Objective To investigate and analyze the risk factors,morbidity and mortality rates of multiple organ dysfunction syndrome (MODS) after multiple trauma.Methods The clinical data of all 155 patients with multiple trauma admitted to our ICU from Sep 2008 to Jun 2011 were retrospectively analyzed,including treatment,injury severity score (ISS) and its relationship with MODS.Results The morbidity of MODS among all 155 patients was 18.7％ (29/155).There were 3,7 and 19 patients died due to multiple trauma in 39 ISS ＜ 16,58 ISS 16-25,and 58 ISS ≥25 cases respectively.The morbidity of MODS was significantly higher in patients with ISS ≥25 ( x2 =12.321,P =0.002) than in others.There were 15 cases with MODS and 28 cases without MODS died respectively in multiple trauma patients ( x2 =10.236,P =0.001 ).Conclusion MODS is the important reason for death in multiple trauma patients.It is pivotal to actively deal with primary trauma to avoid the second insult to the patients and support vital organs early in order to improve the prognosis of multiple trauma.

Objective To investigate the efficacy of combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones.Methods The clinical data of 3780 patients with extra-hepatic bile duct stones who were admitted to the First Hospital of Lanzhou University from March 1998 to June 2010 were retrospectively analyzed.According to the condition of bile duct stones,laparoscope,choledochoscope and duodenoscope were applied separately or combinately.All patients were divided into A,B and C groups.Patients in group A were treated by laparoseopy,choledochoscopy or duodenoscopy;patients in group B were treated by choledochoscopy+duodenoscopy.duodenoscopy+laparoscopy or laparoscopy+choledochoscopy;patients in group C were treated by laparoscopy+duodenoscopy+choledochoscopy.The efficacies of different treatment approaches were analyzed by comparing the results of imaging examination and follow-up.Results The curative rate and complication rate of the group A were 89.54%(1276/1425)and 6.73%(86/1276),respectively.Of the 149 patients in the group A who were failed in the treatment,83 patients were transferred to the group B,and 66 patients were transferred to the group C.The curative rate and complication rate of the group B(including 83 patients transferred from the group A)were 95.93%(1719/1792)and 4.07%(70/1719),respectively,and 73 patients who were failed in the treatment were transferred to the group C.The curative rate and complication rate of the group C(including 139 patients transferred from the group C)were 99.75%(783/785)and 0.26% (2/783),respectively,and 2 patients who were failed in the treatment received open surgery.Conclusion Combined application of laparoscope and endoscopes could raise the success rate of stone clearance and decrease the postoperative complications.

Objective To investigate the efficacy of endoscopy for the treatment of benign biliary stricture after biliary surgery.Methods The clinical data of 127 patients with benign biliary stricture after biliary surgery at the First Hospital of Lanzhou University from January 2007 to December 2011 were retrospectively analyzed.According to the Bismuth classification,there were 60 patients with type Ⅰ,35 with type Ⅱ,21 with type Ⅲ and 11 with type Ⅳ.The efficacies of endoscopy for the treatment of biliary stricture with different Bismuth subtypes were analyzed.Results The location and severity of biliary stricture were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) + cholangiography.Sixteen patients ( including 7 with type Ⅲ and 9 with type Ⅳ) were transferred to surgical treatment due to severe biliary stricture.A total of 111 patients underwent endoscopic treatment successfully,with the success rate of 87.4％ (111/127).The success rates of endoscopy for the treatment of patients with Bismuth Ⅰ,Ⅱ,Ⅲ and Ⅳ biliary strictures were 95％ (57/60),86％ (30/35),9/14and 1/2,respectively.Twenty-nine patients were implanted with retrievable metallic biliary stent,and 82 were implantated with plastic biliary stent.Of the 111 patients,only 6 patients were complicated by acute pancreatitis,and they were cured by conservative treatment.The alleviative rates of yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were 73％ (81/111 ),83％ (74/89),90％ (73/81 ) and 89％(68/76) at 1 week after treatment,and they were 88％ (98/111),91％ (81/89),94％ (76/81) and 92％(70/76) at 8 weeks after treatment.The efficacy of endoscopy was good in 97 patients and poor in 14 patients,and the 14 patients were converted to open surgery.The symptoms including yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were completely alleviated at postoperative month 6.Conclusion Endoscopic treatment for benign biliary stricture is safe and effective.

Objective:To evaluate the effects of amelogenin(AML)on the migration,adhesion and proliferation of periodontal liga-ment stem cells(PDLSCs).Methods:PDLSCs were cultured with AML at 0.25,50 amd 100 μg/ml respectively.The migration, adhesion and proliferation of the cells were examined by wound healing migration assay,transwell migration assay,attachment assay, MTT assay and cell counting,respectively.Results:AML induced the migration of PDLSCs in a dose-dependent manner(P <0.05), increased the adhesion and proliferation of PDLSCs(P <0.05).Conclusion:AML may promote the migration,adhesion and prolifer-ation of PDLSCs.

AIM: To study dynamically the effect on the rabbits after fine carbon fiber powder was transplanted into their cranium. METHODS: After fine carbon fiber powder was injected into subdural cavity of rabbits, examination of histopathology and EEG were carried out. RESULTS: General observation: 1-104 weeks after injecting, no neuropathological changes concerning with the injecting of the carbon fiber powder were found in the rabbits of experimental group; Under optical microscopes: 1-2 weeks after injecting, slight inflammatory reaction in meninx was found and disappeared generally 4 weeks after injecting, no obvious fiber membrane was found around the carbon fiber, no significant differences were showed between the experimental group (EG) and the control group (CG); Examination of EEG: 1-2 weeks after injecting, slight abnormal changes of EEG in both two groups were showed, but no significant differences was found between them. 4 weeks after injecting, the EEG of the two groups was restored to their normal state before injecting. 1-8 weeks after injecting, no obvious epilepsy waves were showed. CONCLUSION: The fine carbon fiber powder showed excellent histocompatibility after injected into the subdural cavity of rabbits.

Objective To investigate the early (within 72 hours) application and effect of endoscopic pancreatic and (or) biliary stents combined with Qingyi granules in treatment of acute biliary pancreatitis (ABP) patients.Methods A retrospective analysis was done to the 245 patients admitted for ABP from Jan.2012 to Jan.2016 in the First Hospital of Lanzhou University.133 patients (group A) were treated within 72 hours by endoscopic pancreatic and (or) biliary stents combined with Qingyi granules through feeding tube.112 patients (group B) were treated by endoscopic pancreatic and (or) biliary stents and feeding tube without Qingyi granules.Then the study was done to compare the difference of recover days of abdominal distension,abdominal pain,normalization time of amylase and WBC,length of stay,decrease level of PCT,and the incidence of ABP complications.Results Group A was superior to group B in terms of the recover days of abdominal distension (3.8±3.2)d vs (5.2± 2.4)d,abdominal pain (2.6±2.1)d vs (4.9±2.7)d,normalization time of amylase(2.8±1.6)d vs (4.4±3.7)d,WBC (2.6±1.3)d vs (4.1± 2.7)d,length of stay(9.4±2.1)d vs (12.6±3.3)d and postoperative PCT level(2.59±2.33)ng/ml vs (3.98±3.03)ng/ml,and the difference had statistical significance (P＜0.05),while there was no significant difference between the two groups in the incidence of ABP complications.Conclusions For ABP patients,early placement of endoscopic pancreatic and (or) biliary duct stents combined with Qingyi granules through feeding tube can remove the etiology,and block the disease from further progress.Early enteral nutrition can contribute to the recovery of intestinal mucosa and the maintenance of internal environment.Combined with Qingyi granules,it can relief the symptoms,decrease the laboratory index and shorten the hospitalization time.

Following Escherichia coli lysis with alkali, cetyltrimethylammonium bromide (CTAB) was directly titrated into the supernatant. An easy and feasible technology for plasmid purification was established with the optimized proportion between the quantity of CTAB and plasmid, combined with the specific solution for DNA release and TritonX-114 for endotoxin removal. Quality detection showed that the purified plasmid was free of contamination of host RNA. The host bacterial genomic DNA, endotoxin and bacterial protein were less than 10 microg, 50 EU and 10 microg per mg plasmids, respectively. The ratio of OD260/OD280 was between 1.75-1.85. Eighty percent of the prepared plasmids were presented in the supercoiled form. The plasmid purified with this technology can satisfy all criteria stipulated by FDA. The main advantages of the technology include the avoidance of animal-derived enzymes such as ribonucleases A, Proteinase K and toxic reagents like chloroform and phenol. In addition, the technology has low cost and no pollution.
Cetrimonium Compounds ; chemistry ; Chemical Precipitation ; DNA ; genetics ; isolation & purification ; DNA, Bacterial ; genetics ; isolation & purification ; Escherichia coli ; chemistry ; genetics ; Plasmids ; genetics ; isolation & purification

Acute respiratory distress syndrome(ARDS) is a common critical syndrome with high morbidity and mortality.The treatments include respiratory support and drug therapy.In this paper, the latest clinical advances in the treatment of ARDS with glucocorticoids, statins, antioxidants, recombinant human activated protein C, sedatives and muscle relaxants, exogenous alveolar surfactants, mesenchymal stem cells, and vasodilators are reviewed.

OBJECTIVETo explore the effects of angiotensin-(1-7) on the learning and memory abilities and the expressions of glial fibrillary acidic protein (GFAP) and glial cell line-derived neurotrophic factor (GDNF) in the hippocampus of diabetic rats.

METHODSForty male SD rats were randomly assigned into 4 groups, namely the control group, diabetic group, Ang(1-7)-treated diabetic group (DM1 group), and Ang-(1-7)- and Mas receptor antagonist A779-treated diabetic group (DM2 group). Diabetic rat models were established by a single intraperitoneal injection of streptozotocin (60 mg/kg). The cognitive function of the rats was assessed with Morris water maze (MWM) test. The expressions of GDNF in the hippocampus were examined by RT-PCR and Western blot. Nissl staining was performed to evaluate the morphological changes in rat hippocampus. The expressions of glial fibrillary acidic protein (GFAP, a key indicator of astrocytic reactivity) and caspase-3 were measured by immunohistochemistry.

RESULTSCompared with the control group, the diabetic rats exhibited significantly impaired learning and memory abilities (P<0.05) with lowered expression of GDNF and increased caspase-3 expression in the hippocampus (P<0.05) and significant hippocampal neuronal and astrocyte injuries (P<0.05). Treatment with Ang(1-7) obviously improved the learning and memory abilities of the diabetic rats (P<0.05), increased GDNF and GFAP expressions (P<0.05), lowered caspase-3 expression (P<0.05), and increased the number of surviving neurons in the hippocampus (P<0.05). Such effects of Ang(1-7) effect was blocked by treatment with A779 of the diabetic rats.

CONCLUSIONAng(1-7) can alleviate cognitive dysfunction in diabetic rats possibly by up-regulating the expressions of GFAP and GDNF and promoting neuron survival in the hippocampus.

Angiotensin I ; pharmacology ; Animals ; Astrocytes ; Caspase 3 ; metabolism ; Cognition ; Cognition Disorders ; Diabetes Mellitus, Experimental ; physiopathology ; Glial Cell Line-Derived Neurotrophic Factor ; metabolism ; Glial Fibrillary Acidic Protein ; metabolism ; Hippocampus ; cytology ; metabolism ; Male ; Memory ; Neurons ; Peptide Fragments ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Streptozocin

Objective: To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods: From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺) in C group were measured at 8∶00 a. m.the next day. Results: The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P<0.05), while the levels of CD₄⁺ were lower than those in C group(all P<0.05). Compared with T0, the plasma NS and Cor decreased at T3 in M, P and D group (all P<0.05). The plasma Cor at T3 in P group was lower than that in M group[(475.77±49.69)μg/L vs.(502.33±60.92)μg/L](t=-26.57, P<0.05). The plasma NS and Cor at T3 in D group were lower than those in M group[(20.64±4.70)ng/L vs.(25.29±4.03)ng/L, (442.83±66.59)μg/L vs.(502.33±60.92)μg/L](t=-4.51, -59.50, all P<0.05), and were lower than those of P group[(20.64±4.70)ng/L vs.(23.60±4.49)ng/L, (442.83±66.59)μg/L vs.(475.77±49.69)μg/L](t=-2.96, -32.93, all P<0.05). Compared with T0, the level of CD₄⁺ decreased at T1, T2 and T3(except T3 in D group) in M, P and D group (all P<0.05), and the level of CD₈⁺ decreased at T1, T2 and T3 in M and P group (all P<0.05), but those in D group at T1, T2 and T3 were not significantly decreased(all P>0.05). The levels of CD₈⁺ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD₄⁺/CD₈⁺ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05). Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol.