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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Objective:To investigate the clinical efficacy of perforator-based neurocutaneous flaps in repairing soft tissue defects of lower extremity in plateau area.Methods:Forty-eight patients who received perforator-based neurocutaneous local flaps to repair soft tissue defects of lower extremity from August, 2017 to December, 2019 were entered a follow-up study. The patients were 17 to 65 years old, 29 males and 19 females. There were 23 flaps with sural neurocutaneous perforator, 15 with saphenous neurocutaneous perforators, and 10 with superficial peroneal neurocutaneous perforators. The size of soft tissue defects ranged from 4.0 cm×3.5 cm to 15.0 cm×12.0 cm. And the size of the flaps ranged from 6.0 cm×4.5 cm to 16.0 cm×13.0 cm. The donor sites of 17 cases were directly sutured, and the rest of 31 were repaired by skin graft. The regular follow-up was performed.Results:Of the 48 cases, 33 neurocutaneous flaps survived completely, 9 had necrosis around edge of the skin after surgery and healed after hyperbaric oxygen therapy and dressing change, and 6 had complete necrosis after surgery and healed after vacuum assisted drainage and skin grafting. In 6 to 12(average, 9.6) months of follow-up after surgery, the shape and texture of flaps were in good condition with the patient satisfaction rate on functional evaluation(joint motions, standing, walking) at 75.45%.Conclusion:Perforator-based neurocutaneous flap is an excellent choice for the repair of soft tissue defects of lower extremity in plateau area because of its reliable blood supply and minimal damage to donor site.
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Objective To evaluate the difference of clinical short-term effect and adverse reaction between paclitaxel liposome and paclitaxel in non-small cell lung cancer patients with lymph node metastasis after pulmonary resection.Methods Sixty-eight patients after pulmonary resection were divided into two groups by random digits table method,37 patients in experimental group with paclitaxel liposome (135mg/m2) combined with carboplatin (CBP) at 300 mg/m2 in chemotherapy,and 31 patients in control group with paclitaxel (135 mg/m2) combined with CBP at 300 mg/m2 in chemotherapy.Results All patients were evaluable.In experimental group,5 patients had complete remission,10 patients had partial remission,17patients were stable,5 patients' condition aggravated,the total effective rate was 40.5％(15/37),clinical control rate was 86.5％ (32/37).In control group,2 patients had complete remission,8 patients had partial remission,15 patients were stable,6 patients' condition aggravated,the total effective rote was 32.3％(10/31),clinical control rate was 80.6％(25/31).The treatment effectiveness in experimental group was significantly higher than that in control group (P ＜ 0.05).The main adverse reaction included marrow suppression,hair loss,muscle and joint pain and gastrointestinal symptom,there was no serious hypersensitivity.The rate of hypotension,face flushing,paresthesia,muscle and joint pain,erythra in experimental group was lower than that in control group [0 vs.9.7％ (3/31),5.4％ (2/37) vs.19.4％ (6/31),10.8％ (4/37) vs.22.6％ (7/31),13.5％ (5/37) vs.38.7％ (12/31),5.4％ (2/37) vs.25.8％ (8/31)] (P ＜0.0 1 or ＜0.05).Conclusion The curative effect rate of paclitaxel liposome is better than paclitaxel in patients with lymph node metastasis after pulmonary resection and with lower incidence of side effects.
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Objective To evaluate the effect of propofol on lung cell apoptosis induced by acute pulmonary thromboembolism (APTE) .Methods Forty male SD rats weighing 280-300 g were randomly divided into 5 groups ( n = 8 each) : group Ⅰ sham operation ( group S) ; group ⅡAPTE and 3 propofol groups ( group P1-3). APTE was produced by iv injection of auto-blood clots. Venous blood 0.2 ml was obtained from rat tail vein and placed in a sterile test tube which was kept in water bath at 37 ℃ overnight. The blood clot was cut into thrombi ( diameter 1 mm, length 5 mm) the next day. Fifteen thrombi in 2 ml of normal saline were injected into immediately after iv injection of auto-bloed clots. The animals were killed at the end of 4 h propofol infusion and lung specimens were obtained for determination of lung cell apoptosis rate by flow eytometry and expression of caspase-3, Bax, Bcl-2, Fas, FasL mRNA and protein by RT-PCR and Western blot.The expression of Bcl-2/Bax mRNA and protein was calculated. Results Compared with group S,APTE significantly increased the lung cell apoptosis rate, and expression of caspase-3, Bax, Fas, FasL and decreased the expression of Bcl-2 and Bcl-2/Bax. Propofol infusion significantly attenuated these APTE-induced changes. Conclusion Propofol can inhibit APTE-induced lung cell apoptosis by down-regulating the caspase-3, Fas and FasL expression and regulating the balance between Bcl-2 and Bax expression.