Age-adjusted Charlson comorbidity index predicts mortality in patients with acute type A aortic dissection / 中华急诊医学杂志

Objective:To evaluate the predictive value of age-adjusted Charlson comorbidity index (ACCI) for in-hospital mortality and 1-year mortality in patients with acute type A aortic dissection (ATAAD).Methods:This was a retrospective cohort study, and the clinical data of ATAAD patients admitted to Wuhan Union Hospital from January 1, 1999 to December 31, 2018 were collected for analysis. All the patients were confirmed by computed tomography angiography or magnetic resonance imaging of the aorta and the onset time was less than 14 days. Patients who survived at discharge were followed up to obtain 1-year survival information. The ACCI score was calculated for patients based on their comorbidities and age at admission, and they were divided into three groups of 0, 1 and ≥2 according to the ACCI score. The in-hospital mortality and 1-year mortality of the three groups were compared. Logistic regression analysis was applied to determine the independent predictors for in-hospital mortality and 1-year mortality.Results:Among 1 133 ATAAD patients, 383, 357 and 393 patients had ACCI score of 0, 1, and ≥2, respectively. The in-hospital mortality and 1-year mortality of patients with ACCI score ≥2 were significantly higher than those of patients with ACCI score of 0 (25.4% vs. 17.0%, 30.0% vs. 19.6%, both P<0.05). Multivariate Logistic regression analysis showed that ACCI score ≥2 was an independent risk factor for in-hospital mortality ( OR=1.670, 95% CI: 1.176-2.370, P=0.004) and 1-year mortality ( OR=1.762, 95% CI: 1.264-2.456, P<0.001). Age (per 10-year increase) and cerebrovascular diseases were independent risk factors for in-hospital mortality and 1-year mortality, while diabetes mellitus was a protective factor for in-hospital mortality. Conclusions:ACCI can predict the in-hospital mortality and 1-year mortality of ATAAD patients, and patients with ACCI score ≥2 have a poorer prognosis.

Analysis of muscle activation in children and adolescents with severe cerebral palsy / Análise da ativação muscular em crianças e adolescentes com paralisia cerebral grave

Abstract Introduction: Children and adolescents with spastic quadriparesis have a worse selective motor control, and studies with this population are still very scarce. The same is true with scientific evidence of one of the methods most used as a physiotherapeutic treatment in this population, the Bobath Concept. Objective: To evaluate spine erector muscles activation, gluteus medius and gluteus maximus, through the handling of the Bobath Concept and the sustained kneeling posture in subjects with a diagnosis of severe cerebral palsy; and to compare muscle activation with a reference group, in order to increase the reliability of this study. Methods: A cross-sectional study was carried out with 38 children and adolescents with cerebral palsy, classified by GMFCS at levels IV and V, and 20 healthy participants, aged between 3 and 18 years. They were submitted to the handling of the Bobath Concept and to the sustained kneeling posture, with muscle activation obtained by electromyography. Results: We observed significant muscle activation during handling in side-sitting, with weight transfer and without the help of another therapist, and in the sustained kneeling posture, for the erector of the spine and gluteus medius. Conclusion: The evidence from this study suggests that both the handling in side-sitting and the sustained kneeling posture cause significant muscle activation in the erector of the spine and gluteus medius for severe quadriparesis subjects, GMFCS IV and V, which can contribute to the improvement of postural control and decision-making in physical therapy practice.

Resumo Introdução: Crianças e adolescentes com quadriparesia espástica apresentam pior controle motor seletivo e estudos com essa população ainda são muito escassos. O mesmo ocorre com as evidências científicas de um dos métodos mais utilizados como tratamento fisioterapêutico nessa população, o Conceito Bobath. Objetivo: Avaliar a ativação dos músculos eretores da coluna, glúteo médio e glúteo máximo por meio do manuseio do Conceito Bobath e da postura ajoelhada sustentada, em indivíduos com diagnóstico de paralisia cerebral grave; e comparar a ativação muscular com um grupo de referência, a fim de aumentar a confiabilidade deste estudo. Métodos: Realizou-se um estudo transversal com 38 crianças e adolescentes com paralisia cerebral, classificados pelo GMFCS nos níveis IV e V, e 20 participantes saudáveis com idade entre 3 e 18 anos. Eles foram submetidos ao manuseio do Conceito Bobath e à postura ajoelhada sustentada, com ativação muscular obtida por eletromiografia. Resultados: Observou-se ativação muscular significativa durante o manuseio na posição sentada de lado, com transferência de peso e sem auxílio de outro terapeuta, e na postura ajoelhada sustentada para o eretor da coluna e glúteo médio. Conclusão: As evidências deste estudo sugerem que tanto o manuseio na posição sentada de lado quanto a sustentação da postura ajoelhada causam significativa ativação muscular no eretor da coluna e glúteo médio para indivíduos com quadriparesia grave, GMFCS IV e V, o que pode contribuir para a melhora do controle postural e tomada de decisão na prática fisioterapêutica.

Research on the signal pathway of hydrogen sulfide regulating autophagy to protect intestinal injury in sepsis / 中华危重病急救医学

Sepsis is one of the main causes of death in critically ill patients. The intestinal tract is not only the organ easily involved in sepsis, but also the initial organ in the progression of sepsis, so the improvement of intestinal barrier function is the key of the treatment of sepsis. In recent years, it has been found that autophagy is involved in the pathological process of sepsis, maintaining mitochondrial function by clearing damaged organelles, inhibiting inflammation, oxidative stress and apoptosis, regulating immunity, maintaining intestinal homeostasis, and improving the condition and prognosis of sepsis. It is an effective target for the treatment of sepsis. As a new type of medical gas signal molecule, hydrogen sulfide (H 2S) can regulate autophagy by regulating multiple signal pathways, which has become a new target in the treatment of sepsis. This article reviews the signal pathway regulation mechanism of H 2S regulating autophagy in septic intestinal dysfunction.

Role of hydrogen sulfide mediated autophagy related genes in intestinal function injury of sepsis / 中华危重病急救医学

Sepsis is an organ dysfunction that endangers a patient's life caused by an imbalanced infection response, and is a clinically critical illness. Despite a deep understanding of the pathogenesis of sepsis, there has been no significant improvement in sepsis mortality during clinical treatment at home and abroad. In recent years, the role of autophagy in the pathogenesis of sepsis has become a new research point in the field of medical research. Autophagy may protect the body by removing pathogenic microorganisms, neutralizing microbial toxins, and regulating cytokine release in sepsis. Studies have shown that autophagy plays a role in heart and lung organ dysfunction and inflammatory immune response in sepsis. Studies have also shown that hydrogen sulphide (H 2S) can activate autophagy through multiple signaling pathways, such as adenylate-activated protein kinase/mammalian target of rapamycin (AMPK/mTOR), phosphoinositide 3 kinase/Akt/mTOR (PI3K/Akt/mTOR), liver kinase B1/STE20 related adapter protein/mouse protein 25 (LKB1/STRAD/MO25) and microRNA-30c (miR-30c), etc. signaling pathways. This article reviewed the effects of H 2S on autophagy-related genes Beclin-1 and microtubule-associated protein light 3 chain (LC3) on intestinal function of sepsis in order to explore the H 2S-mediated autophagy gene expression in pus. The protective role of autophagy gene for intestinal dysfunction provides a new strategy for the treatment of sepsis in the future.

Clinical features of foodborne botulism associated with one local outbreak / 中华急诊医学杂志

Objective:Analyze the epidemiological data and the clinical data of local foodborne botulism, summarize the influencing factors and clinical characteristics of the foodborne botulism, mitigate future misdiagnosis.Methods:An epidemiological investigation was conducted to a local outbreak with botulism, which involved 24 individuals consuming homemade bean curd and 14 cases with foodborne botulism through analyzing the influencing factors of the poisoning. For 14 patients with botulism, their clinical manifestations, first laboratory test and imaging data, treatment and prognosis, were documented and explored.Results:All 14 cases were diagnosed as type A foodborne botulism, of which 2 were misdiagnosed. The incidence of the foodborne botulism was reduced by 81.7% in alcoholic drinkers ( P=0.009). The median incubation period of the 14 patients with botulism was 2.0 (1.0~3.0) days. The initial clinical symptom of 10 patients was diplopia, while that of the other 4 patients was blurred vision. Nine patients subsequently suffered from paralysis of oropharyngeal muscles, leading to dysphagia, speech impairment, etc. Four patients progressed to dyspnea and chest tightness due to respiratory muscle involvement. All of the patients had clear consciousness without sensory abnormalities, no fever and abdominal symptoms such as diarrhea and abdominal pain. There were no obvious abnormal findings in 14 patients with laboratory tests and cranial CT/MRI assessment. 14 patients with the poisoning were relieved after injection of botulinum antitoxin for 8.0 (7.0~8.5) days. Follow-up of all the patients 6 months later found that 9 patients still had slight blurred vision. Conclusions:The typical clinical manifestation of foodborne botulism was symmetric descending flaccid paralysis. Drinking liquor could reduce the incidence of foodborne botulism. Botulinum antitoxin was effective in the treatment of botulism and should be used as early as possible.

Fisioterapia respiratória não altera agudamente os parâmetros fisiológicos ou os níveis de dor em prematuros com síndrome do desconforto respiratório internados em unidade de terapia intensiva / Fisioterapia respiratoria no altera de manera aguda los parámetros fisiológicos o los niveles de dolor en recién nacidos prematuros con síndrome de dificultad respiratoria internados en unidad de cuidados intensivos / Chest physical therapy does not alter acute physiological parameters or pain levels in preterm infants with respiratory distress syndrome in intensive care unit

RESUMO Objetivo: avaliar a ocorrência de alterações fisiológicas adversas agudas e a presença de dor em recém-nascidos prematuros com síndrome do desconforto respiratório internados em uma unidade de terapia intensiva neonatal após a fisioterapia respiratória. Métodos: estudo transversal que avaliou 30 neonatos prematuros em três momentos, sendo eles Momento um (M1), antes da fisioterapia, Momento dois (M2), imediatamente após a fisioterapia, e Momento três (M3), 15 minutos após. Consideraram-se alterações fisiológicas as variações da frequência cardíaca (FC), da frequência respiratória (FR), da saturação periférica de oxigênio (SpO2) e da temperatura corporal. A presença de dor foi avaliada pelas escalas neonatal infant pain scale e neonatal facial coding system. Resultados: houve aumento estatisticamente significativo na FC no M2 quando comparados os três momentos, porém com retorno aos valores basais 15 minutos após a fisioterapia. Outras variáveis fisiológicas (FR, SpO2 e temperatura) e a avaliação da dor não apresentaram alterações significativas. Conclusão: parâmetros fisiológicos e comportamentais permaneceram estáveis após a realização da fisioterapia respiratória, com discretas alterações imediatamente após o procedimento, mas com retorno aos valores basais, indicando que a fisioterapia respiratória não alterou agudamente os sinais vitais e os níveis de dor dos neonatos.

RESUMEN Objetivo: evaluar cambios fisiológicos adversos agudos y la presencia de dolor en bebés prematuros con síndrome de dificultad respiratoria internados en una unidad de cuidados intensivos neonatales después de fisioterapia respiratoria. Métodos: este fue un estudio transversal que evaluó a 30 recién nacidos prematuros en tres momentos: Momento Uno (M1), antes de la fisioterapia, Momento Dos (M2), inmediatamente después de la fisioterapia, y Momento Tres (M3), 15 minutos después. Los cambios fisiológicos incluyeron cambios en la frecuencia cardíaca (FC), en la frecuencia respiratoria (FR), en la saturación periférica de oxígeno (SpO2) y en la temperatura corporal. La presencia de dolor se evaluó mediante la escalas neonatal infant pain scale y neonatal facial coding system. Resultados: hubo un aumento estadísticamente significativo en la FC en el M2, pero con retorno al valor inicial 15 minutos después de la fisioterapia. Otras variables fisiológicas (FR, SpO2 y temperatura) y la evaluación del dolor no presentaron cambios significativos. Conclusión: los parámetros fisiológicos y de comportamiento se mantuvieron estables después de la fisioterapia respiratoria, con ligeros cambios inmediatamente después del procedimiento, pero con retorno a los valores basales, lo que indica que la fisioterapia respiratoria no alteró de manera aguda los signos vitales y los niveles de dolor en los recién nacidos.

ABSTRACT Objective: to evaluate the occurrence of acute adverse physiological alterations and the presence of pain in premature newborns with respiratory distress syndrome in a neonatal intensive care unit after chest physical therapy. Methods: a cross-sectional study evaluating 30 preterm neonates in three moments: Moment one (M1), before physical therapy, Moment two (M2), immediately after physical therapy, and Moment three (M3), 15 minutes after. Physiological alterations were considered as variations in heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and body temperature. The presence of pain was assessed by the scales neonatal infant pain scale and neonatal facial coding system. Results: A statistically significant increase occurred in HR in M2 when comparing the three moments, but with return to baseline values 15 minutes after physical therapy. Other physiological variables (RR, SpO2,and temperature) and pain evaluation did not present significant alterations. Conclusion: physiological and behavioral parameters remained stable after chest physical therapy, with slight alterations immediately after the procedure, but with return to baseline values, indicating that physical therapy has not sharply altered vital signs and pain levels of neonates.

The clinical study of Centaur CP detection of prostate specific antigen / 国际检验医学杂志

Objective To explore the diagnostic value of prostate specific antigen (PSA),compound prostate specific antigen(cPSA),and cPSA / tPSA ratio in prostatic cancer(PCa).Methods Two hundred nineteen people,aged 62-68,were divided into three groups according to the clinical diagnosis,including PCa group(n=73),benign prostatic hyperplasia(BPH) group(n=76) and control group(n=70) composed of healthy people.The various indicators,including tPSA,cPSA and cPSA/tPSA were measured by Advia Centaur CP chemiluminescent analyzer.Results tPSA,cPSA and c/t significantly increased in PCa group compared with those in BPH or control group (P<0.05).ROC analysis indicated that if the tPSA cut-off values was19.89 μg/L,the sensitivity,specificity,the area under the curve (AUC) and Youden index would be 94.5%,97.9%,0.96 and 0.924 respectively.If the cut-off value of cPSA was 13.14 μg/L,the sensitivity,specificity,the area under the curve(AUC) and Youden index would be 95.9%,91.8%,0.98 and 0.877 respectively.The chi-square test showed that there is no correlation between tPSA,cPSA and pathology diagnosis(χ2=102.036、151.409,P<0.05).Conclusion PCa or PCa treatment relapse should be highly suspected when the concentration of tPSA or cPSA in patients reached 19.89 μg/L and 13.14 μg/L,the patients should be reminded for treatment timely.

Distribution of endogenous sulfur dioxide in severe acute pancreatitisrats / 中华急诊医学杂志

Objective The present study is to investigate the distribution of endogenous sulfur dioxide (SO2) in severe acute pancreatitis (SAP) rats.Methods Thirty-two SPF male Sprague-Dawley rats were randomized (random number) into sham operation group,SAP rat 3 h group (SAP 3 h),SAP rat 6 hgroup (SAP6h),SAP rat 12 hgroup (SAP 12 h),n=8 in each group.The SAPmodel rats were induced by retrograde cholangiopancreatic infusion of 5％ sodium taurocholate.Rats were sacrified 3 h,6 h or 12 h after treatment.,then we collected pancrease,liver,lung,kidney and serum.The SO2 concentration in each tissue or serum was detected by enzyme-linked immune sorbentassay.Results The concentration of SO2 in tissues of pancreas (1.72 ± 0.14) μmol/g,liver (1.62 ± 0.11) μmol/g,lung (1.65 ± 0.11) μ.mol/g,kidney (1.12 ± 0.06) μmol/g or serum (16.80 ± 1.27) μmol/g in SAP 3 h rats was not significant compared with the sham operation group (P ＞ 0.05 in each group).The SO2 content in the pancreas (1.89 ± 0.17) μmol/g,liver (1.92 ± 0.16) μmol/g,lung (1.91 ± 0.15) μmol/g,kidney (1.30 ± 0.10) μmol /g and serum (14.93 ± 1.00) μmol /g of SAP 6 h was significantly increased compared with sham operation group (P ＜ 0.05 each group).The content SO2 in the pancreas (2.31 ± 0.23) μmol /g,liver (2.22 ± 0.15) μmol /g,lung (2.17 ± 0.07)μmol /g,kidney (1.55 ± 0.15) μmol /gand serum (18.88 ± 1.56) μmol /g of SAP rats reached the peak 12Hafter treatment and was significantly higher compared with the sham operation group (P ＜ 0.05).Conclusions The increase of SO2 concentration in SAP might be,at least in our present opinion,involved into the pathogenesis of SAP rats.

Clinical significance of pain in patients with chronic heart failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure (CHF) patients. This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain.</p><p><b>METHODS</b>Sociodemographics, serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, and two-dimensional echocardiographic left ventricular ejection fraction (LVEF) were determined in 305 patients with CHF. A questionnaire packet including the Brief Pain Inventory (BPI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess the degree of pain rated on a 0 - 10 scale and the quality of life (QOL). A six-minute walking test was performed during routine clinic visits. Major adverse cardiac events (MACE) were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke at follow-up.</p><p><b>RESULTS</b>Pain occurred in 25.6% of CHF patients, and was more common when the New York Heart Association (NYHA) functional class was worse. More patients with pain were female in gender, and had more co-morbidities, lower LVEF, and shorter distance during the 6-minute walking test. Despite similar serum levels of creatinine, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), IL-6 and IL-10, the TNF-α levels were higher and MLHFQ scores were greater in CHF patients with pain. At follow-up, CHF patients with moderate to severe pain (≥ 4 scale) had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke. Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.</p><p><b>CONCLUSIONS</b>Pain occurs in all stages of the CHF trajectory, and its incidence increases as clinical functional status is worsened. The presence of pain exerts a negative impact on clinical outcome and QOL in patients with CHF.</p>

Impact of potentially lethal ventricular arrhythmias on long-term outcome in patients with chronic heart failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Potentially lethal ventricular arrhythmias (PLVAs) occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases. This study investigated the prevalence and prognostic significance of PLVAs in patients with chronic heart failure (CHF).</p><p><b>METHODS</b>Data concerning demographics, etiology of heart failure, NYHA functional class, biochemical variables, electrocardiographic and echocardiographic findings, and medical treatments were collected by reviewing hospital medical records from 1080 patients with NYHA II-IV and a left ventricular (LV) ejection fraction ≤ 45%. PLVAs were defined as multi-focal ventricular ectopy (> 30 beats/h on Holter monitoring), bursts of ventricular premature beats, and nonsustained ventricular tachycardia. All-cause mortality, sudden death, and rehospitalization due to worsening heart failure, or cardiac transplantation during 5-year follow-up after discharge were recorded.</p><p><b>RESULTS</b>The occurrence rate of PLVAs in CHF was 30.2%, and increased with age; 23.4% in patients < 45 years old, 27.8% in those between 45 - 65 years old, and 33.5% in patients > 65 years old (P = 0.033). Patients with PLVAs had larger LV size and lower ejection fraction (both P < 0.01) and higher all-cause mortality (P = 0.014) during 5-year follow-up than those without PLVAs. Age (OR 1.041, 95%CI 1.004 - 1.079, P = 0.03) and LV end-diastolic dimension (OR 1.068, 95%CI 1.013 - 1.126, P = 0.015) independently predicted the occurrence of PLVAs. And PLVA was an independent factor for all-cause mortality (RR 1.702, 95%CI 1.017 - 2.848, P = 0.031) and sudden death (RR 1.937, 95%CI 1.068 - 3.516, P = 0.030) in patients with CHF.</p><p><b>CONCLUSION</b>PLVAs are common and exert a negative impact on long-term clinical outcome in patients with CHF.</p>

The management of solid-pseudopapillary tumor of the pancreas:a report of 4 cases / 中华内分泌外科杂志

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent.

The role of tissue factor in tumor's invasion and progress in experimental targeted therapy / 国际外科学杂志

Tissue factor(TF)is the most important factor in the physiological coagulation process.TF also plays important roles in tumor growth,angiogenesis,invasion and metastasis by combining with factor VII.In recent years,targeted therapy for the TF has made remarkable progress,showing its significant inhibition of tumor tissue and metastasis.

The Expression and Significance of Myeloperoxidase in Acute Lungs Injury of Severe Acute Pancreatitis Associated Ascetic Fluid / 医学研究杂志

Objective To investigate the expression and significance of myeloperoxidase(MPO) in acute lungs injury of severe acute pancreatitis associated ascetic fluid. Methods Forty-five adult wistar rats were randomly assigned into the group of negative control (group C,n=15),the group of severe acute pancreatitis (group S,n=15) and the group of peritoneal injection (group E,n=15). The group C was cut peritoneum and flipped pancreases softly. In group S,3.5% sodium taurocholate was injected retrograde in pancreatic and bile duct to establish the model of severe acute pancreatitis,and the pancreatic homogenate and ascites of the group S was injected into abdominal cavity of group E rats. After animal model established,rats were killed at 3h,6h and 12h point. The blood of inferior vena cava was sucked for determination of amylase.The inferior lobe of left lung was cut for myeloperoxidase detection.And pathology was regularly done about pancreas and lungs. Results Interstitial edema,hemorrhage and infiltration of neutrophilic granulocyte and macrophage were observed in group S and E. At different time point,the amylase levels of blood and myeloperoxidase of lungs in group S and E were significantly higher than those of group C,and the increasing degree of group E was smaller than group S. Conclusion Acute lung injury can be induced by the severe acute pancreatitis associated ascetic fluid. The expression of myeloperoxidase of lungs was increased to induce acute lungs injury.The reason may be concerned with activation of granulocyte by severe acute pancreatitis associated ascetic fluid.

Research on relationships of gastric cancer with serum trace elements, Helicobacter pylori and COX-2 in gastric tissue / 生物医学工程学杂志

The relationships of gastric cancer with serum trace elements, helicobacter pylori (HP) and COX-2 in gastric tissue were investigated. We took 50 blood samples from the gastric cancer patients in Hexi region (the gastric cancer group), and 50 blood samples from healthy volunteers (control group) and detected the level of trace elements, the rate of HP infection, and the expression of COX-2 in gastric tissue. The results showed the levels of Cu/Zn, Fe in the serum of the gastric cancer group were higher than those of the control group respectively(P < 0.05, 0.01), and the levels of Zn, Mn were lower than those of the control group respectively (P < 0.05, 0.01). The data on Zn were submitted to multi-variate non-conditional logistic analysis. The rate of HP infection and the positive expression of COX-2 were 88% and 78% respectively in the gastric cancer group, 42.0% and 0 in the control group (P < 0.01). These findings suggest that the decrease of Zn in serum may be a precancerous factor of gastric cancer development which induces HP infection and the higher expression of COX-2 and hence may lead to the development of gastric cancer. Detecting the trace elements could conduce to the diagnosis of gastric cancer. Regulating the level of trace element in the patient can be an effective chemoprophylaxis for gastric cancer.

Expression and significance of major histocompatibility complex classⅡgene in multiple organ dysfunction syndrome / 中华创伤杂志

Objective To investigate the expression and significance of major histocompatibility complex classⅡgene in multiple organ dysfunction syndrome.Methods Two-hit porcine model of MODS was duplicated in 18 swine that were randomly assigned into experimental group(Group M,n=9) and control group(Group C,n=9).The Group M was given compound factors including hemorrhagic shock,reperfusion injury and endotoxemia,and the Group C only underwent anesthesia and arterious/ve- nous eannula.After seven days,the animals were killed to remove splenic tissues fro extracting total RNA by Trizol method.The primer of SLA-DQA(MHC classⅡgene of swine)was designed to construct cD- NA by reverse transcription and the quantity of SLA-DQA mRNA detected with real time fluorescent quan- titative polymerase chain reaction(real time FQ-PCR).The standard curve was described by UVP com- puter image analysis system.Results The mortality of Group M was 78%(7/9),and the incidence rate of MODS was 89%(8/9).The expressing quantity of Group M was(1.376?1.006)?10~3,signifi- cantly lower than(5.330?3.053)?10~3 of Group C(P＜0.01).Conclusion Duplication of por- cine MODS model is satisfactory.Down-regulation of MHC classⅡgene may be due to control of classⅡtransactivator(CⅡTA)and release of multiple eytokine,such as TNF-?and IL-10.

Clinical study of acute pancreatitis by Ulinastatin / 临床外科杂志

Objective In order to evaluate the curative effects and mechanism of Ulinastatin on acute pancreatitis(AP). Methods 40 patients with AP were enrolled in this prospective study. They were comparable in dispearing time of symptoms and physical signs and laboratory data. Results The symptoms and physical signs of patients were significantly relieved in Ulinastatin group,and the labrotory data,such as the blood amylase and urine amylase recovered normal after five days with Ulinaststin. Conclution Ulinaststin has good clinical value in AP.

Changes of Th1/Th2 balance in multiple organ dysfunction syndrome / 第二军医大学学报

Objective:To explore the pathogenesis of multiple organ dysfunction syndrome(MODS)with respect to the bal- ance of Th1/Th2.Methods:Eighteen healthy male minipigs,weighing 22-30 kg,were randomly divided into two groups: MODS group and control group.Double-hit method including hemorrhagic shock and endotoxiemia was used to establish the porcine MODS model.The peripheral vein blood samples were collected at different time-points(before bloodletting,before en- dotoxin injection,1 h,24 h,48 h and 72 h after endotoxin injection)in the two groups.The spleen samples were collected after death of the animals.Plasma levels of IFN-?and IL-4 were detected by enzyme-linked immunosorbent assay(ELISA).Real- time PCR was used to detect the expression of IFN-?,IL-4,T-bet and GATA-3 mRNA(The latter 2 were the key transcription factors associated with Th1/Th2 response)in the spleen samples.Results:The plasma levels of IFN-?and IL-4 quickly reached the peak values 1 h after the endotoxin injection,then the level of IFN-?decreased quickly.The ratio of IFN-?/IL-4 was signifi- cantly lower than the baseline value 72 h after endotoxin injection(P=0.000).The ratio of IFN-?/IL-4 mRNA in MODS group was obviously lower than that in the control group(P=0.020);the ratio of T-bet/GATA-3 was also lower in MODS group (P=0.038).Conclusion:The shift from Th1 to Th2 occurs in the progress of MODS.