Objective To investigate the early changes of CD4 + T cells and the relevant cytokines in blood of patients with severe trauma.Methods Sixty-one consecutive patients with trauma admitted into the 97th Hospital of PLA from September 2009 to November 2011 were enrolled in this study.The exclusion criteria included:① Patients were younger than 18 or older than 75 years.②Patients received blood transfusion.③Those suffered from immune system disorders,tumors or diabetes,or recent history of virus,bacteria or parasites infections.④ Those had current or recent treatment with corticosteroids or immunosuppressive drugs.According to ISS score ≥ 16,there were 61 traumatic patients divided into mild trauma group and severe trauma group.Seventeen healthy volunteers were taken as control subjects.At admission,the peripheral venous blood samples of patients were taken to count the number of CD3+,CD4 +,CD8 + T cells by flow cytometry and to detect TNF-α,INF-γ,IL-1,IL4,IL-6 and IL-12 levels in plasma by enzyme linked immunosorbent assay,meanwhile the ratio of Th1 / Th2 type cytokine were calculated.Data were analyzed with t test and ANOVA or Kruskal-Wallis test by using SPSS version 16.0package.P value ＜ 0.05 was considered to be statistical significance.Results Compared with control group,mild trauma and severe trauma groups showed a similar decrease in number of CD3 + T cells,and severe trauma group showed a most significant decrease in number of CD4 + T cells.Severe trauma group had a lower INF-γ level compared with control group; IL-1 level in both mild trauma and severe trauma groups were lower than that in the control group; INF-γ/ IL-6 in severe group was significantly lower than that in the mild group.However,INF-γ IL-6 in mild group was higher than that in the control group.Conclusions The early stage of severe trauma exhibits a significant decrease in number of both CD3 + and CD4 +T cells,accompanied by a significant reduction in most of cytokines,and has a tendency of shift to Th2 type cytokine.Therefore,the changes of immune cells should be promptly and successively monitored after severe trauma.

Objective To investigate the impacts of prehospital endotracheal intubation on postoperative pulmonary infection in the patients with severe traumatic brain injury.Methods Retrospectively, the clinical data of 284 patients with severe traumatic brain injury admitted in the 97th Hospital of PLA from July 2007 to December 2012 were analyzed.The patients were classified into two groups according to the timing of endotracheal intubation, namely, prehospital intubation group and admission intubation group.The postoperative pulmonary infection incidence, occurrence time, and the duration of treatment of the two groups were studied.Results The incidences of postoperative pulmonary infection in patients intubated before and after admission were 38.0％ and 25.2％ respectively.Pulmonary infection occurred in the prehospital intubation group was at the (9.9 ± 0.6) d after admission, and in the admission intubation group was at the (11.6 ± 0.3) d after admission.The duration of treatment for postoperative pulmonary infection was (21.2 ± 7.2) days and (14.5 ± 9.0) days respectively.Compared with the patients intubated after admission, patients intubated before admission suffered higher incidence (P ＜ 0.05), earlier onset (P ＜ 0.05), and longer treatment duration of pulmonary infection (P ＜ 0.01).Conclusions Severe traumatic brain injury patients with prehospital endotracheal intubation are more susceptible to pulmonary infection.Avoiding the tracheal injury and bacterial contamination in the procedure could reduce the incidence of pulmonary infection.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.

Objective:To grasp the degree of coordinated development and spatial distribution characteristics of medical service prices,medical service capacity and regional economic level,so as to promote the benign and coordinated development of medical service prices and various systems.Methods:The entropy value method is used to calculate the comprehensive evaluation index of medical service price,medical service capacity and regional economic level in the sample provinces,and the coupling coordination degree model is used to analyze the degree of coupling coordination between medical service price,medical service capacity and regional economic level in the sample provinces,and carry out spatial autocorrelation analysis.Results:The price of medical services was moderately coupled to the capacity of medical services and the level of the regional economy,and there was moderate dependence between the systems;the price of medical services was poorly coordinated with the capacity of medical services and the level of the regional economy;the coordination between the current price of medical services in China and the capacity of medical services and the level of the regional economy did not have a spatial aggregation and radiation effect in space.Conclusion:Coordination between the price of medical services in China and the capacity of medical services and regional economic level needed to be strengthened urgently.Suggestion:The capacity of medical services should be quantitatively evaluated and the formation of medical service prices should be guided,the coordination and linkage between medical service prices and macroeconomic levels should be strengthened,and efforts should be made to enhance the regional equilibrium of China's medical service price policy.