Thromboelastogram for early diagnosis of deep vein thrombosis after free flap surgery of lower extremity / 中华创伤骨科杂志

Objective:To investigate the clinical value of thromboelastogram in early diagnosis of deep vein thrombosis (DVT) in patients undergoing free flap surgery of lower extremity.Methods:A retrospective study was conducted to analyze the 192 patients undergoing surgical repair of soft tissue defects at lower extremity with free anterolateral femoral flap at Department of Orthopaedics, Tongji Hospital from January 2018 to June 2022. There were 117 males and 75 females, with an age of (45.6±12.7) years and an area of skin defects ranging from 5 cm × 3 cm to 18 cm × 9 cm. The patients were divided into 2 groups according to whether DVT occurred on the first day after surgery. In the DVT group of 22 patients, there were 14 males and 8 females, with an age of (47.7±14.3) years; in the DVT-free group of 170 patients, there were 103 males and 67 females, with an age of (45.3±12.5) years. The 2 groups were compared in terms of reaction time, coagulation time, maximum amplitude and coagulation angle in the thromboelastogram. Diagram of receiver operating characteristic (ROC) curves was used to evaluate the predictive value of thromboelastography in assessing the risk of DVT after surgery.Results:The 2 groups were comparable because there was no significant difference in the baseline information or operation time between them ( P>0.05). The reaction time [(5.21±0.85) min] and coagulation time [(1.12±0.30) min] in the DVT group were significantly shorter than those in the DVT-free group [(6.48±0.06) min and (1.60±0.03) min], and the maximum amplitude [(71.45±1.17) mm] and coagulation angle [69.54° (64.59°, 76.64°) ] in the DVT group were significantly larger than those in the DVT-free group [(66.63±0.40) mm and 64.92°(54.11°, 74.21°)] (all P<0.05). The optimal cut-off points in the ROC diagram were 5.46 min at reaction time, 1.52 min at coagulation time, 72.31 mm at maximum amplitude and 59.89° at coagulation angle. The sensitivity and specificity of detecting DVT on the first day after surgery were 80.7% and 71.6%, respectively, according to the combination of the best cut-off points in the ROC diagram and all the indexes in the thromboelastogram. Conclusion:Thromboelastogram is of a great value for the diagnosis of lower extremity DVT, and of a positive significance for the prevention of serious complications after surgery in patients undergoing free flap surgery of lower extremity.

Clinical features and outcomes of neonatal necrotizing enterocolitis / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of neonatal necrotizing enterocolitis (NEC) and risk factors for poor outcomes.@*METHODS@#A retrospective analysis was performed for the clinical data of 121 preterm infants diagnosed with NEC. According to the treatment method, they were divided into a non-surgical group (n=66) and a surgical group (n=55). According to the outcome, they were divided into a survival group (n=76) and a death group (n=45). Clinical features were compared between these groups. Risk factors for poor outcomes were analyzed by multivariate logistic regression analysis.@*RESULTS@#Compared with the non-surgical group, the surgical group had significantly lower corrected gestational age, minimum platelet count, and incidence rate of bloody stool at the onset of NEC (P<0.05). The maximum C-reactive protein (CRP) and mortality rate in the surgical group were significantly higher than those in the non-surgical group (P<0.05). Compared with the survival group, the death group had significantly lower gestational age at birth, birth weight, proportion of small-for-gestational-age infants, and corrected gestational age, body weight and minimum platelet count at the onset of NEC (P<0.05). The incidence of patent ductus arteriosus, rate of use of ibuprofen, maximum CRP and rate of surgical treatment in the death group were significantly higher than those in the survival group (P<0.05). The multivariate logistic regression analysis showed that ibuprofen treatment was a risk factor for death in infants with NEC (OR=9.149, P<0.05).@*CONCLUSIONS@#Ibuprofen treatment increases the risk for death in preterm infants with NEC.

Serotype distribution and antimicrobial resistance of Salmonella isolates from retail chicken carcasses in six provinces of China / 中华预防医学杂志

Objective@#To obtain the serotype diversity and antimicrobial resistance of Salmonella isolates recovered from retail chicken carcasses for sale in six regions of China.@*Methods@#From August 2010 to March 2012, each month 20 retail chicken carcasses including freshly slaughtered, chilled and frozen samples were collected from supermarkets and farmer's markets in 7 monitoring sites in Beijing, Jilin province, Inner Mongolia Autonomous, Shanxi province, Jiangsu province and Guangdong province, respectively. Samples were routinely collected for 12 months for each site. 1 680 chicken carcasses were collected in total and 2 629 Salmonella strains were isolated by PCR and biochemical method. Luminex xMAP method and classical slide agglutination method were carried out to determine isolates' serotypes. Minimal inhibitory concentrations (MICs) of 10 classes of antimicrobials including 14 agents were determined using broth micro-dilution method. Mocular methods were used to determine antimicrobial resistance genes of CIP-CTX-CT co-resistant isolates.@*Results@#In all, 2 629 Salmonella isolates, there were 17 seorgroups and 58 serotypes, B and D1 were the dominant serogroups with rates of 34.7% (n=913) and 31.0% (n=815), Enteritidis (30.8%, n=810), Indiana (17.6%, n=463), Infantis (10.6%, n=278) were the top three serovars. We found 224 CIP-CTX co-resistant S. Indiana containing 3 colistin resistant strains, one of them carrying mcr-1 gene and being ESBLs positive, which demonstrated a nine multi drug resistance against 11 antimicrobials tested.@*Conclusion@#These data began to describe the complicated serovar diversity and heavy antimicrobial resistance of Salmonella isolates recovered from retail chicken carcasses in six regions of China. The findings highlight the emergence of ciprofloxacin and cefotaxime co-resistant S. Indiana and also a mcr-1 positive S. Indiana with heavy multi drug resistance.

Research advances in necrotizing enterocolitis in neonates / 中国当代儿科杂志

Necrotizing enterocolitis (NEC) is a catastrophic disease caused by a variety of factors in neonates, especially preterm infants. Severe NEC has a high fatality rate, and most survivors may face short- and long-term adverse prognosis. Risk factors for NEC include preterm birth, non-breastfeeding, microbial abnormalities in the digestive tract, and ischemia-reperfusion injury. High-resolution abdominal ultrasound helps with the early diagnosis of NEC. The preventive measures for NEC include protecting the intestinal mucosa through nutritional intervention, interfering with intestinal injury signals, changing intestinal microflora, and performing early minimal enteral nutrition. This disease progresses rapidly, and there are still no effective measures. Supportive care is mainly used for the treatment of this disease, and patients in severe conditions may need surgical treatment. Celastrol, lipopolysaccharide, and fecal transplantation help with the treatment of NEC, but further studies are needed to confirm their clinical effects.

The structure characteristics of prophages of foodborne Enterococcus hirae R17 and their interaction relationships with host bacterium / 中国食品卫生杂志

Objective This study was to understand the structure characteristics of prophages in the genome of Enterococcus hirae R17,and also to analyze their interaction relationships with the host bacterium.Methods The gene distribution and gene encoding characteristics of prophages in the genome of Enterococcus hirae R17 were identified using the PHAST software.The virulence gene,antimicrobial resistance genes,and environmental resistance genes in the prophages were also analyzed.Results Three prophages were found on the chromosome of Enterococcus hirae,including two incomplete prophage elements (Prophage-1 and Prophage-2) and one complete prophage (Prophage-3).Some function genes of bacteria were found in the sequence of three prophages,including nucleotide transportation and metabolism related genes.One incomplete prophage carrying erythromycin-and bacitracin-resistance genes was identified in the plasmid,which suggested that prophage induced gene horizontal transfer caused erythromycin-and bacitracin-resistance of Enterococcus hirae R17.Conclusion This study laid a solid foundation for the diversity analysis of prophages of Enterococcus hirae.Prophages played an important role in promotion of antimicrobial resistance of enterococci.Scientists should pay more attention to the spread of antimicrobial resistance and pathogenicity induced by prophages.

Effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy.METHODS: A retrospective study was designed.160 patients(160 eyes) with diabetic retinopathy from Jan 2015 to Feb 2017 were divided into two groups according to cataract.74 patients(74 eyes) were operated on vitrectomy,and 86 patients(86 eyes) on vitrectomy combined with phacoemulsification cataract surgery and capsular bag implantation of foldable intraocular lens.To record the change of corneal endothelial cells density,average cellular area,coefficient of variation and percentage of hexagonal endothelial cell before and after treatment with Topcon corneal specular microscope.RESULTS: Before and after surgery,the results of corneal endothelial cells density,average cellular area,coefficient of variation and percentage of hexagonal endothelial cell in simple vitrectomy group were no significant difference(P>0.05);After treatment corneal endothelial cells density and percentage of hexagonal endothelial cell were changed with statistical difference as the same as average cellular area and coefficient of variation(P<0.05);There were significantly differences in corneal endothelial cells between two groups(P<0.05).CONCLUSION: It has certain influence on the corned endothelial cells when using vitrectomy combined with cataract surgery in diabetic retinopathy.For patients with indications,it should be paid attention to protecting the corneal endothelial cells.

Genotypic Characterization of Methicillin-resistant Staphylococcus aureus Isolated from Pigs and Retail Foods in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the genotypic diversity of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pigs and retail foods from different geographical areas in China and further to study the routes and rates of transmission of this pathogen from animals to food.</p><p><b>METHODS</b>Seventy-one MRSA isolates were obtained from pigs and retail foods and then characterized by multi-locus sequencing typing (MLST), spa typing, multiple-locus variable number of tandem repeat analysis (MLVA), pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility testing.</p><p><b>RESULTS</b>All isolated MRSA exhibited multi-drug resistance (MDR). Greater diversity was found in food-associated MRSA (7 STs, 8 spa types, and 10 MLVA patterns) compared to pig-associated MRSA (3 STs, 1 spa type, and 6 MLVA patterns). PFGE patterns were more diverse for pig-associated MRSA than those of food-associated isolates (40 vs. 11 pulse types). Among the pig-associated isolates, CC9-ST9-t899-MC2236 was the most prevalent clone (96.4%), and CC9-ST9-t437-MC621 (20.0%) was the predominant clone among the food-associated isolates. The CC9-ST9 isolates showed significantly higher antimicrobial resistance than other clones. Interestingly, CC398-ST398-t034 clone was identified from both pig- and food-associated isolates. Of note, some community- and hospital-associated MRSA strains (t030, t172, t1244, and t4549) were also identified as food-associated isolates.</p><p><b>CONCLUSION</b>CC9-ST9-t899-MC2236-MDR was the most predominant clone in pigs, but significant genetic diversity was observed in food-associated MRSA. Our results demonstrate the great need for improved surveillance of MRSA in livestock and food and effective prevention strategies to limit MDR-MRSA infections in China.</p>

Research progress of the application of probiotics in preterm infants / 中国当代儿科杂志

The gastrointestinal structure, function and immunity of preterm infants are immature. Furthermore the gastrointestinal microbe colonization is abnormal. Therefore the preterm infants are prone to a variety of gastrointestinal diseases. Probiotics can regulate gastrointestinal microbe constitute, improve gastrointestinal barrier function, reduce gastrointestinal inflammation response and regulate the immunity. At present, it is used for the prevention of necrotizing enterocolitis, late-onset sepsis, and feeding intolerance. The safety and efficacy of probiotics for preterm infants are still controversial.

The influence of bFGF gene transfected BMSCs on inflammatory cytokines expression of COPD rat / 实用医学杂志

Objective To study the influence of bFGF gene transfected bone marrow-derived mesenchymal stem cells (BMSCs) on the inflammatory cytokines of COPD rat. Methods The BMSCs were separated from SD rat and cultured and then bFGF gene was imported to BMSCs by liposome transfection method. The samples were prepared into six groups: normal control group, COPD group (A), BMSCs group (B), pcDNA3.1-BMSCs group (C), bFGF-pcDNA3.1-BMSCs group (D), and bFGF group (E). The expressions of TNF-α and IL-1β by QRT-PCR were detected. Results Compared with COPD group, TNF-α and IL-1β genes from groups B to D dropped significantly (P 0.05). Conclusion BFGF transfected BMSCs, sample BMSCs and pcDNA3.1 transfected BMSCs can inhibit the expression of inflammatory cytokines of TNF-α and IL-1β, but there is no obvious advantage in comparison to bFGF transfected BMSCs and sample BMSCs in respect of inhibiting the expression of inflammatory cytokines of TNF-α and IL-1β.

Analysis of hematological phenotype and genotype of 23 patients from Guangdong with co-inherited hemoglobin Hb Westmead and β-thalassemia / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze the genotype-phenotype correlation among carriers from Guangdong with co-inherited hemoglobin Hb Westmead (HbWS) and β-thalassemia.</p><p><b>METHODS</b>Twenty three patients (including 9 males and 14 females, aged 1-53 year old) were diagnosed by hematological analysis and genetic testing. Complete blood cell count and hemoglobin electrophoresis analysis were performed on a XE4000i automatic hemocyte analyzer. Hb, HbF and HbA2 were tested by high performance liquid chromatography (HPLC). Gap-PCR was adopted to detect three common thalassemia deletions. Reverse dot-blotting (RDB) assay was applied for detecting three common non-deletional α2 gene mutations and β-thalassemia.</p><p><b>RESULTS</b>Among the 23 patients, 12 showed anemia, among whom 9 had mild anemia and 3 had moderate anemia. The lowest Hb was 68 g/L, and both mean corpuscular volume and mean corpuscular hemoglobin were lower than average, while HbA2 was higher than 3.5%. Genetic analysis confirmed that 5 cases had αWS-α/α-α, β CD654/β N (21.7%), 4 had α WS-α/α-α, β CD41-42/β N (17.4%), 5 had α WS-α/α-α, β CD17/β N (21.7%), 4 had α WS-α/α-α, β CD28/β N (17.4%), 1 had α WS-α/α-α, β CD71-72/β N (4.3%), 1 had αWS-α/α-α, β CD27-28/β N (4.3%), 1 had α WS-α/α-α, β CD41-42/β CD17 (4.3%), 2 had a concomitant β-thalassemia heterozygosity and -α 3.7 deletion.</p><p><b>CONCLUSION</b>Patients with co-existing Hb WS and other β-thalassemia trait may show variable clinical features. Such compound heterozygotes are usually misdiagnosed during screening by hemoglobin electrophoresis, accurate diagnose should be attained by molecular diagnosis.</p>

Expression of the basic fibroblast growth factor gene after being transfected into rat bone marrow mesen-chymal stem cells / 医学研究生学报

Objective Bone marrow mesenchymal stem cells ( BMSCs) , a kind of stem cells with multiple differentiation po-tentials, exist in the bone marrow and other organizations.This study aimed to investigate the repairing effect of the exogenous basic fi-broblast growth factor ( bFGF) against chronic obstructive pulmonary disease ( COPD) and its action mechanism, and to determine the expression of the bFGF gene in transfected rat BMSCs. Methods BMSCs were isolated, cultured and identified.The recombinant plasmid bFGF-pcDNA3.1 was constructed and sequenced.Liposome-mediated bFGF-pcDNA3.1 plasmid was transfected into the BM-SCs of the rat (bFGF-pcDNA3.1 transfection group), liposome-mediated pcDNA3.1 transfected into the BMSCs (pcDNA3.1 transfec-tion group) , and untransfected BMSCs used as the control.G418 screening was performed for 14 days.The gene and protein expres-sions of bFGF were determined by qRT-PCR and Western blot. Results The full-length sequence of the bFGF gene was consistent with that of the GenBank.The expression of the bFGF gene was significantly higher in the bFGF-pcDNA3.1 transfection group (7.028 ±0.568) than in the pcDNA3.1 transfection group (1.000 ±0.082) and the non-transfection control (1) (P0.05).The expression of the bFGF protein was also re-markably higher in the bFGF-pcDNA3.1 transfection group (1.017 ±0.054) than in the pcDNA3.1 transfection group (0.217 ± 0.009) and the non-transfection control (0.165 ±0.013) (P0.05). Conclusion Mediated by the liposome reagent, the recombinant eukaryotic expression vector bFGF-pcD-NA3.1 can be transfected into rat BMSCs and expresses the bFGF gene and protein.

Effects of interleukin 1β on the expression of prostaglandin E_2 in cultured airway fibroblasts / 中国综合临床

Objective To explore the role of IL-1β in inhalation injury repairment through its effects on the expression of prostaglandin E_2 in cultured airway fibroblasts of mouse. Methods The cultured airway fibroblasts in vivo from male Kunming species mouse were randomly divided into control group and treatment group. The superna-rant and cells were collected at different time after treated with IL-1β. The expressions of PGE_2, COX-2 and mPGES1 protein in supernatant and cells were measured by ELISA and Western Blot. Results ①PGE_2 levels in the cultured airway fibroblast supematant at 8 h(148.2±28.3) ng/L,16 h(267.6±45.4)ng/L,24 h(210.5±38.6) ng/L and 48 h(198.7±36.5) ng/L were higher than that in the control group (P < 0.01), and peaked at 16 h;COX-2 ex-pressions at 8 h(0.478±0.029) COX-2/β-actin, 16 h(0.672±0.047) COX-2/β-actin,24 h(0.617±0.036) COX-2/β-antin, and 48 h (0.593±0.034) COX-2/β-actin were higher than that in control group (P < 0.01), and peaked at 16 h;mPGES1 at 8 h(0.300±0.018) mPGES1/β-actin, 16 h(0.549±0.034) mPGES1/β-actin, 24 h (0.497±0.030)mPGES1/β-actin and 48 h(0.443±0.026)mPGES1/β-actin were higher than that in the control group(P < 0.01), and peaked at 16 h. ②PGE_2 in 0.1 μg/L IL-1β group (142.9±2.3) ng/L, 1.0 μg/L IL-1β group (267.6±45.4) ng/L and 10.0 μg/L IL-1β group (587.3±106.9) ng/L were higher than those in the control group (58.5±16.0) ng/L (P < 0.01), and there was significant difference among the three groups (P < 0.01);COX-2 in 0.1 μg/L IL-1β group(0.525±0.031) COX-2/β-actin, 1.0 μg/L IL-1β group(0.672±0.047) COX-2/ β-actin and 10.0 μg/L IL-1β group(1.012±0.064)COX-2/β-actin were higher than that in the control group (0.309±0.019) COX-2/β-actin (P < 0.01), and there was difference among the three groups (P < 0.01);mPG-ES1 in 0.1 μg/L IL-1β group(0.380±0.021) mPGES1/β-actin, 1.0 μg/L IL-1β group (0.549±0.034) mPG-ES1/β-actin, and 10.0 μg/L IL-1β group(0.879±0.045) mPGES1/β-actin were higher than those in the control group(0.199±0.012)(P<0.01),and there was difference among the three groups(P<0.01).Conclusions IL-1β may upregulate PGE_2, COX-2 and mPGES1 expressions in airway fibroblast, indicating that IL-1β influences PGE_2 synthesis through COX-2 and mPGES1 expression and participates in airway inhalation injury course. Airway fibroblasts may be a main source cell of inflammatory mediators in injury repair.

Effect of cholinesterase inhibitor galanthamine on circulating tumor necrosis factor alpha in rats with lipopolysaccharide-induced peritonitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The nervous system, through the vagus nerve and its neurotransmitter acetylcholine, can down-regulate the systemic inflammation in vivo, and recently, a role of brain cholinergic mechanisms in activating this cholinergic anti-inflammatory pathway has been indicated. Galanthamine is a cholinesterase inhibitor and one of the centrally acting cholinergic agents available in clinic. This study aimed to evaluate the effect of galanthamine on circulating tumor necrosis factor alpha (TNF-alpha) in rats with lipopolysaccharide-induced peritonitis and the possible role of the vagus nerve in the action of galanthamine.</p><p><b>METHODS</b>Rat models of lipopolysaccharide-induced peritonitis and bilateral cervical vagotomy were produced. In the experiment 1, the rats were randomly divided into control group, peritonitis group, and peritonitis groups treated with three dosages of galanthamine. In the experiment 2, the rats were randomly divided into sham group, sham plus peritonitis group, sham plus peritonitis group treated with galanthamine, vagotomy plus peritonitis group, and vagotomy plus peritonitis group treated with galanthamine. The levels of plasma TNF-alpha were determined in every group.</p><p><b>RESULTS</b>The level of circulating TNF-alpha was significantly increased in rats after intraperitoneal injection of endotoxin. Galanthamine treatment decreased the level of circulating TNF-alpha in rats with lipopolysaccharide-induced peritonitis, and there was significant difference compared with rats with lipopolysaccharide-induced peritonitis without treatment. The 3 mg/kg dosage of galanthamine had the most significant inhibition on circulating TNF-alpha level at all the three tested doses. Galanthamine obviously decreased the TNF-alpha level in rats with lipopolysaccharide-induced peritonitis with sham operation, but could not decrease the TNF-alpha level in rats with lipopolysaccharide-induced peritonitis with vagotomy.</p><p><b>CONCLUSION</b>Cholinesterase inhibitor galanthamine has an inhibitory effect on TNF-alpha release in rats with lipopolysaccharide-induced peritonitis, and the vagus nerve plays a role in the process of the action of galanthamine.</p>

Sequencing analysis on rpoB gene mutation of rifampin-resistance in Mycobacterium tuberculosis / 基础医学与临床

Objective Genetic evaluation of relationship between rpoB gene mutation and rifampin-resistance of Mycobacterium tuberculosis (MTB).Methods This study was carded out with 81 clinical isolates and sensitivity test and genotypic analysis by PCR amplification and sequencing of rpoB gene were performed.Results Among these isolates,there were 27 rifampin-resistant and 54 sensitive strains.Of the 27 drug-resistant isolates,20 (74.1%) carried mutations on the amplified fragment of the rpoB gene with 10 mutation types at seven codons including 531 and 526,and two new mutation patterns were recognized.On the uther hand,one mutation (1.9%) appeared in 54 drug-sensitive strains.Conclusion The study shows geographical variation in the mutation types of rpoB gene in M.tuberculosis isolates from Guizhou,China.The result is valuable for the development of fast diagnostic methods.

A report on stress among first year students in an Indian medical school.

Stress is common in medical students. However, studies on stress among students in Indian medical schools are very few. The present study was undertaken to determine the prevalence and sources of stress among first year Malaysian students at Melaka Manipal Medical College (MMMC), (Manipal Campus), India. The General Health Questionnaire (GHQ) was used as the screening instrument. Based on the score, the prevalence of emotional disorders was determined. The sources of stress in students were identified by asking them to respond to a questionnaire which had items categorized under academic and non-academic problems. It was found that the prevalence of stress among the students was 37.3%. Among the sources of stress, frequent examinations and information overload were found to be the greatest sources of stress among academic problems. Among nonacademic problems, limited time for recreation and home-sickness were found to be the greatest sources of stress. The present study revealed that academic problems were greater sources of stress in first year medical students compared to non-academic problems. The study provided scope for adopting strategies intended to reduce students’ stress.

Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Among the deaths due to trauma, about one half of the patients suffer from road traffic injury (RTI). Most of RTI patients complicate acute respiratory distress syndrome (ARDS) and severe multiple injuries. ARDS is a major contributor to morbidity and mortality in trauma patients. Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients, their relative importance in development of the syndrome are undefined. We hypothesize that not all of the traditional risk factors impacting mortality are independently associated with patients strictly identified by traffic injury. This study aimed to sieve distinctive risk factors in our RTI population, meanwhile, we also hypothesize that there may exist significantly different risk factors in these patients.</p><p><b>METHODS</b>This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit (EICU) admission. Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed. Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive items in these severe RTI patients.</p><p><b>RESULTS</b>There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period. The unadjusted odds ratio (OR) and 95% confidence intervals (CI) of mortality were associated with six risk factors out of 23: APACHE II score, duration of trauma factor, pulmonary contusion, aspiration of gastric contents, sepsis and duration of mechanical ventilation. The adjusted ORs with 95% CI were denoted with respect to surviving beyond 96 hours EICU admission (APACHE II score, duration of trauma factor, aspiration of gastric contents), APACHE II score beyond 20 EICU admission (duration of trauma factor, sepsis, duration of mechanical ventilation) and mechanical ventilation beyond 7 days EICU admission (duration of trauma factor and sepsis).</p><p><b>CONCLUSIONS</b>We have retrospectively demonstrated an adverse effect of six different risk factors out of 23 items in mortality of post-traumatic ARDS within severe RTI patients and, moreover, gained distinct outcomes in stratified patients under real emergency trauma circumstance. An impact of APACHE II score and pulmonary contusion contributing to prediction of mortality may exist in prophase after traffic injury. Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome, infection, and secondary multiple organs dysfunction. Eliminating trauma factors as early as possible becomes the critical therapeutic measure. Aspiration of gastric contents could lead to incremental mortality due to severe ventilation associated pneumonia. Long-standing mechanical ventilation should be constrained on account of severe refractory complications.</p>

Comparison of the new injury severity score and the injury severity score in multiple trauma patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess whether these characteristics of less misclassification and greater area under receiver operator characteristic (ROC) curve of the new injury severity score (NISS) are better than the injury severity score (ISS) as applying it to our multiple trauma patients registered into the emergency intensive care unit (EICU).</p><p><b>METHODS</b>This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively registered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and multivariate logistic progression model.</p><p><b>RESULTS</b>Among the 2 286 patients, 176 (7.7%) were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 110 patients. Mean EICU length of stay (LOS) was 7.8 days ?2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the penetrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups (4.01% versus 4.49%). However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate (21.04% versus 15.55% for ISS, t equal to 3.310, P less than 0.001), resulting in an overall misclassification rate of 23.57% for NISS versus 18.79% for ISS (t equal to 3.290, P less than 0.001). In the whole sample, NISS presented equivalent discrimination (area under ROC curve: NISS equal to 0.938 versus ISS equal to 0.943). The H-L statistics showed poorer calibration (48.64 versus 32.11, t equal to 3.305, P less than 0.001) in the penetrating injury group.</p><p><b>CONCLUSIONS</b>NISS should not replace ISS because they share similar accuracy and calibration in predicting multiple blunt trauma patients. NISS may be more sensitive but less specific than ISS in predicting mortality in certain penetrating injury patients.</p>

Development of the trauma emergency care system based on the three links theory / 中华创伤杂志(英文版)

The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

Basic fibroblast growth factor alleviates brain injury following global ischemia reperfusion in rabbits / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The aim of this study was to explore the protective effect of basic fibroblast growth factor (bFGF) on brain injury following global ischemia reperfusion and its mechanisms. Brain injury following global ischemia was induced by four vessels occlusion and systemic hypotension. Twenty-four rabbits were randomized into three groups: group A, only dissection of vessels; group B, intravenous infusion of normal saline after reperfusion for 6 h; group C, 30 microg/kg bFGF injected intravenously at the onset of reperfusion, then infused with 10 microg/(kg.h) for 6 h. Serum neuron specific enolase (NSE), S-100B, tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-8 (IL-8) were measured before ischemia, 30 min after ischemia, 0.5, 1, 3, 6 h after reperfusion. Brain water content was determined and cerebral histopathological damages were compared. NSE and S-100B were increased 1 h after reperfusion and reached their peaks 6 h after reperfusion, but were much higher in group B than those in group C 3, 6 h after reperfusion. In groups B and C, TNF-alpha was increased after ischemia and IL-1 and IL-8 were increased significantly 0.5 h after reperfusion, then reached their peaks 6 h, 3 h, 6 h after reperfusion respectively. TNF-alpha and IL-8 at the time points of 1 h and 3 h and IL-1 at 3 h and 6 h in group C were correspondingly lower than those in group B. These indices in group A were nearly unchanged. There were less severe cerebral histopathological damages in group C compared with group B, but no difference in brain water content. It could be concluded that bFGF alleviates brain injury following global ischemia and reperfusion by down-regulating expression of inflammatory factors and inhibiting their activities.

Epidemiological characteristics of expressway traffic trauma in 2040 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the epidemiologic characteristics of expressway traffic trauma in 2040 cases in Zhejiang Province.</p><p><b>METHODS</b>The data of 2040 cases of expressway traffic trauma taken from Zhejiang Provincial Expressway Traffic Bureau were analyzed with computer techniques.</p><p><b>RESULTS</b>A total of 2040 persons were injured in 7963 expressway traffic accidents in Zhejiang Province from January 1999 to December 2001. Among them, 435 persons died (mortality, 21.3%) and 1 605 were injured. The economic losses were over 170 million yuan RMB. The accidents caused by human factors accounted for 84.9% (vehicle drivers accounting for 79.2%), which mainly included improper measures (20.4%), steering failure (17.7%), insufficient longitudinal space (15.9%), over-speed drive (12.5%), fatigue drive (6.4%), loading violation (5.9%) and careless drive (6.3%). Mechanical troubles and other factors took up 15.1%. There existed obvious uneven distribution among various regions. Jiaxing and Shaoxing were the sections with high incidence of accidents. The accidents mostly happened at 12:00-18:00, but the causing-dead ones most concentrated at 0:00-6:00. The main victims were young and middle-aged people (accounting for 72.3%), but accident-stricken children and elderly persons (over 70 years old) took up higher mortalities (30.2% and 40.7%, respectively).</p><p><b>CONCLUSIONS</b>The number of expressway traffic accidents and the economic losses are increasing year by year, with obvious uneven distribution at different places, different time and under different weather conditions. To reduce the accident frequency, it is important to strengthen the enforcement of traffic regulation, to balance the system of "person-vehicle-road", and to improve the safety consciousness of people.</p>