Objective To explore the treat methods in severe head injury (SHI) with brain herniation.Methods 73 patients suffered from SHI with brain herniation, who were undertaken system therapy in every different phase of post-trauma, were analyzed retrospectively.Results There were 17 patients died and 14 patients was GOS Ⅴ grade.Conclusion The systematic therapy in every different phase can enhance the synthetic therapeutic level of SHI and reduce the mortality and elevate the quality of life.

Objective In this paper we analyzed the major risk factors of hemorrhagic fever with renal syndrome(HFRS) as well as its clinical manifestation,so as to provide a basis for clinical diagnosis and effective control of HFRS in Xi'an.Methods The method of retrospective study was used to collect clinical data of hospitalized patients with HFRS between 2005 and 2010 in the Hospitals for Infectious Diseases in Xi'an city,Zhouzhi and Huxian counties and then clinical manifestations of the patients with HFRS were analyzed and classified according to the national standards for clinical symptoms and test indicators of HFRS.HFRS patients matched by the ratio of 1 ∶ 2 healthy human controls were retrospectively investigated in order to obtain risk factors relevant to HFRS incidence using casecontrol study.Odds ratio(OR) method was used for single factor study.While for the multifactor study,we took the conditional Logistic regression approach.We also built models for both studies.Factor with OR ＞ 1 and P ＜ 0.05 was judged to be a risk factor.Results A total of 3090 cases information of patients with HFRS and 6018 healthy controls were collected.Of the 3090 cases of HFRS patients,sixty vaccinated patients showed atypical clinical manifestations and they were mild or moderate cases and no deaths.A total of 3030 nonvaccinated patients had obvious clinical symptoms.Severe or critical cases accounted for 39.07％(1184/3030)and 60 patients died and the fatality rate was 1.98％ (60/3030).The results of single factor Logistic regression analysis showed that of the 16 factors analyzed,the difference of 11 risk factors between the case group and the control group was statistically significant.Multivariate Logistic regression analysis showed that of the 11 factors,the difference of six factors between the case group and the control group was statistically significant.The main risk factors of suffering HFRS in the order were:exposure to rat pollutants,living in the affected areas,sitting or lying on grass fields in the affected areas,working in the affected areas,house rat infestation,and domesticated cats or dogs(OR =6.826,5.764,4.882,4.857,3.126 and 2.875; P ＜ 0.01 or P ＜ 0.05).Conclusions Vaccines are very useful in the sense that vaccinated HFRS patients tend to have mild symptoms and good prognosis.Health education in this area should be focused on the six risk factors in order to prevent the spreading of HFRS.

Objective To study the effect of injection ganciclovir in infants with rotavirus disease.Methods According to age (6 months to 2 years) and typical clinical symptoms in combination with etiologic evidence of rotavirus, 76 patients within 2 days after onset were selected as study subjects. These young children were randomly assigned to two groups according to the hospitalized order.Treated group received intravenous administration of ganciclovir 5～10 mg/(kg?d) once daily for 3 days while control group didn′t receive any antivirus drugs. Rotavirus testing by ELISA on stool samples was performed for every patient on admission and the third day after treatment. Stool sample was collected to a clear box every day in patients with positive results until the reaction was negative.Results The total effective rate after treatment was 88.1% and 61.8% in treated group and the controll group, respectively. There was significant difference between these two groups(?2=20.42 P

Objective To investigate the role and potential mechanism of interleukin-17A (IL-17A) in the inflammatory response to traumatic brain injury (TBI) in rats.Methods The adult male Wistar rats were randomly (random number) divided into seven groups:control group (n =6),sham operation group (n =6),TBI group (n =24),sham operation + normal saline group (n =6),sham operation + Y320 (an immunomodulator acts as an inhibitor of IL-17A) group (n =6),TBI + normal saline group (n =6) and TBI + Y320 group (n =6).The TBI model of rat was established by using free-falling-body impact device.The levels of IL-17A and nuclear transcription factor kappa B p65 (NF-κB p65) in the cerebral cortex were assayed by using Western Blot.The capability of leaming and memory of rats was assessed by Morris water maze.The beam balance test was employed to evaluating the neurological motor performance and the capability of balance.Results Compared with the sham operation group,the levels of IL-17A and NF-κB p65 in the cerebral cortex of TBI,TBI + saline and TBI + Y320 groups increased significantly (P ＜0.05) and peaked at the 3rd day after TBI.Compared with TBI + normal saline group,the level of NF-κB p65 was significantly down regulated by Y-320 (P ＜ 0.05) at the 3rd day after TBI in TBI + Y320 group.The lengths of latency time required for rats to escape to the platform area in TBI + normal saline group were (57.72±3.29) s,(55.63±3.85) s,and (55.02±3.92) sat the3rd,5th and7th days after TBI,respectively;while those in TBI + Y320 group were (35.45 ± 3.04) s,(30.98 ± 2.92) s,and (23.90 ±2.51) s at the 3rd,5th and 7th days after TBI,respectively.Thus,the capability of learning and memory of rats in TBI + Y320 group was improved significantly 3d,5d and 7 days after TBI (all P ＜ 0.01).Conclusions This study shows IL-17A is involved in the process of secondary brain injury after TBI,and associated with inflammation by activating the NF-κB p65 signaling pathway.

Objective To investigate the effect of combined treatment of p15 gene transfection with arsenic trioxide(As_2O_3)on proliferation and apoptosis of human squamous esophageal carcinoma cell line EC109.Methods Plasmid pcDNA3.1(+)-p15 was introdueted into EC109 cell hy the lipo- somes.As_2O_3(2?mol/L)was added to stable transfeeted cells for succedent experiments.The existence of exogenous p15 gene eDNA and the expression of P15 protein were assayed by PCR and Western blotting,respectively.The proliferation and apoptosis were measured by means of MTT,colony forma- tion assay,transmission electron microscopy,The cell cycle and population of apoptosis were measured by flow cytometry.Results After transfection,p15 gene mRNA and protein expressed in EC109 cells. Combined p15 transfection with As_O_3,the EC109 cell growth and colony formation were significantly decreased(P＜0.05,P＜0.01),compared with either p15 transfected group or treated with As_2O_3 group.After combining p15 transfection with As_2O_3 for 3 days,EC109 cell cycle was more arrested at G_1/S.The population of G_1 phase cells was significantly increased(P＜0.05),the population of S phase cells was significantly decreased(P＜0.05),and the population of the apoptosis cells was significantly increased(P＜0.01),compared with either p15 transfected group or treated with As_2O_3 group.More obvious apoptosis was found in the group with combined treatment of p15 gene transfection and As_2O_3 by transmission electron microscope.Conclusion p15 gene transfection combined with As_2O_3 show a signifi- cant effect on enhancing proliferation inhibition and could induce more apoptosis on EC109 cells in vitro.

Objective:To investigate the relationship between the changes in inflammatory markers levels and the onset of post-traumatic stress disorder (PTSD) in the early stage of acute trauma..Methods:From January 2018 to June 2020, patients with acute trauma who were admitted to the Affiliated Hospital of Xuzhou Medical University were selected as subjects. Peripheral venous blood was collected on admission, on the 3rd and 7th day after trauma for routine blood test, C-reactive protein (CRP) and procalcitonin (PCT). The neutrophil to lymphocyte ratio (NLR) was calculated. The PCL-5 scale was used to evaluate PTSD symptoms one month later. The patients were divided into the PTSD group and non-PTSD group with the score of 38 as the boundary. The change rule of NLR in the PTSD group and the non-PTSD group were analyzed.Results:Ninety-one trauma patients were enrolled, including 23 patients in the PTSD group and 68 patients in the non-PTSD group. Compared with the healthy control group, the NLR of 91 trauma patients on admission, on the 3rd and 7th day were significantly higher (all P< 0.01). The NLR of the PTSD group was increased on the 7th day after trauma, which was significantly higher than that of the non-PTSD group ( P= 0.025). The non-PTSD group showed a decreasing trend, of which NLR on the 7th day was significantly lower than that on admission ( P= 0.001). In addition, high level of NLR on the 7th day after trauma (β= 0.206, P= 0.01) was a risk factor for PTSD onset. Conclusions:Dynamic monitoring of the changes in NLR after acute trauma would be of great clinical value to early warning of PTSD.

Objective To investigate the diagnostic value of dual-energy CT pulmonary angiography (DE-CTPA) and dual-energy CT lung perfusion (DE-CTLP) in the assessment of pulmonary embolism comparing with pulmonary ventilation-perfusion scintigraphy. Methods Fifty patients suspected of PE (26 males, 24 females) underwent both DE-CTPA, DE-CTLP and pulmonary ventilation-perfusion scintigraphy. The results were compared and the correlation between the intravascular clots in DE-CTPA and the perfusion defects in DE-CTLP was analyzed. The sensitivity, specificity and accuracy of DE-CTLP for PE were assessed according to scintigraphic results which was considered as a "gold" standard. Result ( 1 ) Of 50 cases,920 segments in 46 cases were diagnostable, 4 cases were not included because of the poor image quality. lntravascular clots were found in 262 segments on DE-CTPA and perfusion defects in 266 segments were identified on DE-CTLP, while 268 segments were positive on scintigraphy. (2) The perfusion defects on DE-CTLP were correlated well with the clots on CTPA ( r = 0. 883, P < 0. 01 ). The Dual energy CT Lung perfusion imaging had a good consistence with scintigraphy (Kappa = 0. 940, P <0. 01 ). The sensitivity, specificity, positive and negative predictive value were 96. 2% (279/290), 98.0%(641/654), 95. 5% (279/292) and 98. 3% (641/652), respectively. (3)The radiation dose of DE-CTPA and CE-CTLP scan was(4. 37 ± 0. 47) mSv by using CareDose 4D technique. Conclusion DE-CTPA and CE-CTLP can provide pulmonary vascular morphology and parenchyma perfusion information which are useful and valuable for the diagnosis of PE.

OBJECTIVETo compare the anti-rotation biomechanical performances of wire and various cable fixation devices currently used in the posterior Brooks instrumentation for atlantoaxial instability.

METHODSIn this experiment,six specimens of the atlantoaxial complex (Occipital-C3) were used. The models of the normal complex,unstable complex (type II odontoid fracture) and fixed complex were established. On the WD-5 mechanics experimental machine,the parameters including the strength and rigidity of anti-rotation were quantified for the normal complex (group N),the atlantoaxial instability complex (group M), the new type Titanium cable (group A), Atlas titanium cable (group B), Songer Titanium cable (group C), stainless wire(group D).

RESULTSThe max strength of A, B, C, D groups was 12.5, 11.3, 11.52, 11.55 N x m respectively, the max rigidity was 58.81, 53.17, 54.11, 54.35 N x cm/deg respectively. The strength and rigidity of anti-rotation, compare to the unstable atlantoaxial complex which were fixed by the new double locking Titanium cable fixation system were superior to those of normal complex, instability complex, Songer or Atlas Titanium cable (P < 0.05).

CONCLUSIONHaving been changed the locking method, the anti-rotation biomechanical characteristics of the new type double locking Titanium cable fixation system are superior or similar to the traditional Songer or Atlas Titanium cable.

Atlanto-Axial Joint ; physiopathology ; surgery ; Biomechanical Phenomena ; Bone Wires ; Humans ; Joint Instability ; physiopathology ; surgery ; Orthopedic Fixation Devices ; Rotation

BACKGROUND: Ischemia-reperfusion injury in the myocardium after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) is an important pathologic basis of post-cardiac arrest of syndrome (PCAS), and apoptosis is one of the major mechanisms in myocardial ischemia-reperfusion injury. To lessen myocardial ischemia-reperfusion injury after cardiac arrest and CPR, it is important to reduce energy consumption and to increase energy supply in the myocardium. This study aimed to observe changes of cell apoptosis and expression of Bcl-2 and Bax protein on the myocardium after CPR in rats, and the protective effects of different doses of exogenous phosphocreatine (creatine phosphate, CP) on them. METHODS: A total of 32 male adult Sprague-Dawley rats were randomly divided into 4 groups: control group (group A), CPR group (group B), low-dose CP group (group C, CP 0.5 g/kg at beginning of CPR and 1.0 g/kg at 2 hours after CPR) and high-dose CP group (group D, CP 1.0 g/kg at beginning of CPR and 2.0 g/kg at 2 hours after CPR). Cardiac arrest was induced by asphyxiation and CPR started at 7 minutes after asphyxiation in groups B, C and D. Myocardium samples were taken at 24 hours after CPR. Cardiomycytic apoptosis was detected by the TdT-mediated dUTP-biotin nick end labeling (TUNEL) method. The expression of Bcl-2 and Bax protein was measured by immunohistochemistry. RESULTS: Cardiomyocytic apoptosis index (AI) and expression of Bcl-2 and Bax protein increased more significantly in groups B, C and D than in group A (P<0.01), but Bcl-2/Baxratio significantly decreased (P<0.01). Cardiomyocytic AI and expression of Bcl-2 and Bax protein decreased more significantly in groups C and D than in group B (P<0.01), but Bcl-2/Bax ratio increased more significantly (P<0.01). Cardiomyocytic AI and expression of Bcl-2 and Bax protein decreased more significantly in group D than in group C (P<0.05), but Bcl-2/Bax ratio increased more significantly (P<0.05). CONCLUSION: Exogenous phosphocreatine, especially at a large dose, could inhibit cardiomyocytic apoptosis and alleviate myocardial injury after CPR in rats.