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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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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.
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Polytrauma represents severe injuries to multiple body regions, which is associated with high risk of complications and mortality. The definition of polytrauma relies on the basic concept of a combination of injuries that cause a life-threatening condition. The authors strongly call on the healthcare community to list polytrauma as a single disease in the international classification of diseases, rather than "disease combination". Because polytrauma has definite etiology and unique pathophysiological changes after polytrauma, treatment models are different from single trauma. Polytrauma can certainly fulfil any practical and nosological criteria of a single disease according to Berlin definition. The authors explore the importance of polytrauma as a single disease in preventive intervention strategies, therapeutic measures and traumatology development in the future.
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Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.
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Objective:To observe the effect of repeated, bilateral administration of high-frequency transcranial magnetic stimulation (rTMS) in treating post-stroke dysphagia.Methods:Forty-five persons with post-stroke dysphagia were randomly divided into a bilateral group ( n=14 after one dropout), an affected group ( n=15) and a healthy group ( n=15). All received 30 minutes of conventional swallowing rehabilitation training 5 times a week for 2 weeks from a speech therapist. Those in the affected group also received 5Hz rTMS applied to the motor cortex controlling the suprachyoid muscle group. The bilateral group received the same stimulation bilaterally with the same duration and treatment course. Videofluoroscopy was used to assess their swallowing before and after the 2 weeks of treatment. It was rated using the penetration-aspiration scale (PAS) and the functional swallowing disorder scale (FDS). Surface electromyography was employed to evaluate suprachyoid muscle function. Cortical excitability was assessed by measuring the resting motor threshold (RMT) of the unaffected hemisphere. Results:After the treatment, the average PAS, FDS and muscle function values had improved significantly for all three groups, but significant RMT differences were observed only between the bilateral and the unaffected group. Significant differences in the average FDS and PAS scores were observed after the treatment, as well as significant changes in FDS and muscle function between the affected group and the other two groups. The average FDS scores before and after treatment were significantly different between the unaffected and bilateral group, with the former scoring significantly better than the latter. But no significant differences in the average PAS scores were observed after the treatment.Conclusions:5Hz rTMS of either the unaffected or affected cerebral cortex (or bilateral) can effectively improve the swallowing function of persons with post-stroke dysphagia. Bilateral stimulation has the greatest therapeutic effect, followed by stimulation of the unaffected cerebral cortex.
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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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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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Objective:To explore the effect of high-frequency and low-frequency transcranial magnetic stimulation (rTMS) on the unaffected pharyngeal motor cortex of dysphagic stroke survivors.Methods:Forty-two stroke survivors with dysphagia were enrolled and randomly divided into a high-frequency stimulation group ( n=14), a low-frequency stimulation group ( n=13), and a sham group ( n=15). All received conventional swallowing training. The high- and low-frequency stimulation groups additionally received 250 pulses of 5Hz or 1Hz rTMS over the cortical representation of the mylohyoid muscle on the unaffected side daily for 2 consecutive weeks. In the sham group, sham rTMS was applied with identical protocols. Before and after the intervention, all subjects were subjected to a videofluoroscopic swallowing study and surface electromyography (sEMG). They were also evaluated using the fuctional dysphagia scale (FDS) and the penetration aspiration scale (PAS). Results:After the intervention, a significant improvement was observed in the average PAS, FDS and sEMG results in both rTMS groups compared with the sham control group. The average FDS score of the high-frequency stimulation group had improved significantly more than that of the low-frequency group.Conclusions:rTMS of the contra-lesional cortical representation of the mylohyoid muscle at either 5Hz or 1Hz can effectively improve dysphagia post-stroke. The higher frequency gives superior results.
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Objective@#To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training (CTCT)" by investigating the trainees who participated in the course.@*Methods@#A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study. Through questionnaires, the general information (gender, occupation, professional title, discipline source, length of time engaged in trauma treatment), the situation of trauma treatment in their hospitals (hospital level, trauma treatment mode, number of severe trauma cases each year), the recommended model of trauma treatment, learning methods of trauma treatment knowledge, and the trauma training interval were obtained. The trainees took tests before and after the training, and the test results were used to evaluate the training effect and analyze the influencing factors.@*Results@#(1) There were 1 230 males (74.10%), 1 356 physicians (81.93%), 1 247 with intermediate title or lower levels (75.12%), 756 from emergency department/emergency surgery (45.54%), and 899 who were engaged in trauma treatment for more than five years (54.16%). (2) There were 1 068 trainees from tertiary hospitals (64.34%). The main mode of severe trauma treatment in hospitals was "emergency+ consultation+ triage" (1 198 trainees, 72.17%). A total of 1014 trainees treated less than 200 severe trauma patients each year (61.08%). A total of 1210 trainees recommended emergency/emergency surgery (72.89%) and 350 trainees recommended trauma surgery/trauma hospital (21.08%) as the main mode of treatment. (3) There were various approaches to acquire trauma treatment knowledge, including 1 029 person-times (61.99%) through department internal guidelines, 924 person-times (55.66%) through case discussion, 879 person-times (52.95%) through self-teaching, 767 person-times (46.20%) through lectures, 382 person-times (23.01%) through trauma courses and 285 person-times through further studies at home and abroad (17.17%). A total of 951 trainees recommended 1-2 years as the training interval (57.3%). (4) The average test score before training was (67.5±14.5)points, which were influenced by the hospital level, discipline source, title of trainees, length of time engaged in trauma treatment, and amount of severe trauma cases each year in their hospitals. The hospital level and discipline source were the main effect factors. (5) The average test score after training was (83.8±11.6)points, which was significantly higher than that before training (P<0.01), and the scores of trainees in different subgroups were all improved. The main factors influencing the test score included hospital level, number of severe trauma cases each year, discipline source, professional title, number of severe trauma cases each year treated in the hospital. The major effect factor was the amount of severe trauma cases each year.@*Conclusions@#The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+ decentralized treatment" . Few trainees have received systematic trauma treatment training, and their trauma treatment knowledge level and the test scores before training is influenced by hospital level, the case number of severe trauma treatment, discipline source, and trainees’qualifications. After the standardized and standardized trauma treatment training course "CTCT" , the scores of students from different backgrounds have been significantly improved, and the gap between students has been significantly narrowed.
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Objective@#To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6±6.5)kg/m2]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded.@*Results@#A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97% (65/67)], slightly higher than that of the left group [94%(15/16)] , but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complication incidences were as follows: hematoma or arterial injury [5%(4/83)], pneumothorax 2%(2/83), catheter-related thrombosis [12%(10/83)], and catheter ectopia [1%(1/83)]. No catheter-related infection was observed. Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury: 6% vs. 4%, pneumothorax: 0% vs. 3%; catheter ectopic: 0% vs. 1%; catheter-related thrombosis: 13% vs. 12%), and the difference was not statistically significant (P>0.05). The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury: 3% vs. 6%; pneumothorax: 3% vs. 2%; catheter ectopic: 0% vs. 2%; catheter-related thrombosis: 17% vs. 9%), and the difference was not statistically significant (P>0.05).@*Conclusions@#Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients. It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture. However, there still exists a high risk of catheter-related thrombosis, requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
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Objective To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients.Methods A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018.There were 48 males and 35 females,aged 21-84 years [(56.5 ±14.3)years].The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6 ± 6.5)kg/m2].There were 26 patients with mainly craniocerebral injury,15 with mainly thoracic injury,28 with mainly abdominal injury,eight with mainly spinal injury and six with mainly pelvic fracture.The injury severity score (ISS) ranged from 24 to 66 points [(41.8 ± 18.1)points].All the patients received the axillary CVC based on Nickalls' landmarks.The left axillary vein was used as the puncture vein in 16 patients (left group),and the right axillary vein was used as the puncture vein in 67 patients (right group).A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group),while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group).The success rate of catheterization,pneumothorax,hematoma or artery injury,catheter ectopia,catheter-related infection and catheter-related thrombosis were recorded.Results A total of 80 patients were successfully intubated,with a success rate of 96％.Subgroup analysis showed that the success rate of right group was [97％ (65/67)],slightly higher than that of the left group [94％ (15/16)],but the difference was not statistically significant (P ＞ 0.05).And the success rate of adjacent fracture group [94％ (34/36)] was similar to that of non-adjacent fracture group [98％ (46/47)],and the difference was not statistically significant (P ＞ 0.05).Complication incidences were as follows:hematoma or arterial injury [5％ (4/83)],pneumothorax 2％ (2/83),catheter-related thrombosis [12％ (10/83)],and catheter ectopia [1％ (1/83)].No catheterrelated infection was observed.Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury:6％ vs.4％,pneumothorax:0％ vs.3％;catheter ectopic:0％ vs.1％;catheter-related thrombosis:13％ vs.12％),and the difference was not statistically significant (P ＞ 0.05).The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury:3％ vs.6％;pneumothorax:3％ vs.2％;catheter ectopic:0％ vs.2％;catheter-related thrombosis:17％ vs.9％),and the difference was not statistically.significant (P ＞ 0.05).Conclusions Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients.It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture.However,there still exists a high risk of catheterrelated thrombosis,requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.
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Objective To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training(CTCT)" by investigating the trainees who participated in the course.Methods A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study.Through questionnaires,the general information(gender,occupation,professional title,discipline source,length of time engaged in trauma treatment),the situation of trauma treatment in their hospitals(hospital level,trauma treatment mode,number of severe trauma cases each year),the recommended model of trauma treatment,learning methods of trauma treatment knowledge,and the trauma training interval were obtained.The trainees took tests before and after the training,and the test results were used to evaluate the training effect and analyze the influencing factors.Results(1)There were 1 230 males(74.10％),1 356 physicians(81.93％),1 247 with intermediate title or lower levels(75.12％),756 from emergency department/emergency surgery(45.54％),and 899 who were engaged in trauma treatment for more than five years(54.16％).(2)There were 1 068 trainees from tertiary hospitals(64.34％).The main mode of severe trauma treatment in hospitals was "emergency+consultation+triage"(1 198 trainees,72.17％).A total of 1014 trainees treated less than 200 severe trauma patients each Year(61.08％).A total of 1210 trainees recommended emergency/emergency surgery(72.89％)and 350 trainees recommended trauma surgery/trauma hospital(21.08％)as the main mode of treatment.(3)There were various approaches to acquire trauma treatment knowledge,including 1 029 person-times(61.99％)through department internal guidelines,924 person-times(55.66％)through case discussion,879 person-times(52.95％)through self-teaching,767 person-times(46.20％)through lectures,382 person-times(23.01％)through trauma courses and 285 person-times through further studies at home and abroad(17.17％).A total of 951 trainees recommended 1-2 years as the training interval(57.3％).(4)The average test score before training was(67.5±14.5)points,which were influenced by the hospital level,discipline source,title of trainees,length of time engaged in trauma treatment,and amount of severe trauma cases each year in their hospitals.The hospitallevel and discipline source were the main effect factors.(5)The average test score after training was(83.8±11.6)points,which was significantly higher than that before training(P＜0.01),and the scores of trainees in different subgroups were all improved.The main factors influencing the test score included hospital level,number of severe trauma cases each year,discipline source,professional title,number of severe trauma cases each year treated in the hospital.The major effect factor was the amount of severe trauma cases each year.Conclusions The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+decentralized treatment".Few trainees have received systematic trauma treatment training,and their trauma treatment knowledge level and the test scores before training is influenced by hospital level,the case number of severe trauma treatment,discipline source,and trainees' qualifications.Mter the standardized and standardized trauma treatment training course "CTCT",the scores of students from different backgrounds have been significantly improved,and the gap between students has been significantly narrowed.
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Objective To measure the oxygen partial pressure (PtO2) within a situation of vacuum sealing drainage (VSD) implement, and to discuss the potential mechanism of VSD alleviating skeletal muscle ischemia reperfusion (I/R) injury in rabbits. Methods Rabbits were randomly(random number) divided into three groups: sham (n=10), I/R (n=10) and I/R+VSD (n=10) groups. In the I/R group, left hind limb ischemia was induced by clamping the femoral artery and vein for 4 h, then released for 6 h, to allow reperfusion of the limb. VSD was only performed in the I/R+VSD group during the reperfusion period. All rabbits were administered a series test of PtO2 in different time points before and after reperfusion, and the left hind limb skeletal muscle and ear vein blood samples were immediately harvested for biochemical analyses, including hypoxia inducible factor 1 alpha (HIF-1α) mRNA and protein, and lactic acid (LA). One-way analysis of variance (ANOVA), Fisher's least significant difference (LSD) test or Tamhane's T2 test was used where appropriate to analyze the experimental results. Results The levels of PtO2 in the I/R and I/R+VSD groups were decreased after ischemia, but no significant difference was noted between the two groups (t=1.322, P=0.296). The PtO2 levels in the I/R+VSD group were less increased than those in the I/R group after reperfusion (t=2.015, P=0.046). The levels of HIF-1α mRNA and protein were increased after I/R injuries (F=10.120, P=0.002; F=36.480, P<0.01; F=6.960, P=0.015, F=4.470, P=0.035), and the levels in the I/R+VSD group were greater than those in the I/R group (t=1.799, P=0.048, t=5.911, P=0.019; t=1.878, P=0.046, t=2.609, P=0.030). The LA levels were significantly increased in the skeletal muscle and blood samples in the I/R and I/R+NPWT groups compared with those in the sham group at the final stage (F=9.540, P=0.002 and F=13.750, P<0.01), but the levels in the I/R+VSD group were less than those in the I/R group (t=2.263, P=0.040 and t=3.617, P=0.027). Conclusions Our results suggested that VSD technique decreased PtO2 in regional ischemic muscles and led to increases in HIF-1α mRNA and protein that subsequent accumulation of less LA in both of regional skeletal muscle and systemic blood circulation, which provided protection effect after I/R injury in rabbits.
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Obiective To explore the risk factors of endometriosis-associated ovarian cancer (EAOC) in women with ovarian endometriosis aged 45 years and older in China. Methods The medical records of total 1038 women aged 45 years and older with a surgicopathological diagnosis of ovarian endometriosis treated at Peking Union Medical College Hospital from December 1994 to December 2014 were reviewed. Histology evaluation determined ovarian endometriosis with (n=30) or without (n=1008) ovarian cancer. Results (1) There were 30 (2.9%, 30/1018) cases confirmed as having EAOC. Clear cell carcinoma (63.3%, 17/30) and endometrioid adenocarcinoma (23.3%, 7/30) were commonly observed subtypes and 70.0%of EAOC patients were at stageⅠ. (2) Compared women with ovarian endometriosis in the same age group,patients with EAOC were older (50.8 vs 48.5 years, P=0.002). There were more in postmenopausal status at diagnosis of EAOC (P＜0.01). There were more found with a mass ≥8 cm (P＜0.01). Women with EAOC had higher prevalence of coexisting endometrial disorders (P=0.003). No differences were found in preoperative CA125 value and infertile or nulliparous women (P＞0.05). Conclusions For women with ovarian endometriosis aged 45 years and older, the subgroup of patients characterized by postmenopausal status and ovarian endometrioma (≥8 cm) have a higher risk of EAOC. Active intervention or intensive follow-up should be considered for this population group, especially for those concurrent with endometrial disorders.
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Objective To observe the effect of neuromuscular electrical stimulation (NMES) at different intensities on functional swallowing and the velocity of hyolaryngeal excursion in post-stroke dysphagia.Methods Thirty stroke survivors with dysphagia were randomly divided into a control group,an NMES group and an intensive NMES group,each of 10.All 3 groups received conventional swallowing training,while the patients in the NMES group also received NMES at 30 ～ 80 Hz in an intensity of ≤ 25 mA once a day and those in the intensive NMES group received it twice a day.Before,as well as 2 and 4 weeks after the treatment,video fluoroscopy when swallowing pap was used to determine the superior and anterior excursion distances of the hyoid and larynx and the excursion's duration and the corresponding velocity.A water drinking test (WDT) was also administered,and dysphagia severity scale (DSS) and penetration-aspiration scale (PAS) ratings were assessed.Results After the treatment,significant improvement was observed in the average WDT,DSS and PAS scores of all three groups compared to before the treatment.The average WDT score of the intensive NMES group was significantly better than that of the control group after 2 weeks of treatment.After 2 and 4 weeks of treatment,the average DSS of the intensive NMES group was significantly better than that of the control group,while the intensive NMES group's average PAS score was significantly better than those of both of the other groups.The average anterior hyoid excursion velocity of the intensive NMES group was significantly faster than those of the other two groups after both 2 and 4 weeks of treatment.Pearson correlation analysis indicated that the PAS score was significantly correlated with the anterior hyoid excursion velocity.Conclusion Two NMES sessions a day are superior to only one session in improving functional swallowing after stroke.It better promotes quick movement of the body parts involved.
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Objective To compare the phenotype of myeloid derived suppressor cells (MDSCs) separated from the bone marrow of mice 3 d and 7 d after cecal ligation and puncture ( CLP) and to elucidate its potential role in the accumulation and immuno-function of MDSCs by determining the expression of microRNA-146a(miR-146a)in order to explore the effect of miR-146 a on immonosuppression of MDSCs in sepsis .Methods A septic model was prepareol by CLP in adult male C57BL/6J mice.MDSCs(expressing cell-surface CD11b and GR-1 antigens )from bone marrow were harvested 3 and 7 days after CLP and were separated with magnetic bead sorting technique .Then,cytokines secretion and arginase-I activity were detected and the T cell proliferation in vitro and the expression of miR-146a of MDSCs (3 d and 7 d after CLP)were observed.Results MDSCs secreted mostly such promoting inflammatory factors as TNF-α, IL-6 3 days after CLP, but 7 days after CLP , they primarily secreted IL-10 and TGF-βwhich were anti-inflammatory factors . MDSCs had potent immunosuppressive properties by increasing T cell suppression in a late anti-inflammatory phase ( CLP3 d vs CLP7 d, P<0.05).In the meantime,miR-146a of the MDSCs in bone marrow was overexpressed in septic mice at 7 days(P<0.05). Moreover,the expression of miR-146a of the MDSCs in bone marrow of septic mice was higher at 7 days than at 3 days after CLP(P<0.05).Conclusion The data indicate that the phenotype of MDSCs evolves through early pro -inflammatory phase into the late anti-inflammatory phase .MDSCs have potent immunosuppressive properties in the late phase of sepsis . miR-146 a might play a crucial role in the regulation of immunosuppressive activity of MDSCs in late sepsis .
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ObjectiveTo investigate changes of Th17/Treg ratio in peripheral blood of patients with traumatic sepsis and discuss the underlying clinical significance.MethodsThrity-five multi-trauma patients enrolled in the study were divided into trauma group (n =22) and sepsis group (n =13 ).Another nine healthy volunteers were designed as the control group.Peripheral blood was collected from all the groups so as to determine the ratios of Th17 and Treg by flow cytometry,detect the mRNA expressions of RORγt and FoxP3 by real time fluorescence quantitative PCR and measure serum levels of IL-4,IL-6,IL-10,IL-17A,IL-23,transforming growth factor-β (TGF-β),interferon-γ (IFN-γ) and C-reaction protein (CRP) by ELISA.Further,the change of Th17/Treg ratio and its clinical significance were analyzed.ResultsThe proportion of Th17 in the trauma group showed no significant difference with that in the control group, whereas the ratio of Th17/Treg was lower than that in the control group (P ＜ 0.05).The proportion of Th17 and ratio of Th17/Treg in the sepsis group were higher than those in the trauma group and control group (P ＜ 0.01 ).Serum concentrations of TGF-β,IL-6 and IL-23 in the sepsis group were all significantly higher than those in the control group ( P ＜ 0.01 ).Serum levels of TGF-β had no significant difference between the sepsis group and the trauma group,while serum concentrations of IL-6 and IL-23 in the sepsis group were higher than those in the trauma group ( P ＜ 0.01 ).Serum level of IL-17A and mRNA expression of RORγt in the sepsis group were higher than those in the trauma and control groups ( both P ＜ 0.01 ).ConclusionTh17/Treg imbalance is closely correlated with the development of sepsis in patients with severe trauma.
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Objective To explore the quantity change and significance of CD14-/CD11b+/CD33 + myeloid-derived suppressor cells (MDSCs) in patients with multiple injury. Methods Thirtyfour patients with multiple injury and seven healthy volunteers were enrolled in this study. Peripheral blood was collected and the factors of CD14-/CD1 1 b+/ CD33 + were taken as markers of MDSCs. The percentage of MDSCs was determined by flow cytometry (FCM) and serum interleukin-10 and C-reactive protein levels were determined by ELISA to analyze the quantity change and clinical significance of MDSCs. Results The percentage of MDSCs in peripheral blood of healthy volunteers was (1.13 +0. 25) %. At days 1,2, 3 and 7 after injury, the percentage of MDSCs in peripheral blood were (1.20 +0.22) %, (6.44 + 0.35) %, (13.84 ± 2.07) % and (15.60 ± 1.63) % respectively in patients with infection and multiple injury, whereas (1.29 ±0. 30)%, (4.93 +0. 32)%, (5.15 ±0. 21)% and (3.77 ± 0.34) % respectively in patients without infection. The percentages of MDSCs in two groups showed significant differences at days 2, 3 and 7 after trauma (P＜0.05). No correlation was found between MDSCs percentage in peripheral blood and injury severity score, serum interleukin-10 or C reactive protein in patients with multiple injury (P ＞ 0.05). Conclusions The increase of proportion ofMDSCs in peripheral blood correlates with the onset of infection in patients with multiple injury, indicating that the expansion of MDSCs in peripheral blood may play important roles in immune dysfunction after multiple injury.
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Objective To observe change of T regulatory cells (Tregs) and its relation with in-jury severity and sepsis following severe muhiple injury. Methods A total of 60 patients were em-ployed in the study and divided into severe group (30 patients) and critical group (30 patients) based on ISS scores and into sepsis group (22 patients) and non-sepsis group (38 patients) based on complication of sepsis. The proportion of Tregs in peripheral blood in different groups was detected by flow cytometry at days 1,3,5 and 8 after injury. Results The proportion of Tregs was significantly increased at day 5 postinjury, with statistical difference compared with that at day 3 postinjury (P < 0.01). The proportion of Tregs remained increasing at day 8 pestinjury (P < 0.05). At day 8 postinjury, the proportion of Tregs in critical group was significantly higher than that in severe group (P < 0.01). At the same time, the proportion of Tregs in sepsis group was significantly higher than that in non-sepsis group (P < 0.05). Spearman correlation analysis showed a positive correlation of Tregs proportion with ISS score (rs =0.654, P < 0.01). Conclusions Tregs play an important role in suppression of T cell-mediated im-munity after severe injury. The variation of Tregs can help evaluate prognosis and predict the risk of com-plicating sepsis in patients with severe multiple injury.
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Objective To investigate the clinical therapeutic effect of integrative treatment model and damage control theory in treatment of severe multiple injury. Methods A retrospective study was done on 116 patients with severe multiple injuries who were divided into integrative treatment plus damage control group, integrative treatment group and conventional treatment group. The relationship of correlative factors with mortality rate among three groups was compared before operation, during operation and after operation. Results All the indices in integrative treatment plus damage control group were better than other two groups before operation, during operation and after operation, with lower mortality rate (P<0.05). Conclusions Early use of integrative treatment model and damage control theory can obviously decrease complications, improve prognosis and decrease mortality rate for patients with severe multiple injury.
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Objective To investigate the efficacy of emergency vacuum sealing drainage (VSD) in the treatment of crush syndrome. Methods A total of 102 patients with crush injury were randomly screened out and divided into emergency VSD group (n = 50), delayed VSD group (n = 22) and control group (n = 30). The variances of indices of crush syndrome after VSD between three groups were analyzed. Results The vital sign, urine volume, laboratory examination results were improved and the incidence rate of crush syndrome, complications and mortality rate were significantly decreased in emergency VSD group than those in delayed VSD group and control group (P < 0.05). For patients with crush syndrome, the incidence of complications, duration of hospital stay and mortality rate were significantly decreased in emergency VSD group and delayed VSD group than those in control group (P < 0.05). Conclusion Emergency VSD can suck the exudate of the necrotic tissues and the wounds, maintain draining wounds and prevent infection and hence is helpful to prevent and treat the crush syndrome.