Objective To analyze the related factors and the independent risk factors of death in patients with multiple injuries. Methods Data of 651 patients with multiple injuries treated in our hospital from June 2012 to June 2015 were retrospectively analyzed. According to the outcomes, patients were divided into effective group (n=608) and death group (n=43). Data of gender, age, cause of injury, the primary diseases related with the trauma, ISS score, number of trauma, time from injury to the treatment and the body parts of injury were compared between two groups. Logistic regression analysis was used to analyze the risk factors of death in multiple trauma patients. Results The proportion of patients≥60 years old, ISS score≥16 points, the number of trauma≥4, a major brain injury and time of trauma to the treatment ≥3 h were higher in death group than those of effective group (P<0.05). The independent risk factors for emergency death in multiple injuries included patients≥60 years old, major brain injury, ISS score ≥16 points and time of trauma to the treatment ≥ 3 h. The cause of death in patients with craniocerebral trauma (cerebral laceration) accounted for up to 27.91%(n=12), intracranial hematoma accounted for 20.93% (n=9), and traumatic hemothorax accounted for 11.63% (n=5). Conclusion The related factors and independent risk factors should be paid attention to doctors in emergency department, and the emergency plan should be made to reduce the death rate of emergency patients with multiple injuries.

BACKGROUND: Researches suggest that ginseng saponin (GS) has protective effect on central nerve, but the effect on spinal nerves is reported rarely.OBJECTIVE: To investigate the relationship between effect of GS on spinal nerve and level of nitrogen monoxide (NO) and its mechanism.DESIGN: Randomized controlled animal study.SETTING: Military Hyperbaric Oxygen Center of Navy General Hospital of Chinese PLA.MATERIALS: The experiment was completed at Clinical Anatomy Institute (National Key Laboratory) of the First Military Medical University of Chinese PLA in 2000. Forty SD foetus rats with 15-day conception were selected.METHODS: Study Ⅰ: Embryo-spinal nerve cells of SD rats were separated, extracted and modeled with DMEM/F12 culture medium. On the fourth day of inoculated culture, axon of spinal nerve (simulation of peripheral nerve injury) was damaged with scarification method in injury group, but that in non-injury group was not treated. 150 μL cell culture medium and 100 mg/L Griess solution were mixed at 0, 0.5 1, 1.5, 2, 2.5, and 3 hours after injury respectively. Absorbency (A) was assayed with Σ960 (λ=570 nm) enzyme-linked immunoadsordent assay (ELISA) symbolic device 10 min-utes after reaction at room temperature. Study Ⅱ: Embryo-spinal nerve cells of SD rats were separated and extracted. Those in the experimental group were treated with GS + DMEM/F12 culture medium, but with DMEM/F12 culture medium in the control group. A value was assayed with the same method.MAIN OUTCOME MEASURES:① Relationship between injury of spinal neurons and level of NO;② Relationship between protective effect of GS and level of NO.RESULTS:① Relationship between injury of spinal neurons and level of NO: In the injury group, NO secretion was increased after injury of spinal neurons, reached peak 2 hours later, and decreased 3 hours later. There was significant difference as compared 0.5 hour with 0 hour (P ＜ 0.01),and also there was significant difference as compared 2 hourswith 0 hour (P ＜ 0.01).② Relationship between protective effect of GS and level of NO: In the control group, A value was increased with time passing, reached peak 2 hours later, and decreased 3 hours later; but A value in the experimental group was not changed generally. There was significant difference between the two groups at 2-hour point (P ＜ 0.01).CONCLUSION: NO liberation is increased after peripheral nerve injury.GS can inhibit NO liberation so as to protect peripheral nerve.

OBJECTIVE To investigate pulmonary fungal infection spectrum and its resistance in older COPD patients with mechanical ventilation.METHODS Retrospective study were performed in 67 cases of COPD patients with mechanical ventilation treatment who were admitted to our ICU from Jan 2004 to Doc 2007.Bronchoalveolar lavage fluid was cultured,differentiation and antifungal susceptilibity testing were taken.RESULTS Seventy-eight fungi strains were cultured in 78 cases,among them,41 strains were Candida albicans(52.56%),14 of C.tropicalis,9 of C.krusei,5 of C.parapsilosis,7 of yeast-like fungi and 2 of Aspergillus.CONCLUSIONS There were increasing fungal infection rate in older COPD patients with mechanical ventilation and C.albicans is still the most frequent type.The resistance to triazole antifungal drug is also increasing.

OBJECTIVE:To observe clinical efficacy and safety of escitalopram combined with ozagrel sodium for elderly pa-tients with acute cerebral infarction complicated with anxiety and depression. METHODS:140 elderly patients with acute cerebral infarction complicating with anxiety and depression were divided into control group and observation group according to random number table method,with 70 cases in each group. Control group received routine treatment and Sodium ozagrel for injection 40-80 mg added into 0.9% Sodium chloride injection 500 ml,ivgtt,bid. Observation group was additionally given Escitalopram tablet 10 mg,qd. Both groups received treatment for 8 weeks. HAMA,HAMD,NIHSS and BI were compared between 2 groups before and after treatment,and clinical efficacy and the occurrence of ADR were observed. RESULTS:There was no statistical sig-nificance in HAMA,HAMD,NIHSS,BI before treatment and NIHSS,BI 1 week of after treatment between 2 groups(P>0.05). HAMA and HAMD of observation group 1,4,8 weeks after treatment,and NIHSS and BI of it 4,8 weeks after treatment were improved significantly;above indexes of control group were improved significantly 4,8 weeks after treatment,and the observation group was better than the control group,with statistical significance (P<0.05). The total effective rate of observation group was 87.14%,which was significantly higher than 74.29% of control group,with statistical significance(P<0.05). There was no statis-tical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Escitalopram combined with ozagrel so-dium is significantly effective for elderly patients with acute cerebral infarction complicated with anxiety and depression,and can significantly improve anxiety,depression and neurological function with good safety.

AIM: To investigate the effect of exercise training(EX) on the arterial baroreflex and possible mechanisms in rats with chronic heart failure(CHF).METHODS: Experiments were carried out in four groups: EX-CHF,CHF,EX-sham,and sham. CHF was induced by left coronary artery ligation,and EX consisted of 4 weeks of treadmill running. Baroreflex function,plasma angiotensin II(Ang II) and central AT1 receptor expression were determined.RESULTS: (1) The average slope and maximal gain of the baroreflex curve in CHF rats were lower than those in sham rats(P<0.01). EX significantly enhanced baroreflex parameters in CHF group but not in sham group.(2) EX decreased plasma Ang II in CHF rats ［(137±27)ng/L vs (263±55)ng/L,P<0.01］,but had no significant effect on plasma Ang II in sham rats ［(75±17)ng/L vs (92±21)ng/L］.(3) Expression of AT1R protein in the PVN of CHF rats was higher than that in sham rats(1.20±0.21 vs 0.70±0.14,P<0.01). EX reduced AT1R protein level in CHF rats(0.90±0.13),but had no impact in sham rats(0.60±0.16).CONCLUSION: EX restores the attenuated arterial baroreflex function in CHF rats,involving in decrease of plasma Ang II and downregulation of AT1R in the PVN.

Objective　To evaluate the role of transvaginal sonography in diagnosing the normal cervix and its benign lesions.Methods　The one handred and thirty-eight women without malignant findings by colposcopy examination underwent transvaginal sonography within 2 weeks before hyterectomy. The sonography findings were compared with the pathology report.Results　Cervical cysts(39 cases) were the most common sonography findings. In 17 cases, endocervical polyps were found sonographically,in 14 cases, myomas were found,and in 27 cases cervicitis were found. The cervix showed no sonographic abnormal in 41. Pathologic results showed 42 cervical cysts, 14 cervical polyps, 16 myomas, 17 cervicitis and 49 normal cervices.Conclusions　The sensitivity and specificity of transviginal sonography are high in diagnosing normal cervices and benign cervical lessions. Transviginal sonography provides reliable diagnosing information about the cervix for clinic.

To evaluate the effect of problem-based learning (PBL) in internal medicine teaching for residency training of general medicine.Fifty two residents of general medicine were divided randomly into PBL teaching and traditional teaching groups with 26 in each.The evaluation was conducted in combination of examination scores and questionnaire survey in both groups.In questionnaire survey the residents of PBL group responded positively about the use of PBL in teaching, and rated themselves as having much better competencies in problem solving and self-directed learning.The scores of case analysis examination in PBL group were higher than those in traditional teaching group ( 73.7 ± 4.1 vs.71.1 ± 4.8, P ＜ 0.05 ).The results suggest that the application of PBL has better effect than traditional teaching in residency training of general medicine.

Objective To study the clinical value of procalcitonon (PCT) for predicting development of acute kidney injury and outcomes in patients with acute pancreatitis (AP). Methods 205 inpatients with acute pancreatitis in our hospital were enrolled in our study during January 2012 to March 2013. According to acute kidney injury (AKI) occurred in three consecutive days or not, the patients were divided into AKI group (n = 32) and control group (n=173). Crea, Urea, CysC and PCT, serum amyloid A (SAA), interleukin-6 (IL-6) and C reactive protein (CRP) were analyzed. The predictive validity of these indicators was constructed by receiver operating characteristics (ROC) curve. Results PCT, IL-6, and CRP level of AKI group showed significant higher in AKI group than control group (P<0.05). However, there were no statistically significant difference of the level of Urea, Crea, Cys C and SAA between the two groups (P>0.05). The AUC value of PCT showed significant higher than the AUC value of CRP, IL-6 and SAA(P<0.05). Conclusion PCT is a early, sensitive, specific biomarker for predicting AKI of patients with AP.

Leptomeningeal metastasis (LM),with a high omission rate in diagnosis in approximately 5 ％～8 ％ of all patients, is increasingly recognized as a lethality complication. The diagnosis of LM remains challenges,but commonly can be established by CSF cytology or by definitive neuroimaging. Although a combination of focal radiotherapy,intrathecal chemotherapy,and systemic chemotherapy may be necessary to achieve optimal treatment of patients, but prognosis is unacceptable and therapy remains palliative in most patients.

Objective To analyze testing results and values of blood heterotypic lymphocyte in flu patients.Methods 100 cases of influenza patients and 100 healthy people were collected.The observation group for flu patients and control group of healthy people.Extraction of peripheral blood in patients with microscopic examination observing leukocyte,neutrophil,lymphocyte,intermediate cells,atypical lymphocytes under a microscope,and calculated the percentage in the patients in the two group cells to make analysis and comparison.Ratio in peripheral blood of patients and analysis of specific lymphocytes were also calculated between different ages.Results Peripheral blood lymphocytes in observation group was (11.1 ± 2.6) ％,which was significantly higher than than of the control group [(1.5 ± 0.5) ％].The difference was statistically significant (chi-square =16.9,P ＜ 0.05) ; White blood cells,the ratio of neutrophils,lymphocytes in observation group were obvious differenent compared with the control group(t/chi square are:13.2,11.3 and 12.6,P ＜ 0.05) ;Three ages of influenza patients peripheral blood lymphocytes of the opposite sex ratio has no difference(P ＞ 0.05).Conclusion Detection of peripheral blood lymphocyte heterosexual has great significance to the diagnosis of influenza with simple,convenient and feasible characters.It is worth to be used widely in clinical practice.