Objective To evaluate the effect of early limited fluid resuscitation in treatment of severe pelvic fracture accompanied with traumatic hemorrhagic shock. Methods A retrospective study was done on 96 patients with severe pelvic fractures accompanied with traumatic hemorrhagic shock admitted into hospital from January 2002 to December 2006. Of all, 55 patients ( routine resuscitation group)were dealt with routine fluid resuscitation and 41 (limited resuscitation group) with limited fluid resuscitation. The injury severity, degree of shock, start time of resuscitation, transfusion volume were statistically analyzed and compared in two groups. Results Routine resuscitation group received transfusion volume of (3 432 ± 1 156) ml, with cure rate of 64% and mortality rate of 36% ; while limited resuscitation group received transfusion volume of (2 685 ± 524) ml, with cure rate of 83% and mortality rate of 17%. There was statistical difference between both groups ( P ＜ 0.05 ). Conclusion Limited fluid resuscitation can improve cure rate of severe pelvic fracture accompanied with traumatic hemorrhagic shock.

Two systems which covered nearly 1. 1 billion people in China’s social health insurance, namely the New Rural Cooperative Medical Scheme ( NRCMS ) and the Urban Residents’ Health Insurance System ( URHIS ) , have been depended mainly on government support with high percentage of premium subsidies. This paper deals with the current situation and probes into the main subsidy policy problems by making an overall analysis on the policies of 31 cross-country provinces , and in result points out four problems including the long-term mechanism shortage, in-distinct responsibility between governments at different levels, the equity deficiency and the subsidies inefficiency. Finally, the paper concludes with enlightening some corresponding policies and suggestions.

Synaptic injury exists in the early period of vascular cognitive impairment (VCI), and it is closely correlated with the cognitive dysfunction, however, its specific mechanism remains unclear. To study the plasticity of synaptic morphological structure, the plasticity of the efficiency of synaptic transmission as well as the role and mechanism of synapic proteins in the onset of VCI will help to further clarify the pathogenesis of VCI, and thus more effectively combat VCI.

Objective:The protein of missing in metastasis (MIM), a novel discovered actin-binding scaffold protein, is involved in actin cytoskeleton rearrangements, signal transduction and transcriptional activation, and has close association with tumor growth, invasion, and metastasis. Recently, much focus has been placed on the role of MIM performed in tumor progression. In recent years, more and more attention is focused on its action mechanism in various kinds of tumors, which has a wide foreground of investigation. In this paper, we make a comprehensive review of the association of MIM with cancer development, in order to provide the theoretical basis and new strategies for application of MIM proteins in cancer diagnosis and treatment.

Objective To investigate and compare the change of extravascular lung water (EVLW) and levels of cytokines in septic patients without clinical acute lung injury (ALI) /acute respiratory distress syndrome (ARDS) with those in spetic patients with sepsis-induced ALI/ARDS in order to determine the role of EVLW involved in the pathogenesis of lung injury in the patients by quantifying the relationship between EVLW and biomarkers of lung injury in patients with sepsis.Methods A total of 40 septic patients complicated either with or without clinical ALI/ARDS after sepsis. In each patient,transpulmonary thermodilution (PiCCO) was used to measure cardiovascular hemodynamics and EVLWI for 7 days via an arterial cannula indwelled within 72 hours after diagnosis of severe sepsis was made, and serial bronchoalveolar lavages (BAL) were carried out.Other examinations including blood gas analysis,ventilator parameters,chest X-ray and the levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF-oα),interleukin-1 in the BAL were recorded.In-hospital and ICU mortalities were also observed.Results Of total 40 patients,29 were complicated with clinically defined septic ALI/ARDS ( ARDS n =15,and ALI n =14).The septic patients complicated with ALL/ARDS had significantly higher amount of EVLWI and higher levels of TNF-α and interleukin-1 in the BAL than patients without ALI/ARDS ( P ＜ 0.05).The arterial oxygen tension/fractional inspired oxygen ratio,lung injury score,and the levels of TNF-α,IL-1 in the BAL correlated with EVLWI.Moreover,in-hospital mortality,ICU mortality and the length of ICU stay of the patients with high amount of EVLWI were markedly increased than those of patients with low amount of EVLWI. Conclusions In septic patients complicated with ALI/ARDS, the extravascular lung water index correlates with oxygenation,lung injury severity and inflammatory cytokines in lung.Determination of EVLWI may be useful for evaluation of severity of lung injury and prognosis of septic patients.

Objective To compare the clinical effect of two hemostatic methods for patients with pelvic fracture combined with hemorrhagic shock in the early stage.Methods A retrospective analysis was done on clinical data of 90 patients with unstable pelvic fracture combined with hemorrhagic shock managed by damage control resuscitation from January 2008 to December 2012.Unstable blood pressure and abdominal distension were noted postoperatively.Forty patients in Group A received laparotomy and bilateral internal iliac artery ligation from January 2008 to January 2010.Fifty patients in Group B underwent internal iliac artery embolization from February 2010 to December 2012.Comparative measurement was made on parameters of mortality,24-hour blood transfusion volume,24-hour lactic acid value,postoperative systolic blood pressure,postoperative body temperature,and postoperative prothrombin time (PT).Results Following parameters differed significantly between Groups A and B (P ＜ 0.05):mortality rate (53％ vs 12％),24-hour blood transfusion volume[(3 865.5 ±451.3)ml vs (2 108.8 ±336.4)ml],24-hour lactic acid value[(13.0 ± 2.0)mmol/L vs (5.4 ± 1.2)mmol/L],postoperative systolic blood pressure [(80.50 ± 22.73) mmHg vs (113.23 ± 20.89) mmHg],postoperative body temperature [(32.4 ± 0.2)℃ vs (36.1 ±0.3)℃],postoperative PT [(24.5 ±3.6)s vs (18.4±2.1)s].Conclusion For pelvic fracture combined with hemorrhagic shock,if the indications of abdominal viscera rupture are unclear,the interventional embolization can gain advantage over laparotomy in improving treatment success rate and reducing mortality and complications.

Objective To explore the effects of amisulpride on the cognitive function in first-episode schizophrenia patients.Methods 64 patients in first-episode schizophrenia were divided into two groups randomly according to the method of tossing a coin,then treated with amisulpride or risperidone respectively for 12 weeks.The efficacy and adverse effect were evaluated with positive and negative scale (PANSS) and treatment emergent side effect scale (TESS) before treatment and after treatment for 2 weeks,4 weeks,8 weeks,12 weeks.Before and after treatment for 12 weeks,cognitive function of all the patients was blindly evaluated with Wechsler Scale-revised China (WMS-RC),Wisconsin Card Sorting Test(WCST) and Trail Making test A and B.Results After 12-week treatment,statistical difference was found in amisulpride(44.7 ± 6.7) and risperidone (45.2 ± 7.4) groups (P ＜ 0.01).But no statistical difference was found between the two groups (P ＞ 0.05).The cognitive function in firstepisode schizophrenia was damaged obviously.In two groups,the scores in recognize,association,comprehend,back a few and MQ of WMS and TAT-A,TAT-B were improved significantly after treatment for 12 weeks (P ＞ 0.05).These items of WCST were improved more remarkably than baseline (amisulpride (20.63 ± 13.06),(28.75 ± 15.72),(43.17 ±22.13),(3.62 ±2.21),P＜0.05; risperidone(20.41 ±13.82),(29.31 ± 16.12),(42.78 ± 21.42),(3.67 ± 2.32),P ＜ 0.05).The improvement in the scores of WCST were statistical difference compared with control group(P ＜ 0.05).But statistical difference was no found between the two groups (P ＞ 0.05).Conclusion The study shows that the cognitive dysfunction in first-episode schizophrenia can be improved by amisulpride,and the efficacy was similar with risperidone.

Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.

Objective To explore the feasibility and value of dynamic contrast-enhanced (DCE-MRI) parameters in assessing early effects of anti-angiogenesis medicine in targeted therapy for tumors.Methods Twenty BALB/C-nu nude mice were injected subcutaneously with human colon cancer cells HT-29 to the right hind leg.The nude mice were evenly divided into the experimental group and control group with 10 mice in each group.The mice of experimental group were intraperitoneally injected with bevacizumab,and the control group were injected with the same volume of saline.DCE-MRI was performed before medication and one hour,24 h and 48 h after medication.The Ktrans,Kep,Ve and initial area under enhancement curve (iAUC) of DCE-MRI were analyzed.The animals were sacrificed 48 hours after medication.Microvessel density (MVD) of the tumors was detected by immunohistochemistry.One way analysis of variance was performed to analyze parameters of DCE-MRI.The Pearson correlation coefficient was used to analyze the correlation between parameters of DCE-MRI and MVD.Results Under DCE-MRI,the edge of subcutaneous colon cancer xenografts was obviously gradually enhanced,pseudo color indicated high perfusion,the strength degree of the central region was low and which meant low perfusion.The differences in Kep of different time point of experimental group were statistically significant (F=3.752,P=0.016) ; there as no significant difference in other parameters of DCE MRI (all P＞0.05).There was no significant difference in Ktrans and Kep before medication and one hour after medication (all P＞0.05).There were significant difference in Ktrans and Kep 24 hour and 48 hour after medication between experimental group (24 hour∶ (0.095 ± 0.039) min-1 and (0.297 ± 0.141) min-1,48 hour∶ (0.090±0.033) min 1 and (0.314±0.148) min-1) and control group (24 hour∶ (0.150±0.074) nin-1 and (0.494±0.126) min-1,48 hour∶ (0.171±0.045) min-1 and (0.441± 0.092) min-1) (F24h =4.824 and 11.386,F48h =22.605 and 5.455,all P＜0.05).There was no significant difference in Ve and iAUC between two groups at different time points (all P＜0.05).MVD of experimental group was lower than that of control group.Ktrans and Kep were positively correlated with MVD (r=0.745 and 0.400,both P＜0.05).Conclusion Ktrans and Kep parameters of DCE-MRI may be used in monitoring the earlier effects of anti-angiogenesis medicine in targeted therapy for colon cancer.

Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.