The origin, distribution, anastomoses and variations of the arteries of medulla oblongata were observed on 110 Chinese adult brains. The internal arteries and their territories were observed on 20 brains by artereography and clearing method (Spalteholz's technic). The results were as follows: The arteries of medulla oblongata could be divided into four groups according to their distribution. The arteries of the anteromedian and anterolateral groups arose from the anterior spinal artery, and also from the vertebral artery and basilar artery. The arteries of the lateral group contained a series of small arterial rami, which arose from the vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery and basilar artery. The arteries of the posterior group arose from the posterior spinal artery and posterior inferior cerebellar artery. The arteries of each group branched and penetrated into the medulla, they ramify into fine branches, and the capillary network was formed. The internal anteromedian arteries supplied the hypoglossal nucleus, medial lemniseus etc. The internal anterolateral arteries supplied chiefly pyramidal tract. The internal posterior arteries supplied the gracile and cuneate nuclei. The internal lateral arteries supplied the rest of the areas which include reticular formation, dorsal nucleus of the vagus nerve etc.. The arterial supply of the medullary lateral area and the endartery were discussed.

The arteries of 5 human brainstems were injected by using a mixture of preparedchinese ink and gelatin.The capillary densities of 20 various nuclei and tracts inthe medulla oblongata were observed and measured in 300?m and 150?m serial trans-verse sections.The tracts are less vascularized than nuclei.The nuclei have been divided intohigh,medium and low three groups according to their capillary densities.The highdensity nuclei consist of accessory cuneate nucleus,inferior olivary nuclear complex,medial vestibular nucleus,nucleus cuneatus.The medium density nuclei are lateralreticular nucleus,nucleus supraspinalis,hypoglossal nucleus and nucleus gracilis.Thelow density nuclei are dorsal vagal nucleus,spinal trigeminal nucleus,nucleus ofsolitary tract.The pyramidal tract has the lowest density among the tracts observed.

Objective To determine the effect of low power He Ne laser irradiation on expression of myocardial VEGF in precordial region of wistar rat. Methods VEGF expression in myocardium was studied by immunohistochemical methods,RT PCR and computer image analysis.Sixteen rats were divided equally into control and irradiated groups.He Ne laser (632 8?nm)was applied with the dose of 60 5?J/cm 2 in the irradiated group. Results The stain of VEGF immunohistochemistry of myocardium in irradiated group was stronger than that of in control group.The optic density in irradiated group(0 246?0 015)was higher than that of control group(0 218?0 012,P

Objective To study the clinical topography of lateral ligament of the rectum.MethodsDissection in the mesorectal plane was performed on cadavers of semi-pelvis sectioned in the sagittal plane. Results Ten of 14 semi-pelvises had substantial connective tissue between the mesorectum and the pelvic side wall. Eight of 10 lateral ligaments had middle rectal artery. Six of 8 middle rectal arteries run in the lateral ligament. The median height of the lateral ligament above the denticulate line was 14 mm (ranging 10～44 mm). Eight of 12 surgical cases had lateral ligament bilaterally, the remaining had lateral ligament unilaterally. Histologically the lateral ligament was composed of connective tissue. It consisted of vessel and nerve. The outer diameter of vessel in the lateral ligament was no more than 1.5 mm. Conclusions 1. The lateral ligament of the rectum presents in most people. The site and structure of lateral ligament was not constant, especially in vascular tissue. 2. Half of the cadavers have middle rectal artery. The rectal artery was tiny. Most of middle rectal artery runs in the lateral ligament. 3. The nerve in the lateral ligament was the part of rectal nerve plexus.

Objective:To investigate the application of combined distractor in the treatment of refractory distal radius fractures.Methods:From March 2018 to February 2020, the data of 32 patients with refractory distal radius fractures treated with combined distractor-assisted reduction were retrospectively analyzed. The propensity score matching method was used to establish a non-distractor group according to 1∶1 matching, with a total of 32 patients. In the distractor group, there were 15 males and 17 females, age 54.9 ±15.8 years (range, 18-77). According to AO classification, 3 cases were A3, 3 cases were B3, 16 cases were C2, 10 cases were C3. In the non-distractor group, there were 12 males and 20 females, age 59.7±14.8 years, 4 cases were A3, 5 cases were B3, 12 cases were C2 and 11 cases were C3. Main measures: surgical time, radial height, palm inclination, ulnar deviation, range of motion of the wrist, visual analogue scale (VAS), and functional assessment using disability of arm, shoulder and hand (DASH) and modified Mayo wrist score (MMWS).Results:A total of 64 patients were included in this study, and all patients successfully completed the operation and were followed up for 12-54 months, with an average of 17.8 months. The operative time of the distractor group was 91.2±14.6 min, which was significantly lower than that of the non-distractor group 137.6±27.3 min, and the difference was statistically significant ( t=8.48, P<0.001); the radial height in the distractor group 11.5±1.4 mm was significantly higher than that in the non-distractor group 10.6±1.3 mm, and the difference was statistically significant ( t=2.59, P=0.012). At the last follow-up, there were no statistically significant differences in the palm inclination 7.9°±4.4° vs. 7.5°±3.5°, ulnar deviation 23.3°±5.7° vs. 22.3°±4.5°, wrist flexion 63.2°±15.3° vs. 62.6°±11.1°, dorsiflexion 63.5°±10.7° vs. 62.4°±15.2°, pronation 69.2°±11.8° vs. 67.0°±11.0°, supination 73.1°±10.4° vs. 72.0°±8.7°, VAS 0.8±0.5 points vs. 0.9±0.7 points, DASH score 12.9±6.6 points vs. 13.4±7.0 points amd MMWS 84.1±5.8 points vs. 83.5±6.2 points ( P>0.05). One patient in the distractor group had symptoms of extensor muscle irritation, and the symptoms disappeared after the internal fixation was removed; 2 patients in the non-spreader group developed carpal tunnel syndrome, which improved after incision and decompression treatment. Conclusion:For refractory distal radius fractures, the use of combined distractor can achieve better radius height recovery and shorten the operation time, and has a satisfactory postoperative effect.

Objective:To retrospectively assess the relationship between immune disorder and acute gastrointestinal injury (AGI) in patients after severe polytrauma.Methods:Totally 205 patients with severe polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group, and 23 healthy volunteers were served as the control group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI), AGI patients were divided into the S-AGI group or L-AGI group according to the severity. The levels of cytokines and lymphocyte subset were evaluated at day 1, 7, and 14 after severe polytrauma. The differences between groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression analyzed.Results:Totally 79.5% (163/205) of patients with severe polytrauma were accompanied by AGI. There were significant differences in the ratio of Tc, Th at day 1 after trauma, the levels of IL-6, TNF-α, IL-8, IL-10, the ratio of Ts, Th/Ts, Treg at day 7 after trauma, and the levels of IL-8, IL-10,the ratio of Ts, Th/Ts, Treg at day 14 after trauma between the AGI group and N-AGI group ( P<0.05). There were significant differences in the ratio of Tc, Th, the levels of IL-6, TNF-α at day 1 after trauma and the ratio of Ts, Th/Ts, Treg, the levels of IL-8, IL-10 at day 7 and 14 after trauma between the S-AGI group and L-AGI group ( P<0.05). Logistic regression analysis showed that Ts 7 d ( OR=2.018, 95% CI: 1.105-5.364, P=0.013), Treg 14 d ( OR=3.612, 95% CI: 1.375-8.476, P=0.006), IL-6 7 d ( OR=1.824, 95% CI: 1.011-5.835, P=0.024), IL-10 14 d ( OR=2.847, 95% CI: 1.241-6.216, P=0.014), TNF-α 7 d ( OR=1.754, 95% CI: 1.215-5.441, P=0.018) were independent risk factors in patients with AGI after severe polytrauma. Conclusions:AGI is more easily occurred in patients with the heavier immune disorders after severe polytrauma. AGI can also aggravate pre-existing immune disorders in patients after severe polytrauma.

Objective To investigate the value of the difference between peripheral arterial and venous blood gas analysis for the prognosis of patients with septic shock after resuscitation.Methods Patients with septic shock aged 18 to 80 years admitted to intensive care unit (ICU) of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from May 2016 to December 2017 were enrolled. The peripheral arterial blood and peripheral venous blood gas analysis were measured simultaneously after the early 6 hours resuscitation, including pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), base excess (BE), bicarbonate (HCO3-) and lactate (Lac) level, and the difference values between peripheral arterial and venous blood were calculated. According to the 28-day survival, the patients were divided into survival group and death group. Multiple Logistic regression analysis was used to analyze the risk factors of death, and the receiver operating characteristic curve (ROC) was used to analyze the prognostic value of blood gas analysis parameters for prognosis.Results A total of 65 patients with septic shock resuscitation were enrolled in the study, 35 survived while 30 died during the 28-day period. ① There was no significant difference in gender, age, and mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2) and norepinephrine (NE) dose between the two groups.② The arterial and venous Lac, the difference of Lac (ΔLac) and PCO2 (ΔPCO2) between arterial and venous blood in death group were significantly higher than those in survival group [arterial Lac (mmol/L): 7.40±3.10 vs. 4.82±2.91, venous Lac (mmol/L): 9.17±3.27 vs. 5.81±3.29, ΔLac (mmol/L): 1.77±0.54 vs. 0.99±0.60, ΔPCO2 (mmHg, 1 mmHg =0.133 kPa): 9.64±5.08 vs. 6.70±3.71, allP < 0.01], and there was no significant difference in the other arterial and venous blood gas analysis index and its corresponding differential difference between two groups. ③ Multiple Logistic regression analysis showed that ΔPCO2 [β = 0.247, odd ratio (OR) = 1.280, 95％ confidential interval (95％CI) = 1.057-1.550,P = 0.011], and ΔLac (β = 2.696,OR = 14.820, 95％CI = 2.916-75.324,P = 0.001) were the independent risk factors for the prognosis of septic shock. ④ It was shown by ROC curve analysis that arterial blood Lac, ΔLac andΔPCO2 had predictive value on prognosis of septic shock, the area under ROC curve (AUC) was 0.792, 0.857, 0.680, respectively (allP < 0.05). When the best cut-off value of arterial Lac was 4.00 mmol/L, the sensitivity was 100％, and the specificity was 62.86％ for predictor of death in 28-day; when the best cut-off value of ΔLac was 1.25 mmol/L, the sensitivity was 93.33％, and the specificity was 68.57％ for predictor of death in 28-day; when the best cut-off value of ΔPCO2 was 4.35 mmHg, the sensitivity was 83.33％, and the specificity was 37.14％ for predictor of death in 28-day.Conclusions Compared to other parameters, the difference between peripheral arterial and venous blood gas analysis, ΔPCO2 and ΔLac had the best correlation with the prognosis of septic shock. The ΔPCO2 and ΔLac are the independent prognostic predictors for 28-day survival.

Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.

OBJECTIVE: To evaluate the prognostic value of the difference between peripheral venous and arterial partial pressure of carbon dioxide in patients with septic shock following early resuscitation. METHODS: This prospective study was conducted among the patients with septic shock treated in our department during the period from May, 2017 to May, 2018. Peripheral venous, peripheral arterial and central venous blood samples were collected simultaneously and analyzed immediately at bedside after 6-h bundle treatment. Arterial blood lactate concentration (Lac) and the arterial (PaCO), peripheral venous (PpvCO) and central venous partial pressure of carbon dioxide (PcvCO) were recorded. The differences between PpvCO and PaCO (Ppv-aCO) and between PcvCO and PaCO (Pcv-aCO) were calculated. Pearson correlation analysis was used to test the agreement between Pcv-aCO and Ppv-aCO. Multivariable logistic regression analysis was performed to analyze the possible risk factors for 28-day mortality, and the receiver-operating characteristic curve (ROC) was plotted to assess the prognostic values of these factors for 28-day mortality. RESULTS: A total of 62 patients were enrolled in this study, among who 35 survived and 27 died during the 28-day period. Compared with the survivor group, the patients died within 28 days showed significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (24.2±6.0 20.5±4.9, =0.011), sequential organ failure assessment (SOFA) score (14.9±4.7 12.2±4.5, =0.027), PcvaCO (5.5±1.6 7.1±1.7, < 0.001), PpvaCO (7.1±1.8 10.0±2.7, < 0.001), and arterial lactate level (3.3±1.2 4.2±1.3, =0.003) after 6-h bundle treatment. Pearson correlation analysis showed that Ppv-aCO was significantly correlated with Pcv-aCO (=0.897, R= 0.805, < 0.001). Multiple logistic regression analysis identified Ppv-aCO (β=0.625, =0.001, OR=1.869, 95% CI: 1.311-2.664) and lactate level (β=0.584, =0.041, OR=1.794, 95%CI: 1.024-3.415) as the independent risk factors for 28-day mortality. The maximum area under the ROC (AUC) of Ppv-aCO was 0.814 (95%CI: 0.696- 0.931, < 0.001), and at the best cut- off value of 9.05 mmHg, Ppv-aCO had a sensitivity of 70.4% and a specificity of 88.6% for predicting 28-day mortality. The AUC of lactate level was 0.732 (95%CI: 0.607-0.858, =0.002), and its sensitivity for predicting 28-day mortality was 70.4% and the specificity was 74.3% at the best cut-off value of 3.45 mmol/L; The AUC of Pcv-aCO was 0.766 (95%CI: 0.642-0.891, < 0.001), and its sensitivity was 66.7% and the specificity was 80.0% at the best cut-off value of 7.05 mmHg. CONCLUSIONS A high Ppv-aCO after early resuscitation of septic shock is associated with poor outcomes. Ppv-aCO is well correlated with Pcv-aCO and can be used as an independent indicator for predicting 28-day mortality in patients with septic shock.
APACHE ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Humans ; Lactic Acid ; blood ; Organ Dysfunction Scores ; Partial Pressure ; Pilot Projects ; Prognosis ; Prospective Studies ; ROC Curve ; Regression Analysis ; Shock, Septic ; blood ; mortality