Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Osteosarcoma (OS) is the most common primary malignant bone tumor in clinic. It has high mortality and disability rate. Effective neoadjuvant chemotherapy combined with limb salvage surgery can improve the 5-year survival rate of OS patients. Drug resistance or low sensitivity of tumor cells is the most common cause of postoperative local recurrence and metastasis. Therefore, the sensitivity of OS cells to chemotherapy drugs is of great value to the prognosis of the patients. In recent years, traditional Chinese medicine has been widely used because of high efficiency and low toxicity. A large number of studies have confirmed that part of traditional Chinese medicine can reverse the chemotherapy resistance of OS cells by regulating the ABC transmembrane transport protein system. This article gives an overview of its related mechanisms and latest developments.

Objective To assess the protective effect of the normobaric oxygen (NBO)and hyperbaric oxygen (HBO)on the acute ischemic stroke of rat using MR diffusion weighted imaging (DWI).Methods 30 adult male SD rats were subjected to right middle cerebral artery occlusion (MCAO)model using the suture method and transferred into a MRI scanner at 30 minutes after the onset of MCAO,then 30 rats were randomly divided into 3 groups (n=10 in each group),control,NBO and HBO group.NBO group rats were exposed to 100% oxygen for 2 hours,HBO group rats were administrated with hyperbaric oxygen for 2 hours respectively at 45 minutes after the onset of MCAO.Brain MRI scanner was performed at 12 h after the onset of MCAO,then pathological change of brain tissue was observed with hematoxylin-eosin (HE)staining and compared with DWI-infarct lesion.The relative cerebral infarction area and relative apparent diffusion coefficient (rADC)values of every group were measured on ADC maps.Results High signal intensity on MRI was found in the right cerebral ischemic region on DWI in three groups.The increased rates of the infraction lesion area in both NBO and HBO group were lower than that in control group (P<0.01),however,there was no significant difference between NBO and HBO group (P>0.05).The reduction rates of rADC in NBO and HBO group were significantly less than that in the control group (P<0.01),however,there was no significant difference between NBO and HBO group (P>0.05).HE staining confirmed that the cerebral infraction occured in three groups.There were significant positive correlations of the relative infarction lesion area between HE staining and DWI at 12 h after MCAO in three groups (P<0.01).Conclusion MRI shows that NBO and HBO could reduce the growth rates of cerebral infarction lesion area and the reduction rates of rADC,which proves that NBO and HBO have the neuroprotective effect on acute ischemic stroke of rats.

Objective To show epidemiological characteristics of adult emergency patients and to provide data support for grading clinics.Methods Adult emergency patients (older than 14 years) from 50 hospitals in Tianjin were included.Name,gender and age of patients,as well as visiting time/department,chief complaint,severity of the disease,prognosis were considered to cross-sectional survey from 8:00,30 Aug 2016 to8:00,31 Aug 2016.Chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results Of 6 569 patients,most originated from medical (n =3 964,60.34％) and surgical (n =2 017,30.31％).Patients' average age was 46.90 ± 18.70 (14-99) years old and there were more patientsaged from 30 to 39 (n =1 285,19.56％).Hospital crowded periods were between 8:00-11:00 and 17:00-22:00.In these periods,average number of patients was more than 300.Concerning the severity of disease,83 patients (1.26％) were in grade 1 (the most severe cases),301 patients (4.58％) in grade 2,1 500 patients (22.83％) in grade 3,and 4 685 patients (71.33％) were in grade 4 (the less severe cases).Most ambulatory patient represented trauma (n =124,35.23％),neurological (n =68,19.32％) and cardiovascular (n =49,13.92％) diseases.However,50.57％ of them were not considered urgent.Conclusions Most patients visited emergency department were nonurgent and originated from medical and surgical department in Tianjin.Crowded periods gathered at 8:00-11:00 and 17:00-22:00.Most ambulatory patients were trauma,neurological and cardiovascular disease;however,half of them was stable and need no emergency intervention.

Objective To observe the effect of recombinant human growth hormone on flap survival and angiogenesis through preoperative local subcutaneous continuous injection of rhGH in narrow pedicle flap.Methods 40 rats were divided into two groups at random,named as groups Ⅰ and Ⅱ,20 rats each.A narrow pedicle flap was designed on the left back of rat in groups Ⅰ and Ⅱ.Then group Ⅰ was subcutaneously injected with rhGH [0.4 IU/(kg · d)] for 3 days.Another group did not have any injection.After 3 days,we established a model of narrow pedicle flaps in the left back of animals.After operation,the flaps of groups Ⅰ and Ⅱ were injected with rhGH [0.4 IU/(kg · d)]for 7 days.The survival percentage of the flap was calculated at 7'th day.Specimens were collected at the diffent point of time.Expression of VEGF,CD34 was detected by immunohistochemistry and ELISA.The MVD of the flaps was also calculated.Results According to the 7 days' observation after the surgery,the percentage of flap survival area for groups Ⅰ and Ⅱ was (100.00±0.00)％,and (94.00±1.10)％ (P＜0.05).The expression of VEGF,CD34 and the MVD values of group Ⅰ was higher than that of group Ⅱ at the same point of time (P＜0.05),especially on the day of surgery.Conclusions Preoperative and local subcutaneaous continuous injection of rhGH on flaps can enhance the expression of VEGF and CD34 and microvascular formation,mitigate the damage of ischemia and hypoxia to flap during the postoperative period,and therefore improve the survival of narrow pedicle flap.

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning.Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed.The clinical data included blood pH,PvCO2,PvO2,blood lactate,potassium,free-calcium,bicarbonate and blood glucose assayed and recorded at 0 min,30 min and 120 min after hemoperfusion.The statistical software SPSS 18.0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion.Results At the beginning of hemoperfusion therapy,levels of homeostasis indicators were pH (7.36 ± 0.05),PvCO2 (41.0 ± 8.8) mmHg,PvO2 (37.0 ± 11.8)mmHg,lactate (1.35 ± 1.00) mmol/L,potassium (3.1 ± 0.5) mmol/L,sodium (136.3 ± 4.8)mmol/L,free-calcium (0.95 ± 0.11) mmol/L,blood glucose (7.90 ± 3.47) mmol/L,bicarbonate (22.8±3.3) mmol/L.At30min,the levels of those were (7.36±0.04),(40.0±5.7) mmHg,(41.0±7.5) mmHg,(1.11 ±0.57) mmol/L,(3.1±0.4) mmol/L,(137.3 ±5.4) mmol/L,(0.94 ±0.12) mmol/L,(6.20 ± 1.55) mmol/L,(22.2 ±2.3) mmol/L,respectively.At 120 min,the levels of those were (7.35 ± 0.06),(38.0 ± 6.7) mmHg,(46.0 ± 7.9) mmHg,(0.69 ± 0.52)mmol/L,(3.0±0.4) mmol/L,(137.3±5.0) mmol/L,(0.97±0.10) mmol/L,(5.88±1.43)mmol/L,(22.0± 2.2) mmol/L,respectively.Apparently,there were significant statistical difference in PvO2,lactate and blood glucose (P ＜ 0.05) among three different intervals,and no significant statistical differences in other indicators (P ＞ 0.05).Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.

This article was aimed to study the antioxidant and antihyperlipidemic effect of total phenolic composition prepared from pineapple (A nanas comosus L.) leave. It had a rapid absorption after intragastric administration and the principle ingredient, p-coumaric acid, reached the peak concentration after 5 minutes of administration. The mice model with single intragastric administration of lipid and glucose were used in the observation of changes on postprandial glucose, lipid and intestinal lipase at different time points after drug administration. The results showed that phenols of pineapple leave can inhibit triglyceride and glucose absorption in certain extent. No significant effect was observed on inhibition at 30 minutes after the phenol administration. However, the intestinal lipase activity was obviously inhibited in normal mice and the intestinal lipase activity decline caused by acute lipid consumption can be reversed. It was concluded that the phenols pineapple leave may inhibit the absorption of lipids with correlation to lipase activity. It had certain regulation effect on the high postprandial glucose and fat absorption.

This article was aimed to study the general reproductive toxicity in mice in order to give a better evalua-tion of the medicinal plant of pineapple leaves (A nanas comasus L). Adult male and female mice were orally admin-istered with pineapple leaves. And then, each of the male and female mice was put together in one cage for mating. The mating success females were fed continuously. The experimental observation was conducted in pregnancy, fetal development, as well as the offspring of mice. The results showed that in addition to a large dose of pineapple leaves (4 g·kg-1) of the parental male rats having a lower body weight, pineapple leaves did not significantly affect on other parameters. There were no significant effects on pregnant mice and their offspring of mice. It was concluded that the pineapple leaves did not influence the general reproductive function of mice apparently.

Objective To observe the pathogens and drug-resistance of ventilator-associated pneumonia (VAP) patients in emergency intensive care unit (EICU) for rational antibiotic therapy and the prevention of VAP. Method The sputum culture results and drug-resistance of pathogens of VAP patients in EICU from 2007 to 2009 were collected. Results One hundred and two mechanical ventilation patients were selected. VAP was occurred in 70 patients (68.6%). One hundred and fifty-seven pathogens had been examined,including 92 Gram-negative bacilli (58.6%),35 Gram-positive cocci (22.3%) and 30 fungus (19.1%). Pseudomonas aeruginosa and meticillin-resistant-staphylococcus aureus was 22 strains (14.0%)respectively, stenotrop homonas maltophilia was 21 strains (13.4%) and acinetobacter baumanii was 17 strains (10.8%). Fifty-nine patients (84.3%) had suffered from multiple pathogen infection, with 31 cases having 2 pathogens and 28 cases having 3 pathogens. Conclusions Pseudomonas aeruginosaa,methicillinresistant staphylococcus, stenotrophomonas maltophilia and acinetobacter baumanii are main pathogens of VAP in EICU patients,and candida albicans is still the main pathogens in fungal infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe.

OBJECTIVETo investigate brazilein's role in energy metabolism of cerebral ischemia-reperfusion in mice.

METHODFourty mice were randomly divided into the sham group, ischemia group, brazilein 5 mg x kg(-1) group and brazilein 10 mg x kg(-1) group, each with ten cases. Cerebral ischemia model was the built. Mice were injected with brazilein three days before the operation, then they were killed. Cerebrum homogenate was prepared for the detecting of ATP, ADP, AMP and lactic acid by HPLC, expressions of MCT1 and MCT2 in mRNA level by RT-PCR.

RESULTThe lactic acid in cerebrum increased sharply 20 minutes after cerebral ischemia and decreased 1 hour after reperfusion, then returned to the normal level 24 hours after reperfusion. The charge of energy decreased significantly at the beginning of the ischemia-reperfusion, and the charge restored 1 hour after reperfusion though it was still much lower than the normal level at the time point of 24 hours. Moreover, MCT1 and MCT2 upregulated accompanied with the increase of lactate, MCT2 mRNA enhanced in brazilein 5 mg x kg(-1) group (P < 0.05) while both the two factors increased in brazilein 10 mg x kg(-1) group (P < 0.01).

CONCLUSIONBrazilein might protect neurons by changing the charge of energy.

Animals ; Benzopyrans ; administration & dosage ; Brain Ischemia ; drug therapy ; genetics ; metabolism ; Disease Models, Animal ; Energy Metabolism ; drug effects ; Gene Expression ; drug effects ; Humans ; Indenes ; administration & dosage ; Male ; Mice ; Mice, Inbred ICR ; Monocarboxylic Acid Transporters ; genetics ; metabolism ; Random Allocation ; Reperfusion Injury ; drug therapy ; genetics ; metabolism ; Symporters ; genetics ; metabolism