OBJECTIVE To improve real time monitoring,and early precaution and treatment of nosocomial infection(NI) achievement ratio,increase rescue achievement ratio,and reduce mortality and boost medical quality.METHODS NI is related to the health of hospital crowd,especially inpatients′ rehabilitation.NI could aggravate patient pathogenetic condition,and increase complication and case fatality.So NI might make big economic loss to a person,even an nation.In order to prevent and control the incidence of NI,based on the hospital information system(HIS),we fully used the patient information,bacterial culture,and susceptibility test result and network to track,and to analyze the infection case and prewarning monitoring of NI by preset prewarning parameter.Therefore we could promptly discover sporadic infection case and know the infection prevalence and outbreak.RESULTS Now in our hospital we have changed retrospective investigation to prospective and targeted investigation.The hospital infection incidence rate and underreporting rate have reduced efficiently.CONCLUSIONS Real time monitoring of NI network system is a necessary method in modern hospitals.

Objective To explore the impact of insulin secretory function of adult islet cells from barium-alginate microencapsulation in vitro. Methods After weighting the pancreas,human pancreatic islets were isolated with type V collagenase and purified by Ficoll's discontinuous density gradient centrifugation.The islet cell yield and purity were evaluated with microscope by DTZ staining.Human islets were coated by barium-alginate microencapsulation,and the viability was assessed by insulin release assay in vitro.Results After isolation,the average number of islet was about 3600 ±447 per gram pancreas.It was about 2140±207 after purification with more than 70％ purity.At day 2,4 and 6 after islet cell culture in vitro,basal insulin concentrations from the culture medium was measured,and the mean insulin concentration (mU/L) in media of the microencapsulated islet group at 2nd,4th and 6th day were 3.302±1.63、3.504±1.10 and 2.921±1.13 respectively,and those non-microencapsulated islet group were 3.814 ± 1.49、4.175 ±1.60、3.617± 1.34.There were no significant differences between these two groups (P＞0.05).Conclusions The bioartificial pancreas has effective insulin secretory function in vitro without being affected by barium-alginate microencapsulation.

Objective To investigate the methods and feasibility of islets isolation and purification,and to get more islets with high purity and good function for clinical transplantation.Methods After being weighted,human pancreatic islets were isolated with type Ⅴ collagenase,and purified by Ficoll's discontinuous density gradient centrifugation.The yield and purity of islets were evaluated by dithizone(DTZ) staining under microscope,and the viability was assessed by insulin release assay in vitro.Results The average number of islets was about 3 600 ± 447 per gram pancreas after isolation and it was about 2140 ±207 after purification with more than 70％ purity.2,4,6 days after islet cell culture,the basal insulin concentration of the culture medium was measured,and it was 3.302 ± 1.63,3.504 ±1.10,and 2.921 ±1.13 (mIU/L/100 islets) respectively.Conclusion Collagenase digest and Ficoll's discontinuous density gradient centrifugation are effective methods for isolation and purification of human pancreatic islets.

Bacterial endotoxins (LPS) are not only the major constituents of the outer membrane of Gram-negative (G -) bacteria, but also the toxic determinants for G - infection, which is closely related to human health and the development of diseases. Pattern recognition receptors (PRR) have been considered to be the important initial steps for cellular recognition of LPS and consequent initiation of LPS responses. Scavenger receptor, CD14, toll-like receptors, ?2-integrins and L-selectin have been shown to be involved in the clearance of LPS or LPS activation. LPS receptor may be a complex of multiple components. Different individual response to LPS is related to gene background. The gene polymorphism of LPS receptors and LPS-induced cytokines have been shown to contribute to LPS sensitivity, susceptibility and prognosis of sepsis.

With the continuous improvement in weaponry, especially explosive weapons, blast injury has become one of the most common war injuries. Underwater blast injury is a common war injury during combat around islands or fighting for beach-head. The wounding effects of underwater blast wave and the characteristics of underblast injury are quite different from that produced in air due to special physical features of water and the underwater pressure. We have investigated the injurious effects of underwater blast wave and its dose-effect relationship. In addition, some protective measures have been tested to prevent or alleviate underwater blast injury. All of these primary results have provided both experimental and theoretical foundation evidence for further researches in respect to the diagnosis, emergency care and protection against underwater blast injury.

Objective To propose the orientation,goals and some key issues for future research in the field of war wound/trauma through reviewing the updated literature.Methods The latest literature in the field of war wound/trauma were reviewed.Results The notion "medicine always be with soldiers" had been raised by America and the Europe military circles,with special emphasis on emergency techniques and equipments,which were used in the front of battle field.This forwarded the medical aids as quick as possible and the formation of medical rescue system without crack.Meanwhile,much attention had been paid to the pathogenesis and prevention of post-traumatic complications,wounding characteristics and mechanisms of high-tech new weapons,as well as repair and regeneration of injured tissues.In China,a great advances had been made in the filed of emergency rescue,shock resuscitation,complication treatment and wound repair.Conclusions During the coming "twelfth five-year program",the research standpoint is to meet the needs of Chinese troops to perform better in modern wars and non-military actions,and the aim is to significantly reduce the rate of mortality and disability of trauma as well as to improve the whole army's health.To fulfill this aim,a lot of work should be done to enhance the trauma emergency ability at the battle front,the organization and remedy ability at conditions of combined operations of armed forces,and the translational medical research for rescue of trauma,so as to unceasingly increase the medical service ability of our army to cope with secure threaten and to accomplish multiple military missions.

BACKGROUND: There exists a close relationship between the expression of scavenger receptor(SR) and CD14 and the endotoxic lung injury. To further detect the expression of these two receptors and their relationship is helpful to disclose the receptor mechanism of lung inflammatory disequilibrium so as to provide a possible theoretical foundation for sepsis therapy.OBJECTIVE: To investigate the expression of CD14 and SR in murine alveolar macrophages and their effect after trauma and traumatic endotoxin challenge.DESIGN: Randomized and controlled experimental study.SETTING: Fourth Laboratory(a state key laboratory), Trauma, Burns and Combined Injury, the Research Institute of Field Surgery, Daping Hospital,the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was completed in the Research Institute of Field Surgery of Daping Hospital of the Third Military Medical University of Chinese PLA from August 2001 to November 2001. Totally 63 Kunming mice with murine alveolar macrophages were used in the experiment.METHODS: The experimental animals were randomly divided into three groups including control group, trauma group and traumatic endotoxin challenge group. The model mice with both femur fracture and endotoxin challenge were used. Endotoxin at a dose of 5 mg/kg was injected one hour after fracture via tail vein and the dynamic expression of CD14 and SR in murine alveolar macrophages (AM) was detected.RESULTS: Six hours after trauma, the expression of CD14 and that of SR in AM showed the tendency of up-regulation and down-regulation respectively. Furthermore, the post-traumatic endotoxin challenge induced CD14up-regulation and SR down-regulation drastically. Correlation analysis indicated that CD14 and SR showed a significantly negative relationship.CONCLUSION: The study suggested that the dual modulation of CD14 and SR in AM is possibly related with the change of "self-control" to "out of control" of inflammatory reactions in the lungs after endotoxic challenge. The dual regulation of the effective antagonists CD14 and SR are helpful in further understanding lung injury and its repairing mechanism.

Objective To study the role the pathogenesis of early acute lung injury (ALI) of rabbits induced by intravascular injection of endotoxin (ET) with the intervening method of Chloroquine. Methods Rabbits were randomly assigned to three groups: control group, ET group, and ET+ chloroquine group. Acute lung injury was induced by intravascular injection of ET (500μg/kg). The arterial gas analyses, leucocyte and platelet counts in peripheral blood, PLA2 activity both in serum and lung tissue, lipid peroxide (LPO) and superoxide dismutase (SOD) in lung tissue were measured. Electron microscope and light microscope were used to observe the pathological injuries in pulmonary tissue. The protective effects of chloroquine in early ALI were evaluated. Results Compared with saline controls, rabbits treated with ET displayed the early lung injuries, such as the decrease of PaO2 (P＜0.05), the decrease of leucocytes and platelets in peripheral blood, the leukocytes sequestration in lung tissue. The PLA2 activity significantly increased in ET group compared with control group and chloroquine group both in serum and pulmonary tissue. In ET group, concentration of LPO increased in lung tissue (P＜0.05), while concentration of SOD decreased (P＜0.05). Severe histopathological injuries were presented in ET group, including pulmonary edema, lung tissue haemorrhage, inflammatory cells infiltration, asphyxial membrand formation, partial pulmonary closure and emphysema.Ultrastructural changes showed both type Ⅰ and type Ⅱ epithelial cells injury in ET group, the edema of endothelial cells, interalveolar septum thickening. In chloroquine group, PaO2 didn't decrease, PLA2 activities in serum and pulmonary tissue were lower than ET group (P＜0.05, P＜0.05), while the concentration of LPO in lung tissue decreased (P＜0.01) and SOD increased significantly (P＜0.01). Pathological examination showed slight pulmonary edema, inflammatory cells infiltration were extenuated, ultrastructural examination proved that the injuries were alleviated by chloroquine compared with ET group. Conclusion Intravascular injection of ET could successfully induce the early ALI models in rabbits. Chloroquine could inhibit the PLA2 activation and reduce the oxidative injury in lung tissue. The experiment result demonstrated PLA2 activation and oxidative stress played important roles in the pathophysiological process of early ET-induced ALI in rabbits.

Objective To study the changes in activity of phospholipase A2 (PLA2) in the course of endotoxin (ET) induced acute lung injury (ALI) inrabbits and the antagonizing effect of fructose-1, 6-diphosphate (FDP), in order to evaluate the therapeutic effect of FDP on ET-induced ALI. Methods Flapeared white rabbits were randomly assigned to three groups: control group (group A), ET challenge group (group B) and treatment group (ET challenged followedby FDP, group C). Group A animals were injected with saline (2ml/kg) as control. Group B animals were injected with ET (500μg/kg) solution followed by saline. Total amount of liquid was 2ml/kg. Group C animals were given the same amount of ET solution followed by injection of FDP (300mg/kg) solution. Total amount of liquid was also 2 ml/kg. During the experiment, respiratory rate, heart rate, blood pressure, arterial blood gases and the plasma PLA2 activity were determined at 0h, 0. 5h, 2h, 4h and 6h respectively. The rabbits were sacrificed at 6h, pulmonary PLA2 activity was assessed, and the pathologic changes in pulmonary tissues were examined with light microscope and transmission electron microscope. Results Compared with group A,rabbits of group B manifested the typical characters of ALI after ET injection, and the PLA2 activity in both serum and pulmonary tissue was much higher than those of group A (P＜0. 01).Values of the PLA2 activity in group C were between those of the two former groups. At the rame time, obvious pathological changes indicating lung injury were observed in group B and only mild pathological changes could be discerned in group C. Conclusion Activation of PLA2 activity is an important factor in pathogenesis of ET-induced ALI. FDP can antagonize the PLA2 activity and protect rabbits from early ET induced ALI to a certain extent.

Objective To investigate the clinical efficacy of re-modified Sugiura procedure for the treatment of portal hypertension.Methods The retrospective cohort study was adopted.The clinical data of 119 patients with portal hypertension who were admitted to Second People's Hospital of Yichang from June 2006 to October 2014 were collected.Seventy-two patients who underwent pericardial devascularization were allocated into the Hassab group,and the other 47 patients who underwent the re-modified Sugiura procedure were allocated into the R-M Sugiura group.All the patients firstly underwent splenectomy.The patients of the Hassab group received the classical surgery of pericardial devascularization,and the operation in the R-M Sugiura group was improved on the modified Sugiura procedure in several aspects:(1) the cardia was transected obliquely.(2) Paraesophageal vessels were preserved by selective pericardial devascularization.(3) The pedicled omentum covered the anterior anastomosis and was sutured to the posterior abdominal wall.Observed indices included (1) intraoperative and postoperative situations:operation time,volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay.(2) Postoperative complications:postoperative pleural effusion,perioperative digestive tract re-bleeding,difficult swallowing,portal vein thrombosis and gastric dynamic dysfunction.(3) Situation of follow-up.The follow-up was performed by telephone interview and outpatient examination to observe the grading of the esophageal varices at postoperative month 6 and 18 using gastroscope till February 2016.Measurement data with normal distribution were presented as x ± s,and comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Ranked data were analyzed by Wilcoxon rank test.Results (1) Intraoperative and postoperative situations:operation time of the Hassab group and the R-M Sugiura group was (201 ± 27) minutes and (255 ± 32) minutes,respectively,with a statistically significant difference between the 2 groups (t =9.67,P ＜ 0.05).The volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay were (380 ± 86) mL,(2.7 ± 0.7) days,(14.2 ± 2.4) days in the Hassab group and (401 ± 72) mL,(3.0 ± 1.7) days,(15.1 ± 2.7) days in the R-M Sugiura group,respectively,showing no statistically significant difference (t =1.35,1.26,1.86,P ＞ 0.05).(2) Postoperative complications:dysphagia was detected in 3 patients of the Hassab group and in 10 patients of the R-M Sugiura group at the postoperative day 10,with a statistically significant difference between the 2 groups (x2 =0.86,P ＜ 0.05).However,dysphagia was detected in 1 patient of the Hassab group and in 4 patients of the R-M Sugiura group at the postoperative day 20,showing no statistically significant difference between the 2 groups (x2 =2.03,P ＞ 0.05).The number of postoperative pleural effusion,perioperative digestive tract rebleeding,portal vein thrombosis and gastric dynamic dysfunction of the Hassab group and the R-M Sugiura group were 23,6,10,8 cases and 20,1,6,6 cases,respectively,showing no statistically significant difference (x2=1.39,1.02,0.03,0.08,P ＞ 0.05).(3) Situation of follow-up:all the patients were reexamined using gastroscope to observe the grading of esophageal varices.There were 0,7,56,9 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 35,12,0,0 patients in the R-M Sugiura group at postoperative month 6,showing a statistically significant difference between the 2 groups (Z =-9.64,P ＜ 0.05).There were 0,0,48,24 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 24,20,3,0 patients in the R-M Sugiura group at postoperative month 18,showing a statistically significant difference between the 2 groups (Z =-9.28,P ＜ 0.05).Conclusion The re-modified Sugiura procedure is more effective than the Hassab operation in curing portal hypertension,and it could also reduce the rate of rehemorrhage and improve the short-term and long-term prognosis.