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Objective@#To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6±6.5)kg/m2]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded.@*Results@#A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97% (65/67)], slightly higher than that of the left group [94%(15/16)] , but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complication incidences were as follows: hematoma or arterial injury [5%(4/83)], pneumothorax 2%(2/83), catheter-related thrombosis [12%(10/83)], and catheter ectopia [1%(1/83)]. No catheter-related infection was observed. Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury: 6% vs. 4%, pneumothorax: 0% vs. 3%; catheter ectopic: 0% vs. 1%; catheter-related thrombosis: 13% vs. 12%), and the difference was not statistically significant (P>0.05). The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury: 3% vs. 6%; pneumothorax: 3% vs. 2%; catheter ectopic: 0% vs. 2%; catheter-related thrombosis: 17% vs. 9%), and the difference was not statistically significant (P>0.05).@*Conclusions@#Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients. It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture. However, there still exists a high risk of catheter-related thrombosis, requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
ABSTRACT
Objective To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.Methods A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018.There were 48 males and 35 females,aged 21-84 years [(56.5 ±14.3)years].The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6 ± 6.5)kg/m2].There were 26 patients with mainly craniocerebral injury,15 with mainly thoracic injury,28 with mainly abdominal injury,eight with mainly spinal injury and six with mainly pelvic fracture.The injury severity score (ISS) ranged from 24 to 66 points [(41.8 ± 18.1)points].All the patients received the axillary CVC based on Nickalls' landmarks.The left axillary vein was used as the puncture vein in 16 patients (left group),and the right axillary vein was used as the puncture vein in 67 patients (right group).A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group),while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group).The success rate of catheterization,pneumothorax,hematoma or artery injury,catheter ectopia,catheter-related infection and catheter-related thrombosis were recorded.Results A total of 80 patients were successfully intubated,with a success rate of 96％.Subgroup analysis showed that the success rate of right group was [97％ (65/67)],slightly higher than that of the left group [94％ (15/16)],but the difference was not statistically significant (P ＞ 0.05).And the success rate of adjacent fracture group [94％ (34/36)] was similar to that of non-adjacent fracture group [98％ (46/47)],and the difference was not statistically significant (P ＞ 0.05).Complication incidences were as follows:hematoma or arterial injury [5％ (4/83)],pneumothorax 2％ (2/83),catheter-related thrombosis [12％ (10/83)],and catheter ectopia [1％ (1/83)].No catheterrelated infection was observed.Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury:6％ vs.4％,pneumothorax:0％ vs.3％;catheter ectopic:0％ vs.1％;catheter-related thrombosis:13％ vs.12％),and the difference was not statistically significant (P ＞ 0.05).The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury:3％ vs.6％;pneumothorax:3％ vs.2％;catheter ectopic:0％ vs.2％;catheter-related thrombosis:17％ vs.9％),and the difference was not statistically.significant (P ＞ 0.05).Conclusions Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients.It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture.However,there still exists a high risk of catheterrelated thrombosis,requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
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The inhibitory effects of diallyl sulfide (DAS) derived from allicin on in vitro and in vivo proliferation of human osteosarcoma MG-63 cells and the action mechanism, and the influence of DAS on invasive capability of MG-63 cells were investigated in order to search for the novel medicines for osteosarcoma. In the in vitro experiment, MG-63 cells were treated with different concentrations of DSA, and the morphological changes of MG-63 cells were observed under an inverted phase microscope. MTT method was used to assay the proliferation of MG-63 cells. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the VEGF mRNA expression level in MG-63 cells. By using Transwell invasion assay, the influence of DAS on invasive ability of MG-63 cells was tested. In the in vivo experiment, the nude mice MG-63 cells tumor-bearing model was established, and different concentrations of DAS were injected beside the tumor. Twenty-one days after treatment, the mice were killed, the tumor size and tumor inhibition rate were calculated. The microvessel density (MVD) was determined by using immunohistochemistry. In the in vitro experiment, different concentrations of DAS could obviously inhibit proliferation of MG-63 cells in a time- and concentration-dependent manner. RT-PCR revealed that the expression levels of VEGF mRNA in DSA groups (different concentrations) were significant reduced as compared with those in control group (all P<0.05). Transwell invasion assay indicated that in 20 and 40 μg/mL DAS groups, the number of migratory cells was 91.4±8.3 and 81.8±7.4 respectively, which was significantly declined as compared with that in control group (150.4±14.7, both P<0.05). In the in vivo experiment, DAS could significantly suppress the growth of MG-63 tumor-bearing tissue. Immunohistochemistry demonstrated that different concentrations (20 and 40 μg/mL) of DAS could significantly decrease MVD of MG-63 tumor-bearing tissue (all P<0.05). It was suggested that DAS could inhibit the growth of MG-63 cells probably by suppressing the expression of VEGF mRNA.
ABSTRACT
The inhibitory effects of diallyl sulfide (DAS) derived from allicin on in vitro and in vivo proliferation of human osteosarcoma MG-63 cells and the action mechanism, and the influence of DAS on invasive capability of MG-63 cells were investigated in order to search for the novel medicines for osteosarcoma. In the in vitro experiment, MG-63 cells were treated with different concentrations of DSA, and the morphological changes of MG-63 cells were observed under an inverted phase microscope. MTT method was used to assay the proliferation of MG-63 cells. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the VEGF mRNA expression level in MG-63 cells. By using Transwell invasion assay, the influence of DAS on invasive ability of MG-63 cells was tested. In the in vivo experiment, the nude mice MG-63 cells tumor-bearing model was established, and different concentrations of DAS were injected beside the tumor. Twenty-one days after treatment, the mice were killed, the tumor size and tumor inhibition rate were calculated. The microvessel density (MVD) was determined by using immunohistochemistry. In the in vitro experiment, different concentrations of DAS could obviously inhibit proliferation of MG-63 cells in a time- and concentration-dependent manner. RT-PCR revealed that the expression levels of VEGF mRNA in DSA groups (different concentrations) were significant reduced as compared with those in control group (all P<0.05). Transwell invasion assay indicated that in 20 and 40 μg/mL DAS groups, the number of migratory cells was 91.4±8.3 and 81.8±7.4 respectively, which was significantly declined as compared with that in control group (150.4±14.7, both P<0.05). In the in vivo experiment, DAS could significantly suppress the growth of MG-63 tumor-bearing tissue. Immunohistochemistry demonstrated that different concentrations (20 and 40 μg/mL) of DAS could significantly decrease MVD of MG-63 tumor-bearing tissue (all P<0.05). It was suggested that DAS could inhibit the growth of MG-63 cells probably by suppressing the expression of VEGF mRNA.
Subject(s)
Humans , Allyl Compounds , Pharmacology , Cell Line, Tumor , Cell Proliferation , Neoplasm Invasiveness , Osteosarcoma , Drug Therapy , Sulfides , PharmacologyABSTRACT
This study examined the effects of ω-3 polyunsaturated fatty acid (ω-3PUFA) on the expression of toll-like receptor 2 (TLR2), toll-like receptor 4 (TLR4) and some related inflammatory factors in peripheral blood mononuclear cells (PBMCs) of patients with early-stage severe multiple trauma. Thirty-two patients who were admitted to the Department of Traumatic Surgery, Tongji Hospital (Wuhan, China) between May 2010 and November 2010, and diagnosed as having severe multiple trauma with a injury severity score (ISS) no less than 16, were enrolled in the study and divided into two groups at random (n=16 in each): ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days. Peripheral blood from these patients was collected within 2 h of admission (day 0), and 1, 3, 5 and 7 days after the nutritional support. PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively, the levels of NF-κB by quantum dots-based immunofluorescence assay, the levels of TNF-α, IL-2, IL-6 and COX-2 by ELISA, respectively. The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support (both P<0.05). The levels of TNF-α, IL-2, IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day (P<0.05 for all). It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2, TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma, which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.
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OBJECTIVE: To summarize the achievements of technique of tissue engineered tendon transplant on the basis of recent development of materials of tendon transplant at home and aboard.DATA SOURCES: A computer-based online search of Medline database was undertaken to identify articles about materials of tendon transplant and technique of tissue engineered tendon transplant published in English from January 1980 to January 2005, and the keywords were "tendon transplant, tissue engineer, progress". Meanwhile, Chinese relevant articles published between January 1990 and January 2005 were reviewed in CBM database with the keywords of "tendon transplant, tissue engineer, summarization" in Chinese.STUDY SELECTION: Relevant literatures about materials of tendon transplant and technique of tissue engineered tendon transplant were retrieved firstly, and the full-tests were further searched. Those about the materials of tendon transplant and technique of tissue engineered tendon transplant were selected; however, the reviews, repetitive studies and Meta analytic ones were excluded.DATA EXTRACTION: Among 45 articles, 30 ones about materials of tendon transplant and technique of tissue engineered tendon transplant met the required criteria.DATA SYNTHESIS: Main materials of tendon transplant are as follows: autologous tendon, allogeneic tendon, artificial tendon and tissue engineered tendon. Recently, studies on allogeneic tendon are more and more favorable. In late 1980s, establishment and development of tissue engineering bring a new way for repairing deficiency of tendon tissue.Studies on tissue engineered tendon are designed to transplant made-up tendon in vitro to deficient site of tendon in vitro in order to recover articular function. At present, we devote ourselves to study cytoskeleton which is characterized by virtues of both two materials. Combination with tendon cells in vitro can produce a nonvolatile and active tissue engineered tendon.CONCLUSION: Main materials of tendon transplant are as follows: autologous tendon, allogeneic tendon, artificial tendon and tissue engineered tendon. Further application of seed cells and extracellular matrix (ECM) will develop the research in tissue engineered tendon.
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BACKGROUND:Studies confirm that electromagnetic field (EMF) can promote the synthesis and secretion of many bone growth factors,and some growth factors can induce the osteoblastic directional differentiation of bone marrow mesenchymal stem cells (MSCs).OBJECTIVE: To investigate the effect of power-frequency EMF on mRNA expressions of bone morphogenetic protein-2 (BMP-2) and transforming growth factor-beta 1 (TGF-β1) in mouse bone marrow MSCs cultured in vitro.DESTGN: Single sample, block design, observation and controlled animal trial.SETTING: Department of Traumatic Surgery, Tongji Hospital Affiliated to Tongji Medical .College, Huazhong University of Science and Technology.MATERIALS: This trial was carried out in the laboratory of Department of Traumatic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology during February to December 2005. ①Twenty Kunming mice of clean grade were selected for harvest of bone marrow MSCs. ②Magnetic field generator,which could generate EMF with 0 to 100 mT field strength and successive adjustable 50 Hz sinusoidal wave, was developed by Wuhan Naval University of Engineering. ③ Primer was all synthesized by Saibaisheng Bioengineering Co.,Ltd., Beijing.NETHODS: ① The involved mice were sacrificed by cervical dislocation. Bilateral femora and tibia were harvested. Bone marrow MSCs were isolated and cultured in vitro, and the second generation of cells were used for the trial. ②Different intensities of EMF stimulation tests: Negative control group, positive control group, EMF 0.4, 0.8 and 1.6 mT stimulation groups were set. Five bottles of cells of the second generation were chosen from each group for test. The cells in the negative control group and positive control group were not exposed to EMF. But medium containing osteogenic inductor(10-8 mol/L dexamethasone, 10 mmol/L β-sodium glycerophosphate and 50 mg/L Vitamin C included) was added in the positive control group at passage. After adhering to the wall, the cells in the EMF 0.4,0.8 and 1.6 mT stimulation groups were exposed to EMF of 0.4,0.8 and 1.6 mT field strength, respectively, one hour per day, five days later, they were detected.③ EMF stimulation tests in the same field strength and different time: Negative control group, EMF 1.6 mT stimulation 15,30 and 60 minutes groups were set.Five bottles of cells of the second generation were chosen from each group for test. The cells in the negative control group were exposed to EMF. The cells in the EMF 1.6 mT stimulation 15,30 and 60 minutes groups were respectively given 15,30 and 60 minutes of EMF stimulation at 1.6 mT successively.Five days later, they were detected.④ The mRNA expressions of BMP-2 and TGF-β1 were detected in each group by reverse-transcriptase polymerase chain reaction (RT-PCR) technique.MAIN OUTCOME MEASURES: ① The effect of different field strength of exposure of 50 Hz EMF on mRNA expressions of BMP-2 and TGF-β1. ② The effect of the same field strength and different time of exposure of 50 Hz EMF on mRNA expressions of BMP-2 and TGF-β1.RESULTS: ①Five days after EMF stimulation, the mRNA expressions of BMP-2 and TGF-β1 in the positive control group and EMF 0.4,0.8 and 1.6 mT stimulation groups were significantly enhanced as compared with negative control group (all P ＜ 0.01), and the mRNA expression of BMP-2 in the EMF 1.6 mT stimulation group reached the peak [(57.74±0.23)％]and mRNA expression of TGF-β1 in the EMF 0.4 mT stimulation group also reached the peak [(126.20±0.21 )％].② Five days after EMF stimulation, the mRNA expressions of BMP-2 and TGF-β1 in the EMF 1.6 mT stimulation 15,30 and 60minutes groups were significantly enhanced (all P ＜ 0.01) as compared with negative control group, and the mRNA expressions of two factors in the EMF 1.6 mT stimulation 60 minutes group reached peak separately [(28.06±0.11 )％ and (75.20±0.16)％].CONCLUSION:Proper intensity and action time of exposure of power-frequency EMF can obviously promote the mRNA expressions of BMP-2 and TGF-β1 in mouse bone marrow MSCs cultured in vitro.