OBJECTIVETo discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma.

METHODSFrom July 2009 to July 2012, 30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept, included 20 males and 10 females with an average age of (34.03 ± 12.81) years old ranging from 20 to 60 years old; the ISS averaged (35.00 ± 12.81) points (ranged from 26 to 54 points). And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009, there were 23 males and 7 females with an average age of (34.23 ± 11.04) years old ranging from 18 to 65 years old. The ISS averaged (35.56 ± 11.04) points (ranged from 26 to 51 points). The age, gender, ISS, Gustilo classification, operation time, intraoperative blood loss, blood transfusion,postoperative complications and mortality rate were observed and compared.

RESULTSIn the damage control concept group,there were 28 cases surviving and 2 cases (6.7%) death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome, 1 case of multiple organ failure, 1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group, there were 22 cases surviving and 8 cases death(26.7%); 13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure, 2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age, gender, ISS, Gustilo classfication and complication (P > 0.05), however there were statistically significant differences in mortality rate, operation time, blodd loss, blodd transfusion between two groups (P < 0.05).

CONCLUSIONDamage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy, can improve survival rate and reduce complication.

Adolescent ; Adult ; Aged ; Embolism, Fat ; prevention & control ; Extremities ; injuries ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; prevention & control

Objective To investigate the distribution and drug resistance of major pathogens for urinary tract infections in the First Affiliated Hospital of Nanjing Medical University.Methods Strains from midstream urine culture of patients with urinary tract infections were collected during January 1 and December 31,2011.All strains were identified by API system,and disk diffusion method was used for drug sensitivity test.Results Totally 1129 strains were isolated,in which 667 (59.1％ ) were Gram-negative strains,266 (23.5％) were Gram-positive strains,and 196 (17.4) were Candida.Among Gram-negative strains,Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were highly sensitive to carbapenem antibiotics; while Acinetobacter baumannii and Pseudomonas aeruginosa were highly resistant to most antibiotics including cephalosporins and penicillinase inhibitor,and the resistance rates were over 50％.Among Gram-positive strains,the major strains Enterococcus avium and Enterococcusfaecalis were completely sensitive to vancomycin and teicoplanin,and highly sensitive to linezolid (resistance rate below 10％ ).Candida albicans and Candida glabrata were highly resistant to voriconazole and fluconazole (with the resistance rates of 47.2％ - 60.0％ ), but were completely sensitive to amphotericin and nystatin.Conclusion Gram-negative strains account for most urinary tract infections in the First Affiliated Hospital of Nanjing Medical University with high drug resistance rates.

Traumatic brain injury(TBI), also known as intracranial injury or head trauma, specifically refers to the brain tissue damage caused by trauma.Currently the mechanism of TBI and repair therapy after nerve injury become a hotspot in brain research.Duplicating animal models plays a significant role in promoting experimental therapeutics of TBI.This review systematically describes the progress in animal models for TBI including impact brain injury, nonimpact acceleration head injury and blast(explosion)wave-induced neurotrauma, which have been established at home and abroad.Based upon the aforementioned models, some relevant applications in experimental therapeutics are simultaneously enumerated.Hopefully all these information provides scientific guidance for the pharmacodynamic screening of potential neuroprotective drugs.

Objective To investigate the expression of matrix metalloproteinases-7 (MMP-7) in benign and malignant thyroid tissues and its clinical significance. Methods The expression of MMP-7 in 50 thyroid cancers, 45 adenoma and 20 adjacent noncancerous portion tissues were studied by microwave-LSAB immunohistochemical method. Results The positive rate of MMP-7 in thyroid cancer was 64. 0%, which was significantly higher than 37. 0% in adenoma and 25.0% in adjacent noncancerous portion(X_2=8. 72,6. 52, P < 0.01 ). No correlation was observed between the expression of MMP-7 and histological grading of thyroid cancer. The expression of MMP-7 in lymph node metastasis and Grade Ⅲ～Ⅳ were both higher than that in negative cases and in Grade Ⅰ～Ⅱ ( P < 0. 05 ). The percentage of recurrence and death in MMP-7 positive cases were notably higher than that in negative cases( P <0. 05). Conclusion The expression of MMP-7 can be regarded as a parameter for evaluating the degree of malignancy, biological behavior and prognosis of thyroid cancer.

Acute spinal cord injury can lead to severe motor,sen-sory and sphincter muscle dysfunction.Inflammatory response caused by inflammatory cytokines plays a crucial role in the oc-currence and development of secondary damage.Maintaining the body balance between inflammaion and anti-inflammation through an appropriate anti-inflammatory intervention will be an important strategy for drug therapy of spinal cord injury.This paper mainly introduces the cause,process and participation of inflammatory response in the pathophysiological mechanism of acute spinal cord injury,and also reviews the latest progress of experimental research of anti-inflammatory drugs,aiming to provide reference for finding the safe and effective drugs.

Objective To determine the weight coefficient of the customer requirements of emergency infusion equipment.Methods Customer requirements were made clear using methods of literature research, personal interviews and expert meeting. Analytic hierarchy process approach was adopted to establish the hierarchical structure model, construct paired comparison matrix structure, calculate the weight coefficient and make logic consistency check.Results The weight coefficients were determined for 8 primary and 36 secondary customer requirements, which all met the logical consistency check (CR<0.1).Conclusion The research and development of emergency infusion equipment has to pay attention to such key requirements firstly as safety, efficacy and portability, and the intelligence has to be supported by the key requirements and intermediate needs.

Objective To assess the practical value of ultrasound-guided percutaneous pericardium centesis in patients with pericardial effusion.Methods Twenty-eight patients with pericardial effusion were treated with ultrasound-guided percutaneous pericardium centesis from May 2004 to May 2009.Results Operations were successfully done in all 28 patients.The puncture needle,guide wire and drainage catheter could be clearly visualized under ultrasound.Complications included ache,bleeding and drainage catheter obstruction or prolapsus.Conclusion Able to be used bedside,ultrasoundguided percutaneous pericardium centesis is a real time,exact,safe and convenient method for the diagnosis and treatment of pericardial effusion.

Objective To investigate the correlation of expression of SLeX and p16 gene protein with the potential of invasion and metastasis in papillary thyroid carcinoma(PTC). Methods The expression of SLeX and p16 gene protein in 69 cases of PTC were studied by microwave-labelled strept-avidin biotin immunohistochemical method. Results The positive rates of SLeX and p16 in PTC were 69.6% and 58.0% respectively. The posi-tive rate of SLeX expression in the patients with tumor invasion and lymphatic metastasis was significantly higher than that without tumor invasion and lymphatic metastasis (P<0.05). But the positive rate of p16 expression in the patients with tumor invasion and lymphatic metastasis was significantly lower than that without tumor invasion and lymphatic metastasis (P <0. 05). There was a negative correlation between SLeX and p16 expression in PTC (P <0. 05). Conclusions Expression of SLeX and p16 protein were closely correlated with the invasive and metastasic potential in PTC. SLeX and p16 could be considered as prognostic indications for PTC.

Evoked potentials can reflect the integrity of spinal sensory and motor conduction pathway.Evoked potential exami-nation not only provides relatively objective index for patients with spinal cord injury in preoperative diagnosis,intraoperative monitoring and prognosis judging,but also plays an irreplaceable role in evaluating animal models for spinal cord injury.This pa-per systematically reviews evoked potential in the clinical exami-nation of spinal cord injury and its application in evaluating ani-mal models.

AIMTo study the protective effect of sodium oxybate (SO) against focal cerebral ischemia-reperfusion injury in rats, and the relationship between the effects of SO and ?-aminobutyric acid (GABA). METHODSThe reversible middle cerebral artery occlusion (MCAO)model in rats was established to investigate the role of SO. The scores of neurological deficits was detected by Longa EZ method in MCAO rats. The extracellular levels of glutamate (Glu) and GABA in CSF were measured by high performance liquid chromatography-fluorometer (HPLC-FR) method, and the weight of cerebral infraction was detected. RESULTSThe scores of neurological deficits and the weight of cerebral infraction markedly decreased by SO while the ratio of GABA/Glu obviously increased administered SO in MCAO rats. CONCLUSIONSSO could prevent MCAO rats from ischemia-reperfusion injury, the protective effect is related to SO keeping dynamic balance of excition-inhibition, and persisting inhibition-depended effect.