Objective To evaluate the perioperative nutritional risk of patients with colorectal cancer. Methods Totally, the nutritional risk of 144 colorectal cancer patients who were newly admitted to our hospital and were radiotherapy-naive or chemotherapy-naive were evaluated using Nutritonal Risk Screening 2002 (NRS2002 ) before operation and two weeks after operation. Meanwhile, hemoglobin, serum levels of albumin and prealbumin, total lymphocyte count were measured and the postoperative complications were observed. Results The incidence of preoperative nutritional risk was 22. 91% (33/144). The predicted incidence of postoperative nutritional risk was 43. 06% (62/144), while the actual incidence was 54. 86% (79/144) (x2 =4. 016, P < 0.05). About 10. 13% of patients whose preoperative nutritional risk score≥3 experienced complications, while only 1. 54% of patients whose preoperative nutritional risk score < 3 had complications (x2 = 3. 065, P < 0.05). Conclusions The perioperative (especially postoperative) nutrition risk is high in patients with colorectal cancer. Patients with higher nutrition risk tend to experience postoperative complications.

Objective To evaluate the clinical application of HLA-peptides tetramer staining flow cytometry for determining HBV specific CD8+ cells.Methods HBV specific CD8+ cells in whole blood samples of chronic hepatitis B patients were stained with tetramer complex of HLA-A2 and HBV core 18-27 peptide and counted by flow cytometry. Results The medians of percentages of HBV specific CD8+ cells of total CD8+ cells were 0.20%(0.02%～2.04%) in 11 acute hepatitis B patients and 0.05%(

Objective To investigate the prevalence and dissemination mechanism of 16S rRNA methylase genes in extended-spectrum beta-lactamases(ESBLs)-producing Enterobacteriaceae in China.Methods PCR amplification and DNA sequencing were used for screening and identifing 16S rRNA methylase genes and ESBLs genes.Minimal inhibitory concentrations(MICs)of the antimicrobial agents were detected by Etest.Conjugation and plasmid extract were performed to study dissemination mechanism of 16S rRNA methylase genes and ESBLs genes.Results Only one strain.Klebsiella oxytoca strain ZJ157 was screened as positive for armA gene from 447 ESBLs-producing isolates,which also contained CTX-M-15 and TEM-1 genes.It was resistant to aminoglycesides,ciprofloxacin,and most β-lactams,except carbapenems,polymyxin E and tigecyeline.Resistance to amikacin and β-lactams was transferred to a recipient Escherichia coli 600 by conjugation experiment.arntA.CTX-M-15 and TEM-1 genes were detected in the transconjugant.A plasmid about 55 kb was extracted from Klebsiella oxytoca ZJl57 and the transconjugant.Conclusions A 16S rRNA methylase gene armA was detected in an isolate of Klebsiella oxytoca.armA,CTX-M-15 and TEM-1 genes can be co-transferred in the same plasmid leading to multi-drug resistance.

Objective To study the dynamics changes of cerebrospinal fluid (CSF) bacterial load within 48 h after infection in a rabbit meningitis model, and provide information for diagnosis,treatment and prognosis of this disease. Methods Taking New Zealand white rabbit as the study object, meningitis model was established via cerebellar cistern puncture with different concentrations of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) to explore the relationship between the mortality of animals and the subarachnoid inoculation dosage. The dynamics study of CSF bacterial load was conducted with proper inoculation bacterial dosage. Forty-eight rabbits were separated into four groups (12 each group): E. coli meningitis model group, E. coli meningitis + ceftriaxone treated group, S. aureus meningitis model group and S. aureus meningitis + vancomycin treated group. At 0,12, 24, 36 and 48 h of inoculation, CSF and blood samples were obtained for CSF bacterial quantitative culture, CSF leukocyte count and peripheral blood leukocyte count. Finally, the relationships between the early mortality of animals, the efficacy of antibiotics, CSF leukocyte counts and the dynamics changes of CSF bacterial load were analyzed in the bacterial meningitis rabbit model.The CSF bacterial load and the white blood cell count curve were compared by analysis of covariance (ANOVA). Correlation test was done using correlate partial analysis. Results The relationship between subarachnoid inoculation dosage and the mortality of rabbits presented S-curve correlation.The bacterial load in subarachnoid space peaked in 12-24 h after infection and then gradually decreased. Effective antibiotic therapy could significantly speed up the decline of this process. There were significantly different between E. coli meningitis model group and E. coli meningitis+ceftriaxone treated group (F= 27. 10, P<0. 01), between S. aureus meningitis model group and S. aureus meningitis + vancomycin treated group (F=5. 97, P = 0. 016). There was a positive correlation between CSF bacterial load and CSF leukocyte count in E. coli and S. aureus meningitis model groups (r=0. 89, 0.84, respectively; P = 0.046, 0.049, respectively). Conclusions In the treatment of bacterial meningitis, effective and sufficient antibiotics should be used as soon as possible to control the CSF bacterial load and reduce the mortality. The CSF leukocyte count can be used as indicator of CSF bacterial load and guide the antibiotic treatment in clinical bacterial meningitis.

Objective To sum up the experience of application of artificial liver support system (ALSS) combined with liver transplantation(LT) in the treatment of end stage severe hepatitis.Methods Clinical data of 23 patients with end stage severe hepatitis receiving ALSS treatment prior to liver transplantation among 223 patients who underwent LT consecutively between April 1993 and December 2003 were analyzed retrospectively. Twenty three patients with end stage severe hepatitis received 58 courses of ALSS prior to liver transplantation. The 6 month survival rate was compared to those in non ALSS non LT group and non LT group.Results ALSS treatment facilitated improvement of liver function, endotoximia, and the tolerance to LT, thus provided a bridge time for attaining the donor liver. The total serum bilirubin level at LT was significantly lower than that before the first run of ALSS ( P

OBJECTIVETo investigate the effects of treatment with ursodeoxycholic acid (UDCA) on intrahepatic cholestasis in rats, and to explore its mechanism.

METHODRats suffering from intrahepatic cholestasis were treated with UDCA. Their serum alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), gamma-glutamyl transpeptidase (gamma-GT), total cholesterol (TCH), bile flow, total bile acid excretion, total Na(+) and TCH of bile were measured before and after treatment. In addition, the changes of liver tissue under microscrope were observed and recorded.

RESULTSCompared with the control group, serum ALT, ALP, TBIL, DBIL, gamma-GT and TCH of rats in the treatment group decreased, while bile flow, total bile acid excretion, total Na(+) and TCH decreased significantly. Degeneration of hepatocytes, infiltration of inflamed cells and proliferation of small bile ducts in the treatment group were improved under microscope.

CONCLUSIONUDCA may have therapeutic effects on cholestatic hepatitis. The mechanism may involve in its hydrophilicity, choleretic effect and immune modulation.

Objective To explore how the bundle comprehensive brain protection treatments affects cerebral oxygen metabolism,endothelial cell function and intracranial pressure of patients with severe craniocerebral trauma.Methods One hundred and twenty patients with severe craniocerebral trauma were selected from January 2014 to November 2016 in our hospital.The patients were randomly divided into control group and observation group (n=60).Patients from the control group were given normal treatment;whilst patients from the observation group were additionally treated with bundle comprehensive brain protection treatments.The cerebral oxygen metabolism levels (jugular bulb venous oxygen saturation [SjVO2],cerebral extraction of oxygen [CEO2] and arteriovenous oxygen difference [AVDO2]),endothelin (ET) level and intracranial pressure (ICP) were calculated and compared before and after treatment.Results The levels of SjVO2,CEO2 and AVDO2,and ET and ICP levels showed no significant differences between the obvseration group and control group before treatment (P＞0.05).After treatment,the levels of SjVO2,CEO2 and AVDO2 in the observation group were significantly higher than those in the control group (P＜0.05);as compared with those in the control group,the ET and ICP levels in the observation group were significantly decreased (P＜0.05).Conclusion The bundle comprehensive brain protection treatments could improve cerebral oxygen metabolism and endothelial function,and decrease the ET and ICP levels of patients with severe craniocerebral trauma,which has important value in clinical practice.

Objective:To investigate the risk factors for intracranial hematoma progression in patients within 24 h of traumatic brain injury.Methods:A prospective study was performed; 184 patients with traumatic brain injury admitted to our hospital from January 2018 to June 2021 were enrolled. According to the states of intracranial hematoma indicated by head CT within 24 h of injury, these patients were divided into intracranial hematoma progression group ( n=52) and intracranial hematoma stable group ( n=132). The clinical data of patients in the two groups were compared and the independent risk factors for intracranial hematoma progression were screened by multivariate Logistic regression analysis. Results:As compared with intracranial hematoma stable group, patients in the intracranial hematoma progression group had significantly advanced age, significantly higher systolic blood pressure and blood glucose levels, statistically higher proportions of patients with parenchymal hemorrhage, subarachnoid hemorrhage, and multiple hematomas, significantly longer prothrombin time, significantly higher international standardization index and D-dimer level, significantly higher proportion with patients with fibrinogen<2.0 g/L, statistically increased K value (blood coagulation time) of thromboelastic map, proportion of patients with α Angle (blood coagulation angle)<64°, level of vascular endothelial biomarker syndecan-1 (Syn-1), and von willebrand factor (vWF) activity, and significantly decreased Glasgow Coma Scale (GCS) scores at admission and platelet count ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.066, 95%CI: 1.018-1.117, P=0.007), systolic blood pressure ( OR=1.076, 95%CI: 1.041-1.111, P<0.001), multiple hematoma ( OR=6.559, 95%CI: 2.025-21.245, P=0.002), fibrinogen<2.0 g/L ( OR=6.164, 95%CI: 1.586-23.954, P=0.009), K value ( OR=6.500, 95%CI: 1.755-24.082, P=0.005) and Syn-1 level ( OR=1.111, 95%CI: 1.015-1.215, P=0.022) were independent risk factors for intracranial hematoma progression in patients with traumatic brain injury at early stage. Conclusion:Traumatic brain injury patients, at early stage, with advanced age, multiple intracranial hematoma, high systolic blood pressure, low fibrinogen, prolonged K value and high Syn-1 level are trend to have intracranial hematoma progression.

Objective:To investigate the neuroprotective effect of histone deacetylase 3 (HDAC3) specific inhibitor RGFP966 on traumatic brain injury (TBI) and its mechanism in rats.Methods:Forty-eight SD rats were randomly divided into sham-operated group, TBI group, TBI+vehicle group and TBI+RGFP966 group ( n=12). Rats in the later 3 groups accepted hydraulic impact brain injury to establish TBI models; and then, RGFP966 (dissolved in 1% DMSO at a dose of 10 mg/kg) was injected intraperitoneally 30 min after modeling, twice a day for 3 d, in TBI+RGFP966 group; same amount of DMSO was injected into TBI+vehicle group at the same time. Three d after modeling, neurological function was tested by modified neurological severity score (mNSS), water content of brain tissues was detected by dry-wet weight method, proportion of injured neurons at the frontal cortical tissues on the affected side was detected by Nissl staining, expressions of HDAC3 and pyroptosis related proteins were detected by immunohistochemical staining and Western blotting, and serum content of inflammatory factors was detected by ELISA. Results:Three d after modeling, compared with the TBI+vehicle group, the TBI+RGFP966 group had significantly decreased mNSS scores (9.83±0.75 vs. 6.67±0.82), water content of the injured cerebral cortex (82.73%±0.36% vs. 80.92%±0.66%), proportion of damaged neurons (75.60%±7.44% vs. 55.87%±4.10%), and HDAC3 protein expression (0.67±0.09 vs. 0.51±0.07), and significantly increased acetylated H3 (Ace-H3) and acetylated H4 (Ace-H4) protein expressions (0.81±0.02 vs. 1.22±0.02; 0.74±0.01 vs. 1.07±0.02), and statistically decreased protein expressions of nuclear factor-κB (NF-κB, 1.20±0.05 vs. 0.94±0.04), NOD-like receptor thermal protein domain associated protein 3 (NLRP3, 0.72±0.02 vs. 0.40±0.03), Caspase-1 containing cysteine (Caspase-1), dermatin D N-terminal fragment (GSDMD-N, 0.71±0.03 vs. 0.52±0.01), significantly decreased NF-κB and NLRP3 immunohistochemical staining scores, and significantly decreased serum contents of tumor necrosis factor-α, interleukin(IL)-1β and IL-18 ( P<0.05). Conclusion:Early intervention with RGFP966 after TBI can reduce the pyroptosis and inflammatory reaction of nerve cells and play neuroprotective role, whose mechanism may be related to inhibited activation of NF-κB/NLRP3/GSDMD pathway.

Objective:To analyze the risk factors of fatal outcome in patients with severe COVID-19.Methods:The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression.Results:Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators ( P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient’s clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion:COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.