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Objective To evaluate the research of Recombinant Human Tumor Necrosis Factor-αReceptorⅡ:IgG Fc Fusion Protein for Injection in the treatment of patients with ankylosing spondylitis in serum ESR and CRP.Methods 48 cases of patients with ankylosing spondylitis from October 2013 to October 2015 in our hospitol were randomly divided into the control group and treatment group , 24 cases in each group.The control group was treated with sulfasalazine enteric-coated Tablets orally, 1.0 g/time,bid;the experimental group was treated with rhTNFR:Fc for subcutaneous injection, 25 mg/time, two times/week.erythrocyte sedimentation rate (ESR), serum C reactive protein (CRP) level, efficiency of treatment and safety of two groups were compared before and after treatment.Results After treatment, compared with the control group, the ESR and the serum level of CRP were lower in the experimental group (P<0.05); the treatment efficiency of the experimental group 95.84% was significantly higher than that of the control group 75.00% (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion The rhTNFR:Fc can significantly reduce the ESR and the serum level of CRP in patients with ankylosing spondylitis, improve clinical symptoms,the clinical efficacy and safety were high.
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ObjectiveTo investigate the effect of factors correlated with trauma emergency care system on the length of ICU stay and figure out independent risk factors of prolonged ICU stay. Methods A total of 1 361 trauma patients admitted to the ICU of five tertiary hospitals in Zhejiang province in 2009 were retrospectively studied.Demographic data,time of ICU stay and variables related to trauma care were collected.Logistic regression was performed to determine the independent risk factors of prolonged ICU stay ( ≥ 15 days). ResultsOverall,192 trauma patients ( 14.1％ ) had a prolonged ICU stay ( ≥15 days).Single factor analysis indicated that ISS≥ 16 points,GCS≤7 points,blunt trauma,prehospital emergency care,length of emergency department stay ≥4 hours,mechanical ventilation and central venous pressure monitoring were associated with the prolonged ICU stay.Multivariate analysis showed that pre-hospital emergency care was a protective factor for the prolonged ICU stay( ≥ 15 days) and that mechanical ventilation,length of emergency room stay≥4 hours and ISS≥ 16 points were the independent risk factors for the prolonged ICU stay ( ≥ 15 days).Conclusions Pre-hospital emergency care and ICU care show significant influence on the length of ICU stay.Furthermore,shortened length of emergency department stay is also contributive to reduced length of ICU stay.
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ObjectiveTo evaluate the trauma care effect and the value of trauma and injury severity score (TRISS) in prediction of the mortality by using TRISS to calculate the survival probability of trauma patients in five hospitals from Zhejiang province in 2009.MethodsA retrospective study was done on trauma patients (study group) firstly admitted to Emergency Department of five hospitals from Zhejiang province in 2009.The relevant information was collected,including demographic data,trauma types and injury causes.The TRISS score was obtained through calculating injury severity score (ISS) and revised trauma score (RTS) on admission into emergency department.With the major trauma outcome study (MTOS) as control group,M value,standardized Ws value and 95％ confidence interval (CI) were calculated to compare actual survival rate and anticipation survival rate.ResultsA total of 2 193 patients at mean age of 44.39 years were enrolled in the study,including 1 661 male patients (75.74％).Traffic accident injury was the most common,followed by fall injury.The mortality rate according to TRISS was 13.22％,but the actual mortality rate was 9.75％.For all the patients,M =0.80 indicated that the injury severity of the study group was significantly different from that of the control group.At the same time,Ws =2.15,95％ CI for Ws:1.54-2.77 showed that the actual survival rate of the study group was significantly higher than that of the control group.Besides,the survival rate of trauma patients in the affiliated hospitals and three hospitals at class A grade was significantly higher fian that of the control group,but there was no significant difference between three hospitals at class B grade and control group. ConclusionsTRISS overestimates the mortality of the study group,which is probably associated with the rapid development of traumatology and the old coefficients of TRISS.Setting up local trauma database and renewing coefficients of TRISS may improve the ability of TRISS in predicting mortality of the trauma patients.
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Objective To determine risk factors in nosocomial infection of trauma patients during intensive care unit stay. Methods A retrospective study was carried out. A total of 1103 trauma patients admitted to the intensive care unit of five tertiary hospitals in Zhejiang Province in 2009 were reviewed. Demographic data, injury severity score and other variables related to the trauma services were collected. Univariate and multivariate analysis were processed to identify the independent risk factors of nosocomial infection in trauma patients during stay in intensive care unit. Results Overall, 171 patients( 15.5% )developed nosocomial infection during ICU stay. Of 1103 patients, 157 patients (14.2% ) died, and the 59 fatal patients were from infection group. The mortality rate in infection group was 34.7% , which was significantly higher than that in non - infection group (10.5% ). The independent risk factors of nosocomial infection in all the patients determined by using multivariate analysis included central venous monitoring, mechanical ventilation, age ≥65, the length of ICU stay > 14 days and injury severity score ≥ 16. For the severe trauma patients, central venous monitoring, mechanical ventilation, the length of ICU stay > 14 days were independent risk factors of nonsocomial infection. Conclusions The severity of injury, age, the length of ICU stay and invasive procedures were related to the nosocomial infection. To standardize the invasive procedures and to reduce the length of ICU stay may decrease the infection rate of trauma patients.
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Objective To explore risk factors in the mortality of casualties and to find a way to improve trauma emergency service. Method The possible factors likely related to the mortality of casualties were taken into account based on each stage of trauma emergency so as to find the independent risk factors by using univariate and multivariate analyses. Results A total of 3 659 casualties were enrolled in this study.Of them, 226 casualties died and the mortality rate was 6.18%. Following factors were related to mortality after univariate analysis: age, cause of trauma, injury severity score, Glasgow come scale come on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU and mechanical ventilation in ICU. After multivariate analysis, six factors were independently related to the mortality of casualties as follows: Glasgow coma scale, injury severity score, mechanical ventilation, blood pressure at admission, age and professional emergency treatment on the scene. Conclusions It has a great significance to investigate the risk factors of mortality for casualties. Severity of trauma and age were independently associated with the outcomes of trauma. Besides, improving prehospital care and stabilizing the trauma patients in early phase can further decrease the mortality.
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Objective To identify the potential risk factors affecting mortality rate of ALl in severe trauma population. Method It was a retrospective cohort study treating trauma as a single cause for emergency depart-ment (ED)) and emergency intensive care unit (EICU) admissions. Eighteen potential risk factors affecting the mortality of ALI were examined by univariate and multivariate logistic analyses in these severe trauma patients. Re-sults There were 343 severe trauma patients with post-traumatic ALI admitted to ED and EICU the Second Affili-ated Hospital Medical College,Zhejiang University,during the study period. The five risk factors that affected the mortality with unadjusted odd ratios (ORs) and 95% confidence intervals (CIs) were (1) APACHE Ⅱ score, (2)duration of trauma, (3) age, (4) aspiration of gastric contents, and (5) DIC. Specific risk factors also affected different patients subpepulations at different degrees. Conclusions Factors of APACHE Ⅱ score and aspiration of gastric contents that can predict the mortality of ALl may exist in the early stage of trauma. Duration of trauma and DIC that greatly affect the short- and long-term development of ALI deserve special attention. Elderly patients (aged beyond 65 years) are the independent risk factor for the secondary sepsis and deterioration of pulmonary function. Patients with these risk factors need aggressive supportive care as early as possible in order to prevent fur-ther aggravation.
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Objective To retrospectively demonstrate risk factors for mortality in multiple trauma patients with acute respiratory distress syndrome(ARDS).Method This wes a retrospective cohort stuay regarding multi-ple trauma as a single cause for intensive care unit admission.Patients identified multiple trauma with ARDS en-rolled in prospectively maintained database between May 2003 and April 2008 were observed,and 23 items of po-tential risk factors of impacting mortality were calculated by univariate and multivariate logistic analyses in order to find distinctive items in these multiple trauma patients.Information on patients demographics characteristics,treat-ment procedures and injury severity were collected at the time of EICU admission.The criteria used for ARDS met definition of the guideline(2006)of Chinese medical association.The commonly accepted definition of multiple injuries was consistent with both several injury sites(generated from two or more than two anatomic sites)and in-jury in one anatomic site at least threatening life.Severity of injury was quantified by injury severity seore and the simplified acute physiology score and chronic health evaluation score (APACHE Ⅱ)in EICU admission.We in-cluded adult patients(age≥18 years),those with an EICU length of stay longer than 48 hours,and those accept-ing mechanical ventilation more than 24 hours.Patients who were readmitted to EICU by virtue of non-traffic injury or transferred to EICU from other hospitals after long-term treatment were excluded.Mortality was assessed at the 28th clay after trauma.Results There were 269 multiple trauma patients with posttranmatic ARDS admitted to ICU during the study period,the unadjusted odds ratio(OR)and 95% confidence intervals(CI)of mortality were associated with six risk factors(APACHE Ⅱ score,duration of tratuna factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation)out of 23 items.The adjusted Odds Ratios(ORs) with 95% CI were denoted with respect to surviving beyond 96 hours ICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 ICU admission(duration of trauma factor,scpsis,duration of mechanical ventilation)and mechanical ventilation beyond 7 days ICU admission(dura-tion of trauma factor and sepsis).Conclusions Impact of pulmonary contusion and APACHE Ⅱ score contribut-ing to prediction of mortality may exist in prophase after multiple trauma.Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome,infection,and secondary multiple organs dysthnetion.Aspiration of gastric contents could lead to incremental mortality due to scvere ventilation associated pneumonia.Duration of trauma factor determined degree of injury and outcomes,longer duration generally manifested higher mortality.Long-standing mechanical ventilation should be constrained on account of occurring severe refractory complications.
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Objective To evalhate the protective effect of oral raloxifene on lung function after acute lung injury (ALI) in rats. Methods Thirty male adult Sprague-Dawley rats were used and divided into three groups: LPS raloxifene hydrochloric acid. group before secondary impact ( Group A, n = 10 ), LPS raloxifene hydrochloric acid group after secondary impact ( Group B, n = 10) and control group ( n = 10). All the rats were injected intraperitoneally with 5 mg/kg LPS. Raloxifene (30 mg/kg) was orally administered one hour before LPS injection and 14 hours after LPS injection in Groups A and B. The con-trol group remained free. All the animals were anesthetized by intraperitoneal injection of pentobarbital so-dium at 40 mg/kg and the femoral artery was cannulated 16 hours after LPS injection to measure the mean arterial pressure (MAP). All the rats received a direct intratracheal injection of hydrochloric acid ( pH = 1.2, 0.5 ml/kg). Before injection of hydrochloric acid and at 0. 5,1.5 and 4 hours after injection of hy-drochloric acid, the blood gas was measured. Fifteen rats ( five from each group) underwent a micro posi-tron emission tomography ( [18F] FDG microPET) scan of the thorax four hours after hydrochloric acid in-stillation. Then, the lung tissue was collected for histopathological examination. Results The Group B showed better pulmonary gas exchange and more stable MAP compared to the control group. The [18F] fluorodeoxyglueose uptake and histological lung injury score were 9. 01 ± 1.58 and 12.6 ± 0.97 respec-tively in Group B, which were higher than 4. 67 ± 1.33 and 9. 01 ± 1.58 respectively in control group (P < 0. 01 ). Conclusions Raloxifene exerts significant protective effect on lung function after ALI. [18F] FDG microPET is a useful method to evaluate the inflammatory reaction during ALI.
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AIM:To evaluate the relationship between RUNX3,cyclin E,P21,biological features and survival in gastric cancer patients.METHODS:RUNX3 was examined using immunohistochemical staining.Cyclin E and P21 were analyzed by flow cytometry.Survival was evaluated by Kaplan-Meier survival curves.RESULTS:The positive-expression rate of RUNX3,cyclin E and P21 in tumor tissue from 56 patients with gastric cancer were 44.6%,64.3% and 32.1%,respectively.RUNX3 expression was correlated with lymph node metastasis and distant metastasis(P0.05).Using Kaplan-Meier survival curves and the Log-rank test,there was correlation between RUNX3,cyclin E and survival(P0.05).CONCLUSION:RUNX3 may be related with tumorigenesis and tumor progression by affecting P21 expression.The detection of RUNX3 and cyclin E may be helpful in evaluating the clinicopathological parameters and prognosis in gastric carcinoma patients.