Objective To determine the appropriate size of the tube for the thoracic drainage in good efficiency by the experimental study in the influence of the tube size on the flow rate of the fluid with different properties.Methods Three groups were divided according to the different components in the fluid:group A,whole blood with 30％ hematocrit; group B,2.5％ albumin solution; and group C,0.9％ normal saline.The total volume of the fluid was 1000 mL in each group in the experiment.Different sorts of fluids were drained with the chest tubes with different diameters (6F,8F,10F,12F,14F,16F,18F,20F,22F,24F,26F,28F,30F,32F,34F,36F of French F) separately,and the flow rate was calculated.ANOVA was used for the comparison of the differences in flow rate among the groups with given fluid property.Twofactor analysis of variance was used for the analysis of flow rates of fluid with different fluid properties.Curve fitting was performed according to the Poiseuille formula.Results The flow rate was positively correlated with the size of the chest drainage tube.The difference in flow rate among the tubes with difference in size was statistically significant (P ＜ 0.05) but there was no noticeable difference in flow rate between 6F and 8F (P =0.513).The flow rate of the 6F and 8F tubes was higher than that of the control (3.33 mL/min) but there was no significant difference between them (P ＞ 0.05).The flow rate of the tubes in 10F and above was obviously higher than that of control (P ＜ 0.05).The curve was estimated that group A was Q =0.002 9x4,R2 =0.991; group B Q=0.003 2x4,R2 =0.981; group C Q =0.003 4x4,R2 =0.975.When the flow rate was fixed at 3.33 mL/min,the estimated curve in group A was X ≈ 5.82F.Conclusions Our experiment indicated that the chest tube with small diameters (6F-14F) could meet the demand of high efficient drainage in the patients with hemothorax or pleural effusion.

Objective To evaluate the value and significance of bedside ultrasound in diagnosis of lung atelectasis/consolidation in multiple trauma patients with mechanical ventilation.Methods Bedside thoracic ultrasound and chest computed tomography(CT)were performed in 81 multiple trauma patients with mechanical ventilation admitted to the emergency intensive care unit(EICU).CT result was regarded as the "golden standard" to evaluate the value of ultrasound in diagnose lung atelectasis/consolidation.At the same time,the ultrasound was used to dynamically monitor the lung recruitment effect of the therapeutic measures.Results CT detected 154 regions of lung atelectasis/consolidation of 324 lung regions in 81 patients,while ultrasound detected 126 regions that were divided into 87 complete regions and 39 incomplete regions according to different sonogram in the breathing cycle.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound were 81.8%,100%,100%,85.9% and 91.4% respectively.A concordance test showed a very high concordance between ultrasound and CT,with a Kappa coefficient of 0.825(P=0.031).Ultrasound found that 39 regions with incomplete lung atelectasis/consolidation were completely recruited and 62 out of 87 regions with complete lung atelectnsis/eonsolidatian gained visible recruitment within three days after different therapeutic measures,with total effective rate of 80.2%.Conclusion Bedside ultrasound can continuously monitor and guide the therapeutic measure to recruit the lung and is a convenient,safe,direct-viewing and accurate method for diagnosis of lung atelectasis/cansolidation in multiple trauma patients with mechanical ventilation.

Objective To develop a new method to measure pleural effusion volume by ultrasound in critically ill patients. Methods Forty-six critically ill patients admitted to emergency ICU were involved.The height of effusion (H),area of effusion at the middle section (S), thickness of effusion at middle-back line (T1) and posterior axillary line (T2) were measured by ultrasound in supine position at the end of expiration. The measured volume of pleural effusion (Vc) was calculated by H×S,and the actual volume of drainage (V) within 2 hours was also recorded. The correlation of actual volume of pleural effusion (V)with effusion height (H) ,thickness (T1, T2), area (S) and the calculated volume (Vc) were analyzed to decide the most accurate index and method. Results There was much better correlation between actual volume of effusion and S, (H & S), Vc, than these between V and T1 ,T2, H in all patients and subgroup, Vc had good correlation with V and very close to V(the average difference was 56 ml) when the actual volume was less than 500 ml,there was no difference[(417 ± 94)ml vs (402±95)ml, t = 1.095, P = 0. 285]. Both Logistic regression analysis and receiver operating characteristic (ROC) curve showed S was the most reliable index to predict the actual volume to exceed 500 ml,400 ml,and 300 ml when compared with H,S,T1 and T2. The corresponding threshold was 30.3 cm2 , 28.3 cm2 and 23. 1 cm2 , with the sensitivity and specificity of 0. 77 and 0. 88,0.72 and 1.0,0.95 and 1.0, respectively. Conclusions This new method based on measuring the area of effusion by ultrasound is more efficient and reliable than those traditional ones to measure the volume of pleural effusion. It's clinically valuable and easy to perform, and deserves broad application.

Lynch syndrome is an autosomal dominant genetic disease characterized by the early onset of colon cancer, endometrial cancer and other tumors caused by a genetic mutation within DNA mismatch repair (MMR) genes.A small subgroup (approximately 3% -5%) of endometrial cancer and colorectal cancer is related to Lynch syndrome .Identification of these patients in clinical practice will be of great benefit to the relatives and patients themselves .We reported two cases, and reviewed the literature and clinical diagnostic guideline.MMR protein was lost in the tumors.Meanwhile the two cases had different clinicopathological characteristics.Together with the literature, our findings may suggest that the MMR protein expression, associated molecular alterations and clinicopathological features and biological behavior of endometrial cancer and colorectal cancer related to Lynch syndrome are different .Thus the algorithm for detection the patients at highest risk is different .To detect the MMR loss by immunohisto-chemistry is a practicalscreening method.

Acetates ; pharmacology ; Animals ; Disease Models, Animal ; Diving ; adverse effects ; Ear Canal ; injuries ; Nitrogen ; Oxygen ; Protective Agents ; pharmacology ; Rabbits

Objective To approach the changes of serum insulin and peptide C and determine their relationship with inflammatory reaction in patients with severe multiple trauma. Methods The serum insulin, peptide C, tumor necrosis factor (TNF)-α, interleukin (IL)-10, C reactive protein (CRP) were detected in 30 patients with severe multiple trauma at days 1,3 and 7 after trauma to analyze the dynamic changes of serum insulin and peptide C and their correlations with Acute Physiology and Chronic Health Evaluation Ⅲ ( APACHE Ⅲ), cytokines and CRP. The changes of cytokines and CRP were also compared with those of serum insulin and peptide C in patients with different outcomes. The changes of serum insulin and peptide C of 35 healthy subjects were detected and used as control. Re-sults The serum insulin and peptide C levels of patients were higher than those in control group at each time point after trauma, with remarkably positive correlation with APACHE Ⅲ. Whether the serum glu-cose and age were controlled or not,serum insulin and peptide C were positively correlated with IL-10 at each time point and with TNF-α and CRP at days 3 and 7. The levels of serum insulin, peptide C and IL-10 were decreased with time in both groups with different outcomes. Meanwhile, the levels of TNF-α and CRP were decreased in the survival groups but increased in the death groups. The levels of above indices in death group were significantly higher than survival groups at the same time point. Conclusions The increasing of serum insulin and peptide C is correlated with inflammatory reaction after severe multiple trauma. The dynamic changes of both indices can either reflect injury severity or be used as an effective index in dynamically monitoring anti-inflammatory degree of the organism.

Objective To investigate the relationship between serum cholinesterase(ChE) and acute-phase proteins in patients with multiple trauma, then to evaluate their significance to judge prognosis. Method It's a prospective observation study. Patients with multiple trauma admitted to emergency intensive care unit,Second Af-filiated Hospital, Zhejiang Universieg, school of medicihe within 24 h after trauma from Oct. 2005 to Oct. 2007 were enrolled. And those with chronic liver disease, touching orgnaophosphorus, active tuberculosis, tumor, in-fection of major organ before trauma, liver injury or age < 18 year were excluded. Among 81 patients, 57 were male and24 female. The average age was (46±18) years, and the average injury severity score was (34.0±11.9).Seventy six healthy were selected as controls, 53 male and 23 female, with an average age of (44±16)years. The exclusion standards were the same as those in patients. Both groups had same gender proportion and age. Senum ChE and acute-phase proteins(APP) including albumin(ALB), prealbumin(PAB), transferrin(TRF),C-reactive protein(CRP) in patients were detected at 1, 3, 7 d after trauma. The acute physiology and chronic health evaluation Ⅲ (APACHEⅢ) was recorded simuhancously. Serum ChE, ALB, PAB, TRF, CRP in the controls were also detected. All of these indexes in the controls were compared with thoses in patients by t test or rank surn test. The dynamic changes of serum ChE and APPs in patients were analyzed by one way repeated mea-sures ANOVA. The relationships between serum ChE and those APPs and the relationships between APACHE Ⅲ and these indexes were analyzed by Pearson correlation analysis. We also compared these indexes between patients with different outcomes by t test or rank sum test. The values of serum ChE and those APPs to judge prognosis were evaluated by logistic regression analysis. Results Patients had lower serum ChE, ALB, PAB, TRF and higher CRP than the healthy at 1, 3, 7 d post trauma. Serum ChE activity in patients was reducod over 25% (42.3%～50.2%) than that in the healthy, and showed a tendency to decrease after trauma, which resembled PAB and TRF. Serum ChE was positively correlated with ALB, PAB and TRF at 1, 3, 7 d, and negatively correlated with CRP at 3, 7 d. At 1, 3, 7 d post trauma, APACHEⅢ in patients was negatively correlated with serum ChE and TRF, but negatively correlated with ALB only at 1 d, and negatively correlated with PAB only at 1,7 d, and posi-tively correlated with CRP only at 7 d. Non-survivors had lower serum ChE activity and TRF than survivors at 1,3,7 d after trauma, but had lower ALB only at 7 d after trauma and had lower PAB only at 1,7 d after trauma than survivors, and had higher CRP than survivors only at 7 d after trauma. Logistic regression analysis showed serum ChE and PAB were the only two independent risk factors to judge prognosis. Conclusions Serum ChE may be in-cluded as negative acute-phase protein, and is better than other APPs in reflecting injury severity and prognosis in patients with multiple trauma.

Objective To explore the relationship between intracellular calcium levels ([Ca2+]1) and reactive oxygen species (ROS) in sodium fluoride (NaF)-induced injury in human neuroblastoma SH-SY5Y cells. Methods The levels of [Ca2+]1 and ROS were measured in different exposed times(0,3,6,12,18,24 h) respectively after SH-SY5Y cells were exposed to 40 mg/L NaF in vitro, and the optimal expose time was selected. Furthermore, the changes of [Ca2+]1, ROS and LDH levels in 40 mg/L NaF-treated groups incubated with 38.23 mg/L BAPTA-AM or 380.40 mg/L ethylene glycol-bis-(beta-aminoethyl ether)-N, N, N', N'-tetraacetic acid (EGTA) or 16.32 mg/L N-acetyl-L-cysteine(NAC) also observed at the optimal expose time(12 h), respectively. Results At 3,6,12,18 and 24 h, [Ca2+]1 level(5620.0±226.3,4775.5±85.6,3312.3±87.5, 3047.0±75.0,2717.0±66.5) was significantly increased, and so was the ROS level(4449.53±324.61,7463.07±117.43,20 227.33±178.04,8817.56±200.13, 7975.61±92.90) except at 3 h, compared with 0 h(2115.0±24.0,4098.01±21.22, all P<0.05). The levels of [Ca2+]1 and ROS reached the peak at 3 h and 12 h, respectively. [Ca2+]1 and LDH levels in NaF-treated group [3279.5±94.0, (1057.50±64.35)U/L], NaF+NAC treated group[ 3583.0±350.7, (561.02±85.50)U/L], NaF+EGTA treated groups[3701.5±157.7, (1074.50±86.97)U/L], and BAPTA-AM treated group[2766.5±38.9, (521.43±40.80)U/L] had increased, compared with the control[2022.5±118.1, (186.97±8.73)U/L], the difference being statistically significant (P<0.05). ROS levels in NaF-treated group (19 003.04±332.34), and NaF+EGTA treated group(19 170.12±95.46) was higher than that in the controls(4060.98±145.66), the difference being statistically significant (P<0.05). NaF and NAC had antagonistic effect on ROS and LDH levels (F=976.11,43.54,P<0.05). And NaF and BAPTA-AM had antagonistic effect on [Ca2+]1, ROS and LDH levels (F=15.65,1515.53,115.00, P<0.05). Conclusions NaF-related calcium is released from the site of intracellular calcium storage, which induces ROS production, both of them caused cytotoxicity and the increase of LDH level in human neuroblastoma SH-SY5Y cells.

OBJECTIVETo study the prevalence rate of upper respiratory tract group A Streptococcus (GAS) carriage in school-age children from Xinjiang Province.

METHODSA total of 478 children at age of 9-12 years from Tulufan City and Buerjin County of Xinjiang Province were enrolled by random cluster sampling. Throat swab cultures were performed once each season for the determination of presence of GAS.

RESULTSIn the 1 827 samples, 196 GAS strains were isolated, with a GAS carrier rate of 10.7%. The prevalence rate of GAS carrier in Tulufan City ranged from 3.7%-16.5% compared with 4.7%-21.4% in Buerjin County (P < 0.05). The prevalence rate of GAS carrier in winter is the highest, followed by in autumn, spring and summer in both regions. There were significant differences in the GAS carriage rate in autumn between the two regions. There were no significant differences in the GAS carriage rate between boys and girls. Of the 196 GAS strains, 133 from Han, 22 from Uygur and 41 from Hazakh children. There were significant differences in the prevalence rate of GAS carriage among children with different ethic groups.

CONCLUSIONSThe prevalence rate of GAS carriage is high in school-age children from Tulufan and Buerjin of Xinjiang Province. The GAS carrier rate is associated with the season and ethic group. The children from Buerjin County present a higher GAS carrier rate than those from Tulufan City.

Carrier State ; microbiology ; Child ; China ; Female ; Humans ; Male ; Prevalence ; Respiratory System ; microbiology ; Streptococcus pyogenes ; isolation & purification

This study was designed to evaluate the effects of drilling through the growth plate and using adipose-derived stem cells (ADSCs) and bone morphogenetic protein-2 (BMP-2) to treat femoral head epiphyseal ischemic necrosis,which can be done in juvenile rabbits.Passage-four bromodeoxyuridine (BrdU)-labeled ADSCs were cultured,assayed with MTT to determine their viability and stained with alizarin red dye to determine their osteogenic ability.Two-month-old,healthy male rabbits (1.2 to 1.4 kg,n=45) underwent ischemic induction and were randomly divided into five groups (group A:animal model control;group B:drilling;group C:drilling & ADSCs;group D:drilling & BMP-2;and group E:drilling & ADSCs & BMP-2).Magnetic resonance imaging (MRI),X-ray imaging,hematoxylin and eosin staining and BrdU immunofluorescence detection were applied 4,6 and 10 weeks after treatment.Approximately 90％ of the ADSCs were labeled with BrdU and showed good viability and osteogenic ability.Similar results were observed in the rabbits in groups C and E at weeks 6 and 10.The animals of groups C and E demonstrated normal hip structure and improved femoral epiphyseal quotients and trabecular areas compared with those of the groups A and B (P＜0.01).Group D demonstrated improved femoral epiphyseal quotients and trabecular areas compared with those of groups A and B (P＜0.05).In summary,drilling through the growth plate combined with ADSC and BMP-2 treatments induced new bone formation and protected the femoral head epiphysis from collapsing in a juvenile rabbit model of femoral head epiphyseal ischemic necrosis.