Objective To investigate the risk factors to acute lung injury based on multiple trauma to provide a theoretical basis for early intervention .Methods The emergency surgical patients with multiple trauma in our hospital from March 2006 to March 2011 were selected .The patients meeting the diagnostic criteria for acute lung injury were taken as the study group and the others as the control group .All patients were enrolled for evaluating the injury severity score (ISS) ,acute physiology and chronic health Ⅱ(APACHE Ⅱ) score and recording smoking ,alcohol abuse ,diabetes mellitus ,number of organ damage ,gastrointestinal bleeding , pulmonary contusion ,diffuse intravascular coagulation (DIC ) ,vomiting ,traumatic shock ,time to correct shock ,blood transfusion . The polymorphism of rs3788853 ,rs13306087 ,rs12709426 of angiotensin-converting enzyme(ACE) gene were analyzed .Results In the study group and the control group ,there were statistical differences in 6 influencing factors of the ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,time to correct shock>6 h(P<0 .05);the gene and genotype frequencies of ACE between the two groups had no statistical difference (P>0 .05);the 6 kinds of influencing factors were risk to acute lung injury based on multi-ple trauma by Logistic regression analysis .Conclusion The ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,long time to correct shock are the risk factors to acute lung injury based on multiple trauma .

Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.

This study examined the anti-hepatitis B virus (HBV) effect of wild-type (WT) vacuolar protein sorting 4B (VPS4B) and its dominant negative (DN) mutant VPS4B-K180Q in vivo in order to further explore the relationship between HBV and the host cellular factor VPS4. VPS4B gene was amplified from Huh7 cells by RT-PCR and cloned into the eukaryotic expression vector pXF3H. Then, the VPS4B plasmid and the VPS4B-K180Q mutation plasmid were constructed by using the overlap extension PCR site-directed mutagenesis technique. VPS4B and HBV vectors were co-delivered into mice by the hydrodynamic tail-vein injection to establish HBV vector-based models. Quantities of HBsAg and HBeAg in the mouse sera were determined by ElectroChemiLuminescence (ECL). HBV DNA in sera was measured by real-time quantitative PCR. Southern blot analysis was used to assay the intracellular HBV nuclear capsid-related DNA, real-time quantitative PCR to detect the HBV-related mRNA and immunohistochemical staining to observe the HBcAg expression in the mouse liver tissues. Our results showed that VPS4B and its mutant VPS4B-K180Q could decrease the levels of serum HBsAg, HBeAg and HBV-DNA. In addition, the HBV DNA replication and the mRNA level of HBV in the liver tissues of treated mice could be suppressed by VPS4B and VPS4B-K180Q. It was also found that VPS4B and VPS4B-K180Q had an ability to inhibit core antigen expression in the infected mouse liver. Furthermore, the anti-HBV effect of mutant VPS4B-K180Q was more potent than that of wild-type VPS4B. Taken together, it was concluded that VPS4B and its DN mutant VPS4B-K180Q have anti-HBV effect in vivo, which helps develop molecular therapeutic strategies for HBV infection.

BACKGROUND:There are most single-center studies about bone marrow stem cels applied to treat decompensated cirrhosis, but the therapeutic results are not ideal. It is possibly related to aging, physical weakness, poor bone marrow hematopoietic function, less available number of stem cels and feeble ability of regeneration and proliferation in liver cirrhosis patients. Umbilical cord mesenchymal stem cels are characterized of easy to obtain, wide source and weak immunogenicity. Co-transplantation of bone marrow stem cels and umbilical cord mesenchymal stem cels may improve the therapeutic effects on decompensated cirrhosis patients. OBJECTIVE:To investigate the efficacy and safety of co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels on decompensated cirrhosis.METHODS:Thirty-two decompensated cirrhosis patients were randomly divided into two groups: in stem cel group, 13 patients received co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels based on regular medical treatment; in control group, 19 patients only underwent the regular medical treatment. Al the patients were folow-up for 1 year. Alanine aminotransferase, albumin, total bilirubin, prothrombin time, Child-Pugh score and Model for End-Stage Liver Disease score, 1-year survival rate, Quality of Life score and adverse reactions related to stem cel therapy were observed and recorded in the two groups at 4, 12, 52 weeks after treatment. RESULTS AND CONCLUSION:At 4, 12, 52 weeks after treatment, improvements in the liver function, prothrombin time, Child-Pugh score and Model for End-Stage Liver Disease score were found in the two groups, but there was no difference between the two groups (P > 0.05). At 4 weeks after transplantation, the clinical symptoms and Quality of Life score in the stem cel group were significantly improved, which were better than those in the control group (P < 0.05). But at 12 and 52 weeks after treatment, no difference was found between the two groups (P > 0.05). In addition, the 1-year survival rate showed no difference between the two groups, and no severe adverse reactions related to stem cel therapy occurred during the folow-up. Co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels is safe and effective to improve the clinical symptoms of decompensated cirrhosis patients. However, further studies with larger samples are warranted to better clarify the co-transplantation effects.

The pathogenesis of HBsAg (+)/HBsAb (+) double positive hepatitis B virus infection was investigated by simulating HBsAg/HBsAb coexistence in vitro and establishing HBsAg/HBsAb double positive model in vivo. Eukaryotic expression plasmids PCI-SY, PCI-adw, PCI-adr, PCI-ayw, which expressed S gene product of different serotypes, were constructed and transfected into HepG2 cells. Recombinant proteins were purified from the transfected cells. At the same time, HBsAg mouse antiserum was obtained by immunizing mice with PCI-SY plasmid. HBsAg/HBsAb coexistence was simulated using these antigens and antiserum. Furthermore, the expression plasmids expressing different serotypes of S gene product including PCI-adw, PCI-adr, and PCI-ayw were injected into mice via tail vein. HBsAg and HBsAb in mice sera were tested at the first and 7th day respectively after antigen plasmids injection. Both in vitro simulation and in vivo animal models demonstrated that HBsAg antigen and HBsAb of the same serotypes could not coexist, but HBsAg antigen and HBsAb of different serotype could coexist. HBsAg/HBsAb double positive hepatitis B virus infection could be due to infection of viruses of different serotypes.

This study examined the anti-hepatitis B virus (HBV) effect of wild-type (WT) vacuolar protein sorting 4B (VPS4B) and its dominant negative (DN) mutant VPS4B-K180Q in vivo in order to further explore the relationship between HBV and the host cellular factor VPS4. VPS4B gene was amplified from Huh7 cells by RT-PCR and cloned into the eukaryotic expression vector pXF3H. Then, the VPS4B plasmid and the VPS4B-K180Q mutation plasmid were constructed by using the overlap extension PCR site-directed mutagenesis technique. VPS4B and HBV vectors were co-delivered into mice by the hydrodynamic tail-vein injection to establish HBV vector-based models. Quantities of HBsAg and HBeAg in the mouse sera were determined by ElectroChemiLuminescence (ECL). HBV DNA in sera was measured by real-time quantitative PCR. Southern blot analysis was used to assay the intracellular HBV nuclear capsid-related DNA, real-time quantitative PCR to detect the HBV-related mRNA and immunohistochemical staining to observe the HBcAg expression in the mouse liver tissues. Our results showed that VPS4B and its mutant VPS4B-K180Q could decrease the levels of serum HBsAg, HBeAg and HBV-DNA. In addition, the HBV DNA replication and the mRNA level of HBV in the liver tissues of treated mice could be suppressed by VPS4B and VPS4B-K180Q. It was also found that VPS4B and VPS4B-K180Q had an ability to inhibit core antigen expression in the infected mouse liver. Furthermore, the anti-HBV effect of mutant VPS4B-K180Q was more potent than that of wild-type VPS4B. Taken together, it was concluded that VPS4B and its DN mutant VPS4B-K180Q have anti-HBV effect in vivo, which helps develop molecular therapeutic strategies for HBV infection.
ATPases Associated with Diverse Cellular Activities ; Adenosine Triphosphatases ; physiology ; Animals ; Endosomal Sorting Complexes Required for Transport ; physiology ; Female ; Genes, Dominant ; genetics ; Hepatitis B ; metabolism ; virology ; Hepatitis B virus ; physiology ; Liver ; virology ; Mice ; Mice, Inbred BALB C ; Mutation ; genetics ; Virus Inactivation

From January 2014 to June 2018, 28 patients with different types of deep soft tissue injury or infection were admitted to the Affiliated Jiangyin Hospital of Medical College of Southeast University; 5 patients were admitted to the Zhengzhou First People′s Hospital. There were 24 males and 9 females, aged 18-89 (40±20) years. Disposable suction tubes with holes cut on side walls were used as self-made drainage tubes. The authors placed the self-made drainage tubes on different deep soft tissue layers and wound surfaces after debridement. The effective drainage sections of the wound surface drainage tubes were wrapped with silver ion antimicrobial functional active dressings. Bio-permeable membrane was used to close the operative area. The drainage tubes in the deep layer of wound and wound surface were connected in parallel by a tee and connected to wall-hanging medical negative-pressure suction device to conduct negative-pressure wound treatment at -20.0 to -10.6 kPa. The deep drainage tubes were usually removed or changed 4 or 5 days after surgery.The drainage tubes in the wound surface were synchronously replaced when removing or replacing he drainage tubes in the deep layer of wound. On 4 to 15 days after surgery, the deep drainage tubes were removed. On 8 to 25 days after surgery, the wound surface drainage tubes were removed. Then the treatment was changed to a conventional dressing change until the wounds were completely healed or the wound bed was ready for skin grafts or tissue flaps. The indwelling time of deep drainage tubes in this group of patients was (6.2±2.8) days, and the indwelling time of wound surface drainage tubes was (12.0±3.0) days. The wound healing time was (22±5) days, the hospital stay time was (29±7) days, and wound bacteria were reduced from 6 species and 11 strains before treatment to 3 species and 4 strains after treatment. No adverse events such as wound bleeding, irritative pain, and chronic sinus occurred during treatment. Twenty-three patients were followed up for 13 to 28 months, no treatment-related complications were observed.

The pathogenesis of HBsAg (+)/HBsAb(+) double positive hepatitis B virus infection was investigated by simulating HBsAg/HBsAb coexistence in vitro and establishing HBsAg/HBsAb double positive model in vivo. Eukaryotic expression plasmids PCI-SY, PCI-adw, PCI-adr, PCI-ayw, which ex-pressed S gene product of different serotypes, were constructed and transfected into HepG2 cells. Re-combinant proteins were purified from the transfeeted cells. At the same time, HBsAg mouse antiserum was obtained by immunizing mice with PCI-SY plasmid. HBsAg/HBsAb coexistence was simulated using these antigens and antiserum. Furthermore, the expression plasmids expressing different serotypes of S gene product including PCI-adw, PCI-adr, and PCI-ayw were injected into mice via tail vein.HBsAg and HBsAb in mice sera were tested at the first and 7th day respectively after antigen plasmids injection. Both in vitro simulation and in vivo animal models demonstrated that HBsAg antigen and HBsAb of the same serotypes could not coexist, but HBsAg antigen and HBsAb of different serotype could coexist. HBsAg/HBsAb double positive hepatitis B virus infection could be due to infection of viruses of different serorypes.

Objective: To evaluate the feasibility and efficacy of a self-made arborizing clinical pathway(ACP)in acute pediatric intussusceptions and appendicitis. Methods: Based on the clinical pathway(CP)-node concept, an ACP electronic template with some CP branches for dealing with significant variations was made, using a doctor-advices package in the CP program of the Clinical Information System in our hospital.From February 2018 through January 2019, children inpatients diagnosed with acute intussusceptions at our hospital accepted the ACP or the conventional CP management respectively according to parity of admitted order. Results: 426 children diagnosed with intussusceptions and 612 children diagnosed with appendicitis were included. After excluding some unqualified samples, 216 intussusception and 302 appendicitis children were enrolled in the observation group respectively which was subject to the ACP, 210 and 310 in the control group subject to the conventional CP. There were no significant differences between the observation and control groups in both diseases about patient demographics and therapeutic approach. The CP implementation-quality differences between the two groups in both diseases were observed and compared. Significant differences were found between the two groups in both diseases about CP completion rate(97.2% versus 90.5% and 97.7% versus 90.1%), the rate of outside-CP doctor′s orders((4.6±1.3)% versus (19.3±5.3)%and(6.1±1.7)%versus (20.3±5.1)%), the hospitalized period((2.7±0.3)d versus (3.2±0.4)d and(5.6±0.4)d versus (6.2±0.5)d), the hospitalization costs and the satisfaction rate. Conclusions ACP belongs to one of compound CPs, is appropriate to use in these solitary diseases with significant variations. ACP can deal with the CP problem of significant variations rooted in the diseases or treatments, thus contributing to promotion and application of CP.

OBJECTIVE：To su mmarize the achievements and shortcomings of chronic disease management policies in China ， and to provide reference for the formulation and improvement of the policy. METHODS ：Totally 109 documents related to chronic disease management issued by the State Council and various ministries and commissions from 2009 to 2020 were processed by text mining method. PMC index evaluation model of chronic disease management policy was established. Sixteen typical chronic disease management policies were quantitatively evaluated and analyzed by 10 first-level indicators and 40 second-level indicators. RESULTS：Among the 16 policies，10 were of excellent level and 6 were of acceptable level. The average PMC score was 7.243， which was generally acceptable level but still had large room for improvement. By comparing two representative policies ，it was found that the main reasons for the policies with low scores were the lack of long-term development planning ，the absence of “Internet + chronic disease management ”new model and other contents ，and the lack of talent incentive and legal guarantee measures. CONCLUSIONS ：Chronic disease management policy has been improved ，and it can be further improved from the aspects of policy prescription ，policy content and incentive mode.