Objective To explore the feasibility, safety and effectiveness of mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries so as to further improve success rate of treatment of severe thoracic trauma. Methods A retrospective study was done on the clinical data of 72 patients with severe thoracic injuries (AIS≥3) treated by surgeons from Chongqing Emergency Medical Center (CEMC) from April 1998 to August 2008. The patients were divided into pre-hospital group (n = 36) and in-hospital group (n = 36) according to the time that the definite surgery performed. Results (1) There was no significant statistical difference upon arrival time from scene to primary hospital between two groups (P > 0.05). For patients in pre-hospital group, the time to receive definite surgery was (3.9±4.1) hours, which was significant shorter than (9.6±8.2) hours in in-hospital group (P < 0.05). (2) There were no statistical significant differences upon blood loss volume and blood transfusion volume between two groups (P > 0.05). (3) There was no significant statistical difference upon ISS value between two groups (P > 0.05), but the RTS value of pre-hospital group was significantly lower than that of in-hospital group (P < 0.05). The incidence rate of shock in pre-hospital group was 86.1%, which was significantly higher than 41.7% in in-hospital group (P < 0.05). (4) The percentage of patients who received thoracic close drainage in pre-hospital group was 16.7%, which was significantly higher than 5.6% in in-hospital group. There was no significant statistical difference upon thoracic close drainage plus thoracotomy, thoracic close drainage plus laparotomy and thoracic close drainage plus other operations between two groups. However, the operative rate of thoracic close drainage plus thoracotomy for penetrating injury was 4.8 times higher than that for blunt injury in pre-hospital group, and 1.9 times higher than that for blunt injury in-hospitai group. The operative rate of thoracic close drainage plus laparotomy for blunt injury was 5 times higher than that for penetrating injury in prehospital group, and 4.5 times higher than that for penetrating injury in in-hospital group. The overall survival rate was 95.8% (69/72). Five of eight moribund patients were saved in pre-hospital group, the prevented death rate accounted for 13.9% (5/36) in this group. Conclusions It is flexible, safe and effective to implement mobile intensive care and definite lifesaving surgical interventions for patients with severe thoracic injuries in primary hospitals. After the condition of the patient is stabilized, a quick transportation of the patients to a higher level trauma centers (hospitals) for further treatment may reduce the pre-hospital death rate.

Objective To determine the development characteristics of social anxiety of peasant-worker's children in Harbin,and explore the effect of gender,parents quarrel,parents divorced and maternal factors on social anxiety.The study provided a scientific basis for the intervention of social anxiety.Methods The children in grade 1-5 from 3 schools in Harbin were collected by random cluster sampling in 2012.Then the same questionnaire was used to track the peasant-worker's children in 2014.The questionnaire included general information,Social Anxiety Scale for Children (SASC),Egna Minnen av Bardndosna Uppforstran (EMBU),Acceptance Subscale and Psychological Control Scale.Results (1) The detection rates of social anxiety of peasant-worker's children in 2012 and 2014 were respectively 29.3％,30.2％,and the detection rates had no significant difference (x2=0.111,P=0.790).But there was significantly difference between the two years(2012:6.90±4.26;2014:5.88±4.20;t=3.419,P=0.001).Children of newly occurring social anxiety in high grade was fewer and the ability to symptom relief was better.There was no significant difference between boys and girls on newly occurring and symptom relief(newly occurring:x2=0.018,P=0.910;symptom relief:x2 =0.541,P=0.518).(2) In 2012,the differences of the detection rate of children's social anxiety on parents quarrel,parents divorced were not significant (parents quarrel:x2 =0.881,P=0.393;parents divorced:x2=0.246,P=0.658).In 2014,the detection rate of children's social anxiety on parents quarrel,parents divorced were significantly higher than children in normal families (parents quarrel:x2=11.758,P=0.001;parents divorced:x2 =9.907,P=0.004).The detection rate of children's social anxiety of divorced parents increased with age(x2 =4.398,P=0.041).(3) In 2012 and 2014,children' s social anxiety had positive correlation with mother excessive interference and over-protective,mother refusing and denying,mother punishment,and had negative correlation with mother acceptance (P＜ 0.05).In 2014,it had positive correlation with mother control and negative correlation with mother emotional warmth understanding (P＜0.05).(4) In 2012,the regression coefficient of mother refusing and denying was 0.186.In 2014,the regression coefficient of mother acceptance and control were-0.266,0.169.Conclusion Social anxiety can be spontaneous remission,and the ability was better in high grade.Parents quarrel,parents divorced and maternal factors can affect the development of peasant-worker's children' s social anxiety,which should be concerned.

Objective To investigate the standards for management of traumatic intrapulmonary hematoma and hematocele.Methods A retrospective study was conducted on the data of 21 patients with traumatic pulmonary hematoma or hematocele (AIS≥4 points) treated at Chongqing Emergency Medical Center from August 1999 to August 2010.Results The overall mortality was 14％ (3/21)and death causes were respiratory passage hemorrhea and asphyxia.About 67％ of patients ( 14/21 ) were associated with hemoptysis,which lasted for 1-240 days (mean,15.8 days).The duration of hemoptysis due to traumatic intrapulmonary hematoma hematocele was about 3.4 times longer than that due to simple traumatic pneumatocele.The hematoma or cyst disappeared at average 61.6 days,with 3.4 times longer than the disappearance time of intrapulmonary hematoma or hematocele in comparison with that of simple pneumatocele.The size and position of traumatic pulmonary hematoma or pneumatocele influenced the treatment methods,outcomes and prognosis.Conclusions Standardized treatment for traumatic pulmonary hematoma or hematocele is key to improving the cure rate.Early emergency definitive surgery is required for patients with traumatic intrapulmonary hematoma or hematocele greater than 6.0 cm in diameter and for those with pneumatocele greater than 6.0 cm in diameter combined with incapability of keeping breathing due to severe air leakage.

Objective To investigate the role of ISS and new injury severity score (NISS) in evaluation of complications and treatment outcomes in the multiple trauma patients combined with severe chest trauma.Methods AIS-2005 was used to carry out retrospective analysis of the 1 377 multiple trauma patients combined with severe chest trauma (thoracic AIS≥3 points) treated at Chongqing Emergency Medical Center from January 2005 to January 2011.In the meantime,the related NISS and ISS were calculated and their relations with mortality were analyzed.Results The overall healing,mortality and complication rate were 93.2％,6.8％ and 28.5％ respectively.Both the ISSN and ISS had positive correlation with morbidity of complications ( r =0.569,P ＜0.01 ;r =0.442,P ＜0.01 ) and mortality (r =0.693,P ＜ 0.01 ; r =0.774,P ＜ 0.01 ),but a stronger relevance was demonstrated between NISS and morbidity of complications and between ISS and mortality rate.NISS showed a higher sensitivity but less specificity than ISS in prediction of morbidity of complications (P ＜ 0.01 ),and NISS was not superior to ISS in prediction of mortality ( P ＞ 0.05 ).Conclusions Both NISS and ISS work well in evaluating the complications and treatment outcomes in multiple trauma patients combined with severe chest trauma.Thus,NISS should be applied for prediction of complication occurrence and ISS for treatment outcomes to maximize the prediction accuracy.

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.

BACKGROUND:In previous experiments, a polymer-shel ed microbubble contrast agent was successful y prepared using L-polylactic acid-polyethylene glycol methyl-covered liquid fluorocarbon perfluoropentane, which developed wel in vivo and in vitro under a second harmonic contrast-enhanced ultrasound with a low mechanical index OBJECTIVE:To optimize the conditions for preparing polymer-shel ed microbubble contrast agents with high yield and suitable size. METHODS:The polymer-shel ed microbubble contrast agent containing perfluoropentane was prepared by single emulsion method. Three preparation conditions, including polymer mass/perfluoropentane volume ratio (4/1, 2/1, 1/1, 1/2), hemogenate speed (18 000, 26 000, 35 000 r/min) and time (15, 30, 60, 120 seconds), were optimized, and the microbubble yield and size were set as judge standard. The contrast-enhanced ultrasonography of rabbit kidney was performed using the optimized microbubbles, and the arrival time, time to peak, half time of descending and peak intensity were analyzed by TCA software. RESULTS AND CONCLUSION:The preparation conditions were optimized as a polymer mass/perfluoropentane volume ratio of 2/1, homogenate speed of 26 000 r/min and homogenate time of 60 seconds, which presented a high microbubble yield of (1.8±0.4)×109/mL and mean size of (3.7±1.3)μm with uniform distribution. The arrival time, time to peak, half time of descending and peak intensity were detected as (3.1±0.6) seconds, (2.9±0.5) seconds, (4.0±0.7) seconds and (4.7±1.1)×10-5 AU, respectively. The polymeric microbubbles prepared by optimized conditions were of high yield, with suitable size and good contrast-enhanced effect in vivo.

Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.

Objective To study the effective fraction and mechanism of Lycium barbarum leaves on improving learning and memory ability of subacute aging mice induced by D-galactose injection.Methods The model of subacute aging mice was developed by injection of D-galactose subcutaneously,and different extracts of Lycium barbarum leaves were prepared.The effects of the extracts of Lycium barbarum leaves on the learning and memory ability of model mice were evaluated by Y maze experiment and new object recognition experiment.The pathomorphological changes of hippocampus in mice were observed by hematoxylin-eosin and Nissl staining.The levels of brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),glial cell line-derived neurotrophic factor(GDNF),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interferon-γ(IFN-γ)and interleukin-10(IL-10)in hippocampus of mice were detected by enzyme-linked immunosorbent assay.The activities of superoxide dismutase(SOD)and the contents of glutathione(GSH)and malondialdehyde(MDA)in hippocampus of mice were detected by related assay kits.Detection of apoptosis in the hippocampal region of mouse brain tissue using the TUNEL method.Western blotting analysis was used to detect the expressions of antioxidant proteins Nrf2,HO-1 and apoptotic proteins Caspase-3,Caspase-9 in hippocampus of mice.Results The water extraction part and 80%alcohol precipitation supernatant part of Lycium barbarum leaves significantly improved the learning and memory ability of model mice,improved the pathological damage of hippocampus in mice,increased the number of Nissl bodies in hippocampus of mice,and promoted the expression of neurotrophic factors BDNF,NGF and GDNF,and promoted the expression of neurotrophic factors BDNF,NGF and GDNF.Pro-inflammatory factors TNF-α,IL-1β and IFN-γ expression declines while anti-inflammatory factor IL-10 expression rises.The activity of SOD and the expression of GSH were increased,and the expression of MDA was decreased.Increase the expression of Nrf2 and HO-1 antioxidant proteins;reduce the expression of Caspase-3 and Caspase-9 apoptosis pathway proteins.Inhibition of apoptosis in the hippocampal region of mouse brain tissue using a model.Conclusion The water extracts and 80%alcohol precipitation supernatant extracts of Lycium barbarum leaves are the effective fractions of Lycium barbarum leaves to improve the learning and memory ability of D-galactose-induced subacute aging mice,and its mechanism might be related to the inhibition of neuronal apoptosis caused by oxidative stress and inflammation.

ObjectiveTo explore the compatibility advantage of Scutellariae Radix-Coptidis Rhizoma in the prevention and treatment of neuroinflammation， and to elucidate the action characteristics and mechanism of the compatibility advantage based on Toll like receptor （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor kappaB （NF-κB） pathway. MethodRepresentative mouse microglia cells （BV2） in vitro were selected and divided into 8 groups： control group， model group， Scutellariae Radix-Coptidis Rhizoma group， Piracetam group， Scutellariae Radix group and Coptidis Rhizoma group. The BV2 cell inflammatory model was established by lipopolysaccharide （LPS）， and the cell activity was detected by cell counting kit-8 （CCK-8）. Cell morphology was observed under bright field. The production and release of pro-inflammatory factors in BV2 cells were determined by enzyme-linked immunosorbent assay （ELISA） and immunofluorescence assay， and the mRNA expressions of TLR4， MyD88 and NF-κB were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The nuclear translocation of NF-κB p65 was detected by immunofluorescence， and TLR4 signal transduction inhibitor （CLI-095） and NF-κB inhibitor （PDTC） were used to confirm the anti-neuroinflammation targets of Scutellariae Radix-Coptidis Rhizoma. ResultCompared with the conditions in the control group， most cells in LPS-induced model group were activated， and the contents of IL-6， TNF-α and IL-1β in culture medium and cells and the mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were increased （P<0.01）， with obvious nuclear entry of NF-κB p65. Compared with the conditions in the model group， BV2 cell morphology was mostly recovered after pretreatment in Scutellariae Radix-Coptidis Rhizoma and Piracetam groups， and the levels of IL-6， TNF-α and IL-1β and the mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were decreased （P<0.05， P<0.01）， with NF-κB p65 mostly observed in cytoplasm. Compared with the conditions in the model group， cell morphology was slightly recovered in Scutellariae Radix group and Coptidis Rhizoma group， and the levels of pro-inflammatory factors and mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were reduced. In terms of inhibitory effect on pro-inflammatory factors， Scutellariae Radix group and Coptidis Rhizoma group were lower than Scutellariae Radix-Coptidis Rhizoma group （P<0.05）. Compared with the model group， the "Scutellariae Radix-Coptidis Rhizoma+CLI-095" group and "Scutellariae Radix-Coptidis Rhizoma+PDTC" group had lowered mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 （P<0.05， P<0.01）， and the transfer of NF-κB p65 into nucleus was obviously inhibited. ConclusionThe anti-neuroinflammation effect of Scutellariae Radix-Coptidis Rhizoma was significantly better than Scutellariae Radix or Coptidis Rhizom alone， and the anti-neuroinflammation advantage was closely related to the inhibition of activation of TLR4/MyD88/NF-κB signaling pathway in microglial cells. It was confirmed that TLR4， MyD88 and NF-κB were potential targets for Scutellariae Radix-Coptidis Rhizoma to exert the compatibility advantage.