In recent years, foreign army researches showed that moral injury emerged in the war had gradually become a new traumatic act to the veterans. How to effectively evaluate and prevent moral injury has drawn exten-sive attention of scholars. This paper introduced and commented the measurement of the foreign army moral injury. At present, foreign measurement scales of moral injury mainly had three kinds of MIES, MIES ( improved ver-sion) , and MIQ-M. Moral injury is the new horizon of ethical research in our country, and it is of great applica-tion prospect to carry out the research on measurement of moral injury.

OBJECTIVETo explore the characteristics of closed abdominal injury in pregnancy women and its treatment.

METHODSThe clinical data of 37 pregnancy patients with closed abdominal injury treated in our hospital from June 1993 to June 2003 were collected and analyzed.

RESULTSAll the 37 patients were treated with operation. Among them 2 early pregnancy patients with intestinal rupture and 1 patient with retroperitoneal hematoma were treated under laparoscope; in other 34 pregnancy patients laparotomy was performed. Of the 34 patients 8 used cesarean section because premature separation of placenta and enlarged womb interrupted the management of intra-abdominal organ injury. In the 37 patients 33 (89.1%) were cured, 4 (10.8%) die, postoperative complication rate was 16.2% (6/37). Two patients (5.4%) suffered from abdominal cavity infection, 3 (8.1%) from pulmonary infection, and 1 (2.7%) had multi-organ failure.

CONCLUSIONSFor pregnancy patients with closed abdominal injury, besides obsteric diseases intra-abdominal injury should be given much attention. Accurate diagnosis and timely treatment can gain the time to save the life of both mother and fetus.

Abdominal Injuries ; diagnosis ; surgery ; Adult ; Female ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy Complications ; diagnosis ; surgery

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.
After-Hours Care ; Asian Continental Ancestry Group ; Education, Medical ; Humans ; Internal Medicine ; Medical Errors ; Patient Safety ; Patient Satisfaction

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.

OBJECTIVETo explore the effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma.

METHODSForty-eight patients with middle or low thoracic esophageal carcinoma underwent Ivor-Lewis esophagectomy. The patients were divided into small incision group (n = 25) and conventional group (n = 23) according to the patients' will. Serum levels of acute phase proteins C reactive protein (CRP), haptoglobin (HPT), α₁-acid glycoprotein (α₁-AG), ceruloplasmin (CER), transferrin (TRF), β₂-microglobulin (β₂-MG), album protein (ALB), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were measured and compared on 1st day before operation, at 18 hours as well as 3rd and 7th day after operation.

RESULTSThere was no significant difference in all the acute phase proteins indicators and IL-6 between the small incision and conventional groups at each time points after operation (P > 0.05). In both groups the levels of CRP, α₁-AG and HPT were significantly higher after operation than before operation (P < 0.05). The levels of ALB and TRF were significantly lower after operation than before operation (P < 0.05). The levels of CER and β₂-MG were not significantly different during perioperative period (P > 0.05). The level of TNF-α was significantly higher in the small incision group than that in the conventional group at the 18 hours postoperationally (P < 0.05), and were not significantly different on the other time points between the two groups (P > 0.05).

CONCLUSIONCompared with conventional operation, the small incision Ivor-Lewis esophagectomy do not significantly alleviate the stress of the surgical trauma in patients. Unchanging the essence of operation, if one is trying to minimize the stress caused by surgery on patients, the key factor is not the size of incision. An effective approach should be found in other operation-related factors.

Acute-Phase Proteins ; metabolism ; Aged ; C-Reactive Protein ; metabolism ; Carcinoma, Squamous Cell ; blood ; surgery ; Ceruloplasmin ; metabolism ; Esophageal Neoplasms ; blood ; surgery ; Esophagectomy ; methods ; Female ; Haptoglobins ; metabolism ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Orosomucoid ; metabolism ; Perioperative Period ; Serum Albumin ; metabolism ; Serum Albumin, Human ; Transferrin ; metabolism ; Tumor Necrosis Factor-alpha ; blood ; beta 2-Microglobulin ; blood

Although ethylene glycol (EG) has been widely used for embryo cryopreservation in domestic animals, few attempts were made to use this molecule to freeze mouse and human embryos. In the few studies that used EG for slow-freezing of mouse and human embryos, complicated protocols for human embryos were used, and the protocols need to be simplified. Besides, freezing mouse morula with EG as a cryoprotectant has not been reported. In this paper, we studied the effects of embryo stages, EG concentration, duration and procedure of equilibration, sucrose supplementation and EG removal after thawing on the development of thawed mouse embryos, using the simple freezing and thawing procedures for bovine embryos. The blastulation and hatching rates (81.92% +/- 2.24% and 68.56% +/- 2.43%, respectively) of the thawed late compact morulae were significantly (P < 0.05) higher than those of embryos frozen-thawed at other stages. When mouse late compact morulae were frozen with different concentrations of EG, the highest rates of blastocyst formation and hatching were obtained with 1.8mol/L EG. The blastulation rate was significantly higher when late morulae were equilibrated in 1.8 mol/L EG for 10 min prior to freezing than when they were equilibrated for 30 min, and the hatching rate of embryos exposed to EG for 10 min was significantly higher than that of embryos exposed for 20 and 30 min. Both rates of blastocyst formation and hatching obtained with two-step equilibration were higher (P < 0.05) than with one-step equilibration in 1.8 mol/L EG. Addition of sucrose to the EG-based solution had no beneficial effects. On the contrary, an increased sucrose level (0.4 mol/L) in the solution impaired the development of the frozen-thawed embryos. In contrast, addition of 0.1 mol/L sucrose to the propylene glycol (PG)-based solution significantly improved the development of the frozen-thawed embryos. Elimination of the cryoprotectant after thawing did not improve the development of the thawed embryos. The cell numbers were less (P < 0.05) in blastocysts developed from the thawed morulae than in the in vivo derived ones. In summary, embryo stage, EG concentration, duration and procedure of equilibration and sucrose supplementation had marked effects on development of the thawed mouse embryos, and a protocol for cryopreservation of mouse embryos is recommended in which the late morulae are frozen in 1.8 mol/L EG using the simple freezing and thawing procedures of bovine embryos after a two-step equilibration and the embryos can be cultured or transferred without EG removal after thawing.
Animals ; Cryopreservation ; methods ; Cryoprotective Agents ; pharmacology ; Dose-Response Relationship, Drug ; Embryo, Mammalian ; drug effects ; physiology ; Embryonic Development ; physiology ; Ethylene Glycol ; pharmacology ; Female ; Mice ; Morula ; physiology ; Pregnancy ; Sucrose ; pharmacology

OBJECTIVETo explore if the autoimmune of anti-labyrinth tissues acts as one of pathogenic cause by observing the inner ear physiological functions and pathological morphology changes of offspring of autoimmune sensorineural hearing loss (ASHL) female guinea pig.

METHODSThe pregnant guinea pigs were immunized with homogeneous inner ear antigens (HIEAg), then, the hearing function were measured with EcochG [inspecting items including acoustic nerve compound action potential (cAP), summation potential (-SP) and cochlear microphone potential (CM)], while the vestibular function were measured with electronystagmography (inspecting items including spontaneous nystagmus and caloric test), inner ear Celloidin section with haematoxylin-eosin dyeing and being inspected under light microscope. The special antibodies in serum and special lymphocyte immune reaction were measured with ELISA and 3H-TdR intermingling lymphocyte transform test in all female guinea pigs and their offspring guinea pigs.

RESULTSIn 7 offspring guinea pigs, 3 animals appeared sensorineural hearing loss. Immuno-inflammation pathologic changes happened in the labyrinth (including the number of bipolar cells reduced and some kind of inflammatory cells infiltrated in spiral ganglion and endolymphatic hydrops et al.), and rise of special antibodies against HIEAg in serum. There were no any obvious abnormity found in non-ASHL pregnant and normal contrastive pregnant guinea pigs and their offspring.

CONCLUSIONSIn this study, some of ASHL female guinea pig's offspring demonstrated different grades of sensorineural hearing loss and inner ear inflammation, and the special humoral and cellular immune reaction against HIEAg, which could be induced by autoimmune inflammation against inner ear tissues antigens with special antibodies (maybe including special cellular immune reaction) from matrix through placental barrier. This result suggests that the factor of autoimmune against inner ear tissue antigens may be one of pathogenic causes inducing non-heritage congenital sensorineural hearing loss.

Animals ; Antigens ; immunology ; Autoimmune Diseases ; pathology ; physiopathology ; Ear, Inner ; immunology ; Female ; Guinea Pigs ; Hearing Loss, Sensorineural ; etiology ; pathology ; physiopathology ; Male ; Pregnancy ; immunology

OBJECTIVETo explore the clustering character of overweight and obesity with multiple cardiovascular disease risk factors such as blood pressure, serum lipids and glucose, and to provide evidence for intervention in childhood.

METHODSA cross-sectional study was conducted on 913 children aged 7-13 years in urban area of Shijiazhuang. Measurements included height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and serum glucose (GLU).

RESULTSOverall prevalence rate of overweight and obesity was 29.24% (boys: 34.98% vs. girls: 24.23%). When compared with normal children, children with overweight or obesity had significantly higher levels of SBP, DBP, TC, TG but low HDL-C. The prevalence rates of high SBP, DBP, TC, TG, GLU and low HDL-C in overweight and obese children were higher than in normal children. After adjusted for gender and age, the odds ratios of overweight and obese children for high SBP, DBP, TC, TG, GLU and low HDL-C were 6.77, 3.22, 2.55, 6.42, 3.85 and 2.94 (95% CI: 4.15-11.04, 1.38-7.49, 1.59-4.11, 3.46-11.92, 1.69-8.78 and 1.83-4.73), respectively. Odds ratios of overweight and obese children holding any one, two or three of the selected six risk factors appeared to be 2.74, 13.15 and 15.33 (95% CI : 1.92-3.92, 6.69-25.87 and 4.17-56.39), respectively.

CONCLUSIONChildhood overweight and obesity increased the clustering of children's risk factors on cardiovascular diseases, as well as increasing the risk of children acquiring multiple cardiovascular disease risk factors. Controlling overweight and obesity would help early prevention on children from getting cardiovascular diseases.

Adolescent ; Blood Glucose ; metabolism ; Blood Pressure ; Cardiovascular Diseases ; prevention & control ; Child ; China ; epidemiology ; Cities ; statistics & numerical data ; Cluster Analysis ; Female ; Humans ; Lipids ; blood ; Male ; Obesity ; blood ; epidemiology ; physiopathology ; Risk Factors ; Schools ; statistics & numerical data

OBJECTIVETo investigate the main components of inner ear antigens inducing autoimmune Meniere's disease (AIMD) in guinea pigs.

METHODSThe guinea pigs were immunized with isologous crude inner ear antigens (ICIEAg). Then, the hearing function was measured with auditory brainstem response (ABR), the vestibular function was measured with electronystagmography (including spontaneous nystagmus and caloric test), and inner ear histopathological changes were observed by inner ear celloidin section with haematoxylin-eosin staining and observed under light microscope. According to these results, the AIMD-model animals from non-AIMD-model ones were distinguished. The special antibodies against ICIEAg in sera were measured with ELISA. The antigen-antibody reactions against different components of ICIEAg were detected by Western blotting with sera of AIMD and non-AIMD guinea pigs respectively. Then, we analysed the contrast between them and found the main components of the ICIEAg that were positive reaction in AIMD guinea pigs and negative reaction in non-AIMD guinea pigs.

RESULTSThe result of ELISA demonstrated that the sera of both the AIMD and non-AIMD guniea pigs contained the special antibodies against ICIEAg after immunized with ICIEAg. The difference of the amount of antibody against ICIEAg between AIMD guinea pig group and non-AIMD guinea pig group was not significant. Western blotting assay showed only the sera of AIMD guinea pig contained the antibodies against the specific antigens with the molecular of 68 000, 58 000, 42 000 and 28 000.

CONCLUSIONSICIEAg contain many different components, the AIMD might only happen in the guinea pigs in which the special immunization against the main components that could induce this kind of disorder appeared. The inner ear antigens with molecular of 68 000, 58 000, 42 000 and 28 000 might be the main components inducing AIMD in guinea pigs.

Animals ; Autoantigens ; immunology ; Autoimmune Diseases ; immunology ; Disease Models, Animal ; Ear, Inner ; immunology ; Guinea Pigs ; Labyrinth Diseases ; immunology

Intercellular adhesion molecule-1 (ICAM-1) is an important adhesion molecule leading to adhesion between cells; NF-kappaB, being universally distributed in the organism, is an important nuclear transcription factor leading to a rapid response to the stimuli. Line of evidence have shown that ICAM-1 transcription and NF-kappaB activation is an important step of inflammatory reaction. To testify that intrapulmonary regulatory peptides modulate inflammatory lesion of bronchial epithelial cells (BECs) through their effect on ICAM-1 expression and nuclear factor kappaB (NF-kappaB) activation, we used immunocytochemistry, RT-PCR, and electrophoretic mobility-shift assay (EMSA) to determine the ICAM-1 expression and NF-kappaB activity in BECs. The effects of NF-kappaB inhibitor MG-132 on ICAM-1 expression were also observed. The results showed that vasoactive intestinal peptide (VIP) and epidermal growth factor (EGF) decreased ICAM-1 expression in O(3)-stressed BECs, while endothelin-1 (ET-1) and calcitonin gene-related peptides (CGRP) increased ICAM-1 expression in resting BECs. MG-132 blocked ICAM-1 expression induced by O(3), ET-1 and CGRP. The results obtained by using EMSA confirmed that VIP and EGF restrained the activation of NF-kappaB in O(3)-stressed BECs; CGRP and ET-1 promoted activation of NF-kappaB. These observations indicate that VIP and EGF abated the injury by means of down-regulatory effects on ICAM-1 transcription and NF-kappaB activation, while ET-1 and CGRP enhanced the inflammation reaction by an up-regulatory effect. It is suggested that a developing and intensive airway inflammation correlates closely with a persistent expression of ICAM-1 and repeated activation of NF-kappaB.
Animals ; Bronchi ; cytology ; Cell Adhesion ; physiology ; Cells, Cultured ; Endothelin-1 ; metabolism ; Epithelial Cells ; cytology ; metabolism ; Humans ; Inflammation ; metabolism ; Intercellular Adhesion Molecule-1 ; metabolism ; NF-kappa B ; metabolism ; Peptides ; physiology ; Rabbits ; Vasoactive Intestinal Peptide ; physiology