Objective To observe the correlation between CD64 index levels in peripheral blood and the severity and prognosis factors of postoperative traumatic sepsis,and investigate the clinical effect of these changes in the development of postoperative traumatic sepsis.Methods A total of 560 patients with trauma were enrolled in the study,and these patients were divided into the postoperative traumatic sepsis group (210 cases) and the postoperative general trauma group (350 cases) according to clinical manifestations.According to the severity of the postoperative traumatic sepsis,these patients were divided into low-risk group (64 cases),moderate-risk group (75 cases) and high-risk group (71 cases).According to clinical prognosis,these patients with post-traumatic sepsis were divided into survival group (178 cases) and death group (32 cases).The CD64 index in peripheral blood and APACHE Ⅱ score were analyzed and measured by flow cytometry.The differences and correlation between CD64 index levels and APACHE Ⅱ score were compared and analyzed,and the relationship between CD64 index levels and the severity and prognosis of postoperative traumatic sepsis were also assessed.Results The CD64 index levels of postoperative traumatic sepsis group were higher than the postoperative general trauma group (P<0.05).The differences in terms of CD64 index,APACHE Ⅱ score and mortality rate among low-risk group,moderate-risk group and high-risk group were statistically significant,in which high-risk group was the highest,followed by moderate-risk group,and low-risk group was the lowest(P<0.05).Compared with the survival group,the death group had higher CD64 index levels and APACHE Ⅱ score (P<0.05).The CD64 index levels were positive correlated with APACHE Ⅱ score (r=0.72,P=0.00) and mortality (r=0.56,P=0.00).ROC curves analysis results showed that the area under curve of CD64 index was 0.874 (95%CI:0.765~0.896), and the optimal operating point was 7.08,which had 82.6% sensiticity and 86.4% specificity.Conclusion The increased CD64 index levels in postoperative traumatic sepsis are closely related to the severity and prognosis of disease,and the CD64 index levels can be effective predictor with some clinical application value.

Hoarseness ; diagnosis ; etiology ; Humans ; Thyroglossal Cyst ; complications ; diagnosis

Objective To investigate effect of local application of dexmedetomidine on the medium effective concentration (EC50) of ropivacaine for brachial plexus block and the mechanism of the analgesic effect induced by dexmedetomidine.Methods Fifty-two ASA Ⅰ or Ⅱ patients of both sexes,aged 18-50 yr,weighing 50-80 kg,scheduled for elective forearm or hand surgery,requiring ultrasound-guided axillary brachial plexus block,were randomly assigned into 2 groups (n =26 each):control group (group C) and dexmedetomidine group (group D).Axillary brachial plexus block was performed using only ropivacaine in group C.In group D the mixture of ropivacaine and 0.8 μg/kg dexmedetomidine was injected for the block.The effective block was defined as complete loss of pain sensation in the brachial plexus distribution.The volume of local anesthetics was 30 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.5 ％ and the ratio between the two successive concentrations was 1.2.If the block was effective,the next patient received a lower dose of ropivacaine,or if ineffective,a higher dose was given in the next patient.The EC50 and 95 ％ confidence interval of ropivacaine were determined using the Dixon-Massey method.Results The EC50 (95 ％ confidence interval) of ropivacaine was 0.32％ (0.30％-0.33％) in group D and 0.44％ (0.42％-0.46％) in group C.The EC50 of ropivacaine was significantly lower in group D than in group C (P ＜ 0.05).Conclusion Local application of dexmedetomidine can decrease the EC50 of ropivacaine for brachial plexus block guided by ultrasound,indicating that the mechanism of the analgesic effect induced by dexmedetomidine is related to the local anesthetic-like effect.

Objective To supply large amount of seed cells for the cartilaginous tissue engineering,adult adipose-derived stem cells(ADSCs) were differentiated directly into cartilaginous cells.Methods Adipose tissue donated voluntarily by the adult patients after liposuction was isolated and subcultured.The cell activity was detected by methyl thiazolyl tetrazolium(MTT) assay and the proliferation curve line was drawn.The cultured stem cells were identified with flow cytometry.After the subculturing,the fourth generation of ADSCs were differentiated directly into cartilaginous cells,and then were marked by Alcian blue.Type II collagen expression in the ADSCs after cartilaginous differentiation was examined by immunohistochemical assay.Results ADSCs proliferated in vitro fast,and kept a stable multiplication till the 13th~15th generation.The results of flow cytometry showed that the cultured ADSCs had the specific features of the stem cells,and then were differentiated into cartilaginous cells.Positive Alcian blue staining and type II collagen expression indicated that the obtained cells had the function of normal cartilaginous cells.Conclusion ADSCs are differentiated directly into cartilaginous cells successfully,which will supply seed cells for the cartilaginous tissue engineering.

Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis (SAP) swine model with intra-abdominal hypertension (IAH) Methods By self-controlled study,SAP model was made by infusing sodium taurocholate (5％) into the pancreatic duct in 6 domestic swine.Mechanical ventilator mode was volumeassist control with tidal volume 10 ml/kg ; FiO2 40％ and PEEP 5 cm H2O (routine ventilation) given to SAP model swine.After 3 h ventilation,pneumo-peritoneum was made with N2 gas to increase the intraabdominal pressure (IAP) to 25 mm Hg in SAP swine.Three more hours later,PEEP was adjusted as the measurement of esophageal pressure (Pes guided ventilation) to such a level that trans-pulmonary pressure stayed above 0 cm H2O during end-expiratory occlusion.During the investigation period,heart rate (HR),cardiac output index (CI),central venous pressure (CVP),mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor,and oxygen partial pressure of artery (PaO2) and carbon dioxide partial pressure of artery (PaCO2) were measured by blood-gas analysis.In addition,systemic oxygen delivery (DO2) and systemic oxygen consumption (VO2) were calculated by using the data of blood-gas analysis of arterial and central venous blood.Results No swine model was subjected to barotrauma.After routine mechanical ventilation,there were significant differences in HR,CI,MAP,CVP,PAWP,Ppeak,Pplat,Pes,pulmonary compliance (Cstat),PaO2,and DO2 between SAP and IAH in swine (all P ＜ 0.05).Compared with routine ventilation,however,PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure (all P ＜ 0.05).The lactate decreased significantly after esophageal pressure guided ventilation (all P ＜ 0.05).There were no significant changes in PaCO2,HR,MAP,CVP and PAWP in IAH swine after mechanical ventilation with routine parameters (all P ＞ 0.05).Conclusions There were remarkable effects on oxygen metabolism in response to mechanical ventilation guided by esophageal pressure.In case of clinical application of mechanical ventilation,the results of this study are in favor of setting transpulmonary pressure according to measurements of esophageal pressure in SAP patients with IAH in an early stage.

Objective To investigate the expression and early diagnosis value of CD64 index levels in peripheral blood cells in patients with postoperative traumatic sepsis.Methods A number of 420 trauma patients were enrolled in the study,and they were divided into the postoperative traumatic sepsis group(130 cases)and postoperative general trauma group(290 cases)according to the clinical manifestations. The CD64 levels in peripheral blood were measured by flow cytometry,and the levels of C-reactive protein(CRP)and white blood cell count (WBC)were detected.The diagnostic value of these indexes on postoperative traumatic sepsis were evaluated.Results The CD64 index, CRP and WBC levels in postoperative traumatic sepsis group were significantly higher than postoperative general trauma group(P <0.05). After appropriate treatment,the CD64 index,CRP and WBC levels decreased significantly compared with the preoperative levels(P <0.05). The correlation analysis showed that the CD64 index in peripheral blood and CRP level were positively correlated(r =0.79,P <0.01).How-ever,the CD64 index in peripheral blood and WBC level were of no significant correlation(r =0.028,P >0.05).The ROC curve analysis showed that when CD64 index(7.21)considered as the boundary for early diagnosis of postoperative traumatic sepsis,the sensitivity and spe-cificity of diagnosis for postoperative traumatic sepsis were 85.1% and 87.8%,the area under the ROC curve(AUC)was 0.865(95%CI 0.784 ~0.929),which was significantly better than CRP index.Conclusion The expression of CD64 is higher in patients with postoperative traumatic sepsis,which can be used as an effective indicator for early diagnosis of postoperative traumatic sepsis,and it has an important clin-ical application value.

BACKGROUND:The physicochemical properties and bioactivity of titanium surface will degrade with time because of the aging phenomenon,affecting the efficiency of implant-bone osseointegration.Therefore,the re-activation of the implant surface physicochencical properties and bioactivity is important.OBJECTIVE:To investigate the re-activation effect of ultraviolet rays on aging titanium surface.METHODS:Sand-blasted and acid-etched titanium discs were divided into three groups randomly:Group A was new titanium surface,Group B was stored in a sealed container for 4 weeks,Group C was treated with ultraviolet rays for 15 minutes after stored in the sealed container for 4 weeks.The surface roughness,elemental composition and surface energy of the titanium surface were examined by optical profilometer,X-ray photoelectron spectroscopy and contact angle measuring device,respectively.The bioactivity of the titanium surface was examined by cell culture experiments.MG63 osteoblast-like cells were cultured on the different titanium surfaces.After 30 minutes,1,2,4 hours of incubation,the cells were strained with Hoechst33342 fluorescence,and initial attachment of cells was evaluated by measuring the amount of cells attached to the titanium surface.The proliferation of cells was quantified in terms of cell density at 1 and 3 culture days using tetrazolium salt (MTS)-based colorimetry.RESULTS AND CONCLUSION:There was no obvious difference in the surface roughness of the three groups,and ultraviolet treatment did not change the surface morphology of titanium surface.X-ray photoelectron spectroscopy showed that the C element content of group A and group C was lower than that of group B (P ＜ 0.05),and the content of Ti,O,N elements was significantly higher than that of group B (P ＜ 0.05).No difference in the surface element composition between group A and group C was found.Both of the surface contact angles of group A and group C were Oo,but in group B,the value was 115°.The number of initially attached cells of group A and group C was significantly higher than that of group B after incubated 30 minutes,1,2 and 4 hours (P ＜ 0.05),and no difference between group A and group C was found.The proliferation of cells of group A and group C was significantly higher than that of group B after incubated 1 and 3 days (P ＜ 0.05),but no difference between group A and group C was found.In conclusion,ultraviolet rays show good effects on the re-activation of the aging titanium surface,which can reduce hydrocarbon contamination and recover the high surface energy to increase cell adhesion and proliferation.

Objective To analyze the MRI features of chordoid meningioma (CM),and to compare with other meningiomas. Methods Clinical and MRI features of 7 patients with CM confirmed by pathology were analyzed retrospectively.Featrues of every MRI sequence were investigated qualitatively.Meanwhile normalized signal ratios of each sequence were analyzed furtherly,including normalized T1 weighted image intensity ratios (NT1 ),normalized T2 weighted image intensity ratios(NT2 ),normalized ADC ratios (NADC)and normalized T1 WI contast enhancement intensity ratios (NCE).Fisher ’s exact test and Dunnett T 3 test were employed to analyze the difference of CM and nonchordoid meningiomas (34 cases of WHO grade Ⅰ meningioma,1 6 cases of nonchordoid WHO grade Ⅱ meningioma,and 5 case of WHO grade Ⅲ meningioma).Results The CM showed hyperintensity on T2 WI and meanwhile other nonchordoid meningiomas demonstrated isointensity,hypointensity or slight hyperintensity on T2 WI.Evaluations of DWI revealed variable signal intensities of CM.But all 7 cases had no obvious restricted diffusion,and increased signal was seen on the ADC map in each patient.The solid parts of CM enhanced markedly after contrast agent injection.Quantitative indicators NT2 , NADC and NCE of CM were higher than other meningiomas(P <0.01),but NT1 showed no statistic difference between CM and other meningiomas (P =0.889).Whether there was cyst,necrosis,orflow void sign on T2 WI,and no matter with or without perifocal edema,dural tail sign and a broader base among meningiomas had no significance in differentiating CM and other meningiomas.Conclusion CM has typical MRI features.The tumors show hyperintensity on T2 WI,especially have no obvious restricted diffusion and enhance markedly after contrast.The measurement of NT2 ,NADC and NCE enables reliable preoperative prediction of the atypical histopathologic diagnosis.

Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.

Objective Polyinosinic-polycytidylic acid (poly IC) plays an important role in the central nervous system damage and repair.This study was to investigate the effect of poly IC on inflammatory response after spinal cord ischemia-reperfusion injury (SCIRI) in rats.Methods A total of 72 healthy adult male SD rats were equally randomized into a sham-operation, an ischemia-reperfusion (IR), and a poly IC group.The abdominal cavities of the rats were cut open and closed again in the sham-operation group and SCIRI models were established in the IR and poly IC groups by clamping the abdominal aorta, followed by reperfusion 60 minutes later and intraperitoneal injection of saline (0.1 mL) and poly IC (1.25 μg/g), respectively.At 6, 24, and 48 hours after modeling, BBB scores were obtained and the contents of TNFα, IL-1β and IFN-β were measured by ELISA.At 48 hours, the expressions of NF-κB and IL-10 were determined by immunohistochemistry, the area of ischemic necrosis in the spinal cord tissue was calculated by TTC staining, and its morphological changes were observed under the optical microscope.Results At 48 hours after modeling, the BBB scores were significantly lower in the IR and poly IC groups than in the sham-operation group (3.80±0.75 and 9.40±0.49 vs 20.00±0.00, P<0.01), though higher in the poly IC than in the IR group (P<0.01).The rats of the IR group showed extensive degenerated neurons in the gray substance of the spinal cord, with scattered foci of bleeding and blood coagulation, while those of the poly IC group exhibited fewer necrotic neurons and basically normal nuclear morphology, though with a few swelling cells.The ischemic necrosis area of the spinal cord tissue was significantly reduced.The expression of NF-κB was decreased while that of IL-10 increased markedly.Compared with the IR group, the poly IC group showed a significant increase in the expression of IFNβ (117.23±6.06 vs 55.65±4.02, P<0.01) and a remarkably decrease in the expressions of TNFα (190.45±4.16 vs 201.82±2.18, P<0.01) and IL-1β (39.27±2.48 vs 50.59±1.47, P<0.01) at 48 hours.Conclusion Poly IC can protect the spinal cord and reduce inflammatory response after spinal cord ischemia-reperfusion injury.