ABSTRACT
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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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.
ABSTRACT
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.
ABSTRACT
Objective:To investigate the clinical effect of low molecular weight heparin sodium combined with antivenin in the treatment of severe and critical bite by Trimeresurus stejnegeri.Methods:The clinical data of 48 patients with severe or critical bite by Trimeresurus stejnegeri admitted to emergency department of Southeast Hospital Affiliated to Xiamen University from March 2017 to May 2019 were retrospectively analyzed. On the basis of early treatment of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, the patients were divided into heparin treatment group and non-heparin treatment group according to whether the low molecular heparin sodium was used or not. The patients in the two groups were compared in terms of gender, age, clinical classification, swelling degree of injured limbs, change of coagulation function index, bleeding of skin, mucous membrane or digestive tract, blood transfusion, local symptoms of bite, length of hospital stay and prognosis.Results:There was no significant difference in terms of gender, age, clinical classification or swelling degree of injured limbs between the two groups. On the 3rd day of treatment, the platelet count (PLT) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [×10 9/L: 210.0 (160.0, 252.0) vs. 136.0 (104.0, 198.5), P < 0.05]. However, there was no significant difference in the four coagulation test results between the two groups. On the 6th day of treatment, the plasma thrombin time (TT) in the heparin treatment group was significantly shorter than that on the 3rd day of treatment [s: 30.3 (20.4, 37.0) vs. 34.7 (24.0, 73.4), P < 0.05], and the fibrinogen (FIB) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [g/L: 0.60 (0.31, 1.07) vs. 0.20 (0.14, 0.60), P < 0.01]. The incidence of bleeding in the heparin treatment group was significantly lower than that in the non-heparin treatment group [21.7% (5/23) vs. 64.0% (16/25), P < 0.01]; 11 patients in the heparin treatment group and 18 patients in the non-heparin treatment group received blood transfusion and prothrombin complex supplement respectively. There was no significant difference in the length of hospital stay between the heparin group and non-heparin treatment group (days: 6.91±1.92 vs. 7.48±2.27, P > 0.05). The patients in both groups were followed up for 1 week to 1 month after treatment, and no death or local necrosis of skin and soft tissue was found. Conclusions:For the patients with severe and critical bite by Trimeresurus stejnegeri, on the basis of injection of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, early application of low molecular weight heparin sodium anticoagulation and other comprehensive treatment is helpful to improve limb swelling and inflammation, reduce blood transfusion, promote the recovery of coagulation function, and shorten the length of hospitalization.
ABSTRACT
Objective To compare the predictive value of CT severity index(CTSI)and modified CT severity index (MCTSI) for the severity and prognosis of acute pancreatitis (AP).Methods The clinical data of 72 patients with AP were retrospectively analyzed.The consistency between MCTSI,CTSI and revised Atlanta classification of AP-2012 was respectively compared by the Kappa test.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the MCTSI and CTSI in differentiating severe acute pancreatitis (SAP) were calculated.The predictive value of MCTSI and CTSI for SAP and mortality was respectively analyzed by receiver operating characteristic (ROC)curve,and the area under the curve(AUC)was respectively calculated.Results The MCTSI and CTSI showed good agreement with the revised Atlanta classification of AP-2012(the Kappa statistic was 0.653 and 0.656 respectively).The sensitivity,specificity,PPV and NPV of MCTSI were 90.0%(18/20), 86.5% (45/52), 72.0% (18/25) and 95.7% (45/47) respectively; and those of CTSI were 50.0% (10/20), 96.2% (50/52), 83.3% (10/12) and 83.3% (50/60) respectively.The AUC of MCTSI for predicting SAP and mortality were 0.932 and 0.913 respectively, and of CTSI were 0.908 and 0.874 respectively.Conclusions The MCTSI and CTSI have a similar and good consistency in predicting severity of AP.However,the MCTSI shows more sensitive and accurate in predicting SAP and prognosis.
ABSTRACT
Objective To assess the clinical efficacy of vacuum sealing drainage (VSD) in the treatment of mixed poisonous snake bite. Methods A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group (n = 20) and VSD treatment group (n = 23) according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein (CRP), length of hospital stay and disability rate were compared between the two groups. Results Forty-three patients were followed up for 6-12 months with average of (10.3±1.4) months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% (2/23) vs. 40.0% (8/20)], local skin necrosis area was significantly reduced (cm2: 4.2±0.8 vs. 6.0±1.3), the maximum CRP was significantly lowered (mg/L: 50.0±12.1 vs. 68.0±13.4), the hospitalization time was significantly shortened (days: 11.7±2.9 vs. 17.7±4.9), and the difference above was statistically significant (all P < 0.05). The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% (3/23) vs. 13.0% (6/20)] without statistically significant difference. Conclusion Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.
ABSTRACT
Objective To investigate effects of very early hyperbaric oxygen treatment (HBOT) on patients with malignant brain edema after surgical operation for treatment of severe traumatic brain injury (TBI).Methods A total of 146 patients who suffered from malignant brain edema after last surgical operation for severe TBI were enrolled for this study.According to the intervention time of HBOT,they were randomized into a very early group (HBOT within 3 days after operation,n =55),an ordinary group (HBOT at 4 to 10 days after operation,n =65) and a control group (non-HBOT,n =26).Mortality rate of the 3 groups were recorded within 4 weeks after operation,and GCS (Glasgow Coma Scale) score were assessed in 1,2,3 and 4 weeks after operation.Dynamic head CT scan were performed for detecting brain status and for determine the duration of brain edema.Results The mortality of the very early group,the ordinary group and the control group were 10.9％,7.7％ and 11.5％,respectively,and no statistically significant difference was revealed among the groups (P ＞ 0.05).In very early group,the GCS scores of 1,2,3 and 4 weeks after operation were (8.837 ±3.350),(10.755 ± 3.388),(11.633 ± 3.408) and (12.367 ± 3.408),respectively,with significant difference between the time points 1 week and 2,3 and 4 weeks as well as 2 and 4 weeks after surgery (P ＜0.05),but not between 2 and 3 as well as 3 and 4 weeks after surgery (P ＞ 0.05).In ordinary group,the GCS scores at 1,2,3 and 4 weeks after surgery were (8.509 ±3.042),(9.458 ±3.115),(10.186 ±3.203) and (10.627 ±3.439),respectively,with significant difference between 1 week and 2,3 and 4 weeks after operation (P ＜ 0.05).In control group,the GCS scores at 1,2,3 and4 weeks after surgery were (8.042 ±2.881),(8.417 ±2.962),(8.542 ±3.02) and (8.958 ± 3.043),with no statistical difference among different time points (P ＞ 0.05).When compared with the very early group,the GCS sores of the ordinary group and the control group were significantly lower after intervention (P ＜ 0.05),and the GCS of control group was lower than that of the ordinary group (P ＜ 0.05).As for brain edema duration,the very early group was the shortest among the 3 groups (P ＞ 0.05) Conclusion Very early hyperbaric oxygen treatment could improve consciousness state and alleviate malignant brain edema after surgical operation in TBI patients.
ABSTRACT
Objective To evaluate the diagnostic value of dual-source CT angiography (DSCTA) for intracranial aneurysms.Methods The data of DSCTA and digital subtraction angiography (DSA) were collected from 95 patients with subarachnoid hemorrhage (SAH).The efficacies of detection and description of morphologic features of intracranial aneurysms were analyzed retrospectively.Results A total of 117 aneurysms in 88 patients were detected with DSCTA.Two patients were suspected of having aneurysms,and no aneurysrms were detected in 5 patients.These patients were reexamined with DSA,4 were diagnosed as having aneurysm,and the aneurysms were not detected in 3 patients.DSA results were considered as gold standard,the specificity,sensitivity and accuracy of DSCTA for the detection of intracranial aneurysms were 100％,96.7％and 96.8％,respectively.The larger volume of intracranial aneurysm was,the higher the sensitivity of DSCTA diagnosis would be.Even for small aneurysms,the sensitivity of DSCTA diagnose was more than 90％.In addition,tmeasurement results of the maximum diameter and neck width of aneurysms measured by DSCTA were almost consistent with DSA.Condclusions SCTA is a non-invasive,quick,reliable,and effective method,and can provide accurate imaging information for surgery.The specificity and sensitivity of the diagnosis of aneurysms with DSCTA are almost the same with DSA.It has more advantages than DSA in the emergency operation of intracranial aneurysms.
ABSTRACT
We formulated a selective enrichment broth (SVV) for simultaneous growth of Salmonella, Vibrio parahaemolyticus, and Vibrio cholerae by single factor experiment and response surface method. We evaluated the enrichment effect of SVV by conventional culture method and real-time PCR assay. We obtained the SVV broth by supplementting the Buffered Peptone Water (BPW) with bile salt no. 3, potassium tellurite, and sodium citrate as inhibitors, and glucose, mannitol, snhydrous sodium sulfite and sodium pyruvate as accelerants. We also modified the concentration of sodium chloride in BPW. When mixed at equal or varied proportions, the target pathogens had a great accumulation (10(5)-10(8) CFU/mL) after incubated in SVV for 18 h at 37 degrees C with shaking. It can also effectively inhibit the competitive microflora. We detected 10 artificial simulated samples and 608 real samples using SVV with real-time PCR. After enriched in SVV for 18 h, the quantity of the bacteria in samples were above the detection limit. The SVV with PCR assay showed higher tested positive (4.06%) compared to that of the conventional detection method (3.78%) and there was no false report. In summary, SVV is a promising new multiplex selective enrichment broth that can be used in detection of seafood.
Subject(s)
Culture Media , Food Microbiology , Salmonella , Vibrio cholerae , Vibrio parahaemolyticusABSTRACT
Pseudomonas aernginosa (PA) is one of the most universal pathogens in clinical diagnosis, and conventional detection assay has many disadvantages. In this research, a pair of specific primers and a TaqMan fluorescent probe were designed in the conservative region of ETA gene by the method of bioinformatics analysis, the detection method for PA was successfully developed. Different gradient concentrations of PA DNA and various pathogen DNA were amplified by fluorescence quantitative PCR (FQ-PCR) to confirm the specificity and sensitivity of the developed method. Results showed that the developed detection assay is more sensible and specific by comparison to the conventional FQ-PCR method, and it is valuable for research and application prospects.
Subject(s)
ADP Ribose Transferases , Genetics , Bacterial Toxins , Genetics , DNA, Bacterial , Exotoxins , Genetics , Fluorescent Dyes , Fluorometry , Methods , Polymerase Chain Reaction , Methods , Pseudomonas aeruginosa , Genetics , Sensitivity and Specificity , Taq Polymerase , Virulence Factors , GeneticsABSTRACT
<p><b>UNLABELLED</b>We designed a pair of specific primers and a TaqMan fluorescent probe targeting the toxR gene of Vibrio parahaemolyticus (VP). After optimizing the conditions, the specialty, sensitivity and reproducibility of the detection method were evaluated.</p><p><b>RESULTS</b>(1) the developed real-time PCR assay protocol detected only VP and was not affected by other normal food pathogens such as Staphylococcus aureus, Salmonela, Listeria monocytogenes. (2) the limit of detection was 25 copies of toxR gene in the detected samples, and the sensitivity of pure cultures and simulated food samples was 21 cfu/mL and 210 cfu/g. (3) the developed protocol of real-time PCR assay had a high reproducibility, and the sample's variation was 0.9% and 1.3% within the same sample and between tests. (4) the standard curve had a good linearity when the gene quantity was between 2.5x10(1) and 2.5x10(6) copies. The developed detection assay targeting the toxR gene can quantitatively detect VP in only 3 hours, and thus is an efficacious method for the detection of Vibrio parahaemolyticus.</p>
Subject(s)
Bacterial Proteins , Genetics , DNA-Binding Proteins , Genetics , Fluorescent Dyes , Metabolism , Gene Targeting , Polymerase Chain Reaction , Methods , Sensitivity and Specificity , Taq Polymerase , Metabolism , Transcription Factors , Genetics , Vibrio parahaemolyticus , GeneticsABSTRACT
Objective To investigate the distribution rule of NMDA receptor protein localizated on neuron membrane surface. Methods After the primary culture model of forebrain cortex neuron of rat had been set up,the NR1 subunit protein molecule of NMDA receptor has been combined with primary antibody IgG,and marked by Staphylococcus protein A-colloid gold particles (SPA-G). Then the neuron was observed with Field-emission SEM,and the content of AU element was calcalated by software. Results The cluster of NMDA receptor combined with SPA-G particulates was clearly observed as some globular being distributed mainly under some niches of lipid rafts,mainly localized at originating section of dendritic protuberance of neuron membrane surface. Conclusion NMDA receptor molecule protein was distributed on the membrane surface lipid rafts of originating section of dendritic protuberance of neuron. It was in accord with the distribution rule of postsynaptic membrane on neuron. The Field-emission SEM could distinguish single NMDA receptor melocule cluster after being marked with SPA-G molecule in neuron.
ABSTRACT
Object To study the action of lotus leaf extract (LLE) in scavengings hydroxyl and superoxide anion radical Methods By spin trapping with electron spin resonance Results 26 94 ug/mL LLE can scavenge 65 60% superoxide anion radical (O ? 2) produced by Hypoxanthine Xanthine oxidase system, while at concentrations over 8 98 mg/mL a complete eradication of hydroxyl radical (?OH) produced from Fenten reaction system was achieved Conclusion LLE is highly effective in scavenging ?OH and O ? 2 free radicals