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Objective:To explore the effect of the new model of "5G cloud plus medicine" network and linkage in improving the therapeutic effect for patients with severe trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 410 patients with severe trauma admitted to Qingzhou People′s Hospital affiliated to Shandong First Medical University from November 2016 to November 2020. There were 258 males and 152 females, aged 16-80 years [(45.7±16.1)years]. The injury severity score (ISS) ranged from 17 to 55 points [(28.1±7.6)points]. A total of 210 patients with severe trauma were rescued by using the new model of "5G cloud plus medicine" network and linkage from November 1, 2018 to November 30, 2020 (observation group), and another 200 patients with severe trauma were rescued by the traditional treatment mode from November 1, 2016 to October 31, 2018 were selected as the control group. Time to start rescue (time from admission to the start of rescue), CT examination time (time from consultation to completion of CT scan), time to receive blood transfusion (time from blood transfusion request to execution), residence time in emergency room, ISS at postoperative 28 days, proportion of patients with blood transfusion, success rate of rescue and mortality rate were compared between the two groups.Results:Time to start rescue [(2.4±1.1)minutes], CT examination time [(29.1±10.3)minutes], time to receive blood transfusion [(28.1±10.2)minutes] and residence time in emergency room [(3.0±1.1)hours] in observation group were significantly shorter than those in control group [(5.5±1.2)minutes, (42.8±10.1)minutes, (48.5±13.1)minutes, (5.0±1.4)hours] (all P<0.05 or 0.01). ISS was (18.7±2.8)points in observation group, significantly lower than (22.1±3.4)points in control group ( P<0.05). Proportion of patients with blood transfusion was 49.5% (104/210) in observation group, similar with 42.5% (85/200) in control group ( P>0.05). Success rate of rescue was 99.0% (208/210) in observation group, significantly higher than 93.0% (186/200) in control group ( P<0.05). The mortality rate was 4.3% (9/200) in observation group, significantly lower than 8.5% (17/200) in control group ( P<0.05). Conclusion:For patients with severe trauma, the new model of "5G cloud plus medicine" network and linkage can effectively shorten the time to start rescue, CT examination time, time to receive blood transfusion and residence time in emergency room, improve the success rate of rescue and reduce the mortality rate, which is worthy of further promotion.
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Objective:To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO 2/FiO 2) as the end point in patients with severe acute pancreatitis (SAP). Methods:A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO 2/FiO 2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. Results:After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg≈0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found ( P > 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Conclusions:Using IAP and PaO 2/FiO 2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.
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On April 6, 2020, a case of severe crush injuries in head, neck, chest and right upper extremity was admitted to Qingzhou Hospital Affiliated to the First Medical University of Shandong Province. In addition to the crush injuries, the case also suffered from shock, crush syndrome, trauma-induced coagulopathy (TIC), and acute respiratory distress syndrome (ARDS). The female patient was 44 years old, and was admitted to the hospital at 07:00 on April 6, 2020 due to traffic accident with head, neck, chest, right upper limb injuries with disturbance of consciousness for 1 hour. Admission physical examination: body temperature was 35.6 ℃. The patient was drowsy, with swelling and cyanosis around the right orbit and right cheek. The skin was severely abraded with blood seepage. The conjunctiva was pale. The lips were slightly cyanotic. The right chest collapsed and deformed with abnormal breathing. The skin of chest wall was blue and purple with extensive feeling of holding snow under the skin. The breath sound of right lung was low and dry and wet rales could be heard. Laboratory examination: routine blood test showed that white blood cell count (WBC) was normal, red blood cell count (RBC), hemoglobin (Hb) and platelet count (PLT) decreased, blood glucose increased; urine routine examination showed glucose +++, urine occult blood +++, urinary protein +++, visible transparent and granular tube type; coagulation indicators and blood biochemical examination were abnormal. Arterial blood gas analysis showed that pH and arterial partial pressure of oxygen (PaO 2) decreased. X-ray showed comminuted fracture of distal humerus and proximal end of right ulna and radius with dislocation of right elbow joint. CT showed swelling of soft tissue around the right orbit and depressed fracture of inner wall. After admission, single-lung ventilation, tracheotomy and prone ventilation were applied to increase oxygenation level and relieving ARDS. Fluid of damage control for resuscitation was applied to reverse shock and blood transfusion was used to control hemorrhage and TIC. According to the patient's conditions and theory of damage control surgery, right chest drainage and amputation of the right upper extremity amputation were performed in time. Then, the resection in the middle and lower part of right lung, lung repairment, and internal rib fixation were performed. Finally, selective operation was performed to cover the open wound with healing dressing, using negative pressure for suction and carrying out "stamp" skin grafting on the right chest. After treatment, the patient was out of danger, and satisfactory clinical results were achieved in the end.
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Objective To screen the proteins with decreased expression in the synovial tissues of rheumatoid arthritis (RA) patients by comparing their expression profiles with that of osteoarthritis (OA) and ankylosing spondylitis (AS) patients by a proteomic approach,and to explore the association of reduced expression with disease susceptibility by a single nucleotide polymorphism (SNP) analysis.Methods Proteins extracted from the synovial membranes (n=10 for each disease) were separated by 2-D electrophoresis.The proteins with significantly decreased expression in the RA samples were subjected to MALDI-TOF-MS.The results were verified using Western blotting.Tag SNPs located in the targeted gene were assessed using the Taqman assay in a cohort of 267 Chinese patients with RA and 160 healthy controls.The genotyping results were confirmed in a large cohort of 389 patients with RA and 371 healthy controls.SPSS 11.5 software package was used for one way ANOVA and Fisher's exact test.Results The expression of vitamin D-binding protein (VDBP) in the synovial membranes from patients with RA was significantly decreased when examined by proteomic approach.This result was confirmed by Western blotting analysis.The rs2282679 was significantly associated with RA (P=0.026 794).This result was confirmed in a large cohort of RA( OR=0.678 639,95％CI 0.54l 113-0.851 118,P=0.000 776).Conclusion Compared with samples from patients with OA and AS,RA patients' synovial tissues have low VDBP expression when examined by the proteomic method.The tag SNP rs2282679 located in VDBP is significantly associated with RA.The decreased expression and the genetic effect of VDBP in RA suggest that a novel pathogenic pathway,in which vitamin D contributes,may be involved in the arthritis process of RA.
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ObjectiveTo investigate the expression of ATA1 in the synovial tissue from patients with ankylosing spondylitis (AS) and to localize expression of ATA1 in AS synovial membranes.In addition,tag SNPs were genotyped to determine the possible association of this gene with AS risk.MethodsWestern blotting analysis was applied to determine the expression of ATA1 in the synovial tissues by comparing the expression profiles of AS(n=8),rheumatoid arthritis(RA,n=9) and osteoarthritis(OA,n=9) samples.Immuno-histochemistry was used to localize the expression of ATA1 in the synovial membrane.The levels of ATA1 in the synovial fluid of patients with AS were determined using ELISA with OA and RA as controls.Taqman method was used to genotype tag SNPs (rs2753934,rs2749531 and rs6575424) in 56 AS cases,260RA cases and 160 healthy controls.ANOVA,LSD test andx2 test were used for statistical analysis.Results Increased expression of ATA1 in synovial membranes of AS was found when compared with samples from RA and OA.ELISA results showed significantly elevated level of ATA1 in the synovial fluid of patients with AS (1.6+0.6),but not in samples of RA(1.4±0.5) and OA (1.2±0.5)(P＜0.05).Haplotype analysis did not reveal a haplotype association in AS or RA(P＞0.05).ConclusionThe current findings suggest that upregulation of ATA1 may play an important role in the pathogenesis of AS.
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Objective To investigate the expression of thiredoxin domain containing 5 (TXNDC5) in the synovial tissues and blood samples of various arthritic conditions and autoimmune diseases to further confirm the previous findings, investigate the relations between the expression level of TXNDC5 and clinical parameters of RA. Methods The expression of TXNDC5 in the synovium was quantitatively analyzed by immunohistochemistry, real-time quantitative PCR and Western blotting. The levels of TXNDC5 in blood and synovial fluid was determined using sandwich ELISA in patients with RA, osteoarthritis (OA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and normal controls. One-way ANOVA, LSD test and Spearmen' s correlation were used for statistical analysis. Results Immunohistochemistry indicated that TXNDC5 expression was significantly higher in the synovial tissues of RA (100%, 40±9) than in those of OA and AS(200%,4±4). Real time PCR and western blotting confirmed the above findings (P<0.01). Sandwich-ELISA indicated significantly elevated level of TXNDC5 in the blood and synovial fluid of patients with RA (A=1.31±0.37), but not in those of OA, SLE, and AS, the healthy controls (P<0.01). The level of TXNDC5 in the blood of RA patients (A=0.8185±0.299) was positively correlated with the level of anti-CCP (r=0.350, P =0.027). Conclusion The results suggest that the pronounced increase of TXNDC5 expression may stimulate synovial pannus formation in the hypoxic environment of RA.