Risk factors and risk model construction of coronary heart disease in patients with type 2 diabetes mellitus in Suining area / 公共卫生与预防医学

Objective To analyze the risk factors of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2M) in Suining area, and build a risk prediction model to provide theoretical basis for the prevention and treatment of CHD in PATIENTS with T2M. Methods A total of 476 T2M patients treated in our hospital from January 2021 to December 2021 were selected and divided into experimental group (n=79) and control group (n=397) according to whether they had coronary heart disease. The angiographic characteristics of coronary artery lesions in patients with T2M combined with coronary heart disease were observed. Age, sex, body mass index (BMI), smoking, alcohol consumption , T2M course, FBG, FINS, HOMA, TC, LDL-C, SBP, DBP and UA levels of all patients were analyzed. Univariate analysis and Logistic regression were used to analyze the influencing factors of coronary heart disease and establish a risk prediction model. ROC curve was used to predict the efficiency of the model. Results A total of 79 cases (16.60%) of patients with T2M complicated with coronary heart disease, including 64 cases (81.01%) of patients with T2M complicated with coronary artery disease. Mild stenosis in 5 cases (6.33%), moderate stenosis in 20 cases (25.32%) and severe stenosis in 54 cases (68.35%); The mean age, smoking proportion, BMI, T2M course and the levels of FBG, FINS, HOMA-IR, TC, LDL-C, SBP, DBP and UA in experimental group were significantly higher than those in control group (P-(-0.513+0.919×(old age)+1.129×(increased SBP)+ 1.724×(increased FBG)+ 1.529×(increased LDL-C)]. ROC curve was used to analyze the predictive performance of the regression model. The results showed that the AUC of the risk prediction model for coronary heart disease in T2M patients was 0.728, 95% CI (0.651-0.829). Conclusions T2M patients in Suining have a high risk of coronary heart disease. For elderly patients with elevated SBP, LDL-C and FBG, the risk of coronary heart disease can be assessed by predictive model and targeted intervention measures can reduce the risk of coronary heart disease in T2M patients.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Clinical record analysis of 54 cases with automatic external defibrillator in public of mainland china / 中华急诊医学杂志

Objective:To analysis the clinical characteristics of The clinical characteristics of using automated external defibrillation in the public place,To explore the feasibility and effectiveness of AED application in public places in China.Methods:From January 2014 to April 5, 2019, 54 cases of on-site emergency medical records of AED use in public places in China were analyzed retrospectively from three aspects: patient and AED user attributes, and AED clinical performance.Results:After field application of AED analysis, 54 patients did not have out of hospital cardiac arrest in 9 patients; cardiac arrest in 45 patients, cerebral resuscitation in 40 patients (88.9%), death in 5 patients (11.1%), one of them died in hospital. The accuracy of AED for defibrillation rhythm recognition and defibrillation recommendations was 100%. The success rate of shock to VF was 97.22%, and that of non pulse VT was 100%. The data shows that AEDs of different brands show clinical effectiveness in the core indicators of work. The operation level of the rescuer determines the critical time of AED shock, which is closely related to the prognosis of the patient ( P<0.05) . Conclusions:AED is reliable and effective in electric shock decision and performance.The overall efficiency of AED application can be improved by strengthening training, shortening the critical time of electric shock, rational configuration and effective management.

Relationship between expression of miR-203 and FGF-2 in children with hemangiomas and its significance / 国际儿科学杂志

Objective:To analyze the expression levels of microRNA-203(miR-203)and fibroblast growth factor-2(FGF-2)in hemangiomas of infancy(HOI)and to explore their clinical significance.Methods:A total of 55 patients with HOI admitted to our hospital from March 2016 to August 2017 were selected as HOI group and divided into proliferative phase(31 cases)and regressive phase(24 cases), normal tissue specimens were taken as control group(34 cases). Real time fluorescence quantitative PCR(qRT-PCR)was used to detect the expression levels of miR-203 and FGF-2 mRNA in HOI tissues.Immunohistochemistry was used to detect the expression of FGF-2 protein in HOI tissues.Clinical indicators of HOI patients included angiogenin(ANG), vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF), glucocorticoid receptor alpha(GRα), glucocorticoid receptor beta(GRβ). Pearson method was used to compare and analyze the correlation between various indicators in children with HOI group.Logistic multivariate regression analysis was used to analyze the related influencing factors of HOI.Results:Compared with the control group(1.01±0.15), the expression level of miR-203 in HOI group(0.73±0.24)decreased significantly( P<0.05), and the proliferative phase(0.72±0.21)was significantly higher than the regression phase(0.59±0.19)( P<0.05); the expression levels of FGF-2 mRNA and protein in HOI group(2.38±0.74)were significantly higher than those in control group(1.02±0.14)( P<0.05), and the regression phase(2.37±0.79)was significantly higher than the proliferative stage(2.03±0.68)( P<0.05); Pearson analysis showed that miR-203 was negatively correlated with FGF-2, ANG, VEGF and bFGF( P<0.05), while FGF-2 was positively correlated with them( P<0.05); Logistic analysis showed that the expression levels of miR-203 and FGF-2 were both influencing factors of HOI. Conclusion:MiR-203 is low expressed in HOI, while FGF-2 is highly expressed.There is a significant difference in the expression changes of the two in HOI stages and it is important for clinical diagnosis of HOI and treatment.

Common errors analysis on measuring the APPLS related future liver remnant with CT′s image post-processing software / 中华普通外科杂志

Objective:To explore whether CT image post-processing software can accurately measure (associating liver partition and portal vein ligation for staged hepatectomy, ALPPS) related (future liver remnant, FLR).Methods:Clinical data of 9 liver cancer patients undergoing ALPPS were retrospectively analyzed in the Second Affiliated Hospital of Air Force Military Medical University from Mar 2015 to May 2019. All cases were divided into 2 groups by measurement: CT′s image post-processing software, or Myrian software. Two groups were compared with each other by paired t-test. Results:FLR from group CT′s image post-processing software was larger than that by Myrian software, there was statistical difference ( t=2.512, P=0.019). The mistakes of FLR measurements by the radiologist using CT′s image post-processing software couldbe caused by: (1)Lacking theoretical knowledge of liver surgery; (2) Adding devitalized tissue of hepatic section into future liver remnant; (3) Concept confusion about liver anatomy; (4) Lack of precision measurement. Conclusions:The inaccuracies generated during the ALPPS related future liver remnant measurements in CT′s image post-processing technique are all caused by human factors. These problems could be solved if the radiologist who operates 3D reconstruction receives liver surgery training or works with liver surgeons.

A survey of the practice of non-invasive positive pressure ventilation in emergency department in China / 中华急诊医学杂志

Objective To investigate the application of non-invasive positive pressure ventilation in emergency department in China.Methods A questionnaire survey was carried out in the emergency department in China,then the results were analyzed.Results Out of the 317 hospitals,non-invasive ventilators were available in the emergency department in 150 clinics (47.3％).Among them,144 clinics were the tertiary hospitals,and 6 clinics were the secondary hospitals.The leading five causes for NPPV were as follows:acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) (29.7％),acute cardiogenic pulmonary edema (23.2％),ventilator weaning (11.2％),acute respiratory distress syndrome (ARDS) (9.0％),and extubation failure (8.7％).The bi-level positive airway pressure (BiPAP) S/T was the most commonly used ventilation mode (51.8％),followed by the continuous positive airway pressure (CPAP)(30.3％) and BiPAP (S)(12.5％).The oronasal mask (73.7％) and the nasal mask (24.2％) were the most favorable interfaces for NPPV.The reasons for NPPV underusing mainly included insufficient training (36.8％),lacking of related knowledge (22.9％),medical teaching staff shortage (21.1％) and poor compliance of patients (11.0％).The main causes of the failure of NPPV were as follows:poor tolerance (31.5％),irrational parameters setting (25.6％),unfitness of interface (17.8％),airway secretions (14.7％),and disorders of consciousness (10.4％).Conclusions In China,the types of patients most commonly treated with NPPV in the emergency department are those with AECOPD and acute cardiogenic pulmonary edema.Barriers to popularize the use of NPPV in the emergency department include availability of equipment,physician with familiarity in operating the NPPV,and human resources required for NPPV.

The clinical application of adjustable negative pressure drainage technique in the treatment of subcutaneous acute cellulitis / 临床外科杂志

Objective To investigate the clinical effect of adjustable negative pressure drainage technique in the treatment of subcutaneous acute cellulitis.Methods Thirty patients with acute cellulitis were treated with adjustable pressure drainage technique after incision and drainage of subcutaneous infection.Results 22 patients with subcutaneous infectious wounds took the secondary suture after carrying out one-time regulated negative pressure therapy,and 8 patients with subcutaneous infectious wounds took the secondary suture after carrying out twice negative pressure therapies.The average time of negative pressure treatment was (7.3 ± 1.0) days.Thirty patients had subcutaneous infection wounds healed well and no recurrence was observed at 3 months follow-up.ConclusionThe repairment of negative pressure therapy adopted to treat the subcutaneous acute cellulitis can rapidly reduce the local and general symptoms of the patient,and apparently reduce the dressing change times.With simple operation and reliable curative effect the relapse rate of subcutaneous infectious wound can be enormously reduced.

The clinical application of adjustable negative pressure drainage technique in the treatment of subcutaneous acute cellulitis / 临床外科杂志

Objective To investigate the clinical effect of adjustable negative pressure drainage technique in the treatment of subcutaneous acute cellulitis.Methods Thirty patients with acute cellulitis were treated with adjustable pressure drainage technique after incision and drainage of subcutaneous infection.Results 22 patients with subcutaneous infectious wounds took the secondary suture after carrying out one-time regulated negative pressure therapy,and 8 patients with subcutaneous infectious wounds took the secondary suture after carrying out twice negative pressure therapies.The average time of negative pressure treatment was (7.3 ± 1.0) days.Thirty patients had subcutaneous infection wounds healed well and no recurrence was observed at 3 months follow-up.ConclusionThe repairment of negative pressure therapy adopted to treat the subcutaneous acute cellulitis can rapidly reduce the local and general symptoms of the patient,and apparently reduce the dressing change times.With simple operation and reliable curative effect the relapse rate of subcutaneous infectious wound can be enormously reduced.

Expression of miR-146b in peripheral blood serum and aortic tissues in patients with acute type Stanford A aortic dissection and its clinical significance / 中南大学学报(医学版)

Objective:To explore expression of miR-146b in peripheral blood serum and aortic wall tissues in patients with acute Stanford type A aortic dissection (TAAD),and to discuss the significance and underlying mechanisms.Methods:The subjects were divided into a control group (excluded relative aortic diseases) (n=23) and a TAAD group (n=27).The miR-146b levels of serum and aortic wall tissues were detected by quantitative real-time PCR (qRT-PCR).Serum miR-146b and aortic wall tissues miR-146b were compared among different risk TAAD groups.The correlations between miR-146b and severity of aortic dissection were analyzed.MiR-146b related target genes were predicted by the DIANA LAB-TarBase 6.0 and TargetScan.Results:The expression levels of miR-146b in the serum and aortic wall tissues in the TAAD group were significantly elevated compared with those in the control group (P＜0.001).Compared with the mild risk group,the miR-146b levels of serum and aortic wall tissues were significantly higher in the moderate risk and severe risk groups (P＜0.05).The expression of miR-146b was positively correlated with the risk severity of TAAD patients (r=0.862,0.872;P＜0.05).Nuclear factor kappa B1 (NF-κB1),tumor necrosis factor receptor-associated factor 6 (TRAF6),matrix metalloproteinase 16 (MMP16) and actin alpha 2 (ACTA2) were miR-146b related target genes.Conclusion:The upregulation of miR-146b in peripheral blood serum and aortic wall tissues may contribute to the pathogenesis of TAAD and the severity of this disease.

Clinical effect of precise sequential interventional therapy in patients with unresectable hepatic metastasis after surgery for colorectal cancer / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of precise sequential interventional therapy in patients with unresectable hepatic metastasis after surgery for colorectal cancer. MethodsThe clinical data of 63 patients with unresectable hepatic metastasis after surgery for colorectal cancer, who were admitted to Air Force General Hospital, PLA from January 2005 to September 2012, were collected. According to therapeutic methods, these patients were divided into precise sequential interventional therapy group (group A, 33 patients) and systemic chemotherapy group (group B, 30 patients). The patients in group A underwent transcatheter arterial chemoembolization and radiofrequency ablation, and those in group B underwent systemic chemotherapy. The percentages of peripheral blood CD3+, CD4+, and CD8+ T cells and CD4+/CD8+ ratio were measured before and after the initial treatment. The level of carcinoembryonic antigen (CEA) was measured and compared before the initial treatment and after the final treatment, and follow-up was conducted to observe tumor progression and survival. The t-test was applied for comparison of continuous data between groups; the chi-square test was applied for comparison of categorical data between groups; the Wilcoxon rank sum test was applied for comparison of clinical effect; the Log-Rank test was applied for comparison of survival rate. ResultsIn group A, the percentages of CD3+, CD4+, and CD8+ T cells and CD4+/CD8+ ratio changed significantly after the initial treatment (t=4.52, -3.27, 2.95, and 4.54, all P＜0.05); serum CEA level also changed significantly after treatment(3876±957) μg/ml vs (1053±862) μg/ml, t=213,P=003). The serum level of CEA after the final treatment showed a significant difference between group A and group B (10.53±8.62) ug/L vs (35.21±1022) μg/L; t=5.23, P＜0.01). Group A had a significantly higher objective response rate than group B (66.7% vs 43.3%; Z=-2.042, P=0041). Group A had a significantly longer survival time than group B, and group A had a significantly higher surrival rate than group B(455% vs 233%， χ2=397,P=0046). ConclusionIn patients with unresectable hepatic metastasis after surgery for colorectal cancer, precise sequential interventional therapy can improve their immune function, increase clinical outcome, and prolong survival time.

Study on the Determination Method for Related Substances in Bisacodyl Raw Material and Enteric-coated Tablet / 中国药房

OBJECTIVE:To establish a method for the determination of related substances in bisacodyl raw material and enteric-coated tablet. METHODS:HPLC was performed on the column of Hibar C18 with mobile phase of acetonitrile-20 mmol/L ammonium acetate (acetic acid adjust pH to 5.0)(55∶45,V/V),detection wavelength was 265 nm,flow rate was 1.0 ml/min, column temperature was 30℃,and the injection volume was 20 μl. RESULTS:The linear range of bisacodyl was 0.25-5.0 mg/ml (r=0.999 9);the limits of detection and quantification were 19-25 ng and 61-68 ng for bisacodyl and impurity A,B,C,D and E;RSDs of precision,stability and reproducibility tests were lower than 2%;recovery was 99.50%-101.00%(RSD=0.5%,n=9). CONCLUSIONS:The method is specific, sensitive and reproducible, and can be used for the determination of related substance in bisacodyl raw material and enteric-coated tablet.

Echocardiography analysis of bama minipigs anesthesia by xylazine hydrochloride / 中国比较医学杂志

Objective To explore effect of Xylazine hydrochloride on Bama minipigs under general anesthesia. To emphasize safety consciousness of general anesthesia. To research cardiac main function and structure of normal Bama minipigs in preparation for the subsequent comparative medicine research. Methods 43 Bama minipigs, inject in post aurem muscles of neck with 5 mL of mixed drug conclude Xylazine hydrochloride (2 mL), Atropine Sulfate(1 mL) and Droperidol(2 mL) on each one. Echocardiography after general anesthesia. Observe induction and recovery time of anesthesia, anesthesia maintaining time, total check time and the others. Introduce the method of simple endotracheal intubation. Results Anesthesia, induction period (18 ±3)min, maintaining period (40 ±5)min, recovery period (60 ± 10)min. Echocardiography, LAD (2?54 ± 0?20) cm, LVDd (3?41 ± 0?25) cm, LVDs (2?28 ± 0?23) cm, IVSTd (0?60 ± 0?07) cm, LVPWTd (0?59 ± 0?07) cm, AoD (1?77 ± 0?18) cm, EDV (48?59 ± 8?31) cm, ESV (18?28 ± 4?46) mL, SV ( 39?30 ± 5?16 ) mL, LVEF ( 62?76 ± 5?01 )%. Conclusions Intramuscular injection of xylazine hydrochloride with droperidol and atropine sulfate on bama minipigs for general anesthesia is a highly conserved specie in cardiovascular system and safe. We obtained some information of cardiac main function and structure of normal Bama minipigs which could provide reference for scientific research and veterinarian clinic.

Simultaneous Determination of 18α-Glycyrrhizic Acid and 18β-Glycyrrhizic Acid in Diammonium Glycyr-rhizinate by HPLC / 中国药师

Objective:To establish an HPLC method for the simultaneous determination of 18α-glycyrrhizic acid and 18β-glycyr-rhizic acid in diammonium glycyrrhizinate .Methods:A Diamonsil C18 column (200 mm ×4.6 mm, 5 μm) was used with the mobile phase of water (water-60%perchloric acid solution:48∶0.5, adjusting pH to 8.0 with ammonium hydroxide)-methanol (48∶52). The detection wavelength was set at 248 nm and the flow rate was 1.0 ml· min-1 .The column temperature was 30℃and the injection volume was 20 μl.Results:18α-Glycyrrhizic acid and 18β-glycyrrhizic acid were well separated .They had a good linear relationship within the range of 0.005 0-1.000 0 mg· ml-1(r=0.999 7 and 0.999 3).The average recovery was 99.7%and 99.1%, and RSD was 0.9%and 0.4%, respectively (n=9).Conclusion:The method is accurate, simple and reproducible, which can be used for the simultaneous determination of the two constituents in diammonium glycyrrhizinate .

Laparoscopic liver resection using microwave tissue coagulation in 29 cases / 中华普通外科杂志

Objective To evaluate the safety and efficacy of microwave tissue coagulation assisted laparoscopic hepatectomy for the treatment of hepatic tumors.Methods 29 patients underwent laparoscopic hepatectomy using microwave liver tissue coagulation from December 2011 to June 2014 in the General Air Force Hospital.All patients underwent intraoperative ultrasound guided microwave coagulation assisted laparoscopic local hepatectomy.Intraoperative blood loss,operation time,postoperative hospital stay and complications were observed.Results All the operations were successfully performed without conversion to open surgery.There were 18 cases of hepatocellular carcinoma (HCC),2 cases of intrahepatic cholangiocarcinoma,2 cases of hepatic metastases from the rectal carcinoma,5 cases of hepatic hemangioma,1 case of hepatic focal nodular hyperplasia and 1 case of hepatic cystadenoma.Drainage tubes were placed in 3 patients and removed 5-7 d after the operation.The operation time was 150 (125-210) miu,the median amount of intraoperative bleeding was 120 (30-250) ml,the postoperative hospital stay was 7 (5-10) d.All patients recovered well after the operation and no complications such as intraabdominal bleeding and bile leakage were observed.The cutting edges of liver cancer of these 22 cases were negative.The postoperative follow-up time of these 22 cases were 3-36 months and no tumor recurrence and metastasis were observed.Conclusions Laparoscopic liver resection using intraoperative ultrasound guided microwave hepatic tissue coagulation can effectively control the bleeding,improve the safety of laparoscopic liver resection,which makes it a safe and effective minimally invasive technique.

Research approaches to mass casualty incidents response: development from routine perspectives to complexity science / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the research methods of mass casualty incident (MCI) systematically and introduce the concept and characteristics of complexity science and artificial system, computational experiments and parallel execution (ACP) method.</p><p><b>DATA SOURCES</b>We searched PubMed, Web of Knowledge, China Wanfang and China Biology Medicine (CBM) databases for relevant studies. Searches were performed without year or language restrictions and used the combinations of the following key words: "mass casualty incident", "MCI", "research method", "complexity science", "ACP", "approach", "science", "model", "system" and "response".</p><p><b>STUDY SELECTION</b>Articles were searched using the above keywords and only those involving the research methods of mass casualty incident (MCI) were enrolled.</p><p><b>RESULTS</b>Research methods of MCI have increased markedly over the past few decades. For now, dominating research methods of MCI are theory-based approach, empirical approach, evidence-based science, mathematical modeling and computer simulation, simulation experiment, experimental methods, scenario approach and complexity science.</p><p><b>CONCLUSIONS</b>This article provides an overview of the development of research methodology for MCI. The progresses of routine research approaches and complexity science are briefly presented in this paper. Furthermore, the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems. And the only feasible alternative is complexity science. Finally, this summary is followed by a review that ACP method combining artificial systems, computational experiments and parallel execution provides a new idea to address researches for complex MCI.</p>

Relationship of emergency department length of stay with outcome of multiple trauma patients admitted to ICU / 中华创伤杂志

Objective To evaluate the relationship between emergency department length of stay (EDLOS) and outcome of multiple trauma patients in ICU.Methods A retrospective cohort study was performed in multiple trauma patients admitted from the emergency department to ICU during 2010.Patients' data were recorded,including demographic information (gender,age,etc.),characteristics of injury (injury causes,diagnosis,ISS,GCS,emergency operation rate,type of operation),and outcome (inhospital mortality,length of ICU stay,total length of hospital stay,expenditure).Patients were assorted into delayed group (EDLOS ＞ 6 h) and non-delayed group (EDLOS ≤ 6 h),then demographic information,characteristics of injury,and outcome were compared between the two groups.Multivariate Logistic and linear regression analyses were performed to identify the correlation between EDLOS and outcome for all patients and for those with and without emergency operation.Results A total of 476 patients aged (47.5 ± 16.0) years were enrolled in the study and male patients accounted for 73.5％.Median ISS was 29 points (interquartile range,22-34 points),median EDLOS was 4.0 hours (interquartile range,2.8-6.4 hours),and inhospital mortality was 9.2％.Delayed (n =135) and non-delayed (n =341) groups were similar in age,gender,ISS,inhospital mortality (13.3％ vs 7.6％),length of ICU stay,and total length of hospital stay (P ＞ 0.05).Multivariate analysis demonstrated prolonged EDLOS increased inhospital mortality (OR=3.19,95％ CI 1.28-7.95,P ＜ 0.05),especially in patients without emergent operation (OR =4.01,95％ CI 1.31-12.27,P ＜ 0.05).However,prolonged EDLOS produced no effect on mortality in patients with emergent operation (OR =1.72,95％ CI 0.79-3.43,P ＞0.05),length of ICU stay,total length of hospital stay,and expenditure.Conclusion Prolonged EDLOS increases mortality of multiple trauma patients admitted to ICU,especially in patients without emergency operation,thus rapid transportation of these patients from emergency room to ICU will improve the outcome.

Effect of trauma emergency care related factors on length of ICU stay / 中华创伤杂志

ObjectiveTo investigate the effect of factors correlated with trauma emergency care system on the length of ICU stay and figure out independent risk factors of prolonged ICU stay. Methods A total of 1 361 trauma patients admitted to the ICU of five tertiary hospitals in Zhejiang province in 2009 were retrospectively studied.Demographic data,time of ICU stay and variables related to trauma care were collected.Logistic regression was performed to determine the independent risk factors of prolonged ICU stay ( ≥ 15 days). ResultsOverall,192 trauma patients ( 14.1％ ) had a prolonged ICU stay ( ≥15 days).Single factor analysis indicated that ISS≥ 16 points,GCS≤7 points,blunt trauma,prehospital emergency care,length of emergency department stay ≥4 hours,mechanical ventilation and central venous pressure monitoring were associated with the prolonged ICU stay.Multivariate analysis showed that pre-hospital emergency care was a protective factor for the prolonged ICU stay( ≥ 15 days) and that mechanical ventilation,length of emergency room stay≥4 hours and ISS≥ 16 points were the independent risk factors for the prolonged ICU stay ( ≥ 15 days).Conclusions Pre-hospital emergency care and ICU care show significant influence on the length of ICU stay.Furthermore,shortened length of emergency department stay is also contributive to reduced length of ICU stay.

Value of trauma and injury severity score in predicting mortality of trauma patients in different rank hospitals / 中华创伤杂志

ObjectiveTo evaluate the trauma care effect and the value of trauma and injury severity score (TRISS) in prediction of the mortality by using TRISS to calculate the survival probability of trauma patients in five hospitals from Zhejiang province in 2009.MethodsA retrospective study was done on trauma patients (study group) firstly admitted to Emergency Department of five hospitals from Zhejiang province in 2009.The relevant information was collected,including demographic data,trauma types and injury causes.The TRISS score was obtained through calculating injury severity score (ISS) and revised trauma score (RTS) on admission into emergency department.With the major trauma outcome study (MTOS) as control group,M value,standardized Ws value and 95％ confidence interval (CI) were calculated to compare actual survival rate and anticipation survival rate.ResultsA total of 2 193 patients at mean age of 44.39 years were enrolled in the study,including 1 661 male patients (75.74％).Traffic accident injury was the most common,followed by fall injury.The mortality rate according to TRISS was 13.22％,but the actual mortality rate was 9.75％.For all the patients,M =0.80 indicated that the injury severity of the study group was significantly different from that of the control group.At the same time,Ws =2.15,95％ CI for Ws:1.54-2.77 showed that the actual survival rate of the study group was significantly higher than that of the control group.Besides,the survival rate of trauma patients in the affiliated hospitals and three hospitals at class A grade was significantly higher fian that of the control group,but there was no significant difference between three hospitals at class B grade and control group. ConclusionsTRISS overestimates the mortality of the study group,which is probably associated with the rapid development of traumatology and the old coefficients of TRISS.Setting up local trauma database and renewing coefficients of TRISS may improve the ability of TRISS in predicting mortality of the trauma patients.

Efficacy of precise sequential therapy for primary liver cancer / 中华消化外科杂志

Objective To investigate the construction and implementation of the concept of precise sequential therapy for primary liver cancer.Methods The clinical data of 207 patients with resectable liver cancer who were admitted to the Air Force General Hospital from May 2005 to June 2010 were retrospectively analyzed.Of all the patients,81 received conventional therapy (conventional therapy group),and the other 126 patients received precise sequential therapy (precise sequential therapy group).The conditions of the patients in perioperative phase,during postoperative sequential treatment and the period of follow-up between the 2 groups were compared.All data were analyzed by using the covariance analysis,analysis of variance,chi-square test or rank sum test.Results The detection rates of lesions with a diameter less than 1 cm,operation time,liver resection volume,intraoperative blood loss,rate of perioperative blood transfusion,duration of postoperative hospital stay,incidences of postoperative complications were 81％ (22/27),( 186 ± 36) minutes,(75 ± 29) ml,( 189 ± 60) ml,24％(30/126),(21 ± 12)days and 13％ (17/126) in the precise sequential therapy group,and 18％ (2/11),(222 ± 30)minutes,(133 ±88)ml,(327 ±46)ml,51％ (41/81),(26 ± 17)days and 20％ (16/81) in the conventional therapy group,respectively,with significant differences between the 2 groups (F =10.876,7.390,46.996,31.025,14.556,6.315,4.017,P ＜ 0.05).No significant difference was observed on the levels of alanine transaminase,albumin and the Child-Pugh score before and after the intervention in the precise sequential therapy group,but significant differences were observed in the conventional therapy group.The 1-,2-,3-year tumor recurrence rates and the 1-,2-,3-year survival rates were 17％ (21/126),22％ (17/76),26％ (8/31) and 87％ (110/126),87％ (66/76),84％ (26/31) in the precise sequential therapy group,and 31％ (25/81),38％ (27/71),48％(31/65 ) and 77％ (62/81),75％ (53/71 ) and 60％ (39/65) in the conventional therapy group,respectively.There were significant differences in the prognosis of the patients in the 2 groups ( x2 =4.958,4.292,4.168,4.062,3.640,5.470,P ＜ 0.05 ).Conclusion Through accurate assessment of the patients' condition before surgery,precise hepatectomy and precise postoperative intervention,the goal of effective control of tumor recurrence,maximum protection of the liver function and improvement of the survival rate can be achieved.

Risk factors for nosocomial infection in trauma patients during intensive care unit stay / 中华急诊医学杂志

Objective To determine risk factors in nosocomial infection of trauma patients during intensive care unit stay. Methods A retrospective study was carried out. A total of 1103 trauma patients admitted to the intensive care unit of five tertiary hospitals in Zhejiang Province in 2009 were reviewed. Demographic data, injury severity score and other variables related to the trauma services were collected. Univariate and multivariate analysis were processed to identify the independent risk factors of nosocomial infection in trauma patients during stay in intensive care unit. Results Overall, 171 patients( 15.5% )developed nosocomial infection during ICU stay. Of 1103 patients, 157 patients (14.2% ) died, and the 59 fatal patients were from infection group. The mortality rate in infection group was 34.7% , which was significantly higher than that in non - infection group (10.5% ). The independent risk factors of nosocomial infection in all the patients determined by using multivariate analysis included central venous monitoring, mechanical ventilation, age ≥65, the length of ICU stay > 14 days and injury severity score ≥ 16. For the severe trauma patients, central venous monitoring, mechanical ventilation, the length of ICU stay > 14 days were independent risk factors of nonsocomial infection. Conclusions The severity of injury, age, the length of ICU stay and invasive procedures were related to the nosocomial infection. To standardize the invasive procedures and to reduce the length of ICU stay may decrease the infection rate of trauma patients.