Objective:To analyze the changes rule of serum procalcitonin (PCT) levels in patients with traumatic brain injury in plateau areas, and to evaluate its value in assessing the severity and prognosis of the patients.Methods:A prospective cohort study was conducted. The patients with traumatic brain injury admitted to the critical care medicine departments of Xining Third People's Hospital (at an altitude of 2 260 metres) and Golmud City People's Hospital (at an altitude of 2 780 metres) from May 2018 to September 2022 were enrolled. According to the Glasgow coma scale (GCS) score at admission, the patients were divided into mild injury group (GCS score 13-15), severe injury group (GCS score 9-12), and critical injury group (GCS score 3-8). All patients received active treatment. Chemiluminescence immunoassay was used to measure the serum PCT levels of patients on the 1st, 3rd, 5th, and 7th day of admission. The Kendall tau-b correlation method was used to analyze the correlation between serum PCT levels at different time points and the severity of the disease. The patients were followed up until October 30, 2022. The prognosis of the patients was collected. The baseline data of patients with different prognosis were compared. The Cox regression method was used to analyze the relationship between baseline data, serum PCT levels at different time points and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of serum PCT levels at different time points for death during follow-up.Results:Finally, a total of 120 patients with traumatic brain injury were enrolled, including 52 cases in the mild injury group, 40 cases in the severe injury group, and 28 cases in the critical injury group. The serum PCT levels of patients in the mild injury group showed a continuous downward trend with the prolongation of admission time. The serum PCT levels in the severe injury and critical injury groups reached their peak at 3 days after admission, and were significantly higher than those in the mild injury group (μg/L: 3.53±0.68, 4.47±0.63 vs. 0.40±0.14, both P < 0.05), gradually decreasing thereafter, but still significantly higher than the mild injured group at 7 days. Kendall tau-b correlation analysis showed that there was a significant positive correlation between serum PCT levels on days 1, 3, 5, and 7 of admission and the severity of disease ( r value was 0.801, 0.808, 0.766, 0.528, respectively, all P < 0.01). As of October 30, 2022, 92 out of 120 patients with traumatic brain injury survived and 28 died, with a mortality of 23.33%. Compared with the survival group, the GCS score, serum interleukin-6 (IL-6) levels, white blood cell count (WBC) in peripheral blood, and PCT levels in cerebrospinal fluid at admission in the death group were significantly increased [GCS score: 5.20±0.82 vs. 4.35±0.93, IL-6 (ng/L): 1.63±0.45 vs. 0.95±0.27, blood WBC (×10 9/L): 14.31±2.03 vs. 11.95±1.98, PCT in cerebrospinal fluid (μg/L): 11.30±1.21 vs. 3.02±0.68, all P < 0.01]. The serum PCT levels of patients in the survival group showed a continuous downward trend with prolonged admission time. The serum PCT level in the death group peaked at 3 days after admission and was significantly higher than that in the survival group (μg/L: 4.11±0.62 vs. 0.52±0.13, P < 0.01), gradually decreasing thereafter, but still significantly higher than the survival group at 7 days. Cox regression analysis showed that serum IL-6 levels [hazard ratio ( HR) = 17.347, 95% confidence interval (95% CI) was 5.874-51.232], WBC in peripheral blood ( HR = 1.383, 95% CI was 1.125-1.700), PCT levels in cerebrospinal fluid ( HR = 1.952, 95% CI was 1.535-2.482) at admission and serum PCT levels on admission days 1, 3, 5, and 7 [ HR (95% CI) was 6.776 (1.844-24.906), 1.840 (1.069-3.165), 3.447 (1.284-9.254), and 6.666 (1.214-36.618), respectively] were independent risk factors for death during follow-up in patients with traumatic brain injury (all P < 0.05). ROC curve analysis showed that the AUC of serum PCT levels on days 1, 3, 5, and 7 for predicting death during follow-up in patients with traumatic brain injury was all > 0.8 [AUC (95% CI) was 0.898 (0.821-0.975), 0.800 (0.701-0.899), 0.899 (0.828-0.970), 0.865 (0.773-0.958), respectively], indicating ideal predictive value. The optimal cut-off value for serum PCT level at 3 days of admission was 1.88 μg/L, with the sensitivity of 78.6% and specificity of 88.0% for predicting death during follow-up. Conclusions:Abnormal expression of serum PCT levels in patients with traumatic brain injury on the 3rd day of admission was found. The serum PCT levels greater than 3 μg/L may be related to severe illness. The serum PCT levels greater than 1.88 μg/L can predict the poor prognosis of patients. Dynamic observation of changes in serum PCT levels has good evaluation value for the severity and prognosis of patients with traumatic brain injury in plateau areas.

Objective To compare the postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery.Methods Sixty patients undergoing thoracoscopic surgery, 38 males and 22 females, aged 18-65, BMI 18-25 kg/m2, falling into ASA physical status I or II.They were divided into groups S and T by random number table, 30 cases in each group.Two groups of patients were treated with general anesthesia with endobronchial intubation and PCIA after operation.Group S performed Ultrasound-guided serratus plane block and group T performed thoracic paravertebral block, 0.4％ropivacaine 30 ml were used in the two groups.The two groups of patients were observed 30 min after block, and the sensory block plane was measured with acupuncture and recorded.Recording operation time, onset time and duration of the block.Resting and cough VAS score were recorded at 2, 4, 8, 12, 24, and 48 hafter surgery.The first pressing time of the analgesic pump and times of press analgesic pump, the amount of sufentanil used and times the number of cases of useing piperidine were recorded within 48 hafter operation.Block related complications and analgesic related adverse reactions were recorded.Results Compared with group T, the operation time of the block obviously shortening but the duration obviously lengthening (P<0.01).Resting and cough VAS score at 12 hafter surgery significantly was lower (P<0.01).The first pressing time of the analgesic pump obviously lengthening, the number of press analgesic pump and the amount of sufentanil used significantly were reduced (P<0.01) in group S.Conclusion Ultrasound guided SP block and TPVB block can provide good postoperative analgesia for patients undergoing thoracoscopic surgery, but SP block is more durable, with less operation time and complications than TPVB block, and can effectively reduce the opioid demand and incidence of nausea and vomiting after operation.

Objective To investigate the effect of the compound administration of levobupiva-caine and magnesium sulfate in ultrasonography-guided femoral block on postoperative analgesia of anterior cruciate ligament reconstruction.Methods A total of 107 patients,66 males and 41 females, aged 25-60 years,ASA physical status Ⅰ or Ⅱ,undergoing arthroscopic anterior cruciate ligament (ACL)reconstruction,were randomly divided into magnesium sulfate group (n = 56 )and control group (n = 51 ).Both groups were treated with ultrasound-guided ipsilateral femoral nerve block before anesthesia induction.The patients in the magnesium sulfate group were treated with 0.25%levobupivacaine and 2% magnesium sulfate mixture 20 ml,and the control group was treated with 0.25% levobupivacaine 20 ml.The blocking of sensation and movement of femoral nerve was recor-ded.The VAS scores of resting and exercise were recorded at 4,6,12,24 and 48 h after operation. The additional analgesics,tramadol dosage,satisfaction score at postoperative 48 h,incidence of nau-sea and vomiting and other adverse reactions at 48 h after surgery were recorded.Results At postop-erative 12 h,VAS score was significantly lower in the magnesium sulfate group than that in the con-trol group (P <0.05).There were 5 cases (8.9%)needing additional analgesics in the magnesium sulfate group,significantly lower than 10 cases (19.6%)in the control group (P <0.05).The tram-adol dosage of magnesium sulfate group was significantly lower than that in the control group (P <0.05).The duration and onset time of sensation and movement block and Likert satisfaction score in the magnesium sulfate group were significantly superior to that of control group (P <0.05).The inci-dence of adverse reactions between the two groups were not statistically different.Conclusion The combined applications of levobupivacaine and magnesium sulfate in ultrasound-guided ipsilateral femo-ral nerve block could shorten the onset time and prolong the duration of blocking,improve the post-operative analgesic effect and patients' satisfaction, reduce the dosage of analgesic drugs. Additionally,it dose not increase the incidence of adverse reactions.

Objective To identify the risk factors for postoperative cognitive dysfunction (POCD).in the elderly patients requiring general anesthesia.Methods Three hundred elderly patients,aged 65-80 yr,scheduled for thoracic or abdominal surgery under general anesthesia,were enrolled in this study.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 3 days after operation.The patients were diagnosed as having POCD if MMSE ＜ 21.The patients were assigned into POCD and non-POCD group.The general data,fasting plasma glucose,glycosylated hemoglobin (HbAlc) and blood pressure were measured.If there was no significant difference between the 2 groups,the factor was analyzed using logistic regression to select the risk factor for the incidence of POCD.Results Ninety-eight patients developed POCD (32.7 ％).Logistic regression model showed that older age,diabetes and hypertension were independent risk factors for POCD (P ＜ 0.05).Conclusion Older age,diabetes and hypertension are independent risk factors for POCD in the elderly patients requiring general anesthesia.

Objective To observe the possible effect of inactivated schistosome ova on the expression of intestinal epithelial tight junctions ZO-1 and Occludin gene in mouse colitis induced by tinitrobenzene sulfonic acid (TNBS) and its mechanism. Methods Fifty mice were divided into control group (group A, n= 10),TNBS plus normal saline(NS) group(group B, n= 20) and TNBS plus inactivated schistosome ova group(group C, n= 20). Group C was exposed to 10 000 freeze-killed schistosome ova by intraperitoneal injection at day 14 and day 3 before colitis induction. Meanwhile,group B was exposed to 1 ml NS by intraperitoneal injection. The mice in group B and C were challenged with 3 mg TNBS to induce colitis. All mice were killed 7-day after colitis induction and assessed with following variables including mortality, pathological change with HE staining of colon.The transcription levels of ZO-1 and Oceludin in colon tissues were examined using Real-time PCR.The expression and distribution of ZO-1 and Occludin proteins were detected by Western blotting and immunohistochemistry. ResultsIn comparison with group B inactivated schistosome ova most effectively reduced the mortality (30% vs 15 %) and histopathologic severity of TNBS-induced colitis (4.21±0.40 vs 1.74±0.10). The transcription levels of ZO-1 and Occludin in group B were decreased compared with those in group A and group C (P<0.01). When compared with group B,group C showed a significant elevation of the alteration of ZO-1, Occludin proteins expression and localization. Conclusion The results clearly show that schistosome ova treatment reduced the severity of experimental colitis through the regulation of tight junction proteins.

Objective To investigate the effect of Schistosoma japonicum ova on the expression of intestinal NOD2/CARD15 in the mice induced by 2,4,6-trinitrobenzesulfonic acid (TNBS). Methods Mice (n=50) in the experiment were randomly allocated into 3 groups: control group (n=10), TNBS+saline (n=20) and TNBS+Schistosoma japonicum ova (n=20). TNBS enema (100 mg/kg) was applied to the two TNBS groups in order to establish a colonitis model. Schistosoma japonicum ova was administered i.p. on the 14~(th) and 3~(rd) day before the instillation of haptenating agent. All mice were killed on the 7~(th) day after colitis induction. The transcription level of NOD2 in colon tissues was measured by Real time PCR, and the expression of NOD2 protein was measured by Western blot. Results The transcription and protein levels of NOD2 in TNBS-induced mice increased statistically compared with those of the normal group (P<0.05). Compared with the TNBS-induced mice, Schistosoma japonicum ova-treated ones exhibited a statistical reduction of gene and protein expression (P<0.05). Conclusions TNBS-treated mice exhibited a statistical increased expression of NOD2/CARD15, Schistosoma japonicum ova treatment reduced the severity of experimental colitis through down-regulating NOD2/CARD15.

Objective To study the effect of Xuebijing, a Chinese traditional medicine injection, on the THP-1 cells challenged by endotoxin, and to explore whether it induces endotoxin tolerance. Methods The THP-1 cells were pretreated with Xuebijing in different concentrations (10, 25, 50 mg/mL) and times (4, 12, 24 hours), and then challenged by endotoxin. The level of TNF-α in culture supernatant was detected by ELISA assay, and the expression of TLR4 and IRAK-M mRNA were detected by Real time-PCR technique. Results There was no significant difference in TNF-α level among all the groups (pretreated with different concentrations of Xuebijing for different time) (P>0.05). Only in 50 mg/mL Xuebijing group, TLR4 mRNA was 1.547-fold increase in 24 h than in 4 h group (P<0.05). Only when pretreated for 24 h, IRAK-M mRNA was 1.349-fold increase in 50 mg/mL Xuebijing group than in control group (P<0.05). However,there was no significant difference among other groups (P>0.05). Conclusions Xuebijing can not block the release of TNF-α from the THP-1 cells challenged by endotoxin;and it does not induce endotoxin tolerance. When pretreated with high concentration of Xuebijing for long time, the expression of both TLR4 and IRAK-M mRNA is up-regulated, but its significance is not yet clear.

Objective To establish diagnostic models for pancreatic carcinoma(PC)and to find out the biomarkers related to PC.Methods Serum samples obtained from subjects including PC patients,pancreatic benign disease patients and normal controls were examined with strong anionic exchange chromatography(SAX2)chips for protein profiling using surface enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS).The decision tree models and logistic regression models for evaluating the value of serum biomarkers were assessed.SELDI immunoassay and ELISA were used to identify the biomarker and its level in serum respectively.Results Twentysix mass peaks were different between PC patients and normal controls(P＜0.0 1)and 16 mass peaks were different between patients with PC and with pancreatic benign disease(P＜0.05).The decision tree model had a sensitivity of 83.3%and a specificity of 100.0%in differentiation of PC,which was better than that of CA19-9 by ROC curve.There were significant differences in 6 mass peaks among different stages of PC(P＜0.01).Logistic regression model showed a sensitivity of 81.6%and a specificity of 80.6%in diagnosis of early PC.The M/Z 28068 protein was identified as C14orf166 with a sensitivity of more than 82%and a specificity of more than 88%in diagnosis of PC.Conclusions The diagnostic models based on SELDI-TOF-MS were superior to CA19-9 in diagnosis of PC.The identified biomarker C14orf166 is expected to play a role in the diagnosis of PC.

Objective To investigate the preventive effect of inactive schistosome ova on trinitrobenzesulfonic acid(TNBS)-induced colitis in mice and its mechanism.Methods Murine colitis was induced by administration of 3 mg of TNBS.Sixty mice were divided into control group(n=20),treatment group(n=20)and model group(n=20).Ten thousand frozen inactive schistosome ova were intraperitoneal injected at 14th and third day before TNBS induction in treatment group.The mice in model group were intraperitoneaUy injected with saline. All survival mice were killed at 7th day and mortality rate was calculated and morphological and pathological changes were eveluated.Expression of interleukin-10 and interferon-γ at colon tissue and serum were measured by real-time PCR and ELISA,respectively.Results The mortality rate in treatment group was lower than that in model group(20%vs 50%,P＜0.05)and the colonic inflammation alleviated(Ameho-criteria score:1.58±0.5 vs 4.18±0.8,P＜0.05)compared with the model group.Meanwhile,compared with model group,the expression of interferon-γ was decreased[serum:(48.33±16.59)pg/ml vs(29.79±6.97)pg/ml,colon tissue:2.31±1.08 vs 7.23±3.52 P＜0.05]and interleukin-10 was increased significantly[serum:(28.87±5.74)pg/ml vs(38.22±9.96)pg/ml,colon tissue:3.68±1.58 vs 7.44±3.04 P＜0.05]in treatment group.Conclusions IntraDeritonealy injection of inactive schistosome ova can alleviate inflammation of TNBS-induced colitis in mice,which may be the result of increased IL-10 and decreased IFN-γ expression in colon and serum.

OBJECTIVETo investigate the effects of lactulose on intestinal bacterial overgrowth (IBO), bacterial translocation (BT), intestinal transit and permeability in cirrhotic rats.

METHODSBT in all animals was assessed by bacterial culture of mesenteric lymph node (MLN), liver and spleen, and IBO was assessed by a jejunal bacterial count of the specific organism. Intestinal permeability was determined by the 24-hour urinary (99m)Tc-diethylenetriamine pentaacetatic acid ((99m)Tc-DTPA) excretion, and intestinal transit was determined by measuring the distribution of (51)Cr in the intestine.

RESULTSBT and IBO were found in 48% and 80% of the cirrhotic rats, respectively, while not in the control rats. Cirrhotic rats with IBO had significantly higher levels of intestinal endotoxin higher rates of bacterial translocation, shorter intestinal transit time and higher intestinal permeability than those without IBO. It was also found that BT were closely associated with IBO and injury of the intestinal barrier. Compared with the placebo group, lactulose-treated rats had lower rates of BT and IBO, which were closely associated with increased intestinal transit and improved intestinal permeability by lactulose.

CONCLUSIONSOur study indicate that endotoxin and bacterial translocation in cirrhotic rats may attribute to IBO and increased intestinal permeability. Lactulose that accelerates intestinal transit and improves intestinal permeability might be helpful in preventing intestinal bacterial and endotoxin translocation.

Animals ; Bacterial Translocation ; drug effects ; Endotoxins ; analysis ; Gastrointestinal Agents ; pharmacology ; Intestines ; metabolism ; microbiology ; Lactulose ; pharmacology ; Liver Cirrhosis, Experimental ; metabolism ; microbiology ; Male ; Rats ; Rats, Sprague-Dawley