Preparation of tough and stiff ionogels via phase separation.

Ionogels have the advantages of thermal stability, non-volatility, ionic conductivity and environmental friendliness, and they can be used in the field of flexible electronics and soft robotics. However, their poor mechanical strength and complex preparation methods limit their practical application. Herein, we propose a simple strategy to improve the performance of ionogels by adjusting their phase separation behavior. In a polymer-ionic liquid (IL) binary system with an upper critical solution temperature (UCST) and Berghmans' point, the phase separation behavior will be frozen below the temperature corresponding to the Berghmans' point, and thus, the degree of phase separation can be adjusted by controlling the cooling rate. We found that a polyacrylamide (PAM)-IL binary system possessed a UCST and Berghmans' point and the resulting ionogels had excellent mechanical properties. Their tensile strength, tensile modulus, compressive strength and compressive modulus reached 31.1 MPa, 319.8 MPa, 122 MPa and 1.7 GPa, respectively, while these properties of the other ionogels were generally less than 10 MPa. Furthermore, they were highly transparent, stretchable, stable and multifunctional.

Hierarchical Yolk-Shell Porous Ionic Liquids with Lower Viscosity for Efficient C3H6/C3H8 Adsorption and Separation.

Yolk-shell metal-organic framework (YS-MOF) liquids are candidate materials in large-size species with high-efficiency separation, owing to their hierarchical porosity, faster mass transfer, better compatibility, and higher solution processability than MOF liquids with micropores. Nevertheless, facile synthesis strategies of yolk-shell porous ionic liquids (YSPILs) with regulations of size and morphology are an ongoing challenge. Herein, we propose a general strategy to construct YSPILs based on Z67@PDA with tunable core sizes and morphologies. Benefiting from the unique hierarchical yolk-shell structure, as-prepared YSPILs exhibit promise in C3H6/C3H8 capture and separation with the increased sizes of core in yolk-shell ZIF-67@PDA. Advanced YS-MOF liquids have improved the adsorption properties and increased our ability to tailor chemical composition and pore architecture. Impressively, the adsorption capacity of C3H6 and C3H8 of YSPILs exhibits an approximately 3-fold enhancement compared with that of the neat ILs, confirming that the accessible porosities are retained. Effective C3H6/C3H8 separation performance of YSPILs over PILs based on ZIF-67, revealing the hierarchical porosity of YS-Z67@PDA liquids, benefits larger-size gas separation. Therefore, we believe that this work can not only help us to rationally design novel hierarchically porous ionic liquids but also promote candidate applications in large-size species separation, catalysis, and nanoreactors.

Electrostatically Assisted Construction Modified MXene-IL-Based Nanofluids for Photothermal Conversion.

Solar energy, as renewable energy, has paid extensive attention for solar thermal utilization due to its unique characteristics such as rich resources, easy access, clean, and pollution-free. Among them, solar thermal utilization is the most extensive one. Nanofluid-based direct absorption solar collectors (DASCs), as an important alternative method, can further improve the solar thermal efficiency. Notably, the stability of photothermal conversion materials and flowing media is critical to the performance of DASC. Herein, we first proposed novel Ti3C2Tx-IL-based nanofluids by the electrostatic interaction, which consists of functional Ti3C2Tx modified with PDA and PEI as a photothermal conversion material and ionic liquid with low viscosity as the flow medium. Ti3C2Tx-IL-based nanofluids exhibit excellent cycle stability, wide spectrum, and efficient solar energy absorption performance. Besides, Ti3C2Tx-IL-based nanofluids maintain liquid state in a range of -80 to 200 °C, and its viscosity was as low as 0.3 Pa·s at 0 °C. Moreover, the equilibrium temperature of Ti3C2Tx@PDA-IL at a very low mass fraction of 0.04% reached 73.9 °C under 1 Sun, indicating an excellent photothermal conversion performance. Furthermore, the application of nanofluids in photosensitive inks has been preliminarily explored, which is expected to play a role in the fields of injectable biomedical materials and photo/electric double-generation thermal and hydrophobic anti ice coatings.

Fabrication of Durable, Chemically Stable, Self-Healing Superhydrophobic Fabrics Utilizing Gellable Fluorinated Block Copolymer for Multifunctional Applications.

Limited durability and complex materials restrict the application of superhydrophobic fabrics in daily life. In this work, gellable fluorinated block copolymer poly(dodecafluoroheptyl methacrylate)-block-poly(3-(triethoxysilyl)propyl methacrylate) (PDFMA-b-PTEPM) was used to fabricate adhesive-free superhydrophobic poly(ethylene terephthalate) (PET) fabrics via a simple dip-coating technology and sol-gel reaction. The growth of silica nanoparticles builds up a rough hierarchical structure and provides sol-gel reaction sites of PTEPM segments. The grafting of block copolymer significantly reduced the surface free energy of the fabrics, resulting in an excellent superhydrophobicity with a water contact angle of 160.2°. Benefiting from extensive chemical bond grafting and cross-linking of the PTEPM segment, the fabric exhibits excellent durability in mechanical abrasion, chemical treatment, and washing. The coating has withstood 50 sandpaper abrasion cycles and 400 soft friction cycles and can maintain superhydrophobic properties in various solvents, freezing and a wide pH range. These superhydrophobic fabrics with a long life span possess self-cleaning, anti-icing, oil-water separation, and self-healing capabilities. The multifunctional fabrics developed in this study are durable and easy to produce, possessing the potential for applications in industry and daily life.

Synergistic Regulation of the Microstructure for Multifunctional Graphene Aerogels by a Dual Template Method.

The performance of graphene aerogels (GAs) is based on the microstructure. However, GAs face a challenge of simultaneously controlling the size and alignment of pores strategically. Herein, we initially proposed a simple strategy to construct GAs with an adjustable structure based on the emulsion and ice dual template methods. Specifically, GAs with a honeycomb structure prepared by conventional freezing (CGAs) exhibited a high specific surface of 176 m2/g, superelasticity with a compressive strain of 95%, isotropic compression and thermal insulation performances, as well as an excellent absorption capacity of 150-550 g/g. Instead, the GAs with a bamboo-like network frozen by unidirectional freezing (UGAs) showed anisotropy in compression and thermal insulation behavior. Furthermore, UGAs exhibited incredible special stress (7.9 kPa cm3/mg) along the axial direction twice than that of the radial direction. Meanwhile, the apparent temperature of UGAs was only 45.6 °C when placed on a 120 °C hot stage along the radial direction. Remarkably, the properties of CGAs and UGAs were significantly improved with the adjustment of the microstructure.

Injectable, Intrinsically Antibacterial Conductive Hydrogels with Self-Healing and pH Stimulus Responsiveness for Epidermal Sensors and Wound Healing.

Torealize intelligent and personalized medicine, it is a huge challenge to develop a hydrogel dressing that can be used as a sensor to monitor human health in real-time while promoting wound healing. Herein, an injectable, self-healing, and conductive chitosan-based (CPT) hydrogel with pH responsiveness and intrinsic antibacterial properties was fabricated via a Schiff base linkage and a hydrogen bond. Due to the introduction of Schiff base bonds, the injectable CPT hydrogel exhibits various excellent properties, such as pH responsiveness to sol-gel transition, self-healing properties, and broad-spectrum antibacterial properties even without additional antibacterial agents. In vitro experiments verify the excellent biocompatibility of the as-prepared hydrogel. An in vivo experiment in a mouse full-thickness skin-wound model was performed to confirm the outstanding effect on wound healing. Meanwhile, as epidermal sensors, the conductive hydrogel that perceives various human activities in real-time could provide the real-time analysis of the patient's healthcare information. Based on these excellent properties, the CPT hydrogel, as a biological dressing with a sensing function, lays a solid foundation for the further realization of personalized medicine.

Biosafe, self-adhesive, recyclable, tough, and conductive hydrogels for multifunctional sensors.

As a bioelectronic material used in personalized medicine, it is necessary to integrate excellent adhesion and stretchability in hydrogels for ensuring biosafety. Herein, a high-performance multifunctional hydrogel of polyvinyl alcohol-sodium alginate-g-dopamine-silver nanowire-borax (PSAB) is reported. It can not only easily adhere to the surface of various substrates, but also exhibit excellent mechanical properties. Its tensile strength, elongation at break and toughness are 0.286 MPa, 500% and 55.15 MJ m-3, respectively. The excellent mechanical properties and high conductivity guarantee that the PSAB hydrogel can successfully serve as a multifunctional sensor for detecting small activities and large-scale movements of the human body through strain and pressure changes. Meanwhile, the long-lasting potent and broad-spectrum antibacterial activity, combined with good in vitro biocompatibility, guarantees the biological safety and non-toxicity of the PSAB hydrogel. These compelling features, such as high flexibility and elasticity, high adhesion, multi-functional sensing and recyclability, as well as biological safety, pave the way for the application of PSAB hydrogel e-skin in biomedicine.

Transforming Metal-Organic Frameworks into Porous Liquids via a Covalent Linkage Strategy for CO2 Capture.

Porous liquids (PLs), an emerging kind of liquid materials with permanent porosity, have attracted increasing attention in gas capture. However, directly turning metal-organic frameworks (MOFs) into PLs via a covalent linkage surface engineering strategy has not been reported. Additionally, challenges including reducing the cost and simplifying the preparation process are daunting. Herein, we proposed a general method to transform Universitetet i Oslo (UiO)-66-OH MOFs into PLs by surface engineering with organosilane (OS) and oligomer species via covalent bonding linkage. The oligomer species endow UiO-66-OH with superior fluidity at room temperature. Meanwhile, the resulting PLs showed great potential in both CO2 adsorption and CO2/N2 selective separation. The residual porosity of PLs was verified by diverse characterizations and molecular simulations. Besides, CO2 selective capture sites were determined by grand canonical Monte Carlo (GCMC) simulation. Furthermore, the universality of the covalent linkage surface engineering strategy was confirmed using different classes of oligomer species and another MOF (ZIF-8-bearing amino groups). Notably, this strategy can be extended to construct other PLs by taking advantages of the rich library of oligomer species, thus making PLs promising candidates for further applications in energy and environment-related fields, such as gas capture, separation, and catalysis.

Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China.

BACKGROUND: Systematic evaluation of the successful heartbeat recovery rate (HRR) in patients during the platinum ten minutes after cardiac arrest. METHODS: The databases of CNKI (January 1979-March 2019), Chongqing VIP (January 1989-March 2019), Wanfang (January 1990-March 2019) and Web of Science (1900-May 2020) were searched. To collect the clinical data of patients with cardiac arrest before hospitalization and analyze the cardiopulmonary resuscitation (CPR) at different times. Literature selection and data extraction were carried out by two researchers independently, and the meta package of R software (version 3. 61) was used for analysis. RESULTS: A total of 116 papers met the inclusion criteria, including 37,181 patients. Of these patients, 3367 had their heartbeats successfully restored. The results showed a high degree of heterogeneity (χ2 = 6999.21, P < 0.01, I2 = 97.6%). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.199 (0.157-0.250). (1) According to the five CPR groups (International Cardiopulmonary Resuscitation Guide 2000, 2005, 2010, 2015 and other versions), the HRR of other versions [0.264 (0.176-0.375)] was higher than the International Cardiopulmonary Resuscitation 2005 edition [0.121 (0.092-0.158)]. (2) The rescue time was divided into the 0 to ≤5 min group, the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. The HRR were 0.417 (0.341-0.496), 0.143 (0.104-0.193), 0.049 (0.034-0.069), and 0.022 (0.009-0.051), respectively. The HRR was higher in the 0 to ≤5 min group than in the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. There was no difference between the 10 to ≤15 min group and the > 15 min group. (3) When the groups were stratified with the cutoff of 10 min, the ≤10 min group HRR [0.250 (0.202-0.306)] was higher than the > 10 min group rate [0.041 (0.029-0.057)]. (4) The HRR of the telephone guidance group was [0.273 (0.227-0.325)] lower than that of the 0 to ≤5 min group [0.429 (0.347-0.516)] but higher than that of the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. (5) The HRR of the witness group [0.325 (0.216-0.458)] was not different from that of the 0 to ≤5 min group, but it was higher than those of the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. (6) There was no significant difference HRR between the witnessed group, the telephone guidance group and the ≤10 min group. CONCLUSIONS: (1) The HRR is time-sensitive, and early rescue can improve it. (2) CPR performed within the platinum ten minutes must be executed by the public, and other forces are auxiliary. (3) The concept of peri-cardiac arrest period (PCAP) should be established and improved to guide CPR.

A meta-analysis of the success rates of heartbeat restoration within the platinum 10 min among outpatients suffering from sudden cardiac arrest in China.

BACKGROUND: The optimal time to save a person who has had a sudden cardiac arrest is within the first few minutes of the incident. Early compression and early defibrillation should be performed at this time. Timeliness is the key to successful CPR; as such, Prof. He proposed the "platinum 10 min" system to study early CPR issues. This paper systematically evaluates the success rates of heartbeat restoration within the "platinum 10 min" among patients suffering from sudden cardiac arrest. METHODS: The clinical data of outpatients suffering from a cardiac arrest were retrieved from the China Knowledge Network (January 1975-January 2015), the Chongqing VIP database (January 1989-January 2015), and the Wanfang database (January 1990-January 2015). The success of the cardiopulmonary resuscitation (CPR) performed at different times after the patients had cardiac arrests was analyzed. Two researchers screened the literature and extracted the data independently. A meta-analysis was conducted using Stata12.0. A total of 57 papers met the inclusion criteria, including 29,269 patients. Of these patients, 1776 had their heartbeats successfully restored. The results showed high heterogeneity (X (2) = 3428.85, P < 0.01, I(2) = 98.4 %). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.171 (0.144-0.199). RESULTS: (1) The success rate of heartbeat restoration did not differ among the four emergency treatment methods that patients received: the methods described in the 2000 Guidelines for CPR and Emergency Cardiovascular Care, that described in the 2005 version, 2010 version, and another CPR method. (2) The patients were divided into five groups based on the time when CPR was performed: the ≤1 min group, the 1- ≤ 5 min group, the 5- ≤ 10 min group, the 10- ≤ 15 min group and the >15 min group. The CPR success rates of these five groups were 0.247 (0.15-0.344), 0.353 (0.250-0.456), 0.136 (0.109-0.163), 0.058 (0.041-0.075), and 0.011 (0.004-0.019), respectively. The CPR success rates did not differ between the patients in the ≤1 min group and the 1- ≤ 5 min group. This success rate was higher for the patients in the 1- ≤ 5 min group than those in the 10- ≤ 15 min group, those in the 10- ≤ 15 min group, and those in the >15 min group. The CPR success rate was higher for the patients in the 5-10 min group than those in the 10- ≤ 15 min group and those in the >15 min group. CONCLUSIONS: The CPR success rate was higher for the patients in the 10- ≤ 15 min group than those in the >15 min group. In addition, the patients were divided into two groups based on whether CPR was performed within the first 10 min after the cardiac arrest occurred: the ≤10 min group and the >10 min group. The CPR success rate was higher for the patients in the ≤10 min group (0.189 [0.161-0.218]) than those in the >10 min group (0.044 [0.032-0.056]). (3) Differences were not found between the CPR success rates among the patients in the telephone guidance group (0.167 [0.016-0.351]) and those in the ≤1 min, 1- ≤ 5 min, 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. (4) The CPR success rates did not differ among in the patients in the witness + public group (0.329 [0.221-0.436]), those in the ≤1 min group, and those in the 1- ≤ 5 min group. However, this success rate was higher in the patients in the witness + public group than those in the 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. CONCLUSIONS: The success rate of heartbeat restoration did not differ among patients receiving CPR based on different guidelines. The success rate of CPR lies in its timeliness. The participation of the general population is the cornerstone of improving CPR. Providing complete emergency treatment equipment and perfecting comprehensive measures can improve the success rate of CPR among patients within the platinum 10 min. CPR research in China must be improved.

Weaning critically ill patients from mechanical ventilation: A prospective cohort study.

PURPOSE: A proposal was made at the International Consensus Conference to classify weaning of patients in intensive care units from mechanical ventilation into simple, difficult, and prolonged weaning groups based on the difficulty and length of the weaning process. The objective of the present study was to determine the incidence and outcome of weaning according to these new categories. METHODS: We examined the weaning of patients in intensive care units from mechanical ventilation in a prospective multicenter cohort study. RESULTS: In total, 343 patients were included in the final analysis. Simple, difficult, and prolonged weaning occurred in 200 (58%), 99 (29%), and 44 (13%) patients, respectively. Hospital mortality rates were higher for patients in the prolonged weaning group than in the simple and difficult weaning groups. Multivariate analysis revealed that a lower Glasgow Coma Scale score (P < .014) and hypercapnia at the beginning of the first spontaneous breathing trial (P = .038) were independent predictors of prolonged weaning. CONCLUSIONS: Patients who experienced prolonged weaning had significantly higher mortality rates than patients who experienced either simple or difficult weaning. A lower Glasgow Coma Scale score and hypercapnia at the beginning of the weaning process were independent risk factors for prolonged weaning.

[Preparation and identification of recombinant sarcosine oxidase].

An important index determination for clinical diagnosis of renal function is to assay the creatinine concentration in serum. In the analytical process applied with coupled-enzyme, the quality control of sarcosine oxidase (SOX) as a key enzyme is the first problem to be solved. In order to establish an efficient and laboratory-scale production of SOX, the recombinant sarcosine oxidase (r-SOX) gene was a high-level expression in E. coli induced with lactose on a large-scale fermentation in 300 L fermenter. The results suggested that the biomass concentration reached OD600 of 22 and the expression of recombinant sarcosine oxidase in E. coli accounted for about 25% of total soluble protein in culture after fermentation. The cell-free extract obtained from high pressure homogenizer was processed by selective thermal denaturation and then purified with Ni-Sepharose FF chromatography. The sarcosine oxidase with 97% purity, 25 U/mg specific activity and 92.4% activity recovery was obtained. The molecular weight with single peptide chain of 53 kD and 55 kD of recombinant sarcosine oxidase was assessed by SDS-PAGE in presence or absence of 2-mercaptoehanol and Sephacryl S-200 chromatography. This sarcosine oxidase was found to be a conjugated protein, yellow enzyme, which combined with FAD as prosthetic group by covalent linkage. The contaminant of catalase was not detected in the sample pool of this enzyme. In addition, a further test to the thermal stability of sarcosine oxidase was done. According to the above results, the development and utilization of this enzyme has been set up on a reliable foundation.

Anticoagulant effect of Huisheng Oral Solution in a rat model of thrombosis.

OBJECTIVE: To investigate whether Huisheng Oral Solution has an anticoagulant effect in a rat model of thrombosis. MATERIALS AND METHODS: A total of 40 male SD rats were equally and randomly divided into four groups: blank group, model group, and two treatment groups (A and B). Rats were subcutaneously injected with carrageenan to induce thrombosis. Rats in the treatment group A were intragastrically administered with Huisheng Oral Solution at a dose of 2 ml/100 g body weight (once per 8 hours), 72 hours after carrageenan injection, while those in the treatment group B were administered with Huisheng Oral Solution both 72 hours before and after induction of thrombosis. Blood samples were collected 24, 48, and 72 hours after carrageenan injection for measurements of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (FIB), prothrombin activity (PTA), platelets (PLT), fibrin degradation products (FDPs), and D-dimer. Lung, liver, and mesentery samples were taken 72 hours after carrageenan injection for histopathological analysis. The numbers of microthrombi in sections of different tissue samples were counted under a microscope. Blood parameters among each group were compared using the Welch test, the Kruskal-Wallis test, or the SNK test after testing for normality, while the number of microthrombi was compared using the Bonferroni test. RESULTS: Compared to those in the model group, PT, APTT, and INR were significantly prolonged or increased while FIB was significantly reduced at the majority of time points in the two treatment groups (P < 0.05 for all). The levels of FDPs and D-dimer and PLT counts at the majority of time points were significantly lower (P < 0.05 for all), and the numbers of microthrombi in lung, liver, and mesentery samples were significantly decreased (P < 0.05 for all) in the two treatment groups. The above parameters at the majority of time points showed no significant differences between the two treatment groups. CONCLUSIONS: Huisheng Oral Solution can significantly improve coagulation parameters, fibrinolysis parameters, and PLT count, and reduce blood hypercoagulability and microthrombosis, suggesting that Huisheng Oral Solution has an anticoagulant effect in a rat model of thrombosis.

[Sedation with stimulative circadian rhythm in mechanically ventilation patients in intensive care unit].

OBJECTIVE: To sedate the mechanically ventilation patients in intensive care unit (ICU) with stimulative circadian rhythm, and evaluate whether the protocol has advantages in recovering natural circadian rhythm, duration of mechanical ventilation, and length of ICU stay after weaning of sedation. METHODS: A prospective random control trial was conducted. One hundred and twenty ventilated patients in ICU were randomly assigned to four groups: circadian rhythm (CR), daily interruption (DI), continuous sedation (CS) or demand sedation (DS) group, each n = 30. Given more complications, DS group was deleted after recruiting 10 cases and 90 patients were admitted ultimately. Patients' age, gender, body weight, acute physiology and chronic health evaluation II (APACHE II) scores, sedatives dosages, daily arousal time, duration of mechanical ventilation, length of ICU stay, complications (ventilator-associated pneumonia, barotrauma with intrathoracic drain tube) and untoward reactions (accidental extubation, reintubation, tracheotomy, death) were recorded, the biochemical indicators were determined, as well as number of nurses on duty at 10:00 and 22:00. RESULTS: The patients' sex ratio, age, body weight, APACHEII scores, duration of mechanical ventilation, length of ICU stay showed no difference among CR, DI and CS groups. The total sedatives dosages (mg: 5466.7 ± 620.4) and average sedatives dosages [mg×h(-1) ×kg(-1): 2.19 ± 0.61] in CS group were significantly higher than those in CR group (4344.5 ± 816.0, 1.00 ± 0.51) and DI group (4154.3 ± 649.4, 1.23 ± 0.62, all P < 0.01), and there was no difference between CR group and DI group. Daily arousal time in the CR group (hours: 4.40 ± 1.30) was significantly lengthened compared with that in DI group (0.59 ± 0.26) and CS group (0.15 ± 0.02, both P < 0.05). The complications showed no differences in each group, but incidences of the untoward reactions in DI group (2 cases) were significantly increased compared with that in CR group (1 case) and CS group (0 case, P = 0.0477). After weaning of sedation, patients with normal circadian rhythm were significantly more in CR group than that in CS group (19 vs. 9, P = 0.0339). Among CR group, DI group and CS group, there were significant differences in the numbers of nurses on duty in the daytime (1.65, 1.41, 1.14, all P < 0.01), but there was no difference in the night. The biochemistry index showed no difference in each group. CONCLUSIONS: It demonstrated that sedation with stimulative circadian rhythm be helpful to create circadian rhythm after weaning of sedation. While complications and untoward reactions did not increase, as well as duration of mechanical ventilation and length of ICU stay. Therefore, the clinical applicability of this sedative strategy was highlighted.

[Ulinastatin combined with thymosin α1 for treatment of severe sepsis: a histopathological observation in rats].

OBJECTIVE: To evaluate the therapeutic effect of ulinastatin combined with thymosin α1 in the treatment of severe sepsis in rats. METHODS: Normal Wistar rats were subject to cecal ligation and puncture (CLP) to establish models of severe sepsis. The rats were then randomized into 4 groups for treatment with saline (control), ulinastatin, thymosin α1, or the combination of the latter two injected through the caudal vein or subcutaneously at 6, 24, 48 and 72 h after modeling. The mortality rate was recorded daily and the rats were executed at 24, 48, 72 and 96 h after CLP to harvest the heart, liver, spleen, lung, kidney and small intestines for pathological examination. The spleen of the rats were taken for detection of apoptosis of the spleen cells. RESULTS: The mortality rate of the septic rats in the combined treatment group was decreased significantly (P=0.0325). The control group showed the most severe organ damage, which was moderate in single drug treatment group and the mildest in combined treatment group. Obvious spleen cell apoptosis was found in the control group, and was significantly ameliorated in the combined treatment group[(47.4∓10.9)% vs (39.3∓11.4)%, P=0.0000]. CONCLUSION: Combined treatment with ulinastatin and thymosin α1 can significantly improve the prognosis and ameliorate organ damage and spleen cell apoptosis in rats with sever sepsis.

[Effects of intensive insulin therapy on serum immunoglobulin, complement levels and phagocytosis of monocytes in patients with severe trauma].

OBJECTIVE: To investigate the influence of intensive insulin therapy on serum immunoglobulin (Ig), complement levels and phagocytosis of monocytes in patients with severe trauma. METHODS: Severe injured patients with injury severity score (ISS)>20 in surgical intensive care unit (ICU) were randomly divided into two groups, intensive insulin therapy and conventional therapy. Blood glucose levels in intensive insulin therapy and conventional therapy groups were maintained at 4-6 mmol/L and <11.1 mmol/L, respectively. Blood samples were obtained on 0, 2, 4, 6 and 8 days after admission. Dynamic changes of immunological parameters including serum IgA, IgG, IgM, complements (C3, C4) levels were determined in each group at various intervals following trauma. Phagocytosis of monocytes was also measured by use of phagotest kits after blood cells were incubated with fluorescein isothiocyanate (FITC)-labeled E. coli in a heated water bath at 37 centigrade. RESULTS: Serum IgA, IgG, IgM, C3 and C4 levels were low in two groups at admission, and elevated after treatment with recovery to normal range on 6-8 days. Serum C3 and C4 levels in intensive insulin therapy group were much lower than those in conventional therapy group (both P<0.05) with delayed recovery to normal range. There were no significant differences in serum IgA, IgG and IgM levels between two groups (all P>0.05). For the patients with intensive insulin therapy, phagocytosis of monocytes was markedly enhanced on 4 and 6 days compared with those at admission (both P<0.05), and E. coli-FITC positive rates were significantly higher than those with conventional therapy on 2, 4 and 6 days after admission (all P<0.05). CONCLUSION: Intensive insulin therapy can markedly improve immune function and enhance phagocytosis of monocytes, which might be used as one of effective methods to increase the host defense ability in traumatic patients.

[Changes in tumor necrosis factor-alpha mRNA expression in peripheral polymorphonuclear leukocyte and tissues during posttraumatic sepsis].

OBJECTIVE: To evaluate the changes in tumor necrosis factor-alpha (TNF-alpha) mRNA expression in peripheral polymorphonuclear leukocyte (PMNs) and tissues after cecal ligation puncture (CLP) in rats. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect TNF-alpha mRNA expression in peripheral PMNs and tissues. RESULTS: The TNF-alpha mRNA expression in peripheral PMNs rose gradually after CLP, and it began to decrease after reaching the peak at 48 hours, but it was still higher than normal. The elevation of TNF-alpha mRNA expression was first limited in the regional tissues (P<0.01 at 12 hours after CLP and peaked at 24 hours in the intestine), then it entered the blood circulation later to affect the sensitive organs--lungs and livers (P<0.01 at 24 hours after CLP and peaked at 48 hours in the lung; P<0.05 at 24 hours after CLP and peaked at 48 hours in the liver). CONCLUSION: The rise of TNF-alpha mRNA expression plays an important role in pathogenesis of sepsis.

[Suggestive guideline for respiratory support in emergency--stepwise breath management].

OBJECTIVE: To propose a guideline of respiratory support for emergency patients. METHODS: To summarize the experiences gained in giving stepwise respiratory support (SRS) in 2,548 patients for emergency care (including 1,823 trauma patients and 725 non-trauma patients) between 1992 to 2002. RESULTS: There were 1,876 male and 672 female patients with the ratio of male to female 2.79:1. The age of patients ranged between 4 to 86 years, and the mean age of traumatic patients was (32.3+/-19.8) years, and the dominant ages were between 20 to 39. The mean age of non-traumatic patients was (65.2+/-17.3) years, and the dominant ages were between 50 to 69. The traumatic and non-traumatic patients accounted for 60.2% and 32.0% of all patients, respectively. The respiratory management included resuscitation positioning in 816 (32.0%), open airway and suctioning in 314 patients (12.3%), oxygenation through nostril or nasal intubation in 2,311 patients (90.7%), oxygenation by mask in 124 patients (4.9%), endotracheal intubation in 254 patients (10.0%), thyrocricocentesis or cricothyrotomy in 25 patients (1.0%), tracheotomy in 195 patients (7.7%), percutaneous tracheotomy in 58 patients (2.3%). SRW management included two types, four steps and ten ways. The two types included traumatic and non-traumatic; the four steps and ten ways included first step of manual treatment (including (1) resuscitation positioning, (2) open airway and suction and (3) chest-back press), second step oxygenation (including (4) oxygenation through nostril or nasal intubation, (5) oxygenation by mask, (6) endotracheal intubation), third step invasive airway support (including (7) thyrocricocentesis or cricothyrotomy and (8) tracheotomy or percutaneous tracheostomy), fourth step mechanic ventilation (covering (9) manual ventilation and (10) mechanical ventilator). CONCLUSION: The series of SRS management plan and principles can improve the respiratory support in rescuing emergency patients efficiently.

[Effect of intensive insulin therapy on serum proinflammatory cytokine levels in patients with severe trauma].

OBJECTIVE: To investigate the effect of intensive insulin therapy on serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C reaction protein (CRP), all of which reflected the inflammatory status in patients with severe trauma. METHODS: Forty patients with severe trauma [injury severity score (ISS)>or=20] were randomly divided into intensive insulin therapy group and control group. Enzyme-linked immunoadsorbent assay (ELISA) method was used to determine the TNF-alpha and IL-6 levels within 72 hours after admission. RESULTS: Serum levels of TNF-alpha, IL-6 and CRP in patients received intensive insulin therapy were significantly lower than those in patients without the therapy (P<0.05 or P<0.01). CONCLUSION: Intensive insulin therapy can attenuate the systemic inflammatory response to trauma. The anti-inflammatory actions of insulin, as well as its glycemia controlling effects, might contribute to the improved outcomes of patients with severe trauma.