Objective To retrospectively demonstrate risk factors for mortality in multiple trauma patients with acute respiratory distress syndrome(ARDS).Method This wes a retrospective cohort stuay regarding multi-ple trauma as a single cause for intensive care unit admission.Patients identified multiple trauma with ARDS en-rolled in prospectively maintained database between May 2003 and April 2008 were observed,and 23 items of po-tential risk factors of impacting mortality were calculated by univariate and multivariate logistic analyses in order to find distinctive items in these multiple trauma patients.Information on patients demographics characteristics,treat-ment procedures and injury severity were collected at the time of EICU admission.The criteria used for ARDS met definition of the guideline(2006)of Chinese medical association.The commonly accepted definition of multiple injuries was consistent with both several injury sites(generated from two or more than two anatomic sites)and in-jury in one anatomic site at least threatening life.Severity of injury was quantified by injury severity seore and the simplified acute physiology score and chronic health evaluation score (APACHE Ⅱ)in EICU admission.We in-cluded adult patients(age≥18 years),those with an EICU length of stay longer than 48 hours,and those accept-ing mechanical ventilation more than 24 hours.Patients who were readmitted to EICU by virtue of non-traffic injury or transferred to EICU from other hospitals after long-term treatment were excluded.Mortality was assessed at the 28th clay after trauma.Results There were 269 multiple trauma patients with posttranmatic ARDS admitted to ICU during the study period,the unadjusted odds ratio(OR)and 95% confidence intervals(CI)of mortality were associated with six risk factors(APACHE Ⅱ score,duration of tratuna factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation)out of 23 items.The adjusted Odds Ratios(ORs) with 95% CI were denoted with respect to surviving beyond 96 hours ICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 ICU admission(duration of trauma factor,scpsis,duration of mechanical ventilation)and mechanical ventilation beyond 7 days ICU admission(dura-tion of trauma factor and sepsis).Conclusions Impact of pulmonary contusion and APACHE Ⅱ score contribut-ing to prediction of mortality may exist in prophase after multiple trauma.Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome,infection,and secondary multiple organs dysthnetion.Aspiration of gastric contents could lead to incremental mortality due to scvere ventilation associated pneumonia.Duration of trauma factor determined degree of injury and outcomes,longer duration generally manifested higher mortality.Long-standing mechanical ventilation should be constrained on account of occurring severe refractory complications.

Objective To investigate the effect of β-elemene on SGC7901 gastric cancer cell line and the potential proteins involved. Methods Human SGC7901 gastric cancer cells were treated with different concentrations ofβ-elemene.Cell viability was assessed.A proteomic method,isobaric tags for relative and absolute quantitation (iTRAQ),was employed to detect the proteins altered by β-elemene.Protein expression was validated by Western blot.Results β-elemene inhibited the viability of SGC7901 gastric cancer cells in a dose-dependent manner.Altogether,147 upregulated proteins and 86 downregulated proteins were identified in response to β-elemene treatment in SGC7901 gastric cancer cell line.Among them,the expressions of p21-activated protein kinase-interacting protein 1 (PAK1IP1 ),Bcl-2-associated transcription factor 1 (BTF)and topoisomerase 2-alpha (TOPIIα)were validated by Western blot and the trends were consistent with iTRAQ results.Top pathways involved inβ-elemene treatment in SGC7901 gastric cancer cell line included ribosome signaling,peroxisome proliferator-activated receptors (PPARs)signaling pathway,regulation of actin cytoskeleton,phagosome,biosynthesis and metabolism of some amino acids.Conclusion Our results suggest a promising therapeutic role of β-elemene for gastric cancer.The differentially expressed proteins give us better insights into the potential mechanisms involved in gastric cancer treatment using β-elemene.

Objective:To assess the effects of preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage on blood loss in complex tibial plateau fractures (Schatzker types Ⅴ-Ⅵ).Methods:A sequence randomly generated by computer was used to randomize a cohort of 40 patients into 2 groups who were to receive surgery at Department of Orthopaedics and Trauma, Hong Hui Hospital from June 2018 to January 2019 for complex tibial plateau fractures. They were 24 men and 16 women, aged from 35 to 55 years (average, 46.0 years). In group A, intravenous injection of normal saline was conducted 5 to 10 min before surgical incision and no elastic bandage was used after surgery. In group B, a dose of 15 mg/kg tranexamic acid was intravenously given 5 to 10 min before surgical incision and elastic bandage was used to bandage the knee with compression after surgery. The 2 groups were compared in terms of total blood loss, hidden blood loss, transfusion rate, 48-h drainage flow, venous thromboembolism, postoperative wound complications, postoperative visual analogue scale (VAS), and D-dimer value 24 h after surgery.Results:There were no significant differences between the 2 groups in age, gender, body mass index, smoking history, concomitant medical conditions, American Society of Anesthesiologists (ASA) score, preoperative hemoglobin, preoperative hematocrit, preoperative D-dimerization or fibrin degradation products, showing comparability ( P>0.05). In groups A and B, hemoglobin values 24 h after surgery were 104.6 g/L ± 10.4 g/L versus 113.3 g/L ± 11.9 g/L, drainage volumes 48 h after surgery 277.1 mL ± 229.2 mL versus 207.1 mL ± 124.3 mL, hidden blood loss volumes 318.0 mL ± 83.4 mL versus 266.2 mL ± 60.9 mL, total blood loss volumes 792.8 mL ± 202.8 mL versus 692.2 mL ± 124.9 mL, D-dimer values 24 h after surgery 5.1 mg/L ± 1.3 mg/L versus 4.1 mg/L ± 0.7 mg/L, postoperative VAS scores 5.2 ± 0.9 versus 3.9 ± 1.1, lower limb cross-section diameters 24 h after surgery 35.5 cm ± 3.0 cm versus 34.4 cm ± 2.6 cm, lower limb cross-section diameters 72 h after surgery 33.8 cm ± 2.1 cm versus 32.8 cm ± 2.3 cm, postoperative rates of wound ecchymosis hematoma 20.0% (4 cases) versus 0 (0 cases), and hospital stays 6.6 d ± 1.0 d versus 6.2 d ± 1.2 d. There were significant differences between the 2 groups in all the above items ( P<0.05). However, there were no significant differences between the 2 groups in incidence of postoperative DVT, pulmonary embolism or other wound complications ( P>0.05). Conclusions:Preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage is reasonable and safe for complex tibial plateau fractures, because it significantly reduces intraoperative blood loss but does not increase the risk of venous thromboembolism, and thus has a positive role in accelerating the recovery of patients.

Objective To investigate the protective effect and mechanism of ginsenoside Rg1(G-Rg1)on interleukin-6(IL-6)-induced neuronal injury in rats by regulating Janus activated kinase(JAK)/signal transducer and activator of transcription 3(STAT3)signaling pathway.Methods After culture,rat hippocampal neurons were divided into the control group(normal culture),the IL-6 model group(50 μg/L IL-6 was used to treat rat hippocampal neurons for 18 h to simulate the inflammatory environment in brain),the G-Rg1 low dose(10 μmol/L)group and the G-Rg1 high dose(40 μmol/L)group.After 48 h of normal culture,the survival rate of hippocampal neurons was determined by MTT method.The total iron load of neurons was detected by spectrophotometry,and levels of ferroptosis markers glutathione(GSH)and glutathione peroxidase 4(GPX4)were detected.The mRNA expression level of ferroportin 1(FPN1)in hippocampal neurons was detected by qRT-PCR.The expression of proteins related to the neuronal JAK/STAT3 signaling pathway was detected by Western blot assay.Results Compared with the CON group,the neuronal survival rate,GSH content,GPX4 content and FPN1 mRNA expression level were decreased in the IL-6 model group,and the total iron load,p-JAK and p-STAT3 protein expression levels were increased(P＜0.05).Compared with the IL-6 model group,the neuronal survival rate,GSH content,GPX4 content and FPN1 mRNA expression level were increased in the low-dose and high-dose G-Rg1 groups,and the total iron load,p-JAK and p-STAT3 protein expression levels were decreased(P＜0.05).Changes of the above indicators were more significant in the high-dose G-Rg1 group than those in the low-dose G-Rg1 group(P＜0.05).Conclusion The mechanism of G-Rg1 alleviating ferroptosis of hippocampal neurons in rats may be related to the inhibition of IL-6/JAK/STAT3 signaling pathway,up-regulation of FPN1 expression,and prevention of iron overload.

Objective To explore the effect of motivational interview in the psychological counseling and management abilities of family caregivers of children with recurrent wheezing.Methods A total of 120 children with recurrent wheezing who were treated in Hangzhou Children's Hospital from May 2023 to May 2024 were selected.The family caregivers of children were randomly divided into control group and observation group,with 60 people in each group.The control group received conventional knowledge training and health education,while the observation group received motivational interviews based on control group.Compare the asthma control level,anxiety and depression levels of family caregivers of children,scores of various dimensions of the family caregivers of children management measurement scale,and satisfaction between two groups before and after intervention.Results After intervention,the frequency of recurrent wheezing in observation group was lower than that in control group,and the difference was statistically significant(P＜0.05).There was a statistically significant difference(P＜0.05)in family management measure scores between two groups before and after intervention.The satisfaction of family caregivers of children in observation group was significantly higher than that in control group,and the difference was statistically significant(P＜0.05).Conclusion Motivational interview intervention can effectively alleviate the wheezing frequency of children with recurrent wheezing,improve the response of family care,reduce anxiety and depression of family caregivers of children.

Objective To explore the effects of Qa-1 and PD-L1 loaded artificial liposomal treatment in allograft rejection and its outcomes .Methods The extracellular domains of Qa-1 and PD-L1 were loaded on liposome surface by streptavidin-biotin system . Mixed lymphocyte reaction (MLR) was performed for measuring Qa-1/PD-L1 liposome biological function .Then liposome was co-transplanted with allo-islets via portal vein .The levels of blood glucose and C-peptide were detected daily after transplantation .Also hepatic lymphocytes after transplantation were isolated for determining the proportion of activated cells and signaling pathway changes .Results Artificial liposome could be easily loaded with biotinylated peptide and its diameter was between 50 to 500 nm . Qa-1/PD-L1 liposome could significantly suppress lymphocyte proliferation , activation and secretion of IFN-γ in MLR by an activation of SHP1/2 and an inhibition of Syk pathway .Qa-1/ PD-L1 liposomes could suppress the activation of hepatic lymphocytes in vivo by activating SHP1/2 ,protecting islet allografts and maintaining a normal level of blood glucose in recipients .Conclusions Qa-1/PD-L1 loaded liposome can effectively suppress allograft rejection and improve the outcomes of islet transplantation .

Objective To investigate the effects of adoptive reinfusion of regulatory T cell (Treg) on the recovery of islet function and graft survival time after islet allograft transplantation. Methods The diabetic model was established using C57BL/6 mice as recipients, and Balb/c mice were chosen as donors for islet allografts transplantation beneath the renal capsule. The recipient mice were divided into 3 groups and 3 mice in each group according to different processing Methods: Treg experiment group (Treg group, 1×10⁶ Treg cells were injected via tail vein at 1 d before operation), positive control group [sirolimus (SRL) group, SRL at a dose of 300 μg/(kg·d) was intragastrically given every day from 1 d before operation] and blank control group (control group, an equivalent volume of normal saline was intragastrically given every day from 1 d before operation). Enzyme-linked immune absorbent assay (ELISA) was used to detect the changes of blood glucose and C-peptide in mice within 14 days after transplantation. In vivo imaging technique was used to dynamically monitor the survival of mice within 14 days after transplantation. Results In each group, the blood glucose levels at postoperative 3 d were significantly decreased compared with those before transplantation (all P < 0.001). At postoperative 1 d, the C-peptide levels showed an explosive rise to varying degree in each group. At postoperative 3 d, the C-peptide levels in each group were significantly higher than that before operation (all P < 0.001). At the end of the observation period at 14 d after operation, the C-peptide levels in the SRL and Treg groups were (427±50) pmol/L and (833±57) pmol/L, relatively higher than that in the control group. But the blood glucose levels were (14.5±0.5) mmol/L and (12.1±0.6) mmol/L, significantly lower than that in the control group (all P < 0.001). Compared with the SRL group, the explosive release amount of C-peptide was significantly lower, the declining trend was more remarkably stable, and the C-peptide level was considerably higher in the Treg group at the end of the observation period (all P < 0.001). At postoperative 14 d, the grafts were almost completely apoptotic in the control group, over 50% of the grafts survived in the SRL group, and over 80% of the grafts survived in the Treg group. Conclusions Adoptive reinfusion of Treg cells can effectively protect islet grafts, prolong the survival time of grafts, and maintain the normal levels of blood glucose and C-peptide in the recipient mice.

OBJECTIVETo investigate the effects of β-elemene in suppressing the proliferation and apoptosis of SGC7901 gastric cancer cells in vitro and explore the underlying mechanisms.

METHODSUsing MTT assay, flow cytometry, and clonogenic survival assay, we assessed the effects of β-elemene on the viability, apoptosis, cell cycle distribution, and clonogenic survival of gastric cancer SGC7901 cells and gastric mucosal epithelial GES-1 cells. Western blotting was employed to determine the changes in the protein expression profiles in SGC7901 cells in response to β-elemene treatment.

RESULTSβ-elemene significantly suppressed the cell viability and increased the apoptosis of SGC7901 cells, and these effects were less obvious in GES-1 cells. β-elemene decreased clonogenic survival of SGC7901 cells, increased the proportion of G2/M phase cells, decreased the expression of Bcl-2, and increased the expression of Bax and cleaved caspase-3. β-elemene did not obviously affect the expression of total p21-activated protein kinase 1 (Pak1) but decreased the level of phospho-Pak1 (Thr423) and phospho-ERK1/2 (Thr202/Tyr204) in SGC7901 cells.

CONCLUSIONβ-elemene inhibits the proliferation and induces apoptosis of gastric cancer cells possibly by inhibiting Pak1/ERK signaling and regulating apoptosis-associated proteins such as Bcl-2 and Bax.

Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle ; Cell Division ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Cell Survival ; Humans ; Sesquiterpenes ; pharmacology ; Signal Transduction ; Stomach Neoplasms ; pathology

Objective:To conduct a Meta-analysis of the efficacy and safety of laparoscopy-assisted pylorus-preserving gastrectomy(LPPG) and laparoscopy-assisted distal gastrectomy(LDG) in early gastric cancer(EGC).Methods:Searched Web of Science, Cochrane library, Embase, Chinese Biomedical Medical Database, CNKI, Wanfang Database to identify all qualified studies comparing LPPG and LDG in EGC. The retrieval time was from the database establishment to October 2020. Measurement data with normal distribution were represented as ( Mean± SD). Comparing two groups by mean difference(MD) with 95% confidence interval(CI) for contious outcomes and odds ratio(OR) with 95% CI for dichotomous data.The RevMan software was used to analyze the perioperative outcome. Results:A total of 10 studies were included, with a total of 1613 patients, 624 in the LPPG group and 989 in the LDG group. Operation time, intraoperative blood loss, postoperative anal exhaust time, hospital stay, and overall complication rate of LPPG were similar to LDG.Compared with the LDG group, the LPPG group had fewer lymph node dissections ( MD=-2.51, 95% CI: -4.31~-0.71, P=0.006), longer postoperative gastric tube indwelling time ( MD=1.05, 95% CI: 0.31~1.80, P=0.006), and a higher incidence of delayed gastric emptying ( P<0.01). There was no statistically significant difference between the two groups in terms of other perioperative complications. Conclusion:LPPG is a safe and feasible surgical method for the treatment of EGC, and can be used as an alternative to LDG.

Objective:To investigate the perioperative risk factors of surgical site infection (SSI) of subaxial cervical spine injury after anterior surgery and provide a basis for the development of nursing measures.Methods:A retrospective case-control study was conducted to analyze the clinical data of 754 patients with subaxial cervical spine injury who underwent anterior surgery from January 2014 to January 2018, including 511 males and 243 females, aged 44-61 years [(50.2±5.1)years]. The fracture segment was C 3 in 60 patients, C 4 in 159, C 5 in 197, C 6 in 236 patients, and C 7 in 102. The patients were divided into two groups according to SSI occurrence. There were 28 patients in infected group and 726 patients in non-infected group. Data of the two groups were recorded, such as demographic data, American Spinal Injury Association (ASIA) scale, comorbidity, time interval from skin preparation to operation, preoperative urinary catheterization or not, consecutive operation or not, total number of staff involved in the operation, layer flow level of operating room, operating room temperature, relative humidity, operation duration, intern nurse involved in the operation or not and surgical methods. Univariate analysis was used to screen the indicators with statistically significant differences between the two groups. Multivariate Logistic regression analysis was further used to identify the risk factors of SSI. Results:The occurrence rate of SSI was 3.71% (28/754). The univariate analysis showed that there were significant differences between the two groups in ASIA scale, diabetes, dietary nursing, time interval from skin preparation to operation, preoperative urinary catheterization, consecutive operation, total number of staff involved in the operation, layer flow level of operating room and operation duration( P<0.01). The multivariate Logistic regression analysis showed that the ASIA scale (grade A: OR= 84.421, grade B: OR=27.200, P<0.01), diabetes ( OR=3.234, P<0.05), without diet nursing ( OR=2.375, P<0.05), time interval from skin preparation to operation ≥ 6 h ( OR=2.542, P<0.05), preoperative urinary catheterization ( OR=4.085, P<0.01), consecutive operation ( OR=2.894, P<0.05), total number of staff in the operating room ≥ 8 ( OR=3.137, P<0.01), layer flow level of operating room is grade 10, 000 or above ( OR=5.380, P<0.01) and operation duration≥ 3 h ( OR=2.405, P<0.05) were positively correlated with perioperative SSI. Conclusions:The factors associated with SSI of subaxial cervical spine injury after anterior surgery are the ASIA scale (grade A and B), diabetes, without diet nursing, time interval from skin preparation to operation ≥ 6 h, preoperative urinary catheterization, consecutive operation, total number of staff in the operating room ≥ 8, layer flow level of operating room (grade 10, 000 or above) and operation duration ≥3 h. For patients with subaxial cervical spine injury, attention should be paid to diet care, blood glucose monitoring should be strengthened, and operating room management should be optimized.