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Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.
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A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.
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Epidemic of corona virus disease 2019 (COVID-19) has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the COVID-19 patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the COVID-19 patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of COVID-19, providing a basis for the clinical treatment of such kind of patients.
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Objective To investigate the diagnosis and treatment method of complicating acute pulmonary embolism(APE) after surgery in ICU.Methods Ten patients with complicating APE after surgery in ICU of this hospital from July 2014 to November 2016 were selected.Their clinical characteristics,age,basic diseases,clinical diagnosis and treatment process were retrospectively analyzed.Results Ten cases occurred on mean postoperative(2.4 ± 1.1) d,which manifested by different degrees of respiratory failure,circulatory failure,renal function failure,chest pain,hemoptysis and cough.10％ and 40％ respectively.Five cases(50％) used rt-PA thrombolysis,2 cases(20 ％) were treated with low molecular weight heparin anticoagulation and 3 cases (30 ％) were treated with heparin anticoagulation,One case(10 ％) died after treatment,1 case(10 ％) was discharged from hospital and 8 cases (80％)were improved and discharge from ICU.Conclusion Postoperative complicating pulmonary embolism has high probability.The postoperative complicating pulmonary embolism risk should be evaluated for prevention as early as possible.If APE occurs,adopting thrombolysis or anticoagulation therapy has good effect.
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Objective To explore the effects of different concentrations of propofol postconditioning against glutamate neurotoxicity to brain slices of neonatal rats.Methods The brain slices of neonatal rats were prepared and cultured in complete medium.They were randomly divided into five groups:the normal control group,glutamate injury group(RI group),1 mg/L propofol postconditioning group(PL1+RI group),3 mg/L propofol postconditioning group(PL3+RI group),5 mg/L propofol postconditioning group(PL5+RI group),12 cases in each group.The RI,PL1+RI,PL3+RI,PL5+RI groups were cultured for 6 days,then the brain slices were moved into the culture medium containing glutamate(1 mmol/L) and incubated for 30 minutes.And then,respectively,the brain slices of RI group were put into another complete culture medium,the PL1+RI group,PL3+RI group and PL5+RI group were put into the medium containing corresponding concentrations of propofol medium and long chain fat emulsion injection.All of the above were cultured for 24 hours in order to establish the injury model.The numbers of the Nissl body,the LDH release rates and the brain tissue damage rates of each brain slice were detected to evaluate the effects of propofol postconditioning on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.Results Compared with the RI group,the numbers of the Nissl body of the PL1+RI group,PL3+RI group and PL5+RI were higher,the LDH release rates and the brain tissue damage rates of the PL1+RI group,PL3+RI group and PL5+RI were lower,the diferences were significant(P<0.05).Among the three PL+RI groups,the LDH release rates and the brain tissue damage rates of the PL3+RI group were lower than those of the other two groups,the diferences were significant(P<0.05),at the same time,the numbers of Nissl body were more than the other two groups,the diferences were significant(P<0.05).Conclusion Propofol postconditioning has protective effects on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.However,the protective effects are not dose-dependent,and 3 μg/mL is the best dose of propofol to keep the glutamate-damaged brain slices from reperfusion injury in this research.
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Objective To investigate the expression and early diagnosis value of CD64 index levels in peripheral blood cells in patients with postoperative traumatic sepsis.Methods A number of 420 trauma patients were enrolled in the study,and they were divided into the postoperative traumatic sepsis group(130 cases)and postoperative general trauma group(290 cases)according to the clinical manifestations. The CD64 levels in peripheral blood were measured by flow cytometry,and the levels of C-reactive protein(CRP)and white blood cell count (WBC)were detected.The diagnostic value of these indexes on postoperative traumatic sepsis were evaluated.Results The CD64 index, CRP and WBC levels in postoperative traumatic sepsis group were significantly higher than postoperative general trauma group(P 0.05).The ROC curve analysis showed that when CD64 index(7.21)considered as the boundary for early diagnosis of postoperative traumatic sepsis,the sensitivity and spe-cificity of diagnosis for postoperative traumatic sepsis were 85.1% and 87.8%,the area under the ROC curve(AUC)was 0.865(95%CI 0.784 ~0.929),which was significantly better than CRP index.Conclusion The expression of CD64 is higher in patients with postoperative traumatic sepsis,which can be used as an effective indicator for early diagnosis of postoperative traumatic sepsis,and it has an important clin-ical application value.
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Objective To establish an universal primer-multiplex PCR system for diagnosis of Y chromosome AZF region microdeletions in 262 patients with non-obstructive azoospermic and severe oligozoospermic male infertility. Methods In each panel of multiplex PCR, YUP and YCP containing a fragment of non-human DNA sequence at their 5' ends were designed. The universal primers and chimiric primers were employed for the amplification at the same multiplex PCR system to screen for the Y chromosome AZF region ( a, b and c) microdeletions in 262 non-obstructive azoospermic and severe oligozoospermic male infertility patients. Results Thirty-three out of 262 patients (12. 60% ) were detected with Y chromosome AZF microdeletions. Among them, 27 cases were AZF c microdeletions and 6 ones were AZF b + c microdeletions. These results were in agreement with the results from EMQN method. There was no false-positivity. The gel electrophoresis for detection of multiple STS from both methods showed that the sY84,sY86, sY127, sY134, sY254, sY255, SRY bands were homogeneous and clear with similar brightness. Conclusion The modified multiplex PCR is suitable for screening of Y chromosome AZF microdeletions in non-obstructive azoospermic and severe digozoospermic male infertility patients.
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Objective To evaluate the potential effects of RS504393, CC chemokine receptor (CCR) 2b and CCR1 antagonist, on LPS-induced acute lung injury (ALI) and to investigate the underlying mechanisms. Method A549 cell line was stimulated with LPS (10 μg/mL) and then treated with RS504393 (10 μg/mL) for 6 hours. ALI model was established with intranasal administration of LPS (5 mg/kg) in C57BL/6J mice. RS504393 (5 mg/kg) was administered 30 min before LPS dripped nasally. IL-8, IL-1β, plasminogen activator inhibitor (PAI)-l,monocyte chemoattractant protein (MCP)-2,and the expressions of CCR1 and CCR2b were studied by using Realtime-RT-PCR, ELISA and cyto-flowmetry. Results In A549 cell line treated with RS504393,the expressions of CCR1, CCR2b and IL-8 were significantly inhibited after LPS stimulation. In rats with LPS-induced ALI, treatment with RS504393 significantly protected mice against lung injury by attenuating influx of leukocytes and protein into bronchoalveolar space and by lessening pathological changes of lung. Treatment with RS504393 down-regulated IL-1β and PAI-1 expressions in bronchoal veolar lavage fluid (BALF) and lungs at mRNA and protein levels along with up-regulation MCP-2 expression compared to rats of vehicle-treated groups. Conclusions CCR2b and CCR1 play pivotal roles in the development of ALl,and RS504393 as a antagonist can halt the development of ALI.