Retrospective study on the types and characteristics of shock in polytrauma patients at different stages after trauma / 中华急诊医学杂志

Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.

Early risk factors for persistent inflammation immunosuppression and catabolism syndrome in patients with severe polytrauma / 中华急诊医学杂志

Objective:To retrospectively assess early risk factor of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with severe polytrauma, in order to deepen the understanding of the pathological changes of chronic critical illness (CCI) after severe polytrauma.Methods:A total of 276 patients with severe polytrauma admitted to Department of Trauma Surgery of Tongji Hospital from March 2019 to December 2020 were enrolled. Inclusion criteria included patients who suffered severe polytrauma, and injury severity score (ISS) ≥27, age ≥18 years old, and had length of hospital stay >15 days. Exclusion criteria included previous medical history of malignancy, or immunological, consumptive, and metabolic diseases. The patient’s clinical characteristics, ISS scores, Glasgow coma scale (GCS), sequential organ failure assessment, APACHEⅡ scores, and nutrition and immune indexes on day 3 after injury were collected. The difference between the PICS group and N-PICS group were performed by Student’s t test, χ2 test or Mann-Whitney U test. The early risk factors were assessed in patients with PICS after severe polytrauma by logistic regression analysis. Results:According to the diagnostic criteria of PICS, all enrolled patients were divided into two groups: PICS group ( n=102) and N-PICS group (without PICS, n=174). Compared with the N-PICS group, patients in the PICS group were older and associated with more brain and chest injuries. On the third day after injury, serum levels of IL-6 and IL-10, and the ratio of Treg cells were significantly higher, the number and ratio of NK cells subset, and the ratio of activated T lymphocyte were significantly lower in the PICS group than in the N-PICS group ( P<0.05). Logistic regression analysis showed that the age>65 years old ( OR=2.375, 95% CI: 1.442-4.531), GCS ≤8 scores ( OR=3.431, 95% CI: 1.843-8.512), IL-10 >10 pg/mL ( OR=2.173, 95% CI: 1.751-5.614), the ratio of Treg cells >7% ( OR=3.871, 95% CI: 1.723-6.312), and the occurrence of traumatic brain and chest injuries ( OR=2.846, 95% CI: 1.522-5.361) were the early risk factors in patients with PICS after severe polytrauma. Conclusions:Age>65 years old, GCS score, IL-10, the ratio of Treg cells, and the occurrence of traumatic brain and chest injuries could be used as the early risk factors in patients with PICS after severe polytrauma. The discovery of early risk factors will help identify patients at high risk of PICS after severe polytrauma, and create the possibility for early intervention.

The relationship between immune disorder and acute gastrointestinal injury in patients after severe polytrauma / 中华急诊医学杂志

Objective:To retrospectively assess the relationship between immune disorder and acute gastrointestinal injury (AGI) in patients after severe polytrauma.Methods:Totally 205 patients with severe polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group, and 23 healthy volunteers were served as the control group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI), AGI patients were divided into the S-AGI group or L-AGI group according to the severity. The levels of cytokines and lymphocyte subset were evaluated at day 1, 7, and 14 after severe polytrauma. The differences between groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression analyzed.Results:Totally 79.5% (163/205) of patients with severe polytrauma were accompanied by AGI. There were significant differences in the ratio of Tc, Th at day 1 after trauma, the levels of IL-6, TNF-α, IL-8, IL-10, the ratio of Ts, Th/Ts, Treg at day 7 after trauma, and the levels of IL-8, IL-10,the ratio of Ts, Th/Ts, Treg at day 14 after trauma between the AGI group and N-AGI group ( P<0.05). There were significant differences in the ratio of Tc, Th, the levels of IL-6, TNF-α at day 1 after trauma and the ratio of Ts, Th/Ts, Treg, the levels of IL-8, IL-10 at day 7 and 14 after trauma between the S-AGI group and L-AGI group ( P<0.05). Logistic regression analysis showed that Ts 7 d ( OR=2.018, 95% CI: 1.105-5.364, P=0.013), Treg 14 d ( OR=3.612, 95% CI: 1.375-8.476, P=0.006), IL-6 7 d ( OR=1.824, 95% CI: 1.011-5.835, P=0.024), IL-10 14 d ( OR=2.847, 95% CI: 1.241-6.216, P=0.014), TNF-α 7 d ( OR=1.754, 95% CI: 1.215-5.441, P=0.018) were independent risk factors in patients with AGI after severe polytrauma. Conclusions:AGI is more easily occurred in patients with the heavier immune disorders after severe polytrauma. AGI can also aggravate pre-existing immune disorders in patients after severe polytrauma.

A retrospective study of risk factors of patients with acute gastrointestinal injury after polytrauma / 中华急诊医学杂志

Objective:To retrospectively assess the occurrence and risk factors in patients with acute gastrointestinal injury (AGI) after polytrauma.Methods:Totally 430 patients with polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI). The patients with abdominal injury or previously suffered from gastrointestinal disease were excluded. The patient's clinical characteristics lab tests results, and the first ISS, APACHEⅡ, SOFA and GCS scores were collected. The differences between different groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression.Results:65.3% of patients with polytrauma were accompanied by AGI (281/430 cases).There were significant differences between the AGI group and N-AGI group in ISS, GCS, APACHE Ⅱ and SOFA score, PCT or IL-6 level, shock index and length of stay in ICU ( P<0.05). Logistic regression analysis showed that shock, ISS≥16, APACHE Ⅱ≥16, SOFA≥5, GCS≤8 and IL-6>50 pg/mL were the early independent risk factors in patients with ACI after polytrauma. Conclusion:The incidence of AGI in patients after polytrauma is higher, which is related to ischemia, hypoxia, abnormal blood coagulation and stress in the early stage after trauma.

Clinical observation of three drug therapies in patients with generalized anxiety disorder and its effect on psychological fluctuation / 中国生化药物杂志

Objective To investigate the clinical efficacy and psychological status of three kinds of drug therapy in patients with generalized anxiety disorder. Methods 90 patients with generalized anxiety disorder in our hospital from January 2015 to December 2016 were selected,and according to the different treatment methods divided into the observation group A, observation group B and observation group C,45 cases in each groups. The observation group A with venlafaxine treatment, observation group B with tandospirone treatment, observation group C treated with Laura Si; comprehensive observation of 3 groups of patients with clinical treatment, improve psychological status and the incidence of adverse reactions, drug compliance, strict record the relevant data and comparative analysis. Results 3 groups of patients with clinical curative effect, no significant difference ; observation group A patients psychological status were better than those observed in B and C group. The incidence of adverse reaction was lower than observed in B and C group, medication compliance was higher than B, C group, the difference was statistically significant (P<0.05). Conclusion The patients with generalized anxiety disorder can choose Vin Rafa Sin, tandospirone, Laura Si treatment, but Vin Rafa Sin on the psychological status of patients with improvement is more significant, less adverse reactions, medication compliance of patients, is worthy of clinical application.

Two new phenylpropanoid glycosides from the aerial parts of

Two new phenylpropanoid glycosides named cuneataside E () and cuneataside F (), were isolated from the aerial parts of(Dum. Cours.) G. Don, whose structures wereandisomer, respectively. Their structures were elucidated on the basis of comprehensive spectroscopic analysis (UV, IR, HR-ESI-MS, 1D and 2D NMR). Inbioassays at 10 μmol/L, compoundshowed moderate hepatoprotective activity against-acetyl--aminophenol (APAP)-induced toxicity in HeG2 cells.

Study on chemical constituents from leaves of Tripterygium wilfordii / 中国中药杂志

In order to study the chemical constituents of the leaves of Tripterygium wilfordii and provide references for the bio-active study, we isolated nine compounds from the dried leaves of Tripterygium wilfordii. Their structures were determined by application of spectroscopic (NMR, MS) and chemical methods. These compounds were isolated and identified as (+)-lyoniresinol (1), (+)-isolariciresinol (2), burselignan (3), dibutyl phthalate (4), cyclo-(S-Pro-R-Phe) (5), cyclo-(S-Pro-R-Leu) (6), cyclo-(S-Pro-S-Ile) (7), 3-hydroxy-1-(4-hydroxy-3,5-dimethoxyphenyl)-1-propanone (8) and daucosterol (9). Compounds 1-3, 5-8 were isolated from this plant for the first time.

Chemical constituents from Hydrangea paniculata / 中国中药杂志

In order to study the chemical constituents of the plant of Hydrangea paniculata and provide reference for the study of the bioactive substances, we isolated nine compounds from the dried branches of H. paniculata. Their structures were determined by application of spectroscopic (NMR, MS) and chemical methods. These compounds were identified as skimmin (1), isotachioside (2), 8-methoxy-7-O-beta-D-glucopyranosyloxy coumarin glycoside (3), scopolin (4), 1-(alpha-L-rhamnosyl-(1 --> 6) -O-beta-D-glucopyranosyloxy) - 3, 4, 5-trimethoxybenzene (5), apiosylskimmin (6), umbelliferone (7), scopoletin (8), 7-hydroxy-8-methoxycoumarin (9). Compounds 1 - 7 were isolated from H. paniculata for the first time.

Chemical constituents from Sarcandra glabra / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of the plant of Sarcandra glabra and provide reference for the study of the bioactive substances.</p><p><b>METHOD</b>The compounds were isolated from the EtOH extract by various chromatographic methods and their structures were elucidated by their physico-chemical properties and the analysis of their spectral data.</p><p><b>RESULT</b>Nine compounds were isolated and identified as isoscopletin (1), syringaresinol monoside (2), styraxjaponoside B (3), 5-O-caffeoylshikimic acid (4), shizukanolide E (5), isoastilbin (6), neoisoastilbin (7), astilbin (8), neoastilbin (9).</p><p><b>CONCLUSION</b>Compounds 1-7 were isolated from S. glabra for the first time.</p>

Chemical constituents of Clausena lansium / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of the leaf of Clausena lansium (Lour.) Skeels.</p><p><b>METHOD</b>The compounds were isolated by various chromatographic techniques and their structures were elucidated by their physicochemical properties and the analysis of their spectroscopic data.</p><p><b>RESULT</b>Seven compounds were isolated and identified as corchoionoside C (1), 1'-O-beta-D-glucopyranosyl (2R,3S)-3-hydroxynodakenetin (2), quercetin-3-O-robinobioside (3), rutin (4), quercetin-3-O-scillabioside (5), keampferol-3-O-alpha-L-rhamnopyranosyl(1-->2) [alpha-L-rhamnopyranosyl(1-->6)]-beta-D-glucopyranoside (6), mauritianin (7).</p><p><b>CONCLUSION</b>Compounds 1-7 were isolated from the genus Clausena for the first time.</p>

Studies on chemical constituents from herbs of Viola yedoensis / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of the whole plant of Viola yedoensis.</p><p><b>METHOD</b>The compounds were isolated by various chromatographic techniques and their structures were elucidated by their physicochemical properties and the analysis of their spectral data.</p><p><b>RESULT</b>Seven compounds were isolated and identified as esculetin (1), isoscopoletin (2), 6-hydroxymethyl-3-pyridinol (3),5,5-bi (6,7-dihydroxycoumarin) (4), 6,6,7,7-tetrahydroxy-5,8-bicoumarin (5), loliolide (6), dehydrololiolide (7).</p><p><b>CONCLUSION</b>Compounds 2-7 were isolated from V. yedoensis for the first time.</p>