ObjectiveTo analyze the characteristics of severe trauma patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), in order to look for the risk factors of AKI and the opportune time for the initiation of RRT on prognosis.Methods A retrospective cohort study involving consecutive patients with severe trauma in emergency intensive care unit (ICU) in the Second Affiliated Hospital of Zhejiang University School of Medicine, from August 2011 to December 2014, was conducted. Inclusion criteria included age≥18 years, injury severity score (ISS)> 16, AKI receiving RRT, and the duration of hospital stay> 24 hours. The general data, the risk factors of AKI, the prognostic indicators, and the information of RRT were recorded. All patients were divided into two groups according to the prognosis, the time of onset of AKI and the initiation time of RRT. The independent risk factors for prognosis were screened by binary logistic regression analysis.Results Seventy-three patients were eligible for enrollment, including 48 deaths (65.8%); 49 patients suffered from AKI≤48 hours after trauma (early stage group), and in 24 patients it was longer than 48 hours (late stage group). In 55 patients RRT was routinely started (routine RRT group), 18 patients underwent RRT ahead of routine criteria decided by the judgment of the attending doctor (earlier RRT group). The main risk factors of RRT in traumatic patients with AKI were shock and sepsis, each accounted for 90.4% and 53.4%. Compared with survival group, in death group, the proportion of male patients was lower (70.8% vs. 100.0%,χ2 = 7.238,P = 0.007), acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were higher (23.7±5.1 vs. 14.4±3.7,t = 8.031,P< 0.001), Glasgow coma score (GCS) was lower [5.0 (3.0, 15.0) vs. 15.0 (8.0, 15.0),U = 320.000,P = 0.001], incidence of shock and sepsis was higher (97.9% vs. 76.0%,χ2 =6.755,P = 0.009; 64.6% vs. 32.0%,χ2 = 7.014,P = 0.008), the rate of use of contrast medium was lower (27.1% vs. 56.0%,χ2 = 5.898,P = 0.015), the time for the diagnosis of AKI post trauma was delayed [days: 2 (1, 5) vs. 2 (1, 2), U = 762.000,P = 0.049], the time for the initiation of RRT post trauma was later [days: 6.0 (3.0, 12.0) vs. 3.0 (2.0, 4.5), U = 868.500,P = 0.002], the recovery rate of renal function at discharge was lower (10.4% vs. 100.0%,χ2 = 54.497, P< 0.001). Compared with late stage group, in early stage group, the mortality was lower (55.1% vs. 87.5%,χ2 =7.509,P = 0.006), and the incidence of sepsis before AKI was also lower (38.8% vs. 83.3%,χ2 = 12.854,P< 0.001). Compared with routine RRT group, the recovery of renal function at discharge was better with a lower mortality rate in the earlier RRT group, but the difference was considered to be insignificant (55.6% vs. 36.4%,χ2 = 2.064,P = 0.151;50.0% vs. 70.9%,χ2 = 2.633,P = 0.105). Logistic regression analysis showed GCS [odds ratio (OR) = 0.852, 95%confidence interval (95%CI) = 0.747-0.972,P = 0.017], shock before AKI (OR = 85.350, 95%CI = 5.682-1 282.073, P = 0.001), and sepsis before AKI (OR = 11.499, 95%CI = 2.127 - 62.161,P = 0.005) were independent risk factors for the judgment of prognosis.Conclusions Shock and sepsis are the major risk factors of RRT in trauma patients with AKI. Shock, sepsis and traumatic brain injury are the independent risk factors of death. Perhaps early initiation of routine RRT cannot improve the outcome of the patients with posttraumatic renal insuficiency.

OBJECTIVE:To ensure clinical medication safety and avoid medication errors. METHODS: Various errors occurred during 2006～2007 in the pharmacy intravenous admixture service of our hospital were analyzed in accordance with drug package inserts, Chinese Pharmacopeia, and Clinical Medication Information, meanwhile the countermeasures were formulated. RESULTS: The ratio of errors in the pharmacy intravenous admixture service was 0.001%, and the internal ratio of errors was 0.04%. The errors occurred mainly in the following steps: medical orders (by doctors), input of medical orders (by nurses), arrangement of drugs (by pharmacists), allocation of nurses, as well as the check of finished products. CONCLUSIONS: By taking the following measures such as constructing consummate quality safety management system, enhancing pharmacists’ prescription-checking ability, strengthening management on personnel, intensifying checking system etc, the incidence of errors in pharmacy intravenous admixture service can be reduced and the rational clinical medication can be promoted.

The studies on pathophysiological mechanism and treatment method of spontaneous intracerebral hemorrhage mainly focus on animal experiment,which has been established various animal models in the laboratory.According to the different implanted tissues,there are four kinds of intracerebral hemorrhage,including ischemia,trauma,spontaneous or implanting intracal extraneous materials reduced intracerebral hemorrhage.Further more,the implanted extraneous materials contain inert substances-reduced intracerebral hemor-rhage,biological agent induced and autologous arterial blood simulated intracerebral hemorrhage.This paper summarizes the kinds,preparation methods and characteristics of each animal models of intracerebral hemorrhage.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

Adaptor Proteins, Signal Transducing ; Animals ; Carrier Proteins ; CpG Islands ; DNA Methylation ; Genes, Tumor Suppressor ; Genes, p16 ; Genes, p53 ; Humans ; MutL Protein Homolog 1 ; Mutation ; Neoplasm Proteins ; genetics ; Neoplasms ; genetics ; Nuclear Proteins

Polylactic acid (PLA) and its copolymer are biodegradable polymer materials which are widely used in the medical field because of their excellent mechanical properties, chemical stability, good biocompatibility, and biodegradability. In this paper, research advances in the study on polylactic acid and its application in vascular stent are discussed.

The rabbit enteropathogenic E. coli (rEPEC) strain RDEC-1 possesses a lifA homologue adjacent to the LEE pathogenicity island. To study the entire nucleotide sequence and biological function of lifA,the DNA sequence and biological function of RDEC-1 lifA were analysed with gene cloning,gene knock-out and in vivo virulence examination. The result showed that the entire coding sequence of the lifA of RDEC-1 shares nearly absolute homology with the lifA of human isolates. RDEC-1 lifA inhibited IL-2 expression in stimulated rabbit peripheral blood mononuclear cells. We further demonstrated significant reduction in fecal bacterial shedding by RDEC-1 derivative lifA mutant when compared with its parent strain. In a competitive study when rabbits were inoculated with a combination of the WT and the mutant, the WT was the predominant bacteria recovered from fecal samples, while fewer mutant bacteria were recovered. However,the lifA mutant is able to induce A/E type of lesions as efficient as the parent strain. The data provide direct evidence that lifA of rEPEC plays a role in immunomodulation and in in vivo colonization in the intestinal tract.

Objective To evaluate the effectiveness of VEGF-transfected neural stem cells (NSCs) transplantation to striatum for amelioration of neural damage induced by cerebral ischemia.Methods Temporary middle cerebral artery occlusion (tMCAO) models were established and randomly divided into control group, PBS transplantation group, NSCs transplantation group (n=10) and VEGF-secreting NSCs transplantation group (n=20). The grafts in each group were transplanted into right striatum respectively 3 days after tMCAO model established. NSS was checked in all groups 2, 4, 6, 8, 10, 12 weeks respectively after transplantation. By using immunofluorescent staining, VEGF expression in transfected NSCs was detected 7 days after transplantation. Differentiation of transplanted NSCs was investigated 12 weeks after transplantation. Endothelial cells around the transplantation area were semi-quantitated by using immunohistochemistry staining.Results NSS in VEGF-secreting NSCs transplantation group was lower than in other three groups from 2-12 weeks. There was significant difference in NSS among the groups 12 weeks after transplantation (P