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 significance of RYBP expression in primary hepatocellular carcinoma / 中南大学学报(医学版)

To explore the clinical significance of the altered expression of polycomb group (PcG)-associated protein RYBP in hepatocellular carcinoma (HCC) specimens.
 Methods: The expression levels of RYBP in tumor tissues and adjacent normal tissues in 77 HCC cases were detected by immunohistochemistry (IHC), and the relationships between RYBP expression levels and HCC clinicopathological characteristics, five-year survival rates or prognosis of HCC patients were analyzed.
 Results: RYBP expression level was significantly decreased in HCC tumor tissues than that in the adjacent normal tissues (P<0.05). The expression levels of RYBP in HCC specimens were highly correlated with HBsAg, ALT, GGT, Type III procollagen, tumor size, distant metastasis, and tumor differentiation (P<0.05). The RFS and OS for patients with RYBP-low expression were markedly lower than those with RYPB-high expression (P<0.05). Both age and RYBP expression level were protective factors for RFS, while GGT, lymph node metastasis, TNM stage, tumor differentiation and tumor size were risk factors for RFS (P<0.05). As to OS, RYBP expression level was a protective factor, while tumor number, ALT, GGT, AFP, pCEA, lymph node metastasis, TNM stage, tumor differentiation and tumor size were risk factors (P<0.05). The age, GGT, lymph node metastasis and TNM stage were independent prognostic factors for RFS (P<0.05), and both lymph node metastasis and TNM stage were independent risk factors for OS (P<0.05). Comparing to serum alpha fetoprotein (AFP) level, RYBP expression level in tumor tissues was applied to predict the prognosis of HCC patients more accurately.
 Conclusion: PcG associated protein RYBP displays a reduced expression in HCC tissues, which is related to poor prognosis of HCC patients. It might be a promising therapeutic target for HCC treatment.

YAF2 promotes tumor cell proliferation via targeting cyclin D1 expression / 基础医学与临床

Objective To explore the molecular mechanism by which YY1 associated factor 2(YAF2) up-regulates cyclin D1 expression in tumor cells as well as the effect of YAF2-cyclin D1 regulatory loop on tumor cell prolifera-tion. Methods Overexpression and knockdown experiments combined with Western blot and real-time quantitative PCR were used to detect the expression of YAF2 and cyclin D1;Dual luciferase reporter assay was performed to in-vestigate the effect of YAF2 on cyclin D1 promoter activity;Flow cytometry analysis was carried out to elucidate the effect of YAF2 on cell cycle progression through targeting cyclin D1;Colony formation assay was employed to deter-mine cell proliferation under different YAF2 and cyclin D1 expression level. Results YAF2 upregulated the ex-pression of cyclin D1 at both the mRNA(P<0.05) and protein level;YAF2 activated the promoter activity of cyc-lin D1 (P<0.05);YAF2 silencing increased significantly the proportion of cells in G0/G1phase(P<0.0001) and reduced the proportion of cells in S phase by regulating cyclin D1 (P<0.002); YAF2 facilitated the cell colony formation via targeting cyclin D1(P<0.05). Conclusions In tumor cells,YAF2 promotes the expression of cyclin D1,and enhances cell cycle progression and cell proliferation.

Therapeutic Observation of Acupuncture at Baihui (GV20) in Improving Executive Dysfunction After Cerebral Stroke / 上海针灸杂志

Objective To observe the therapeutic efficacy of acupuncture at Baihui (GV20) in treating post-stroke executive dysfunction.Method Fifty-six eligible patients with post-stroke executive dysfunction were randomized into a treatment group (30 cases) and a control group (26 cases). The treatment group was intervened by acupuncture at Baihui and the control group was intervened by ordinary acupuncture. Before and after the intervention, the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Trail Making Test (TMT) were adopted to evaluate the executive function, and Modified Barthel Index (MBI) was used to estimate the activities of daily living (ADL).Result Before the intervention, there were no significant differences in comparing the BADS, TMT and MBI scores between the two groups (P>0.05); after the treatment, each scale was improved significantly in both groups (P<0.05). The scores of Rule Shift Cards Test (RSCT), Key Search Test (KST), Temporal Judgment Test (TJT), Zoo Map Test (ZMT) and total point of BADS, TMT-A and MBI scores in the treatment group were superior to those in the control group (P<0.05).Conclusion Acupuncture at Baihui works effectively in improving the executive function of cerebral stroke patients.

Spatio-temporal variations of origin,distribution and diffusion of Oncome-lania hupensis in Yangtze River Basin / 中国血吸虫病防治杂志

As the only intermediate host of Schistosoma japonicum,Oncomelania hupensis in China is mainly distributed in the Yangtze River Basin. The origin of the O. hupensis and the spatio-temporal variations of its distribution and diffusion in the Yangtze River Basin and the influencing factors,as well as significances in schistosomiasis elimination in China are reviewed in this paper.

Therapeutic Observation of Acupuncture at Baihui (GV20) in Improving Executive Dysfunction After Cerebral Stroke / 上海针灸杂志

Objective To observe the therapeutic efficacy of acupuncture at Baihui (GV20) in treating post-stroke executive dysfunction.Method Fifty-six eligible patients with post-stroke executive dysfunction were randomized into a treatment group (30 cases) and a control group (26 cases). The treatment group was intervened by acupuncture at Baihui and the control group was intervened by ordinary acupuncture. Before and after the intervention, the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Trail Making Test (TMT) were adopted to evaluate the executive function, and Modified Barthel Index (MBI) was used to estimate the activities of daily living (ADL).Result Before the intervention, there were no significant differences in comparing the BADS, TMT and MBI scores between the two groups (P>0.05); after the treatment, each scale was improved significantly in both groups (P<0.05). The scores of Rule Shift Cards Test (RSCT), Key Search Test (KST), Temporal Judgment Test (TJT), Zoo Map Test (ZMT) and total point of BADS, TMT-A and MBI scores in the treatment group were superior to those in the control group (P<0.05).Conclusion Acupuncture at Baihui works effectively in improving the executive function of cerebral stroke patients.

Cloning and characterization of a novel mouse aging-related gene Arzc / 中国医学科学院学报

<p><b>OBJECTIVE</b>To clone and identify novel mouse aging-related genes.</p><p><b>METHODS</b>The improved differential display reverse transcription-polymerase chain reaction method was used to analyze the differential expression of old and young BALB/C mouse cortex tissues. The novel expression sequence targets (EST) with differential expression were further confirmed by Northern blot and used as original sequence to clone the full-length cDNA sequence by bioinformatics technique. The reverse transcription products of BALB/C mouse cortex total RNA was used as the amplification template.</p><p><b>RESULTS</b>A total of 42 differentially expressed EST were obtained. Homologic analysis showed that 29 EST represented known cDNAs and 13 were probably new EST. One of the EST, which were confirmed to have down regulative expression in the old mouse cortex tissues by Northern blot analysis, was used to obtain the full-length cDNA sequences from reverse transcription products of total RNA of BALB/C mice cortex by bioinformation method. A 1 382 bp of cDNA sequence including the EST was obtained and designed as Arzc (GenBank accession number: AY344585). The Arzc cDNA contains an open reading frame of 261 bp and encodes a peptide of 86 amino acids residuals. FASTA analysis showed that the deduced peptide had a homology with a portion of integrase/recombinase, a member of a phage integrase family.</p><p><b>CONCLUSION</b>A novel mouse gene that is probably related to aging was identified and cloned.</p>

Association between Alzheimer's disease and nitric oxide synthase III polymorphism / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the association between Alzheimer's disease (AD) and nitric oxide synthase (NOS) III in Chinese Han population.</p><p><b>METHODS</b>Seventy-five AD and 68 normal controls were genotyped for NOS III G894T polymorphism. Genotyping was carried out by PCR-RFLP methods.</p><p><b>RESULTS</b>There were two genotypes of NOS III, GG and GT, in either AD patients or normal controls. The frequencies of these two genotypes were 78.7% and 21.3% in AD patients and 82.4% and 17.6% in normal controls, respectively. No association was found between AD and NOS III genotype (P > 0.05). There were two alleles, G and T, in AD patients and normal controls. The frequencies of these two alleles were 89.3% and 10.7% in AD patients and 91.2% and 8.8% in normal controls, respectively, indicating that there was no association between AD and NOS III allels (P > 0.05).</p><p><b>CONCLUSIONS</b>There was no association between AD and NOS III G894T polymorphism in Chinese Han population.</p>

Identification and analysis of expressed sequence tags related to K562 cells into erythroid differentiation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To isolate expressed sequence tags (ESTs) related to K562 cells erythroid differentiation.</p><p><b>METHODS</b>Modified differential display reverse transcription polymerase chain reaction (DDRT-PCR) method was applied to identify differential ESTs in uninduced and induced K562 cells by HEMIN for 36 hours. Remarkable differential ESTs were firstly selected for cloning, sequencing and bioinformational analyzing. Several ESTs representing new sequence or providing functional clue were selected for Northern blot analysis.</p><p><b>RESULTS</b>Sixty differentially expressed cDNA fragments related to K562 cells inducted into erythroid differentiation by HEMIN were obtained. Among them, 38 were upregulated and 22 downregulated. Among the 40 differential ESTs selected for cloning, sequencing and bioinformationally analyzing, 23 were found to match to known GenBank sequences and 10 represented cDNA sequences with only dbEST database matches and 7 ESTs have no any database matches. The results of 6 in 8 ESTs selected for Northern blot analysis were shown to be consistent with the differential expressions of DDRT-PCR.</p><p><b>CONCLUSIONS</b>The improved DDRT-PCR method had successfully overcome the problem of false positive. These ESTs provide some clue for studying the molecular mechanisms and regulation network of erythroid differentiation.</p>

The alteration of gene expression in cortex tissue following BALB/c rat aging / 中华老年医学杂志

Objective To identify and clone rat aging-related genes to provide clues for human aging mechanism. Methods Improved different display reverse transcript-PCR method was applied to identify differentially expressed genes in cortex tissues of 4-month and 24-month old BALB/c mouse. Results Forty-two cDNA fragments with differential expression were identified, and 21 with increase and 21 with decrease of expression in old mice. Among them, 17 represented genes with known protein function, 12 represented known gene sequences but their protein function was unknown, and the other 13 probably belonged to new cDNAs. Among the genes with known protein function, 2 genes were associated with oxidative stress, 3 with energy production, and 4 with protein metabolism, respectively. Additionally, gene expression alterations were also found in those related to cell apoptosis, neurodegenerative disorder, and growth and development regulation. Conclusions Rat aging might be related with the alteration of oxidative stress status, energy production and protein metabolism.