Influence of intensive insulin therapy on vascular endothelial growth factor in patients with severe trauma.

The influence of early-stage intensive insulin therapy on the plasma levels of vascular endothelial growth factor (VEGF) and the related parameters in patients with severe trauma and the clinical implication were investigated. Sixty-four cases of severe trauma (injury severity score ≥20) with stress hyperglycemia (blood glucose >9 mmol/L) were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient gradation one-step process were used to determine plasma VEGF, endothelin-1 (ET-1), and the number of circulating endothelial cells (CECs) at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF (ng/L), 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P<0.05, 0.01, 0.05, 0.05 respectively; for ET-1 (ng/L), 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P<0.05, 0.01, 0.01, 0.01 respectively; for CRP (mg/L), 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P<0.05; for CECs (/0.9 µL), 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P<0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.

[Effect of early intensive insulin therapy on high mobility group box 1 protein levels and prognosis of patients with severe trauma].

OBJECTIVE: To study the effect of intensive insulin therapy on serum high mobility group box 1 (HMGB1) levels and its relationship with the prognosis in early phase of severe trauma. METHODS: Eighty severe trauma patients [injury severity score (ISS)≥ 16] were divided into groups according to injury to matched anatomical regions. Forty patients of intensive therapy group were given early intensive insulin therapy, while another 40 patients of the conventional treatment group received routine treatment based on clinical experience with insulin treatment. The insulin dose and the blood glucose levels were recorded within 72 hours after treatment. The relationship between HMGB1 levels and prognosis was analyzed by testing serum HMGB1 levels at 24, 36, 48, 60 or 72 hours after treatment, and clinical terminal events such as multiple organ dysfunction syndrome (MODS) and death rate within 1 week were recorded. Results The insulin dose of intensive therapy group was significantly greater than that of conventional treatment group following the blood glucose levels were significantly lower than those of the conventional treatment group after treatment for 72 hours. The levels of HMGB1 (µg/L) lowered after intensive insulin therapy for 36 hours , and were significantly lower than those of conventional treatment group at 36, 48, 60 and 72 hours after intensive treatment (36 hours: 41.3 ± 9.5 vs. 52.7 ± 11.5, 48 hours: 48.6 ± 17.6 vs. 124.1 ± 22.9, 60 hours: 47.7 ± 23.3 vs. 132.9 ± 33.4, 72 hours: 54.3 ± 26.3 vs. 140.6 ± 16.5, P <0.05 or P <0.01). The incidence of MODS and mortality in intensive therapy group was respectively significantly lower than that of the conventional treatment group (20.0% vs. 55.0%, 10.0% vs. 30.0%, both P <0.05). In conventional treatment group the patients with HMGB1 ≥ 132.26 µg/L ( n =22) occurred MODS, and those with HMGB1<132.26 µg/L ( n =18) did not occur MODS. The HMGB1 levels in death patients ( n =12) were ≥ 132.26 µg/L. CONCLUSION: Early intensive insulin treatment could probably reduce MODS and mortality by inhibiting stress hyperglycemia and serum HMGB1 levels effectively. Serum HMGB1 of severe trauma patients can be used for the clinical indicator of prognosis.

Respiratory failure in pregnant women infected by Swine-Origin influenza A (H1N1).

Two pregnant women developed acute respiratory distress syndrome from Swine-Origin influenza A (H1H1) virus. They were put on mechanical ventilation. We discussed the issues that face obstetricians and intensive care physicians in such situations.

A study of the application of EZSCAN in pilots and in the general population.

OBJECTIVE: This study aims to evaluate EZSCAN detection in pilots and the general population, and determine the significance of EZSCAN detection in the identification of a pilot's health. METHODS: A total of 87 cases of non-diabetic Air Force pilots (pilot group) and 49 cases from the general population without diabetes were collected. These two groups of subjects underwent EZSCAN detection, as well as the detection of blood glucose, lipid and uric acid levels. RESULTS: Subjects in the pilot group had the highest detection rate of no risk and the lowest detection rate of high risk, while the general population had the highest detection rate of high risk, followed by low risk. The difference in diabetic risk between these two groups were statistically significant (P < 0.01). Various indicators were compared according to different risk levels. In the no risk group, age, BMI and the triglyceride of pilots were lower than in the general population; and the difference was statistically significant (P < 0.05). In high risk group, BMI and blood uric acid of pilots were lower than in the general population; and the difference was statistically significant (P < 0.05). CONCLUSIONS: BMI and blood uric acid are positively correlated to diabetic risk. The EZSCAN detection system can be used for assessment of pilot's diabetic risk, and has certain significance in a pilot's health identification.