Overview of polytrauma patients in the first 10 days after the Sichuan earthquake: a report from the No. 903 Military Hospital, Jiangyou

PURPOSE

The purpose of this study was to investigate the profile of traumas, the severity, and mortality of polytrauma patients in a front-line hospital after the 2008 Sichuan earthquake.

METHODS

Patients who had two or more injuries to physical regions or organ systems, where at least one injury or the combination of injuries carried a certain risk of fatal outcome, with Injury Severity Score (ISS) ≥16, were considered as polytrauma patients and included in this study. Medical records consisting of demographic data, distribution and type of injuries, Abbreviated Injury Scale (AIS) score of each injury, ISS, surgical procedures, mortality rate, and features of the deaths were collected and analyzed.

RESULTS

A total of 70 earthquake-related polytrauma patients were treated in our hospital during the first 10 days after the earthquake. The mean ISS of these patients was 26.9, and 77.1% of these patients were critically injured (ISS ≥ 25). Among the 224 injuries, the most common injury site was the extremities (30.8%), 81.2% of which were fractures. A total of 152 surgical procedures were performed on these patients, of which orthopedic procedures accounted for 85.5%. During the first 10 days, 21 patients with significantly higher ISS than the survivors died in the hospital.

CONCLUSIONS

The mortality rate of the polytrauma patients in this rescue operation was high. The ISS was a feasible tool to estimate the severity of polytrauma patients. Specialists in orthopedics, critical care, and respiratory disorders were in great demand during the management of these patients in such conditions.

Agonist of 5-HT1A/7 receptors but not that of 5-HT2 receptors disinhibits tracheobronchial-projecting airway vagal preganglionic neurons of rats

The vagus nerves supply the major cholinergic tone to airway smooth muscles physiologically and play critical roles in the genesis of airway hyperreactivity under some pathological conditions. Postganglionic airway cholinergic tone relies largely on the ongoing activity of medullary airway vagal preganglionic neurons (AVPNs), of which the tracheobronchial-projecting ones are primarily located in the external formation of the nucleus ambiguus (eNA). AVPNs are regulated by 5-HT, and 5-HT(1A/7) and 5-HT(2) receptors have been indicated to be involved. But the mechanisms at synaptic level are unknown. In the present study, tracheobronchial-projecting AVPNs (T-AVPNs) were retrogradely labeled from the trachea wall; fluorescently labeled T-AVPNs in the eNA were recorded with whole-cell voltage patch clamp; and the effects of 5-HT(1A/7) receptor agonist (±)-8-Hydroxy-2-(dipropylamino) tetralin hydrobromide (8-OH-DPAT) (1 μmol L(-1)) and 5-HT(2) receptor agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) (10 μmol L(-1)) on the synaptic inputs were examined. 8-OH-DPAT significantly inhibited the GABAergic and glycinergic spontaneous inhibitory postsynaptic currents (sIPSCs) of T-AVPNs in both the frequency and amplitude but had no effect on the GABAergic and glycinergic miniature inhibitory postsynaptic currents (mIPSCs). The 8-OH-DPAT inhibition of the GABAergic and glycinergic sIPSCs was prevented by 5-HT(1A/7) receptor antagonist N-[2-[4-(2-Methoxyphenyl)-1-piperazinyl] ethyl]-N-2-pyridinylcyclohexanecarboxamide maleate salt (WAY-100635) (1 μmol L(-1)). 8-OH-DPAT had no effect on the glutamatergic spontaneous excitatory postsynaptic currents (sEPSCs) and caused no alterations in the baseline current and input resistance of T-AVPNs. DOI had no effect on any types of the synaptic inputs of T-AVPNs. These results suggest that 5-HT(1A/7) receptor agonist causes "disinhibition" of T-AVPNs, which might, in part, account for the reflex increase of airway resistance.

Diffusion tensor imaging findings in young children with benign external hydrocephalus differ from the normal population

PURPOSE

To compare a pediatric population diagnosed with benign external hydrocephalus (BEH) to normal age-matched controls using diffusion tensor imaging (DTI) techniques.

METHODS

We retrospectively identified 17 BEH patients by specific clinical and neuroimaging criteria. Fractional anisotropy (FA) and mean diffusivity (MD) values obtained from DTI scans were compared to a population of age-matched controls and group differences were examined by mixed model analysis. A longitudinal comparison was completed on a subset that underwent multiple scans (n = 8).

RESULTS

In the genu of the corpus callosum (gCC), six of 15 BEH children had an FA value above the upper limit of 95% prediction interval, nine of 15 BEH children had MD values below the lower limit of 95% prediction interval. A similar trend applied to the other regions of interest (ROIs): splenium of the corpus callosum (sCC), ALIC, and PLIC. Statistical analysis demonstrated significant differences in FA within the gCC, sCC, and PLIC and in MD within the sCC between BEH patients and controls given (P = 0.05). No statistical differences were identified at any ROIs at the later scans.

CONCLUSIONS

We found a significant increase in FA and decrease in MD in children with BEH compared with normal children in specific white matter (WM) ROIs, notably in the gCC and sCC; furthermore, in longitudinal comparison, DTI parameters normalized over time. The current study further demonstrates the ability of DTI to distinguish between subtle diffusion changes in periventricular white matter and establishes preliminary objective radiographic parameters for watchful observation of patients with BEH.

Microarray profiling analysis uncovers common molecular mechanisms of rubella virus, human cytomegalovirus, and herpes simplex virus type 2 infections in ECV304 cells

To study the common molecular mechanisms of various viruses infections that might result in congential cardiovascular diseases in perinatal period, changes in mRNA expression levels of ECV304 cells infected by rubella virus (RUBV), human cytomegalovirus (HCMV), and herpes simplex virus type 2 (HSV-2) were analyzed using a microarray system representing 18,716 human genes. 99 genes were found to exhibit differential expression (80 up-regulated and 19 down-regulated). Biological process analysis showed that 33 signaling pathways including 22 genes were relevant significantly to RV, HCMV and HSV-II infections. Of these 33 biological processes, 28 belong to one-gene biological processes and 5 belong to multiple-gene biological processes. Gene annotation indicated that the 5 multiple-gene biological processes including regulation of cell growth, collagen fibril organization, mRNA transport, cell adhesion and regulation of cell shape, and seven down- or up-regulated genes [CRIM1 (cysteine rich transmembrane BMP regulator 1), WISP2 (WNT1 inducible signaling pathway protein 2), COL12A1 (collagen, type XII, alpha 1), COL11A2 (collagen, type XI, alpha 2), CNTN5 (contactin 5), DDR1 (discoidin domain receptor tyrosine kinase 1), VEGF (vascular endothelial growth factor precursor)], are significantly correlated to RUBV, HCMV and HSV-2 infections in ECV304 cells. The results obtained in this study suggested the common molecular mechanisms of viruses infections that might result in congential cardiovascular diseases.

"Embryo glue" does not seem to improve chances of subsequent pregnancy in refractory in vitro fertilization cases

PURPOSE

To determine if the use of Embryo glue improves implantation and pregnancy rates following embryo transfer (ET) in women who failed to conceive in three previous attempts.

METHODS

A matched controlled study was performed in women undergoing IVF-ET, donor oocyte recipients and women using their own oocytes having fresh or frozen ETs. A woman having Embryo glue was matched with the very next woman not using glue within six months of age and having the same number of previous failed ETs.

RESULTS

Embryo glue did not seem to improve pregnancy or implantation rates. In fact, in evaluating fresh embryo transfers there was a significantly higher live delivered pregnancy rate in the women not using Embryo glue (39.3%) vs those using the glue (14.3%).

CONCLUSIONS

Embryo glue does not improve pregnancy outcome in women failing in previous IVF cycles.

Pregnancy outcome following in vitro fertilization-embryo transfer according to the percentage of metaphase II oocytes retrieved

PURPOSE

To determine if the presence of a lower percentage of metaphase II eggs during oocyte retrieval leads to a lower fertilization rate of these metaphase II eggs since they may be more likely to be not quite fully mature, and to determine if transfer of embryos made from these eggs leads to lower pregnancy and implantation rates.

METHODS

Fertilization and pregnancy rates determined according to deciles of percent of metaphase II eggs beginning with <30%.

RESULTS

Though there was no difference in fertilization rates when comparing those with <60% metaphase II eggs vs a 60%, there were significantly higher clinical and live delivered pregnancy rates and implantation rates when there were a 60% of the eggs retrieved that were metaphase II.

CONCLUSIONS

An inferior pregnancy outcome with a lower percentage of metaphase II eggs despite similar fertilization rates is consistent with the hypothesis that subtle full maturation defects may result in pregnancy failure despite embryo transfer.

Oocytes from women of advanced reproductive age do not appear to have an increased risk of zona pellucida hardening

PURPOSE

To test the hypothesis that very advanced reproductive age leads to an increased risk of zona pellucida hardening by comparing fertilization rates and rates of failed fertilization with conventional oocyte insemination vs intracytoplasmic sperm injection (ICSI).

METHODS

Women aged > or = 45 were given the option of ICSI vs conventional oocyte insemination in circumstances where there was no male factor present. They were advised of the theoretical benefit of ICSI overcoming zona hardening but also advised that ICSI might lower pregnancy rates and is more costly.

RESULTS

There were 364 cycles evaluated and 74% chose ICSI. The failed fertilization rates were similar--28.4% (66/232) for ICSI vs 26.5% (35/132) for conventional insemination. The fertilization rates were similar 56.0% with ICSI vs 50.9% with conventional oocyte insemination.

CONCLUSION

Based on similar fertilization and failed fertilization rates in women aged > or = 45 undergoing IVF-ET, zona hardening does not appear to be a consequence of reproductive aging.

Intracytoplasmic sperm injection completely negates the implantation problem associated with conventional fertilization with sperm with low hypo-osmotic swelling test scores as evidenced by evaluating donor-recipient pairs

PURPOSE

To corroborate or refute the claim that intracytoplasmic sperm injection (ICSI) can overcome the problem found after conventional insemination of oocytes with sperm with low hypoosmotic swelling (HOS) tests of forming embryos with low implantation potential.

METHODS

Matched couple pairs sharing one pool of oocytes were identified where one of the male partners had a low HOS test score and the other one with a normal one. Intracytoplasmic sperm injection was always used in those with low HOS test scores (i.e., < 50%) vs ICSI only used for semen abnormalities in the normal HOS group.

RESULTS

There were no differences found in either fertilization rates or clinical or live delivered pregnancy rates or implantation rates between these groups.

CONCLUSIONS

Intracytoplasmic sperm injection can completely negate the adverse effect that fertilization with sperm with subnormal HOS scores has on embryo implantation potential.

Effect of method of oocyte fertilization on fertilization, pregnancy and implantation rates in women with unexplained infertility

PURPOSE

To determine if intracytoplasmic sperm injection (ICSI) offers an advantage over conventional oocyte insemination for women undergoing in vitro fertilization (IVF) and embryo transfer for unexplained infertility.

METHODS

A retrospective seven-year review of outcome following IVF with conventional insemination vs ICSI for the category of unexplained infertility. The decision on which method of insemination to use was made by the couple after hearing pros and cons with the consulting physician.

RESULTS

There was no difference in failed fertilization rates. However, the live delivered pregnancy rates were significantly higher for the group using conventional oocyte fertilization methods.

CONCLUSIONS

Because of increased embryologist time and therefore increased expense to the patient it makes more sense to first try conventional oocyte insemination over ICSI for unexplained infertility, especially since the former results in a significantly higher live delivery rate

PTEN deletion prevents ischemic brain injury by activating the mTOR signaling pathway

It is increasingly clear that the tumor suppressor PTEN (phosphatase and tensin homolog deleted on chromosome 10) is a negative regulator of neuronal cell survival. However, its molecular mechanisms remain poorly understood. Here we found that PTEN/mTOR is critical for controlling neuronal cell death after ischemic brain injury. Male rats were subjected to MCAO (middle cerebral artery occlusion) followed by pretreating with bpv (pic), a potent inhibitor for PTEN, or by intra-cerebroventricular infusion of PTEN siRNA. bpv (pic) significantly decreased infarct volume and reduced the number of TUNEL-positive cells. We further demonstrated that although bpv (pic) did not affect brain injury-induced mTOR protein expression, bpv (pic) prevented decrease in phosphorylation of mTOR, and the subsequent decrease in S6. Similarly, down-regulation of PTEN expression also reduced the number of TUNEL-positive cells, and increased phospho-mTOR. These data suggest that PTEN deletion prevents neuronal cell death resulting from ischemic brain injury and that its neuroprotective effects are mediated by increasing the injury-induced mTOR phosphorylation.

Morphology and texture evolution of nanostructured CaF2 films on amorphous substrates under oblique incidence flux

The morphology and biaxial texture of vacuum evaporated CaF(2) films on amorphous substrates as a function of vapour incident angle, substrate temperature and film thickness were investigated by scanning electron microscopy, x-ray pole figure and reflection high energy electron diffraction surface pole figure analyses. Results show that an anomalous [220] out-of-plane texture was preferred in CaF(2) films deposited on Si substrates at < 200 °C with normal vapour incidence. With an increase of the vapour incident angle, the out-of-plane orientation changed from [220] to [111] at a substrate temperature of 100 °C. In films deposited with normal vapour incidence, the out-of-plane orientation changed from [220] at 100 °C to [111] at 400 °C. In films deposited with an oblique vapour incidence at 100 °C, the texture changed from random at small thickness (5 nm) to biaxial at larger thickness (20 nm or more). Using first principles density functional theory calculation, it was shown that [220] texture formation is a consequence of energetically favourable adsorption of CaF(2) molecules onto the CaF(2)(110) facet.

ERIC-PCR identification of the spread of airborne Escherichia coli in pig houses

To understand the spread of microbial aerosols in pig houses, with Escherichia coli (E. coli) as indicator, the airborne E. coli in 4 pig houses and their surroundings at different points 10, 50m upwind and 10, 50, 100, 200 and 400m downwind respectively from the pig houses were collected, and the concentrations were calculated at each sampling point. Furthermore, the feces of pigs were collected to separate E. coli. The ERIC-PCR (Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction) technology was used to amplify the isolated E. coli DNA samples, then the amplified results were analyzed by NTSYS-pc (Version 2.10) to identify the similarity of isolated E. coli. The results showed that the airborne E. coli concentrations in indoor air of the 4 pig houses (21-35CFUm(-)(3) air) were much higher than those in upwind and downwind air (P<0.05), but there were no significant differences (P>0.05) at downwind distances. The ERIC-PCR results also showed that 52.4% of the fecal E. coli (four houses being respectively 2/4, 50%; 2/4, 50%; 3/6, 50%; 4/7, 57.1%) were identical to the indoor airborne E. coli isolates, and there was more than 90% similarity between the majority of E. coli (50%, 21/42) isolated from downwind air at 10, 50, 100 and 200m and those from indoor air or feces. It could be concluded that the aerosols in pig houses can spread to the surroundings, and thus effective measures should be taken to control and minimize the spread of microbial aerosols.

Spinal Cord Injury Blunted Effects of Endothelin-1 on Ca2+ Transients and Calcium Current in Isolated Rat Cardiomyocytes

Plasma endothelin-1 (ET-1) levels are elevated in spinal cord injury (SCI), and ET-1 may be involved in the pathophysiology of this condition. However, its effects on contractile function of the heart of SCI rats are still unknown. To define more clearly the possiblel role of ET-1 following SCI, we investigated the effect of ET-1 on the contraction, calcium transients and L-type calcium current (ICa,L) in the cardiomyocytes of control and SCI rats. Sixteen Sprague-Dawley male rats aged 80-100 days and weighing 250-350 g were randomized into control and SCI groups. Fourteen days following compression injury to the spinal cord, effects of ET-1 on the contraction, calcium transients and ICa,L were studied in the cardiomyocytes of control and SCI rats by the technique of simultaneous measurement of intracellular Ca2+ and contraction and by whole-cell configuration of the patch-clamp technique. In myocytes from control rats, ET-1 significantly increased contraction, the magnitude of Ca2+ transients and the peak amplitude of ICa,L. However, ET-1 had little effect on the amplitude of contraction, calcium transients and ICa,L in myocytes from SCI rats. These results suggest that the positive inotropic effects of ET-1 on control myocardial contraction may be altered in pathological states such as SCI.

Length of time of embryo storage does not negatively influence pregnancy rates after thawing and transfer

PURPOSE

To determine if longer storage of embryos in a cryopreserved state negatively affects the chance of successful implantation following thawing and transfer.

METHODS

A retrospective cohort analysis of frozen-thawed embryos that had been donated to recipients. Four time periods were evaluated.

RESULTS

No significant decrease in pregnancy or implantation rates was found in the longest freezing group (> or =6 years). In fact, if there was a trend, it was for improved pregnancy rates with longer storage. One of the successes was from embryos stored about 12 years.

CONCLUSIONS

Hopefully these data and results from other IVF centers will influence those countries having a mandatory discarding policy to reconsider and lift these restrictions, especially to increase the pool of embryos available for donation.