Objective To investigate the risk factors of trauma induced coagulopathy and its effect on the outcome of ICU patients with severe trauma.Methods Totally 223 severe trauma patients admitted to emergency ICU within 24h after injuring between June,2008 and September,2009 were retrospectively analyzed.Injury severity score (ISS),APACHE Ⅱ score,coagulation function,routine blood test,biochemical test,and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage,or base deficit (BD) ≥ 6 or shock index ≥ 1. Patients were divided into coagulopathy group and non-coagulopathy (control) group according to coagulation function.ISS,APACHE Ⅱ score,the occurrence of hypothermia and hypoperfusion were compared between the two groups.The risk factors of trauma induced coagulopathy were analyzed,and the multivariate logistic regression equation was formulated.Coagulation function and incidence of trauma induced coagulopathy were compared between nonsurvival and survival group.Results Fifty-two of 223 (23.3 ％ ) patients met the criteria of trauma induced coagulopathy.Mortality rate in this group was significantly higher than that in non-coagulopathy group (36.5％ vs 9.4％, P ＜ 0.01 ). Patients in both groups had the comparability in age,sex, injury mechanism and time after trauma.ISS,the incidence of hypothermia,hypoperfusion and severe traumatic brain injury in coagulopathy group were higher than those in non-coagulopathy group ( P ＜ 0.01 ).GCS,hemoglobin,hematocrit,and platelet counts in coagulopathy group were significantly lower than that in noncoagulopathy group (P＜ 0.01).Base deficit ≥6,GCS ≤ 8,and platelet counts were considered as the independent risk factors involved in trauma- induced coagulopathy according to logistic regression in this study.Coagulation function of non-survivors also remarkably attenuated when compared with survival group.Conclusions The incidence rate of trauma induced coagulopathy is high in severe trauma patients admitted to ICU within 24h. Trauma induced coagulopathy correlates well with ISS core,severe traumatic brain injury,shock and hypothermia,and results in high mortality.

Objective To identify the promoter sequence of endothelial-overexpressed lipopolysaccharideassociated factor 1 ( EOLA1) gene and to elucidate the molecular mechanisms controlling EOLA1 expression. Methods A DNA fragment containing 1 723 bp 5' upstream of the EOLA1 gene and the transcription start site was generated by polymerase chain reaction and then cloned into a luciferase reporter gene vector,pGL3-basic. The relative luciferase activities driven by this 5'-upstream fragment and a series of deletion mutants were measured in transiently transfected human ECV304 cells,respectively. At last,the 1 723 bp upstream of the EOLA1 gene was analyzed online with Cluster Buster. Results A fragment 785 bp upstream of the EOLA1 coding region was sufficient to promote transcription. Further deletion analysis of the 785 bp fragment indicated that a 68 bp element from-738 to -676 was important for EOLA1 transcription in ECV304 cells. The 1 723 bp sequence contains binding sites for Sp1 and Myf. Conclusion We map the EOLA1 promoter by deletion analysis and reveal that the proximal region ( -738 to -676 bp) ,which contains binding sites for Sp1 and Myf,is essential for human EOLA1 promoter activity in ECV304 cells.

Objective:To establish the preliminary somatosensory data stratified by gender, age group, and sites in the trigeminal region through standardized quantitative sensory testing on healthy individuals, and to evaluate the effects of gender, age, and sites on somatosensory functions. Methods: The stan-dardised QST battery developed by the German Research Network on Neuropathic Pain consists totally of 13 different parameters. A total of 70 healthy individuals participated. The subjects were stratified into two groups according to age: younger group ( 16 female, 16 male, age 24 -40 years old ) and elder group (20 female, 18 male, age 41-69 years old) . The test was performed bilaterally over the infraor-bital, mental, and hand regions. Results:The preliminary orofacial somatosensory data stratified by gen-der, age group, and sites were presented. Female were more sensitive than male for most of the parame-ters ( P<0 . 05 ) . Age had a significant effect on most of the parameters ( P<0 . 05 ) , the younger group was more sensitive compared with the elder group (P<0. 01) for heat pain threshold (HPT): younger group (38. 07 ± 2. 94) ℃, elder group (39. 85 ± 3. 52) ℃;warmth detection threshold (WDT):youn-ger group (1.40 ±0.74) ℃, elder group (1.89 ±1.14) ℃; mechanical detection threshold (MDT):younger group (0. 73 ± 1. 66) mN, elder group (1. 41 ± 2. 82) mN; pressure pain threshold ( PPT):younger group ( 171. 71 ± 92. 51 ) kPa, elder group ( 196. 36 ± 73. 73 ) kPa; cold pain threshold (CPT):younger group (25. 90 ± 5. 38) ℃, elder group (21. 64 ± 6. 78) ℃; cold detection threshold (CDT):younger group ( -0. 97 ± 0. 55) ℃, elder group ( -1. 36 ± 0. 90) ℃, and wind-up ratio (WUR):younger group (3. 33 ± 2. 20), elder group (2. 67 ± 1. 68). The inverse results were demon-strated for mechanical pain threshold ( MPT ): younger group ( 111. 50 ± 88. 93 ) mN, elder group (104. 49 ± 94. 94) mN;mechanical pain sensitivity (MPS):younger group (6. 96 ± 5. 61), elder group (8.93 ±6.53), and vibration detection threshold (VDT): younger group (7.44 ±0.52) scale, elder group (7.55 ±0.48) scale (P<0.05). Somatosensory function was site dependent (P<0.001), the two trigeminal sites ( infraorbital and mental) were more sensitive than the hand for CDT, HPT, WDT, thermal sensory limen (TSL), MDT, MPT, MPS, and PPT (P <0. 001), but the inverse result was observed for VDT ( P <0 . 001 ) . Conclusion: The preliminary orofacial somatosensory data of Han Ethnicity stratified by gender, age group, and sites were established. The study evaluated the effects of gender , age and sites on orofacial somatosensory functions by employment standardized quantitative senso-ry testing.

AIM:To investigate the effect of capsaicin on lipopolysaccharide ( LPS)-induced activation of cul-tured endothelial cells of mouse aorta in vitro.METHODS:The endothelial cells were isolated from mouse aorta and cul-tured in vitro, and the specific cell markers of the cells were identified by immunofluorescence staining.The cells were stimulated with LPS (100μg/L) combined with or without capsaicin, and the cells and supernatant were collected at 12 h, 24 h and 48 h.The levels of soluble intercellular adhesion molecule 1 ( sICAM-1) , soluble vascular cell adhesion molecule 1 (sVCAM-1) and soluble P-selectin (sP-selectin) in the supernatant were measured by ELISA.The levels of nuclear NF-κB p65 and cytopasmic p-IκBαand IκBαwere detected by Western blotting.RESULTS: Compared with control group, the levels of sP-selectin, sICAM-1 and sVCAM-1 in LPS group were significantly increased (P<0.05), and LPS promoted the expression of sICAM-1 and sVCAM-1 in a time-dependent manner.Compared with LPS group at the same time point, capsaicin inhibited the expression of sP-selectin, sICAM-1 and sVCAM-1 in a dose-dependent manner.Compared with con-trol group, the protein levels of NF-κB p65 and p-IκBαin LPS group at 24 h were significantly increased (P<0.05), while the protein level of IκBαin LPS group at 24 h were significantly decreased (P<0.05).Compared with LPS group, capsaicin decreased the protein levels of NF-κB p65 and p-IκBαand increased the protein level of IκBαin a dose-depend-ent manner.CONCLUSION:Capsaicin has a protective effect on LPS-induced vascular endothelial cell activation, which potentially contributes to the suppression of IκBαdegradation and NF-κB p65 nuclear translocation.

Objective:To explore the prognostic factors of patients with Vibrio vulnificus sepsis. Methods:The clinical data of 67 patients with Vibrio vulnificus sepsis from January 2008 to December 2019 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. Univariate analysis was used to compare the differences in general information, clinical manifestations, admission laboratory indicators, antibiotics and surgery between the death group and the cured group. Then the factors with significant difference in univariate analysis were included in multivariate analysis, and the factors of prognosis were obtained. Results:Univariate analysis showed that there were significant difference in liver disease, admission with hypotension shock, multiple limb injuries; admission leukocytes, platelets, pH value, albumin, lactic acid, aspartate aminotransferase, creatinine, procalcitonin, creatine kinase, activated partial thromboplastin time, prothrombin time between the death group and the cured group (all P <0.05). Multivariate analysis showed that admission lactate ( OR=0.628, 95% CI: 0.461-0.855, P=0.003), albumin ( OR=1.330, 95% CI:1.062-1.667, P=0.013), creatine kinase ( OR=0.999, 95% CI: 0.998-1.000, P=0.016) and admission surgery time ( OR=0.118, 95% CI: 0.015-0.938, P=0.043) were risk factors of the prognosis. Patients with high lactate, creatine kinase and low albumin at admission indicate poor prognosis; patients with admission surgery time≤ 12 h have better prognosis. Conclusion:For the treatment of patients with Vibrio vulnificus sepsis, medical staff should dynamically evaluate these prognostic factors in the early stage, and early surgical treatment should be adopted to improve the prognosis of patients.

ObjectiveToevaluateourrevisedsyndromicalgorithmforthemanagementinpatientswithvaginaldischargeanddetermineitssensitivity,specificity,andpositivepredictivevalue(PPV).MethodsPatientswithvaginaldischargesyndromewereselectedintheirfirstvisitstotwoSTDclinicsinShanghaiandSichuan.Theyweremanagedaccordingtorevisedsyndromicflowcharts.Theetiologyofthesyndromewasdetectedbylaboratorytesting.ThedatawereanalyzedusingEPIINFOV5.0software.ResultsTherewere27(8.1%)patientswithgonorrhea,57(17.1%)withchlamydialinfection,and18(5.4%)withbothinfectionsin334patientswithvaginaldischarge.Thesensitivitywas70.6%,specificity54.7%,PPV40.7%,andnegativepredictivevalue(NPV)80.9%forthediagnosisofgonorrheaand/orchlamydialinfectionbysyndromicapproach.ConclusionThespecificityandPPVforsyndromicmanagementofvaginaldischargearenotsatisfied.Furthervalidationandrevisionareneededforsyndromicapproachesofvaginaldischarge.

Objective To discuss the protective effect of bone marrow mesenchymal stem cell(BMSC)on lung injury induced by vibrio vulnificus sepsis and its mechanism. Methods BMSCs were isolated by whole bone marrow adherent culture from mouse. Male ICR mice were randomly divided into normal saline control group(NS group),normal saline+BMSC control group(NSB group),vibrio vulnificus sepsis group(VV group),vibrio vulnificus sepsis + BMSC group(VVB group)according to random number table,with 40 mice in each group. Sepsis mouse model was reproduced by injecting vibrio vulnificus(1×107 cfu/mL)5 mL/kg through the left side peritoneal cavity, and caudal intravenous injection of BMSC(4×105 cfu/mL)5 mL/kg for intervention after model reproduction. Ten mice in each group were sacrificed at 6,12,24 or 48 hours after injecting vibiro vulnificus,and their lung tissues were harvested. The lung wet/dry(W/D)ratio was calculated. The expression of nuclear factor-κBp65(NF-κBp65)in nucleus was measured by Western Blot. The levels of tumor necrosis factor-α(TNF-α)and interleukins(IL-1β, IL-6)in lung tissue were detected by enzyme-linked immunosorbent assay(ELISA). The pathological changes in lung tissue were observed after hematoxylin-eosin(HE)staining and uranyl acetate-lead citrate staining. Results After vibrio vulnificus injection,lung W/D ratio,the expression of NF-κBp65 in nucleus,and the levels of TNF-α, IL-1β,IL-6 in the lung tissues were significantly increased in VV group compared with those in NS group at all the time points,and peaked at 12 hours. Compared with the VV group,the VVB group had significantly decreased levels of lung W/D ratio,NF-κBp65 expression,and the levels of TNF-α,IL-1β,IL-6,with significant differences at all the time points〔VV group vs. NS group at 12 hours:lung W/D ratio 7.22±0.03 vs. 5.21±0.02,NF-κBp65 expression (glay scale)1.86±0.74 vs. 0.75±0.07,TNF-α(ng/L)433.24±3.23 vs. 106.57±1.21,IL-1β(ng/L)35.64±0.15 vs. 10.64±0.48,IL-6(ng/L)58.84±0.55 vs. 17.69±1.35,all P<0.05;VVB group vs. VV group at 12 hours:lung W/D ratio 6.49±0.06 vs. 7.22±0.03,NF-κBp65 expression(A value)1.16±0.08 vs. 1.86±0.74,TNF-α(ng/L)357.22±3.25 vs. 433.24±3.23,IL-1β(ng/L)27.77±0.59 vs. 35.64±0.15,IL-6(ng/L)38.68±1.29 vs. 58.84±0.55,all P<0.05〕. There were no significant differences in above indexes between NS group and NSB group. In the NS and NSB groups pathological changes were not obvious under light microscopy,in the VV group lung tissue hyperemia and edema was significant,the edema fluid,red blood cells and inflammatory cells also could be seen, and in the VVB group lung damage that mentioned above could be alleviated. In the NS and NSB groups epithelial cell structure of type Ⅰ and type Ⅱ was completed,and the changes were not obvious under the transmission electron microscopy. In the VV group the alveolar walls were damaged significantly,with type Ⅰ epithelial cell cytoplasm swelling,bubbling and rupture,with type Ⅱ epithelial cells visible cytoplasm decrease,cavitation,addiction to osmium lamellar corpuscle emptying,lysosome hyperplasia,microvilli reduction,and in the VVB group the above damage was alleviated. Conclusion Vibrio vulnificus sepsis can cause acute lung damage and edema,and BMSC can down regulate inflammatory cytokines,reduce lung injury caused by vibrio vulnificus sepsis.

Objective To explore the effect of time nursing in patients with gastrointestinal bleeding by endoscopic therapy.Methods A total of 172 gastrointestinal hemorrhage patients by endoscopic therapy in our hospital were randomly divided into two groups, 86 cases in the control group was given routine nursing, and anther 86 cases in the observation group was given time nursing based on the control group, hemostatic effect, re-bleeding rate, hospitalization time and compliance were compared.Results The hematemesis disappeared time, occult blood clearance time and drainage tube cleaning time and hospitalization time in the observation group were shorter than that in the control group, and the differences were statistically significant (P<0.05).The 72 h re-bleeding rate in the observation group was lower, and the bleeding volume was less than that in the control group, the differences were statistically significant (P<0.05).Compliance of reasonable diet, prescribed medication, alcohol control, timely rest in the observation group during the follow-up was better than that in the control group, the differences was statistically significant(P<0.05).Conclusion Time nursing conforms to physiological characteristics of patients with gastrointestinal bleeding by endoscopic therapy, and it can reduce the rate of re-bleeding, shorten the course of disease, and improve the compliance behavior of patients.

Objective To explore the effect of time nursing in patients with gastrointestinal bleeding by endoscopic therapy.Methods A total of 172 gastrointestinal hemorrhage patients by endoscopic therapy in our hospital were randomly divided into two groups, 86 cases in the control group was given routine nursing, and anther 86 cases in the observation group was given time nursing based on the control group, hemostatic effect, re-bleeding rate, hospitalization time and compliance were compared.Results The hematemesis disappeared time, occult blood clearance time and drainage tube cleaning time and hospitalization time in the observation group were shorter than that in the control group, and the differences were statistically significant (P<0.05).The 72 h re-bleeding rate in the observation group was lower, and the bleeding volume was less than that in the control group, the differences were statistically significant (P<0.05).Compliance of reasonable diet, prescribed medication, alcohol control, timely rest in the observation group during the follow-up was better than that in the control group, the differences was statistically significant(P<0.05).Conclusion Time nursing conforms to physiological characteristics of patients with gastrointestinal bleeding by endoscopic therapy, and it can reduce the rate of re-bleeding, shorten the course of disease, and improve the compliance behavior of patients.

Objective: To investigate the effects of mono-carbonyl analogues of curcumin (L6H21) on paraquat (PQ) -induced injury in HK-2 cell line and explore its underlying mechanisms. Methods: Cultured HK-2 cells were challenged by PQ with or without L6H21 treatment. Cell viability and apoptosis were determined by CCK-8 assay and flow cytometry, respectively. Gene expressions and protein levels of apoptotic and inflammatory factors were assessed by RT-PCR, ELISA, and western blot. Intracellular ROS production was detected by DCFH-DA staining. Superoxide dismutase (SOD) and malondialdehyde (MDA) were examined by chemical colorimetry. Results: 1) PQ challenge significantly inhibited HK-2 cells proliferation, which was prevented by L6H21 administration. PQ dramatically induced HK-2 apoptosis evidenced by increasing expressions of caspase-9, caspase-3 and Bax, while decreasing Bcl-2 level. However, PQ induced these apoptotic effects in HK-2 cells were reversed by L6H21. Similarly, PQ exposure obviously enhanced activity of NF-κB and levels of cytokines (TNF-α、IL-6) in HK-2 cells, which was inhibited by L6H21. Furthermore, administration of L6H21 inhibited PQ induced ROS and MDA production, and promoted SOD level in HK-2 cells. Conclusion L6H21 administration inhibits PQ-induced apoptosis in HK-2 cells possibly by reducing inflammation and oxidative damage.