Recurrent hypoglycemic coma and diabetic ketoacidosis caused by insulin antibody: a rare case of type 1 diabetes mellitus / Hipoglicemia hiperinsulinémica causada por anticuerpos antiinsulina: informe de un caso

ABSTRACT Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal: 300 mU/L and < 0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.

Los anticuerpos contra la insulina (AI) inducidos por la insulina exógena raramente causan hipoglucemia. No obstante, los autoanticuerpos contra la insulina (AIA) en el síndrome autoinmune de insulina (SAI) pueden causar hipoglucemia. Las manifestaciones típicas del SAI son la hipoglucemia en ayunas o posprandial, niveles elevados de insulina, la disminución del nivel de péptido C y AIA positivos. Presentamos un paciente hombre de 45 años con diabetes mellitus de tipo 1 (DMT1) tratado con análogos de insulina, que sufría comas hipoglucémicos recurrentes y cetoacidosis diabética (CAD). Sus síntomas fueron causados por la insulina exógena y fueron similares al SAI. La posible razón fue que la insulina exógena indujo AI. El título de AI era del 61,95% (Normal: 300 mU/L y < 0,02 nmol/L cuando se producía la hipoglucemia. Basados en sus síntomas clínicos y otros exámenes, se le diagnosticó hipoglucemia hiperinsulinémica causada por la AI. Sus síntomas mejoraron después de cambiar el régimen de insulina de lispro más insulina detemir a insulina humana recombinante (Gensulin R) y de empezar a tomar prednisona.

Retrospective analysis of laboratory-acquired infection in China / 中国热带医学

@#Abstract: Objective To collect the cases of laboratory-acquired infections (LAI) reported in literatures in China, summarize the infection routes and causes of LAI in China, in order to improve laboratory staff's understanding of its occupational health and safety risks. Methods　The cases of laboratory-acquired infection reported in domestic literatures were collected from PubMed, CNKI, Wanfang Database, CBM China Biomedical Literature Database up to April 11, 2022, retrospectively analyze the number and causes of LAI reports, the main risk factors of LAI and its harm to society, the consequences of LAI or the leakage of pathogenic microorganisms, and put forward the relevant countermeasures of biological safety. Results　A total of 22 LAI reports were collected, reviewed and integrated into 21 reports. There were 7 kinds of pathogenic microorganisms. The main pathogenic microorganisms were hantavirus (42.86%, n=9) and Brucella (33.33%, n=7). There were 122 cases and 3 deaths in the laboratory. Most of the reports came from research laboratories (66.67%, n=14). The main route of infection was inhalation of aerosol (42.86%, n=9), followed by transdermal route (38.09%, n=8). Conclusions Failure to report LAI events will increase the risk of pathogenic microorganisms spreading to people outside the laboratory and the environment through infected laboratory staff. Local health institutions and laboratories should be encouraged to report LAI cases as a powerful tool for monitoring accidental leakage of pathogenic microorganisms and further improving laboratory biosafety. The laboratory needs strong biosafety measures to protect staff's health and prevent environmental pollution caused by accidental leakage of pathogenic microorganisms.

Current status and demand of health services in primary and middle school clinic in 16 provinces of China / 中国学校卫生

Objective@#To analyze the current situation and needs of primary and secondary school health clinic services, and to provide a reference for strengthening school health service in China.@*Methods@#Investigation provinces were selected according to China s three major economic zones, 1 or 2 survey centers were selected from each province, 16 provinces and 26 survey centers were selected. In each survey centers, six schools from primary and secondary schools, junior high schools and high schools in urban and rural areas were randomly selected as research sites. Each research site randomly selected 10 students in each grade(grade three, four, five from primary schools) to fill in the questionnaire anonymously. A total of 4 661 valid questionnaires were collected.@*Results@#Among the services provided by the school clinics to students, "trauma treatment" "consulting health problems" "physical examination" accounted for 49.4%, 40.5% and 39.0% respectively. Within the past one year, 45.1% students went to the school clinic for consultation or consultation 1-3 times, 6.4% for 4-5 times, and 3.7% for 6 times or more. When students were sick in school, 65.8%(primary school), 64.0%(junior high school), and 54.4%(high school) of them selected to go to the school clinic. When suddenly suffered trauma in school, 78.2%(primary school), 73.2%(junior high school) and 69.6%(high school) of the students went to the school clinic.@*Conclusion@#Primary and middle school students have a great demand for school health services, and it is necessary to continue to strengthen the construction of primary and secondary school health clinics.

The relationship between serum and seminal plasma vitamin D and male reproductive function / 医学研究生学报

Objective Male infertility accounts for 40 to 50% of the total number of infertility in the world. Among many factors that cause male infertility, vitamin D is considered to be directly related to male fertility. The purpose of this study was to explore the relationship between serum and seminal plasma vitamin D and male reproductive function, and provide a more comprehensive research direction for studying the specific mechanism of vitamin D on male reproduction. Methods A total of 198 infertile males, receiving andrological examination from June 2017 to January 2018 in the Center for Reproductive Medicine, Jinling Hospital (Nanjing, China) was included in our study. Serum and seminal plasma vitamin D levels were measured by electrochemiluminescence immunoassay (ECLIA) kits. The associations between vitamin D and biomarkers of male reproduction were analyzed. Results Serum 25(OH) vitamin D level [26.17(19.61-31.99)ng/mL] was in positive relation with semen volume[3.8(3.1-4.8)ng/mL] (r=0.229,P=0.003). Seminal plasma 25(OH) vitamin D level was not related to serum 25(OH) vitamin D level, but in negative relation with sperm concentration(r=0.174,P=0.016) and positive relation with semen volume(r=0.271,P=0.0001). Serum 25(OH) vitamin D level was in positive relation with seminal plasma fructose concentration(r=0.256,P=0.002), total fructose content (r=0.310,P=0.0002) and total zinc content(r=0.26,P=0.002). The level of serum and seminal plasma vitamin D leve was not related to serum anti-Mullerian hormone(AMH), seminal plasma AMH, serum inhibin (INH B) and seminal plasma INH B(P>0.05). Conclusion Vitamin D is associated with affiliated gland function. The seminal vesicles and prostate produced by semen may be the main source of vitamin D in the male reproductive system.

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review / 中华创伤杂志(英文版)

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

Cervical brucellar spondylitis causing incomplete limb paralysis

Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

The effect of Nd：YAG lasers used in root canal therapy： a Meta-analysis / 口腔疾病防治

Objective @#Meta-analysis was used to assess the effect of Nd: YAG Lasers used in root canal therapy. @*Methods @# A search of literatures about clinical effect of Nd:YAG lasers in root canal therapy in PubMed, Embase, Cochrane Library, CMCC, CNKI, VIP, Wanfang databases was conducted from 1997 to 2015. The quality of included studies was stringently evaluated and data was analyzed by the RevMan 5.3 software.@*Results@#8 studies were included in the Meta-analysis. Meta-analysis results showed that the ratio of the occurrence of endodontic interappointment emergencies (EIAE) of 24 ~ 48 hours and 1 week after the therapy was significantly lower in the Nd: YAG lasers group compared with the control group (24 h: OR = 0.27, 95％CI = 0.15 ~ 0.48; 1week: OR = 0.26, 95％CI = 0.13 ~ 0.54). The six months to one year failure rate of root canal therapy was lower in Nd:YAG lasers group compared with the control group, the differences were statistically significant (OR = 0.24, 95％CI = 0.06 ~ 1.00). @*Conclusion@# The use of Nd: YAG laser in root canal therapy relieves post-treatment pain response after the therapy and also reduces the long-term failure rate of root canal treatment.

Research progress of integrin β1 effect in cardiovascular diseases / 心血管康复医学杂志

As important adhesion molecule on cell surface,integrin is a kind of important receptor family. It′s im- portant role is to mediate intercellular adhesion and adhesion between cells and extracellular matrix,also regulate proliferation,differentiation,migration of cells and tissue remodeling,and plays an important role in maintaining cellular form and growth.The present article made a short review about research progress of integrin β1 effect in cardiovascular diseases in recent years.

Investigation on the role of VEGF gene polymorphisms in the risk of osteosarcoma

The VEGF in low oxygen conditions are reported to prolong the survival of malignant cell, and thus this gene has a critical role in tumor growth and invasion as well as development of malignant tumor. We aimed to assess the association between the six common SNPs and the risk of osteosarcoma, and their association with environmental factors. 176 subjects with osteosarcoma and 176 gender- and sex-matched healthy control individuals were enrolled into our study. The VEGF -2578C/A, -1156G/A, +1612G/A, +936C/T, -634G/C and -460T/C gene polymorphisms were determined using a polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] assay according to manufacturer's instructions By conditional logistic regression analysis, AA and CA+AA genotypes of VEGF -2578C/A were associated with significant increased risk of osteosarcoma compared with CC genotype, and the ORs [95%CI] were 2.32 [1.18-4.60] and 1.68 [1.07-2.64], respectively. Moreover, individuals with CC and TC+CC genotypes of VEGF-460T/C had significant increased risk of osteosarcoma compared with those carrying with the TT genotype, and ORs [95%CI] were 2.15 [1.10-4.21] and 1.60 [1.0-2.58], respectively. By stratified analysis, we did not find statistically significant associated between VEGF -2578C/A and -460T/C gene polymorphisms and cancer risk by stratification analysis. Our results suggested that VEGF -2578C/A and -460T/C gene polymorphisms may be association with an increased risk of osteosarcoma

In vitro and in vivo studies of pirarubicin-loaded SWNT for the treatment of bladder cancer

Intravesical chemotherapy is an important part of the treatment for superficial bladder cancer. However, the response to it is limited and its side effects are extensive. Functional single-walled carbon nanotubes (SWNT) have shown promise for tumor-targeted accumulation and low toxicity. In the present study, we performed in vivo and in vitro investigations to determine whether SWNT-based drug delivery could induce high tumor depression in rat bladder cancer and could decrease the side effects of pirarubicin (tetrahydropyranyl-adriamycin, THP). We modified SWNT with phospholipid-branched polyethylene glycol and constructed an SWNT-THP conjugate via a cleavable ester bond. The cytotoxicity of SWNT-THP against the human bladder cancer cell line BIU-87 was evaluated in vitro. Rat bladder cancer in situ models constructed by N-methyl-N-nitrosourea intravesical installation (1 g/L, 2 mg/rat once every 2 weeks for 8 weeks) were used for in vivo evaluation of the cytotoxicity of SWNT and SWNT-THP. Specific side effects in the THP group including urinary frequency (N = 12), macroscopic hematuria (N = 1), and vomiting (N = 7) were identified; however, no side effects were observed with SWNT-THP treatment. Flow cytometry was used to assess the cytotoxicity in vitro and in vivo. Results showed that SWNT alone did not yield significant tumor depression compared to saline (1.74 ± 0.56 and 1.23 ± 0.42%) in vitro. SWNT-THP exhibited higher tumor depression than THP-saline in vitro (74.35 ± 2.56 and 51.24 ± 1.45%) and in vivo (52.46 ± 2.41 and 96.85 ± 0.85%). The present findings indicate that SWNT delivery of THP for the treatment of bladder cancer leads to minimal side effects without loss of therapeutic efficacy. Therefore, this nanotechnology may play a crucial role in the improvement of intravesical treatment of bladder cancer.

Abscess formation in vertebral canal and presacral area following penetrating injury of rectum and sacral vertebra by a steel rod / 中华创伤杂志(英文版)

Penetrating injury to the rectum, vertebral body and spinal cord by a steel rod is a rare condition. Treatment of this kind of injury is very challenging. Rectal injury requires repair and fecal diversion, while debridement of the spine is difficult, especially when the injury site is very long. Here we report a case of penetrating injury of rectum and sacral vertebra by a steel rod after falling onto the ground from 1 m height. The abscess cavity was irrigated with 3% hydrogen peroxide and physio-logical saline repeatedly. The bony canal was carefully debrided, curetted and bony fragments were removed. Spinal irrigation and drainage lasted for 2 months and sensitive antibiotic (amikacin sulfate) was given 7 days after surgery, but abscess was still formed in the vertebral canal. At 6-month follow-up, the patient was paralyzed without any neurological improvement, and the pain in low back and lower limb still continued.

Recent progress of study on imbalance of Th17/Treg cells in aplastic anemia / 中国实验血液学杂志

Aplastic anemia (AA) is an autoimmune disease characterized by destruction of hematopoietic tissue resulting in hyperfunction of effector T-lymphocytes. Recent studies indicate that Th17 and Treg cells are functionally antagonistic each other, and the increase of Th17 cells and decrease of Treg cells are closely related with AA. In vivo experiments showed that both anti-IL-17 treatment and Treg cell infusion can protect against immune-mediated bone marrow failure in mouse with AA. This review summarizes the recent progress of study on imbalance of Th17/Treg cells in AA, so as to explore the pathogenesis of AA and provide approach to clinical treatment. The main problems that are discussed in this review include biological characteristics of Th17/Treg cells, the regulation of Th17/Treg cell balance and related cytokines, the relationship between Th17/Treg cells and AA.

Lack of response in severe pneumocystis pneumonia to combined caspofungin and clindamycin treatment: a case report / 中国医学科学杂志(英文版)

Pneumocystis pneumonia (PCP) is among the most common opportunistic infections in patients with acquired immune deficiency syndrome (AIDS). Although trimethoprim-sulfamethoxazole (TMP-SMX) is the first line therapy for that condition given its efficacy, approximately one third of patients experienced dose-limiting toxicity. For cases of severe to moderate PCP, if TMP-SMX treatment fails or is contraindicated, primaquine combined with clindamycin or intravenous pentamidine is recommended as second line therapy. However, both primaquine and pentamidine are associated with severe adverse reactions and often unavailable at hospitals in China.As a result, other treatment options have been explored. Caspofungin, an echinocandin, has broad antifungal activity against a wide range of fungi including Candida and Aspergillus species. Cases of PCP patients treated with caspofungin have been reported, although conflicting conclusions have been arrived at. In addition, the use of caspofungin and clindamycin as the first line therapy for severe PCP in AIDS patients has not been reported yet. This article described an AIDS case with severe PCP, treated with the combination of caspofungin and clindamycin.

Study on the integrated monitoring program regarding mouse and main mouse-borne disease in Zhejiang province / 中华流行病学杂志

Objective To study the integrated monitoring program regarding mouse and plague, hemorrhagic fever of renal syndrome(HFRS)and leptospirosis. Methods Integrated monitoring plan was used. A designated office coordinated 5 departments' actions within the Zhejiang Provincial Center for Disease Control and Prevention(CDC). Cage-trapping method was conducted to monitor the density of mice from June to October, respectively. Results Lishui municipal CDC had finished the integrated monitoring program on mouse and mouse-borne disease while the Longyou CDC had finished the field investigation, using the integrated monitoring program.Specimens were sent to provincial CDC. The integrated monitoring program needed more number of personnel and better coordination. Lishui reported 3 leptospirosis cases and 58 HFRS cases in 2009,with the incidence rates as 0.13 and 2.44 per 100 000, respectively. Longyou reported 2 leptospirosis case and 1 HFRS cases in 2009, with the incidence rates as 0.49 and 0.25 per 100 000, respectively.Lishui and Longyou had no plague case. Lishui caught 91 mice in 2009 and the density was 4.17%.Longyou caught 37 mice in 2009, with the density as 1.18 percent. Most mice caught from Lishui were Apodemus agrarius and the next was Mus musculus. In Longyou the Rattus tanezumi ranked the first, followed by Apodemus agrarius. The positive rate of HFRS antigen in Lishui and Longyou were 10.42% and 4.59% respectively. The positive rate of HFRS antibody in Longyou was 3.70%. The culture positive rate of leptospirosis in mouse renal of Lishui and Longyou were 0 and 0.98%respectively. The culture positive rate of leptospirosis in pig renal, duck renal, frog renal and cattle urine of Longyou was 0. The culture positive rate of leptospirosis in duck blood of Longyou was 80%.Conclusion The integrated monitoring program on mouse and mouse-borne disease seemed to be feasible and could promote the integrated surveillance and control program on mouse and mouse-borne diseases in China.

Surgical treatment strategy for multiple injury patients in ICU / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the surgical treatment for patients with multiple injuries in ICU.</p><p><b>METHODS</b>Clinical data of 163 multiple injury patients admitted to ICU of our hospital from January 2006 to January 2009 were retrospectively studied, including 118 males and 45 females, with the mean age of 36.2 years (range, 5-67 years). The injury regions included head and neck (29 cases), face (32 cases), chest (89 cases), abdomen (77 cases), pelvis and limbs (91 cases) and body surface (83 cases). There were 57 cases combined with shock. ISS values varied from 10 to 54, 18.42 on average. Patients received surgical treatments in ICU within respectively 24 hours (10 cases), 24-48 hours (8 cases), 3-7 days (7 cases) and 8-14 days (23 cases).</p><p><b>RESULTS</b>For the 163 patients, the duration of ICU stay ranged from 2 to 29 days, with the average value of 7.56 days. Among them, 143 were cured (87.73%), 11 died in the hospital (6.75%) due to severe hemorrhagic shock (6 cases), craniocerebral injury (3 cases) and multiple organ failure (2 cases), and 9 died after voluntarily discharging from hospital (5.52%). The total mortality rate was 12.27%.</p><p><b>CONCLUSIONS</b>The damage control principle should be followed when multiple injury patients are resuscitated in ICU. Surgical treatment strategies include actively controlling hemorrhage, treating the previously missed injuries and related wounds or surgical complications and performing planned staging operations.</p>

Efficacy of polyethylene glycol 4000 on constipation of posttraumatic bedridden patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of polyethylene glycol 4000 on adult patients with functional constipation due to posttraumatic confinement to bed.</p><p><b>METHODS</b>A total of 201 posttraumatic bedridden patients were studied in this prospective, open-labeled, single-group study. Polyethylene glycol 4000 was administered orally for 14 days and the dosage was adjusted according to the Bristol stool types. Demographic characteristics, disease status, treatment period and factors affecting clinical outcome, especially the concomitant medications, were recorded.</p><p><b>RESULTS</b>After administration of polyethylene glycol 4000, 194 cases (96.52%) showed remission of constipation, including 153 (76.12%) persistent remission. The average defecation frequency increased significantly after treatment and the percentage of patients with stools of normal types (Bristol types 3-5) increased as well. Genders, ages and concomitant medications showed no significant influence on the persistent remission rate. After consecutive treatment for two weeks, patients with slight movement showed a significantly higher remission rate than those without movement (95% vs 80%). At the end of treatment, most accompanying symptoms were relieved obviously. Patients with a medical history of constipation or ever taking laxatives showed a lower remission rate. Sixty cases (29.85%) developed diarrhea during the observational period, among whom 6 (10%) withdrew from the clinical observation voluntarily at the first onset of diarrhea. Two cases suffered from abdominal pain.</p><p><b>CONCLUSIONS</b>Polyethylene glycol 4000 has efficacy on functional constipation in posttraumatic bedridden patients. Furthermore, patients with milder symptoms, more movement in bed, and longer duration of treatment but without accompanying symptoms can achieve a higher remission rate.</p>

Minimally invasive plate internal fixation for calcaneal fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.</p><p><b>METHODS</b>Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.</p><p><b>RESULTS</b>All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.</p><p><b>CONCLUSION</b>Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.</p>

Outcome of organic acidurias in China

From June 1998 to May 2007, 9566 urine samples were collected from patients with psychomotor deficits, seizures, vomiting and unconsciousness in Peking University First Hospital. Their urine organic acids profiles were analysed using gas chromatography - mass spectrometry (GCMS), GCMS solution and Inborn Errors of Metabolism Screening System software. In all patients, blood acylcarnitines were analysed using tandem mass spectrometry. One hundred and sixty-eight patients (1.76%) with organic acidurias were detected. Among them, 116 (116/ 168, 69.0%) had methylmalonic aciduria, 63 (54.3%) of these 116 patients had methylmalonic aciduria combined with homocysteinemia. Sixteen (9.5%) of those patients detected with organic acidurias had propionic aciduria, and 15 (8.9%) had multiple carboxylase deficiency. Seven (4.2%) had glutaric aciduria type 1. After dietary treatment, medicine and rehabilitation, clinical improvements were observed in more than half of the patients. Twenty-eight of the 168 patients (16.7%) recovered and led a normal life. The method of urine organic acid analysis by gas chromatography - mass spectrometry and blood acylcarnitines analysis by tandem mass spectrometry have been established and applied successfully in China, namely Beijing, Shanghai, Wuhan and Guangzhou. The prognoses of Chinese patients with organic acidurias have also improved significantly.

Relationship of myeloid differentiation-2 gene promoter polymorphisms with susceptivity of complications after severe trauma in Chinese Han population / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the polymorphisms of myeloid differentiation-2 (MD-2) gene promoters, and to explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome (MODS) and sepsis in Chinese Han population.</p><p><b>METHODS</b>Using polymerase chain reaction-restriction fragment length polymorphism method, the authors detected the single nucleotide polymorphisms of the promoter region of MD-2 gene at position - 1625C/G in 105 severe trauma patients (42 with sepsis). The organ function was scored.</p><p><b>RESULTS</b>The frequency of CC genotype in MD-2 gene promoter region at position - 1625 was 0.5 (21/42) in septic patients and 0.7 (44/63) in non-septic patients. The frequency of CG genotype was 0.38 (16/42) in septic patients and 0.27 (17/63) in non-septic patients. The frequency of GG genotype was 0.12 (5/42) in septic patients and 0.03 (2/63) in non-septic patients. The MODS scores in trauma patients carrying G allele at position - 1625 were significantly higher than those carrying C allele (P<0.001 for dominant effect, and P>0.05 for recessive effect). Moreover, trauma patients carrying G allele appeared to have higher risk of sepsis comparing to those carrying C allele (OR 0.477, 95% CI 0.266-0.855, P<0.05). Sepsis morbidity was significantly different between subjects with C and G alleles (P<0.05 for dominant effect, P>0.05 for recessive effect).</p><p><b>CONCLUSIONS</b>The polymorphisms of the promoter region of MD-2 gene at position - 1625 C/G is correlated with MODS and sepsis after severe trauma in Chinese Han population. The people with - 1625 G allele in the promoter region of MD-2 gene may be a risk factor of severe complications.</p>