Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

Objective To evaluate the effect of ecoimmunonutrition enteral nutrition on systemic inflammatory response and prognosis in patients with acute severe acute pancreatitis. Methods Fifty-seven patients with severe acute pancreatitis were randomly divided into two groups: parenteral nutrition (PN) group(28 cases), and ecoimmunonutrition(EIN) group (29 cases), each of the two nutrition formulas was given to each group respectively for 7 days. The level of plasma endotoxin and serum concentrations of TNF-α ,IL-1β ,IL-6 and IL-10 and monocyte NF-κB were tested at admission,1 d,3 d,5 d,7 d after nutrition support. Statistics the two groups results of clinical prognosis. Results The levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were no significant difference compared with PN group at admission. After nutrition support 7 d, the levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were (2.70 ± 0.13) ng/L, (30.13 ± 8.12) ng/L, (20.17 ± 8.04) ng/L, (36.43 ± 8.24)ng/L, (86.45 ± 14.54) ng/L, (70.4 ± 3.2)% respectively, which all were significantly lower than those in PN group [(3.25 ±0.32) ng/L, (313.42 ± 144.35) ng/L,( 155.29 ±32.78) ng/L, (324.15 ± 31.47) ng/L, (472.72 ±48.55) ng/L, (88.4±53)% ](P<0.05 or <0.01). Conclusion EIN can attenuate endotoxemia.decrease NF-κB activities and concentrations of cytokines, maintain the balance of pro-and anti-inflammation, improve patients' condition and prognosis.

Objective To investigate the effect of enteral nutrition support on prognosis in patients with severe acute stroke.Methods Ninety-eight cases of severe acute stroke were divided into nutrition supported group(50 cases) and control group(48 cases) randomly.All patients were treated by conventional therapy.Nutrition supported group received high energy nutrition diet and control group received common liquid diet by nasal feeding.The levels of hemoglobin,serum albumin,neurologic impairment score (NIHSS)and the incidence rates of complications were assessed at the 1st,10 th and 21st day after admission.Results Hemoglobin was (122.5 ± 2.4),(106.4 ± 2.8) g/L and serum albumin was (36.5 ± 4.7),(34.2 ± 5.1) g/L at the 21st day after admission in nutrition supported group and control group,and there was significant difference between two groups (P < 0.05).The complication rate in control group was higher than that in nutrition supported group (P< 0.05).NIHSS score was(8.45 ± 3.02) scores in nutrition supported group and (10.24 ± 2.57)scores in control group at the 21st day after admission,and there was significant difference between two groups (P <0.05).Conclusion Early enteral nutrition support can significantly improve nutritional status and decrease the incidence rates of complications in patients with severe acute stroke,and it is helpful for clinical prognosis.

Fast tract surgery (FTS) has been implemented in different fields of surgery to attenuate the surgical stress response and accelerate recovery.Liver resection is the preferred treatment for a variety of primary and secondary liver tumors.However,liver resection is associated with severe stress response and higher rate of postoperative morbidity and mortality.Fast tract surgery has been reported to accelerate recovery following liver resection.In this review,we summarize the recent progress of fast tract surgery in liver resection.

Objective To investigate the clinical manifestations and prognosis of infants less than three months with kawasaki disease (KD).Methods Clinical manifestations,diagnosis,treatment and follow-up of the infants less than 3 months diagnosed with KD and hospitalized from Jan 2009 to Jan 2012 in Capital Institute of Pediatrics were collected and reviewed.Results Fourteen infants less than 3 months were diagnosed as KD during recent 3 years.Among them 8 cases were diagnosed as typical KD,6 cases as incomplete KD.The infants with KD had clinical features as fever longer than 5 d (14/14),cervical lymphadenopathy (11/14),rash (11/14),extremity changes (9/14),mucositis (10/14),conjunctivitis (5/14).Infants with incomplete KD had fever longer than 5 d (6/6) and extremity changes (4/6),cervical lymphadenopathy (3/6),rash (3/6).But fewer infants (2/6) had extremity changes later than 2 weeks.It was difficult to diagnose atypical KD earlier.More than half (8/14) of all the infants with KD had complications,6/14 had damaged liver function.Nearly all the cases (12/14) received intravenous immunoglobulin 1 g/.(kg·d) within 10 d of presentation.The coronary artery lesion was found in 2 infants during hospitalization.2 cases were found to have CAL during the follow-up after discharge from the hospital.The coronary artery lesion of the 4 infants recovered during follow-up.Conclusion Infants less than 3 months have higher rate of incomplete KD.All infants with KD should be followed-up and monitored for the coronary artery lesion.

Blood-brain barrier(BBB)is mainly composed of brain microvascular endothelial cells(BMECs).According to the special cell membrane transport system and the extensive tight junctions,the brain microvascular endothelial cells play an important role in the CNS.Also,there is a close relationship between BMECs and the cerebrovascular diseases,such as cerebral ischemia,cerebral edema,and so on.Therefore,the culture of brain microvascular endothelial cells provides a new tool for studying the cerebrovascular diseases in vitro.The researches in recent years have been reviewed in this test,approaching the cultivation of the rat brain microvascular endothelial cell from the segregation,purification and culture in turns,in order to provide a foundation for the studies of the brain microvascular endothelial cell;in vitro.

Objective To investigate the relationship of cellular immunity of the hand-foot-mouth disease (HFMD) children and the disease severity and the variation following the recovery of disease.Methods A total of 560 HFMD cases was collected,and divided into severe and common groups.Another 120 cases were collected for comparison.T cell subsets (CD3 +,CD4 +,and CD8 +) rates were tested.The difference in cell immunity in each group were compared,and the comparison of cell immunity improv-ment during acute and recovery periods was conducted at the same time.Results In the 560 cases of children with HFMD,CoxA16-positive rate in common group was higher than that in severe group (x2 =280.72,P ＜0.01,severe cases); EV71 and other virus positive rates in severe group were higher than that in common group (x2 =127.75,P ＜ 0.01,x2 =5.43,P ＜ 0.05).Cell immunity was compared among3 groups (t =9.82,4.98,3.06); CD3+,CD4+,CD8+ results,tested within 2h after admission and after 1 week,were compared between severe and common groups (common group t =7.73,3.86,4.71; severe group t =6.13,2.60,3.36).Compared to severe group,cell immunity improvement was more obvious between before and after 1-week treatment in common group (t =2.57,2.51,2.95).The difference was statistically significant (P ＜ 0.05).Conclusions According to the etiology test of children with HFMD,CoxA16-positive rate was higher in common group; EV71 and other virus positive rates were higher in severe group.Cell immunity function decreased in severe and common group at the beginning of the disease; it was,however,significantly restored after 1-week treatment; and it was related to the severity of clinical symptoms.

Objective To evaluate the role of hypoxia inducible factor?1α ( HIF?1α) in reduction of apoptosis in cortical neurons of rats by sevoflurane preconditioning and the relationship with Slit2∕Robo signaling pathway. Methods Primary cortical neurons obtained from neonatal Sprague?Dawley rats were seeded in 6?well (2 ml∕well) or 96?well plates (100 μl∕well) at a density of 1×106∕ml, and randomly divided into 4 groups ( n=24 each ) using a random number table: control group ( C group ) , anoxia?reoxygenation ( A∕R ) group, sevoflurane preconditioning group ( SP group ) and HIF?1α inhibitor 2?methoxyestradiol group ( H group ) . The neurons were subjected to O2?glucose deprivation for 90 min followed by restoration of O2?glucose supply for 24 h. In group SP, the neurons were exposed to 2%sevoflurane for 2 h followed by 5 min washout with phosphate buffered saline for 3 times, and then sevoflurane preconditioning was performed immediately. In group H, sevoflurane preconditioning was performed with 5μmol∕L 2?methoxyestradiol at 72 h of incubation. The apoptosis in neurons was assessed using AnnexinⅤ?FITC∕PI assay, and apoptosis rate ( AR) was calculated. The amount of lactic dehydrogenase ( LDH) released was measured using colorimetric method. The expression of Slit2, Robo1 and Robo4 mRNA and protein was detected by fluorescent quantitative real?time polymerase chain reaction or Western blot. Results Compared with group C, the amount of LDH released and AR were significantly increased, Silt2 and Robo1 mRNA and protein expression was up?regulated, and no significant change was found in Robo4 mRNA and protein expression in A∕R group. Compared with group A∕R, the amount of LDH released and AR were significantly decreased in SP and H groups, and Silt2 and Robo1 mRNA and protein expression was up?regulated, and no significant change was found in Robo4 mRNA and protein expression in SP group. Compared with group SP, the amount of LDH released and AR were significantly increased, and Silt2 and Robo1 mRNA and protein expression was down?regulated in H group. Conclusion HIF?1α mediates reduction of apoptosis in cortical neurons of rats by sevoflurane preconditioning, and the mechanism is associated with Slit2∕Robo1 signaling pathway, but not with Slit2∕Robo4 signaling pathway.

Objective To evaluate the role of hypoxia inducible factor-1α (HIF-1α) in reduction of apoptosis in cortical neurons of rats by sevoflurane preconditioning.Methods Primary cortical neurons obtained from neonatal Sprague-Dawley rats were seeded in 6-well plates (2 ml/well),and randomly divided into 4 groups (n =15 each) using a random number table:control group (C group),anoxiareoxygenation (A/R) group,sevoflurane preconditioning group (SP group) and HIF-1α inhibitor 2-methoxyestradiol group (H group).The neurons were subjected to O2-glucose deprivation for 90 min followed by restoration of O2-glucose supply for 24 h.In group SP,the neurons were exposed to 2.0％ sevoflurane for 2 h followed by 5 min washout for 3 times,and then sevoflurane preconditioning was performed immediately.In group H,sevoflurane preconditioning was performed at 72 h of incubation with 5 μmol/L 2-methoxyestradiol.The apoptosis in neurons was assessed using Annexin V-FITC/PI assay,and apoptosis rate was calculated.The expression of Bid,Bim,Puma and activated caspase-3 in neurons was detected by Western blot.Results Compared with group C,apoptosis rate was significantly increased,and the expression of Bid,Bim,Puma and activated caspase-3 was up-regulated in group A/R.Compared with group A/R,apoptosis rate was significantly decreased,and the expression of Bid,Bim,Puma and activated caspase-3 was down-regulated in group SP.Compared with group SP,apoptosis rate was significantly increased,and the expression of Bid,Bim,Puma and activated caspase-3 was up-regulated in group H.Conclusion HIF-1α mediates reduction of apoptosis in rat neurons by sevoflurane preconditioning,and down-regulated expression of Bid,Bim,and Puma is involved in the mechanism.

Objective To investigate the imaging manifestations of congenital intestinal malrotation. Methods The clinical data of 92 infants with congenital intestinal malrotation admitted from January 1993 to December 2012 were studied retrospectively. All the 92 cases enrolled in this study were diagnosed based on imaging examinations and confirmed surgically. The imaging features of four examinations including plain abdominal radiography, upper gastrointestinal radiography, lower gastrointestinal angiography and ultrasound examination were analyzed. Results The percentage of the infants who presented with the initial clinical symptoms of vomit, blood stool and abdominal dilatation was 87.0%(80/92), 3.3%(3/92) and 1.1%(1/92), respectively, and eight cases [8.7%(8/92)] received prenatal ultrasound, which showed intestinal malrotation. Clinical examination showed no abdominal abnormalities in 68 (73.9%) cases. Seventy-seven cases underwent plain abdominal radiography, revealing intestinal obstruction in 31 cases. Thirty-six cases underwent upper gastrointestinal radiography, which revealed malrotation in 14 cases, and duodenal complete/incomplete obstruction or stenosis in 19 cases. Twenty-two cases underwent lower gastrointestinal angiography, and all of them were diagnosed as malrotation. Seventy-nine cases were examined with abdominal ultrasonography, and 58 cases were diagnosed as malrotation. Conclusions Rational selection of imaging examinations can improve the preoperative diagnosis. When congenital intestinal malrotation is suspected, abdominal ultrasound should be done as the first optional examination. At the same time, plain abdominal radiography should be selected accordingly. When intestinal malrotation with or without midgut volvulus is suggested, surgery should be performed as early as possible. When the diagnosis is not clear, upper or lower gastrointestinal radiography should be done.