Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

Objective To evaluate the effect of ecoimmunonutrition enteral nutrition on systemic inflammatory response and prognosis in patients with acute severe acute pancreatitis. Methods Fifty-seven patients with severe acute pancreatitis were randomly divided into two groups: parenteral nutrition (PN) group(28 cases), and ecoimmunonutrition(EIN) group (29 cases), each of the two nutrition formulas was given to each group respectively for 7 days. The level of plasma endotoxin and serum concentrations of TNF-α ,IL-1β ,IL-6 and IL-10 and monocyte NF-κB were tested at admission,1 d,3 d,5 d,7 d after nutrition support. Statistics the two groups results of clinical prognosis. Results The levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were no significant difference compared with PN group at admission. After nutrition support 7 d, the levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were (2.70 ± 0.13) ng/L, (30.13 ± 8.12) ng/L, (20.17 ± 8.04) ng/L, (36.43 ± 8.24)ng/L, (86.45 ± 14.54) ng/L, (70.4 ± 3.2)% respectively, which all were significantly lower than those in PN group [(3.25 ±0.32) ng/L, (313.42 ± 144.35) ng/L,( 155.29 ±32.78) ng/L, (324.15 ± 31.47) ng/L, (472.72 ±48.55) ng/L, (88.4±53)% ](P<0.05 or <0.01). Conclusion EIN can attenuate endotoxemia.decrease NF-κB activities and concentrations of cytokines, maintain the balance of pro-and anti-inflammation, improve patients' condition and prognosis.

Objective To compare the value of clinical application of the ratio of urine albumin to creatinine (ACR) in the community-dwelled middle-aged and elderly at high-risk for diabetes in screening for albuminuria with casual and morning urine specimens. Methods Totally, 443 middle-aged and elderly people (234 men and 209 women) at high-risk for diabetes, with an average age of (59±8) years, were recruited from Changfeng Community of Shanghai in screening for albuminuria with casual and morning urine specimens collected on the same day, as well as another two morning urine specimens collected at an interval of two weeks, for determination of urine ACR. Albuminuria was defined as ACR equal to or more than 30 mg (albumin)/g (creatinnine) in two or more of the three urine specimens collected. Results Overall prevalence of albuminuria was 6. 3% ( 28/443 ) in the middle-aged and elderly according to diagnostic standard mentioned above, significantly higher in casual urine specimens than in morning urine specimens (14. 9% vs. 5.9%, P <0. 05). Urine ACR of casual urine specimens was significantly higher than that of morning urine (7. 1 mg/g vs. 3. 2 mg/g, P<0. 001 ). There was no significant difference in sensitivity and positive predictive value (PPV) between casual and morning urine specimens in screening for albuminuria (96. 4% vs. 92. 9%, and 99.7% vs. 99. 5%, respectively, P >0. 05). Specificity and negative predictive value (NPV) of casual urine specimens was significantly lower than those of morning urine specimens (90.6% vs. 100.0%, and 40.9% vs. 100.0%, respectively, P<0.05). The optimal cut-off value of ACR by casual urine specimens was 40. 0 mg/g in screening for albuminuria, based on receiver operating characteristic (ROC) curve, with sensitivity of 96. 4%, specificity 95.2%, PPV 57.5% and NPV 99. 8%. The middle-aged and elderly with negative albuminuria in morning urine but positive in casual urine had more risk factors for cardiovascular and chronic kidney diseases than those with negative albuminuria in both morning and casual urine specimens. Conclusions Morning urine specimen is better than casual urine for albuminuria screening in the middle-aged and elderly people with risk factors for diabetes in urban community, but casual urine used in screening for albuminuria is very convenient for collection. It is suggested that urine ACR of 40. 0 mg/g be used as an optimal cut-off value for casual urine in albuminuria screening among them.

Objective To explore an optimal cut-off value of waist circumference(WC)for identifying metabolic syndrome(MS)in middle-aged and elder residents in an urban community.Methods Database of 1558 residents aged 40-79 years at high-risk in screening for diabetes from Changfeng community,Putuo District,Shanghai during 2005 to 2007 was used to analyze sensitivity and specificity of varied cut-off values of WC for identifying two or more components of MS in men and women,respectively.Receiver operating characteristics(ROC)curve was used to explore the optimal value.Results Optimal cut-off value of WC was 85.0 cm for men and 80.0 cm for women,respectively,for identifying two or more components of MS bv ROC curve,with sensitivity of 72.3%and 74.9%,and specificity of 50.2%and 62.2%,respectively.Based on that optimal cut-off value of WC and definition of International Diabetes Federation(IOF),prevalence of MS was 38.8%in this population,40.7%in men and 37.8%in women,respectively.Conclusion The optimal cut-off value of WC was 85.0 cm in men and 80.0 cm in women,respectively,for identifying MS in the middle-aged and eldedy in an urban community of Shanghai.

A longitudinal study was carried out on zinc, copper, calcium, phosphorus and magnesium status of 104 normal primigravidas. The five elements in serum and hair of the mothers and their newborns were estimated with inductive coupled plasma emission spectroscopy. The results showed that the concentration of serum zinc, calcium, magnesium decreased gradually while copper and phosphorus increased remarkably in the course of pregnancy. The serum copper and phosphorus of cord blood were lower, zinc and calcium were higher than that of mothers' blood. The contents of hair zinc, copper, and phosphorus showed no differences but calcium and magnesium decreased gradually during pregnancy. Except that the level of copper in the newborns' hair was much lower, other elements were much higher than that in the mothers' hair.

Objective:To observe the clinical effect of self-prescribed Zuoyu No. 2 (ZY2) in the treatment of anal eczema after complex anal fistula operation. Methods: Totally 100 patients were randomly divided into two groups, the patients in the treatment group were given ZY2 combined with the conventional wound dressing treatment after defecation everyday, while the patients in the con-trol group were treated with washing infection area with warm water followed by applying triamcinolone acetonide and econazole creams on the lesion or itching skin combined with the conventional wound dressing after defecation everyday. Results:The efficiency rate in the treatment group was higher than that in the control group (82. 0% vs 60. 0%, P<0. 05), the total effective rate in the treatment group was also significantly higher than that in the control group (100% vs 90. 0%, P<0. 05). The anal pruritus disappearance time and the skin lesion recovery time in the treatment group were better than those in the control group(P<0. 05). Conclusion:ZY2 has a good clinical curative efficacy in the treatment of anal eczema after complex anal fistula operation with improvement of clinical symp-toms, which is worthy of promoted application.

To explore the expressional information of PIWIL4 in human ovarian cancer, semi-quantitative reverse transcription polymerase chain reaction(semi-qRT-PCR) was used to detect the mRNA expression level of PIWIL1, PIWIL2, PIWIL3 and PIWIL4 in human ovarian clear cell carcinoma ES-2 cells.Meanwhile, in human ovarian cancer and adjacent normal tissues, the mRNA expression of PIWIL4 was determined.Then, PIWIL4-siRNA, which was designed to target PIWIL4 and chemical synthesized, was transfected into ES-2 cells with lipofectamine.MTT assay and clone formation assay were used to investigate the effects of PIWIL4-siRNA on the cell growth activity and proliferation capacity of ES-2 cells.Experimental results showed that the mRNA expression level of PIWIL4 was the highest compared to PIWIL1, PIWIL2 and PIWIL3 in ES-2 cells(P

Objective:To understand the current situation of hospital violence medical students experienced during the internship period and their professional identity.Method:With the method of cluster sampling,a questionnaire survey was conducted among 500 medical students from a medical college in Ganzhou,to understand the characteristics of hospital violence and compare the difference between the medical students who experienced violence and those not.Results:The effective recovery rate of questionnaire was 90.8％,of which 61.4％ of medical students had witnessed hospital violence,8.1％ of students had experienced hospital violence;the hospital violence that medical students experienced were characterized by low frequency and emotional violence.The overall score of personal identity was (117.05 ± 19.65),was in a medium level.Among the comparison of personal identity between the medical students who had experienced violence and those not,there was a significant difference in occupational cognition dimension (P ＜ 0.01),but there was no significant difference in the total score and other four dimensions (P ＞ 0.05).Conclusion:We should pay attention to the current situation of hospital violence that students experienced and their professional attitude,carry out targeted training and psychological counseling to improve their ability to respond to hospital violence and enhance their professional identity.

Objective:To observe the clinical effects of Zuoyu üo. 1(ZY1)in the prevention of concomitant concurrent complica-tions after operation for anorectal diseases. Methods:164 patients who had received operation for anorectal diseases were randomly di-vided into 2 groups. Patients in the treatment group were treated with sitz baths in ZY1 and the conventional wound dressing method. Patients in the control group were treated with sitz baths in warm water and the conventional wound dressing method. Results:The effi-ciency rate of the treatment group was significantly higher than that of the control group(53. 57% vs. 27. 5%,P<0. 05),as well as the total effectiveness(95. 23% vs. 88. 75%,P<0. 05). The comparison showed that better curative effects existed in the treatment group on distress,bleeding,and edema ratings and wound healing time. Conclusion:Sitz bath in ZY1 after operation for anorectal dis-eases reduces complications and shortens the wound healing time without any side effect. It is thus extensively promising in clinical ap-plications.

To observe a PPAR-alpha agonist effect of N-oleoylethanolamine (OEA) on CB2 (cannabinoid receptor 2), an anti-inflammatory receptor in vascular endothelial cell, healthy HUVECs and TNF-alpha induced HUVECs were used to establish a human vascular endothelial cell inflammatory model. Different doses of OEA (10, 50 and 100 micromol x L(-1)) had been given to HUVECs, cultured at 37 degrees C for 7 h and then collected the total protein and total mRNA. CB2 protein expression was detected by Western blotting and CB2 mRNA expression was assayed by real-time PCR. As the results shown, OEA (10 and 50 micromol x L(-1)) could induce the CB2 protein and mRNA expression, but not 100 micromol x L(-1). To detect if anti-inflammation effect of OEA is partly through CB2, CB2 inhibitor AM630 was used to inhibit HUVEC CB2 expression, then the VCAM-1 expression induced by TNF-alpha was detected, or THP-1 adhere to TNF-alpha induced HUVECs was examined. OEA (50 micromol x L(-1)) could inhibit TNF-alpha induced VCAM-1 expression and THP-1 adhere to HUVECs, these effects could be partly inhibited by a CB2 inhibitor AM630. The anti-inflammation effect of OEA is induced by PPAR-alpha and CB2, suggesting that CB2 signaling could be a target for anti-atherosclerosis, OEA have wide effect in anti-inflammation, it may have better therapeutic potential in anti-inflammation in HUVECs, thus achieving anti-atherosclerosis effect.