ObjectiveTo analyze the characteristics of severe trauma patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), in order to look for the risk factors of AKI and the opportune time for the initiation of RRT on prognosis.Methods A retrospective cohort study involving consecutive patients with severe trauma in emergency intensive care unit (ICU) in the Second Affiliated Hospital of Zhejiang University School of Medicine, from August 2011 to December 2014, was conducted. Inclusion criteria included age≥18 years, injury severity score (ISS)> 16, AKI receiving RRT, and the duration of hospital stay> 24 hours. The general data, the risk factors of AKI, the prognostic indicators, and the information of RRT were recorded. All patients were divided into two groups according to the prognosis, the time of onset of AKI and the initiation time of RRT. The independent risk factors for prognosis were screened by binary logistic regression analysis.Results Seventy-three patients were eligible for enrollment, including 48 deaths (65.8%); 49 patients suffered from AKI≤48 hours after trauma (early stage group), and in 24 patients it was longer than 48 hours (late stage group). In 55 patients RRT was routinely started (routine RRT group), 18 patients underwent RRT ahead of routine criteria decided by the judgment of the attending doctor (earlier RRT group). The main risk factors of RRT in traumatic patients with AKI were shock and sepsis, each accounted for 90.4% and 53.4%. Compared with survival group, in death group, the proportion of male patients was lower (70.8% vs. 100.0%,χ2 = 7.238,P = 0.007), acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were higher (23.7±5.1 vs. 14.4±3.7,t = 8.031,P< 0.001), Glasgow coma score (GCS) was lower [5.0 (3.0, 15.0) vs. 15.0 (8.0, 15.0),U = 320.000,P = 0.001], incidence of shock and sepsis was higher (97.9% vs. 76.0%,χ2 =6.755,P = 0.009; 64.6% vs. 32.0%,χ2 = 7.014,P = 0.008), the rate of use of contrast medium was lower (27.1% vs. 56.0%,χ2 = 5.898,P = 0.015), the time for the diagnosis of AKI post trauma was delayed [days: 2 (1, 5) vs. 2 (1, 2), U = 762.000,P = 0.049], the time for the initiation of RRT post trauma was later [days: 6.0 (3.0, 12.0) vs. 3.0 (2.0, 4.5), U = 868.500,P = 0.002], the recovery rate of renal function at discharge was lower (10.4% vs. 100.0%,χ2 = 54.497, P< 0.001). Compared with late stage group, in early stage group, the mortality was lower (55.1% vs. 87.5%,χ2 =7.509,P = 0.006), and the incidence of sepsis before AKI was also lower (38.8% vs. 83.3%,χ2 = 12.854,P< 0.001). Compared with routine RRT group, the recovery of renal function at discharge was better with a lower mortality rate in the earlier RRT group, but the difference was considered to be insignificant (55.6% vs. 36.4%,χ2 = 2.064,P = 0.151;50.0% vs. 70.9%,χ2 = 2.633,P = 0.105). Logistic regression analysis showed GCS [odds ratio (OR) = 0.852, 95%confidence interval (95%CI) = 0.747-0.972,P = 0.017], shock before AKI (OR = 85.350, 95%CI = 5.682-1 282.073, P = 0.001), and sepsis before AKI (OR = 11.499, 95%CI = 2.127 - 62.161,P = 0.005) were independent risk factors for the judgment of prognosis.Conclusions Shock and sepsis are the major risk factors of RRT in trauma patients with AKI. Shock, sepsis and traumatic brain injury are the independent risk factors of death. Perhaps early initiation of routine RRT cannot improve the outcome of the patients with posttraumatic renal insuficiency.

[Objective]To evaluate the clinical value of surgical treatment of multiple thoracolumbar spinal fractures by pedicle screw/rod Instrumentation system.[Method]Ninteen cases of male 14 and femal 5 of multiple injuries involving thoracic and lumbar spine were surgically treated through anterior approach by open reduction,selective vertebral canal decompression,internal fixation with pedicle screw/Rod spine instrumentation,and followed by anterior lateral bone graft fusion according to complex classification system 19 cases,Ba.m1T_(11) 1 cases,Ba.m.p2T_(11) 2 cases,Ba.m1T_(12) 1 cases,Ba.m.p2T_(12) 1cases,Ba.m.p3T_(12) 1cases,Ba.m1_L 4 cases,Ba.m.p2L_1 3cases,Fa.m.p3(T_(12),L_1) 2cases,Sa.m.p3L_2 1cases,Ba.m.p1L_2 1 cases.[Result]All cases were followed up form 6 to 15 months averageing 10.5 months.No implant failure and late kyphosis deformity was observed.The average vertebra height was improved from preoperative 48.14% to postoperative 92.14%.The postoperative neurological function in two cases of complete spina lcord injuries and 11 incomplete spina lcord injuries were improved according to JOA criterion.Astable bone fusion according to radiological criteria was achieved in call cases postoperatively,and progressive compression did not occur.[Conclusion]Pedicle screw/rod instrumentation system can achieve effective reduction for the fractured vertebrae and simultaneously restore spine stability on the basis of adequate vertebral canal decompression.Posterior spine instrumentation is an ideal choice for surgical treatment of thoracolumbar unstable fractures with or without spinal cord dysfunction.

Objective:To study intervenient action of Qixue Bingzhi Prescription on the patient of cervical atherosclerosis(AS). Methods:63 cases of cervical AS were randomly divided into a treatment group(n=33) and a control group(n=30), with 25 cases of same age ranges used as healthy group. The control group was treated with basic treatment of western medicine and the treatment group with the basic treatment plus Qixue Bingzhi Prescription for one month. Changes of blood lipid metabolism, interleukin levels, supersensitive C-reactive protein(Hs-CRP) content and the leukocyte adherence expression rate were observed. Results: The total cholesterol (TC), triglyceride(TG), AS index (TC/HDL-C), interleukin-6 (IL-6), interleukin-8 (IL-8) and Hs-CRP levels and lymphocytes and the neutrophilic granulocyte adhesion molecule expression rate (ICD11b and zCD11b) decreased significantly(P 0. 05), Conclusion: Qixue Bingzhi Prescription can effectively and safely intervene in blood lipid metabolism and inflammatory reaction in the patient of cervical AS, and it has prospect of development in preventing formation of AS and stabilizing plaque.

Objective To explore the effect of fuzhengyangyingtang (FZYYT) on bone marrow proliferation in aplastic anemia (AA) mice. Methods AA mice models were set up according to Yaojun descriptive method, and then were randomly divided into FZYYT group, CsA group, FZYYT+CsA group, and AA group, each group containing 10 animals. 10 healthy mice served as control. The former three groups were fed with FZYYT, CsA and FZYYT+CsA, respectively, and the last two groups were fed with normal saline. After fed 10 days the changes in hemoglobin(Hb), platelet, BMNC and bone marrow hematopoiesis tissue volume were determined. Resutls Hb, platelet, BMNC and bone marrow hematopoiesis tissue volume obviously increased in groups FZYYT and CsA compared with AA group, and were the highest in group FZYYT+CsA. Conclusion The results indicated that FZYYT was effective in the treatment of AA.

Objective To develop a gas chromatographic (GC)method for simultaneously determination of benzyl alcohol,2-phenoxyethanol,methyl-p-hydroxy benzoate (PHBA-Me?雪,ethyl-p-hydroxybenzoate(PHBA-Et?雪,isooropyl-p-hydroxybenzoate(PHBA-iPr?雪,propyl-p-hydroxybenzoate (PHBA-Pr),isobuty-p-hydroxy benzoate(PHBA-iBu)and butyl-p-hydroxy benzoate(PHBA-Bu)in cosmetics. Methods The 8 kinds of preservatives could be separated completely using the packed column and their peaks were not interfered by the other components in cosmetics. Results The detection limits of were 0.27,0.38,0.78,0.83,0.95,1.40,1.50 and 2.1ng respectively. The linear ranges of benzyl alcohol,2-phenoxyethanol and PHBA-iPr were 25-1 000 mg/L and the linear ranges of PHBA-Me?PHBA-Et?PHBA-Pr?PHBA-iBu and PHBA-Bu were 25-500 mg/L. The recoveries were between 92.6%-101.3% and the relative standard deviations(RSD)were between 2.31%-6.44%(n=6?雪. Conclusion The method was simple,rapid,sensitive and accurate. It was suitable for the detecting of preservatives in cosmetics.

Extraction of teeth is the most basic and widely used operation of oral and maxillofacial surgery. According to characteristics of extraction of teeth, the author views medical ethics principles which in the diagnoses and treatments process from the aspect of medical ethics, they are,①Doctors must intensify their own quality and self - cultivations and establish the idea of " People First ". ②Doctors must carry on the overall and systematic inspection, make the plan of diagnoses and treatments synthetically toimplement the idea of " People First ". ③Doctors should pay attention to interact with patient, meet different patients' demands and create the harmonious medical environment.

Objective To study the efficacy of chemotherapy combined with immunotherapy in treatment of middle and advanced stage non-small cell lung cancer and improvement of patients'life quality.Methods 140 patients with middle and advanced stage non-small cell lung cancer treated from Mar .2012 to Mar.2014 were in-cluded and they were randomly divided into two groups:the observation group(70 cases)and the control group(70 cases).The observation group took chemotherapy combined with immunotherapy , while the control group took chemotherapy treatment alone .Patients'life quality , treatment effects and changes in immune indexes were co-mared between the two groups .Results The improvement rate of life quality of the observation group (90.0%) was significantly higher than that of the control group (58.6%), and the difference had satistical significance (P<0.05).The response rate of the observation group (88.6%) was significantly higher than that of the control group(70.0%), and the difference had statistical significance (P<0.05).The increasement rate of CD3 +, CD4 +, CD8 +cells, as well as CD4 +/CD8 +cells was significantly higher in the observation group than in the control group, and the difference had statistical significance (P<0.05).Conclusion Chemotherapy combined with immunotherapy in teatment of patients with middle and advanced non-small cell lung cancer has obvious effect, high safety, and high clinical value .

BACKGROUND: Cervical lymph nodes are draining region of cornea. It is believed that aqueous fluid goes through a minor pathway named uveoscleral drainage, which will allow passage of antigen-presenting cells (APC) directly to the draining lymph nodes and induce allograft rejection after keratoplasty.OBJECTIVE: To explore the inhibitory effects of cervical lymphadenectomy in alkali induced high-risk corneal transplantation.DESIGN: A randomized controlled animal experiment.SETTING: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University.MATERIALS: The experiment was performed in the State Key Laboratory of Ophthalmology (No. 2006DA105054), Zhongshan Ophthalmic Center, Sun Yat-sen University from May 2005 to February 2007. 144 male animals (1-2 months old) including 104 SD rats and 40 Wistar rats were provided by the animal experimental center of Sun Yat-sen University. Sandwich enzyme-linked immunosorbent assay (ELISA) kits for interleukin-2 (IL-2) and interferon-γ (IFN-γ) were brought from BioSource International company (USA). The animal treatment in the experiment was accorded with the statement in Association for Research in Vision and Ophthalmology (ARVO) for animals.METHODS: With the SD rats as recipients, and Wistar rats as donors, all rats were subjected to corneal allografting. The recipient rats were randomly divided into 4 groups (n=20): group A (control group) which underwent corneal transplantation; group B which was subjected to bilateral cervical lymphadenectomy; group C, corneal transplantation 21 days after the alkali burn injury; group D, cervical lymphadenectomy following group C. The immune rejection of grafts was evaluated by detecting the expression of IFN-γ and IL-2 using ELISA. The time when allograft rejection occurred was recorded and mean survival time (MST) was compared among the groups. The development of corneal inflammation and new vessels was examined by slit lamp microscope and histopathological examination.MAIN OUTCOME MEASURES: ①The development of corneal inflammation after corneal alkaline burns. ②MST of rats in each group following transplant. ③The expression of IL-2 and IFN-γ in grafts of each group. RESULTS: ①Normal rat cornea was transparent without inflammation or neovascularization. There were many inflammatory cells invading to stroma on day 3 after burn. Then, the inflammation of cornea resolved gradually 3 weeks after the burn, but corneal neovascularization reached the peak at that time. Corneal blood vessels regressed completely at the end of 8 weeks after the burn. ②The MST of group A, B, C, and D was (10.40±1.14), (46.30±9.46), (7.00±1.58), and (15.00±3.39) days, respectively. Compared with the group A, the MST of group B was significantly longer (P < 0.05), and the MST of grafts in group D was also significantly longer than group C (P < 0.05). ③The expression of IFN-γ and IL-2 proteins was absent in group B. Compared with group C, the expression of IL-2 and IFN-γ proteins in group D significantly decreased on days 3, 7, 10, and 14 after keratoplasty (P < 0.05). CONCLUSION: Cervical lymphadenectomy therapy can effectively inhibit corneal allograft rejection in normal and high-risk corneal beds after alkali burn injury.

Objective To explore clinical effect of choledocholithotomy by laparoscopy-assisted choledochoelectroscopy and endoscopic retrograde cholangiopancreatography.Methods The clinical data of 126 gallstone and choledocholithiasis patients treated by laparoscopy-assisted choledochoelectroscopy(L group)and endoscopic retrograde cholangiopancreatography(E group)were analyzed retrospectively.In L group,the patients were performed LC and choledocholithotomy by laparoscopy-assisted choledochoelectroscopy directly,but in E group,the treatment procedures were finished by two steps.Firstly,the bile duct stones were carried out by ERCP,days later LC operations were performed.Between the two groups,the hospital days,costs,the rate of residual stone,the rate of bihary infection or panereatitis and the rate of stone recur were compared.Results In the two groups,hospital days were(6.5±0.3)d and(12.5±0.5)d,costs were(1.22±0.17)and(1.98±0.24)ten thousand yuan,the rate of residual stone was 0 and 5.3%,the rate of biliary infection or pancreatitis was 1.4%and 15.8%,and the rate of stone recur was 1.4%and 10.5%respectively.When compared each other the difference was statistically significant(t=2.48,1.96,χ2=4.32,4.90,8.79,all P＜0.05).Conclusion In patients with gallstone and bile duct stones,laparoscopy-assisted choledochoelectroseopy presented more predominances when compared with two steps methods.

Objective The comparison research of protective effect between intravenous infusion injection of safflor yellow and hydroxyl safflor yellow A on acute myocardial ischemia injury in rats. Methods Qualified 60 male Wistar rats were divided into 5 groups at random (12 in each group):Blank control group, AMI model (treated with normal saline) group, intravenous infusion injection of safflor yellow (90 mg/kg) group, HSYA low dosage (20 mg/kg) group and high dosage (40 mg/kg) group. The acute myocardial ischemia injury in rats was induced by ligating the anterior descending coronary artery in Wistar rats and administered different dosage of safflor yellow and hydroxyl safflor yellow A with intraperitoneal injection. Myocardial infarction degree (MID) was calculated by detecting myocardial infarction area with nitroblue tetrazolium(NBT) assay. The changes of ST-elevation, CK-MB, cTnT, SOD activities and MDA contents were detected and analyzed. Results The intravenous injection of safflor yellow and HSYA low dosage group can significantly decreased ST-elevation [difference is (0.087?.022)mv,(0.091?.014)mv],MID[difference is (20.13?.17)%,(18.36+9.38)%], CK-MB [difference is (1460.70+219.73)U/L, (1472.72?85.61)U/L], cTnT[difference is (2.345?.883)ng/ml, (2.358?.843)ng/ml], and MDA [difference is(5.71 ?.67) mmol/ml, (5.76?.84)mmol/ml] contents in serum, increased SOD[difference is(58.27?.99)U/ml,(56.49+5.19)U/ml]activities in serum.Conclusion It showed that intra venous injection of safflor yellow and hydroxyl safflor yellow A had the same protective effect on acute myocardial ischemia injury in rats. Hydroxyl safflor yellow A is an important portion of safflor yellow.