Adolescent ; Adult ; Aged ; Antigens, Human Platelet ; immunology ; Case-Control Studies ; Child ; Female ; Humans ; Immunologic Techniques ; Male ; Middle Aged ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; immunology ; Young Adult

Objective To discuss the application indications of emergency thoracotomy (ET) and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score (ISS) was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases (80 .00% ) manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room (6 cases) and the operative room (29 cases) .The time of admission to surgery in all cases was<30 min .12 cases (34 .29% ) died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases (65 .71% ) survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% (18/23) and 41 .67% (5/12) respectively .The occurrence rate of complications in the survivals was 39 .13% (9/23) .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .

Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.

Objective To assess early diagnosis and treatment experience of colorectal injuries.Methods We retrospectively analyzed the clinical data of 72 patients with colorectal injuries in January 2001 to December 2001.Results In this group of 72 cases,ISS score was 29 ± 18.Forty-five suffered from blunt injuries,27 cases from penetrating wounds,Peritoneal colorectal injuries in 57 cases,extraperitoneal rectal injury in 15 cases.Hemorrhagic shock existed in 28 patients at admission.69 were with multiple injuries.Diagnosis:injury tract probing in 13 cases,digital rectal inspection in 3 cases,microscopy in 1 case,the contrast examination in 2 cases,laparotomy in 53 cases.Treatment:repairment in 46 cases,injuried bowel excision anastomosis in 6 cases,18 cases underwent colostomy.5 cases died postoperatively with ISS score of 43 ± 7,among those 3 cases died of uncontrolled hemorrhagic shock,one of severe craniocerebral injury,one of postoperative SIRS and MODS.Other nonlethal postoperative complications occurred in 13％ (9/67),all were cured.Conclusions Early diagnosis and emergency operation is the key to successful treatment for colorectal injuries.The indication of one stage operation should be strict and accurate.Staged operation should be adopted in cases of extra-abdominal rectal injury.

Objective To investigate the application value of double-tube gastrostomy in the duodenal rupture repair.Methods The retrospective cohort study was adopted.The clinical data of 41 patients who underwent duodenal rupture repair at the Chongqing Emergency Medical Center from January 2005 to January 2015 were collected.Twenty-five patients using Hassan triple-tube gastrostomy technique between January 2005 and December 2009 were divided into the triple-tube (TT) group and 16 patients using double-tube gastrostomy technique between January 2010 and January 2015 were divided into the double-tube (DT) group.Duodenal rupture repair included suture repair,pedicled ileal flap to repair duodenal defect and end to end anastomosis.Patients underwent the regular treatments of anti-infection,antishock,somatostatin inhibition,nutritional support and complications prevention.Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation,and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube.The postoperative complications (duodenal fistula,intraperitoneal infection,incision infection,pulmonary infection and intestinal obstruction),operation method,operation time,volume of blood loss,euteral nutritional tube removal time and duration of hospital stay were observed.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using an independent sample t test.Comparison of count data was analyzed using chi-square test or Fisher exact probability.Results All the 41 patients underwent duodenal rupture repair,including 28 using suture repair of duodenal rupture,8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis,with the intraoperative duodenal decompression and placement of intestinal feeding tube.The operation time was (184 ± 38)minutes in the TT group and (153 ± 37)minutes in the DT group,with a significant difference between the 2 groups (t =2.566,P ＜0.05).The volume of intraoperative blood loss was (1 112 ± 707)mL in the TT group and (1 011 ± 595)mL in the DT group,with no significant difference between the 2 groups (t =0.476,P ＞ 0.05).The proportions of duodenal fistula,intraperitoneal infection,incision infection and pulmonary infection in the TT and DT groups were 3/25 and 1/16,8/25 and 5/16,9/25 and 4/16,10/25 and 6/16,respectively,showing no significant difference between the 2 groups (x2=0.003,0.545,0.026,P ＞ 0.05).Eleven patients were complicated with postoperative early intestinal obstruction,including 10 (3 with partial duodenal stenosis and 7 with incomplete small intestinal obstruction) in the TT group and 1 (partial duodenal stenosis) in the DT group,showing a significant difference in the incidence of postoperative early intestinal obstruction between the 2 groups (P ＜ 0.05).Patients with early intestinal obstruction had remission after conservative treatment of gastrointestinal decompression and fasting.The time of intestinal feeding tube indwelling and duration of hospital stay were (25 ±9)days and (29 ± 9)days in the TT group,(19 ± 9)days and (23 ± 8) days in the DT group,with significant differences between the 2 groups (t =2.188,2.120,P ＜ 0.05).Conclusion Double-tube gastrostomy technique for duodenal rupture repair can simplify the operation procedures and reduce operation time,recovery time and risk of postoperative intestinal obstruction,with a reliable efficacy.

Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to thelethal triadprecursor,and terminate the operation quickly when it happens.

AIMTo investigate the effects of exogenous NO donors sodium nitroprusside (SNP) and 3-morpholinosydnonimine (SIN-1) on automaticity of the rabbit sino-atrial node in vitro and the action mechanism.

METHODSThe intracellular microelectrode technique is used to record the action potentials of rabbit sino-atrial node and APA (amplitude of AP), V(max) (maximal rate of depolarization), VDD (velocity of diastolic depolarization), RPF (rate of pacemaker firing) are analyzed.

RESULTSSNP(10(-5) - 10(-2) mol/L) increased its RPF and VDD dose-dependently. 10(-3) mol/L SNP increased RPF (beats/min) from 163 +/- 10.8 to 195.0 +/- 13.1 increased VDD (mV/s) from 50.3 +/- 9.6 to 70.2 +/- 12.1 (P < 0.01). SIN-1(10(-3) - 10(-2) mol/L) also increased RPF and VDD (P < 0.01).10(-4) mo/L Methylene blue (MB), a blocker of GMP cyclase, prevented the positive chronotropic effect and increasement of VDD induced by 10(-3) mol/L SNP totally (P < 0.01). 2. CsCl (2 mmol/L), a blocker of I(f) prevented the increasement of RPF and VDD in part (P < 0.05). 3. NIF (0.46 micromol/L), a blocker of I(Ca-L, had no significant effects on chronotropic effect and increasement of VDD (P < 0.01).

CONCLUSIONExogenous NO can increase the automaticity of rabbit sino-atrial node in vitro. The chronotropic effect is involved in NO-cGMP pathway and results from increasement of I(f) in the sino-atrial node at least in part; I(ca-L) is unlikely to play a major role in this effect.

Action Potentials ; Animals ; Heart Rate ; Molsidomine ; analogs & derivatives ; pharmacology ; Nitric Oxide ; metabolism ; Nitroprusside ; pharmacology ; Rabbits ; Sinoatrial Node ; drug effects ; physiology

OBJECTIVETo investigate the cardiac effect of interleukin-2 (IL-2) and to explore the underlying mechanism.

METHODSThe video tracking system and spectrofluorometric method were used to measure the cell contraction and intracellular calcium. Fura-2/AM was used as a calcium fluorescence probe. Langendorff perfusion technique was used to determine the effect of IL-2 on the intact heart.

RESULTSCompared with the control group, IL-2 5 U/ml, 50 U/ml significantly decreased cell contraction amplitude [(74.95+/-4.79) vs (98.09+/-5.02)%, (64.30+/-5.24) vs (97.38+/-4.05)%], peak velocity of cell shortening [(70.23+/-4.85)% vs (98.09+/-5.46)%, (61.15+/-5.20)% vs (97.38+/-6.85)%], peak velocity of cell relengthening [(71.22+/-4.79)% vs (98.32+/-6.08)%, (68.16+/-5.24)% vs (97.55+/-5.00)%] and end- diastolic cell length [(88.28+/-5.84)% vs (97.95+/-5.52)%, (84.18+/-6.52)% vs (98.94+/-6.76)%]. IL-2 (5 U/ml, 50 U/ml) also markedly inhibited intracellular calcium transient [(74.94+/-4.90)% vs (98.09+/-3.74)%,(71.00+/-5.28)% vs (97.38+/-5.52)%], and elevated end-diastolic calcium level of ventricular myocytes [(113.91+/-5.93)% vs (100.10+/-3.02)%, (119.09+/-7.12)% vs (100.52+/-6.00)%], which were attenuated by the opioid receptor antagonist naloxone (Nal,10 nmol/L). In the isolated perfused rat heart,when compared with the control group, IL-2 50 U/ml markedly decreased left ventricular developed pressure [(79.91+/-2.18) vs (93.84+/-2.94)mmHg], maximal rate of rise of left ventricular pressure [(2370.7358.29) vs (2591.50+/-62.81)mmHg] maximal rate of fall of left ventricular [-(1460.95+/-38.6) vs -(1634.24+/-54.05) mmHg/s] and heart rate [(217.35+/-10.56) vs (244.52+/-11.23) beats/min], but increased left ventricular end-diastolic pressure (11.44+/-1.02 vs 9.23+/-0.46). Pretreatment with Nal (10 nmol/L) antagonized the cardiac depression and left ventricular end-diastolic pressure elevation induced by IL-2.

CONCLUSIONThe cardiac effect of IL-2 is mediated by opioid receptors on the membrane of cardiomyocytes.

Animals ; Calcium ; metabolism ; Depression, Chemical ; In Vitro Techniques ; Interleukin-2 ; pharmacology ; Male ; Myocardial Contraction ; drug effects ; Naloxone ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Opioid, kappa ; drug effects ; physiology

OBJECTIVETo establish a stable and reliable model of Helicobacter pylori infection in Mongolian gerbil and to observe pathological changes in gastric mucosa from the infected animals.

METHODSMongolian gerbils were randomly divided into six groups infected with H.pylori strain NCTC11637 (n=6, group N), six groups infected with H.pylori clinical strain Y06 (n=6, group Y) and six groups as negative control (n=4, group C). H.pylori suspensions at the concentrations of 2 X 10(8)CFU/ml and 2 X 10(9) CFU/ml of strain NCTC11637 and strain Y06 were prepared with Brucella broth from Columbia agar containing sheet blood. The animals in one group N and in one group Y were orally challenged once with 0.5 ml of 2 X 10(8) CFU/ml H.pylori suspension. The animals in another group N and in another group Y were orally challenged with 0.5 ml of 2 X 10(9) CFU/ml H.pylori suspension for three times at the intervals of 24 hours, respectively. The animals were killed after 2nd, 4th and 6th week of the last infection and the gastric mucosal samples were taken for urease test, bacterial isolation, routine pathological and H.pylori histochemical examinations.

RESULTSInfection rates of the animals in group N and group Y at the 2nd, 4th and 6th week after one challenge were 0%, 0%, 66.7% and 0%, 16.7%, 16.7%, respectively. Infection rates of the animals in groups N and Y at the 2nd, 4th and 6th week after three challenges were 66.7%, 100%, 100% and 66.7%, 66.7%, 100%, respectively. In animals with positive bacterial isolation H.pylori was found to colonized on the surface of gastric mucosal cells and in the gastric pits, and the lamina propria of gastric mucosal was infiltrated with chronic inflammatory cells.

CONCLUSIONBy using H.pylori suspension at high concentration of 1 X 10(9) CFU for multiple times, the orally challenged Mongolian gerbils can be prepared as a stable and reliable H.pylori infection model. H.pylori can colonize in gastric mucosa of the infected animals, and mild inflammation reactions can be seen.

Animals ; Disease Models, Animal ; Female ; Gastric Mucosa ; microbiology ; Gerbillinae ; Helicobacter Infections ; microbiology ; pathology ; Helicobacter pylori ; isolation & purification ; Immunohistochemistry

OBJECTIVETo determine the effects of lactose inducing on the expression of recombinant Helicobacter pylori rUreB and rhpaA, and Escherichia coli rLTB and rLTKA63.

METHODSBIO-RAD gel image analysis system was applied to detect the outputs of the recombinant proteins. SDS-PAGE was performed to measure the target protein expression of recombinant genes at various periods of growth, different lactose concentrations, various inducing temperatures and times. The results of the target protein expression induced by lactose were compared to those by isopropyl-beta-D-thiogalactoside (IPTG).

RESULTSLactose showed higher efficiency to induce the expression of rHpaA, rUreB, rLTB and rLTKA63 than IPTG. The expression outputs of target recombinant proteins induced at 37 degrees C were remarkably higher than those at 28 degrees C. The optimal expression parameters were 0.8 of OD600 value, 50 g/L of lactose, 4 hours of inducing time for rHpaA, and 1.2 of OD600 value, 100 g/L of lactose, 5 hours of inducing time for both the rUreB and rLtB,and 0.8 of OD600 value, 100 g/L of lactose, 4 hours for rLTKA63.

CONCLUSIONLactose, a sugar with non-toxicity and low cost, is able to induce the recombinant genes to express the target proteins with higher efficiency than IPTG.

Adhesins, Bacterial ; biosynthesis ; genetics ; Bacterial Toxins ; biosynthesis ; genetics ; Bacterial Vaccines ; biosynthesis ; genetics ; Enterotoxins ; biosynthesis ; genetics ; Escherichia coli ; genetics ; metabolism ; Escherichia coli Proteins ; biosynthesis ; genetics ; Genetic Engineering ; Helicobacter Infections ; prevention & control ; Helicobacter pylori ; genetics ; metabolism ; Humans ; Lactose ; pharmacology ; Recombinant Proteins ; biosynthesis ; genetics ; Urease ; genetics ; Vaccines, Synthetic ; biosynthesis ; genetics