Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

Objective To systematically evaluate the similarities between six-gene-modified pig red blood cells and human red blood cells in multiple dimensions, including cell morphology, hematological parameters, microbial safety and serological compatibility, and to verify the feasibility of using six-gene-modified pig red blood cells as an alternative for blood transfusion in cases of traumatic hemorrhage. Methods Blood samples from O-type human donor, six-gene-modified O-type pig and wild-type O-type pig were collected. The pig gene-modified phenotype was identified by flow cytometry. The morphology was observed using field emission scanning electron microscopy and the diameter was measured. Hematological tests, including blood routine, osmotic fragility test, adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) content and partial pressure of oxygen at 50% hemoglobin saturation (P50), were conducted to assess the deformability of red blood cells. Real-time fluorescent quantitative polymerase chain reaction was used to screen for zoonotic viruses, and cross-matching was performed using column gel method, condensation amine method and saline tube method. Results The six-gene-modified pig red blood cells successfully knocked out the α-Gal, Neu5Gc and Sda antigens and expressed hCD55. Wild-type pig red blood cells expressed these three antigens but did not express human complement regulatory proteins. All three types of red blood cells presented a biconcave discoid morphology. The diameter of O-type human red blood cells was larger than that of the six-gene-modified porcine red blood cells and wild-type pig red blood cells (all P < 0.05). The average red blood cell volume and average red blood cell hemoglobin of O-type humans were higher than those of the six-gene-modified pig red blood cells, and the distribution width-variable coefficient of O-type human red blood cells was lower than that of the six-gene-modified pig red blood cells (all P < 0.05). There were no statistically significant differences in the permeability fragility, ATP content, 2,3-DPG content, P50 and red blood cell deformability indicators of the three types of red blood cells (all P > 0.05). The screening for zoonotic viruses in human and animal cells of the six-gene-modified pigs and wild-type pigs was negative. The cross-matching results showed that in the column gel method and condensation amine method, the primary and secondary sides of the six-gene-modified pig red blood cells did not agglutinate with human red blood cells, while the wild-type pig red blood cells agglutinated with human red blood cells in all cross-matching methods. Conclusions The six-gene-modified pig red blood cells are highly similar to human red blood cells in terms of morphology, key hematological parameters, energy metabolism, oxygen-carrying capacity, mechanical properties, microbial safety and serological compatibility, providing an experimental basis for the clinical transformation of xenotransfusion.

Pancreatic cancer is characterized by nerve invasion and a high mortality rate， and its pathological process depends on the complex interaction network between tumor and the nervous system. Based on the concept of “pancreatic cancer neuroecology”， this article analyzes the mechanism of action of peripheral motor nerve， sensory nerve， and central nerve in tumorigenesis， pain regulation， and cachexia formation and emphasizes the synergistic regulatory role of immune cells， Schwann cells， and extracellular matrix in the microenvironment of perineural invasion. At the same time， this article further elaborates on the metabolic interaction and chemotaxis between neuraxis and tumor， the effect on promoting chemotherapy resistance， and the dynamic relationship between neuroplasticity and tumor adaptability. In clinical practice， this article summarizes the key value of perineural invasion in prognostic evaluation， preoperative evaluation， and the selection of surgical strategy. In addition， this article reviews the basic research advances in the biomarkers and potential targets associated with perineural invasion in pancreatic cancer and points out the limitations of current model and transformation research. In the future， systematically analyzing the nerve-tumor-immune network and targeting its key nodes may provide multi-dimensional strategies and new breakthroughs for the precise intervention of pancreatic cancer， the reversal of drug resistance， and the relief of symptoms.

Objective To investigate the value of strong ion gap (SIG) for predicting acute heart failure (AHF) after acute myocardial infarction. Methods A total of 189 patients with acute myocardial infarction were enrolled from July 2015 to December 2016 in the First Affiliated Hospital of Soochow University. Based on AHF occurrence, the patients were divided into the AHF group (n=76) and the non-AHF group (n=113). General clinical data and laboratory tests were compared between the two groups. The univariate analysis and multivariate logistic regression analysis were performed to estimate the contribution of clinical risk factors to triggering AHF after acute myocardial infarction. Spearman correlation analysis was performed to estimate the correlation between SIG and Killip classification. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of ALB, anion gap (AG) and SIG in AHF after acute myocardial infarction. Results Age, proportion of history of diabetes, the serum level of C-reactive protein (CRP), AG and SIG of the AHF group were higher than those of the non-AHF group (P<0.05). Meanwhile, the serum level of albumin (ALB) of the AHF group were lower than those of the non-AHF group (P<0.05). Univariate analysis showed AHF after acute myocardial infarction was closely associated with age, history of diabetes, serum ALB, AG and SIG (P<0.05). Multivariate logistic regression analysis showed that history of diabetes (OR=2.034, 95％CI:1.075-4.113, P<0.05) and SIG (OR=2.445, 95％CI: 1.538-4.297, P<0.05) were significantly correlated with AHF after acute myocardial infarction. The ROC analysis revealed SIG (AUC=0.837,95％CI:0.781-0.893) had a large area under curve compared to ALB (AUC=0.671,95％CI: 0.593-0.750) and AG (AUC=0.728,95％CI: 0.654-0.802). The optimal diagnostic intercept value was 5.24 mmol/L, and the sensitivity and specificity were 76.32％ and 78.36％, respectively. Conclusions SIG could be used as an independent predictor for AHF secondary to acute myocardial infarction, and was significantly correlated with severity of AHF.

Objective To find out risk factors affecting the prognosis of adult cardiogenic shock patients treated with extracorporeal membrane oxygenation.Methods From January 2003 to December 2010,patients with cardiogenic shock required veno-arterial ECMO after failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied. Patients with severe traumatic brain injury,advanced malignancies and multiple organ failure were excluded.All patients were divided into survival group and death group.The risk factors were found out using one-way ANOVA and a multivariate logistic regression analysis was used to determine independent factors associated with survival.Results Thirty-one patients successfully weaned from ECMO. Twenty-two patients were successfully discharged.The average duration of ECMO was 41.56 ± 43.07 hours.Factors associated with failure of hospital discharge were age,pre-ECMO levels of ejection fraction,pre-ECMO levels of lactate,disseminated intravascular coagulation,renal failure and multiorgan failure (P ＜ 0.05). Conclusions Irreversible heart failure and the complications are significantly correlated with survival,and the early use of ECMO for cardiogenic shock and recognize the factors are key to the success of ECMO treatment.

Objective To investigate the clinical value of laryngeal mask airway (LMA) in patients with a-cute severe asthma(ASA). Methods 32 patients with ASA treated with LIMA or mouth-nose mask during 2002 -2009 in our hospital were retrospectively analyzed. Those treated with laryngeal mask airway was taken as observation group and those with Mouth-nose mask as control group. Results The period to oxygen saturation in arterial blood, the time to remove ventilator, and the time to disease improvement in the observation group (389.63±32.82)s, (19.31±2.26) hours,(16.22±3.85) hours were different from that in control group (467.36±41.15) s, (25.18±3.73) hours,(23.66±2.38) hours (P<0.01). After non-invasive positive pressure ventilation, PaCO_2 decreased, PaO_2 and pH increased at 3 and 12 hours in the observation group (P<0.05 or 0.01) from that before treatment. PaCO_2 and pH at 3 hours in the control group were no significant difference before and after treatment (P > 0.05),with an exception of PaO_2 (P < 0.05). PaCO_2, PaO_2 and pH were significantly different (P < 0.05) at 12 hours after treatment from those before treatment. Conclusions LMA should be considered in the selection of non-invasive positive-pressure ventilation (NIPPV) in patients with ASA, for a better improvement of ventilation ef-fectivenoss and accelerating the mitigation of clinical manifestations.

OBJECTIVE: To investigate the incidence rate of deviated nasal septum (DNS) of the young men who are going to join the army, and of the students in key high schools in Jimo, and record their educational background, then analysis the influence of DNS on the youth's learning quality. METHOD: Random select 3085 young men who are going to be recruited in 2006-2008, and 2628 students in 3 key high schools of Jimo. Investigate the two groups' incidence rate of DNS and make a correlative statistic analyses with their educational background. RESULT: There are 395 young men with DNS, which account 12.8% of the 3085 men, with the educational background of college degree and above account 3.0%; high school diploma 12.4%; junior secondary education 27.5%. One hundred and ninety-four students with DNS in key high schools, which account 7.4, and the subsequent entrance examination results shows, undergraduate students account 14.9%, junior college students and considerable education 32.5%, and graduates 52.6%. CONCLUSION DNS can influence the learning quality of the adolescent. It is necessary to operate on those patients and improve the complaint symptom.
Adolescent ; Educational Status ; Female ; Humans ; Learning ; Male ; Nasal Septum ; abnormalities ; Students ; Young Adult

Objective To investigate the effects and values of extracorporeal membrane oxygenation (EC-MO) used in patients after cardiac arrest. Method During five years period from June 2002 to June 2007,fifteen cases taken for cardiopulmonary resuscitation were treated by using ECMO in the emergency department and ICU. All the measures for disgnosis and treatment were observed to the guidelines for cardiopulmonary resuscitation and emergency cardiovasculat care set by the American Heart Association in 2005, and ECMO was applied in addition. The study was a self-comparison trial. The biomarkers including heart rate (HR), mean arterial pressure (MAP), central venous pressure( CVP) , arterial partial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide ( PCQ2), oxygen saturation (SaO2), hydrogen power (PH), and concentration of lactic acid were taken and assayed before and 10 min, 1 h,6 h, 12 h, and 24 h after treatment. Differences between the results of measurements were analysed by t -test for matched pairs using SPSS version 10.0 software package. Neurological sequelae was also observed and described. Results Ten minutes after ECMO treatment, MAP rose dramatically (P < 0.01) and got to further higher level one hour later ( P < 0.05). On the other hand, CVP dropped off 10 minutes after ECMO treatment and further lowered one hour later, and PaO2 and SaO2 were improved apparently ( P < 0.01), and pH was increased significantly (P < 0.01), while a derease in concentration of arterial LA of significantly (P < 0.01). Of the 15 cases, 11 patients got well,including completely recovered without sequelae in 5,memory disorders in 2 and hemipleggia in 2 patients. Conclusions ECMO provides effective blood flow to hearts, and therefore, improves oxygenation and oxygen consumption greatly. Moreover, it provides stable oxygenated blood to brain and therefore, it is a good approach to cardiopulmonary cerebral resuscitation.

Objective To explore the effective countermeasures for treatment of multiple trauma. Methods The clinical data of 135 cases with multiple trauma admitted into the emergency center of Zhongshan City from June 2002 to June 2003 were applied to study the mode and the key point of integrated treatment for multiple trauma. Results Of 135 cases,107 survived with a success rate of 79.3% and 28 died with a mortality of 20.7%. Conclusions (1)The integrated treatment in the emergency center is an effective way to improve the curative rate of multiple trauma as well as a development trend in treatment of multiple trauma. (2) The mode to make integrated diagnosis and treatment includes the following parts: set up wound center in emergency center,build a united rescue system and train high quality professional personnel. The diagnosis and treatment of multiple trauma must be organized and carried out by doctors in the emergency center. (3)The key treatment points for serious multiple trauma include firstly,active pre-hospital medical care and in-hospital medical care to save the lives;secondly,timely surgical operation to repair the damaged organ and eliminate the factors of lethality and cripples;and thirdly,necessary intensive care to treat the original damage further,protect various function of organs,promote recovery of body and prevent the complications.