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.

Objective To investigate the relationship between the serum apolipoprotein B (ApoB)/ ApoA-Ⅰ ratio and intracranial artery stenosis in young patients with ischemic stroke.Methods Patients with ischemic stroke aged from 18 to 45 were enrolled in the study.Brain CT angiography was used to evaluate the degree of intracranial artery stenosis,and the concentrations of serum total cholesterol,triglyceride,highdensity lipoprotein cholesterol,low-density lipoprotein cholesterol,ApoA-Ⅰ,and ApoB were detected.The ratio of ApoB/ApoA-Ⅰ was calculated.The Demographic and clinical characteristics of the intracranial artery stenosis group and the non-intracranial artery stenosis group were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke.Results A total of 161 young patients with ischemic stroke were enrolled,including 89 in the intracranial artery stenosis group and 72 in the non-intracranial artery stenosis group.The constituent ratios of diabetes mellitus (20.2％ vs.6.9％;x2 =4.641,P =0.032),smoking (47.5％ vs.15.2％;x2 =15.121,P=0.001),hyperlipidermia (56.1％ vs.48.6％;x2 =4.197,P=0.040),as well as the radios in serum high-density lipoprotein cholesterol (1.29 ± 0.30 mmol/L vs.1.65 ± 0.34 mmol/L;t =7.131,P=0.002),ApoA-Ⅰ (1.49 ± 0.65 g/L vs.1.63 ± 0.23 g/L;t =2.751,P =0.001),ApoB (1.49 ± 0.65 g/L vs.1.63±0.23 g/L;t=2.751,P=0.001),and ApoB/ApoA-Ⅰ ratio (1.49±0.65 vs.1.63± 0.23;t =2.751,P=0.001) had significant differences between the two groups.Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 3.052,95％ confidence interval [CI] 1.186-7.856;P =0.021),smoking (OR 2.997,95％ Cl 1.456-6.172;P =0.003),hyperlipidemia (OR 4.745,95％ CI 2.108-10.668;P =0.001),ApoB (OR 4.861,95％ CI 3.029-7.802;P=0.001),and ApoB/ ApoA-Ⅰ ratio (OR 5.684,95％ CI 2.215-14.584;P=0.002) were the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke,while HDL-C (OR 0.561,95％ CI 0.354-0.888;P=0.014) and ApoA-Ⅰ (OR 0.065,95％ CI 0.010-0.409;P=0.004) were the independent protective factors.After adjustment for hypertension,diabetes,smoking,hyperlipidemia,HDL-C,ApoA-Ⅰ,and ApoB,ApoB/ApoA-Ⅰ ratio was still an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke (each increase of 1 standard deviation,OR 4.255,95％ CI 2.348-7.711;P=0.001).Conclusion ApoB/ApoA-Ⅰ ratio is an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke.

Objective To evaluate the changes in autophagy in spinal neurons of rats with diabetic neuropathic pain (DNP).Methods Forty-eight male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into control group (group C,n =8) and group DNP (n =40) using a random number table.Diabetes mellitus was induced by a single intraperitoneal injection of streptozotocin (STZ) 60 mg/kg.Before STZ injection and at 1,2,4,and 8 weeks after STZ injection,8 rats randomly chosen from each group were used to measure mechanical pain threshold.The animals were sacrificed after measurement of mechanical pain threshold and the spinal cords were removed for determination of the expression of LC3-Ⅰ,LC3-Ⅱ,Beclin-1 and p62 protein.LC3-Ⅱ/LC3-Ⅰ ratio was calculated.Results Compared with group C,mechanical pain threshold was significantly decreased at 2,4,and 8 weeks after STZ injection in group DNP.The expression of LC3-Ⅱ and Beclin-1 in the spinal cord was significantly up-regulated,p62 protein expression was down-regulated,and LC3-Ⅱ/LC3-Ⅰ ratio was increased at 2,4,and 8 weeks after STZ injection as compared with the baseline value before STZ injection in group DNP.Conclusion Enhanced autophagy in spinal neurons may be involved in the development and maintenance of DNP in rats.

Objective To analyze the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Fuyang City of Anhui Province.Methods Epidemiological information was collected by case investigation questionnaire of tsutsugamushi disease.Diagnosis was determined by the detection of OXK antigen by Weil-Felix test.Results Seventy-eight cases with tsutsugamushi disease were discovered in the outbreak.All the patients had an experience of working in this area before the starting of symptoms.The clinical features of the patients were fever,headache,skin eschar,tetter and lymphadenectasis.No severe complications occurred in each patient.All the patients recovered after getting deoxycycline.Conclusions This was the first report for the tsutsugamushi disease occurred in Fuyang City of Anhui Province.And the declaration for the new happened tsutsugamushi disease would provide strong support evidence for the prevention and control of this event and ensure the safety for working in this area.Also the deoxycycline was very effective for the treatment of tsutsugamushi disease.

Objective To evaluate the role of nitric oxide (NO) in the spinal cord in the maintenance of diabetic neuropathic pain in rats.Methods Male Sprague-Dawley rats,aged 2 months,weighing 180-200 g,were used in the study.Diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg and confirmed by blood glucose ＞ 16.7 mmol/L on day 2 after STZ injection.Twenty diabetic rats were randomly allocated into diabetes mellitus group (DM group,n =10) and L-NAME (non-selective NOS inhibitor) group (LN group,n =10).Another 10 age-matched normal rats served as control group (C group).On 21 days after STZ injection,L-NAME 10 mg/kg was injected intraperitoneally once a day for 7 consecutive days in LN group,whereas the equal volume of normal saline 5 ml/kg was given instead of L-NAME in DM group.Paw withdrawal threshold to yon Frey filament stimulation (PWT) was measured before STZ infection and on 7,14,21 and28 days after STZ injection.The rats were sacrificed after the last measurement of PWT and the lumbar segments of spinal cord were removed for determination of NO content and neuronal nitric oxide synthase (nNOS) expression (by Western blot analysis) in spinal cord tissues.Results Compared with C group,PWT was significantly decreased on 14,21 and 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were increased in DM and LN groups (P ＜ 0.05).Compared with DM group,PWT was significantly increased on 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were decreased in LN group (P ＜ 0.05).Conclusion NO in the spinal cord is involved in the maintenance of diabetic neuropathic pain in rats and the mechanism is related to the enhanced function of nNOS.

Objective To evaluate the effects of curcumin preconditioning on the activity of xanthine oxidase (XOD) during intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty female Sprague-Dawley rats,aged 180-220 g,were randomly divided into 3 groups (n =10 each) using a random number table:sham operation group (S group),intestinal I/R group (I/R group),and curcumin preconditioning group (Cur group).Intestinal I/R was induced by clamping the superior mesenteric artery for 75 min followed by reperfusion.Curcumin 200 mg/kg was given everyday for 5 days before intestinal I/R in Cur group and the equal volume of normal saline was given instead of curcumin in S and I/R groups.The rats were sacrificed at 4 h of reperfusion and the intestinal specimens were obtained for microscopic examination of pathologic changes which were graded using Chiu scoring system and for determination of XOD activity,content of malondialdehyde (MDA),and superoxide dismutase (SOD) activity.Results Compared with S group,the Chiu score,activity of XOD and content of MDA were significantly increased,while the activity of SOD was decreased in I/R and Cur groups (P ＜ 0.05).Compared with I/R group,the Chiu score,activity of XOD and content of MDA were significantly decreased,and the activity of SOD was increased in Cur group (P ＜ 0.05).Conclusion Curcumin preconditioning can attenuate intestinal I/R injury in rats,which may be due to inhibition of XOD activity and decreased oxidative stress in intestinal tissues.

ObjectiveTo compare the efficacy of step-up and top-down infliximab therapy on patients with Crohn's disease (CD).MethodsA prospective and open-label study was performed by the First Affiliated Hospital of SUN Yat-sen University during September 2007 to December 2010.Active CD patients who were refractory to steroid/immunomodulator or who were steroid-dependent were enrolled into step-up group.Active CD patients who had no steroid or immunomodulator therapy before were enrolled into top-down group. All patients were intravenously infused with infliximab of 5 mg/kg body weight in an induction regimen of 3 doses at week 0,2 and 6,followed by maintenance dosing every 8 weeks beginning at week 14.The clinical and endoscopic follow up lasted 30 weeks.Clinical symptoms and mucosal healing status under endoscopy were evaluated by follow-up at week 10 and 30.Results Forty-one CD patients were enrolled,with 24 in step-up group and 17 in top-down group. There were significant differences in disease duration (P =0.006),combination therapy (P ＜ 0.001 ) and severity of disease ( P =0.011 ) in baseline between step-up and top-down groups.At week 10 and 30 during treatment,the clinical remission rates in step-up group were 45.8％ (11/24) and 58.3％ (14/24) respectively; the mucosal healing rates in step-up group were 33.3％ (8/24) and 54.2％ (13/24) respectively; the clinical remission rates in topdown group were 70.6％ ( 12/17)and 82.4％ (14/17) respectively; and the mucosal healing rates in topdown group were 35.3％ (6/17) and 52.9％ (9/17) respectively.No significant differences in clinical remission and mucosal healing rates at both week 10 and 30 were observed between the two groups.The prevalences of adverse events in step-up and top-down group were 41.7％ (10/24) and 29.4％ (5/17)respectively ( P =0.422).ConclusionBoth step-up and top-down infliximab therapy can induce remission in more than half of CD patients,while top-down therapy might be more benefitiary to symptom and endoscopic remission.

Objective To investigate the effects of sevoflurane and propofol on postoperative cognitive function after abdominal surgery for elderly patients with diabetes. Methods Seventy diabetic patients (aged 60~75 yr, ASAⅠorⅡ) underwent abdominal surgery and are included in the research. Diabetic patients were randomly divided into two groups (n=35): sevoflurane group(group DS) and propofol group (group DP). MMSE score, the attachment test, words memory test and Stroop color word test were carried and the results were recorded before operation (T1), postoperative 24 h (T2), 48 h (T3) and 1 w (T4). Results Compared with T1, patients′ MMSE score reduced at T2 and T3. Time spent in attachment test is longer at T2 and T3. Mistaken incidences in Stroop color words test 1, 2 and 3 are higher and time longer at T2. Time spent on Stroop color words test 2 and 3 is longer in T3. Words memory test reveals decline at T2 and T3, whose difference is statistically significant (P < 0.05). Cognitive dysfunction incidence in the two groups shows no statistical significance (P > 0.05). Conclusion Sevoflurane and propofol can result in postoperative cognitive dysfunction for elderly patients with diabetes within 48 h after abdominal surgery, there were no difference between the effects of them.

Objective To investigate the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and to decrease misdiagnosis rate. Methods Thirty-one patients with 35 FV-PTCs and 66 patients with 75 conventional PTCs (C-PTCs) were enrolled in this study. The sonographic features were reviewed retrospectively between the two groups with universally accepted standards. Results The sonographic features of 35 FV-PTCs included irregular shapes (6/35), anteroposterior to transverse diameter ratio A/T > 1 (7/35), spiculated margins (25/35), marked hypoechogenicity (0/35), hypoechogenicity (18/35), isoechogenicity (16/35), no calcification (15/35), microcalcifications (11/35), macrocalcification (9/35), color Doppler lfow patternⅠ(20/35), color Doppler lfow patternⅡ(10/35), color Doppler lfow patternⅢ(5/35). Irregular shapes, A/T>1, spiculated margins, marked hypoechogenicity, microcalciifcations, and color type Ⅱ were rarer in FV-PTCs than in C-PTCs, while isoechogenicity, no calciifcation, macrocalciifcation, and color type Ⅲwere more frequent in FV-PTCs than in C-PTCs. The differences of the above features were statistically significant [χ2=4.276, P=0.039; χ2=8.125, P=0.004; P=0.009 (Fisher′ s exact test); χ2=8.548, P=0.003;χ2=4.898, P=0.027,χ2=7.796, P=0.005;χ2=5.462, P=0.019;P=0.001 (Fisher′s exact test)] . During the preoperative ultrasonography, 20 of 35 FV-PTCs were diagnosed as malignancy, and others were misdiagnosed as benign nodules (misdiagnosis rate was 43%). The lymphatic metastasis rate of FV-PTCs was 29%(9/31), significantly lower than C-PTCs [62%(41/66),χ2=9.246, P=0.002]. In terms of the sonographic features of metastatic lymph nodes, there was no marked difference between FV-PTCs and C-PTCs. Conclusions Some FV-PTCs are lack of malignant features, and tend to be misdiagnosed frequently when coexisting with benign thyroid nodules. Observing the echogenicity, color lfow characteristics and other features of each thyroid nodule and cervical lymph node with multiple views may decrease the misdiagnosis rate.

Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 ％.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1％ and 36.8％ respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9％.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100％.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.