Hemodynamic monitoring is a very important measure for critically ill patients with burn and trauma, and it should be carried out throughout the course of treatment. Functional hemodynamic monitoring consists of the assessment of the dynamic interactions of hemodynamic variables in response to a defined volume change. Accordingly, response of fluid volume can be assessed in a quantitative fashion by measuring variation of both arterial pulse pressure and left ventricular stroke volunime during positive pressure breathing, or the change in cardiac output response to passive leg raising maneuver. Functional hemodynamic monitoring, contrary to that of static condition in order to realize dynamic and individual monitoring, is related to response to treatment, and it is a useful complement to static (routine) hemodynamic monitoring. At present, in the care of sepsis, shock, and mechanical ventilation, etc. related to burn injury and trauma, functional hemodynamic monitoring is more and more accepted and applied by medical personnel of ICU in burn and trauma departments. Therefore, further study on functional hemodynamic monitoring should be emphasized and practised.
Blood Pressure ; Burns ; therapy ; Critical Care ; Critical Illness ; Fluid Therapy ; Hemodynamics ; physiology ; Humans ; Positive-Pressure Respiration ; Respiration, Artificial ; Sepsis ; diagnosis ; therapy ; Shock ; diagnosis ; therapy ; Stroke Volume ; Systole

Objective To investigate the dynamic changes in the serum inflammatory cytokines and their association with neurogenic pulmonary edema (NPE) in the patients with severe hand-foot-mouth disease (HFMD).Methods Eighty-nine patients with severe HFMD from March 2010 to December 2012 were recruited in the study.The patients were divided into NPE group and central nervous system diseases (CNSD) group according whether they had NPE.The cytokines,including interleukin (IL)-4,IL-6,IL-10,IL-17,tumor necrosis factor-α (TNF-α) and interferon-γ(IFN-γ)were evaluated by using enzyme-linked immunosorbent assay on day 1,3 and 5 after admission to hospital.Risk factors for NPE involvement during hospital stay were analyzed with multivariate Logistic regression analysis.Results (1) Compared with the CNSD group,the serum levels of IL-6 (Ftime =1.876,P =0.177,Ftime* group =2.192,P =0.145,Fgroup =7.855,P =0.007),TNF-α(Ftime =13.133,P =0.001,Ftime* group =0.291,P =0.592,Fgroup =3.644,P =0.042),IL-10 (Ftime =14.580,P =0.001,Ftime* group =2.612,P =0.078,Fgroup =16.823,P =0.000),INF-γ (Ftime =3.093,P =0.045,Ftime* group =0.513,P =0.600,Fgroup =20.141,P =0.000) were significantly higher than those in NPE group.(2)The serum levels of TNF-α,IL-10,INF-γ rose to the peak on the third day.(3) By using multivariate Logistic regression analysis,age (OR =3.383,95％ CI:1.173-4.759),days of fever (OR =4.925,95％ CI:1.758-3.794),hyperglycaemia (OR =3.465,95％ CI:1.303-5.220),leucocytosis (OR =7.579,95 ％ CI:2.530-12.704) and elevation of IL-10 (OR =1.228,95 ％ CI:1.007-1.523) were entered into equation.In the risk evaluation model,these variables remained independent predictors for NPE.Conclusions Abnormal cytokine productions appear to be responsible for the pathogenesis of NPE,and might be an effective tool for predicting NPE in infants with severe HFMD.

0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group ( P

Objective To analyze behavior of having multiple sexual partners among outside school adolescents and the impact factors in one county.Method Participatory method was adopted in the survey,trainees of an occupational training center were trained to investigate their peers with anonymous questionnaires.Results The subjects who had more than 3 sexual partners accounted for 38.3%,and the factors related to multiple sexual partners were complicated.The most im- portant protective factor was to raise level of HIV/AIDS related knowledge (OR=0.85);the key risk factors were: promiscuous behaviors (OR=4.91) and prostitution(OR=3.37) among their friends.Conclusion For reducing behav- ior of having multiple sexual partners among outside school adolescents,it is essential to promote HIV/AIDS related health education and to enhance their ability to respond to pressures from their bad peers.

Objective To evaluate the indications,techniques and effects of high speed drill assisted cervical pedicle screw-rod system in treatment of cervical interlocking dislocation.Methods A retrospective review was made on data of 13 cases of cervical interlocking dislocation undergone pedicle screw-rod fixation and reduction with assistance of high speed drills from December 2006 to July 2011.Dislocation localized in C3/4 (n =3),C4/5 (n =5),C5/6 (n =4) and C6/7 (n =1) respectively.Causes for injury contained cervical hyperextension due to traffic accidents (n =7) and a fall from the height (n =6).Two remained neurological intact,seven were combined with syndrome of central canal damage,and four had paraplegia.All the 13 cases received posterior pedicle screw fixation and reduction within 7 days after injury.Pedicle screws were implanted on adjacent segment of cervical spine with unlocking the interlocked small joints by a distraction device.Results All 13 cases obtained good reduction,including eight with complete anatomic reduction and five with 1-2 mm of vertebral slight slippage.Fifty-two screws were inserted and 49 pedicle screws were put in place except for the excursion in three pedicle screws on the postoperative radiographic and CT scans.There was no injury of spinal cord,nerve root or vertebral artery during operation.The patients showed significant improvement in sensory and motor function of the upper extremities in the follow-up of 12-36 months.One case had screw breakage at postoperative three months with no nerve symptoms.Conclusion High speed drill assisted pedicle screw-rod system is suitable for treatment of cervical interlocking dislocation,for its reduction process accords with the biomechanics and allows decompression therapy.

Objective To evaluate the mid-and long-term follow-up outcome of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion. Methods Consecutive data of 27 patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent ischemic events during the follow-up period were recorded. The modified Rankin scale(mRS) scores were used and compared between pre-and postoperation. Results All 27 patients except one(96.3%) obtained successful recanalization. After the procedure, 13 patients showed improvement, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4(interquarter range-IR, 2-5) preoperatively and 3(IR, 1-5) on discharge. Five patients suffered from procedural complications and three of them resulted in aggravation. Nineteen patients received imaging follow-up during the median 10 months, 6 restenosis occurred and 3 of them were symptomatic. During median 55 months clinical follow-up after operation, 2 ipsilateral stroke and 2 ipsilateral transient ischemic attack occurred. The mRS scores decreased significantly in the first one year after procedure. Conclusions Revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion can prevent recurrent ipsilateral ischemic event and improve disability recovery in the first one year.

Objective To study collagen changes in dermis of hairless mice that were exposed to ultraviolet. Methods The hairless mice was irradiated under UVA, UVB and the combination of the two for 20 weeks, total dose of UVA was 222J/cm~2, and that of UVB was 5.9J/cm~2. After irradiation, the dorsal skin's collagens of animals were analysed by computer imaging analysis system, histopathologic examination, specific stains and electorn microscopy. Results The hairless mice exposed to ultraviolet A were unchanged in dermis collagen. The hairless mice was irradiated under UVB and the both UVA and UVB, and the content of collagen was decreased with less affinity for collagen staining. These findings were supported by electron microscopy, which showed fraying, thickened, and proliferating collagen, coalesced into extensive denaturalization. The ratio of types Ⅲ/Ⅰ+Ⅲ collagen was significantly increased. Conclusion The qualitative and quantitative changes of the collagen in the ultraviolet irradiated skin of hairless mice are related to ultraviolet B but not to UVA. UVB is a key factor of skin collagen damage in UV-irradiation.

Objective To study the changes of skin wrinkles in hairless mice while exposed to ultraviolet. Methods The hairless mice were irradiated under long-wave ultraviolet ray (UVA), medium-frequency wave ultraviolet ray (UVB) and the combination of the two for 20 weeks. Total dose of UVA was 222J/cm~2, and that of UVB was 5.9J/ cm~2. After irradiation, the skin wrinkling of animals were analysed by the naked eye, dermatoglyphics enlarges and applied color skin system of pathologic portrait quantitative analysis. Results Control group: The hairless mice skin were fine and delicate, the ditch and ridge of skin distributed even, and had no the obvious cornification. Long wave ultraviolet ray (UVA) set: The skin was slightly rough, skin ditch and ridge distributed still even, and had no obvious cornification; quantitative analysis had no the obvious difference from that of control group. Medium-frequency wave ultraviolet ray (UVB) set: The dermatoglyphics were disorderly, and the skin ditch deepened, widened, and the skin ridge increased the breadth and obvious cornification, and quantitative analysis had obvious difference from that of control group. Long wave and medium-frequency wave ultraviolet ray (UVA+ UVB) set: The dermatoglyphics was disorderly, and the skin ditch deepened, widened, the skin ridge increased the breadth, skin cornification was more obvious, quantitative analysis had obvious difference from that of control group. Conclusions The qualitative and quantitative changes of the wrinkles in the ultraviolet irradiated skin of hairless mice are related to ultraviolet B but not to UVA. UVB is a key factor of skin wrinkling in UV-irradiation.

Objective To promote the use of chemical peeling in facial rejuvenation with the phenol and croton oil peeling agents to the UVA/B-irradiated skin of hairless mice, and to provide the experimental evidence for the clinical application of the treatment of irradiated skin.Methods Sixty BALB/C hairless mice were photo-aged by use of chronic ultraviolet A and ultraviolet B irradiation for 20 weeks. After irradiation the animals were randomly divided into two groups:untreated (10 mice) and treated (50 mice). The phenol and croton oil chemical peeling agents were applied to the dorsal skin of treated animal group while it was full anesthetized. Punch biopsies were taken at 7, 14, 30, 60, and 90 days after peel for histological analysis. At 60 days after irradiation, the skin wrinkling of animals were analyzed by macroscopy, cleavage line amplification, and computer imaging analysis system. Results The treated areas of irradiated skin recovered rejuvenation and exhibited a unique connective tissue layer composed of fine collagen fibers beneath the epidermis. Conclusion The mixture of phenol-croton oil may reverses the visible stigmata of photoaging skin. Our results will be of great help to promote the use of chemical peeling in facial rejuvenation.

BACKGROUND: This study was undertaken to determine the effect of mesenchymal stem cells (MSCs) engraftment on vascular endothelial cell growth factor (VEGF) in lung tissue, plasma and extravascular lung water at early stage of smoke inhalation injury. METHODS: A rabbit smoke inhalation injury model was established using a home-made smoke inhalation injury generator, and rabbits were divided into two groups randomly: a control group (S group, n=32) and a MSCs treatment group (M group,n=32). 10 ml PBS was injected via the ear marginal vein immediately at injury into the S group. Third generation MSCs with a concentration of 1×107/10 ml PBS were injected via the ear marginal vein immediately at injury into the M group. VEGF in peripheral blood and lung tissue were measured at 0 (baseline), 2, 4 and 6 hours after injection respectively and analyzed. The right lungs of rabbits were taken to measure lung water mass fraction. RESULTS: In the lung tissue, VEGF decreased gradually in the S group (P<0.05) and signifi cantly decreased in the M group (P<0.05), but it increased more signifi cantly than the values at the corresponding time points (P<0.05). In peripheral blood, VEGF increased gradually in the S group (P<0.05) and markedly increased in the M group (P<0.05), but it decreased more signifi cantly than the values at corresponding time points (P<0.05). CONCLUSION: MSCs engraftment to smoke inhalation injury could increase VEGF in lung tissue, decrease VEGF in plasma and reduce extravascular lung water, indicating its protective effect on smoke inhalation injury.