Design and application of fiberoptic bronchoscopy training box / 第二军医大学学报

Objective: To design and prepare a fiberoptic bronchoscopy training box and to study its primary application. Methods: According to the length of optical fiber, the height, the length and the width of the box were set at 400 mm, 200 mm and 200 mm. The box contained 6 layers from the top to the bottom: the top-layer, layer-A, layer-B, layer-C, layer D and the bottom layer, with the area of each layer being 200 mm × 200 mm and the distance between each 2 layers was about 80 mm. According to the diameter of optical fiber, the diameter of the holes was set at 6 mm. Except for the bottom-layer, the other 5 layers had different numbers of holes: the top-layer and layer-A only had a central hole(central hole in every layer was defined as hole-0), layer B had 5 holes(hole-0 to 4), layer C had 9 holes(hole-0 to 8), layer D had 17 holes(hole-0 to 16). The training started from the top-layer. The orders were given according to the layers and the numbers of the holes and the orders were executed, then the box was open to examine the outcome of the execution. Results: We successfully designed a fiberoptic bronchoscopy training box. If the training instruction order was A0-B2-C4-D7, the trainees should manipulate the optical fiber via the central hole in top-layer and layer-A, hole-2 in layer B, hole 4 in layer-C, and hole-7 in layer-D. The results of manipulation can be examined after opening the door. Conclusion: The fiberoptic bronchoscopy training box is a easy-to-operate and practical tool for training of fiberoptic bronchoscopy manipulation.

Treatment of severe crush syndrome caused by earthquake: a report of 35 cases / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of the crush syndrome in the earthquake.</p><p><b>METHODS</b>Thirty-five patients with crush syndrome caused by earthquake were involved the retrospective study. The role of nutritional support, active wound treatment and hemodialysis on the patients' recovery was observed.</p><p><b>RESULTS</b>The function of the heart and kidneys were gradually improved by the planned removal of the necrotic tissue, which laid a foundation for the further repair of the wound.</p><p><b>CONCLUSION</b>The removal of necrotic tissue, which can decrease the toxic absorption, will improve the success rate for treatment of the crush syndrome patients when being assisted with the hemodialysis.</p>

Retrospective analysis on acute respiratory distress syndrome in ICU / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).</p><p><b>METHODS</b>A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference (AECC). Acute physiology and chronic health evaluation III (APACHE III), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.</p><p><b>RESULTS</b>Totally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left, accounting for 2.2% of the total admitted patients. Their average ICU stay was (11.27+/-7.24) days and APACHE III score was 17.23+/-7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE (base excess). The hospital mortality was 55.7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS > or = to 8, and LIS > or = 2.76.</p><p><b>CONCLUSIONS</b>ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.</p>