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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Objective:To analyze the prognostic risk factors of patients with traumatic pancreatitis (TP) and establish an early combined prediction of multiple indicators model for TP.Methods:Patients admitted to the ICU of the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2022 were collected retrospectively. Based on their prognosis, the patients were divided into two groups: the good prognosis group and the poor prognosis group. The general data such as sex, age, underlying diseases, Glasgow Coma Scale (GCS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), injury severity score (ISS), bedside index for severity in acute pancreatitis (BISAP), and clinical test indices such as blood routine, blood coagulation, blood gas analysis, and liver and kidney function at admission were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to screen the early independent predictors of poor prognosis of TP, and the prediction model of TP was established by combining all of the independent indicators. The receiver operating characteristic (ROC) curve of each independent predictor and prediction model was drawn, and the area under the curve (AUC), sensitivity, specificity, and optimal cut-off value were calculated to examine the diagnostic impact of each independent predictor and the combined prediction model.Results:There were statistically significant differences in the complication rate of mental disorders, GCS, APACHE II, combined craniocerebral injury, combined chest injury, activated partial thromboplastin time, fibrin(pro)degradation products, lactate, aspartate aminotransferase, glomerular filtration rate, amylase, lipase, NT-proBNP, myoglobin, procalcitonin, ISS, and BISAP between the good and poor prognosis groups (all P<0.05). Multivariate logistic regression analysis showed that lactate ( OR=1.636, 95% CI: 1.046-2.559), lipase ( OR=1.005, 95% CI: 1.001-1.008), and ISS ( OR=1.161, 95% CI: 1.064-1.266) were independent risk factors influencing the prognosis of patients with TP. Based on the risk factors listed above, a prediction model was created: Logit P=-9.260+0.492×lactate+0.005×lipase+0.149×ISS, and the ROC curve was plotted. The AUC curve of the prediction model was 0.96 (95% CI: 0.91-1.00). Conclusions:Lactate, lipase, and ISS are early independent risk factors associated with the prognosis of TP. Their combined multi-indicator prediction model has an excellent clinical prediction effect, which can provide a clinical reference for early prediction and treatment of TP.
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Objective:To explore the predictive value of combined detection of serum interleukin-6 (IL-6), chloride (Cl -), D-dimer and fibrin degradation products (FDP) for severity of acute pancreatitis (AP). Methods:From December 2020 to March 2022, 132 AP patients who met the criteria for inclusion were screened for retrospective analysis from 292 AP patients admitted in emergency surgery at the First Affiliated Hospital of Zhengzhou University and they were divided into severe acute pancreatitis (SAP) group and non-SAP group, with 63 in SAP group and 69 in non-SAP group, according to classification criteria. The data including lab results, abdominal doppler ultrasound and chest and abdominal CT, etc. The bedside index for severity in acute pancreatitis (BISAP) score was calculated. Multivariate Logistic regression analysis was carried out to find the risk factors for the severity of AP patients. The receiver operator characteristic curve (ROC) was drawn to judge the clinical predictive value of each factor.Results:A total of 132 AP patients were enrolled. The serum IL-6, D-dimer, FDP levels and the BISAP score in SAP group were significantly higher than those in non-SAP group [serum IL-6 (ng/L): 62.73 (21.54, 187.47) vs. 8.22 (4.13, 14.70), D-dimer (mg/L): 5.36 (2.94, 8.25) vs. 0.94 (0.42, 2.21), FDP (mg/L): 13.54 (6.76, 22.45) vs. 3.20 (2.50, 6.10), BISAP score: 2.00 (1.00, 3.00) vs. 1.00 (0, 2.00), all P < 0.05], while the serum Cl - level was significantly lower than that of non-SAP group (mmol/L: 97.90±4.86 vs. 101.73±4.32, P < 0.05). Multivariate Logistic regression analysis showed that increased levels of IL-6 [odds ratio ( OR) = 1.02, 95% confidence interval (95% CI) was 1.01-1.04], D-dimer ( OR = 1.21, 95% CI was 1.05-1.40) and decreased Cl - level ( OR = 0.88, 95% CI was 0.79-0.98) were risk factors for SAP (all P < 0.05). The ROC curve analysis showed that the area under the ROC curve (AUC) of IL-6, Cl -, D-dimer and FDP combined to predict the severity of AP patients was larger (0.89), and the sensitivity (82.50%) and specificity (85.50%) were higher. Conclusion:Compared with single index, the combined detection of serum IL-6, Cl -, D-dimer and FDP is more precise in determining the condition of AP.
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Objective:To explore whether the adoption of high-flow nasal cannula (HFNC) as an initial oxygen therapy in emergency department (ED) could reduce the intubation rate and improve the clinical outcomes of patients with dyspnea and hypoxemia compared with conventional oxygen therapy (COT).Methods:A perspective single-center randomized controlled trial was conducted in the First Affiliated Hospital of Zhengzhou University from October 1, 2019 to September 30, 2020. A total of 210 eligible patients with acute dyspnea and hypoxemia in ED were recruited and randomized (in 1:1) to receive HFNC or COT for 1 h immediately after the grouping. The primary outcome was the rate of intubation within 24 h. The secondary outcomes included total intubation rate, escalation of breathing support method, patients’ disposition, length of ICU stay and hospital mortality. Continuous outcomes were analyzed by independent samples t test or Mann-Whitney U test according to the data distribution. Discontinuous outcomes were compared with the Chi-square test. Kaplan-Meier curve analysis was performed for 60-day survival. Results:Finally, 105 patients were recruited in each group. HFNC reduced the intubation rate within the first 24 h (4.8% vs. 14.3%, P = 0.019) and the rate of patients escalated to upgrade oxygen therapy (34.3% vs. 53.3%, P = 0.005), but did not affect the total intubation rate during the whole attendance ( P = 0.509). In ED, HFNC helped more patients to achieve the targeted saturation of pulse oxygen (90.5% vs. 78.1%, P = 0.02), and reduced respiratory rate (RR) to < 25 breaths per min (68.6% vs. 49.0%, P = 0.004), but did not affect the length of hospital stay, hospital mortality and 60-day survival rate ( P > 0.05). Conclusions:Initial application of HFNC in ED could reduce the intubation rate within 24 h, decrease the rate of escalation of oxygen therapy, improve oxygenation and relieve dyspnea.
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Objective:To investigate the protective effect of overexpressed tripartite motif containing (TRIM27) on severe acute pancreatitis (SAP) in mice and its possible mechanism.Methods:Twenty-four mice were randomly divided into the sham operation + control virus group (AAV-GFP group), sham operation + overexpression of TRIM27 group (AAV-TRIM27 group), SAP + control virus group (SAP+AAV-GFP group), SAP + overexpression of TRIM27 group (SAP + AAV-TRIM27 group), with 6 mice in each group. SAP model of mice was established by intraperitoneal injection of L-arginine (4 mg/kg). The sham operation group was injected with equal volume of normal saline, and the virus group was injected with control or TRIM27 overexpression adeno-associated virus (2×10 11 μg/ per mice). The serum and pancreatic tissue samples were collected 72 h after modeling. The levels of serum amylase, lipase, tumor necrosis factor α (TNF-α), interleukin-1b (IL-1b), IL-6, macrophage chemoattractant protein-1 (MCP-1) and the expression of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) in pancreatic tissue were detected by enzyme-linked immunosorbent assay. Hematoxylin eosin staining was used to observe the pathological damage of pancreatic tissue. The expressions of myeloperoxidase (MPO) and Ly6g positive inflammatory cells in mouse pancreas were observed by immunohistochemistry. The expression of p-p65, p65, p-ASK1, ASK1, p-JNK, JNK, p-p38 and p38 in pancreatic tissue were detected by Western blot. Results:The expression of TRIM27 in pancreatic of mice was significantly down regulated after SAP ( P<0.05); after overexpression of TRIM27 by adeno-associated virus, the expression of TRIM27 in mouse pancreas was significantly up-regulated ( P<0.05). There was no significant difference in the indexes of mice between the AAV-GFP group and AAV-TRIM27 group ( P>0.05). Compared with the SAP + AAV-GFP group, the levels of serum amylase, lipase, TNF-α, IL-1b, IL-6 and MCP-1 in mice of the SAP + AAV-TRIM27 group were significantly decreased, MDA in pancreatic tissue was decreased, SOD and GSH were increased, MPO and Ly6g inflammatory cells were significantly decreased, and p-p65, p-ASK1, p-JNK, and p-p38 protein expression were down regulated. Conclusions:Overexpression of TRIM27 alleviates SAP in mice by inhibiting inflammatory response and oxidative stress, and its mechanism may be through inhibiting NFκB/MAPK signaling pathway.
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Objective:To investigate the predictive value of dynamic platelet and hemagglutination-related parameters in patients with acute pancreatitis (AP).Methods:The patients admitted to the Department of Emergency Surgery in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2020 were analyzed. According to the inclusion criteria and exclusion criteria, patients with AP were retrospectively enrolled. According to the Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (Shenyang, 2019), the patients were divided into two groups: severe acute pancreatitis (SAP group) and non-severe acute pancreatitis (non-SAP group) [including mild acute pancreatitis (MAP) and moderate severe acute pancreatitis (MSAP)]. A normal distribution of the maximum and mean aggregation rates of dynamic platelets (arachiidonic acid), plateletcrit (PCT) and bedside index for severity in acute pancreatitis (BISAP) scores and other measurement data were tested by t test, while measurement data of prothrombin time (PT), fibrinogen (FIB) and D-dimer that did not conform to normal distribution were tested by Mann-Whitney U test. χ 2 test was used for the counting data such as sex, age and etiology of patients in the two groups. The prognostic value of statistically significant indicators for non-SAP group and SAP group was further analyzed by receiver operating characteristic (ROC) curve. Results:A total of 146 patients with AP were enrolled, including 50 patients in SAP group and 96 in non-SAP group. The maximum and average aggregation rates of dynamic platelet (aracidonic acid) in the SAP group were (71.76±17.62) % and (67.91±18.10) %, PT (12.02±1.33) s, FIB (4.76±2.08) g/L, D-dimer (3.75±6.04) μg/L, PCT (0.23±0.08) %, and BISAP scores (1.42±1.18), which were all significantly higher than those in the non-SAP group [the maximum and average aggregation rates of dynamic platelet (arachiidonic acid) (46.65±20.11) % and (42.50±20.71) %, PT (11.50±1.51) s and FIB (3.91±1.48) g/L, D-dimer (1.00±1.37) μg/L, PCT (0.19±0.06) %, BISAP scores (0.45±0.66)] (all P<0.05). According to area under the ROC curve, the maximum and average aggregation rates of dynamic platelets (arachiidonic acid) in serum of patients with SAP were 0.83 and 0.82, respectively, and the sensitivities were 0.56 and 0.68, respectively. The specificity was 0.99 and 0.81, respectively, which was better than PT, FIB, D-dimer, PCT and BISAP scores in predicting the severity of AP. Conclusions:The maximum and average aggregation rates of dynamic platelets (arachidonic acid), PT, FIB, D-dimer, PCT and BISAP scores can be used as predictors of the severity of acute pancreatitis. The maximum and average aggregation rates of dynamic platelets (arachiidonic acid) were the best in predicting the severity of AP.
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Objective:To investigate the role of macrophage migration inhibitory factor (MIF) in severe acute pancreatitis (SAP) associated lung injury in mice.Methods:Totally 32 mice were randomly divided into 4 groups ( n=8/per group): wild type control group (WT+CON group), wild type SAP group (WT+SAP group), MIF gene knockout control group (KO+CON group), and MIF gene knockout SAP group (KO+SAP group). SAP model was established by intraperitoneal injection of L-arginine (4 mg/g). The expression of serum amylase, IL-6, TNF-α and MIF were detected by ELISA. The pathological changes of pancreatic and lung tissues were observed by HE staining. The expression of IL-6 and TNF-α in lung tissue was detected by immunohistochemistry. The expression of NF-κB in lung tissue was detected by Western blot. For measurement data, t test was used for comparison between two groups, and one-way analysis of variance was used for comparison between multiple groups. Results:Compared with the WT+CON group, pathological score of pancreatic and lung injury, serum amylase, TNF-α and IL-6 expression in serum and lung tissues were significantly increased in the WT+SAP group ( P<0.05), while the above indexes were significantly decreased in the KO+SAP group ( P<0.05). In addition, the expression of NF-κB protein in KO+SAP group was significantly lower than that in the WT+SAP group ( P<0.05). Conclusions:MIF gene knockout can alleviate severe acute pancreatitis associated acute lung injury in mice, and its mechanism may be related to NF-κB.
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Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.
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Objective:To investigate the value of macrophage migration inhibitor factor (MIF) in early severe acute pancreatitis (SAP).Methods:①Animal experiment: according to the random number table method, 24 male Sprague-Dawley (SD) rats were divided into Sham group and SAP 3, 6 and 12 hours groups, with 6 rats in each group. SAP rat model was prepared by injecting 5% sodium taurocholate via the retrograde cholangiopancreatic duct. Liver, kidney, lung, pancreas and serum samples were harvested after 3, 6 and 12 hours. In the Sham group, tissue and serum were harvested immediately after pancreas was turned over. The histopathological changes of the pancreas were observed microscopically by hematoxylin-eosin (HE) staining. The MIF levels of serum, liver, kidney, lung and pancreas were measured by enzyme linked immunosorbent assay (ELISA). ② Clinical study: an observational study was conducted. Seventy-two adult patients within 24 hours of the onset of abdominal pain (blood amylase was 3 times the normal level), and the clinical diagnosis met the criteria of acute pancreatitis (AP) admitted to the emergency department of the First Affiliated Hospital of Zhengzhou University from December 2018 to October 2019 were enrolled. Venous blood was extracted and serum MIF level was determined by ELISA. Acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) was recorded for 24 hours. Patients were divided into SAP group (17 cases), moderate severe acute pancreatitis (MSAP) group (25 cases), and mild acute pancreatitis (MAP) group (30 cases) according to the revised Atlanta criteria for comparison between groups.Results:① The results of animal experiments showed that the serum, liver, and pancreatic MIF levels of rats in the SAP group all reached the peak at 6 hours after modeling, and the differences were statistically significant compared with the Sham group [serum MIF (ng/L): 2 862.79±238.33 vs. 1 728.32±197.59, liver MIF (ng/L): 2 141.39±328.07 vs. 1 372.70±163.41, pancreas MIF (ng/L): 4 468.00±1 324.31 vs. 1 572.06±108.40, all P < 0.01]; although the levels of MIF in serum, liver and pancreas decreased at 12 hours after modeling, they were still significantly higher than Sham group. However, there was no statistically significant difference in MIF levels of lung and kidney in SAP rats compared with Sham group at 3, 6 and 12 hours after molding. ② Clinical observation showed that early serum MIF levels of SAP, MSAP and MAP patients decreased in order, (14.83±2.99), (10.17±2.64), and (7.21±2.47) μg/L, respectively; APACHEⅡ scores also decreased in order, 10.41±3.74, 7.60±3.18 and 4.00±2.41 respectively. Correlation analysis showed that serum MIF levels in patients with SAP, MSAP, and MAP had a good correlation with APACHEⅡ scores of the respective groups, showing that MIF levels was positively correlated with disease severity (SAP: r = 0.51, P = 0.03; MSAP: r = 0.45, P = 0.02; MAP: r = 0.45, P = 0.01). Conclusion:MIF can predict the occurrence of early SAP, and it is related to the severity of early AP.
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Objective:To investigate the effect and tolerance of non-invasive ventilation (NIV) with helmet in patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the effect on improving blood gas, alleviating dyspnea and the occurrence of complications.Methods:Patients with AECOPD and respiratory failure admitted to emergency intensive care unit (EICU) and respiratory intensive care unit (RICU) of the First Affiliated Hospital of Zhengzhou University from January 1st, 2018 to May 31st, 2019 were enrolled. After obtaining the informed consent of the patients or their authorized family members, the patients were divided into two groups: the helmet group and the facial mask group by random number table. NIV was carried out by using helmet or facial mask, respectively. During the course of NIV (immediately, 1 hour, 4 hours and at the end of NIV), the tolerance score, blood gas analysis, heart rate (HR), respiratory rate (RR) of patients were monitored, and the incidence of tracheal intubation, in-hospital mortality and complications were observed. Kaplan-Meier survival curve was plotted to analyze the 30-day cumulative survival of the two groups.Results:A total of 82 patients with AECOPD and respiratory failure were included during the study period. After excluding patients with the oxygenation index (PaO 2/FiO 2) > 200 mmHg (1 mmHg = 0.133 kPa), with tracheal intubation or invasive ventilation, suffering from acute myocardial infarction, severe trauma within 2 weeks, excessive secretion, sputum discharge disorder or refusal to participate in the study, 26 patients were finally enrolled in the analysis, randomly assigned to the helmet group and the facial mask group, with 13 patients in each group. The PaO 2/FiO 2 after NIV of patients in both groups was increased significantly as compared with that immediately after NIV, without significant difference between the two groups, but the increase in PaO 2/FiO 2 at the end of NIV compared with immediately after NIV in the helmet group was significantly higher than that in the facial mask group (mmHg: 75.1±73.2 vs. 7.7±86.0, P < 0.05). RR at each time point after NIV in the two groups was lower than that immediately after NIV, especially in the helmet group. There were significant differences between the helmet group and facial mask group at 1 hour, 4 hours, and the end of NIV (times/min: 17.5±4.1 vs. 23.1±6.3 at 1 hour, 16.2±2.5 vs. 20.0±5.5 at 4 hours, 15.5±2.5 vs. 21.2±5.9 at the end of NIV, all P < 0.05). The NIV tolerance score of the helmet group at 4 hours and the end was significantly higher than that of the facial mask group (4 hours: 3.9±0.3 vs. 3.3±0.9, at the end of NIV: 3.8±0.6 vs. 2.9±0.9, both P < 0.05). There was no significant difference in the improvement of pH value, arterial partial pressure of carbon dioxide (PaCO 2), or HR between helmet group and facial mask group. The total number of complications (cases: 3 vs. 8) and the nasal skin lesions (cases: 0 vs. 4) in the helmet group were significantly less than those in the facial mask group (both P < 0.05). Only 2 patients in the helmet group received endotracheal intubation, and 1 of them died; 5 patients in the facial mask group received endotracheal intubation, and 3 of them died; there was no significant difference between the two groups (both P > 0.05). The Kaplan-Meier survival curve analysis showed that the cumulative survival rate of 30 days in the helmet group was lower than that in the facial mask group, but the difference was not statistically significant (Log-Rank test: χ 2 = 1.278, P = 0.258). Conclusion:NIV with helmet has better comfort for patients with AECOPD combined with respiratory failure, and better effect on improving oxygenation and relieving dyspnea, and its effect on carbon dioxide emissions is not inferior to that of traditional mask NIV.
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Objective:To investigate the effect of thymosin α1 on the differentiation of T lymphocyte and the secretion of inflammatory factors in septic mice, thus to explore the effect of thymosin α1 on the prognosis of sepsis.Methods:Adult female C57 mice were randomly (random number) divided into 3 groups: blank control group, sepsis group, and thymosin α1 treatment group. T cell counts and the corresponding inflammatory factors in the further differentiation of T lymphocytes as well as plasma and lung tissues were statistically analyzed, and the survival rate of the mice within 96 h was also analyzed. Graphpad 7.0 software was used for statistically analysis of the study results.Results:There was no significant difference in T cell counts among the three groups of mice, but in the further differentiation of T lymphocytes, the expression of Th17 in the thymosin α1 treatment group was significantly lower than that in the sepsis group, and the expression of Treg was significantly increased in the sepsis group. The expression of the inflammatory cytokine IL-10 was significantly increased in plasma and lung tissues of the thymosin α1 treatment group, while the expression of IL-17A in plasma and lung tissues of the thymosin α1 treatment group was significantly lower ( P <0.05). Survival analysis showed that the survival rate of the thymosin α1 treatment group increased significantly at 96 h, and the difference was significant statistically ( P <0.05). Conclusions:Thymosin α1 can enhance the cellular immunity in sepsis, ameliorate the systemic inflammation, and further protect against sepsis.
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Objective To investigate the relationship between the levels of Thl and Th2 cells and their cytokines IFN-γ,TNF-αt,IL-2,IL-4,IL-5 and IL-13 in peripheral blood of patients with acute pancreatitis and the clinical severity of acute pancreatitis,and to evaluate the diagnostic value and significance for the severity of acute pancreatitis.Methods This study enrolled 72 patients with acute pancreatitis and 30 healthy controls admitted to the Emergency Surgery Department of the First Affiliated Hospital of Zengzhou University from January 2015 to June 2017.The patients were divided into the mild MAP group,moderate MSAP group,and severe SAP group according to the 2012 Atlanta classification criteria.Whole blood and serum samples were taken on the day of admission for all confirmed cases,the number of Th1 and Th2 cells was detected by flow cytometry,the expression levels of IFN-γ,TNF-α,IL-2,IL-4,IL-5 and IL-13 were determined by ELISA.The total length of hospital stay and length of hospital stay in ICU of each group were recorded.The number of Th 1 and Th2 cells and the expression of related cytokines in patients with mild,moderate and severe acute pancreatitis were compared by one-way analysis of variance.Pearson linear correlation was used to analyze the correlation between Th1and Th2 cytokines and the length of hospital stay and the length of hospital stay in ICU.A P＜0.05 was considered statistically significant.Results Compared with the healthy controls,the number of Th1 and Th2 cells,the levels of Th1 cytokine IFN-γ,TNF-α IL-2 and Th2 cytokine IL-4 were significantly increased in acute pancreatitis.Th1 cells in the SAP group were significantly higher than those in the MAP and MSAP groups (F=11.137,P＜0.01),while Th2 cells in the SAP group were significantly lower than those in the MAP and MSAP groups (F=9.493,P＜0.01),and there was no significant difference between the MAP group and MSAP group.The expression level of IFN-γ was higher in the SAP and MSAP groups than that in the MAP group (F=8.605,P=0.001).The expression level of TNF-α was higher in the SAP group than those in the MSAP and MAP groups (F=1 1.847,P＜0.01),and the IL-4 expression level was significantly lower in the SAP group than those in the MAP and MSAP groups (F=8.042,P=0.001).The expression level of IFN-γ was positively correlated with the length of hospital stay and the length of hospital stay in ICU (r=0.569,P=0.014;r=0.538,P=0.021).The expression level of TNF-α was positively correlated with the length of hospital stay (r=0.475,P=0.046).The expression level of IL-4 was negatively correlated with the length of hospital stay and the length of hospital stay in ICU (r==0.577,P=0.012;r=-0.657,P=0.003).Conclusions Th1 and Th2 cells and their associated inflammatory factors IFN-γ,TNF-α,IL-2 and IL-4 are elevated in patients with acute pancreatitis.The increase in the number of Th1 proinflammatory cytokines IFN-γ,TNF-α and Th1 cells tends to aggravate the development of acute pancreatitis,and the increase in the number of Th2 cells and the anti-inflammatory cytokine IL-4 are associated with a better prognosis.
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Objective To study the influence of prebiotics and probiotics combined with early enteral nutrition (EN) on the recovery of gastrointestinal function, improvement of nutritional status and prognosis in postoperative patients with pancreatic trauma. Methods A retrospective analysis of the clinical data of pancreatic injury patients admitted to our hospital from January 2012 to December 2017 was carried out, and those patients were divided into 3 groups: group A (control group), patients treated with operation and routine treatment; group B, patients treated with prebiotics and probiotics in addition to surgery and routine treatment; group C, patients treated as group B in addition to early EN. Comparisons of blood biochemical markers, mortality, time required for resolution of abdominal pain, length of hospital stay, hospitalization expenses and complication rate among three groups. Results The time required for resolution of abdominal pain, length of hospital stay, hospital costs in group C were significantly lower than those in other groups (P＜ 0.05). The score of gastrointestinal dysfunction at one week after surgery in group C was significantly lower than that in group A and group B (P＜0.05). Serum amylase, lipase and CRP levels were significantly lower in group C than those in other groups (P＜ 0.05). Plasma albumin level significantly higher in group C than that in other groups (P＜ 0.05). Conclusion Prebiotics and probiotics combined with early EN treatment have certain advantages in patients with pancreatic injury.
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Objective To evaluate the effect of enhanced recovery after surgery (ERAS) on immune function and clinical signs in patients with acute abdomen.Methods From March 2016 to March 2017,patients with acute abdominal admitted in the Emergency Care Center of the First Affiliated Hospital of Zhengzhou University were collected and randomized into ERAS group and conventional peri-operative management group (CPM group).In addition to clinical signs (the time of bowel movemtn recovery,the time of first postoperative ingestion and ambulation,hospital stay,complication rates),the celluar immunity (CD4 +,CD8 +,CD4 +/CD8 +) were determined during peri-operation period.Results A cohort of 240 patients were in ERAS group and 192 patients in CPM group.There was no significant difference in general condition between the two groups (P ＞ O.05).On the first day after operation,the levels of CD4 +,CD4 + /CD8 + decreased in both groups (P ＜ 0.05),but the CPM group had lower levels of CD4 +,CD4 +/CD8 +than the ERAS groups.On the 3rd and 7th days after surgery,the ERAS groups had higer levels of CD4+,CD4+/CD8+ than the CPM groups,(the levels of CD4+,CD4+/CD8+ recovery on the 3rd and 7th day after operation,and the ERAS group was significantly better than the CPM group) (P ＜ 0.05).Compared with CPM group,the recovery of bowel movement appeared earlier after operation in ERAS group with sooner resuming ingestion and ambulation after operation,shorter hospital stay,and lower WHO pain rating scale and complication rates (P ＜ O.05).Conclusions ERAS for patients with acute abdomen can alleviate postoperative suppression of immunity,preserving immune function intact and accelerating postoperative rehabilitation.
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Objective To observe how brain death affects the hepatic morphology and function of pigs and explore the roles of NF-κB. Methods Under general anaesthesia twelve healthy pigs were allocated randomly to two groups:control group(6 pigs),with non-inflacted Foley balloon catheter placed in the cerebral ventricle for 24 h,and brain death group,6 pigs,with estabhshment of brain death for 24 h.The serum and hepatic tissues in the same locus were taken at 6 h,12 h,and 24 h after the initial conformation of brain death.AST and ALT were determined by automatic biochemistry analyzer.IL-1βwas determined by ELISA.The NF-κB mRNA was determined by Real-time PCR and the NF-κB p65 by immunohistochemistry. Results The AST,ALT,IL-1β in serum,the NF-κB mRNA and the NF-κB p65 in hepatic tissues in brain death group were higher than those in control group and they all increased with the time(P<0.05).In brain death group,hepatocytes were edematous lightly after 12 hours,and the swelling progressively deteriorated after 24 hours,but there were no necrosis. Conclusion The activated NF-κB by brain death promoted the synthesis and release of inflammatory mediators,resulting in the hepatic dysfunction.