Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group.No significant differences were shown in the rest of treatments.Parameters were compared between groups such as blood pressure,shock index,coagulation function,imaging data,GCS,and GOS at 6 months postinjury.Results Between-group differences were insignificant with regard to mean arterial pressure (MAP),shock indices,ISS,trauma severity indices (TSI),and GCS (P ＞0.05).Blood pressure fluctuation in LFR group was (18.5 ±9.9) mmHg vs (29.4 ± 11.1) mmHg in AFR group (P ＜ 0.01).Eight patients developed intracranial hemorrhage progression in LFR group,with 3 being treated with craniotomy.In comparison,19 patients developed intracranial hemmorrhage progression in AFR group,with 10 being treated with craniotomy (P ＜ 0.01).Improvement in coagulation disorders was better in LFR group than in AFR group.On days 7 after admission,GCS in LFR groups was (9.1 ± 3.6) points vs (7.2 ± 2.3) points in AFR group (P ＜0.05).At 6-month follow-up,results were 34 good and 27 poor in LFR group,better than 23 good and 40 poor in AFR group.Conclusion For moderate to severe craniocerebral injury combined with multiple trauma,LFR is effective to treat coagulation disorders and hemorrhagic shock,reduce the probability of delayed intracranial hemorrhage,and further improve the outcome.

ObjectiveTo study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.MethodWe studied 11 patients.ResultsThere was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.ConclusionWhen combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation.

Sperm-mediated gene transfer (SMGT) is one of the most methods in the transgenic animal research and the efficiency of spermatozoa binding and internalization exogenous DNA after sperm/DNA co-culture is important to a successful SMGT.In this study,the influencing factors of exogenous DNA uptake by spermatozoa were detected using DIG labeled EGFP as exogenous gene.The results demonstrated that porcine spermatozoa could spontaneously take up exogenous DNA which mainly binding occurs on the sub-acrosomal and nuclei region of the sperm head.The rate of spermatozoa binding exogenous DNA increased with the extending action of time.At 37℃ and 39℃,the rate of spermatozoa uptake exogenous DNA would not increase after 60 min incubation,and the similar result was observed on 90 min at 17℃.Binding rates and internalization rates of washed ejaculated sperm cells from the 15 boars varied between 6.57%-35.81% and 2.990%-24.66%,respectively.The binding rate and intemalization rate were mostly inhibited by seminal plasma.The binding rates were significantly increased by liposome and DMSO,respectively.Dead-spermatozoa could bind exogenous DNA,the intermalization process could not be completed.Furthermore,the highest binding rate was found in membrane broken spermatozoa as a result of freeze-thawing and this was independent of the sperm donors.

Objective:To conduct data mining on hospital accreditation results for inspirations and clues in hospital management.Methods:The Apriori function contained in the arules package of R software was used to extract the association rules. This practice aimed to analyze association rules of the accreditation results of 56 tertiary hospitals which were made based on tertiary hospital accreditation standard(2011)and Detailed Rules from 2017 to 2019; to explore the correlation between the clauses, and analyze the inspirations for hospital management.Results:A total of 6 566 138 and 247 rules were generated for all clauses and core clauses, receptively. The top 10 rules sorted by lift were selected as strong association rules. Among them, the minimum lift of all clauses and core clauses was 1.41 and 1.53, respectively. There was a strong correlation between the establishment of a quality and safety management team in the hospital and the development & implementation of relevant regulations by the hospital. There were strong correlations among emergency service procedure and regulations, patient rights to know, responsibility system by the first one to receive a complaint, medical safety(adverse)event reporting, development & implementation of antimicrobial management system, as well as training for prevention of multi-drug resistance infection measures, and multi-drug resistance infection hospital infection control system.Conclusions:This study suggested that hospital management should highlight the correlation between regulations development and staffing, that between indicator systems and monitoring feedback systems, and that between indicators in different sectors in the medical process. These correlations can be used as management clues and inspirations for hospital management.

OBJECTIVE：To investigate the consistency and difference of f luorescence immunochromatographic and liquid chromatography-tandem mass spectrometry （LC-MS/MS）and enzyme multiplied immunoassay technique （EMIT）in the blood concentration monitoring of mycophenolic acid. METHODS ：Fluorescence immunochromatography ，LC-MS/MS and EMIT were used to detect the blood concentration of mycophenolic acid in 61 blood samples of children treated with mycophenolate mofetil ester orally at different time points. Kolmogorov-Smirnov method ，Wilcoxon pairing test ，Passing-Bablok regression ，Cusum method，Spearman correlation analysis ，Bland-Altman scatter diagram were adopted for statistical analysis. RESULTS ：Blood concentrations of mycophenolic acid ，which were determined by fluorescence immunochromatography ，LC-MS/MS and EMIT ， showed non-normal distribution. Passing-Bablok regression analysis showed that regression equation of fluorescence immunochromatography and LC-MS/MS ，fluorescence immunochromatographic method and EMIT were CFI=0.928 3CLC-MS/MS+0.961 7 and CFI＝0.880 7CEMIT－0.488 2（FI means fluorescence immunochromatographic ）. Spearman correlation analysis showed that the correlation coefficients between fluorescence immunochromatography and LC-MS/MS ，fluorescence immunochromatography and EMIT were 0.968 and 0.929， respectively （P＜0.000 1）. Bland Altman scatter plot analysis showed that 3.28％ of the 358341451@qq.com difference between fluorescence immunochromatography and LC-MS/MS was outside the consistency limit （±1.96SD）， and 1.64％ of the difference between fluorescence immuno- chromatography and EMIT was outside the consistency limit （± 1.96SD）. Wilcoxon pairing test showed that the results of fluorescence immunochromatography were higher than those of LC-MS/MS （Z＝3.76，P＝0.000 2）and lower than those of EMIT （Z＝－5.96，P＜0.000 1）. CONCLUSIONS ：Fluorescence immunochromatography shows good consistency and correlation with LC-MS/MS and EMIT ；the blood concentrations of mycophenolic acid detected by fluorescence immunochromatography were higher than those by LC-MS/MS and lower than those by EMIT . It can be used for bedside rapid detection. When using the test results of different methods for clinical medication ，the differences of test methods need to be considered.