Integrative Medicine ; Professional Competence

Objective To explore the risk factors in the prognosis of patients with severe multiple trauma related factors.Methods Ninety-three patients with severe multiple trauma(ISS score≥16 points) were selected as our subjects,who all hospitalized in the second hospital affiliated to Dalian medical University.Among of which,38 cases' ISS score was 16-25,and 55 cases' ISS score was higher and equal to 25.Clinical data and general information were recorded.ISS score,APACHE Ⅱ score and 6 h lactate clearance rate score were measured.Results Twenty-seven dead among these 93 cases and the mortality was 29.03％.There were significant differences in terms of ISS score,APACHE Ⅱ score,lactate level when entering ICU,6 h lactate level and 6 h lactate clearance rate between death patients (27 cases) and survival patients (66 cases) (t =9.846,9.812,7.112,7.012,9.831 ; P ＜ 0.001).In multiple organ dysfunction syndrome (MODS) patients,the mortality of ISS score:16-25 group was different from that of ISS score≥25 (15.78％ (6/38) vs.35.18％ (21/93),x2 =21.52,P ＜0.001).Among the 93 cases of severe multiple trauma,35 cases with MODS(37.6％ (35/93)),and 20 cases of which were dead(57.1％ (20/35)).There was statistic difference between MODS group(35 cases) and non-MODS(58 cases) in term of mortality(37.6％ (35/93) vs.12.1％ (7/58) ;x2 =21.52,P ＜ 0.001).Multivariate logistic regression analysis showed that the ISS score,APACHE Ⅱ score,6 h lactate clearance rate and MODS were independently prognostic correlation factors (P ＜ 0.05).Operating characteristic curve (ROC) showed that AUC of ISS score was 0.735 (95 ％ CI 0.629-0.842),of APACHE Ⅱ score was 0.888 (95％ CI 0.821 =0.956),of 6 h lactate clearance rate score was 0.951 (95％ CI 0.906 -0.997).Conclusion The factors of ISS score,APPCHE Ⅱ assessment,6 h lactate clearance rate,the occurrence of MODS are independent prognostic factors.

Background The rejection following keratoplasty still is a leading cause of corneal transplantation failure.Studies showed that the interleukin-22 (IL-22) ,one of the effector molecules of T helper cell 17 (Th17) participated on the rejection after heart,liver and bone marrow transplantation.However,the effect of IL-22 on corneal graft rejection is not well understood.Objective This study was to investigate the expression of IL-22 mRNA in the corneal grafts and the role of IL-22 in the immune rejection after corneal transplantation in rats.Methods Seventy-two Wistar rats were randomized into autologous keratoplasty group,allograft keratoplasty group and anti-rejection group,and other 4 normal Wistar rats served as normal control group.Autologous keratoplasty was operated on the Wistar rats of the autologous keratoplasty group,and allograft keratoplasty were carried out with the 24 SD rats as donors and 48 Wistar rats as recipients.Tobramycin and dexamethasone eye drops were topically administrated after autologous keratoplasty for 2 weeks in the anti-rejection group.The experimental eyes were examined by slit lamp microscope after surgery and graft survival was evaluated based on the rejection scoring criteria of Larkin.Intergroup accumulated survival rates of grafts were compared using Kaplan-Meier analysis.Histopathological examination of grafts was carried out in 5 and 14 days after operation respectively,and the related expression levels of IL-22 mRNA and aryl hydrocar-bon receptor (AhR) mRNA were carried out by real-time fluorescence quantitative PCR.The feeding and use of the experimental animals followed the Guangdong provincial regulations on the management of experimental animals.The experimental design was approved by the ethics committee of Southern Medical University.Results The median survival time of grafts in the allograft keratoplasty group was 10 days,and that in the anti-rejection group was 17 days,showing a significant survival extention in the anti-rejection group (x2=16.442,P =0.000).Significant differences were found among the 4 groups in the related expression levels of IL-22 mRNA in both 5 days and 14 days after surgery (postoperative 5 days : F=2.44,P =0.00;postoperative 14 days: F=267.92, P =0.00), and the related expression levels of IL-22 mRNA were remarkably higher in the allograft keratoplasty group than those in the anti-rejection group at different time points (postoperative 5 days :9.70±0.35 vs.0.46±0.21;postoperative 14 days : 23.12 ± 1.89 vs.3.14±0.94) (both at P＜0.05).The related expression levels of AhR mRNA in the grafts were considerably different among the 4 groups (postoperative 5 days : F =395.73, P =0.00;postoperative 14 days : F =942.37, P =0.00) , and the expression levels were significantly elevated in the allograft keratoplasty group compared with the anti-rejection group at various time points (postoperative 5 days:2.52±0.32 vs.1.89±0.10;postoperative 14 days:7.20±0.25 vs.2.60±0.17) (both at P＜0.05).Conclusions The expression level of IL-22 RNA up-regulates in the grafts with immuno-rejection.Topical administration of tobramycin and dexamethasone eye drops inhibits the rejection after keratoplasty.AhR plays a regulative role to the expression of IL-22 in rats after keratoplasty.

Perforator stroke(PS)is one of peri-procedural complications associated with stenting of intracranial arterial stenosis.A lot of perforator arteries are derived from intracranial arteries with difference from coronary arteries,because once the intracranial perforator arteries of crucial regions are occluded,may lead to fatal prognosis.Three hypothesis have been used to explain PS including snow-plowing,stent jailing effect and in-stent neointimal growth.In vivo models,investigators have already found these phenomenas.After much attention been paid on PS,authors have published a report covered with a large amount of cases in 2006. The author figured out that patients with perforator infarct adjacent to the stenotie segment(PIAS)under MRI beforehand would have higher chance occurring PS after stenting of intracranial stenosis.The patients with priority of PS easily are affected by the morphology,location,etiology,sites,the type and equipments.Many yet unsolved problems including the prevention would arouse us to go deeper into for the exploration of the mechanism.(J Intervent Radiol,2007,16:858-862)

Objective To evaluate the surgical technique and procedures of transumbilieal breast augmentation with an inverse U-shape incision and insertion of saline-filled breast implants. Methods With specialized instruments, the subcutaneous tunnel was undermined to the inframammary crease after inverse U incision made along the umbilical border. The subpectoral space was dissected with a dissector after the advancement of obturator across the inframammary crease. The expander was inserted into the subpectoral pocket to be filled to obtain the high degree of symmetry of the breasts. Finally, the previous-ly prepared implants were inserted after the expander deflated and removed. Results All patients gained satisfactory results with no complications, such as hematoma, infection, implant deflation and Baker Ⅲ or Ⅳ capsular contracture. Conclusions Breast augmentation could be performed through umbilical inci-sion with the usage of saline-filled breast implant. This is an alternative of incisions in breast augmenta-tion.

Objective　To analyze the advantages of intracrani al hematoma smash puncture (IHSP) in the treatment of cranial hemorrhage for the elderly. Methods　A total of 104 cases of cerebral hemorrhage a dmitted in the recent 3 years were collected and divided into 4 grou ps, i.e . group A, elderly with IHSP treatment (n=36), group B, elderly with regular medical treatment (n=33), group C, non-elderly with IHSP treatment (n= 21) and group D, non-elderly with routine therapy (n=14). The clinical and follow-up outcomes were studied and analyzed. Results　There w as significant difference in rehemorrhage rate after puncture between grou p A (0/36) and group C (2/21). Significant difference was found in early mortali ty rate in group A (16.67%) and group B (39.40%). The rate of activity of daily living (ADL) 1-2 was significantly higher in group A (58.62%) than group B (5.88 %)(P<0.005) and that of ADL 4-5 was obvious lower in group A (13.79%) than g roup B (47.06%)(P<0.025). Conclusion　Intracranial hematoma smash hemorrage is safe and efficient in the treatment of elderly cerebr al hemorrhage, especially in reducing the disability rate.

Objective To retrospectively analyze the diagnosis and treatment of multicentric Castleman's disease (MCD) ,and review related literatures. Methods A total of six patients were first-ever diagnosed as MCD and treated with combination chemotherapy and/or interferon α. The clinical manifestation, laboratory findings and therapeutic strategies were recorded in detail. Results In the six HIV-negative patients, histologically, four of them were diagnosed with plasma cell type of Castleman's disease, two with mixed type. All the six patients showed multiple lymphadenopathy, polyclonal hypergammaglobulinemia and hypoalbuminemia. One of the two patients treated with interferon α achieved complete remission, and the other,who showed no effects with hormone and combination chemotherapy ,achieved sustained partial remission after treatment with interferon α for 3 months. Of the four patients treated with combination chemotherapy, three achieved partial remission, and one died of no effects. Conclusions Interferon α and combination chemotherapy might be the most effective and convenient therapeutic methods for MCD. Serum albumin level may be used as a diagnostic and monitoring index for MCD.

OBJECTIVETo investigate the efficacy mechanisme of chicory extract interventing abdominal obesity rat from the aspect of gut bacteria.

METHODMale SD rats were randomly divided into five groups, namely the normal group, model group, large and small dose group of chicory and the fenofibrate group. Normal group was given deionized water, the other group was given fructose water and give the medical treatment of chicory and fenofibrate. Assay triglycerides, total cholesterol, LDL and HDL by biochemical methods and measure body weight and abdominal circumference and microscopicly observe the count changes of gut bacteria through real-time PCR method.

RESULTCompared with normal group, the triglyceride level and abdominal circumference were significantly higher (P < 0.05), weight and high-density lipoprotein increased but no significant changes and E. coli, lactobacillus increased significantly. Compared with model group, chicory extract large and small dose group and the fenofibrate group can significantly reduce triglyceride levels (P < 0.05), reduce the number of E. coli and Lactobacillus and increase the number of bifidobacteria. The fenofibrate group can significantly reduce total cholesterol and high-density lipoprotein levels.

CONCLUSIONThe chicory's treatment effect on abdominal obesity is significant. The efficacy mechanisme intervention abdominal obesity may be related to the reduction of the number of lactic acid bacteria and E. coli and the increase of bifidobacteria.

Animals ; Bacteria ; classification ; genetics ; isolation & purification ; Biodiversity ; Chicory ; chemistry ; metabolism ; Cholesterol ; metabolism ; Gastrointestinal Tract ; microbiology ; Humans ; Male ; Microbiota ; Obesity, Abdominal ; metabolism ; microbiology ; Plant Extracts ; metabolism ; Rats ; Rats, Sprague-Dawley ; Triglycerides ; metabolism

Animals ; Cell Line, Tumor ; Enoyl-CoA Hydratase ; genetics ; metabolism ; Liver Neoplasms, Experimental ; metabolism ; pathology ; Lymphatic Metastasis ; Mice ; Plasmids ; Recombinant Proteins ; genetics ; metabolism ; Transfection

OBJECTIVETo explore rest, cold compress and elevate (RICE) with rest, compress and elevate (RCE) without cold for the treatment of acute ankle sprain, in order to clear mid-term clinical effects.

METHODSEighty-nine patients with acute ankle sprains were collected from January 2013 to March 2014,including 30 males and 59 females aged from 18 to 60 years old with an average of 36 years old; the time from injury to hospital ranged from 3 to 24 h with an average of 9 h. All patients were divided into two groups according to visiting sequence. There were 45 patients in RICE group, and 45 patients in RCE groups. The main therapeutic effect index was evaluated by Karlsson scoring, and secondary therapeutic effect index was pain and satisfactory VAS scores. Safety index evaluated by adverse event.

RESULTSOn the 2nd weeks after injury, Karlsson score in RICE group was 44.66 ± 11.58, and 46.67 ± 8.52 in RCE group, while there was no statistical significance between two groups in Karlsson scores (P > 0.05). Karlsson score of two groups after treatment were higher than before treatment. There was no significantly meaning in pain and satisfactory VAS scores between two groups (P > 0.05). No adverse reaction were occurred between two groups.

CONCLUSIONCold compress did not receive much more final gains, and no evidence showed cold compress could affect recovery of joint function.

Acute Disease ; Adolescent ; Adult ; Ankle Injuries ; physiopathology ; therapy ; Case-Control Studies ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Sprains and Strains ; physiopathology ; therapy