Clinical characteristics and prognosis of 132 patients with surgical site infection / 医学研究生学报

ObjectiveSurgical site infection (SSI)is a type of common hospital-acquired wounds. The purpose of this study is to understand its clinical characteristics and prognosis in order to provide evidence for taking appropriate measures.Methods132 wound patients who met the diagnostic criteria of surgical site infection in the wound care center in recent 3 years were enrolled. The patients were treated locally with nanosilver dressing combined with red light and infrared ray. Individualized nutritional recipes and activity prescriptions were given, and the skin was showered every other day to heal or last 2 months.Observation indicators: demographics and wound characteristics; changes of area and depth after14 days intervention; the posi-tive rate of bacteria before and after the intervention, and healing rate and healing time of 2 months were analyzed and compared.ResultsA total of 132 cases of SSI(52.27% superficial and 47.73% deep ) was identified. The average age was 48.33±16.90 years. The average age and gender of the two groups were similar (P>0.05).Peri-wound skin is contaminated in all cases. The mean onset time of SSIs was 19.82±5.64 days, and the median onset time was 20 days. The onset time and duration of deep SSIs were longer than that of superficial SSIs (P0.05), and the depth of deep SSIs was deeper than that of superficial SSIs (P<0.05).The positive rate of bacterial culture inthe deep SSI group (79.31%) was higher than that of the superficial SSI group (59.46%) (P<0.05). After 14 days treatment, the area was smaller, the depth was lower (P<0.05), and the positive rate of bacteria was significantly decreased in the two groups (P<0.05). The healing rate ofsuperficial SSI group (84.06%) was higher than that of deep SSI group (66.67%) (P<0.05) in two months, and the healing time of superficial SSI group was significantly shortened (35.46<11.12 days vs 41.08<11.33 days, P<0.05). Logistic regression analysis showed that negative bacterial culture before intervention increased the healing index (OR=0.190). Long-term use of antibiotics did not promote healing (OR=0.343).ConclusionSuperficial and deep SSIs are common types of SSIs. Gender and age are similar, and skin contamination may play a role in the development of SSI,which needs attention. Local and systemic interventions can effectively improve wound healing. Negative bacterial culture and proper use of antibiotics can improve the healingprobability.

Risk factors of mortality in severe chest trauma patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the risk factors of mortality in patients with severe chest trauma (SCT).</p><p><b>METHODS</b>The clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors.</p><p><b>RESULTS</b>Seven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001).</p><p><b>CONCLUSIONS</b>Age, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.</p>

Prevalence and mortality of severe chest trauma in Three Gorges Area of China / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the epidemiological features of severe chest trauma (SCT) and investigate the risk factor of its mortality in the Three Gorges Area of China.</p><p><b>METHODS</b>The clinical data of 1834 SCT patients who were admitted in three hospitals in this area from January 1990 to December 2009 were retrospectively reviewed. Th epidemiological features of SCT were analyzed using a database. Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality.</p><p><b>RESULTS</b>The morbidity rates of blunt trauma (68.5% vs. 74.7%,p=0.006) and sharp instrument injury (12.2% vs. 15.9%,p=0.039) showed significant differences before and after 2000. The pre-hospital time [(3.45±2.38)h vs. (2.20±4.39)h,p<0.01] and transfer rate (32.39% vs. 36.80%,p=0.01) significantly improved. The thoracic Abbreviated Injury Scale (AIS)(3.56±0.71vs. 3.43±0.58,p<0.01)score and Revised Trauma Score (RTS)(7.14±2.18 vs. 6.93±1.07,p<0.01) significantly increased. Treatment for pulmonary infection (12.63±4.79 vs. 17.16±6.41,p=0.019) and hemorrhagic shock (2.4±0.75 vs. 3.4±1.34,p=0.008 )was significantly improved. The leading cause of death was hypovolemic shock (59.41%). The independent rik factors of death among these SCT patients included: hemorrhagic shock (B=1.710,OR=1.291,p=0.001), multiple organ dysfunction syndrome (B=3.453,OR=1.028,p<0.001), pulmonary infection(B=2.396,OR=10.941,p<0.001), abdominal organ injury(B=1.542,OR=1.210,p=0.005), and thorax AIS(B=0.487,OR=1.622,p<0.001).</p><p><b>CONCLUSIONS</b>The prevalence of SCT shows an increasing trend in the Three Gorges Area in recent years, but with a decreased rate of complications and improved treatment. Age, complications, thorax AIS, and GCS are useful prognostic indicators.</p>

Comparative analysis of characteristics and risk factors of traffic injury in aged people from urban and rural areas in Chongqing / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the epidemiologic characteristics of traffic injuries among people over 60 years old in the Nan'an district (urban) and Jiangjin district (rural) of Chongqing, and to discuss the corresponding strategies for its prevention and cure.</p><p><b>METHODS</b>Records of traffic injuries in people over 60 years old registered by the traffic police between 2000 and 2006 in Nan'an district and Jiangjin district were collected in the Database of Road Traffic Accidents and Traffic Injuries. Epidemiologic characteristics of traffic injuries among the aged people were analyzed and compared.</p><p><b>RESULTS</b>Between the year 2000 and 2006, the average annual incidence of traffic injuries and mortality rate in the aged people in Nan'an district were 124.62/100 000 and 13.85/ 100 000 respectively, higher than that in Jiangjin district (27.49/ 100 000, 7.13/100 000, P less than 0.01). However, the mortality rate for the aged people who were involved in traffic injuries in Jiangjin district was 20.60%, higher than that in Nan'an district (10.00%, P less than 0.01). Head injury was the primary cause of death. Totally 76.58% of casualties were pede-strians. Over 90% of the traffic accidents occurred in the areas with no traffic signal or traffic control system.</p><p><b>CONCLUSIONS</b>The traffic environment is unfavorable to the aged people. It is important to enhance traffic safety consciousness of drivers and the elderly and to strengthen traffic safety system and traffic law, so as to provide a safe road traffic environment for the aged people.</p>

Experimental study on calibration system of side-impact dummy neck / 医用生物力学

Objective To investigate the design approaches and manufacturing techniques for the calibration system of side impact dummy neck. Method The ES-2 side impact dummy neck was selected as the research subject and a set of calibration system of ES 2 side impact dummy neck was developed in this experiment according to the pendulum impact theory, and the new design approaches and new manufacturing techniques suitable for the present industrial conditions in China were created to establish its two key components: the pendulum device and the head-neck flexion angle measurement device. The optimal designs for the quality distribution and inertia moment distribution of the whole pendulum were also carried out to assure the pendulum initial velocity and the pendulum impact velocity time curve during the pendulum absorber impact, while optimal designs for three angle sensors and the complex stereoscopically dependent relationship among those three sensors were carried out to assure the reliability of the head neck flexion angle measurement device. Correspondingly, a total of six calibration tests were carried out to validate this calibration system in terms of the technical requirements of ECE R95. Results The pendulum initial velocity of 3.36～3.48 m/s and the pendulum impact velocity time curve during the pendulum absorber impact, which were generated by the pendulum device in this calibration system of ES 2 side impact dummy neck, were in accordance with the ECE R95. Meanwhile, the head neck flexion angle measurement device of this calibration system was sufficient to detect the following three target angle values more accurately: the maximum values of fore pendulum base angles, the maximum values of aft pendulum base angles, and the maximum values of head neck complex flexion angles. Conclusions The calibration system of ES-2 side impact dummy neck is basically capable of meeting the demands of the existing international rule, the ECE R95. Besides, this neck calibration system is convenient and practical, and its design approaches and manufacturing techniques are likely to find the wider application in the impact biomechanics field.

Effects of low frequency resonance on physiological function in rats / 医用生物力学

Objective To study the effect of continuous low frequency resonance on blood pressure, heart rate, breath rate and body temperature of the rat so as to provide basic data for the study of organs’ resonance injury and its reaction. Method Thirty two SD rats were divided into four groups randomly: false vibration group, 3 Hz vibration group, 6 Hz vibration group and 21 Hz vibration group. Femoral artery intubatton was given after anaesthesia with 1.5% sodium pentobarbital. All the rats were fastened on their back on the vibration platform staying calmly for 30 min. Then the vibration groups were given sine wave vibration with 5 mm amplitude(p-p), while the blood pressure, heart rate, breath rate and body temperature of the rats were measured at 0, 1, 3, 5, 10, 30, 60, 120, 180, 240, 300 and 360 min. The above physiological data were also observed in false vibration group at corresponding time. Results Continuous low frequency resonance could cause the blood pressure, heart rate, breath rate of the rat to rise rapidly after 1 min of vibration, and to reach the maximum value after 1 min to 3 min of vibration, and then to descend gradually and to be lower than the normal value after 30 min of vibration. The body temperature of the rat did not change at the beginning of vibration, but descended gradually after 10 min of vibration. At the beginning of vibration, the effect of 6 Hz resonance on blood pressure, heart rate, breath rate was dominating, while at the later stage, 3 Hz resonance was dominating. But the effect of the two frequencies on body temperature was accordant. Conclusions Continuous low frequency resonance can cause the blood pressure, heart rate, breath rate of the rat to rise rapidly at the beginning of vibration and then to descend gradually, and it can also depress the ability of body temperature regulation in rats.

Analysis of injuries and treatment of 3,401 inpatients in 2008 Wenchuan earthquake--based on Chinese Trauma Databank / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008 and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters.</p><p><b>METHODS</b>Based on inpatients'medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients'general information, causes, clinical characteristics and treatment of injuries were studied.</p><p><b>RESULTS</b>Main causes for seismic injuries were blunt strike (68.2%), crush/burying (18.7%) and slip/falling (11.5%). Slip/falling was the main cause for spinal injuries and accounted for 19.1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8% of all injuries. Fractures accounted for 53.1%. Lower extremity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury. The proportion of spinal injuries with AIS larger than or equal to 4 was higher than that of other injured locations except for the abdomen. Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively.</p><p><b>CONCLUSIONS</b>Blunt strike, crush/burying and slip/falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine. Multiple injury patients were mainly treated by operation, including debridement and suturation, closed reduction and external fixation, etc.</p>

X-ray observation on how axial compression stimulates tibial fracture healing / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.</p><p><b>METHODS</b>Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups: the control group (C Group, n equal to 6) without application of any axial compression stress stimulation postoperatively and the stimulation group (S Group, n equal to 90). The S Group was further divided into 20 subgroups (S11 to S54) in terms of 5 axial compression stress stimulation levels (112.8 kPa, 289.8 kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa) and 4 experimental endpoints (1, 3, 5 and 8 weeks after operation). A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process.</p><p><b>RESULTS</b>At 8 weeks after operation, there existed a "arch shape" relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels (0-602.3 kPa), no obvious healing effect was found.</p><p><b>CONCLUSIONS</b>It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.</p>

Influence of distal tibiofibular synostosis on ankle function / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the influence of distal tibiofibular synostosis on ankle function.</p><p><b>METHODS</b>From October 1998 to October 2004, a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula. Distal tibiofibular synostosis occurred after operation in 8 patients. The duration of follow-up averaged 20.6 months (14-44 months). The ankle function was assessed on the basis of functional rating system described by Mazur.(1)</p><p><b>RESULTS</b>According to Mazur's ankle evaluation system, 4 patients achieved an excellent result, 2 a good result and 2 a fair result. The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle, and there was little influence on the plantar flexion. All the patients had a normal gait.</p><p><b>CONCLUSION</b>The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.</p>

Road crash in China from 2003 to 2005 / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.</p><p><b>METHODS</b>The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.</p><p><b>RESULTS</b>From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100,000 persons and per 10,000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450,000 and deaths to 99,000, with the mortality rate per 10,000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2% and 26.6% of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.</p><p><b>CONCLUSIONS</b>At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.</p>

Motorcycle accidents in China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005.</p><p><b>METHODS</b>We collected data on possession of motorcycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package.</p><p><b>RESULTS</b>During 6 years, the number of motorcycle accidents were up to 122,300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26,200 deaths and 157,500 injuries in 2005. The mortality per 10, 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles (P less than 0.01).</p><p><b>CONCLUSIONS</b>China has attached great importance to the management of traffic safety, which is beneficial to control and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.</p>

Comparative observation of protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP).</p><p><b>METHODS</b>The hearing thresholds of the guinea pigs were assessed with auditory brainstem responses (ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection.</p><p><b>RESULTS</b>An important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa ( P<0.01). The rate of perforation of tympanic membrane reached 87.5% and that of total OHCs loss was 19.46% +/- 5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01).</p><p><b>CONCLUSIONS</b>The earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.</p>

Treatment of displaced radial head fractures by internal fixation with absorbable pins / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures.</p><p><b>METHODS</b>From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason types II and III) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey.</p><p><b>RESULTS</b>All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15 degrees (0 degrees-35 degrees), and pronation and supination decreased by 10 degrees (0 degrees-30 degrees) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey.</p><p><b>CONCLUSIONS</b>Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.</p>

Molecular mechanism of anti-apoptotic action of survivin in NCI-H446 lung cancer cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate cell apoptosis induced by survivin ASODN and clarify the precise mechanism of anti-apoptotic action of survivin.</p><p><b>METHODS</b>Cells of lung cancer cell line NCI-H446 were treated with survivin ASODN at different concentrations. The changes of survivin mRNA and protein expression were assessed by RT-PCR and Western blot assay. The apoptosis index (AI) and proliferation index (PI) were determined by flow cytometry (FCM). After 500 mmol/L survivin ASODN treatment, cells were stained with Rh123 to detect changes of mitochondrial membrane potential (deltapsim) by FCM. The concentration of cytoplasmic cytochrome c (cyt-c) was continuously determined by ELISA. Relative activities of caspase-9 and caspase-3 were assessed by colorimetric assay. The expression of caspase-8 protein was measured by Western blot assay. The apoptotic rates of lung cancer cells induced by survivin ASODN with or without mitochondrial permeability transition pole (MPTP) inhibitor CsA treatment were assessed by FCM.</p><p><b>RESULTS</b>Down-regulated survivin mRNA was shown to be in dose-dependent and time-dependent manners. Its maximal effect was achieved at a concentration of 500 nmol/L for 72 h, at which mRNA was down-regulated by 62.7%, the expression of survivin protein in NCI-H446 cells was also obviously decreased. After treatment with survivin ASODN at concentration of 500 mmol/L for 72 h, AI was 48.35%, higher than that of control, lipofectin, NSODN, survivin ASODN 100 mmol/L and 300 mmol/L groups (3.75%, 3.41%, 4.69%, 19.85% and 34.39%, respectively). PI was 24.38%, lower than that of control, lipofectin, NSODN, survivin ASODN100 and 300 mmol/L groups (75.74%, 73.12%, 71.76%, 51.03% and 38.94%, respectively). Deltapsim was decreased in 9.54% of NCI-H446 cells treated with survivin ASODN for 3 h and 97.06% for 24 h. Following it, release of cyt-c from mitochondria to cytosol and activation of caspase-9 and caspase-3 increased significantly. The above mentioned indicators changed with a time-dependent and time diversity relationship. In the presence of CsA, the apoptotic rate of lung cancer cells induced by survivin ASODN was decreased significantly. No up-regrulation and activation in caspase-8 protein was observed.</p><p><b>CONCLUSION</b>Survivin inhibits apoptosis via regulation of mitochondrial-dependent pathway. survivin ASODN can not only induce apoptosis but also inhibit cell proliferation through blocking the expression of survivin mRNA and protein.</p>

Construction of the subtractive cDNA library of injured adult and fetal rabbit skins / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Early gestational mammalian fetuses possess the amazing ability to heal cutaneous wounds in a scarless fashion. Over the past years, scientists have been working to decipher the mechanisms underlying this regenerative repair. The remarkable phenotypic differences between fetal and adult healings behooves us to learn their characteristics in genetics, which represents potentially important mechanisms involved in wound repair observed in fetal versus adult tissues. In this sense, it is reasonable to construct subtractive cDNA library for future research.</p><p><b>METHODS</b>Middle laparotomy and hysterotomy were performed on pregnant rabbits at 20-day gestation to expose the fetal back, and a longitudinal incision through the skin was made on the back of the fetus. The traumatized fetal skin was harvested 12 hours post-operation, the fetus control and traumatized adult skin specimens were taken at the same time. dscDNA was synthesized from total RNA of skin samples with SMART technology. Taking one of the three samples as Tester respectively and the other two as Drivers, we obtained 1 forward and 2 reverse hybridization products. After being amplified with selective polymerase chain reaction, the products were inserted into a vector, and then transferred into E. coli HB101. The colonies were screened afterwards.</p><p><b>RESULTS</b>The wounded fetuses were alive for a long time even after birth. Every determinant step, such as RNA isolation, cDNA synthesis, Rsa I digestion, adaptor ligation and hybridization, was well-operated. Subtractive efficiency identification demonstrated that the suppression subtractive hybridization (SSH) was successful. Insertion into vector and transferring to E. coli were satisfactory.</p><p><b>CONCLUSIONS</b>Instead of classic SSH, an improved SSH with 2 Drivers was applied for the experiment. Results confirmed that the improved program was reasonable and correct in both theory and practice. The subtractive cDNA library we have obtained is going to be used for future researches to reveal scarless healing related gene(s) and its (their) expression.</p>

Effect of environment on extremely severe road traffic crashes: retrospective epidemic analysis during 2000-2001 / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To make an epidemiological analysis of the effect of environment on extremely severe road traffic crashes (RTCs).</p><p><b>METHODS</b>Epidemiologic data of extremely severe RTCs associated with environmental factors, including weather, topography, road conditions and other traffic conditions in Mainland China during 2000-2001, were collected and analyzed.</p><p><b>RESULTS</b>(1) During 2000-2001, there were 3365 extremely severe RTCs with 13666 deaths, 12204 injuries and a direct economical loss of 136 million RMB. (2) Most extremely severe RTCs occurred in fine weather days and in the daytime. The high occurrence sites were plain areas, horizontal and straight roads, Grade B and C roads, ordinary road segment, and asphalt, smooth and mixed roads. (3) Compared with other RTCs, extremely severe RTCs were more likely to happen under following conditions: on cloudy, snowing, misty and blustering days; in hill and mountainous areas; on crooked and sloping roads; on freeway, Grade A, B, and C roads; mixed roads; ordinary, bridge, narrow and transitional roads; sand and dirt-roads; without traffic control measures; night without lighting. (4) Extremely severe RTCs of mountainous area or crooked and sloping roads were most severe in terms of deaths and injures per crash.</p><p><b>CONCLUSIONS</b>Extremely severe RTCs are closely related with environmental factors. Rational road programming, enhancing road establishment and improving road conditions are probably effective measures to reduce the road traffic injuries.</p>

Changes of balance between proteinase and their inhibitors in blood of pigs with high-velocity missile wounds / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the effect of imbalance between lysosomal enzymes and their inhibitors in blood on disturbance of the local and whole body after trauma.</p><p><b>METHODS</b>The dynamic changes of lysosomal enzymes and proteinase inhibitors were studied in 12 pigs with femoral comminuted fractures in both hind limbs caused by high velocity missiles. Four normal pigs served as controls.</p><p><b>RESULTS</b>After injury, the activity of Cathepsin D in arterial plasma increased gradually and reached the highest level at 8 hours, acid phosphatase in serum began to increase at 12 hours and the value of serum elastase did not change significantly. The level of alpha1-antitrypsin, a proteinase inhibitor in plasma, decreased significantly in the early stage after injury [73.5%+/-6.4% and 81.0%+/-5.1% of the baseline value (1.67 micromol x ml(-1) x min(-1)+/- 0.29 micromol x ml(-1) x min(-1)) at l and 2 hours after injury, respectively, P<0.05], then increased gradually and was higher than the baseline value at 12 hours after injury.</p><p><b>CONCLUSIONS</b>Imbalance between lysosomal enzymes and proteinase inhibitors occurs soon after injury, which might result in continuous tissue damage and play an important role in the disturbance of general reaction after injury.</p>

The analysis of epidemiological characteristics of road traffic crashes in a mountain city in western China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the epidemiological characteristics and preventive methods of road traffic crashes in a mountain city in western China through sampling investigation of traffic crashes in different regions of Chongqing city in recent years.</p><p><b>METHODS</b>Two police teams of traffic management in downtown, two teams in suburb, one team in county and one freeway team were randomly selected, and road traffic crashes between 1988 and 1997 were investigated and analyzed.</p><p><b>RESULTS</b>A total of 13121 road traffic crashes with 6201 crashes with casualties were analyzed. The incidence of crashes was higher in May, June and July, and on Friday and Wednesday and at 8:00-12:00 and 14:00-18:00 within a day. Casualties were 44.0% in pedestrians and 42.5% in passengers of total casualties. The deaths and severe injuries in pedestrians were 59.1% of total deaths and 56.4% of total severe injuries. The age of drivers and passengers were mainly at 18-30 years, followed by 31-40 years. People over 60 years old accounted for 24.1% of total pedestrian casualty. Head injury was the most common reason for deaths. The main reasons for these crashes were improper driving and violating traffic laws. Violating traffic laws by pedestrian was one of the main reasons for pedestrian casualty.</p><p><b>CONCLUSIONS</b>The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing. The traffic casualty of pedestrian is a big problem in Chongqing. To prevent and decrease road traffic injuries effective methods should be worked out and propaganda on traffic safety and traffic management should be strengthened according to different characteristics of different regions. To strengthen the first aid and treatment of cranium-brain injury and chest-back injury is also helpful in decreasing traffic deaths.</p>

Changes of pulmonary intercellular adhesion molecule-1 and CD11b/CD18 in peripheral polymorphonuclear neutrophils and their significance at the early stage of burns / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the accumulation of polymorphonuclear neutrophils (PMN) in the lungs at the early stage of burns.</p><p><b>METHODS</b>Myeloperoxidase content in lung tissues and bronchoalveolar lavage fluid (BALF) were detected. ICAM-1 and its mRNA expression in lung tissues were determined by immunohistochemical method and in situ hybridization. CD11b/CD18 expression on the peripheral PMNs was measured by flow cytometry.</p><p><b>RESULTS</b>The levels of myeloperoxidase in lung tissues and BALF after burn injury were markedly higher than those of control. Expression of ICAM-1 and its mRNA in the lung tissues and CD11b/CD18 on peripheral PMNs surface was significantly increased at 2, 6, 12, 24 h after burns.</p><p><b>CONCLUSIONS</b>PMNs accumulation in the lungs is related to increased ICAM-1 expression on pulmonary microvascular endothelial cells and CD11b/CD18 expression on PMN at the early stage of burn injury.</p>

Study on trauma of tympanic membrane and ossicular chain of guinea pigs exposed to experimental blast underpressure / 中华创伤杂志

Objective To probe into the characteristics of traumatic effect of blast underpressure (BUP) on tympanic membrane and ossicular chain of guinea pigs exposed to blast underpressure. Methods The guinea pigs were exposed to experimental BUP generated by the underpressure generator and their tympanic membranes and auditory ossicules were observed with stereo-microscope.Results Most of the tympanic membranes in 72 guinea pigs (141 ears) presented with traumatic changes,such as engorgement,haemorrhage,epidermic desquamation and perforation,combined with fracture of ossicles in some guinea pigs.The traumatic severity of the tympanic membranes and auditory ossicules was related to the peak and the declinating duration of BUP.The minimum peak of the underpressure inducing perfo- ration was between-22.4kPa and-23.9kPa and the minimum peak inducing perforation of all the tym- panic membranes was between-83.1kPa and-87.2kPa.Conclusion The tympanic membrane in guinea pigs exposed to BUP changed traumatically,such as engorgement,haemorrhage,epidermic des- quamation,perforation and fracture of ossicles.The traumatic severity of the tympanic membranes and au- ditory ossicules is related to the peak and declinating duration of BUP.