Objective To explore the role and mechanism of warm malate ringer's solution(MR)in resuscitation of the lethal triad caused by severe trauma.Methods A rat model of severe trauma was established in SPF-grade SD rats(half male and half female,weighing 200～220 g)using combined multiple injuries and hemorrhagic shock,and the rats were randomly divided into 8 groups(n=8):Sham group,only arterial and venous catheterization;Trauma(Tra)groups with different time points(10,30,60,90,120,180 min)and a Trauma group that were observed without any treatment for 180 min after model establishment.The changes of activated clotting time(ACT),reaction time(R),maximum amplitude(MA),and rate of blood clot formation(Angle)at different time points were detected by using thromboelastography,and tail bleeding,core body temperature and arterial blood gas parameters,were also observed and detected.The plasma von Willebrand Factor(vWF)level,mitochondrial respiratory control ratio in pulmonary venous endothelium,and expression levels of vascular endothelial cadherin(VE-Cadherin),peroxisome proliferator activating receptor gamma coactivator 1α(PGC1α),dynamin-related protein 1(Drp1),p-Drp1,and mitofusin 2(Mfn2)were detected to evaluate the vascular endothelial injury and mitochondrial dysfunction.Another group of SD rats were randomly divided into severe trauma group(no treatment for 180 min after injury),and MR solution at room temperature and at 37 ℃ groups.MR solution at room temperature or at 37 ℃ was given to the rats using a medical blood transfusion apparatus at 60 min post-trauma.Above indicators were observed and detected to investigate the resuscitation effect of the MR solution.Results Compared with the Sham group,the severely traumatic rats at 180 min after injury had significantly prolonged ACT and R values(P＜0.05),shortened MA and decreased Angle values(P＜0.05),extended tail bleeding time(P＜0.05),lower partial pressure of carbon dioxide(PCO2)and HCO3-and base excess(BE)levels(P＜0.05),and continuously increasing K+(P＜0.05)and decreasing Na+(P＜0.05)and Ca2+levels(P＜0.05).Additionally,plasma vWF level(P＜0.05)and protein levels of VE-cadherin,PGC1α and Mfn2 in pulmonary vein endothelium were significantly reduced(P＜0.05),the expression of p-Drp1 was enhanced and the mitochondrial respiration control rate was declined in the rats at 180 min after injury(P＜0.05).MR solution resuscitation shortened tail bleeding time(P＜0.05),increased core body temperature(P＜0.05),elevated plasma vWF level(P＜0.05),increased protein levels of VE-cadherin,PGC1α and Mfn2(P＜0.05),and decreased that of p-Drp1 protein expression(P＜0.05)when compared with the rats at 180 min after severe traumatic injury.The above effects were more significant in the rats infused with the solution at 37 ℃ than those at room temperature.Conclusion Warm MR solution significantly improves the lethal triad in rats after severe trauma,which may be associated with its improving mitochondrial function and attenuating vascular endothelial damage.

Objective To investigate the protective effects of remimazolam(Remi),a novel benzodiazepine sedative,on intestinal barrier function in septic mice.Methods A mouse model of sepsis was established using cecal ligation and puncture(CLP).A total of 96 SPF-grade adult male C57BL/6 mice were randomized into sham operation(Sham),sepsis(Sepsis),and sepsis with Remi intervention(Sepsis+Remi)groups.Survival rate and survival time were recorded within 72 h after modeling.Intestinal pathological alterations,barrier functional indicators,ZO-1 expression,and macrophage polarization status were observed and detected to evaluate the effects of Remi.Lipopolysaccharide(LPS)was used to treat RAW264.7 cells for 24 h to simulate in vitro sepsis model.The cells were divided into control(Control),LPS,and LPS+Remi groups.Immunofluorescence staining was performed to assess macrophage phenotype,mitochondrial morphology,and mitochondrial reactive oxygen species(MtROS),and Western blotting was applied to detect the protein expression of iNOS and CD206.Results Compared with the sepsis group,Remi intervention significantly improved the survival rate of septic mice from 12.50%to 68.75%and markedly prolonged survival duration(P<0.05).Histopathological analysis demonstrated partial restoration of intestinal villus architecture,accompanied with attenuated interstitial edema and reduced inflammatory cell infiltration after Remi intervention.Furthermore,the intervention group demonstrated significant improvement in functional indicators.Both in vivo and in vitro experiments demonstrated elevated iNOS and decreased CD206 expression in the septic mice and LPS-stimulated macrophages(P<0.05),which were partially reversed after Remi intervention.Furthermore,LPS-stimulated macrophages exhibited fragmented mitochondria and elevated MtROS level,whereas Remi intervention ameliorated these conditions(P<0.05).Conclusion Remi protects intestinal barrier function in septic mice by mitigating mitochondrial dynamics imbalance-induced oxidative damage and ameliorating inflammatory macrophage activation.

Objective To observe the ameliorative effect of inhibiting acetyl-CoA carboxylase 2(ACC2)on cardiac dysfunction in septic mice and investigate its underlying mechanism.Methods Mouse model of sepsis was established by cecal ligation and perforation.A total of 24 male C57BL/6 mice(aged 8 weeks,weighing 20～25 g)were divided into sham operation group,sepsis group and ND-630+sepsis group.The cardiac specific ACC2 knockout(ACC2△CM)mice were constructed by Cre-LoxP recombinase system,and ACC2flox/flox Myh6-Cre-(ACC2fl/fl)mice were used as control.Several genetically engineered mice(8 weeks old,20～25 g,male)were divided into ACC2fl/fl+sham operation group,ACC2fl/fl+sepsis group,ACC2△CM+sepsis group,ACC2△CM+Mal-CoA+sepsis group,and ACC2△CM+sham operation group according to the random number table method.The contractile function and myofilament calcium sensitivity of cardiomyocytes were measured by a cell microtensiometer.Western blotting was used to detect the expression level of ACC2,and ELISA was employed to measure the level of malonyl-CoA(Mal-CoA)in myocardial tissue.The survival of the mice in 36 h after sepsis was observed.Results Compared with the sham operation group,the contraction amplitude of cardiomyocytes in sepsis group was decreased markedly,and the calcium sensitivity decreased significantly as well(P＜0.05).Based on the ACC2fl/fl+sham operation group,the ACC2△CM+sepsis group showed significant improvement in myocardial contraction compared with the ACC2fl/fl+sepsis group,with the contraction amplitude of cardiomyocytes recovered by 48.1％,and significantly restored calcium sensitivity(P＜0.05).ACC2△CM+Mal-CoA+sepsis group showed a notable decrease in myocardial cell contraction amplitude and a significant decrease in calcium sensitivity when compared to the ACC2△CM+sepsis group(P＜0.05).Compared with the sepsis group,the contraction amplitude of cardiomyocytes in the ND-630+sepsis group increased significantly,and the calcium sensitivity of myofilament also increased(P＜0.05).The expression level of ACC2 protein in the myocardial tissue of mice in the sepsis group increased compared to the sham operation group(P＜0.05).The level of myocardial Mal-CoA in the sepsis group was higher than that in the sham operation group(P＜0.05);Mal-CoA level in the myocardium of ACC2△CM+sepsis group mice was lower than that of sepsis group(P＜0.05).The 36-hour survival rate of the ACC2△CM+sepsis group.mice was 37.5％higher than that of the ACC2fl/fl+sepsis group mice.(P＜0.05).Conclusion Inhibition of ACC2 exerts a protective effect on myocardial contractility and calcium sensitivity in septic mice by reducing Mal-CoA.

Objective:To analyze the application effect of integrated medical and nursing management model based on intelligent medical system in preventing postoperative breast cancer lymphedema.Methods:A total of 180 patients undergoing axillary lymph node dissection for breast cancer were selected in the Affiliated Hospital of Nantong University from July 2018 to August 2019. According to the random number table method, they were divided into treatment group and control group for 90 cases in each group, and finally completed the study: 86 cases in treatment group and 82 cases in control group. The control group was given routine health management, and the treatment group was given an integrated management model based on intelligent medical systems. After 6 months of follow-up, the two groups of patients were compared for their cognition of lymphedema, prevention behavior, incidence of lymphedema, and patient satisfaction.Results:The incidence, clinical manifestations, risk factors, prevention methods, and overall awareness rates of lymphedema in the treatment group were 82.56%(71/ 86), 84.88%(73/86), 83.72%(72/86), 83.72%(72/86), 83.72%(72/86), and the control group were 67.07%(55/82), 70.73%(58/82), 68.29%(56/82), 69.51%(57/82), 70.73%(58/82), the differences were statistically significant ( χ2 values were 4.046-5.508, P<0.05). The total scores of skin care, lifestyle, avoidance of upper limb compression, and prevention of lymphedema in the treatment group were (9.54±1.04), (30.45±2.45), (9.35±1.08), (58.92±8.20) points, and the control group were (8.12±1.32), (8.12±1.32), (8.74±1.14), (53.45±7.64) points, the differences were statistically significant ( t values were 3.561-7.764, P<0.01). The incidence of lymphedema in the treatment group was 9.30%(8/86), and that in the control group was 23.17%(19/82), the difference was statistically significant ( χ2 value was 5.985, P<0.05). Satisfaction was 95.35%(82/86) in the treatment group and 82.93%(68/82) in the control group, the difference was statistically significant ( χ2 value was 6.771, P<0.01). Conclusions:The integrated management of medical care and patients based on intelligent medical system can help improve the level of lymphedema cognition in patients with breast cancer surgery, promote the development of lymphedema prevention behavior, reduce the incidence of postoperative lymphedema, and improve patient satisfaction.

Objective To investigate the expression of miR-155 in rats exposed to PM2.5 and its signifi-cance.Methods Thirty-two 12-weeks-old healthy male SD rats were randomly divided into PM2.5-primary expo-sure group (P1),PM2.5-three times exposure group (P3), saline-control group and blank-control group (O), with 8 rats in each group. The pathological changes of lung tissue of each group were observed by HE staining and the expressions of miR-155 in lung tissue of each group were measured by RT-PCR. The expressions of TNF-α, IL-6 and IL-1β in serum of each group were measured by ELISA.One-way ANOVA and LSD-t test were used for statistical analysis,and Pearson′s correlation analysis was used to evaluate the relationship between the levels of miR-155 and TNF-α,IL-6 and IL-1β. Results The expression of inflammatory cytokines TNF-α,IL-6 and IL-1β in P1 and P3 increased when compared with that in saline control group and blank-control group, and the amount of expression increased with the increase of the number of exposure and dose;the difference between groups was statistically sig-nificant(P<0.01).At the same time,with the increase of the dose and number of PM2.5,the inflammatory damage of lung tissue was enhanced.The expression of miR-155 in lung tissue also increased with the increase of the dose and number of PM 2.5,and it had significantly positive correlation with serum inflammatory cytokines(P<0.01),and had statistical significance. Conclusions The lung tissue of rats exposed to PM2.5 can produce inflammatory injury, and the damage is enhanced with the increase of exposure times and dose.The expression of miR-155 is positively correlated with inflammatory injury in rats.Consequently,miR-155 may participate in PM2.5-induced inflammatory lung injury in rats.

Objective This present study was to examine the prevalence and determinants of one-night-stand behavior among young men who have sex with men (YMSM).Methods A total of 403 YMSM aged 16 to 25 were recruited through internet promotion,extending activity and HIV VCT in Wuhan.Data was gathered through anonymous questionnaire.Binary logistic regression was used to examine factors associated with one-night-stand behavior.Results Of the 398 YMSM,48.99％ (195/ 398) reported having had casual sex in the last 6 months.Of the ones having had casual sex,34.29％ (60/175) and 28.65％ (49/171) reported using condoms consistently during anal or oral sexual contacts,respectively.These figures were lower than those of YMSM not having casual sexual contacts [with anal sex as 49.08％ (80/163) and oral sex as 38.85％ (61/157)].76.80％ (149/194) of the YMSM reported having had multiple sexual partners,with the figure higher than those without [33.15％ (60/ 181)] (P＜0.01).Results from the logistic regression analysis showed that the following factors seemed to be associated with casual sex activities among YMSM,including:often using intemet,(OR=4.89,95％ CI:1.90-12.54),taking illegal drugs (OR=2.72,95％ CI:1.60-4.63).Conclusions YMSM who bad engaged in casual sex,practicing unprotected sex or having multiple sexual partners,were recognized as high risk population.Targeted intervention programs are needed to decrease the one-night-stand behavior.Internct intervention strategy seemed an important method to serve the purpose.

Objective To explore the application effect of SCD EXPRESS pressure system in preventing postoperative deep venous (DVT) thrombosis in patients with malignant tumors.Methods Management group of DVT prevention was founded.The operative procedure of SCD EXPRESS pressure system was developed and all people received training.120 patients in Nantong Tumor Hospital from June 2014 to June 2015 were selected and were assigned to the observation group and the control group according the order of admission,with 60 cases in each group.Patients in the control group received routine preventive nursing measures,while patients in the observation group received SCD EXPRESS pressure system to prevent DVT based on the routine measures.The incidence rate of DVT,the time that treatment and care spend,daily cost,average hospitalization time and patient satisfaction degree were compared between two groups.Results One week after surgery,in the intervention group,the incidence rate of DVT was 3.3％,and it was 15.0％ in the control group (x2=4.22,P＜ 0.05).In the intervention group,the time that treatment and care spend was (6.73± 1.04) h and the average hospitalization time was (10.71±1.05) d;while in the control group,they were [(15.57±2.52) h,(17.00± 1.80) d].The satisfaction degree in the intervention group was (93.50±5.50) points and it was higher than that in the control group (84.90 ± 6.40) points (t =17.761,17.876,5.600;P ＜ 0.05).The daily cost in the intervention group was (624.38±85.21) yuan,and it was (593.62±71.74) yuan in the control group (t =-1.76,P＞ 0.05).Conclusions SCD EXPRESS pressure system can effectively prevent the formation of postoperative DVT in patients with malignant tumors;save the time that treatment and nursing spend;shorten the average confinement;improve patient satisfaction;and will not increase the daily cost of treatment.

Objective:To explore therapeutic effect of rosuvastatin and atorvastatin treatment on levels of lipoprotein and inflammatory factors in patients with acute coronary syndrome (ACS) .Methods :A total of 74 ACS patients , who were treated in our department of cardiology from Mar 2008 to Feb 2014 ,were selected .According to random number table ,they were randomly and equally divided into rosuvastatin group and atorvastatin group .Therapeutic effect on 24d after administration ,levels of low density lipoprotein cholesterol (LDL‐C) ,high density lipoprotein cholesterol (HDL‐C) ,interleukin (IL)‐18 and C reactive protein (CRP) before and four weeks after treatment were compared between two groups .Results:On 24d after treatment ,total effective rat of rosuvastatin group was significantly higher than that of atorvastatin group (83.8% vs .75.7% , P< 0.05);after four‐week treatment , compared with atorvastatin group ,there were significant reductions in levels of LDL‐C [ (1. 8 ± 0. 2 ) mmol/L vs . (1.4 ± 0.1) mmol/L] ,IL‐18 [ (1.8 ± 0.2) vs .(1.4 ± 0.1)] and CRP [ (1.9 ± 0.3) pg/ml vs .(1.4 ± 0.2) pg/ml],andsignificantriseinHDL‐Clevel[(1.4±0.2)mmol/Lvs.(1.9±0.3)mmol/L]inrosuvastatingroup,P<0.05 all .Conclusion:Rosuvastatin therapy can achieve better adjusting lipid and anti‐inflammation effect than those of atorvastatin in patients with acute coronary syndrome ,which is worth clinical extending .

Objective To investigate the influence of strengthening nursing intervention on acute coma patients with hypertension combined cerebral vascular accident. Methods From April 2013 to April 2014,a total of 102 acute coma patients with hypertension combined cerebral vascular accident,were divided into the control group(n = 50),which were given the conventional treatment and nursing methods,and the observation group(n = 52),which were given the strengthening nursing intervention. The effects and nursing related complications rate were compared. Results The rates of cure,morbidity,mortality and plants survival of two groups had no significant differences( P > 0. 05). Nursing complication of infection,pressure ulcer,brain edema,cerebral hernia and low extremity deep vein thrombosis of the observation group were significantly lower than those of the control group(P < 0. 05). The nursing satisfaction rate between two groups was significantly different(P < 0. 05). The nursing satisfaction of the observation group was significantly higher than that of the control group. Conclusions Intensive observation of disease condition and effectively strengthening nursing intervention are associated with prognosis of acute coma patients with hypertension combined cerebral vascular accident. It helps to reduce nursing complication and improve the quality of nursing care.