Objective To observe the variation of mortality and discharge against medical advice in major trauma patients admitted to the ICU and thus to improve the level of trauma care.Methods A retrospective analysis was performed on major trauma patients who died or discharged against medical advice in the emergency 1CU from 2003 to 2011.Patients were categorized as the dying,worse,and improved according to their situation at discharge.The dying was included into the death group.Annual variation of mortality and discharge against medical advice were analyzed in these 9 years.These parameters were also compared among three diverse periods (2003-2005,2006-2008 and 2009-2011).Results Ultimately,452 patients were recruited from the 3,343 major trauma patients admitted to the emergency ICU from 2003 to 2011.There were 231 deaths occupying 6.91％ (135 patients died in hospital and 96 patients were dying at discharge) and 221 discharges against medical advance occupying 6.61％ (175 patients deteriorated and 46 patients improved).Within the 9 years,a significant decrease was found in the annual rate of inhospital death,dying at discharge,and total death.Meanwhile,there was an increase in the rate of deterioration at discharge (x2 =15.305,P ＞0.05).However,no significant difference was found in the rate of total death plus deterioration at discharge.During the three periods of 2003 to 2005,2006 to 2008,and 2009 to 2011,number of patients admitted to the emergency ICU was 687,1,143,and 1,513 respectively.Age and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the dead,the patients with deterioration at discharge,and the dead plus the patients with deterioration were gradually higher through the three periods; on the contrary,GCS lowered.Total mortality decreased from 11.06％ to 4.63％ (x2 =31.174,P ＜0.01) ; rate of deterioration at discharge increased continuously from 2.77％ to 6.35％ (x2 =12.203,P ＜0.01) ; rate of death plus deterioration at discharge was declined from 13.83％ to 10.97％ (x2 =4.09,P ＞ 0.05).Conclusions From 2003 to 2011,the level of severe trauma care in emergent ICU is obviously improved.Ratio of deterioration at discharge increases with more aged patients.Discharge against medical advance interferes with the accurate assessment of trauma care and should be paid more attention.

BACKGROUND AND OBJECTIVEAs a barrier to metastases, cells normally undergo apoptosis after they lose contact with their extra cellular matrix (ECM). This process has been termed "anoikis". Tumour cells that acquire malignant potential have developed mechanisms to resist anoikis and thereby survive after detachment from their primary site while traveling through the lymphatic and circulatory systems. This "anoikis resistance" is considered the first step to tumor metastases. The aim of this study was to screen metastasis-associated genes from anoikis resistant and adherent growth A549 lung cancer cell by Human Genome Array.

METHODSEstablish anoikis resistant A549 lung cancer cell lines by using poly-hydroxyethyl methacrylate resin processed petri dishes, which causes cell free from adherent. The different expressed gene between anoikis resistant A549 cell and adherent growth A549 cell was tested using human V2.0 whole-genome oligonucleotide microarray, a product of Capitalbio Corporation, Beijing. Screen metastasis-associated genes.

RESULTS745 different expressed genes were screened, including 63 highly metastasis-associated genes.

CONCLUSIONThe successfully established anoikis resistant A549 cell lines and screened different expressed genes provide us basis for further research on metastasis of lung cancer.

Anoikis ; genetics ; physiology ; Cell Line, Tumor ; Flow Cytometry ; Gene Expression Profiling ; Genome, Human ; genetics ; Humans ; Lung Neoplasms ; genetics ; Oligonucleotide Array Sequence Analysis

Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.

Objective:To investigate the sex differences in severe traumatic death patients of different ages.Methods:A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into the children group (≤ 14 years old, n = 47), the adult group (14-50 years old, n = 171), and the older adult group (> 50 years old, n = 90). Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups. Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate. Results:Traffic accidents were the most common cause of death among men in the adult group (58.93%, χ2 = 7.95, P = 0.027). Falls were the most common cause of death among men in the older adult group (57.36%, χ2 = 8.63, P = 0.001). The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group [adult group: men: (24.39 ± 4.17) points, women: (26.32 ± 4.31) points, t = 2.84, P = 0.005). The incidence of post-traumatic complications in the older adult group was very higher in men than in women (respiratory failure: 28.68% in men, 14.75% in women, χ2 = 4.37, P = 0.036; circulatory failure: men: 27.13%, women: 13.11%, χ2 = 4.64, P=0.031; neuropsychiatric disorders: men: 20.93%, women: 8.20%, χ2 = 4.79, P = 0.029; respiratory infection: men: 31.78%, women: 18.03%, χ2 = 5.55, P = 0.047; other infectious diseases: men: 28.68%, women: 13.11%, χ2 = 0.69, P = 0.018). After adjusting for covariates, the mortality rate of men in the older adult group was significantly higher than that of women in the same group ( OR: 1.261, 95% CI: 1.185-1.343, P < 0.001). With the increase of age, the predicted survival rate after the trauma in patients of different sexes also decreased, in particular in men aged > 50 years (interaction P = 0.051). Among patients with blunt and severe head trauma, age-related mortality decline in patients aged > 50 years had a strong interaction with sex (interaction P = 0.002). In patients with penetrating trauma, there was a weak interaction between the predicted survival rate of different sexes (interaction P = 0.192). Conclusion:There is no significant difference in age-related change in post-traumatic mortality between different sexes. In the population aged > 50 years, men have a relatively higher risk of death than women.

Objective To study the clinical effect of diversion treatment for complex anal fistula.Methods A total of 60 patients with complex anal fistula were enrolled in this study were divided into control group and experimental group according to the random number table method,with 30 cases per group.All patients were given routinely imaging examination and other related checks,and the intestine tract was cleaned in the morning of the operative day.The control group were treated with low anal fistula resection,while the experimental group with diversion treatment.The efficacy of treatment,postoperative anal function,wound healing time and pain were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group (P ＜ 0.05).The Wexner score of the anus function in the experimental group was lower than that in the control group at 1,7,14 and 21 d after the operation,and the differences were statistically significant (P ＜ 0.05).The wound healing time,VAS score on 14thpostoperative day,intraoperative wound area and postoperative scar size were lower in the experimental group than that in the control group (P ＜ 0.05).Conclusion Diversion treatment for complex anal fistula has significant efficacy,faster postoperative wound healing,and it can effectively relieve clinical symptoms and signs,improve anal function,reduce body pain,so it is worthy of clinical promotion.

Objective To study the clinical effect of diversion treatment for complex anal fistula.Methods A total of 60 patients with complex anal fistula were enrolled in this study were divided into control group and experimental group according to the random number table method,with 30 cases per group.All patients were given routinely imaging examination and other related checks,and the intestine tract was cleaned in the morning of the operative day.The control group were treated with low anal fistula resection,while the experimental group with diversion treatment.The efficacy of treatment,postoperative anal function,wound healing time and pain were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group (P ＜ 0.05).The Wexner score of the anus function in the experimental group was lower than that in the control group at 1,7,14 and 21 d after the operation,and the differences were statistically significant (P ＜ 0.05).The wound healing time,VAS score on 14thpostoperative day,intraoperative wound area and postoperative scar size were lower in the experimental group than that in the control group (P ＜ 0.05).Conclusion Diversion treatment for complex anal fistula has significant efficacy,faster postoperative wound healing,and it can effectively relieve clinical symptoms and signs,improve anal function,reduce body pain,so it is worthy of clinical promotion.

Proton pump inhibitors (PPIs) are commonly used in clinical practice and are currently widely used in people with acute-on-chronic liver failure (ACLF). However, such medication is still not supported by the recommendations in the latest version of Clinical guidelines for acute-on-chronic liver failure issued by American College of Gastroenterology. With reference to the guidelines or consensus statements in China and globally and the latest research advances, this article elaborates on the indications, possible benefits, and potential risks of PPIs used in people with ACLF, in order to provide a reference for the standardized use of PPIs in the population with ACLF in clinical practice.

Objective To review and analyze the effect of probiotics in preventing the overt hepatic encephalopathy (OHE) in patients with minimal hepatic encephalopathy (MHE). Methods Studies about this subject were searched in PubMed, Web of Science, Cochrane Library, Chinese journal full-text database (CNKI), WanFang data knowledge service platform (WanFang Data) from their establishment to November 2021. Meta-analysis was performed using RevMan 5.4. Description analysis was used for data that could not be pooled. The relative risk ( RR ) and 95% confidence interval ( CI ) were used to present pooled data. Results Six RCT studies with a total of 404 patients were included in this meta-analysis. The results showed probiotics users had a significant reduction of the OHE incidence, as compared with the controls ( RR =0.46, 95% CI : 0.26 - 0.81; P =0.007), but an increase in the reversal MHE rate ( RR =4.94, 95% CI : 2.82-8.66; P < 0.000 01). Conclusion This finding demonstrated that probiotics were able to effectively reduce the OHE incidence and improve the reversal MHE rate in the patients with MHE. This study could provide novel evidence for probiotics treatment of MHE.