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Objective:To explore the independent risk factor for in-hospital mortality of patients with multiple trauma, and to construct a prediction model of risk of death and validate its efficacy.Methods:A retrospective cohort study was performed to analyze the clinical data of 1 028 patients with multiple trauma admitted to Affiliated Hospital of Jiangsu University from January 2011 to December 2021. There were 765 males and 263 females, aged 18-91 years[(53.8±12.4)years]. The injury severity score (ISS) was 16-57 points [(26.3±7.6)points]. There were 153 deaths and 875 survivals. A total of 777 patients were enrolled as the training set from January 2011 to December 2018 for building the prediction model, while another 251 patients were enrolled as validation set from January 2019 to December 2021. According to the outcomes, the training set was divided into the non-survival group (115 patients) and survival group (662 patients). The two groups were compared in terms of the gender, age, underlying disease, injury mechanism, head and neck injury, maxillofacial injury, chest injury, abdominal injury, extremity and pelvis injury, body surface injury, damage control surgery, pre-hospital time, number of injury sites, Glasgow coma score (GCS), ISS, shock index, and laboratory test results within 6 hours on admission, including blood lactate acid, white blood cell counts, neutrophil to lymphocyte ratio (NLR), platelet counts, hemoglobin, activated partial thromboplastin time (APTT), fibrinogen, D-dimer and blood glucose. Univariate analysis and multivariate Logistic regression analysis were performed to determine the independent risk factors for in-hospital mortality in patients with multiple trauma. The R software was used to establish a nomogram prediction model based on the above risk factors. Area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and clinical decision curve analysis (DCA) were plotted in the training set and the validation set, and Hosmer-Lemeshow goodness-of-fit test was performed.Results:Univariate analysis showed that abdominal injury, extremity and pelvis injury, damage control surgery, GCS, ISS, shock index, blood lactic acid, white blood cell counts, NLR, platelet counts, hemoglobin, APTT, fibrinogen, D-dimer and blood glucose were correlated with in-hospital mortality in patients with multiple trauma ( P<0.05 or 0.01). Logistic regression analysis showed that GCS≤8 points ( OR=1.99, 95% CI 1.12,3.53), ISS>25 points ( OR=7.39, 95% CI 3.50, 15.61), shock index>1.0 ( OR=3.43, 95% CI 1.94,6.08), blood lactic acid>2 mmol/L ( OR=9.84, 95% CI 4.97, 19.51), fibrinogen≤1.5 g/L ( OR=2.57, 95% CI 1.39,4.74) and blood glucose>10 mmol/L ( OR=3.49, 95% CI 2.03, 5.99) were significantly correlated with their in-hospital mortality ( P<0.05 or 0.01). The ROC of the nomogram prediction model indicated that AUC of the training set was 0.91 (95% CI 0.87, 0.93) and AUC of the validation set was 0.90 (95% CI 0.84, 0.95). The calibration curve showed that the predicted probability was consistent with the actual situation in both the training set and validation set. DCA showed that the nomogram prediction model presented excellent performance in predicting in-hospital mortality. In Hosmer-Lemeshow goodness-of-fit test, χ2 value of the training set was 9.69 ( P>0.05), with validation set of 9.16 ( P>0.05). Conclusions:GCS≤8 points, ISS>25 points, shock index>1.0, blood lactic acid>2 mmol/L, fibrinogen≤1.5 g/L and blood glucose>10 mmol/L are independent risk factors for in-hospital mortality in patients with multiple trauma. The nomogram prediction model based on these 6 predictive variables shows a good predictive performance, which can help clinicians comprehensively assess the patient′s condition and identify the high-risk population.
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Objective To investigate the risk factors of polytrauma combined with multiple organ dysfunction syndrome (MODS).Methods A retrospective case control study was performed on the clinical data of 299 polytrauma patients admitted to the Affiliated Hospital of Jiangsu University from December 2011 to June 2017.The collected information included gender,age,length of hospital stay,number of injured parts,injury severity scores (ISS),neutrophil count,leukocyte level,hemoglobin level,platelet count,activated partial thromboplastin time (APTI),and D-dimer level within 24 hours since admission.In addition,shock within 24 hours since admission,infection after 3 days since admission,damage control surgery,underlying diseases and prognostic outcomes were also recorded.All the patients were divided into MODS group (94 patients) and non-MODS group (205 patients).Univariate and multivariate logistic regression analyses were used to determine the risk factors of polytrauma combined with MODS.Receiver operating characteristic (ROC) curve was applied to further analyze those risk factors identified by the former analyses.Results In the univariate analysis,there were statistically significant differences between the two groups in the number of injured parts,ISS,hemoglobin level,platelet count,APTT,D-dimer level within 24 hours since admission,shock within 24 hours since admission,infection after 3 days since admission,damage control surgery and prognostic outcomes (P ＜ 0.05).No significant differences were found in gender,age,underlying disease,length of hospital stay,neutrophil level,the leukocyte level within 24 hours since admission between the two groups (P ＞ 0.05).The multivariate logistic regression analysis showed that ISS (OR =1.048),shock within 24 hours since admission (OR =3.913),infection after 3 days since admission (OR =27.715),and D-dimer level within 24 hours since admission (OR =1.015) were significantly associated with polytrauma combined with MODS (P ＜ 0.05).In addition,the area under ROC curve of ISS was 0.726 (95 ％ CI 0.667-0.784),and the area under ROC curve of D-dimer was 0.638 (95％ CI 0.571-0.706).Conclusions The risk factors of polytrauma patients combined with MODS include ISS,infection after 3 days since admission,D-dimer level and shock within 24 hours since admission.In the treatment of polytrauma patients,attention should be paid to assessment of injury severity and coagulation function,active resuscitation to correct shock,prevent and control infection,which can reduce and prevent the risks for polytrauma patients combined with MODS.
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Objective To construct the teaching model of medical statistics in universities of TCM through the questionnaire of knowledge,attitude and practice structure.Methods Medical statistics KAP questionnaire survey was conducted among postgraduates using proportional stratified sampling according to the grade.It describes the present situation and calculates the knowledge loss coefficient,knowledge demand index and behavioral application intensity of medical statistics.The Chi-square test was used to analyze the differences among different grades.Results 109 questionnaires were withdrawn.The recovery was 83.84％.45 cases (41.3％) were first year postgraduate,33 cases (30.3％) were 2nd year postgraduate,and 31 cases (28.4％) were 3rd year postgraduate.At the knowledge level,the knowledge loss coefficient of the second year postgraduates was 0.635,and there was no statistical difference (P=-0.651) vs the first year postgraduate (0.638).At the attitude level,Knowledge demand index had no statistical significance difference (P=0.213)between postgraduates in grade two (96.87％) and grade three (75.00％).Most medical postgraduates held positive attitudes toward medical statistics,hoping to strengthen the training of their application ability such as medical statistics in design and research thinking (29.18％),the statistical methods selection and the interpretation of the results (31.53％) and the statistical software operation (36.07％).At the practice level,the percentage of application intensity with statistical methods of third-year postgraduates (100.00％) was higher than the second-year postgraduates (37.50％),and the second-year postgraduates higher than the first-year postgraduates (20.45％).And with the growth of year,the percentage of application intensity was gradually increasing (P=O.O03).Among them,published scientific papers accounted for 16.5％,and 58.6％ paper grade concentrated in the core journals.Conclusion Application development should be enhanced by modularization teaching with practical issues.
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Objective:To establish a method for the determination of chloramphenicol residue in Wuji Baifeng pills by liquid chro -matography tandem mass spectrometry with normal solid-phase extraction .Methods:A normal solid-phase extraction column was used for the sample pretreatment and enrichment , and high performance liquid chromatography tandem mass spectrometry was used to deter-mine chloramphenicol residue in Wuji Baifeng pills .The analysis was performed on an Agilent-ODS C18 (250 mm ×4.6 mm,5 μm) column .The mobile phase was composed of methanol and water with gradient elution at 40℃ (0-7 min, 30% methanol;7-15 min, 30%-80%methanol;15-25 min, 80%-30%methanol).The flow rate was 1.0 ml· min-1 , and the quantitation ion was m/z 152.1 (the negative ionization) under the mode of multiple reaction monitoring .Results:The limit of detection was 0.016 ng.The calibra-tion curves were linear within the range of 0.187-3.749 ng.The method recovery was 94.3% with RSD of 3.19%(n=9).Conclu-sion:The method is simple with accurate results .It is suitable for the determination of chloramphenicol residue .
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BACKGROUND:A group of nuclease-like proteins were previously purified from Eisenia foetida tissues, exploring primary structures of these proteins wil help to uncover basic structure characteristics of them and provide foundations for the study addressing the relationship of their structures and functions. OBJECTIVE:To explore primary structures of nuclease-like proteins EWD1 and EWD2. METHODS:Edman degradation method was used to sequence the N-terminal amino acids of EWD1 and EWD2, acid hydrolisis method was used to analyze amino acid compositions of EWD1 and EWD2, LC-MS/MS was used to analyze some peptide sequences within the proteins, and MALDI-TOF-MS was used to calculate the number of the disulfide bonds and the contents of polysaccharides. RESULTS AND CONCLUSION:Among the amino acid compositions in EWD1 and EWD2, the sum contents of aspartate and asparagines were the highest (al nearly 10%), the contents of hydrophobic amino acids were also high, and the contents of cysteine was low. The EWD1 and EWD2 had similar amino acid compositions with other nucleases. Edman degradation results showed that, the N-terminal sequences of the large subunit of EWD1 were in turn as fol ows:D, E, W, V, Y, P;the N-terminal sequences of EWD2 were as fol ows:L, L, G, P, Y, K, P, K, C. The results of LC-MS/MS indicated the two proteins were novel proteins;MALDI-TOF-MS results showed that 8 cysteine residues formed 4 disulfide bonds in EWD1, 6 cysteine residues formed 3 disulfide bonds in EWD2. EWD1 and EWD2 were al glycoproteins, the content of polysaccharides was 17.3%in EWD1 and 15.6%in EWD2.
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Chemotherapy completion rate can reflect the tolerance and compliance of patients to chemotherapy. Poor tolerance may result in delay or suspension of the comprehensive treatment plan, thus affect the efficacy of cancer treatment. Evaluating methods to improve the completion rate of chemotherapy and reduce the occurrence of delayed chemotherapy has gained increasing attention and is the significant area of study in the field of cancer treatment. Studies have shown that Chinese medicine combined with chemotherapy could improve the quality of life in patients with stage IIIB/IV non-small-cell lung cancer (NSCLC).
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Objective To study the effect of allo-human bone marrow mesenchymal stem cells (BMSCs) on T and B cells from patients with Rheumatoid arthritis (RA) in vitro. Methods BMSCs were isolated from bone marrow samples of healthy volunteers and purified by density gradient centrifugation and cultured in vitro. Peripheral lymphocytes were isolated from patients with RA.Then, BMSCs and lymphpcutes were co-cultured. The modulatory effect of BMSCs on proliferation, activation and maturation of T and B lymphocytes of RA patients stimulated by PHA and SAC respectively was observed. The cell generation cycle and the degree of apoptosis were assessed by flow cytometry with PI/ Annexin V. After co-cultured with or without BMSCs for 72 hours, T cells were harvested, then they were labeled with anti-CD3, anti-CD4, anti-CD8, anti-CD25 antibodies and analyzed by flow cytometry. The density of IgG in the co-culture system was detected by ELISA. Results T and B cells proliferation was significantly suppressed when co-cuhured with bMSCs but did not induce T cell apoptosis. There was a significant decrease in the ratio of CD4+ CD3+ T cells in the co-cuhure group (34±6), as compared with the control group (44±7) (P<0.05). There was a decrease in CD25+ T cells and increase of CD4+ CD25+ cells in BMSCs co-cultured group (P<0.05). IgG was in creased in the cocuhure system. Conclusion Human BMSCs inhibit T and B cell activation and proliferation in patients with RA in vitro. And these immunomodulatory effects are not MHC restricted. The results of this study have provided evidence for the fact that BMSCs has the potential to be an effective treatment for RA.
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Recently the maintenance therapy of non-small-cell lung cancer (NSCLC) patients who completed required treatment cycles has caused widespread interests in the medical field. Traditional Chinese medicine may be a useful complement in maintenance treatment of mid-to-late stage NSCLC.
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Objective:To purify a kind of deoxyribonuclease from earthworm Eisenia foetida (named earthworm DNase, EDNase) and study its characteristics. Methods: Acetone precipitation, ion-exchange chromatography, high performance liquid chromatography, SDS-PAGE, CapiUary electrophoresis isoelectric focusing and MALDI-TOP MS were used for the study. Results: This purified protocol improved 137-fold purification and 45.6 % recovery of enzyme activity. The molecular mass of EDNase was estimated to be 63 000. Mg2+ , Mn2+ and Ca2+ were strong inhibitors of EDNase, while Na+ slightly increasd the enzyme activity. The enzyme was completely stable in the pH range from 4. 4 to 5.2 and had a pH optimum of 4.8. The optimum temperature was 37℃ and the enzyme was stable up to 40 ℃. The pI of the enzyme was 6. 20. Km and Vmax for the enzyme were 1.52 g/L and 4. 89 mg/(mL ·min), respectively, with calf thymus DNA as substrate. The enzyme was able to degrade chromosemal DNA, linear λbacteriophage DNA as well as supereoiled plasmid DNA, but didn' t display any RNase activity. Conclusion: This kind of deoxyribonuclease possesses unique characteristics, which is different from the deoxyribonucleases which we have known before.
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Objective Feitai Capsule,a compound of traditional Chinese herbal medicine,has been screened and refined repeatedly for many years and shown to have a good anti-tumor effect.Strict quality control and further screening of the efficacious components of the compound are of great clinical significance.The purpose of this study was to establish the methods for determining the isofraxidin content in Feitai Capsule.Methods We determined the content of isofraxidin in Feitai Capsule by high performance liquid chromatography (HPLC),using the chromatographic column Hypersil ODS-C18 (4.6 mm?150 mm,5 ?m),with the mobile phase as acetonitrile 0.2% phosphoric acid solution (21∶79),the flow rate of 1.0 ml/min,the detective wavelength of 344 nm and the column temperature at 30℃.Results Isofraxidin showed a good linearity,within the range of 2.00-10.80 ?g/ml (y=69 427x+15961,r = 0.999 9),with the average recovery of 97.89% and RSD of 1.64% (n = 6).Conclusion HPLC,accurate and reproducible,is suitable for the determination of the isofraxidin content in Feitai Capsule.