Objective To observe the influence of intensive insulin therapy on inflammatory fac-tors and prognosis in severe multiple trauma patients.Methods A total of 53 cases of severe multiple trauma were randomly divided into the treatment group(n =27)and the control group(n =26).Besides basic treatment,patients in the treatment group received additional intensive insulin therapy by micro-pump.The level of blood glucose in the control group was controlled under 11.1 mmol/L.Levels of TNF-α,IL-1β,IL-6,and CRP were tested before and after treatment.Multiple organ dysfunction syndrome,noso-comial infection rate,and mortality rate were also observed.Results The levels of TNF-α,IL-1β,IL-6, and CRP in the treatment group were significantly lower than those of the control group(P <0.05 or P <0.01).The incidence of multiple organ dysfunction syndrome,nosocomial infection,and mortality rate in the treatment group was lower(P <0.05).Conclusion Intensive insulin therapy can effectively decrease the expressions of inflammatory factors in patients with severe multiple trauma,improve the prognosis,re-duce the incidence of nosocomial infection and mortality.

Objective To study the role of changes of oropharyngeal microflora in pathogenesis of post-traumatic ventilator-associated pneumonia (VAP). Methods Forty-five patients with post-traumatic VAP treated with intubation and mechanical ventilation were involved in the study.Microbiologic cultures and drug-sensitivity test of oropharyngeal secretions,subglottic secretions,sputum from deep airway and gastric fluid samples were performed at days 1,3,7 and 14 after mechanical ventilation.The stool samples were collected to detect the coccus and bacillus ratio and the fungus.The concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions were compared. Results The main pathogens for VAP patients were gram-negative bacilli.The study showed an increase in aspects of the positive rate of etiology cultures of subglottic secretions,sputum and gastric fluid samples,the concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions and the number of ESBL + and multi-resistant bacteria,along with the prolonged mechanical ventilation. Conclusions The changes of oropharyngeal microflora are closely associated with the development of VAP.The enterobacteria in the gastric cavity always reversely colonize in the oropharynx and the retrograde stomach-pharynx-lower respiratory tract infection is a major infection route of VAP.

After a description of the new connotations of information literacy education in medical undergraduates in the era of omnimedica such as visual information literacy education, media information literacy education and mobile information literacy education, new strategies were proposed for the information literacy education in medical undergraduates in the era of omnimedia, including updating teaching model, adding education contents, and improving omnimedia presentation ability.

Objective To observe the pathomorphological changes and expressions of TNF-α, SOD1 and SOD2 in cardiac tissues of rats with abdominal aorta champing(AAC)and LPS attack.Methods Forty Wistar rats were randomly divided into four groups:sham operated group (Group S),ischemia reperfusion with AAC group(Group I /R),intraperitoneal injection of endotoxin group(Group LPS)and AAC +LPS group(Group I /R +LPS).Animals were sacrificed after 20 minutes of AAC and 8 hours of reperfusion.Cardiac tissues were observed with HE staining for pathmmorphological changes,and detection of TNF-α,SOD1 and SOD2 expressions were tested by immunohistochemistry.Results The mortality rate of Group I /R +LPS was highest.HE staining of the cardiac tissues revealed that the pathological changes of myocardial tissue were not obvious in Group S;myocardial cells were disordered and slightly swollen and red blood cell and inflammatory cells were observed in the intramuscular space of the Group LPS;these injuries were more serious in the Group I /R;the injuries of cardiac tissues were most serious in Group I /R +LPS.The results of immunohistochemical staining revealed that TNF-αexpression level of cardiac tissue increased as followings:Group S,Group LPS,Group I /R and Group I /R +LPS.Significant differences were observed among groups,except for the difference between Group LPS and Group I /R.The expression level of SOD1 decreased as followings:Group S,Group LPS,Group I /R and Group I /R +LPS. Significant differences were observed among groups,except for the difference between Group I /R and Group I /R +LPS.The expression level of SOD2 decreased as followings:Group S,Group LPS,Group I /R +LPS and Group I /R.Significant differences were observed among groups,except for the differences between Group LPS and I /R and Group I /R +LPS.Conclusion The mortality in rats with sepsis after abdominal aorta clamping is high.Obvious myocardial morphological changes and injuries exist either in ischemia reperfusion or sepsis state.At the same time,the expression of TNF-αis up-regulated while SOD1 and SOD2 are down-regulated.

Objective To investigate the effects of different concentrations of ketamine on the apoptosis of cultured spinal dorsal horn neurons and astrocytes induced by glutamate. Methods Newborn Wistar rats (1-3 days old) weighing 10-15 g were used in this study. The animals were anesthetized and the dorsal hom of T11-L5 segment of the spinal cord was separated under sterile condition. The neurons and astrocytes were obtained by trypsin digestion of the tissue and mixed and cultured for 2 weeks. The cells were then randomly divided into 6 groups ( n = 8 each) : control group (C) in which Hank solution 50 ?l was added; glutamate group (G) glutamate was added (the final concentration was 100 ?mol?L-1); ketamine group (K) ketamine was added (final concentration = 1 mmol?L-1) and glutamate-ketamine groups (GK1 , GK2, GK3) glutamate was added first (final concentration was 100 ?mol?L-1) and 30 minutes later ketamine was added (the final concentration was 0.1, 1 or 10 mmol?L-1). After being incubated for 48 h the supernatant was harvested for determination of IL-1? and TNF-? concentrations. The morphological changes of the cells were examined by Wright staining. The apoptotic neurons and astrocytes were detected by flow cytometry.Results The number of apoptotic cells was significantly greater and the concentrations of IL-1? and TNF-? were significantly higher in group G and GK1 than in group C (P

Objective To investigate the effect of propofol on expression of cyclinD1 and apoptosis in spinal cord neurons induced by ischemia-reperfusion (I/R) .Methods Sixty male Wistar rats weighing 200-250 g were randomly divided into 2 groups ( n = 30 each): group A I/R and group B propofol + I/R. The animals were anesthetized with 7% chloral hydrate 6 ml?kg-1. The abdomen was opened and the abdominal aorta was clamped distal to the left renal artery for 20 min. The aortic cross clamp was then released to allow reperfusion. In propofol group propofol 100 mg?kg-1 was administered intraperitoneally (IP) during the operation. Neurologic function was assessed using Taylor scale (0 = unable to move hind limbs, 4 = normal function) at 6 h after operation and on postoperative day 1, 2, 3, 7 (n = 6 at each time point) . The animals were killed after neurologic function evaluation and the spinal cord was removed for microscopic examination, detection of apoptosis in the spinal cord neurons ( TUNEL) and determination of cyclinD1 expression (immuno-histochemistry) . Results The histo-pathological damage to the neurons was significantly lighter, the neurological function better and the apoptotic index and the cyclinD1 expression were significantly lower in propofol group than in I/R group. Conclusion Propofol protects spinal cord against I/R injury by reducing neuronal apoptosis through down-regulation of cyclinD1 expression.

Objective To compare the myocardial damage in patients with severe valvular heart disease undergoing open heart surgery under propofol and sevoflurane combined anesthesia.Methods Thirty-two patients with severe heart valvular disease undergoing open heart surgery were randomized into 3 groups:midazolam group (group M,n =8),propofol group (group P,n =12) and sevoflurane group (group S,n =12).Midazolam 1-5 mg,vecuronium 0.15 mg/kg and fentanyl 10-20 μg/kg were injected intravenously in group M.Propofol 1-2 mg/kg,vecuronium 0.15 mg/kg and fentanyl 10 μg/kg were injected intravenously in group P.In group S,the patients inhaled sevoflurane until the eyelash reflex disappeared,the end-tidal concentration of sevoflurane was 0.5 ％-2.0％,and vecuronium 0.15 mg/kg and fentanyl 10μg/kg were injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with iv infusion of midazolam 0.1 mg· kg-1 · h-1,fentanyl 0.2 μg· kg-1 · min-1,and vecuronium 0.12 mg· kg-1 · h-1 in group M,with iv infusion of propofol 150 μg· kg-1 · min-1 and fentanyl μg· kg-1 · min-1 in group P,or with inhalation of 0.5％-2.0％sevoflurane in group S.CPB was established routinely.The concentration of sevoflurane was 0.5 ％-1.0％ during CPB.Venous blood samples were collected before anesthesia (T1),at 20 min and 2 h after aortic unclamping (T2,3),and at 24 h after operation (T4) for determination of the levels of plasma lactic dehydrogenase (LDH),creatine kinase (CK),creatine kinase MB (CK-MB),cardiac troponin Ⅰ (cTnⅠ),superoxide dismutase (SOD)and tumor necrosis factor (TNF)-α.Myocardial tissues were taken at T2 for determination of heme oxygenase-1 (HO-1) expression and for examination of the myocardial ultrastructure.Results Compared with group M,the levels of plasma LDH,CK-MB,and CK were significantly decreased at T2-4,the levels of plasma SOD and cTnⅠ were significantly increased at T2,3,and the expression of HO-1 was up-regulated at T2 in groups P and S,and the levels of plasma TNF-α were significantly decreased at T2-4 in group P and at T2,3 in group S (P ＜ 0.05).The pathologic changes induced by I/R were less severe in groups P and S than in group M.Conclusion Both propofol and sevoflurane can attenuate the myocardial damage in patients with severe valvular heart disease undergoing open heart surgery and the effects are comparable.

Objective To investigate the protective effect of multidrug resistant associated protein 4 (MRP4) inhibitor on rats with sepsis-induced acute lung injury (ALI). Methods Sixty Sprague-Dawley (SD) rats were randomly divided into sham group, sepsis group and MRP4 inhibitor MK571 treatment group, with 20 rats in each group. Sepsis model was reproduced by cecal ligation and puncture operation (CLP), and the rats in sham group were only received celiotomy without ligation and puncture. Rats in MK571 treatment group were intraperitoneally injected with MRP4 inhibitor MK571 (20 mg/kg) 30 minutes before model reproduction, while rates in sham group and sepsis group were given the same amount of normal saline. Twenty-four hours later, the femoral artery blood of mice was collected, and arterial blood gas analysis was measured. Serum tumor necrosis-α (TNF-α) was determined by enzyme-linked immunosorbent assay (ELISA). The lung tissues were collected, and the wet/dry weight ratio (W/D) was calculated. The expression of MRP4 protein in lung tissue was determined by Western Blot. Results Compared with sham group, arterial blood pH value and arterial partial pressure of oxygen (PaO2) were significantly lowered [pH value: 7.18±0.03 vs. 7.40±0.03; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 63.15±6.24 vs. 98.05±2.58], while arterial partial pressure of carbon dioxide (PaCO2) was dramatically higher in the sepsis group (mmHg: 56.60±8.30 vs. 37.85±3.18), serum TNF-α level in the sepsis group was significantly increased (ng/L: 146.24±19.99 vs. 25.77±9.83), the W/D ratio of lung tissue was significantly increased (7.75±0.47 vs. 4.09±0.58), and the expression of MRP4 protein was up-regulated in the sepsis group (gray value: 0.153±0.006 vs. 0.087±0.005, all P < 0.05). Compared with the sepsis group, arterial blood pH value (7.30±0.02 vs. 7.18±0.03) and PaO2 (mmHg: 80.30±5.34 vs. 63.15±6.24) were significantly elevated in the MK571 treatment group, while PaCO2 was dramatically decreased (mmHg: 29.25±3.24 vs. 56.60±8.30), the serum level of TNF-α was significantly decreased (ng/L: 97.96±16.72 vs. 146.24±19.99), the W/D ratio of lung tissue was significantly reduced (5.89±0.51 vs. 7.75±0.47), and MRP4 protein expression was significantly down-regulated (gray value: 0.124±0.006 vs. 0.153±0.006, all P < 0.05). Conclusion MRP4 inhibitor may improve lung function in rats with sepsis-induced ALI by down-regulating MRP4 protein expression and reducing levels of inflammatory cytokines, which exerts protective effect on ALI.

After a description of the application of education game in literature retrieval teaching and the practical activities of information literacy education game in our library, suggestions were put forward for the problems that need to be concerned in performing information literacy education game, namely pursuing the benefits and avoi-ding the hazards, making entertainment a medium of education, rational application of small game in classroom teaching, taking immediate action, and leaving it undone as it is small.

BACKGROUND: Ketamine is a kind of frequently used general venous anesthesia drug in clinic, and the medication in vein or epidural cavum has analgesic effect. It is N-methyl-D-aspartic acid (NMDA) receptor noncompetitive antagonist, which can inhibit toxic effect of excitatory amino acids.OBJECTIVE: To observe effect of ketamine on apoptosis of dorsal horn astrocytes of spinal cord of rats induced by NMDA receptor over activation and explore its possible mechanism of action.DESIGN: Randomized controlled observation.SETTING: Department of Anesthesiology, Taihe Hospital Affiliated to Yunyang Medical College.MATERIALS: The experiment was conducted at Cell Biology Laboratory,Institute of Basic Medical Sciences, Yunyang Medical College between September 2003 and January 2005. Neonatal Wistar rats of two or three days were provided by Animal Experimental Center of Wuhan University. METHODS: Primary astrocytes in dorsal horn of T11-L6 spinal cord of Wistar rats were purified and cultured. Astrocytes were used in the experiment when its purity coefficient reached 98% assessed by gial fibrillary acidic protein. The cultured cells in 24-well plates were divided randomly into 6 groups (9 portions in each group): ①50 μL Hanks liquor was added into the control group. ②Amount of 100μmol/L was added into the NMDA group. ③Amount of 1 mmol/L was added into the ketamine group. ④100μmol/L NMDA + 0.1 mmol/L ketamine group. ⑤100 μmol/L NMDA + 0.5 mmol/L ketamine group. ⑥100μmol/L NMDA + 1 mmol/L ke tamine group. 1 mmol/L ketamine was clinical antalgic dosage. Activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were examined after 24-hour culture. Content of Bcl-2 protein and change of morphology were observed with immunocytochemistry. Apoptosis of astrocytes was measured with flow cytometry. MAIN OUTCOME MEASURES: ① Counterstain cell staining and changes of morphology of Bcl-2 protein with immunohistochemical method and hematoxylin-esoin staining (HE). ②Apoptosis of astrocytes was detected with flow cytometry. ③Content of MDA and activity of SOD.RESULTS: ①Mean absorbance (A) of Bcl-2 as expression of Bcl-2 protein measured semiquantitatively: It was lower in the 100μmoL/L NMDA group than the control group, which had significant difference [0.054±0.021,0.108±0.039, respectively, P＜0.01]. It was higher in the 100 μmol/L NMDA + 1 mmol/L ketamine group than the 100 μmol/L NMDA group,which had significant difference [0.148±0.045, 0.054±0.021, respectively,P ＜ 0.01]. ②Apoptosis of astrocytes detected with flow cytometry: It was higher in the 100μmol/L NMDA group than the control group, which had significant difference [(25.26±6.13)%, (5.66±2.24)%, respectively, P＜0.01].It was lower in the 100μmol/L NMDA + 1 mmol/L ketamine group than in the 100μmol/L NMDA group, which had significant difference[(24.41±4.82)%, (25.26±6.13)%, respectively, P＜0.01]. ③Content of MDA and activity of SOD: 100 μmol/L NMDA made the content of MDA in astrocytes obviously increase , while the activity of SOD markedly decrease. 1 mmol/L ketamine remarkably decreased the content of MDA, distinctly increased the activity of SOD. This effectiveness had evidently dosage-effect relationship in clinical antalgic dosage, which had obviously difference as compared with that of the NMDA group (P ＜ 0.01 ). The differences between the 1 mmol/L ketamine group and the control group as well as between the 100 μmol/L NMDA + 0.1 mmol/L ketamine group and the NMDA group had insignificant difference.CONCLUSION: NMDA receptor over activation can induce apoptosis of a great number of astrocytes in spinal dorsal horn of rats. Suitable ketamine dramatically inhibits apoptosis, and its mechanism can enhance the expressionof Bcl-2 protein of astrocytes, at the same time inhibit the production of free radical and reinforce the activity of SOD.