Objective To study the changes in tumor necrosis alpha(TNF ?), interleukin 6(IL 6), procalcitonin(PCT) and C reactive protein (CRP) levels and their values in the prediction and assisting diagnosis of infection complications in severe multiple trauma patients. Methods TNF ?, IL 6 and CRP were measured by enzyme linked immunosorbant assay(ELISA) and PCT was determined by immunoluminometric assay(ILMA) in serial samples of plasma from 34 patients with severe multiple trauma(ISS≥16) and compared with those of 11 normal control volunteers. Patients were divided into 2 groups(infection and non infection groups). The differences of the above parameters between groups were compared. In addition, all data were managed by receiver operating characteristic(ROC), and sensitivity, specificity, negative and positive predictive values for the diagnosis of infection complications were calculated. Results Plasma levels of TNF ?, IL 6, PCT and CRP in multiple trauma patients without infection complications were increased differently in the early posttrauma period. TNF ? and CRP levels in the early posttrauma period before infection were not significantly different from those in patients without infection complications, but they increased significantly following infection. However, during the whole observing period, plasma levels of PCT and IL 6 in the patients with infection complications were higher than those in patients without. The value of those parameters in assisting diagnosis of infection was evaluated. PCT was of the highest specificity and higher negative and positive predictive values. Conclusion All the parameters are of clinical value in infection diagnosis after severe multiple trauma. PCT is the best index for the prediction and assisting diagnosis of infection after multiple trauma.

OBJECTIVETo study the effect of close needling in the treatment of calcifying tendonitis.

METHODSSeventeen patients with calcifying tendonitis who had received close needling treatment were followed-up for 9.3 months on average. An 18-gauge or 16-gauge needle was used during needling. X-ray examination was given 4, 6, 8 and every 4 weeks after needling. SST (simple shoulder test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, constant-Murley score and UCLA score were adopted for evaluation before and after treatment.

RESULTSCalcium deposition disappeared within 4 - 20 weeks mean 9.4 weeks in 15 of the 17 patients after needling for 1 - 3 times. Average ASES score before treatment was 47.7 (34 - 59), forward elevation was 90 degrees (70 degrees - 100 degrees ), external rotation was 15 degrees (0 degrees - 30 degrees ), and internal rotation was L3-4 (L1-buttock). Average constant-Murley score before treatment was 44.6 (34 - 54), UCLA score was 11.6 (8 - 15), and numbers of questions for "yes" in SST questionnaire was 3.4 (2 - 5). After needling the average ASES score was 87.1 (72 - 91), forward elevation was 143.5 degrees (120 degrees - 160 degrees ), external rotation was 40 degrees (30 degrees - 50 degrees ), internal rotation was T(8)-T(9), constant-Murley score was 87.8 (64 - 94), UCLA score was 29.5 (19 - 33), and numbers of questions for "yes" in SST questionnaire was 9.1 (6 - 12). Significant difference was found between before and after needling (ASES: P < 0.01, forward elevation, external rotation and internal rotation: P < 0.01, constant-Murley: P < 0.01, UCLA: P < 0.01, SST: P < 0.01).

CONCLUSIONSClose needling is an effective method for the treatment of calcifying tendonitis. Symptoms and disability are greatly relieved non-surgically in most of patients. Care should be taken in differential diagnosis of degenerative calcification in chronic rotator cuff disease.

Adult ; Aged ; Calcinosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nerve Block ; methods ; Rotator Cuff ; innervation ; Tendinopathy ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo study the changes of partial pressure of brain tissue oxygen (PbtO2) and brain temperature in acute phase of severe head injury during mild hypothermia therapy and the clinical significance.

METHODSOne hundred and sixteen patients with severe head injury were selected and divided into a mild hypothermia group (n=58), and a control group (n=58) according to odd and even numbers of hospitalization. While mild hypothermia therapy was performed PbtO2 and brain temperature were monitored for 1-7 days (mean=86 hours), simultaneously, the intracranial pressure, rectum temperature, cerebral perfusion pressure, PaO2 and PaCO2 were also monitored. The patients were followed up for 6 months and the prognosis was evaluated with GOS (Glasgow outcome scale).

RESULTSThe mean value of PbtO2 within 24 hour monitoring in the 116 patients was 13.7 mm Hg +/- 4.94 mm Hg, lower than the normal value (16 mm Hg +/- 40 mm Hg ) The time of PbtO2 recovering to the normal value in the mild hypothermia group was shortened by 10 +/- 4.15 hours compared with the control group (P<0.05). The survival rate of the mild hypothermia group was 60.43%, higher than that of the control group (46.55%). After the recovery of the brain temperature, PbtO2 increased with the rise of the brain temperature.

CONCLUSIONSMild hypothermia can improve the survival rate of severe head injury. The technique of monitoring PbtO2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy.

Adult ; Blood Gas Monitoring, Transcutaneous ; Body Temperature ; Brain ; metabolism ; Brain Chemistry ; Craniocerebral Trauma ; metabolism ; therapy ; Female ; Humans ; Hypothermia, Induced ; Male ; Oxygen ; metabolism ; Partial Pressure ; Regional Blood Flow ; Treatment Outcome

OBJECTIVE: To study molecular mechanism of suppressive effect of macrophages posttrauma on T cell functions. METHODS: A murine closed trauma model was used, macrophages were harvested from the abdominal cavity and added into the culture system of T cells, which were separated from splenocytes in normal mice using nylon column. T cell functions and intracellular messenger molecules were determined. In addition, the effect of macrophages' removal from splenocytes of traumatized mice on T cell functions and intracellular messenger molecules was investigated. RESULTS: Macrophages posttrauma in vitro could obviously suppress ConA stimulated normal T cell functions such as T lymphocyte transformation, interleukin 2 (IL-2) production, IL-2 receptor alpha (IL-2Ralpha) expression, IL-2 mRNA and IL-2Ralpha mRNA levels, and elevate cAMP contents of activated normal T cells while decreasing cGMP contents, intracellular free calcium ([Ca(2+)]i) concentration and protein kinase C (PKC) activity. Removal of macrophages from splenocytes of traumatized mice could at certain degree reverse the suppression of T cell functions, decrease cAMP contents while increasing cGMP contents, [Ca(2+)]i concentration and PKC activity. CONCLUSIONS: Macrophages posttrauma may suppress T cell functions via altering messenger molecule levels in activated T cells.

BACKGROUNDIt is still controversial whether the serum inhibin B level is a superior predictor of the presence of sperm in testicular sperm extraction (TESE) in azoospermic men compared with serum follicle-stimulating hormone (FSH). In this study, we evaluated the diagnostic accuracy of serum inhibin B levels as a predictor of the outcome of TESE in Chinese non-obstructive azoospermic men and compared it with the traditional marker serum FSH and testicular volumes.

METHODSBasal values of serum hormone levels, testicular volumes and histological evaluation of 305 Chinese non-obstructive azoospermic men were analyzed. The level of inhibin B was measured using a three-step enzyme-linked immunoassay before sperm extraction, and the diagnostic accuracy of prediction of the outcome of TESE was compared for different markers by the receiver operating characteristics (ROC) curve analysis.

RESULTSTesticular sperm was successfully retrieved in 137 of 305 patients (44.9%). The serum level of inhibin B, the FSH and the testicular volume were significantly different between the successful TESE group and the unsuccessful group. According to the ROC curve analysis, for inhibin B, the cut-off value for discriminating between successful and failed TESE was 28.39 pg/ml (sensitivity 83.5%, specificity 79.1%). For FSH, the best cut-off value for discriminating was 11.05 pg/ml (sensitivity 83.5%, specificity 74.5%). The area under the ROC curve of serum inhibin B was similar to that of FSH. Combining the serum inhibin B with FSH levels did not improve the predictive value for successful TESE.

CONCLUSIONSSerum inhibin B and FSH levels are correlated with spermatogenesis. However, inhibin B is not superior to FSH in predicting the presence of sperm in TESE. And the combination of them does not improve the diagnostic accuracy on TESE outcome.

Adult ; Azoospermia ; blood ; Biomarkers ; blood ; Follicle Stimulating Hormone ; blood ; Humans ; Inhibins ; blood ; Male ; Sperm Retrieval ; Spermatogenesis ; physiology ; Testis ; cytology

OBJECTIVE: To determine whether macrophages post trauma have inhibitory effect on normal T cells via direct cell to cell contact. METHODS: A murine amputation injury model was used, macrophages were harvested from abdominal cavity and treated with mitomycin-C to abrogate the secretion of cytokines. Separation of T cells from splenocytes in normal mice was performed using nylon column method. Mitomycin-C treated macrophages from control and traumatized mice were added into the normal T cell culture systems, then various parameters of T cell functions were determined. RESULTS: The production and secretion of interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor (TNF) and prostaglandin E-2 (PGE-2) could be abrogated after macrophages were treated with 25 &mgr;g/mL mitomycin-C for 30 minutes. Mitomycin-C treated macrophages from traumatized mice could obviously suppress T lymphocyte transformation, IL-2 mRNA and IL-2Ralpha mRNA levels, IL-2 production, IL-2Ralpha expression, IL-2 mediated lymphocyte proliferation response of normal T cells, could not affect IL-2-IL-2R interaction but elevated suppressive action of Ts cells. Removal of Ts cells from T cells could almost abolish the inhibition of macrophages. CONCLUSIONS: Macrophages post trauma can suppress T cell functions by depressing IL-2 and IL-2Ralpha gene expression via direct cell to cell contact, and this effect may be mediated mainly by increasing the action of Ts cells.

OBJECTIVETo study the inhibitive effect of exogenous carbon monoxide-releasing molecules 2 (CORM-2) on the activation of Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway in sepsis.

METHODSRAW264.7 cells were divided into normal control group, LPS group (10 mg/mL LPS, the same concentration below), LPS + inactive CORM-2 (iCORM-2) group, LPS + 50 mmol/L CORM-2 group, and LPS + 100 mmol/L CORM-2 group. TNF-alpha level in the supernatant was determined with ELISA, and the phosphorylation levels of JAK1 and JAK3 were determined with Western blot. Thirty-five male BALB/c mice were divided into normal control group, cecal ligation and puncture (CLP) group, CLP + iCORM-2 (8.0 mg/kg) group and CLP + CORM-2 group (8.0 mg/kg) according to the random number table. Mice in CLP + CORM-2 group were treated the same as mice in CLP group except for administration of CORM-2 after CLP. The plasma levels of TNF-alpha, IL-1beta, and the phosphorylation levels of JAK1, JAK3 in liver tissue were determined with ELISA 24 hours post CLP. Data were processed with t test.

RESULTSCompared with that of normal control group [(1.9 +/- 0.3) pg/mL], the TNF-alpha level [(8.2 +/- 2.7) pg/mL, t = 2.844, P < 0.01] and phosphorylation levels of JAK1, JAK3 in LPS group increased significantly; while TNF-alpha levels in LPS + 50 mmol/L CORM-2 and LPS + 100 mmol/L CORM-2 groups decreased obviously as compared with that of LPS group [(5.7 +/- 1.4), (3.2 +/- 0.9) pg/mL, with t value respectively 2.104 and 2.363, P values all below 0.05], and it was the same with phosphorylation levels of JAK1, JAK3 in a dose-dependent manner. Compared with those of normal control group, plasma levels of TNF-alpha and IL-1beta and phosphorylation levels of JAK1, JAK3 in liver tissue significantly increased in CLP group (with t value respectively 2.916 and 2.796, and P values all below 0.05); while plasma levels of TNF-alpha and IL-1beta and the phosphorylation levels of JAK1, JAK3 in liver tissue decreased significantly in CLP + CORM-2 group (with t value respectively 2.115 and 2.398, and P values all below 0.05).

CONCLUSIONSExogenous CORM-2 can obviously inhibit the phosphorylation of JAKs molecules and then inhibit the activation of JAK/STAT signal pathway in sepsis, and decrease the expression of downstream cytokines to effectively prevent cascade reaction in the inflammatory response after severe infection.

Animals ; Carbon Monoxide ; pharmacology ; Cells, Cultured ; Interleukin-1beta ; blood ; Janus Kinase 1 ; metabolism ; Janus Kinase 3 ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Organometallic Compounds ; pharmacology ; Phosphorylation ; Sepsis ; metabolism ; Signal Transduction ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVEThe indication, surgical techniques and results had been discussed through clinical analysis of percutaneous pinning for the treatment of proximal humerus fractures.

METHODSForty-nine patients with 49 shoulders treated with percutaneous pinning had been reviewed with a mean follow-up period of 16.9 months. All were acute fractures, with a mean age of 40.4 years. There were 39 2-part surgical neck fractures, 6 impacted 2-part greater tuberosity fractures and 4 valgus-impaction 4-part fractures. SST (Simple Shoulder Test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for final evaluation at the latest follow-up.

RESULTSThe mean ASES score was 91.4, the mean VAS score was 1.7, the mean forward flexion was 146.7 degrees, external rotation 39.6 degrees, internal rotation at T(8)-T(9) level; the mean Constant-Murley score was 88.2; the mean UCLA score was 31.2; the mean number of questions for "yes" in SST questionnaire was 10.1. All fractures healed with a mean period of 8.8 weeks. No patient had been found for any evidence of humeral head necrosis at the latest follow-up The total satisfaction rate for pain relieve was 95.9% (47/49), and for functional recovery was 91.8% (45/49).

CONCLUSIONSMost 2-part surgical neck fractures, impacted 2-part greater tuberosity fractures and 4-part valgus-impaction fractures are good indications for percutaneous pinning. With appropriate and intense rehabilitation, satisfactory results can be expected in percutaneous pinning for the treatment of certain types of proximal humerus fractures.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged ; Shoulder Fractures ; surgery ; Treatment Outcome

Objectives To explore the effects of visual tasks added in physical activities on kinetic and static visual acuity for 6-9 years old children.Methods Children's visual function and seeing activity were analyzed and four kinds of physical activities with visual tasks were designed. From June to August, 2018, 38 pupils from a sports summer camp aged 6 to 9 years with normal vision participated in the eight-week training. Their kinetic and static visual acuity was measured before, four weeks, and eight weeks after training.Results Both kinetic and static visual acuity improved after training (F＞ 24.368, P ＜ 0.001), and the binocular static visual acuity improved more in the boys than in the girls (t＞ 2.161, P ＜ 0.05). There was a moderate positive correlation among kinetic and static visual acuity (r＞ 0.424, P ＜ 0.01).Conclusion Physical activities with visual tasks are beneficial for kinetic and static visual acuity for children aged 6-9 years, which may be an approach to promote vision health.