Objective To study the expression of liver X receptor (LXR) during the progress of multiple organ dysfunction syndrome (MODS) caused by wound infection, and its role in the lipid metabolism during MODS. Method The MODS models caused by wound infection were produced. One hundred Wistar rats were randomly divided into wound group (group T, n = 30) and MODS caused by wound infection group (group M, n = SO). The closed multi-fracture and extensive soft-tissue injury was produced in rats using jaw. After 12 hours, a thirty percent total body surface area Ⅲ (TBSA Ⅲ ) bum was induced in group M,and the rats were contaminated by pseudomonas aeruginosa. The levels of endotoxin ( LPS), alanine transaminase (ALT), free fatty acid ( FFA), TG, HDL, VLDL were determined before injuries and post injuries 24, 48, 96, 120 hours, and at each time point in each group, only 10 rats were determined. And at the same tune, real-time quantitative reverse transcription polymerase chain reaction technique was used to measure the gene expression of LXR. Chi-square test was used. Results The blood ALT and LPS levels in rats were increased slowly, the levels of FFA reached peak at 96 hours post injuries (P ＜ 0.05), the level of TG increased first and then decreased to the lowest at 96 hours, HDL dropped slowly, and VLDL decreased first and then increased. The gene expression of LXR increased slightly at 24 hours and then gradually decreased in group T, and the gene expression of LXR decreased more obviously in group M, and there was significant difference compared with group T. Conclusions ALT increased slowly, and was positively correlated with IPS post injuries. This indicated that infection aggravated the liver injury. The gene expression of LXRα increased in the early stage and then decreased in the late stage, LPS and LXRα were negatively correlated, which may cause the change of LXRα. The decreased expression of LXRα during MODS may contribute to dysfunction of cholesterol transport and fatty acid synthesis.

Objective To make clear the knowledge level of emergency treatment during the disasters among emergency nurses,and then make out the countermeasures.Methods Using the self-designed questionary to investigate the knowledge level of emergency treatment during the disasters among emergency nurses.The contents of survey included: general condition,related experiences about emergency treatment,the anxiety and the pattern of how to obtain the related knowledge.Results The level of knowledge of emergency treatment was different in the different nurses according to their different working time.Most of the emergency nurses had not accepted the normal training about the emergency treatment of disasters.Conclusion The nursing administers should put out certain measures to strengthen the training about emergency treatment,and then improve the nurses ability to deal with disaster.

Objective To determine the expression spectrum of microRNA(miRNA)in the lung homogenate of rats with chronic obstructive pulmonary disease(COPD)or healthy rats,to look for differentially expressed miRNA, and to explore their potential role in pathogenesis of COPD. Methods Twenty male Sprague-Dawley(SD)rats were randomly divided into normal control group and COPD model group,with 10 rats in each group. COPD rat models were reproduced by smoke inhalation as well as intratracheal instillation of lipopolysaccharide(LPS). The samples of the lung were harvested,and the histopathological examination of the right lung was carried out to evaluate the degree of lung injury. Total RNAs were isolated from the left lung. The miRNA expressions in lung tissue of rats with COPD or normal rats were determined by miRNA chip eichnology to screen the miRNA with differential expression, and hierarchical clustering analysis was made. The data were analyzed to study the expression difference of miRNAs between the two groups,and to construct the miRNA-Target network. Results Compared with normal control group, 20 miRNA with increased expression were found in COPD model group,the top 10 were miR-30c-2,miR-199a-5p, miR-30a, miR-145, miR-151, miR-674-5p, miR-214, miR-423, miR-28 and miR-181b, and only miR-376b-3p showed down-regulation. Hierarchical clustering analysis showed that significant differences in individual miRNA in lung tissue between rats of two groups were found. However,similar samples could not be gathered well,thus it may give rise to inconsistency during the sample preparation. Many miRNAs had multiple target genes in miRNA-Target network, such as miR-30c-2, miR-145, miR-181b, miR-181a, miR-181d, miR-199. Conclusions The study reveals that there is a variance of miRNAs expression profile in lung homogenates between COPD group and the normal control group of rats,and many miRNAs have multiple target genes,such as miR-30c-2,miR-145,miR-181b,miR-181a,miR-181d,and miR-199. Therefore,the results may be valuable to centain extent for the interpretation of COPD pathogenesis.

Objective To review computed tomographic angiography (CTA) signs and its potential use in the diagnose of blunt thoracic aortic injury Methods We reviewed 37 cases with blunt thoracic aortic injury (TAI) confirmed by surgery or aortography in Chinese PLA General Hospital emergency department from June 2004 to June 2014.CTA were performed on these patients,and CTA images were analyzed retrospectively to obtain characteristic CTA signs of blunt thoracic aortic injury.Results Of the 37 cases,the blunt injury in aortic isthmus were 83.8％ (31/37),aortic arch 5.4％ (2/37),descending aorta 8.1％ (3/37),and ascending aorta 2.7％ (1/37),respectively.CTA signs of thoracic aortic injury manifested as intimal flap in 34 patients (91.8％),abnormal aortic contour or cavity in 37 cases (100％),arterial contraction in 17 cases (45.9％),aortic dissection in 10 cases (27.0％),pseudoaneurysm in 21 cases (56.7％),thrombosis in 1 case (2.7％).Conclusions CTA signs could be used to facilitate the diagnosis of blunt thoracic aortic injury with a qualitative diagnostic value.

Objective To explore the effect of toll-like receptor 4 (TLR4), myeloid differentiation protein-2 (MD2), and stromal interaction molecular 1 (STIM1) for regulating human vascular endothelial calcium overload injury and inflammatory reaction induced by bacterial endotoxin (LPS).Methods Human umbilical vein endothelial cells (HUVECs) were cultured in Dulbecco's modification of Eagle's medium (DMEM). ① The levels of TLR4, MD2 and nuclear factor-κB (NF-κB) were detected by reverse transcriotion-polymerase chain reaction (RT-PCR) before and 0.5, 1, 6, 12, 24 hours after LPS stimulation. ② Intracellular calcium peak level was detected by confocal following probe fluo-3 AM loading in HUVEC cells induced with LPS and transfected by psiSTIM or psiTLR. ③ MD2, STIM1 or NF-κB protein level was detected by immunoprecipitation (IP) and immuno-blotting in HUVEC cells which were transfected by TLR4 inhibited expression (psiTLR) for 12 hours and followed by LPS stimulation for 6 hours. ④ HUVEC cells were randomly divided into 6 groups: control group, LPS group, PDTC 0.1 mg/L group, PDTC 1 mg/L group, psiTLR 1 h group and psiTLR 12 h group. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by enzyme linked immunosorbent assay (ELISA) in supernatant. The mRNA levels of STIM1 and NF-κB were detected by RT-PCR.Results ① The mRNA levels of TLR4, MD2, and NF-κB gradually increased after LPS induction and peaked at 6 hours (2-ΔΔCt: 23.52±2.88, 17.43±3.43, 18.13±2.99, respectively), which were statistically significant before the stimulation with LPS (2-ΔΔCt: 7.02±2.81, 5.19±3.22, 8.11±1.42, allP < 0.05). ② Extracellular calcium influx in LPS group was increased significantly higher than control group (nmol/L: 108.13±22.33 vs. 41.57±13.19, P < 0.01). Extracellular calcium influx in psiSTIM+LPS group (nmol/L: 62.61±14.12 vs. 108.13±22.33,P < 0.05) and psiTLR+LPS group (nmol/L: 50.78±8.05 vs. 109.43±20.21,P < 0.01) were both suppressed as compared with LPS group. While extracellular calcium peak level in psiTLR+psiSTIM+LPS group further decreased (nmol/L: 39.31±6.42 vs. 109.43±20.21,P < 0.01). ③ MD2 protein but not STIM1 or NF-κB can be detected in anti-TLR4 precipitates in control (ctrl-) by immunoprecipitation. MD2 protein level increased in anti-TLR4 precipitates in LPS group (ctrl+) and was suppressed in TLR4 inhibiting group (psiTLR). ④ The levels of TNF-α in PDTC 1mg/L group were significantly lower than those of LPS group (ng/L: 0.60±0.24 vs. 1.77±0.66,P < 0.01). The levels of IL-6 in PDTC 0.1 mg/L, 1 mg/L group and psiTLR 12 h group decreased significantly lower than that of LPS group (ng/L: 232.10±63.54, 134.32±37.23, 284.23±56.14 vs. 510.22±89.23, allP < 0.05). Compared to LPS group, the mRNA levels of NF-κB and STIM1 were obviously inhibited in PDTC1 mg/L group and psiTLR 12 h group [NF-κB mRNA (2-ΔΔCt): 17.22±2.35, 13.24±3.54 vs. 30.16±2.06; STIM1 mRNA (2-ΔΔCt): 12.57±2.43, 12.21±2.46 vs. 25.12±2.02, allP < 0.05]. Conclusions TLR4, MD2, NF-κB signal and SOC calcium channel STIM1 mediate LPS induced-calcium influx and inflammatory mediators level in HUVEC cells. Extracellular calcium overload and inflammatory response by endotoxin induction can be effectively inhibited by down-regulation of TLR4, NF-κB and/or STIM1.

Objective To demonstrate the effect of tumor necrosis factor-α induced protein 8 like-2 (TIPE2) expression in patients with acute respiratory distress syndrome (ARDS) and its mechanism. Methods A prospective observation was conducted. Thirty-nine patients with ARDS admitted to department of emergency of PLA General Hospital from July 2013 to July 2015 were enrolled, and 35 healthy persons served as control group. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours after admission, blood gas analysis, procalcitonin (PCT), and C-reactive protein (CRP) were recorded. The mRNA expressions of TIPE2 in peripheral blood mononuclear cell (PBMC) and myxoma resistance protein 1 (MX1) in plasma were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The correlations were analyzed by Spearman rank correlation analysis. Results The mean of APACHE Ⅱ score in 39 patients with ARDS was 25±3, the mean of PCT was (1.85±0.41) μg/L, and the mean of CRP was (18.0±3.0) mg/L. The TIPE2 mRNA expression in PBMC of ARDS patients was significantly down-regulated as compared with that of healthy control group (2-ΔΔCt: 3.28±0.15 vs. 8.87±0.20, P < 0.001), and the MX-1 mRNA expression in plasma was significantly higher than that of healthy control group (2-ΔΔCt: 39.44±0.46 vs. 20.10±0.32, P < 0.001). It was shown by correlation analysis results that the TIPE2 mRNA expression was negatively correlated with MX1 mRNA expression (r = -0.630, P < 0.001), so as APACHE Ⅱ score (r = -0.781, P < 0.001), but no correlation was found between TIPE2 mRNA and PCT as well as CRP (r value was 0.143 and 0.330, respectively, both P > 0.05). The MX1 mRNA expression was positively correlated with APACHE Ⅱ score (r = 0.893, P < 0.001), but no correlation was found between MX1 mRNA and PCT as well as CRP (r value was 0.230 and 0.210, respectively, both P > 0.05). Conclusion TIPE2 expression was decreased in ARDS patients, which negatively correlate with disease severity, and indicate TIPE2 might be involved in the pathogenic process of ARDS.

Medical care on the battlefield is the core and basis of echelons of care.This review summarizes the background and characteristics of medical care units on the battlefield from the birth and growth of mobile army surgical hospitals before being replaced by forward surgical teams and combat support hospitals, since the United States Armed Forces began to lead the world military revolution during and after the World WarⅡ.Quick adaptation to the combat envi-ronment and the combat modes is the main reason that medical care units on the battlefield are adjusted continuously.This paper may provide some ideas for the development of our medical care units on the battlefield in the future.

Objective To explore a method of establishing a canine model of intracerebral hemorrhage (ICH) by puncturing the main branch of middle cerebral artery (MCA) under ultrasonic guidance and proceed a pilot study of contrast-enhanced ultrasound (CEUS) of ICH.Methods Twelve adult healthy mongrel dogs were enrolled in the experiment.In the condition of bone window,the main branch of MCA was punctured to bleed under the ultrasonic guidance.CEUS of brain was performed every 30 minutes until hematoma formed and another CEUS was performed at 24 hours.Then brains were collected for pathologic examination after dogs were euthanized.Results Eleven of twelve dogs developed ICH successfully that located in the Out edge of basal ganglia,which was confirmed by CEUS and autopsy.One dog died within 6 hours due to intraventricular hemorrhage which was confirmed by autopsy.The hematoma diameters were measured as (22.4 ± 7.1)mm by CEUS before euthanasia and as (21.6 ± 6.9)mm on autopsy.There was no significant difference between the two methods of measurement (t =1.521,P =0.1565).The characteristics of active bleeding and hematoma on ICH were performed in the CEUS imaging.Conclusions A model of dog ICH by puncturing the main branch of MCA under the guidance of ultrasound was established successfully,and it proved to be simple,effective and repeatable.The imaging characteristics of this model are in good accordance with those of ICH in patients.

Objective To evaluate percutaneous injection of hemostatic agents under the guidance of contrast-enhanced sonography(CEUS) in controlling hemorrhage from severe splenic trauma. Methods Eight patients with splenic traumas of grade Ⅲ, Ⅳ were consecutively enrolled in this study. Percutaneous injection of hemocoagulase atrox and α-cyanoacrylate was performed by CEUS-guidance in all patients. Ultrasound examination was performed at 1,3,7 and 14 days after focal injection. Vital signs and hemoglobin (Hb) level were recorded. Results After the injection,immediate CEUS demonstrated that active bleeding from the injury sites disappeared. From 30 minutes after the injection arterial blood pressure began to ascend ( P <0. 05), and heart rate decreased to the normal level after the treatment ( P <0.05). Hb decreased at first and then gradually increased to the normal level. Conclusions Pereutaneous injection of hemoeoagulase atrox and α-cyanoacrylate under the guidance of CEUS can effectively control bleeding from a severe splenic trauma. CEUS can be helpful to the diagnosis of the suspected splenic trauma and to ensure hemostatic materials to be injected exactly into injury sites.

Objective To investigate the efficacy and safety of contrast enhanced ultrasound (CEUS)-guided local injection therapy in treatment of abdominal trauma. Methods CEUS was per-formed in 12 patients with abdominal trauma to determine the location,iniury severity and possible active bleeding. Then,all 12 patients underwent CEUS-guided local injection therapy with haemostat. Conven-tional ultrasound and CEUS examinations were performed at days 0,1,3,7,14 and 30 after the treat-ment. Results The bleeding was instantly controlled by using CEUS-guided local injection therapy without delayed rehemorrhage. Conclusion Compared with conventional ultrasound,CEUS Call more significantly elevate diagnostic accuracy of abdominal trauma and accurately guide local injection therapy, with satisfactory curative effect and safety.