Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.

Objective To analyze the echocardiographic findings , associated anomalies and chromosomal characteristics in fetuses with pulmonary atresia with ventricular septal defect ( PA/VSD ) . Methods T he echocardiographic data and follow‐up materials were retrospectively reviewed in 30 256 fetuses from December 2012 to M arch 2018 in the consultation center of fetal heart disease in maternal‐fetal medicine in Anzhen hospital . Of all the fetuses ,59 cases ( 0 .19% ) had PA/VSD . T he echocardiographic findings ,associated anomalies and chromosomal characteristics were retrospectively analyzed in all the 59 fetuses with PA/VSD . Based on w hether the presence of the native pulmonary arteries and the major aortopulmonary collateral arteries ( M APCAs) or not ,the PA‐VSD was classified into type A ,type B ,and type C . Results A large ventricular defect was demonstrated in five‐chamber view with 61 .7% of the mean ratio of the aortic overriding . O ther fetal echocardiographic features of all the 59 fetuses with PA/VSD included :the right aortic arch ( n ＝19 ) ,reversal flow in the ductus arteriosus ( n ＝40 ) ,M APCAs ( n ＝24) . T he classification of the PA/VSD included :type A ( n ＝35) ,type B ( n ＝5) and type C ( n ＝19) . Associated anomalies :persistent left superior vena cava ( n ＝ 13 ) ,anomalous pulmonary vein connection ( n＝5 ) ,complete atrioventricular septal defect ( n ＝ 5 ) ; single umbilical artery ( n ＝ 3 ) ,right atrial isomerism ( n ＝3) . Of all the 30 cases performed chromosomal test ,3 cases had aneuploidy and 7 cases had microdeletion of chromosome . Conclusions The fetal echocardiographic findings of the PA/VSD are characteristic . For prenatal diagnosis of PA/VSD ,the type of PA/VSD should be defined and chromosomal test should be performed ,w hich can be helpful for prenatal consulting .

Objective To evaluate the CT features of small lung invasive adenocarcinoma with air?containing space and its relationship with pathological types, and to explore the pathological basis of air?containing space. Methods CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air?containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air?containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air?containing space were compared with regard to pathological types using chi?square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal?Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types. Results (1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor?lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air?containing space:Air?containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air?containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air?containing spaces less than 5mm were found in 35 cases (70%), and air?containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air?containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short?dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001). Conclusion The detection rate of air?containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air?containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air?containing space was supposed to be dilated distal bronchiole induced by check?valve mechanism and destruction of alveolar structure by tumor.

Objective: To evaluate the CT features of small lung invasive adenocarcinoma with air-containing space and its relationship with pathological types, and to explore the pathological basis of air-containing space. Methods: CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air-containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air-containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air-containing space were compared with regard to pathological types using chi-square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal-Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types. Results: (1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor-lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air-containing space: Air-containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air-containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air-containing spaces less than 5mm were found in 35 cases (70%), and air-containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air-containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short-dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001). Conclusion The detection rate of air-containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air-containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air-containing space was supposed to be dilated distal bronchiole induced by check-valve mechanism and destruction of alveolar structure by tumor.

Objective: To investigate the clinical efficacy of Jiuwei-Zhenxin granules and buspirone hydrochloride tablets for geriatric anxiety patients. Methods: A total of 136 elderly anxiety patients who met the inclusion criteria were randomly divided into two groups with 68 patients in each group. Patients in the control group were treated with butyrocyclone hydrochloride tablets, while the patients in the treatment group were treated with Jiuwei-Zhenxin granules on the basis of control group. Both groups were treated for 4 weeks. The average R-R interval standard deviation at 24 h (SDNN), the standard deviation of the mean normal R-R interval value for every 5 minutes in 24 h (SDANN) and mean square root of inter-period difference between adjacent R-R at 24h (RMSSD) were measured by heart rate variation analyzer. The 5-hydroxytryptamine (5-HT), norepinephrine (NE) and dopamine (DA) were detected using ELISA. The HAMA scale was used to evaluate anxiety and adverse reactions. Results: After treatment, the SDNN (132.04 ± 30.17 ms vs. 107.23 ± 23.44 ms, t=16.901), RMSSD (70.12 ± 21.85 ms vs. 46.43 ± 20.09 ms, t=20.367) and SDANN (136.45 ± 27.18 ms vs. 125.62 ± 20.92 ms, t=6.945) of the treatment group were significantly higher than those of the control group (P<0.01). The serum 5-HT (119.69 ± 10.24 ng/L vs. 142.26 ± 13.71 ng/L, t=21.523), NE (126.47 ± 20.15 ng/L vs. 205.84 ± 23.12 ng/L, t=35.776), DA (130.12 ± 15.95 ng/ml vs. 156.47 ± 15.09 ng/ml, t=14.198) were significantly lower than those of the control group (P<0.01). The HAMA scores of the treatment group at week 1, 2, 3 and 4 after treatment were significantly lower than those of the control group (t=2.105, 4.116, 4.270, 3.369, P<0.05). Conclusions The Jiuwei-Zhenxin granules combined with buspironone hydrochloride tablets can reduce the anxiety of elderly anxiety patients, and its mechanism may be related to regulating the body's neurotransmitter to inhibit autonomic nervous dysfunction and reduce anxiety.

Objective To evaluate different inflammation markers for predicting the risk of acute kidney injury (AKI) in sepsis patients. Methods A retrospective observational study was conducted. The adult patients with sepsis for more than 24 hours admitted to intensive care unit (ICU) of Beijing Friendship Hospital, Capital Medical University from March 1st, 2010 to November 1st, 2017 were enrolled. Inflammatory markers such as white blood cell count (WBC), erythrocyte sedimentation rata (ESR), neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), etc. were collected at ICU admission. The patients were divided into different groups according to the 24-hour AKI, and subgroup analysis was conducted according to the criteria of the Global Renal Disease Prognostic Organization (KDIGO)-AKI staging. The receiver operating characteristic curve (ROC) was plotted with statistically significant inflammatory markers to assess the predictive value of AKI for patients with systemic infection. Results A total of 753 patients with sepsis were enrolled. 405 AKI patients were diagnosed within 24 hours, with a prevalence of 53.8%. There were 118 cases (15.7%) in AKI stage 1, 48 cases (6.4%) in stage 2 and 239 cases (31.7%) in stage 3. PCT in AKI group was significantly higher than that in non-AKI group [μg/L: 4.98 (1.51, 32.75) vs. 3.00 (0.37, 11.40), P < 0.01]. PCT of AKI stage 2 group was significantly higher than that of AKI stage 1 and 3 groups [μg/L: 27.86 (4.80, 37.26) vs. 3.00 (0.98, 16.10), 4.98 (1.51, 42.55), both P < 0.01]. Although ESR in AKI group was lower than that of non-AKI group (mm/1 h: 45.25±37.42 vs. 52.28±34.89, P < 0.01), there was no significant difference among the subgroups. CRP in AKI group was slightly higher than the non-AKI group [mg/L: 96.00 (42.20, 160.00) vs. 73.60 (21.01, 157.50)], but the difference was not statistically significant (P > 0.05). There was no significant difference in WBC or NLR between AKI group and non-AKI group. It was shown by ROC curve analysis that the area under ROC curve (AUC) of PCT in predicting the occurrence of septic AKI was 0.619, with the 95% confidence interval (95%CI) of 0.545-0.689 (P < 0.01). When the cut-off value of PCT > 0.4 μg/L, the sensitivity was 94.2%, the specificity was 26.5%, the accuracy was 64.2%, the positive predictive value was 61.6%, and the negative predictive value was 78.6%. Conclusion PCT could be a marker to predict AKI with sepsis patients.

Objective To study the expression of inflammatory factors in the saliva and the stability of implants after implant denture repair in pa-tients with dysplasia of the dentition defect ,and to analyze the prognosis of patients with lipid metabolic disorder. Methods The dentition defect patients with lipid metabolism disorder were selected as the experimental group. Patients with lipid defect were selected as the control group. Saliva was collected before implantation,1 month and 3 months after implantation. ELISA method was used to detect IL-6,IL-1βand TNF-α. Osstell ISQTM radio frequency analyzer was used to detect the stability of the implants and the periodontal status was detected by Florida probe. Re-sults There were no significant differences in the depth of implant probing(PD),bleeding index(BI)and ISQ between the two groups by radio frequency analyzer(all P>0.05). The levels of IL-6,IL-1βand TNF-αin the pre-implantation,1 month and 3 months after implantation were sig-nificantly higher than those in the control group(all P<0.05). The levels of IL-6,IL-1βand TNF-αin the experimental group were significantly higher than those in the control group before planting(all P<0.05) 3 months after planting,there were no significant differences of IL-6,IL-1β, and TNF-αbetween the experimental group and control group(all P>0.05). Conclusion The patients with dyslipidemia after implantation have good implant stability as those with normal blood lipid ,and the patients with dyslipidemia can also obtain good prognosis.

Objective Meta-analysis the efficacy and safety of Exenatide and insulin therapy oral hypoglycemic drugs effect of obesity with type 2 diabetes .Methods According to the research purpose to set up the screening of related literature and exclusion criteria; formulatethe searching strategy, through PubMed、the Chinese Biological Medicine Datebase(CBM)、 CNKI、Wanfang Data Knowledge Service Platform, VIP to retrieve all theliterature selection of efficacy and safety by Exenatide oral hypoglycemic drugs and insulin therapy of obese type 2 diabetes mellitus.Choose met inclusion exclusion criteria, the complete data information randomized controlled trial (RCT) as the research object; Apply to the international commonly used Jadad score method to evaluate quality included in the test; To process the relevant data in the test ; Apply the ReviewManager 5.1 software to analysis the extracted research data.Analysis the results and put forward conclusions.Results Participants included 11 RCT , meta analysis results showed that compared with the Exenatide, in terms of reducing fasting glucose ,insulin effect more apparent [MD = 0.35, 95％CI: (0.11, 0.59), P = 0.004)]. In control effect of glycosylated hemoglobin, there was no statistically significant difference[MD=-0.04 ,95％CI:(-0.20,0.11), P=0.58],between Exenatide and insulin. Compared with the insulin, Exenatide reduce BMI more apparent[MD=-2.77,(95％CI: -3.34,-2.20),P<0.00001]; Compared with the insulin, Exenatide reduce insulin resistance index, the effect is more obvious[MD=-1.67,95％CI:(-1.93,-1.41), P<0.00001]; Adverse reaction in the process of treatment, the insulin is more likely to lead to hypoglycemia, [OR = 0.32, 95％ CI: 0.19, 0.54), P<0.0001]; While Exenatide are more likely to lead to gastrointestinal adverse reaction [OR = 4.04, 95％ CI: 2.35, 6.93), P<0.00001).Conclusion According to the Meta-analysis: Exenatide can be used in the treatment of oral hypoglycemic drugs of adult obesity with type 2 diabetes, and obvious effects of treatment of insulin resistance, long-term results still needs a large number of samples of high quality RCT to verify.

OBJECTIVE:To investigate the effects and safety of erythropoietin on nerve function and brainstem auditory evoked potential in the preterm children with brain damage. METHODS:46 preterm children with brain damage were randomly di-vided into treatment group and control group,with 23 cases in each group. Control group received conventional symptomatic treat-ment as respiratory support,nutritional support,vitamin K supplement and ganglioside. Treatment group was additionally given rhE-PO for injection (CHO cell) 500 IU/kg hypodermically,3 times a week,on the basis of control group. Both group received 3-4 weeks of treatment continuously. MDI,PDI,the content of serum nerve injury factor(NSE,S-100β),latent period and peak inter-val of brainstem auditory evoked potential were compared between 2 groups before and after treatment,and the occurrence of ADR was observed in 2 groups. RESULTS:There was no statistical significance in MDI,PDI,the content of serum nerve injury mole-cule,latent period and peak interval of brainstem auditory evoked potential between 2 groups before treatment (P>0.05). After treatment,MDI and PDI of 2 groups increased significantly,while the content of serum nerve injury factor,latent period and peak interval of brainstem auditory evoked potential decreased significantly;the treatment group was better than the control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Erythropoietin can significantly im-prove intelligence development,protect the damaged nerve cells and auditory nerve pathways with good safety.

OBJECTIVETo examine the associations of apparent diffusion coefficient (ADC) value from MR diffusion-weighted imaging (DWI) with Ki-67 expression and differentiation grade in gastric cancer.

METHODSImages and pathologic data of 68 gastric cancer patients between September 2013 and February 2015 in Affiliated Changshu Hospital of Soochow University were analyzed retrospectively. The expression of Ki-67 antigen in cancer tissue sample was determined by immunohistochemistry. Ki-67 labeling index(LI) was calculated to divide the cases into low Ki-67 group(Ki-67 LI <50%) and high Ki-67 group (Ki-67 LI ≥ 50%). Associations of ADC value with differentiation grade and Ki-67 LI were examined.

RESULTSMean ADC value of low Ki-67 LI group was significantly higher than that of high Ki-67 LI group [(0.977 ± 0.100) × 10(-3) mm(2)/s vs. (0.859 ± 0.064) × 10(-3) mm(2)/s, P=0.000]. The ADC value was negatively correlated with Ki-67 LI (r=-0.685, P=0.000). Mean ADC value of well differentiated adenocarcinoma, moderately differentiated adenocarcinoma, poorly differentiated adenocarcinoma, and signet-ring cell carcinoma was (1.124 ± 0.080) × 10(-3) mm(2)/s, (0.950 ± 0.064) × 10(-3) mm(2)/s, (0.899 ± 0.091) × 10(-3) mm(2)/s, and (0.894 ± 0.081) × 10(-3) mm(2)/s respectively. Difference of ADC value among differentiation grades was significantly different (F=11.405, P=0.000). Difference of ADC value between well differentiated adenocarcinoma and non-well differentiated adenocarcinoma was significantly different(P=0.000).

CONCLUSIONADC value is associated with differentiation grade and Ki-67 LI of gastric cancer, which may be used as a noninvasive predictor for evaluating the proliferation and differentiation grade of gastric cancer.