Objective To observe the variations of biochemical indicators in serum followed the different contusion on soft tissues and also analyze their significance in forensic practice.Methods The SD rats were selected as experimental animal as well as were randomly divided into four groups: sham control,mild,medium and strong force depending on the height of strike falling in anesthesia state.Sacrificed the rats at the same time point and harvested the blood.Serumal creatine kinase(CK),isoenzyme of creatine kinase(CK-MB),lactate dehydrogenase(LDH),creatinine(Cr),urea nitrogen(UN) ?-hydroxybutyrate dehydrogenase(HBDH) and aspartic acid transferase(AST) were tested.The data were analyzed quantitatively with SPSS 12.0.Results The AST,CK,CK-Mb,HBDH,UN and Cr all increased accompanied with higher scale of strike.The statistics showed that a dramatically difference existed between the overall traumatic groups(including to the mild,medium and strong) and the control.The AST,CK and CK-MB showed significant differences in 3 experimental groups.Meanwhile,the perimeter of the traumatic limbs was a good marker for the power of the strike.Conclusion The contusion not only appeared in the local areas but also cause the myocardial damage in the period of early trauma.

Background Neurotransmitter secretion disorder induced by chronic manganese poisoning has always been one of the important causes of body injury, but the mechanism of neurotransmitter secretion disorder caused by manganese is not clear at present. Objective To investigate the effects of presynaptic membrane intracellular protein 13-1 (Munc13-1) and synapse fusion protein binding protein 18-1 (Munc18-1) on dopamine secretion dysfunction induced by manganese chloride (MnCl₂) in human neuroblastoma (SH-SY5Y) cells. Methods A SH-SY5Y cell model induced by MnCl₂ was established. Cell viability was measured by MTT assay. Four experimental groups were set up: control group and low-, medium-, and high-dose manganese groups (0, 100, 200, and 400 μmol·L⁻¹ MnCl₂). They were treated with corresponding doses of MnCl₂ for 24 h. The secretion of dopamine was measured by enzyme-linked immunosorbent assay. The mRNA expression of Syntaxin-1 was detected by real-time quantitaive PCR. Total cell proteins were extracted, and the protein expression levels of Munc13-1, Munc18-1, and Syntaxin-1 were detected by Western blotting. The correlations of MnCl₂ exposure and dopamine secretion with the protein expressions of Munc13-1 and Munc18-1 were also analyzed by Pearson correlation. Results Compared with the control group, the cell viability rate decreased gradually with the increase of manganese exposure concentration, and the difference between the medium- and the high-dose manganese groups was statistically significant (P<0.05). The concentration of dopamine in cell culture medium of all manganese exposure groups decreased with the increase of manganese concentration, and compared with the control group and the low-dose manganese group, the medium- and the high-dose manganese groups were statistically significant (P<0.05). The expression of Syntaxin-1 at mRNA or protein level did not change significantly among groups (P>0.05). Compared with the control group, the protein expression of Munc13-1 decreased and that of Munc18-1 increased with the increase of manganese concentration (P<0.05). Compared with the low-dose manganese group, the changes of Munc13-1 protein in the high-dose manganese group and Munc18-1 protein in the medium- and high-dose manganese groups had statistical significance (P<0.05). Compared with the medium-dose manganese group, the protein changes of Munc18-1 in the high-dose manganese group were statistically significant (P<0.05). The correlation analysis showed that MnCl₂ dose was negatively correlated with Munc13-1 protein expression (r=−0.898, P<0.05), and positively correlated with Munc18-1 protein expression (r=0.678, P<0.05). Dopamine secretion was positively correlated with Munc13-1 protein expression (r=0.932, P<0.05), and negatively correlated with Munc18-1 protein expression (r=−0.817, P<0.05). Conclusion The inhibition of dopamine secretion in SH-SY5Y cells induced by manganese exposure is related to up-regulation of Munc18-1 and down-regulation of Munc13-1 expression levels, which may be one of the reasons for nerve injury caused by manganese.

Objective To analyze the clonal gene rearrangement and complementarity determining region 3 (CDR3) repertoire of TCR β-chain in fine needle aspiration biopsy (FNAB) specimens of lymph node metastasis in patients with breast cancer. Methods The TCR CDR3 region genes of 24 TCR Vβ subfamilies were amplified by utilizing RT-PCR technology, and the CDR3 lengths of TCR β-chain were analyzed with gene scan technology for 2 cases with lymph node reactive hyperplasia and 3 patients with lymph node metastasis of breast cancer. The clonality of T cells presumed by spectra typing was further confirmed by CDR3 sequencing. Results TCR β-chain presented specific repertoire skewing in metastatic lymph node,and only 3-5 TCR Vβ subfamily of T cells were identified, respectively. Clonal expanded T cells, including oligoclonal, polyclonal patterns, in one or more Vβ subfamilies were found in all cases. The oligoclonal expanded T cells had different CDR3 amino acid sequences. Conclusion There are characteristic T cells cloning proliferation and selected usage of TCR Vβ subfamily T cells could be found in metastatic lymph node.The sequences of CDR3 in different TCR clone proliferation are mostly different.

Objective To investigate the approach of diagnosis and therapy of particular tracheal bronchus foreign body.Methods The clinical materials of 26 cases cured in our department were analyzed retrospectively.Results All foreign bodies of cases were taken out successfully.Among them,the foreign bodies of 18 cases were removed from glottis;the foreign bodies of 4 cases were pulled out via laryngoscope;the foreign bodies of 3 cases were drawn away through tracheotomy by endoscopy and 1 case was moved out by bronchofibroscopy.Only 1 case had lung edema and then was cured by proper treatment.Conclusion Considering that the particular foreign bodies in tracheal bronchus are complicated sometimes,the diagnosis and therapy should be treated appropriately according to different situation.Furthermore,properly choosing surgical appliances and the approaches of anaesthesia and surgery is also critical.

In recent years, there has been a comprehensive reform of higher medical education in the Medicine School of Wuhan University. According to the need for reform, the teaching of neurology has to be changed from the traditional form to a new form, and be integrated into the clinical pathophysiology and therapeutics (CPPT) courses. Currently neurology in CPPT takes the form of theoretical lectures, case discussions, combined with practical lessons to observe sections under the microscope and clinical practice, for the cultivation of students'!self-learning ability and clinical thinking. In the commissioning process, it exposes some problems in teaching process due to the characteristics of the course in neurology. For example, the knowledge of neuroanatomy is insufficient and review lessons relatively too short, and the teaching effect may be worse due to the fact that teachers have busy clinic work. In addition, students participate in case discussions with less enthusiasm. To solve these problems, we take some measures to promote teaching reform in neurology, such as increasing the review hours of neuroanatomy section in the CPPT neurology, training a group of specialized medical teachers to enrich and stabilize teacher team, adjusting the content and form of discussion class to improve students'!interest and participation, and increasing assistant jobs by the student to assist discussion teaching.

Objective To investigate the value of procalcitonin (PCT) on predicting the severity and prognosis in patients with early acute respiratory distress syndrome (ARDS).Methods A prospective observation study was conducted. A total of 113 patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Affiliated People's Hospital ofJiangsu University from October 2012 to April 2016 were enrolled. Based on oxygenation index (PaO2/FiO2), the patients were classified into mild, moderate, and severe groups according to Berlin Definition. Twenty-five healthy volunteers were served as controls. Demographics, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and Murray lung injury score were recorded. Within 24 hours after diagnosis of ARDS, the serum levels of PCT and C-reactive protein (CRP) were determined by enzyme-linked fluorescence analysis (ELFA) and immune turbidimetric method, respectively. The patients were also divided into survival and non-survival groups according to clinical outcome within 28-day follow-up, and the clinical data were compared between the two groups. Spearman rank correlationwas applied to determine the correlation between variables. The predictive value of the parameters on 28-day mortality was evaluated with receiver operating characteristic curve (ROC). Kaplan-Meier survival curve analysis was used to compare different PCT levels of patients with 28-day cumulative survival rate. Results After excluding patients who did not meet the inclusion criteria and loss to follow-up, the final 89 patients were enrolled in the analysis. Among 89 ARDS patients analyzed, 27 of them were mild, 34 moderate, and 28 severe ARDS. No significant differences were found in age and gender between ARDS and healthy control groups. Infection and trauma were the most common etiology of ARDS (55.1% and 34.8%, respectively). Compared with healthy control group, both CRP and PCT in serum of ARDS group were higher [CRP (mg/L): 146.32 (111.31, 168.49) vs. 6.08 (4.47, 7.89), PCT (μg/L): 3.46 (1.98, 5.56) vs. 0.02 (0.01, 0.04), bothP < 0.01], and the two showed sustained upward trends with the ARDS course of disease. Compared with mild group, severe group had significantly higher APACHE Ⅱ and Murray scores. Spearman rank correlation analysis showed that both serum PCT and CRP in patients with ARDS was correlated well with APACHE Ⅱ score (r values were 0.669 and 0.601, respectively, bothP < 0.001), while PCT was weakly but positively correlated with Murray score (r = 0.294,P = 0.005), but not the case of CRP (r = 0.203,P = 0.052). APACHE Ⅱ score and serum PCT in non-survival group (n = 38) were significantly higher than those of the survival group [n = 51; APACHE Ⅱ score: 26.00 (23.00, 28.50) vs. 21.00 (17.00, 25.00), PCT (μg/L): 6.38 (2.82, 9.49) vs. 3.09 (1.08, 3.57), both P < 0.01], but Murray score and CRP level were similar between survivors and non-survivors. The areas under ROC curve (AUC) of APACHE Ⅱ score and PCT for predicting 28-day mortality were 0.781 and 0.793, respectively, which were better than those of AUC of Murray score and CRP (0.606 and 0.561, respectively, allP < 0.05). The AUC of APACHE Ⅱ score combined with PCT was significantly higher than that of PCT (0.859 vs. 0.793,P = 0.048) or APACHE Ⅱ score alone (0.859 vs. 0.781,P = 0.038). Using a PCT cut-off value of > 4.35μg/L for predicting 28-day mortality, the sensitivity and specificity was 92.2% and 63.2%, respectively, and the positive and negative likelihood ratios were 2.50 and 0.12 respectively. Kaplan-Meier survival curve analysis indicated that the patients whose PCT more than 4.35μg/L, had lower 28-day cummulative survival rate as compared with those with PCT ≤ 4.35μg/L (log-rank test: χ2 = 5.013,P = 0.025).Conclusion The elevated serum PCT level in patients with ARDS seems to be correlated well with the severity of lung injury, and appears to be a useful prognostic marker of outcome in the early phases of ARDS.

Objective To observe the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) on patients with type A thoracolumbar fractures treated by pedicle screw fixation via dorsal-approach and vertebral body bone graft.Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with type A thoracolumbar fractures treated from June 2012 to July 2015.The patients were divided into control group (32 cases) and research group (32 cases) according to the random number table.There were 22 males and 10 females aged (48.2 ± 11.2)years old in control group.The injury was located at T11 in 2 cases,T12 in 4,L1 in 9,L2 in 7,L3 in 7 and L4 in 3 in control group.There were 24 males and 8 females aged (50.7 ± 11.4) years old in research group.The injury was located at T11in 2 cases,T12in 4,L1in 8,L2 in 8,L3 in 7 and L4 in 3.The control group was treated with posterior pedicle screw reduction,internal fixation and allograft cancellous bone grafting through pedicle of vertebral arch.The research group was treated with rhBMP-2 (mixed with cancellous bone implants) on the basis of the control group.The time of operation,the amount of bleeding during operation,the volume of postoperative bleeding,the amount of postoperative drainage,the recovery of the injured vertebra,the Lane-Sandhu score,the time of fracture healing,and the postoperative complications were compared.Results There was no difference between two groups on operation time,amount of bleeding during operation or amount of postoperative drainage (P ＞ 0.05).No difference existed in two groups about Cobb angle and injured vertebral leading edge height at one week after operation (P ＞ 0.05).At the time of last follow-up (12 months),in research group,Cobb angle was lower while injured vertebral leading edge height was much higher than that of control group (P ＜ 0.05),both of which were better than before (P ＜ 0.05).At 12 months after surgery,the lost Cobb angle of [(2.0 ± 0.7) °] and lost height of injured vertebral leading edge [(3.2 ± 1.0) ％] were smaller than those in control group [(5.6 ± 1.7) ° and (6.8 ± 2.4) ％ respectively] (P ＜ 0.05).The Lane-Sandhu score and healing time of fracture in research group were (8.9 ± 0.8) points and (6.9 ± 0.9) months,which were better than that (6.8 ±0.8)points and (8.4 ± 1.6)months in control group respectively (P＜0.05).The complication rate of research group was lower than that of control group,with no significant difference (P ＞ 0.05).Conclusion Compared with simple vertebral bone graft,posterior thoracolumbar vertebrae pedicle screw fixation with vertebral bone graft and hBMP-2 treatment for type A thoracolumbar fractures can restore vertebral stability,shorten the time of fracture healing and reduce the incidence of complications.

Objective To investigate the feasibility and the clinical effect of bronchial arterial chemoembolization with ADM-Lipiodol mixture in the treatment of brochogenic carcinoma. Methods Thirty-three cases of bronchogenic carcinoma undertaken bronchial arterial chemoembolization, including 20 cases of adenocarcinoma, 8 of squamous cell carcinoma, 1 of small cell carcinoma and 4 of undifferentiated carcinoma. The clinical staging consisted of 5 cases in II, 13 in III A, 11 in IIIB and 4 in IV. Using Seldinger's technique and selective bronchial arterial catheterization (5 cases of super-selective catheterization). After perfusion of 80 - 100 mg CDDP and 10 mg MMC, embolization with a mixture of 30 mg ADM and 2 - 10 mg Lipidol was performed. Another 3 cases were undergone surgery within 1 week after bronchial arterial chemoembolization. Results The 33 cases of bronchial arterial chemoembolization, showed 2 cases of complete response(CR), 21 of partial response (PR), 9 of stable (S) and 1 of processes (P). The pathology revealed massive necrosis of tumor cells after bronchial arterial chemoembolization. No severe complications such as spinal injury occurred. Conclusions Bronchial arterial chemoembolization with ADM-Lipiodol mixture for the treatment of brochogenic carcinoma is good short-term effectiveness. The procedure should be carried out carefully on the basis of fine digital subtraction angiography.

Air Pollution, Indoor ; analysis ; Anesthetics ; analysis ; Environmental Monitoring ; methods ; Isoflurane ; analysis ; Methyl Ethers ; analysis ; Operating Rooms

12 point indicating poor outcome;The release of S 100 in patients were associated with the volume of brain lesions ( P