ObjectiveTo analyze the characteristics of severe trauma patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), in order to look for the risk factors of AKI and the opportune time for the initiation of RRT on prognosis.Methods A retrospective cohort study involving consecutive patients with severe trauma in emergency intensive care unit (ICU) in the Second Affiliated Hospital of Zhejiang University School of Medicine, from August 2011 to December 2014, was conducted. Inclusion criteria included age≥18 years, injury severity score (ISS)> 16, AKI receiving RRT, and the duration of hospital stay> 24 hours. The general data, the risk factors of AKI, the prognostic indicators, and the information of RRT were recorded. All patients were divided into two groups according to the prognosis, the time of onset of AKI and the initiation time of RRT. The independent risk factors for prognosis were screened by binary logistic regression analysis.Results Seventy-three patients were eligible for enrollment, including 48 deaths (65.8%); 49 patients suffered from AKI≤48 hours after trauma (early stage group), and in 24 patients it was longer than 48 hours (late stage group). In 55 patients RRT was routinely started (routine RRT group), 18 patients underwent RRT ahead of routine criteria decided by the judgment of the attending doctor (earlier RRT group). The main risk factors of RRT in traumatic patients with AKI were shock and sepsis, each accounted for 90.4% and 53.4%. Compared with survival group, in death group, the proportion of male patients was lower (70.8% vs. 100.0%,χ2 = 7.238,P = 0.007), acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were higher (23.7±5.1 vs. 14.4±3.7,t = 8.031,P< 0.001), Glasgow coma score (GCS) was lower [5.0 (3.0, 15.0) vs. 15.0 (8.0, 15.0),U = 320.000,P = 0.001], incidence of shock and sepsis was higher (97.9% vs. 76.0%,χ2 =6.755,P = 0.009; 64.6% vs. 32.0%,χ2 = 7.014,P = 0.008), the rate of use of contrast medium was lower (27.1% vs. 56.0%,χ2 = 5.898,P = 0.015), the time for the diagnosis of AKI post trauma was delayed [days: 2 (1, 5) vs. 2 (1, 2), U = 762.000,P = 0.049], the time for the initiation of RRT post trauma was later [days: 6.0 (3.0, 12.0) vs. 3.0 (2.0, 4.5), U = 868.500,P = 0.002], the recovery rate of renal function at discharge was lower (10.4% vs. 100.0%,χ2 = 54.497, P< 0.001). Compared with late stage group, in early stage group, the mortality was lower (55.1% vs. 87.5%,χ2 =7.509,P = 0.006), and the incidence of sepsis before AKI was also lower (38.8% vs. 83.3%,χ2 = 12.854,P< 0.001). Compared with routine RRT group, the recovery of renal function at discharge was better with a lower mortality rate in the earlier RRT group, but the difference was considered to be insignificant (55.6% vs. 36.4%,χ2 = 2.064,P = 0.151;50.0% vs. 70.9%,χ2 = 2.633,P = 0.105). Logistic regression analysis showed GCS [odds ratio (OR) = 0.852, 95%confidence interval (95%CI) = 0.747-0.972,P = 0.017], shock before AKI (OR = 85.350, 95%CI = 5.682-1 282.073, P = 0.001), and sepsis before AKI (OR = 11.499, 95%CI = 2.127 - 62.161,P = 0.005) were independent risk factors for the judgment of prognosis.Conclusions Shock and sepsis are the major risk factors of RRT in trauma patients with AKI. Shock, sepsis and traumatic brain injury are the independent risk factors of death. Perhaps early initiation of routine RRT cannot improve the outcome of the patients with posttraumatic renal insuficiency.

Objective To investigate the effect of carbon dioxid insufflation on cerebral blood flow (CBF) during laparoscopic cholecystectomy. Methods Thirty patients ASA grade Ⅰ- Ⅱ undergoing laparoscopic cholecystectomy were selected. The values of jugular venous oxygen partial pressure(PjvO2 ) jugular venous oxygen saturation (SjvO2 ), arterial partial pressure of carbon dioxide (PaCO2), oxygen (PaO2) and saturation (SaO2 ) were measured before the insufflation, 10 min and 30 min after the insufnation, respectively. Results Compared with those before the insufflation, SjvO2 and PacO2 were increased significantly, and arterial--jugular venous oxygen content difference (Ca-jvDO2 ) decreased markedly 10 min and 30 min after insufflation (P

To observe the D-dimer levels and the numbers of micro-embolic signals (MES) in atrial fibrillation patients with different thromboembolic risk scores. A total of 216 persistent atrial patients were classified according to their different scores with a range of 0 -6.They were also divided into two groups by ≥2 or ＜ 2 according to the CardiacFailure,Hypertension,Age,Diabetes,Stroke 2 (CHADS2) point system.D-dimer levels and the numbers of MES were detected in all patients.A rising trend of D-dimer level and the number of MES was observed with the increases of CHADS2 score. D-dimer level and the number of MES in group 0 or 1 score were significantly lower than those in other high score groups (P ＜ 0.05).And the number of MES in group 5 or 6 score was significantly higher than those in other low score groups (P ＜ 0.05).D-dimer level and the number of MES in the group of ≥ 2 score were significantly higher than those in group ＜ 2 score ( P ＜ 0.01 ).It suggests that D-dimer level and the nunber of MES may reflect the thromboembolic risks in atrial fibrillation patients.

Objective To investigate the monocyte chemoattractant protein (MCP1) gene expression of the bladder urothelial carcinoma and its correlation with the pathogenesis of the bladder urothelial carcinoma.Methods Thirty cases of patients with the bladder urothelial carcinoma, including 20 cases of male and 10cases of female, were taken the blood and bladder tissue.In control group, 30 cases of non-cancer patients,including 20 cases of male and 10 cases of female, were taken the blood samples.ELISA method was used to detected the concentration of plasma MCP1, immunohistochemical method to investigate the expression of MCP1 in the bladder urothelial carcinoma and adjacent tissues.Real-time quantitative RT-PCR was applied to detected the expression of MCP1. Data of the two groups were comparied and the relationship between the expression of MCP1 and the clinical characteristics of the bladder urothelial carcinoma was analyzed.Results MCP1 in group of patients with the bladder urothelial carcinoma was (193.4±105.7) pg/ml, and higher than that in non-tumor group (91.8±34.6) pg/ml (t = 8.37, P ＜0.001).MCP1 in invasive bladder cancer was (204.3±167.5) pg/ml and superficial bladder cancer was (130.6±69.2) pg/ml (t = 2.667, P = 0.013). By immunohistochemistry, the MCP-1 positive rate in the bladder urothelial carcinoma was 70.0 % (21/30), that in adjacent cancer tissue was 43.3 % (13/30) (χ2 = 4.9, P ＜0.05). The positive rate of MCP1 in invasive bladder cancer in tumor group was 80.0 % (8/10) and that in superficial bladder cancer was 65.0 %(13/20).At the same time, MCP- 1 positive intensity in the bladder urothelial carcinoma was significantly higher than that in adjacent tissues. The intensity in invasive bladder cancer was higher than that in superficial ones. Total RNA and mRNA levels of MCP-1 in the bladder urothelial carcinoma were statistically differences compared with that in adjacent tissues (χ2 = 10.08, P ＜0.05).Conclusion The upregulation of MCP1 gene expression is likely to play an important role in the incidence and metastasis of the bladder urothelial carcinoma.

0.05);the therapeutic effect on slight syncope-collapse syndrome and septic shock is superior to the control group(P

Objective To investigate the effect of Treg cells and Th17 cells on the pathogenesis of SLE in patients with SLE,by detecting levels of serum IL-10 and IL-17 in patients with systemic lupus erythematosus (SLE).Methods Selected 54 patients with SLE diagnosed in Suzhou Municipal Hospital Affiliated to Nanjing Medical University from July 2013 to July 2015 as subjects,and 19 healthy persons were selected as control group.Using double antibody sandwich method (ELISA) to detect the levels of IL-10 and IL-17 in two groups.Using indirect immunofluorescence and western blot method to detect ANA,dsDNA,RNP,Sm,SSA and SSB in patients with SLE.Then compared and correlation analysed the level of IL-10 and IL-17,the levels of IL-10 and IL-17 in ANA,RNP,Sm,SSA and dsDNA groups were analyzed simultaneously.Results The level of IL-10 and IL-17 in SLE were 63.7±89.0 pg/ml and 87.7±123.0 pg/ml,and control group were 20.8±8.9 pg/ml and 18.5 ± 111.6 pg/ml,with the statistically significant difference (trL10 =3.484,tIL-17 =4.076,P＜0.01).The level of positive group in SLE were 176.5±93.2 pg/ml and 237.2±107.5 pg/ml,and negative group were 16.2±5.7 pg/ml and 12.9 ±8.3 pg/ml,with the statistically significant difference (tIL-10 =6.875,tIL-17 =8.843,P＜0.01).The level of IL-10 was positively correlated with IL-17 level in SLE (r=0.96,P＜0.05).The level of IL-10 and IL-17 in ANA high titer group were 91.8±100.8 pg/ml and 135.5±140.9 pg/ml,ANA low titer group were 44.5±76.7 pg/ml and 54.4±98.5 pg/ml,with the statistically significant difference (tIL10 =2.215,tIL-17 =2.345,P＜0.05).The level of IL-10 and IL-17 in anti ds-DNA antibody positive group were 87.1 ± 101.1 pg/ml and 122.4 ± 137.1 pg/ml,negative group were 27.4± 50.1 pg/ml and 28.6 ± 61.6 pg/ml,with the statistically significant difference (tIL-10 =2.904,tIL-17 =3.443,P＜0.05).Conclusion The levels of IL-10 and IL-17 were significantly increased and there was positive correlation.It was explained that the anti-inflammatory and pro-inflammatory response existing at the same time in SLE patients and Treg cell and Th17 cell may also play an important role in the occurrence and development in SLE.

Objective:To explore the effect of spinal interleutkin-33 (IL-33) on radicular pain in rats modeling non-compressive lumbar disc herniation.Methods:A total of 80 male Sprague-Dawley rats were randomly divided into a sham operation group, a model group, a lentivirus negative control group, a low-dose IL-33 recombinant lentivirus group and a high-dose IL-33 group, each of 16. Non-compressive lumbar disc herniation was successfully induced in all except the rats in the sham operation group. Two days later, the model group was injected intrathecally with 10μl of enhanced infection solution. The lentivirus control group received 10μl of negative lentivirus, the low-dose IL-33 recombinant lentivirus group received 5μl of IL-33 recombinant lentivirus and the high-dose IL-33 recombinant lentivirus group received 10μl of IL-33 recombinant lentivirus. The 50% paw withdrawal threshold (50% PWT) was measured one day before the modeling and on the 1 st, 3 rd, 5 th, 7 th, 9 th, 11 th, 13 th, 15 th, 17 th, 19 th, and 21 st day afterward. On the 12 th day the expressions of IL-33 protein and mRNA were evaluated. Results:The average expression of IL-33 protein and mRNA in the model and the lentivirus negative control group increased significantly after the modelling compared with the sham group, while expression in the low- and high-dose IL-33 recombinant lentivirus groups was significantly lower than in the lentivirus negative control group. Compared with one day before the modelling, average 50% PWTs on the affected side decreased significantly in all of the modelling groups. From the 9 th to the 21 st day significantly increased 50% PWTs were observed on the affected side in the low-dose and high-dose IL-33 recombinant lentivirus groups compared with the other two modelling groups. Immunostaining showed significant increase in the expression of IL-33 in the dorsal horn of the spinal cord in the model group, compared with the sham operation group. Significant decrease in the average expression of IL-33 in the spinal dorsal horns was observed in the low-dose and high-dose IL-33 recombinant lentivirus groups. Conclusions:Intervertebral disk herniation may increase the expression of IL-33 in the spinal cord, and may cause radicular pain.

Objective To evaluate the efficacy and reliability of intraoperative microvascular Doppler uhrasonography (IMDU)in urgent clipping surgery of ruptured aneurysms,and assess the impact of this method on the surgical procedure itself.Methods For 62 patients who underwent urgent clipping surgery for the treatment of ruptured aneurysms,both blood flow velocities in the aneurismal sac and in the adjacent vessels and alterations of the Doppler spectrum were determined by IMDU before and after aneurysm clipping.The findings of IMDU were analysed and compared with those of visual inspection of the surgical site and postoperative angiography. Results A relevant stenosis of an adjacent vessel induced by efip position that had escaped detection by visual inspection was identified by IMDU in 12 out of 62 patients.In addition, IMDU demonstrated a primarily incomplete clipping aneurysm in 4 out of 62 patients.The clipping aneurysm was repositioned on the basis of the IMDU findings in 16 out of 62 patients.The findings from IMDU equated with those from angiography in 38 eases.Conclusion IMDU is a safe,instantaneous,effective and reliable technique for the urgent dipping surgery of raptured aneurysms.

P-450-dependent epoxygenase pathway of arachidonic acid and the products of epoxyeicosatrienoic acids (EETs) have been demonstrated to be involved in angiogenesis and tumor progression. This study examined the expression of EETs and the role of the pathway in the angiogenesis of multiple myeloma (MM). MM cell lines of U266 and RPMI8226 were cultured, and the EETs levels (11, 12-EET and 14, 15-EET) in the supernatant were determined by ELISA. Human umbilical vein endothelial cells (HUVECs) were cultured and used for analysis of the angiogenesis activity of the two MM cell lines, which was examined both in vitro and in vivo by employing MTT, chemotaxis, tube formation and matrigel plug assays. 11, 12-EET and 14, 15-EET were found in the supernatant of the cultured MM cells. The levels of the two EETs in the supernatant of U266 cells were significantly higher than those in the RPMI8226 cell supernatant (P<0.05), and the levels paralleled the respective angiogenesis activity of the two different MM cell lines. 17-octadecynoic acid (17-ODYA), as a specific inhibitor of P450 enzyme, suppressed HUVECs proliferation and tube formation induced by MM cells. Furthermore, 17-ODYA decreased the EET levels in the supernatant of MM cells. These results suggest that EETs may play an important role in the angiogenesis of MM, and the inhibitor 17-ODYA suppresses this effect.

Objective To investigate the mechanism underlying sufentanil postconditioning-induced reduction of myocardial ischemia-reperfusion (I/R) injury in rats through evaluating the relationship between phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/Akt) signaling pathway and mitochondrial permeability transition pore (mPTP).Methods Forty-eight pathogen-free healthy male SpragueDawley rats,aged 3 months,weighing 250-300 g,were divided into 4 groups (n=12 each) using a random number table:sham operation group (group S),group I/R,sufentanil postconditioning group (group SP) and snfentanil postconditioning plus PI3K inhibitor wortmannin group (group SP +W).The rats were anesthetized with 20％ urethane 5 ml/kg.Myocardial I/R was induced by ligation of the anterior descending branch of left coronary artery for 30 min,followed by 120 min reperfusion.Sufentanil 1.0 μg/kg was injected via the sublingual vein at 5 min before reperfusion in SP and SP+W groups.Wortmannin 15 pμg/kg was injected via the sublingual vein at 5 min before reperfusion,and then sufentanil 1.0 μg/kg was given in group SP+W.Blood samples were taken from the abdominal aorta at the end of reperfusion for detection of serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) concentrations.The rats were then sacrificed and hearts were removed for determination of cell apoptosis (by TUNEL),nicotinamide adenine dinueleotide (NAD+) content (by speetrophotometry),and expression of phosphorylated Akt (p-Akt) in myocardial tissues (by Western blot).Apoptosis index (AI) was calculated.The myocardial mitochondria and cytoplasm were isolated for detection of the expression of cytochrome c (Cyt c) and apoptosis-inducing factor (AIF) using Western blot.Results Compared with group S,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was up-regulated,the expression of Cyt e and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in I/R,SP and SP+W groups (P＜0.05).Compared with group I/R,the serum cTnI and CK-MB concentrations and AI were significantly decreased,the content of NAD+ was increased,the expression of p-Akt was up-regulated,the expression of Cyt c and AIF in mitochondria was up-regulated,and the expression of Cyt c and AIF in cytoplasm was down-regulated in group SP (P＜0.05).Compared with group SP,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was down-regulated,the expression of Cyt c and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in group SP+W (P＜0.05).Conclusion Sufentanil postconditioning can activate PI3K/Akt signaling pathway,inhibit mPTP opening,mitigate mitochondrial injury and inhibit apoptosis in cardiomyocytes,thus attenuating myocardial I/R injury in rats.