of plasma endotoxin and fungus of human healthy volunteers were (2.03?2.32)ng/L and (2.46?2.15)ng/L respectively. The plasma endotoxin level of abdominal infection patients was increased significantly to 50-3 958 ng/L. The fungus level of deep mycosis patients was enhanced to 20-2 381 ng/L. Conclusion: The methods of endotoxin and fungus quantitatively measurement by MB-80 are simple and convenient and have results with good repeatability. The new detection methods of endotoxin and fungus can be used for diagnosis of endotoxemia and deep mycosis in early stage of infection.