OBJECTIVE: To eludicate the risk factors of mechanical ventilation and prolonged mechanical ventilation in patients with severe multiple injuries. METHODS: Consecutive patients with severe multiple injures who were treated in Peking University People's Hospital Trauma Medical Center between December 2016 and December 2019 were enrolled in this restropective chart-review study. According to mechanical ventilation and ventilatory time, the patients were divided into mechanical ventilation (MV) group and non-mechanical ventilation (NMV) groups, prolonged mechanical ventilation (PMV) group and shortened mechanical ventilation (SMV) groups. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow Coma Scale (GCS), abbreviated injury scale (AIS) and injury severity score (ISS) were collected. To indentify the risk factors of mechanical ventilation and prolonged mecha-nical ventilation, univariate and multivariate Logistic analyses were carried out. RESULTS: In the present study, 112 patients (82 male, 30 female) with severe multiple injuries having a median age of 52 (range: 16-89 years) and a median ISS of 34 (range: 16-66) were enrolled. The primary mechanism of injury was traffic accident injury and falling injury. In the study, 62 and 50 patients were assigned to MV and NMV groups, respectively. Logistic analysis showed that GCS (OR=0.72, 95%CI: 0.53-0.92, P=0.03), base excess (OR=0.56, 95%CI: 0.37-0.88, P=0.002) and multiple rib fracture (OR=1.72, 95%CI: 1.60-2.80, P=0.012) were independent significant risk factors for mechanical ventilation after severe multiple injuries. Within the mechanical ventilation group, 38 and 24 patients were assigned to PMV and SMVgroups, respectively. Compared with the SMV group, the PMV group had a higher ISS and higher rate of severe head trauma. The length of hospital stay of PMV group was longer than that of SMV groups. Meanwhile, the incidence of tracheotomy in PMV group was high. CONCLUSIONS GCS, base excess and rib fracture might be independent risk factors for mechanical ventilation. Higher ISS and lower GCS might prolong the ventilatory time and the length of hospital stay. Meanwhile, the incidence of tracheotomy was high in PMV group because of the longer ventilatory time and poor consciousness.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Young Adult

Objective To evaluate the effects of nerve growth factor (NGF)polybutylcyanoacrylate (PBCA)- nanoparticles (NP) on PC12 cells induced by Aβ1-40 Methods The emulsion polymerization method was used to prepare the NGF-PBCA-NP. Morphology of the NGF-PBCA-NP was observed by transmission electron microscopy. The entrapment efficiency and loading efficiency of NGF-PBCA-NP were measured by means of ultraviolet spectrophotometry. The effects of NGF-PBCA-NP on proliferation and cell apoptosis of β1-40-PC12 cells were observed by MTT and FCM methods. Results The NGF-PBCA-NPs were uniform spheres with drug entrapment efficiency of 80.87％ and loading efficiency of 19.88％.Compared with the cells in the NGF group,cells in the NGF-PBCA-NP group exhibited a significantly better proliferation rate and a significantly lower apoptosis rate (P＜0.05). Conclusion NGF-PBCA-NPs obtained by emulsion polymerization method are uniform in morphology and possess a high drug entrapment efficiency and a high loading efficiency.They can restrain significantly the in vitro growth of Aβ1-40-PC12.

objecfive To know and compare the intelligence level of children born in different time periods in regions with iodine deficiency disorders(IDD)in Liaoning province.Methods All 7-14 year-old children from ten schools were chosen as the subjects respectively from six villages in each of the six counties and in regions with iodine deficiency,who were respectively born at the initialization of iodinated salt supplying period(1978-1980);non-iodinated salt supplying period(1981-1990);recovery of supplied iodized salt period(1991-1995);universal iodized salt period(1996-2000),respectively.Intelligence quotient(IQ)was measured by Combined Ravens Test in China(CRT-C)and Combined Ravens Test-the Rural,in China,2nd edition(CRT-RC2).Results IQ of children during the non-iodized salt period(91.9±14.3)was significantly lower than the initial supply of iodized salt period(95.8±14.6,q=8.60,P<0.01),recovery of supplied iodized salt period(99.7±14.7)was significantly higher than the initial supply of iodized salt period, non-iodized salt sales period(q = 9.53, 18.13, all P < 0.01 ),universal salt iodization( 104.3 ± 14.9) was significantly higher than the initial supply of iodized salt period, non-iodized salt sales period, recovery of supplied salt iodization(q = 20.00,28.00,10.46, all P < 0.01). Children's rate of mental retardation (IQ≤69) was higher in non-iodinated salt supplying period (6.7%, 88/1314 ) than the initial supply of iodized salt (4.4%, 21/471, χ2 = 3.85, P < 0.05), recovery of supplied iodized salt period(3.3%,48/1470) was significantly lower than non-iodinzed salt supplying period (χ2 = 15.37, P < 0.01), universal salt iodization period(2.7%, 36/1344) was lower than the initial supply of iodized salt period(χ2 = 4.41, P < 0.05) and non-iodinzed salt supplying period(χ2 = 26.34, P < 0.01 ). The IQ and intelligent retarded rates in children born during the initial years of iodinated salt supplying period were not different. The IQ of the children during ten years of non-iodized salt supplying period fluctuated in a "∪" curve, while the intelligent retardation rates in a "∩" curve.The children born during the period of recovery supplied iodized salt increased their IQ and lowered the retardation rates year after year. The IQ of the children in universal iodized salt period kept on increasing while intelligent retarded rates reduced to the lowest level. Conclusions The intelligence level of children born in regions with IDD during non-iodized salt supplying period is remarkably lower than that of the beginning years of iodinated salt supplying period. The intelligence level of children born after universal iodized salt period is remarkably higher than that of the initial iodinated salt supplying period and recovery of supplied iodized salt period, respectively.

Background: Approximately 15–20% cases of systemic lupus erythematosus (SLE) are diagnosed in children. There have been a few studies reporting the epidemiological data of pediatric?onset SLE (cSLE) in China, neither comparing the differences between cSLE and adult?onset SLE (aSLE). The aim of this study was to describe the impact of age of onset on clinical features and survival in cSLE patients in China based on the Chinese SLE Treatment and Research group (CSTAR) database. Methods: We made a prospective study of 225 cSLE patients (aged <16 years) and 1759 patients aged 16–50 years based on CSTAR registry. We analyzed initial symptoms, clinical presentations, SLE disease activity, damages, and outcomes of cSLE, as well as compared with aSLE patients. Results: The mean age of cSLE patients was 12.16 ± 2.92 years, with 187 (83.1%) females. Fever (P < 0.001) as well as mucocutaneous (P < 0.001) and renal (P = 0.006) disorders were found to be significantly more frequent in cSLE patients as initial symptoms, while muscle and joint lesions were significantly less common compared to aSLE subjects (P < 0.001). The cSLE patients were found to present more frequently with malar rash (P = 0.001; odds ratio [OR], 0.624; 95% confidence interval [CI ], 0.470–0.829) but less frequently with arthritis (P < 0.001; OR, 2.013; 95% CI, 1.512–2.679) and serositis (P = 0.030; OR, 1.629; 95% CI, 1.053–2.520). There was no significant difference in SLE disease activity index scores between cSLE and aSLE groups (P = 0.478). Cox regression indicated that childhood onset was the risk factor for organ damage in lupus patients (hazard ratio 0.335 [0.170–0.658], P = 0.001). The survival curves between the cSLE and aSLE groups had no significant difference as determined by the log?rank test (0.557, P = 0.455). Conclusions: cSLE in China has different clinical features and more inflammation than aSLE patients. Damage may be less in children and there is no difference in 5? year survival between cSLE and aSLE groups.

BACKGROUNDThere is still a paucity of data on hepatitis B virus (HBV) subgenotype prevalence in North China based on sequencing of large-size samples. In addition, whether HBV genotypes impact drug-resistance-associated and HBV e antigen (HBeAg)-loss-associated mutations in patients with chronic hepatitis B (CHB) is still under investigation. This study aimed to disclose clinical prevalence of HBV genotypes/subgenotypes in North China and the clinical implications of HBV genotype classification in respect to HBeAg loss and drug-resistant occurrence.

METHODSSera were collected from 1301 nucleos(t)ide analog-experienced CHB patients. Viral DNA was extracted and used as template for HBV genome amplification by nested PCR. DNA sequencing was performed for the analysis of HBV genotypes/subgenotypes, drug-resistance-associated mutations in polymerase gene and HBeAg-loss-associated mutations in precore/basal core promoter (BCP) regions.

RESULTSHBV/B, HBV/C, and HBV/D were detected in 190 (14.6%), 1096 (84.2%), and 15 (1.2%) patients, respectively. HBV/B2 (182/190), HBV/C2 (1069/1096), and HBV/D1 (12/15) were predominant subgenotypes within individual genotypes. By contrast, C2 prevalence is relatively lower in Beijing area (77.2%) than in other north areas (84.9% - 87.4%). HBV/C-infected patients had an older age and a lower serum albumin level but similar HBV DNA and alanine aminotransferase (ALT) levels compared to HBV/B-infected patients. HBV/C infection had a higher incidence of lamivudine-resistant mutations rtM204I/V (44.9% vs. 30.2%, P < 0.01) and BCP mutations A1762T+G1764A (65.8% vs. 40.0%, P < 0.01) compared with HBV/B infection.

CONCLUSIONSC2 is the most prevalent HBV subgenotype followed by B2 in CHB patients in North China; and HBV genotype prevalence is influenced by immigrant population. HBV/C infection is likely to have longer disease duration and severer liver functional impairment and might be more susceptible to develop lamivudine resistance compared to HBV/B infection.

Adult ; Antiviral Agents ; therapeutic use ; China ; DNA, Viral ; genetics ; Drug Resistance, Viral ; genetics ; Female ; Genotype ; Hepatitis B virus ; classification ; drug effects ; genetics ; Hepatitis B, Chronic ; virology ; Humans ; Male ; Middle Aged ; Mutation

BACKGROUNDAccurate assessment of intra- as well as extra-cardiac malformations and radiation dosage concerns are especially crucial to infants and children with interrupted aortic arch (IAA). The purpose of this study is to investigate the value of prospective electrocardiogram (ECG)-triggered dual-source computed tomography (DSCT) angiography with low-dosage techniques in the diagnosis of IAA.

METHODSThirteen patients with suspected IAA underwent prospective ECG-triggered DSCT scan and transthoracic echocardiography (TTE). Surgery was performed on all the patients. A five-point scale was used to assess image quality. The diagnostic accuracy of DSCT angiography and TTE was compared with the surgical findings as the reference standard. A nonparametric Chi-square test was used for comparative analysis. P <0.05 was considered as a significant difference. The mean effective radiation dose (ED) was calculated.

RESULTSDiagnostic DSCT images were obtained for all the patients. Thirteen IAA cases with 60 separate cardiovascular anomalies were confirmed by surgical findings. The diagnostic accuracy of TTE and DSCT for total cardiovascular malformations was 93.7% and 97.9% (P > 0.05), and that for extra-cardiac vascular malformations was 92.3% and 99.0% (P < 0.05), respectively. The mean score of image quality was 3.77 ± 0.83. The mean ED was 0.30 ± 0.04 mSv (range from 0.23 mSv to 0.39 mSv).

CONCLUSIONSIn infants and children with IAA, prospective ECG-triggered DSCT with low radiation exposure and high diagnostic efficiency has higher accuracy compared to TTE in detection of extra-cardiac vascular anomalies.

Aorta, Thoracic ; diagnostic imaging ; pathology ; Coronary Angiography ; methods ; Electrocardiography ; methods ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Radiation Dosage

BACKGROUNDSirolimus-eluting stents (SES) are reported to be associated with reduced late lumen loss (LLL), resulting in less frequent restenosis when compared to bare-metal stent. The current study aimed to assess the difference in LLL between SES with biodegradable and with permanent polymer.

METHODSFrom March 2010 to June 2011, 300 consecutive patients having only biodegradable polymers or permanent polymer SES for all diseased vessels were included. Serial quantitative coronary analysis was performed on both the "in-stent" and "segment" area, including the stented segment, as well as both five mm margins proximal and distal to the stent. The primary endpoint was the LLL defined as the minimal lumen diameter (MLD) post-stenting minus the MLD at nine-month after the indexed procedure.

RESULTSLLL was comparable between the two stents. Importantly, LLL for the distal segment (median 0.05 mm, interquartile 0 to 0.09 mm) was less severe compared with in-stent (median 0.13 mm, interquartile 0.08 to 0.18 mm) and proximal segment LLL (median 0.12 mm, interquartile 0.06 to 0.14 mm, all P < 0.001). In general, the LLL was associated with the post-procedure MLD (b = 0.28, P = 0.002), hyperlipidemia (b = 0.14, P = 0.021), and calcified lesions (b = 0.58, P = 0.001). The R(2) and Radj of the multiple regression model were 0.651 and 0.625, respectively.

CONCLUSIONSSES with either biodegradable or permanent polymer had lower value of LLL. The small amount of LLL at the distal segment possibly contributed to the less distal edge stenosis.

Aged ; Aspirin ; therapeutic use ; Coronary Restenosis ; prevention & control ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Polymers ; chemistry ; Regression Analysis ; Sirolimus ; therapeutic use ; Ticlopidine ; analogs & derivatives ; therapeutic use

OBJECTIVETo investigate the relationship between pathological abnormalities of placenta and small-for-gestational-age neonates.

METHODSOne hundred placentas of small-for-gestational-age (SGA group) and 200 appropriate-for-gestational-age (AGA group) with single living birth in third trimester were investigated by gross and microscopic examination. The AGA placentas were collected from 2 cases following every SGA placenta. All cases were collected from Shanghai Changning District Maternity and Infant Health Hospital from January 2010 to December 2011.

RESULTSThe gestational week, neonatal birth weight, full-term neonatal birth weight, the preterm birth rate and vaginal spontaneous delivery rate were significantly lower in SGA group than that in AGA group (P < 0.002). Full-term placental volume, placental weight and fetal placental weight ratio were lower in SGA group than that in AGA group (P < 0.05). Unusual insertion and torsion of umbilical cord were more common in SGA group (P < 0.05). Syncytial knots increase, avascular villi and villous infarcts were significantly higher in SGA group (P < 0.005), but there were no significant difference between SGA group and AGA group in intervillous thrombi, chronic villitis and chorangiosis (P > 0.05). Gestational hypertension disease and abnormality of fetal monitoring were more common in SGA group (P < 0.05).

CONCLUSIONSGestational hypertension disease is the main clinical cause of SGA. Some placental abnormality can affect the growth and development of intrauterine fetus.

Birth Weight ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Infant, Small for Gestational Age ; Placenta ; pathology ; Pregnancy ; Torsion, Mechanical ; Umbilical Cord ; pathology

OBJECTIVE: To explore the application of imaging techniques in determining the death cause and injury manner. METHODS: One case due to high fall was fully examined using multi-slice spiral computed tomography (MSCT), 3-D imaging creation and magnetic resonance imaging (MRI). The systemic and detailed autopsy was subsequently performed to compare with the results from imaging studies. The advantages and disadvantages of autopsy and imaging studies were then analyzed. RESULTS: Most of the important information such as trauma, fracture and hemorrhage could be obtained by imaging techniques. Furthermore, imaging methods can predict injuries in internal body before autopsy and be minimal or non-invasive to the cadaver. However, the imaging techniques probably also can not find some details in comparison to autopsy in forensic practice and need to improve in their future application. CONCLUSION Application of imaging techniques can be used as the guidance and complimentary for the forensic autopsy in the identification of injury manner. In addition, the application can even be used to replace autopsy in some special circumstances.
Autopsy ; Cervical Vertebrae/pathology* ; Craniocerebral Trauma/pathology* ; Forensic Pathology ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sensitivity and Specificity ; Spinal Fractures/pathology* ; Tomography, X-Ray Computed/methods* ; Wounds and Injuries/pathology*

OBJECTIVE: To study the application value of multi-slice computed tomography (MSCT) and 3D reconstruction in biomechanical analysis of traffic accidents in forensic medicine. METHODS: Based on a real case, the tomoscan images were obtained from a corpse by MSCT scanning. The 3D images were reconstructed. The biomechanic process of injury manners of impacting, rolling and crushing in traffic accidents was analyzed together with autopsy, vehicle inspection, etc. The MSCT results were compared with the autopsy results. RESULTS: Some characters in situ including the part of fracture on different site that suffered by force from different directions, trends of fracture line, and status of smash inner bones were obtained trough MSCT and 3D reconstruction. Some details like fracture were even better than those from autopsy. CONCLUSION MSCT and 3D reconstruction have some advantages such as in situ reconstruction, easily controlled image and fully conserved evidence. It may be a supplementary method and have a directive function for the biomechanical analysis of traffic accidents.
Accidents, Traffic ; Adult ; Automobiles ; Autopsy/methods* ; Biomechanical Phenomena ; Bone and Bones/injuries* ; Craniocerebral Trauma/pathology* ; Female ; Forensic Pathology ; Fractures, Bone/diagnostic imaging* ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional/methods* ; Tomography, Spiral Computed/methods* ; Wounds and Injuries/pathology*