Objective To observe the influence of intensive insulin therapy on inflammatory fac-tors and prognosis in severe multiple trauma patients.Methods A total of 53 cases of severe multiple trauma were randomly divided into the treatment group(n =27)and the control group(n =26).Besides basic treatment,patients in the treatment group received additional intensive insulin therapy by micro-pump.The level of blood glucose in the control group was controlled under 11.1 mmol/L.Levels of TNF-α,IL-1β,IL-6,and CRP were tested before and after treatment.Multiple organ dysfunction syndrome,noso-comial infection rate,and mortality rate were also observed.Results The levels of TNF-α,IL-1β,IL-6, and CRP in the treatment group were significantly lower than those of the control group(P <0.05 or P <0.01).The incidence of multiple organ dysfunction syndrome,nosocomial infection,and mortality rate in the treatment group was lower(P <0.05).Conclusion Intensive insulin therapy can effectively decrease the expressions of inflammatory factors in patients with severe multiple trauma,improve the prognosis,re-duce the incidence of nosocomial infection and mortality.

Objective To study the role of changes of oropharyngeal microflora in pathogenesis of post-traumatic ventilator-associated pneumonia (VAP). Methods Forty-five patients with post-traumatic VAP treated with intubation and mechanical ventilation were involved in the study.Microbiologic cultures and drug-sensitivity test of oropharyngeal secretions,subglottic secretions,sputum from deep airway and gastric fluid samples were performed at days 1,3,7 and 14 after mechanical ventilation.The stool samples were collected to detect the coccus and bacillus ratio and the fungus.The concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions were compared. Results The main pathogens for VAP patients were gram-negative bacilli.The study showed an increase in aspects of the positive rate of etiology cultures of subglottic secretions,sputum and gastric fluid samples,the concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions and the number of ESBL + and multi-resistant bacteria,along with the prolonged mechanical ventilation. Conclusions The changes of oropharyngeal microflora are closely associated with the development of VAP.The enterobacteria in the gastric cavity always reversely colonize in the oropharynx and the retrograde stomach-pharynx-lower respiratory tract infection is a major infection route of VAP.

Objective To observe the pathomorphological changes and expressions of TNF-α, SOD1 and SOD2 in cardiac tissues of rats with abdominal aorta champing(AAC)and LPS attack.Methods Forty Wistar rats were randomly divided into four groups:sham operated group (Group S),ischemia reperfusion with AAC group(Group I /R),intraperitoneal injection of endotoxin group(Group LPS)and AAC +LPS group(Group I /R +LPS).Animals were sacrificed after 20 minutes of AAC and 8 hours of reperfusion.Cardiac tissues were observed with HE staining for pathmmorphological changes,and detection of TNF-α,SOD1 and SOD2 expressions were tested by immunohistochemistry.Results The mortality rate of Group I /R +LPS was highest.HE staining of the cardiac tissues revealed that the pathological changes of myocardial tissue were not obvious in Group S;myocardial cells were disordered and slightly swollen and red blood cell and inflammatory cells were observed in the intramuscular space of the Group LPS;these injuries were more serious in the Group I /R;the injuries of cardiac tissues were most serious in Group I /R +LPS.The results of immunohistochemical staining revealed that TNF-αexpression level of cardiac tissue increased as followings:Group S,Group LPS,Group I /R and Group I /R +LPS.Significant differences were observed among groups,except for the difference between Group LPS and Group I /R.The expression level of SOD1 decreased as followings:Group S,Group LPS,Group I /R and Group I /R +LPS. Significant differences were observed among groups,except for the difference between Group I /R and Group I /R +LPS.The expression level of SOD2 decreased as followings:Group S,Group LPS,Group I /R +LPS and Group I /R.Significant differences were observed among groups,except for the differences between Group LPS and I /R and Group I /R +LPS.Conclusion The mortality in rats with sepsis after abdominal aorta clamping is high.Obvious myocardial morphological changes and injuries exist either in ischemia reperfusion or sepsis state.At the same time,the expression of TNF-αis up-regulated while SOD1 and SOD2 are down-regulated.

After a description of the new connotations of information literacy education in medical undergraduates in the era of omnimedica such as visual information literacy education, media information literacy education and mobile information literacy education, new strategies were proposed for the information literacy education in medical undergraduates in the era of omnimedia, including updating teaching model, adding education contents, and improving omnimedia presentation ability.

Objective To investigate the effects of different concentrations of ketamine on the apoptosis of cultured spinal dorsal horn neurons and astrocytes induced by glutamate. Methods Newborn Wistar rats (1-3 days old) weighing 10-15 g were used in this study. The animals were anesthetized and the dorsal hom of T11-L5 segment of the spinal cord was separated under sterile condition. The neurons and astrocytes were obtained by trypsin digestion of the tissue and mixed and cultured for 2 weeks. The cells were then randomly divided into 6 groups ( n = 8 each) : control group (C) in which Hank solution 50 ?l was added; glutamate group (G) glutamate was added (the final concentration was 100 ?mol?L-1); ketamine group (K) ketamine was added (final concentration = 1 mmol?L-1) and glutamate-ketamine groups (GK1 , GK2, GK3) glutamate was added first (final concentration was 100 ?mol?L-1) and 30 minutes later ketamine was added (the final concentration was 0.1, 1 or 10 mmol?L-1). After being incubated for 48 h the supernatant was harvested for determination of IL-1? and TNF-? concentrations. The morphological changes of the cells were examined by Wright staining. The apoptotic neurons and astrocytes were detected by flow cytometry.Results The number of apoptotic cells was significantly greater and the concentrations of IL-1? and TNF-? were significantly higher in group G and GK1 than in group C (P

Objective To investigate the effect of propofol on expression of cyclinD1 and apoptosis in spinal cord neurons induced by ischemia-reperfusion (I/R) .Methods Sixty male Wistar rats weighing 200-250 g were randomly divided into 2 groups ( n = 30 each): group A I/R and group B propofol + I/R. The animals were anesthetized with 7% chloral hydrate 6 ml?kg-1. The abdomen was opened and the abdominal aorta was clamped distal to the left renal artery for 20 min. The aortic cross clamp was then released to allow reperfusion. In propofol group propofol 100 mg?kg-1 was administered intraperitoneally (IP) during the operation. Neurologic function was assessed using Taylor scale (0 = unable to move hind limbs, 4 = normal function) at 6 h after operation and on postoperative day 1, 2, 3, 7 (n = 6 at each time point) . The animals were killed after neurologic function evaluation and the spinal cord was removed for microscopic examination, detection of apoptosis in the spinal cord neurons ( TUNEL) and determination of cyclinD1 expression (immuno-histochemistry) . Results The histo-pathological damage to the neurons was significantly lighter, the neurological function better and the apoptotic index and the cyclinD1 expression were significantly lower in propofol group than in I/R group. Conclusion Propofol protects spinal cord against I/R injury by reducing neuronal apoptosis through down-regulation of cyclinD1 expression.

Objective To compare the myocardial damage in patients with severe valvular heart disease undergoing open heart surgery under propofol and sevoflurane combined anesthesia.Methods Thirty-two patients with severe heart valvular disease undergoing open heart surgery were randomized into 3 groups:midazolam group (group M,n =8),propofol group (group P,n =12) and sevoflurane group (group S,n =12).Midazolam 1-5 mg,vecuronium 0.15 mg/kg and fentanyl 10-20 μg/kg were injected intravenously in group M.Propofol 1-2 mg/kg,vecuronium 0.15 mg/kg and fentanyl 10 μg/kg were injected intravenously in group P.In group S,the patients inhaled sevoflurane until the eyelash reflex disappeared,the end-tidal concentration of sevoflurane was 0.5 ％-2.0％,and vecuronium 0.15 mg/kg and fentanyl 10μg/kg were injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with iv infusion of midazolam 0.1 mg· kg-1 · h-1,fentanyl 0.2 μg· kg-1 · min-1,and vecuronium 0.12 mg· kg-1 · h-1 in group M,with iv infusion of propofol 150 μg· kg-1 · min-1 and fentanyl μg· kg-1 · min-1 in group P,or with inhalation of 0.5％-2.0％sevoflurane in group S.CPB was established routinely.The concentration of sevoflurane was 0.5 ％-1.0％ during CPB.Venous blood samples were collected before anesthesia (T1),at 20 min and 2 h after aortic unclamping (T2,3),and at 24 h after operation (T4) for determination of the levels of plasma lactic dehydrogenase (LDH),creatine kinase (CK),creatine kinase MB (CK-MB),cardiac troponin Ⅰ (cTnⅠ),superoxide dismutase (SOD)and tumor necrosis factor (TNF)-α.Myocardial tissues were taken at T2 for determination of heme oxygenase-1 (HO-1) expression and for examination of the myocardial ultrastructure.Results Compared with group M,the levels of plasma LDH,CK-MB,and CK were significantly decreased at T2-4,the levels of plasma SOD and cTnⅠ were significantly increased at T2,3,and the expression of HO-1 was up-regulated at T2 in groups P and S,and the levels of plasma TNF-α were significantly decreased at T2-4 in group P and at T2,3 in group S (P ＜ 0.05).The pathologic changes induced by I/R were less severe in groups P and S than in group M.Conclusion Both propofol and sevoflurane can attenuate the myocardial damage in patients with severe valvular heart disease undergoing open heart surgery and the effects are comparable.

Objective In order to explore the possibility of autologous transplantation of olfactory mucosa for spinal cord repair,the changes of autologous olfactory mucosa being transplanted into spinal cord and the effect of promoting axon regeneration in adult rats were investigated. Methods Forty male adult rats were divided into two groups randomly:olfactory mucosa transplantation and control groups.Olfactory mucosa (1*!mm+2) was taken from the posterior region of nasal septum,and this graft was transplanted into the posterior funiculus of cervical 1 segment of spinal cord and destructed the corticospinal tract(2*!mm?1^5*!mm).The control graft was derived from the respiratory lamina and then was grafted into the corresponding lesion.After being survived for 4-6 weeks,the animals were killed,the transplanted site was sectioned horizontally,immunofluorescence double labeled with the neurofilament(NF) and anti-NGFR-p75,investigated under the confocal microscope.Another set of slice was used immunohistochemistry to investigate the olfactory mucosa how to integrate with the surrounding tissue. Results The control lesions have the obvious hollow,no p75-positive reaction in the respiratory lamina and no NF-positive fibers grew through it;olfactory mucosa group showed that olfactory mucosa which is labeled p75-positive healed up with surrounded tissue,the hollow declined markedly,the labeled olfactory ensheathing cells(OECs) soakage into the nerve tissue.OECs induced a fine,unbranched,elongative growth of the cut CST axons.The axons were regenerated through the graft and continued to reenter into the caudal host part.Conclusion Autologous olfactory mucosa may be the donor which could repair the spinal cord injury for clinical situations.

BACKGROUND: It has been reported that the ischemia preconditioning (IPC) had credible protective efficiency on ischemic injury of the spinal cord during aorta operation, but the mechanism of the protective efficiency of IPC had not been clarified.OBJECTIVE: To study the protective effects of repetitive IPC on ischemic injury of spinal cord and its mechanism in rabbits.DESIGN: A completely randomized controlled study based on the experimental animals.SETTING: Department of anesthesiology in a university hospital.MATERIALS: The experiment was completed in the Department of Anesthesiology, Renmin Hospital, Wuhan University during September and December 2002. Twenty-four Japanese rabbits were randomly and double-blindly divided into sham-operation group, ischemia-reperfusion group and IPC group with 8 rabbits in each group.INTERVENTIONS: In sham-operation group, abdominal aorta was not clamped. Spinal cord ischemia was induced by infra-renal aortic cross-clamp for 45 minutes in ischemia-reperfusion group. Before the 45 minutes ischemia, the rabbits in the IPC group underwent four cycles of ischemia preconditioning, i.e. clamping abdominal aorta for 5 minutes then reperfusion for 5 minutes.MAIN OUTCOME MEASURES: The concentrations of calcium, magnesium, copper and zincum in spinal cord were measured in the 7th day after operation. Postoperative neurological function, EMG of rear limb, and spinal cord histopathological changes were assessed in all groups after operation.RESULTS: The concentrations of calcium and copper in spinal cord in ischemia-reperfusion group were significantly higher than those in sham-operation group( P ＜ 0. 05 or 0. 01 ), but magnesium and zincum significantly lower( P ＜ 0. 05). Compared with IPC group, calcium in ischemia-reperfusion group was significantly higher( P ＜ 0.01 ), but zincum significantly lower( P ＜ 0.01 ) . The neurological function and histopatholohical changes in ischemia-reperfusion group were much lower than those in sham-operation group and IPC group ( P ＜ 0.05 or P ＜ 0.01) . And there was significantly worse change of EMG in ischemia-repeffusion group than that in IPC group(P ＜ 0.01).CONCLUSION: Repetitive ischemic preconditioning can protect rabbit spinal cord from ischemia reperfusion injury quickly, and one possible reason for its protective effect is to maintain the balance of calcium, magnesium,copper and zincum in ischemic region.

After a description of the application of education game in literature retrieval teaching and the practical activities of information literacy education game in our library, suggestions were put forward for the problems that need to be concerned in performing information literacy education game, namely pursuing the benefits and avoi-ding the hazards, making entertainment a medium of education, rational application of small game in classroom teaching, taking immediate action, and leaving it undone as it is small.