Epidemiological investigation of 511 adult inpatients with gas burns

Paternal behavior is not innate but arises through social experience. After mating and becoming fathers, male mice change their behavior toward pups from infanticide to paternal care. However, the precise brain areas and circuit mechanisms connecting these social behaviors are largely unknown. Here we demonstrated that the c-Fos expression pattern in the four nuclei of the preoptic-bed nuclei of stria terminalis (BST) region could robustly discriminate five kinds of previous social behavior of male mice (parenting, infanticide, mating, inter-male aggression, solitary control). Specifically, neuronal activation in the central part of the medial preoptic area (cMPOA) and rhomboid nucleus of the BST (BSTrh) retroactively detected paternal and infanticidal motivation with more than 95% accuracy. Moreover, cMPOA lesions switched behavior in fathers from paternal to infanticidal, while BSTrh lesions inhibited infanticide in virgin males. The projections from cMPOA to BSTrh were largely GABAergic. Optogenetic or pharmacogenetic activation of cMPOA attenuated infanticide in virgin males. Taken together, this study identifies the preoptic-BST nuclei underlying social motivations in male mice and reveals unexpected complexity in the circuit connecting these nuclei.

Objective: To explore the influence of inhalation injury on fluid resuscitation of massive burn patients during shock stage. Methods: A total of 74 massive burn patients (65 males and 9 females, aged 21 to 65 years) admitted to the Second Affiliated Hospital of Air Force Medical University (n=57) and Yan'an University Affiliated Hospital (n=17) from May 2009 to December 2019 were enrolled in this retrospective cohort study. Patients were divided into inhalation injury group (n=56) and non-inhalation injury group (n=18) based on clinical symptoms, vital signs, and results of bronchofibroscopy. Then 26 patients in inhalation injury group and 13 patients in non-inhalation injury group were 1∶2 matched by case-control matching based on the difference of total burn surface area. The total fluid replacement coefficient, crystalloid replacement coefficient, colloid replacement coefficient, glucose input volume, ratio of crystalloid to colloid, urine volume, and cumulative ratio of input to output volume during the first 24 h post injury, the second 24 h post injury, and the third 24 h post injury, heart rate, respiratory rate, mean arterial pressure (MAP), and hematocrit (HCT) at post injury hour (PIH) 24, 48, and 72 were recorded and compared between the two groups. Data were statistically analyzed with analysis of variance for repeated measurement and Bonferroni correction, t test, Fisher's exact probability test, and Mann-Whitney U test. Results: (1) After matching, during the first to third 24 h post injury, the total fluid replacement coefficient and glucose input volume of patients in inhalation injury group were significantly higher than those in non-inhalation injury group (F=4.202, 10.671, P<0.05 or P<0.01). During the first, second, and third 24 h post injury, the total fluid replacement coefficient, crystalloid replacement coefficient, colloid replacement coefficient, and ratio of crystalloid to colloid were similar between the patients in two groups(t=-1.336, -1.452, -1.998; -0.148, 0.141, 0.561; 0.916, -0.046, -0.509; -1.024, 0.208, 0.081, P>0.05). During the first, second, and third 24 h post injury, the glucose input volume of patients in inhalation injury group were respectively (2 996±1 176), (2 659±1 030), and (2 680±1 509) mL, which were significantly higher than (2 125±898), (1 790±828), and (1 632±932) mL in non-inhalation injury group (t=-2.334, -2.639, -2.297, P<0.05). (2) After matching, in overall comparison between groups, during the first to third 24 h post injury, the urinary output volumes and cumulative ratios of input to output volume of patients in inhalation injury group were significantly lower or higher than those in non-inhalation injury group, respectively (F=12.158, 9.111, P<0.01). At PIH 24, 48, and 72, heart rate of patients in inhalation injury group were significantly higher than those in non-inhalation injury group (F=4.675, P<0.05). There were no statistically significant differences in heart rate, respiratory rate, MAP, and HCT between patients in the two groups at PIH 24 and 48 (t=-0.039, -1.688, 1.399, 1.299, -1.741, 0.754, -0.677, 0.037, P>0.05). During the first and second 24 h post injury, the urine volume and cumulative ratio of input to output volume of patients in inhalation injury group were respectively significantly lower and higher than those in non-inhalation injury group (t(urine volume)=2.421, 2.876, t(cumulative ratio of input to output volume)=-2.687、-2.943, P<0.05 or P<0.01). At PIH 72, the heart rate and HCT of patients in inhalation injury group ( (114±13) times/min, 0.42±0.06) were significantly higher than those in non-inhalation injury group ( (98±18) times/min, 0.38±0.06, t=-3.182, -2.123, P<0.05 or P<0.01), there were no statistically significant differences in respiratory rate and MAP between the patients in two groups (t=0.359, 1.722, P>0.05). During the third 24 h post injury, there were no statistically significant differences in urine volume and cumulative ratio of input to output volume between the patients in two groups (t=1.664, -1.895, P>0.05). Conclusions: The presence of inhalation injury can lead to increased fluid requirement in massive burn patients during shock stage. An appropriate increase of fluid volume in the fluid resuscitation of burn patients combined with inhalation injury would be beneficial for maintaining ideal urine output.

As the mental health care system in Japan is putting an increased emphasis on community rehabilitation, an effective working-support program is needed for patients with schizophrenia. In order to examine personal factors associated with competitive employment, a retrospective, cross-sectional study was conducted with patients involved in an integrated program that provides both psychiatric care and a working-support service for patients with schizophrenia. Thirty six schizophrenic outpatients who were employed in the working support program participated. Patients were divided into a working group and a non-working group, depending on whether they worked more or less than 20 hours a week. The working group significantly differed from the non-working group in that they were more likely to have completed high school (p<0.05, Fisher's exact probability test), disclosed their disability to their employers (p<0.05, Fisher's exact probability test) and worked less than 20 hours in their initial employment (p<0.001, Fisher's exact probability test). Logistic regression analysis revealed that the disclosure of disabilities (odds ratio=6.00, p=0.02), shorter initial working-time (odds ratio=27.6, p<0.001), or higher educational level (odds ratio=6.42, p=0.02) increased the probability of success of competitive employment. For the other outcomes (severity of psychotic symptoms, disability of daily life or subjective QOL), there was no difference between the two groups (p>0.05, respectively, Mann-Whitney's U-test). In this program, participation in competitive employment may not be associated with the severity of psychotic symptoms, disability of daily life or subjective QOL but may be promoted by the disclosure of disabilities, shorter initial working-time and higher education.

Subroutines to calculate exact chi-square and Fisher's exact probability tests are presented for 3 by 2 cross-classification tables. A nondirectional probability value for each test is computed recursively. The use of an arbitrary starting value in each recursion eliminates the cumbersome computation of initial probability values based on the hypergeometric distribution.

Objective: To explore the epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns. Methods: A retrospective case series study was conducted. From January 2017 to December 2021, 135 patients with extremely severe burns who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 100 males and 35 females, aged 18-84 years. The incidence and diagnosis time of sepsis, the rate of positive microbial culture of blood samples (hereinafter referred to as positive blood culture), and the mortality rate of all patients, as well as the incidence of sepsis and the pathogen of infection in patients with positive blood culture were recorded (statistically analyzed with chi-square test or Fisher's exact probability test). According to the occurrence of sepsis, all patients were divided into sepsis group (58 cases) and non-sepsis group (77 cases), and the gender, age, body mass index, history of hypertension, history of diabetes, combination of inhalation injury, burn site, burn type, total burn area, and combined injury of patients were compared between the two groups. According to the outcome, all patients were divided into death group (37 cases) and survival group (98 cases), and the aforementioned data grouped according to sepsis as well as the stability of shock period and the combination of sepsis of patients were compared between the two groups. The aforementioned data between two groups were statistically analyzed with univariate analysis of independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, or Fisher's exact probability test. Factors with P<0.1 were selected for multivariate logistic regression analysis to screen independent risk factors of sepsis and death in patients with extremely severe burns. Results: Among all patients, the incidence of sepsis was 42.96% (58/135), the diagnosis time of sepsis was 14 (7, 24) d after injury, the positive blood culture rate was 62.22% (84/135), and the mortality rate was 27.41% (37/135). The incidence of sepsis of patients with positive blood culture was 69.05% (58/84). The top 5 pathogenic bacteria in the detection rate of septic patients with positive blood culture were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter cloacae, ranking from high to low, and the proportion of Acinetobacter baumannii infected was significantly higher than that of non-septic patients with positive blood culture (χ2=7.49, P<0.05). Compared with those in non-sepsis group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the total burn area of patients in sepsis group increased significantly (with χ2 values of 11.08 and 17.47, respectively, Z=5.68, P<0.05), while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that combination of inhalation injury, total burn area ≥80% total body surface area (TBSA), and perineal burns were independent risk factors for patients with extremely severe burns developing sepsis (with odds ratios of 3.15, 7.24, and 3.24, respectively, with 95% confidence intervals of 1.07 to 9.29, 1.79 to 29.34, and 1.21 to 8.68, respectively, P<0.05). Compared with those in survival group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the proportion of combination of sepsis (with χ2 values of 6.55, 11.64, and 22.26, respectively, P values all <0.05), total burn area (Z=4.25, P<0.05), and proportion of instability of shock period (P<0.05) of patients in death group all increased significantly, while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that the instability of shock period and combination of sepsis were independent risk factors for death of patients with extremely severe burns (with odds ratios of 4.87 and 3.45, respectively, with 95% confidence intervals of 1.21 to 19.57 and 1.28 to 9.33, respectively, P<0.05). Conclusions: Patients with extremely severe burns have a high incidence of sepsis and a high mortality rate. The peak period of sepsis onset is 2 weeks after injury, with Acinetobacter baumannii as the most prominent infectious pathogen. Combination of inhalation injury, total burn area ≥80% TBSA, and perineal burns are independent risk factors for extremely severe burn patients complicated with sepsis, and combination of sepsis and instability of shock period are independent risk factors for death of patients with extremely severe burns.

<b>Objective:</b> To explore the effects of enteral immunonutrition support therapy on nutritional metabolism, immune function, and inflammatory response in adult burn patients at nutritional risk as assessed by the modified 2^nd nutrition risk screening (NRS) 2002. <b>Methods:</b> A prospective randomized controlled study was conducted. From December 2019 to January 2022, 500 adult patients who were admitted to the Affiliated Huaihai Hospital of Xuzhou Medical University and had nutritional risk assessed by the modified 2^nd NRS 2002 were recruited into the study. According to burn severity, the patients were divided into common burn patients (<i>n</i>=450) and severe burn patients (<i>n</i>=50). According to the random number table, the patients with common burn were divided into common burn diet nutrition group and common burn diet enteral immunonutrition group, with 225 patients in each group, and the patients with severe burn were divided into severe burn diet enteral non-immunonutrition group and severe burn diet enteral immunonutrition group, with 25 patients in each group. The patients in each group were given the corresponding nutritional support therapies on the basis of routine burn treatment. On post injury day (PID) 1, 3, 7, 14, and 21, the total energy intake and total protein intake of the patients in 4 groups were recorded, the plasma prealbumin, albumin, transferrin, serum immunoglobulin A (IgA), IgG, IgM, peripheral blood CD3 positive T cell percentage, CD4 positive T cell count, CD8 positive T cell count, the ratio of CD4 positive T cells to CD8 positive T cells, natural killer cell percentage, plasma interleukin-6 (IL-6), free mitochondrial DNA (mtDNA) copy number, and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) of the patients in 4 groups were detected, and the nitrogen balance of the patients in 4 groups on the day was calculated. On PID 7, 14, and 21, the modified 2^nd NRS 2002 scores of the patients in 4 groups were reassessed. The sepsis incidence during treatment and the length of hospital stay of the patients in 4 groups and the length of intensive care unit (ICU) stay of the patients in the 2 severe burn groups were recorded. Data were statistically analyzed with chi-square test, Fisher's exact probability test, Mann-Whitney <i>U</i> test, independent sample <i>t</i> test, analysis of variance for repeated measurement, and Bonferroni correction. <b>Results:</b> A total of 476 patients completed the trial, with 213 patients in common burn diet nutrition group (112 males and 101 females, aged (37±19) years), 218 patients in common burn diet enteral immunonutrition group (115 males and 103 females, aged (42±16) years), 22 patients in severe burn diet enteral non-immunonutrition group (11 males and 11 females, aged (35±8) years), and 23 patients in severe burn diet enteral immunonutrition group (12 males and 11 females, aged (35±8) years). Compared with those in common burn diet nutrition group, the patients in common burn diet enteral immunonutrition group had significantly higher total energy intake on PID 1 (<i>t</i>=6.06, <i>P</i><0.01), significantly lower total energy intake on PID 7 and significantly lower total protein intake on PID 1 (with <i>t</i> values of 6.17 and 4.59, respectively,<i>P</i><0.01). On PID 21, the total energy intake of patients in severe burn diet enteral immunonutrition group was significantly lower than that in severe burn diet enteral non-immunonutrition group (<i>t</i>=2.70, <i>P</i><0.01). The total protein intake of patients in severe burn diet enteral immunonutrition group and severe burn diet enteral non-immunonutrition group were similar at each time point post injury (<i>P</i>>0.05). Compared with those in common burn diet nutrition group, the patients in common burn diet enteral immunonutrition group had significantly higher level of prealbumin on PID 3, 7, 14, and 21 (with <i>t</i> values of 2.05, 2.33, 2.45, and 2.11, respectively, <i>P</i><0.05), significantly higher level of albumin on PID 7, 14, and 21 (with <i>t</i> values of 2.30, 2.56, and 2.15, respectively, <i>P</i><0.05), significantly higher level of transferrin on PID 7 and 14 (with <i>t</i> values of 1.99 and 2.27, respectively, <i>P</i><0.05), significantly higher nitrogen balance on PID 14 and 21 (with <i>t</i> values of 2.51 and 2.07, respectively, <i>P</i><0.05), and significantly lower modified 2^nd NRS 2002 score on PID 21 (<i>t</i>=1.99, <i>P</i><0.05). Compared with those in severe burn diet enteral non-immunonutrition group, the patients in severe burn diet enteral immunonutrition group had significantly higher level of prealbumin on PID 3, 7, 14, and 21 (with <i>t</i> values of 2.50, 2.64, 2.18, and 2.39, respectively, <i>P</i><0.05), significantly higher level of albumin​on PID 7, 14, and 21 (with <i>t</i> values of 2.27, 2.39, and 2.69, respectively, <i>P</i><0.05), significantly higher level of transferrin and nitrogen balance but significantly lower modified 2^nd NRS 2002 score on PID 14 and 21 (with <i>t</i> values of 2.30, 2.35, 2.41, 2.16, 2.31, and 2.73, respectively, <i>P</i><0.05). Compared with those in common burn diet nutrition group, patients in common burn diet enteral immunonutrition group had significantly higher level of IgA and IgG on PID 7, 14, and 21 (with <i>t</i> values of 2.19, 2.36, 2.17, 2.49, 1.97, and 2.24, respectively, <i>P</i><0.05), significantly higher level of IgM on PID 21 (<i>t</i>=2.06, <i>P</i><0.05), significantly higher percentage of CD3 positive T cells and ratio of CD4 positive T cells to CD8 positive T cells on PID 3, 7, 14, and 21 (with <i>t</i> values of 2.49, 2.25, 2.33, 2.41, 2.39, 2.24, 2.46, and 2.18, respectively, <i>P</i><0.05), significantly higher CD4 positive T cell count (with <i>t</i> values of 2.15 and 2.27, respectively, <i>P</i><0.05) but significantly lower CD8 positive T cell count on PID 14 and 21 (with <i>t</i> values of 2.58 and 2.35, <i>P</i><0.05), and significantly higher percentage of natural killer cells on PID 7, 14, and 21 (with <i>t</i> values of 2.53, 2.21, and 2.36, respectively, <i>P</i><0.05). Compared with those in severe burn diet enteral non-immunonutrition group, patients in severe burn diet immunonutrition group had significantly higher level of IgA on PID 7 and 14 (with <i>t</i> values of 2.15 and 2.03, respectively, <i>P</i><0.05), significantly higher level of IgG on PID 7, 14, and 21 (with <i>t</i> values of 2.09, 2.56, and 2.15, respectively, <i>P</i><0.05), significantly higher level of IgM on PID 21 (<i>t</i>=2.08, <i>P</i><0.05), significantly higher percentage of CD3 positive T cells, CD4 positive T cell count, and percentage of natural killer cells on PID 14 and 21 (with <i>t</i> values of 2.52, 2.14, 2.14, 2.39, 2.56, and 2.19, respectively, <i>P</i><0.05), significantly lower CD8 positive T cell count but significantly higher ratio of CD4 positive T cells to CD8 positive T cells on PID 7, 14, and 21 (with <i>t</i> values of 2.27, 2.81, 2.01, 2.11, 2.69, and 2.05, respectively, <i>P</i><0.05). Compared with those in common burn diet nutrition group, patients in common burn diet enteral immunonutrition group had significantly lower level of IL-6 (with <i>t</i> values of 2.34 and 2.32, respectively, <i>P</i><0.05) and significantly lower free mtDNA copy number on PID 14 and 21 (with <i>Z</i> values of -2.28 and -2.34,respectively, <i>P</i><0.05), significantly lower level of sTREM-1 on PID 7, 14, and 21 (with <i>t</i> values of 2.02, 2.94, and 3.72, respectively, <i>P</i><0.05). Compared with those in severe burn diet enteral non-immunonutrition group, patients in severe burn diet enteral immunonutrition group had significantly lower level of IL-6 and sTREM-1 on PID 7, 14, and 21 (with <i>t</i> values of 2.15, 2.29, 2.47, 2.43, 2.07, and 2.32, respectively, <i>P</i><0.05), and significantly lower free mtDNA copy number on PID 14 and 21 (with <i>Z</i> values of -2.49 and -2.21, respectively, <i>P</i><0.05). During treatment, the sepsis incidences of patients in 2 common burn groups were similar (<i>P</i>>0.05), the sepsis incidences of patients in 2 severe burn groups were similar (<i>P</i>>0.05). The length of ICU stay of patients in severe burn diet enteral immunonutrition group was (11±3) d, which was significantly shorter than (14±3) d in severe burn diet enteral non-immunonutrition group (<i>t</i>=3.12, <i>P</i><0.01). The length of hospital stay of patients in common burn diet enteral immunonutrition group was significantly shorter than that in common burn diet nutrition group (<i>t</i>=3.11, <i>P</i><0.01). The length of hospital stay of patients in severe burn diet enteral non-immunonutrition group was similar to that in severe burn diet enteral immunonutrition group (<i>P</i>>0.05). <b>Conclusions:</b> Enteral immunonutrition support therapy for adult burn patients at nutritional risk assessed by the modified 2^nd NRS 2002 can better improve the nutritional status and the immune function of patients, reduce inflammatory response of the body, and shorten the length of hospital stay in common burn patients and the length of ICU stay in severe burn patients.

Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns

Objective: To analyze the relationship between serum lactic acid value and risk of death in patients with extensive burn during shock stage and the related influencing factors. Methods: Clinical data of 127 patients (111 males and 16 females) with extensive burn admitted to Institute of Burn Research of the First Affiliated Hospital of Army Medical University from January 2009 to December 2013 and Department of Plastic Surgery and Burns of the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018, who met the admission criteria, were retrospectively analyzed. The patients aged 21 to 62 years, with total burn area more than 50% total body surface area. All patients were treated with antishock therapy after admission. (1) According to the treatment outcome, the patients were divided into survival group (n=98) and death group (n=29). The gender, age, total burn area, partial-thickness burn area, full-thickness burn area, abbreviated burn severity index (ABSI), admission time after injury, number of patients with inhalation injury, number of patients with acute renal failure, and serum lactic acid values on admission and at post admission hour (PAH) 12, 24, 36, and 48 were recorded. (2) According to the optimal positive cut-off value of serum lactic acid 48 hours after admission, the patients were divided into high lactic acid group and normal lactic acid group. Age, gender, total burn area, indexes at PAH 48 including urea nitrogen, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin, alkaline phosphatase (ALP), albumin, white blood cell count, platelet count, lymphocyte count, prothrombin time (PT), hematocrit value, oxygenation index, respiratory index (RI), the alveolar-arterial oxygen partial pressure difference, mean arterial pressure (MAP) at PAH 48, the average urine volume within 48 hours after admission, the total volume of intravenous fluid infusion within 48 hours after admission, the volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, the volume of fluid infusion per one percent of body surface area per kilogram of body mass within the first 24 hours after admission, the volume of urine per kilogram of body mass per hour within the first 24 hours after admission, and the percentage of hospital death were recorded. Data were processed with t test, chi-square test, and Fisher's exact probability test. Cox regression analysis was used to screen independent risk factors affecting the prognosis of patients. Receiver operating characteristic curve (ROC) of serum lactic acid value at PAH 48 of 127 patients was drawn to predict patients' death and determine the optimal positive cut-off value. Multivariate logistic regression analysis was used to screen independent risk factors causing increase of serum lactic acid. Results: (1) There were significantly statistical differences in total burn area, full-thickness burn area, and ABSI of patients between survival group and death group (t=6.257, 4.476, 5.727, P<0.01), while other indexes between the two groups were close. (2) The serum values of lactic acid of patients in death group on admission and at PAH 12, 24, 36, and 48 were (4.00±0.28), (4.50±0.26), (4.02±0.31), (3.48±0.22), (3.40±0.19) mmol/L, respectively, which were significantly higher than those in survival group [(3.30±0.21), (3.20±0.19), (2.33±0.17), (1.85±0.18), (1.50±0.09) mmol/L, t=14.552, 29.603, 38.133, 40.648, 74.973, P<0.05 or P<0.01]. (3) Cox regression analysis showed that the serum value of lactic acid at PAH 48 was the independent risk factor affecting the prognosis of patients, with risk ratio of 1.853 and 95% confidence interval of 1.342-2.559, P<0.01. (4) The total area under ROC of serum value of lactic acid at PAH 48 to predict death of 127 patients was 0.811, with 95% confidence interval of 0.699-0.924, P<0.01. The optimal positive cut-off value of serum value of lactic acid was 1.75 mmol/L, with sensitivity of 75.0% and specificity of 79.5% for predicting death. (5) There were significantly statistical differences in total burn area, ALT, AST, ALP, PT, total serum bilirubin, total volume of intravenous fluid infusion within 48 hours after admission, volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, and percentage of hospital deaths of patients between high lactic acid group (n=34) and normal lactic acid group (n=93), t=3.592, 6.797, 10.367, 2.089, 2.880, 4.517, 2.984, 4.044, χ(2)=58.498, P<0.05 or P<0.01, while other indexes were close between the two groups. (6) Multivariate logistic regression analysis showed that AST and total serum bilirubin were independent risk factors for increase of serum lactic acid, with odds ratios of 1.021 and 1.064 and 95% confidence intervals of 1.001-1.040 and 1.001-1.132, P<0.05. Conclusions: Serum value of lactic acid at PAH 48 can independently predict the death of patients with extensive burns. Liver injury is an important risk factor causing hyperlacticemia during burn shock stage. Widespread increase of vascular permeability and large amount of fluid resuscitation are the core factors leading to aggravation of abdominal organ injury.

OBJECTIVE: It is well known that eradication of Helicobacter pylori infection results in healing of peptic ulcer and regression of gastric mucosal inflammation. Cranberry juice beverages have been shown to achieve good results in the prevention of recurrent urinary tract infection. The present study aimed to investigate whether a cranberry juice cocktail could eradicate or prevent H. pylori infection in mice.METHODS: In the therapeutic trial, C57BL/6 mice were infected with H. pylori and 2 weeks later, 80 mice were randomly allocated into four groups: Group A, cranberry juice (0.5 mL/mouse, p.o. daily for 30 days); Group B, triple therapy (amoxycillin 50 mg/kg, bismuth subcitrate 6.15 mg/kg, and metronidazole 22.5 mg/kg, daily for 14 days); Group C, a combination of cranberry juice and triple therapy; Control Group, the mice were infected with H. pylori and left untreated. The mice were killed after 24 h and 4 weeks and H. pylori infection status was assessed by rapid urease test and by culture and histology, respectively. In the prevention trial, 40 mice had oral cranberry juice for 30 days. In the last 5 days (days 26−30), the mice were divided into four groups: Group A, challenged orally with H. pylori three times on days 26, 28 and 30 when the mice were not given cranberry juice; Group B, challenged with H. pylori suspended in cranberry juice; Group C, challenged with H. pylori 6 h after receiving juice; Control group, no cranberry juice, but challenged with H. pylori. Two weeks later, the mice were killed to assess the status of H. pylori infection.RESULTS: The clearance rates at 24 h after treatment in groups A, B and C were 80%, 100%, and 90%, respectively (P &lt; 0.01 as compared with Control group, two tailed Fisher's Exact Probability Test). Four weeks after cessation of treatment the eradication rates in groups A, B and C were 20% (P = 0.474, two tailed Fisher's Exact Probability Test), 80% and 80%, respectively (P &lt; 0.01). None of the mice were clear of H. pylori infection.CONCLUSIONS: Cranberry juice can clear H. pylori infection in mice with a clearance rate of 80%, but the eradication rate was low (20%). Cranberry juice was not effective in preventing H. pylori infection in the mice used in this study.

A minimally invasive method to prevent postlaryngectomy major pharyngocutaneous fistula using infrahyoid myofascial flap

While intraoperative transcranial motor evoked potential (tcMEP) monitoring is widely used in spinal and brain surgery, it is sometimes not used because it can exhibit low specificity and give false-positive results. We studied 1833 muscles in 477 patients and 482 muscles in 206 patients without preoperative paralysis of manual muscle test of 2/5 or less in whom spinal and brain surgery, respectively, was performed under tcMEP monitoring. A receiver operating characteristic (ROC) analysis was used to calculate the cutoff point of amplitude relative values that cause postoperative paralysis, and the sensitivity and specificity of tcMEP monitoring with or without compound muscle action potential (CMAP) normalization after peripheral nerve stimulation. In spinal surgery, the rate of tcMEP amplitude reduction resulting in postoperative paralysis was 54.0% without CMAP normalization and 73.9% under CMAP normalization, with a sensitivity of 92.3% with or without CMAP normalization, a specificity of 95.8% without CMAP normalization vs. 97.4% under CMAP normalization, and this difference was significant by Fisher's exact probability test (two-tailed P=0.0133, one-tailed P=0.0067). In brain surgery, the percentage of tcMEP amplitude reduction resulting in postoperative paralysis was 55.0% without CMAP normalization vs. 68.1% under CMAP normalization, with a sensitivity of 87.0% without vs. 91.3% with CMAP normalization, and a specificity of 91.3% without vs. 95.6% with CMAP normalization, and these values were significantly different by Fisher's Exact Probability Test (two-tailed P=0.0225, one-tailed P=0.0112). CMAP normalization after peripheral nerve stimulation may significantly increase specificity in intraoperative tcMEP monitoring during spinal and brain surgery.

Fisher's exact probability test is a nonparametric statistical technique for determining the significance of a difference for independent groups with discrete data. Whenever computing the exact test for tables larger than 2 × 2, two problems arise (Hays, 1973): (1) the computations become very tedious and (2) there is a need to measure the strength of statistical association in each sample. The purpose of this paper was to provide a mathematical algorithm for Fisher's test (1) which is adaptable to n × m contingency tables and (2) which provides the user with lambda (λ), an index of predictive association designed for crosstabulations of nominal-level variables.

본 연구는 심폐소생술 시행 시 구조자의 무릎이 바닥으로부터 10 cm 높은 위치와 바닥 위치 간에서 흉부압박의 질에 차이가 있는지를 알아보고자 시행하였다. G광역시의 G대학 응급구조과 1학년 재학생으로 심폐소생술 교육 과정을 이수한 66명 중, 무작위추출과정을 통해 2011년 11월 8일부터 9일까지 실험군 31명, 대조군 32명으로 선정하였다. 바닥으로부터 10 cm 위치(재질: B4 Copy Paper)와 바닥 위치에는 공통으로 매트리스(재질: PVC, 사이즈: <TEX>$185{\times}125{\times}0.65cm$</TEX>)를 깔고 2분 동안 흉부압박 만을 시행하였다. 실험 처치는 Resusci Anne 마네킨 1대를 사용하였으며, Laerdal PC SkillReporting System으로 시행결과를 기록하였다. 수집된 자료는 SPSS 14.0 for Window으로 <TEX>$x^2$</TEX>-test와 Fisher's exact probability test, Mann-Whitney U-test, Wilcoxon signed rank test를 사용하였다. 연구결과, 심폐소생술 구조자의 무릎이 바닥으로부터 10 cm 높은 위치가 바닥 위치보다 흉부압박 적절한 깊이(회), 평균 흉부압박 깊이(mm)가 더 효과적이었는데, 신장 170 cm 이하 그룹, 몸무게 65 kg 이하 그룹에서 흉부압박의 적절한 깊이(회), 평균 흉부압박 깊이(mm)가 효과적 이었다. This study was conducted to examine the differences of the quality of chest compression between 10 cm higher position of rescuer's knee from the bottom and its bottom position during implementation of CPR. It selected randomly subjects out of 66 students who attend the Dept. of Emergency Medical Technology in G college, G metropolitan city as the first grader and divided them into 31 experimental group and 32 control group from Nov. 8 to 9, 2011. Mattress was spread 10 cm higher from the bottom(material: B4 Copy Paper) and on the bottom(material: PVC, size: <TEX>$185{\times}125{\times}0.65cm$</TEX>) and only chest compression was conducted for 2 minutes. Experiment was conducted with 1 Resusci Anne mannequin and the results of experiment were recorded with Laerdal PC Skill Reporting System. Data collected were analyzed with <TEX>$x^2$</TEX>-test and Fisher's exact probability test using SPSS 14.0 for Window, Mann-Whitney U-test, and Wilcoxon signed rank test. As a result of the study, it was found that 10 cm higher position of rescuer knee from the bottom than the bottom position and group below 170 cm in their height and 65 kg in their weight were more effective in proper depth of chest compression and average chest compression depth.

Inappropriate sexual behavior in a geriatric population.

To study the expression of D2R, MGMT and VEGF for clinical significance in pituitary adenomas, and to predict the potential curative medical therapy of dopamine agonists, temozolomide and bevacizumab on pituitary adenomas. Immunohistochemistry and western blot were performed to detect the expression of expression of D2R, MGMT and VEGF in pituitary adenoma tissue samples. The ratio of high expression of D2R, MGMT or VEGF in different subtypes of PA was compared by the use of chi-squared tests. The relationships between D2R, MGMT and VEGF expression were assessed by the Spearman rank correlation test. The association between their expression and clinical parameters was analyzed using a chi-squared test, or Fisher's exact probability test when appropriate. The data showed that in 197 different histological subtypes of pituitary adenomas (PAs), 64.9% of them were D2R high expression, 86.3% were MGMT low expression and 58.9% were VEGF high expression. D2R high expression existed more frequently in PRL- and GH- secreting PAs. MGMT low expression existed in all PA subtypes. VEGF high expression existed more frequently in PRL, ACTH, FSH secreting and non-functioning PAs. The data of western blot also support the results. Spearman's rank correlation analysis showed that expression of MGMT was positively associated with D2R (r = 0.154, P = 0.031) and VEGF (r = 0.161, P = 0.024) in PAs, but no correlation was showed between D2R and VEGF expression (r = −0.025, P = 0.725 > 0.05). The association between their expression and clinical parameters was analyzed using a chi-squared test, or Fisher's exact probability test when appropriate, but the result showed no significant association. PRL-and GH-secreting PAs exist high expression of D2R, responding to dopamine agonists; Most PAs exist low expression of MGMT and high expression of VEGF, TMZ or bevacizumab treatment could be applied under the premise of indications.