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The analysis of influencing factors of emergency death in multiple trauma patients

Gengzhuang WANG ; Zhaoyu PAN ; Lifeng PAN

Tianjin Medical Journal.2017;45(8):885-888. doi:10.11958/20170171

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.

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The clinical features and risk factors of children with post-infectious bronchiolitis obliterans treated with invasive mechanical ventilation because of severe pneumonia

Xiaoqing LI

Tianjin Medical Journal.2017;45(8):881-884. doi:10.11958/20170723

Objective To summarize the clinical features and risk factors of children with post-infectious bronchiolitis obliterans (PBO), who were treated with invasive mechanical ventilation because of severe pneumonia, and to provide clinical reference for early diagnosis, early treatment and improvement of prognosis of pediatric patients with PBO. Methods The pediatric patients treated with invasive mechanical ventilation because of severe pneumonia, who were hospitalized in PICU of Tianjin Children's Hospital from October 2010 to December 2015 were included in this study. The pediatric patients who were diagnosed with PBO were used as the observation group. The general characteristics, clinical presentation, treatment time, treatment results, distribution of pathogens and relevant laboratory examination results were analyzed by using SAS 9.3 statistical software. Results A total of 73 pediatric patients were included in this study, including 49 male and 24 female, and their mean age was 8 months (P25-P75:4-12), the minimum age was 1 month and the maximum age was 36 months. They were divided into PBO group (n=30) and control group (n=43). It was found that wheezing (27 cases, 90.0%), persistent cough (22 cases, 73.3%) and exercise intolerance (22 cases, 73.3%) were the main clinical symptoms in PBO group. Results of physical examination showed wheeze (24 cases, 80.0%) and crackles (21 cases, 70.0%). Mosaic perfusion (25 cases, 83.3%) was the most prominent sign in lung CT scan. More than 2/3 of the pediatric patients were found moderate and severe pulmonary dysfunction. Pathogen detection rate was 50%in PBO group, and virus was prevalent (respiratory syncytial virus 4 cases, influenza virus 1 case, measles virus 2 cases and adenovirus 4 cases). The results of Logistic multivariate regression analysis showed that the risk factors included using corticosteroids at the beginning of disease (OR=8.515, 95%CI:1.948-37.224), prolonged mechanical ventilation (OR=1.116, 95%CI:1.031-1.327) and postponing clinic time (OR=1.114, 95%CI:1.010-1.227). Conclusion Once the severe pneumonia children, with the risk factors of using corticosteroids at the beginning of disease, prolonged invasive mechanical ventilation and postponing clinic time, are found the wheezing, persistent cough and exercise intolerance, and persisting wheeze and/or crackles, the PBO relevant examination should be executed as soon as possible to diagnosis and treatment.

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Protective effect and its mechanism of Shenkang injection on peritoneal mesothelial cells in CAPD mice

Li WANG ; Tian XIA ; Hongzhen ZHANG ; Rong LI

Tianjin Medical Journal.2017;45(8):860-864,前插3. doi:10.11958/20170502

Objective To study the protective effect of Shenkang injection on peritoneal mesothelial cells (PMCs) of continuous ambulatory peritoneal dialysis (CAPD) mice, and explore the possible mechanism. Methods Forty ICR mice were randomly divided into blank control (A) group, peritoneal dialysis (B) group, low dose of Shenkang (C) group ( 2.5%dialysate+5 mL/kg Shenkang injection), medium (D) group (2.5% dialysate+10 mL/kg Shenkang injection) and high (E) group (2.5% dialysate+ 20 mL/kg Shenkang injection). Mice were observed for 4 weeks. Fasting blood glucose, total cholesterol, triglyceride and C-reactive protein (CRP) were detected by biochemical assay. Tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) levels of serum and dialysate were detected by ELISA. Pathological changes of peritoneal tissue were observed by HE staining. Expression and mRNA transcription levels of these four cytokines in the peritoneal tissue were detected by immunohistochemical staining and real-time PCR respectively. Results There were no significant differences in body weight, fasting blood glucose, total cholesterol and triglyceride between 5 groups of mice (P>0.05). Compared with group B, there was no significant difference in CRP level between group C and group E, but which was significantly decreased in group D (P<0.05). The serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were decreased in group C and group D. The serum and dialysate levels of TNF-αand TGF-β1 were significantly increased in group E (P<0.05), but there was no significant difference between VEGF and CTGF in group E. Compared with group E, except for CTGF in dialysate of group C, the serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were significant decreased in group C and group D (P<0.05). Damaged PMCs were found in group B, which were improved in various degrees in group C, group D and group E. Compared with group B, the protein expression and mRNA relative transcription levels of TNF-α, TGF-β1, VEGF and CTGF tended to decrease gradually in group C, group D and group E (P<0.05). Conclusion A certain concentration of Shenkang injection can protect PMCs by inhibiting the expression of TNF-α, TGF-β1, VEGF and CTGF in CAPD mice, so as to control the occurrence and development of peritoneal fibrosis.

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Selection and identification of human monoantibody TRAb Fab fragment

Xiaoming DU ; Ning LI ; Peihua FANG

Tianjin Medical Journal.2017;45(8):851-855. doi:10.11958/20170531

Objective To select and express a human thyrotrophin receptor antibody (TRAb) Fab fragment from phage antibody library constructed with phage display technology. Methods With immobilized antigen, the reconstructed humanized TRAb Fab library was enriched by five rounds panning (adsorption-elution-amplification). The TSAb Fab and TBAb Fab fragment were selected by coated fusion proteins of hTSHRn and hTSHRc. The positive clones were identified and selected by Phage-ELISA. TRAb positive clones were identified by PCR and double restriction enzyme digestion. The soluble TRAb (TSAb, TBAb) Fab fragments were expressed. TRAb (TSAb, TBAb) Fab fragments were identified by Western blotting assay. The DNA fragment was sequenced from the positive clones. Results Following five rounds of biopanning, TRAb (TSAb,TBAb) Fab phage antibody was screened. The enrichment effect reached to 77 times and 94 times. The soluble TRAb (TSAb,TBAb) Fab antibodies were expressed from positive clones and identified by phage ELISA. Western blotting analysis showed that the phage displaying Fab had significant binding activity with antigens. These sequence analysis showed that all of the heavy chain Fd gene and light chain gene were derived from human immunoglobulin variable region. The light chain variable region of the monoclonal 48 was homologous to the immunoglobulin light chain Vλ homology of 94.4%, and the heavy chain variable region of the monoclonal 48 was homologous to the immunoglobulin heavy Fd chain VH4 homology of 88.9%. The light chain variable region of the monoclonal 56 was homologous to the immunoglobulin light chain Vλ homology of 95.6%, and the heavy chain variable region of the monoclonal 56 was homologous to the immunoglobulin heavy Fd chain VH3 homology of 84.6%. Conclusion We have successfully selected TRAb (TSAb, TBAb) Fab fragment from a human phage display immune antibody library.

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The molecular mechanisms of hypothermia cerebral protection

Jing WANG ; Chong CHEN ; Xiaohong LI

Tianjin Medical Journal.2017;45(8):845-850. doi:10.11958/20170661

Therapeutic hypothermia (TH), also known as targeted temperature management (TTM), is the intentional reduction of core body temperature to 32-35℃. Mild-to-moderate hypothermia and advanced cooling technology can be used as an effective component of multimodal therapy for ischemic encephalopathy, brain trauma, haemorrhagic stroke, or other forms of severe brain injury and acute neurological injuries to achieve neuroprotection. The events occured after an episode of acute neurological injuries and cerebral ischemia are multiple. And the possible explanation for the neuroprotective benefits of hypothermia therapy is inhibiting metabolic disruption, excitotoxicity, oxidative stress, cell apoptosis signals, inflammatory responses, and promoting neuronal integrity and blood-brain barrier integrity. To know the molecular mechanisms of action of TH, which exerts neuroprotective function, will provide clinicians a better understanding the indications and contraindications of this therapy, and provide a possible theoretical reserves and clinical practice for other therapies when used in conjunction with hypothermia.

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Advances in the application of neurophysiological monitoring in spinal cord injury

Kefeng BIAN ; Sai ZHANG ; Yongqing ZHAO

Tianjin Medical Journal.2017;45(8):841-845. doi:10.11958/20170659

In recent decades, the development of the neurosurgery has changed from the traditional anatomical model to the modern anatomical-functional model. The nerve functions are maximally protected while lesions are removed as far as possible. Neurophysiological monitoring especially somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) can directly reflect the integrity of the sensory and motor nerve conduction pathways of the nervous system. At present, it has been widely used in the neurosurgery, spinal surgery, vascular surgery and other surgical fields. In recent years, more and more clinical surgeries involved spinal surgery, intraoperative neurophysiological monitoring could timely find any reversible spinal cord damage such as mechanical stretch, ischemia, and anesthetic drugs, which not only improve the quality of surgery, reduce iatrogenic spinal cord injury, but also greatly improve the prognosis of patients and reduce postoperative neurological dysfunction and complications. In this paper, the research progress of neural electrophysiological monitoring techniques in spinal cord surgery is reviewed.

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The effectiveness of lactobacillus acidophilus combined with electroacupuncture on gastrointestinal function in patients with traumatic brain injury

Yahong HOU ; Sai ZHANG

Tianjin Medical Journal.2017;45(8):837-840. doi:10.11958/20170754

Objective To observe the effectiveness of lactobacillus acidophilus combined with electroacupuncture on gastrointestinal function in patients with traumatic brain injury. Methods A total of 167 patients with traumatic brain injury treated in our hospital from June 2013 to December 2016 were randomly divided into combining treatment group (n=84) and lactobacillus acidophilus group (n=83). The lactobacillus acidophilus group was given routine treatment and lactobacillus acidophilus. The combining group was given the routine treatment, electroacupuncture treatment and lactobacillus acidophilus. Data of gastronintestinal function, infection, pH of gastric juice, serum two amine oxidase (DAO) and D-lacticacid level were compared between two groups. Results Compared with lactobacillus acidophilus group, the incidence rates of reflux (χ2=7.948), vomit (χ2=7.514), diarrhea (χ2=4.521), abdominal distension (χ2=5.968), pulmonary infection (χ2=4.521) and enterogenic infection (χ2=4.531) were significantly decreased in the combining treatment group (P<0.05). After 20-day treatment, pH value of gastric juice (t=8.125) was significantly increased, the serum DAO value (t=6.383) and D-lacticacid level (t=6.745) were decreased, in combining treatment group than those of lactobacillus acidophilus group (P<0.05). Conclusion Lactobacillus acidophilus combined with electroacupuncture can improve the gastrointestinal function, stimulate gastric acid secretion and decrease serum levels of DAO and D-lacticacid.

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Precise medicine of traumatic brain injury

Tangming PENG ; Ligang CHEN

Tianjin Medical Journal.2017;45(8):788-790. doi:10.11958/20170651

With the efforts of several generations, modern medicine has been from experience medicine and evidence-based medicine to the precise medicine. The precision medicine has also become a common goal for global clinical workers. However, traumatic brain injury involves a wide range and various types of injuries. The extent of the brain damage caused by trauma is complex. There is still a big gap between current medicine and precise medicine in the treatment of traumatic brain injury. Therefore, to achieve accurate, punctual, sharing and individualized precision medicine of traumatic brain injury, we must follow the objective routines of traumatic brain injury, and constantly improve the monitoring and treatment means of traumatic brain injury, and constantly improve the clinical research with globalization, multi-center, large data and prospection.

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Keep up with the pace of the times, comprehensively improve the level of treatment for nerve trauma

Sai ZHANG ; Xuyi CHEN

Tianjin Medical Journal.2017;45(8):785-788. doi:10.11958/20170675

With the emergence of new technologies such as brain imaging, bio-sensing, human-computer interaction, cloud computing and large data, the treatment of traumatic brain injury has entered a new era. However, it must be clearly recognized that the central nervous system (CNS) trauma remains a worldwide medical problem. Based on the existing medical knowledge, it is important for promoting CNS trauma treatment levels including nerve trauma standardized treatment, professional management team, multi modal monitoring and data analysis, actively participating in domestic and international multi-center clinical research. Medical workers should dare to explore and innovate, keep up with the pace of the times, and truly achieve the overall improvement of nerve trauma.

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Effects of fermented cordyceps powder on the expression of NLRP3 in myocardium of diabetic rats

Yuanjun LYU ; Zhuo WANG ; Zhuang CUI ; Jine LI ; Xiaofeng TAN ; Changping LI

Tianjin Medical Journal.2017;45(8):856-859,前插2. doi:10.11958/20170594

Objective To investigate the therapy effect of fermented cordyceps powder on diabetic cardiomyopathy, and the effect on expressions of NLRP3, Caspase-1 and interleukin (IL)-1βin myocardium of diabetic rats. Methods A total of 45 male SD rats were randomly divided into normal control group (group CON), diabetes group (group DM) and fermented cordyceps powder administration group (group CS, 1 g · kg-1 · d-1). Diabetes rat model was induced by tail vein injection with streptozotocin (45 mg/kg) in group DM and group CS. The rats in group CS were given fermented cordyceps powder solution by gavage at a single dose of 1 g·kg-1·d-1 for 18 weeks. Rats of group CON and group DM were given 0.9%NaCl in the same way. All rats were sacrificed after 18 weeks. The pathological changes in myocardium were observed by HE staining and electron microscope. The expression of NLRP3 in myocardium was detected by Western blotting. The expression levels of NLRP3, Caspase-1 and IL-1βin myocardium were detected by immunohistochemistry. Results (1) Myocardial necrosis and fibrosis and mitochondrial damages were observed under electron microscope in group DM. The above-mentioned pathological changes were improved in the group CS. (2) The result of Western blotting showed that the expression of NLRP3 in myocardium was significantly increased in group DM and group CS than that in group CON, and the expression of NLRP3 was significantly lower in group CS than that in group DM. (3) The result of immunohistochemistry showed that, compared with the group CON, the expressions of NLRP3, Caspase-1 and IL-1β in myocardium were significantly increased in group DM and group CS, and which were significantly lower in group CS than those in group DM. Conclusion Fermented cordyceps powder can improve diabetic cardiomyopathy through decreasing the expressions of NLRP3, Caspase-1 and IL-1βin myocardium.

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