Alteraciones de la salud humana por artefactos explosivos improvisados. Revisión sistemática exploratoria / Alterations of human health due to improvised explosive devices. Exploratory systematic review / Mudanças na saúde humana devido a dispositivos explosivos improvisados. Revisão sistemática exploratória

Objetivo: revisar la literatura existente indagando por los tipos de lesión o enfermedad que se han identificado en supervivientes de artefactos explosivos improvisados (AEI), así como aspectos individuales y colectivos relacionados con la protección o destrucción de la salud humana enfrentada a los AEI. Metodología: revisión sistemática exploratoria de literatura publicada en bases de datos, como PubMed, SciELO, LILACS, JSTOR, OpenGrey y Google Scholar, entre 2001 a 2021 en cualquier localización geográfica. Se incluyeron artículos de investigación, de revisión o reflexión, libros o capítulos de libro de investigación e informes técnicos, en inglés, español, francés y portugués. Resultados: cumplieron con los criterios de inclusión y fueron revisados 76 documentos. Se han reportado múltiples lesiones asociadas al uso de los AEI, sin que exista un patrón característico de lesión o enfermedad; no obstante, la lesión más común es la amputación bilateral de miembros inferiores. En supervivientes se ha encontrado que el personal militar afectado suele mostrar una mayor capacidad de resiliencia, calidad de vida, tratamiento oportuno y capacidad física funcional más alta, comparado con civiles. El apoyo social genera efectos positivos en la salud y bienestar de los afectados. Conclusiones: los AEI generan múltiples afectaciones a la salud humana, físicas y psicosociales, los cuales requieren una atención integral y multidisciplinaria para el tratamiento, rehabilitación y reintegración de los supervivientes. Los aspectos protectores y destructivos identificados se encuentran asociados a mejores o peores resultados en la salud, existe una representación desigual entre civiles y militares.

Objective: to review the existing literature where we inquired for injury types or illness identified in victims of improvised explosive devices (IED), and also to look for individual and collective processes described in literature in relation with the protection or destruction of human's health and IEDs. Methodology: exploratory systematic review of the literature published on PubMed, SciELO, LILACS, JSTOR, OpenGrey and Google Scholar databases between 2001 and 2022, in any geographic location. We included research, review and opinion articles, books and book chapters reporting research results, and final technical reports in English, Spanish, French and Portuguese. Results: 76 documents met the inclusion criteria and were reviewed. Multiple types of injuries have been reported in relation with the use of IEDs, without a characteristic pattern of injury or disease reported; however, the most common injury is bilateral lower limb amputation. In survivors it has been found that affected military personnel tend to show greater resilience capacity, better quality of life, timely treatment, and higher functional physical capacity, compared to civilians. Social support generates positive health effects and wellness of people affected by IED. Conclusion: IEDs generate multiple effects on human health, both physical and psychosocial, which is why comprehensive and multidisciplinary care is required for the treatment, rehabilitation, and reintegration of their victims. The protective and destructive processes identified are associated with better or worse health outcomes, with unequal representation between civilians and military personnel.

Objetivo: Revisar a literatura existente investigando os tipos de lesão ou doença que foram identificados em sobreviventes de artefatos explosivos improvisados ​​(IED), bem como aspectos individuais e coletivos relacionados à proteção ou destruição da saúde humana diante de IEDs. Metodologia: Revisão sistemática exploratória da literatura publicada nas bases de dados Pubmed, Scielo, Lilacs, JSTORE, Open Gray e Google Acadêmico, entre 2001 e 2021 em qualquer localidade geográfica. Foram incluídos artigos de pesquisa, revisão ou reflexão, livros ou capítulos de livros de pesquisa, relatórios técnicos, em inglês, espanhol, francês e português. Resultados: Atenderam aos critérios de inclusão e foram revisados ​​76 documentos. Múltiplas lesões associadas ao uso de IEDs foram relatadas, sem um padrão característico de lesão ou doença; entretanto, a lesão mais comum é a amputação bilateral de membros inferiores. Nos sobreviventes, verificou-se que os militares acometidos tendem a apresentar maior resiliência, qualidade de vida, tratamento oportuno e maior capacidade física funcional, em comparação aos civis. O apoio social gera efeitos positivos na saúde e bem-estar das pessoas afetadas. Conclusões: Os IEDs geram múltiplos efeitos na saúde humana, física e psicossocial, que requerem atenção integral e multidisciplinar para o tratamento, reabilitação e reintegração dos sobreviventes. Os aspectos protetores e destrutivos identificados estão associados a melhores ou piores resultados de saúde, com representação desigual entre civis e militares.

Effects of simulated gas of warm pressure charge explosion on neurobehavior and hippocampal neurogenesis in rats / 中华行为医学与脑科学杂志

Objective:To investigate the effects of thermobaric charge explosion simulated gas on long-term neurobehavior and hippocampal neurogenesis in rats.Methods:A total of 48 male SPF grade SD rats aged 8-10 weeks were randomly divided into control group, 5 min exposure group, 10 min exposure group and 15 min exposure group, with 12 rats in each group. Twenty-eight days after inhalation of infection, the anxiety-like behavior of rats was evaluated by an elevated cross maze, and the learning and memory function of rats was evaluated by two-way active avoidance experiment. The number of positive cells of rat hippocampal dentate gyrus neural stem cells marker molecule neural epithelial cell protein (SOX2) and mature neuron marker molecular neuronal nuclei (NeuN) was detected by immunofluorescence staining. Western blot was used to detect SOX2 and NeuN protein expression in the hippocampal tissues of rats. GraphPad prism 8.0 software was used for data analysis.The comparison of repeated measurement design data was carried out by repeated measurement ANOVA.One-way ANOVA was used for inter group comparisons, and Tukey test was used for pairwise comparison. Hippocampal nerve cells were counted using the Image J software.Results:(1) The experimental results of the elevated cross maze showed that the percentage of arm opening and the percentage of open arm residence time in each group had significant group effects ( F=22.31, 5.43, all P<0.05). The percentage of open arm entry times of rats in the 5 min, 10 min and 15 min exposure group ((28.85±1.47)%, (15.04±4.69)%, (12.66±2.89)%) and the percentage of residence time in open arm ((12.12±2.64)%, (12.16±1.11)%, (8.73±3.52)%) were all lower than those of the control group ((65.40±1.86)%, (42.92±3.12)%) (all P<0.05). There were no statistically significant differences in pairwise comparison among the three exposure groups (all P>0.05). (2)During the memory acquisition period, the results of repeated-ANOVA showed that the time main effect ( F=56.46), the group main effect ( F=16.64) and the interaction effect had significant differences( F=4.21)(all P<0. 05). The difference values of active avoidance number between the 4th day and 1st day among the four groups were significant different ( F=68.63, P<0.05). During the memory reproduction period, there were significant differences in active avoidance number and active avoidance time among the four groups ( F=8.17, 8.28, both P<0.05). The active avoidance numbers in 10 min and 15 min exposure groups((2.50±0.26) times, (2.33±0.06) times)were significantly lower than those in the control group ((8.33±3.72) times) (both P<0.05), and the active avoidance time ((6.25±0.40)s, (6.61±1.63)s) were significantly higher than those in the control group((3.69±1.41)s) (both P<0.05). The active avoidance numbers in 10 min and 15 min exposure groups were significantly lower than that in 5 min exposure group (both P<0.05). (3) The results of immunofluorescence staining showed that the numbers of SOX2-positive cells in the four groups were statistically significant ( F=5.33, P<0.05). The SOX2-positive cells in 15 min exposure group (4.33±1.12) was significantly lower than that in control group (7.67±1.52) ( P<0.05). The numbers of NeuN-positive cells in the four groups were significantly different ( F=11.06, P<0.05), and the NeuN-positive cells in the 10 min and 15 min exposure groups((105.67±8.50), (88.33±9.50)) were significantly lower than that in the control group (127.00±6.56) ( P<0.05). The NeuN-positive cells in 15 min exposure group were significantly lower than that in 5 min exposure group (110.67±8.32) ( P<0.05). (4) Western blot results showed that the relative expression of SOX2 and NeuN proteins in the four groups was statistically significant ( F=11.560, 7.035, both P<0.05). The relative expression of SOX2 and NeuN proteins in the 15 min exposure group were significantly lower than those in control group (both P<0.05). The relative expression of SOX2 protein in 15 min exposure group was significantly lower than that in 5 min exposure group ( P<0.05). Conclusion:Acute exposure to warm pressure charge explosion simulated gas can lead to anxiety-like behavior, learning and memory deficits in rats, and significantly reduce the protein expression levels of hippocampal dentate gyrus neural stem cells and mature neuronal marker molecules SOX2 and NeuN.

Intoxicación cronica por metales tóxicos en supervivientes de artefactos explosivos improvisados con fragmentos incorporados y su potencial neoplásico. Revisión sistemática exploratoria / Chronic heavy metal intoxication in survivors of improvised explosive devices with embedded fragments and its neoplastic potential. Exploratory systematic review

Resumen Introducción: Los artefactos explosivos improvisados son armas no convencionales que pueden provocar múltiples lesiones y dejar esquirlas a modo de cuerpos extraños que pueden contener metales tóxicos, con potencial afectación a la salud de las víctimas según reportes datados desde 1977, los cuales mencionan alta mortalidad por cáncer y otros síntomas compatibles con toxicidad crónica Objetivo: Describir los resultados de investigación que informen sobre la toxicidad crónica producida por metales en personas víctimas de artefactos explosivos improvisados con esquirlas internalizadas, y sus posibles relaciones con cáncer. Metodología: Revisión sistemática exploratoria de literatura publicada y gris que se realizó entre los meses de marzo a mayo de 2021 en diferentes repositorios de tesis y bases de datos (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); sin límite temporal o geográfico. Se incluyeron artículos originales de revistas indexadas o informes finales no publicados, correspondientes a investigaciones científicas con texto completo, en inglés, español y portugués. Resultados: De 56 documentos evaluados, solamente tres cumplieron criterios de inclusión. Todos estaban escritos en idioma inglés. Solo un estudio iraquí abordó población civil y los otros trabajos aludían a veteranos norteamericanos. Los niveles elevados de metales tóxicos, asociados con alteraciones tisulares circunscritas, fueron hallazgos recurrentes. No hubo reportes de patologías instauradas o manejos clínicos. Conclusión: Fue escasa la evidencia científica recabada; sin embargo, sí se han reportado cambios tisulares circundantes a esas esquirlas. Se considera necesario realizar más estudios relacionados con el tema, incluyendo seguimientos a largo plazo de las afectaciones tisulares detectadas.

Abstract Introduction: Improvised explosive devices are unconventionalweapons that can cause multiple injuries and splinters internalized containing heavy metals, potentially affecting the victim's health, according to reports dating from 1977, which mention high mortality from cancer and other symptoms suggestive of chronic metal toxicity. Objective: To describe the research results that report on the chronic toxicity produced by heavy metals in people who are victims of improvised explosive devices with internalized splinters, and its possible links with cancer. Methodology: Systematic exploratory review of published and grey literature which was carried out between march and may of 2021, in thesis repositories and different databases (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); without time or geographical limit. Original articles from indexed scientific research journals or unpublished final reports were included, corresponding to scientific research with full text, in english, spanish and portuguese. Results: 56 documents were evaluated, three were selected fulfilling the inclusion criteria. They were all written in the english language. Only one Iraqi study addressed the civilian population and the other studies referred to North American veterans. Elevated heavy metal levels, associated with circumscribed tissue abnormalities, were recurrent findings. There were no reports of established pathologies or clinical management. Conclusion: The scientific evidence was scarce; as well as its relationship with established cancer, however, tissue changing surrounding these splinters have been reported. It is considered necessary to carry out more studies related to the subject, including long-term follow-up of detected tissue damage.

Anaesthetic Management of a Patient During Transurethral Resection of Prostate with Iatrogenic Intraperitoneal Bladder Explosion: An Atypical Event

Transuretheral resection of prostate (TURP) is one of the most commonly performed urological procedure. Though considered to be safe, it is sometimes associated with atypical complications. We hereby report a successful anaesthetic management of bladder explosion, a very rare complication of TURP, occuring towards the end of the procedure at the time of removal of resectoscope. The prompt recognition and management of the same led to uneventful postoperative course.

Role of pyroptosis pathway related molecules in acute lung injury induced by gas explosion in rats / 中华劳动卫生职业病杂志

Objective: To explore the role and significance of pyroptosis in gas explosion-induced acute lung injury (ALI) in rats. Methods: In February 2018, 126 SPF male SD rats were selected and randomly divided into blank control group (18 rats) and experimental group (40 m, 80 m, 120 m, 160 m, 200 m and 240 m, 18 per group) . The experimental group carried out gas explosion in the roadway to build the ALI model, the control group did not carry out gas explosion, and other conditions were consistent with the experimental group. Respiratory function indexes such as respiratory frequency (f) , tidal volume (TV) , minute ventilation (MV) and airway stenosis index (Penh) were measured 24 hours after the explosion. 5 rats in each group were sacrificed after anesthesia, Hematoxylin-Eosin (HE) staining was used to observe the pathological morphology of lung tissue. Immunohistochemistry was used to detect the content of Caspase-1. Western blotting was used to detect the content of cell pyroptosis including nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) , Caspase-1, interleukin-1β (IL-1β) and interleukin-18 (IL-18) in lung tissue related protein expression. Results: The f and MV of rats in the experimental group were higher than those in the control group (P<0.05) . Except for the 40 m and 80 m groups, the TV of rats in the other experimental groups were higher than those in the control group (P<0.05) . Except for the 40 m group, the Penh of rats in the experimental groups were lower than those in the control group (P<0.05) . HE staining showed that the lung tissue of the experimental groups at different distance points showed obvious edema of the pulmonary interstitium and alveoli, a large number of red blood cells and inflammatory cells exuded in the alveolar space, thickening of the pulmonary interstitium, and increased lung injury score (P<0.05) . The results of immunohistochemistry showed that the positive expression of Caspase-1 in each experimental group was higher than that in the control group (P<0.05) . Western blotting results showed that the expression of pyroptosis-related proteins in each experimental group was higher than that in the control group (P<0.05) . Conclusion: Pyroptosis is involved in the pathophysiological process of gas explosion-induced ALI in rats.

Disparidades por etnia en la mortalidad por minas antipersona: un análisis a nivel país / Ethnic disparities in mortality from landmines: A country-level analysis

Resumen Introducción. El Registro Colombiano de Víctimas de Lesiones por Minas Antipersona fue lanzado por el gobierno de Colombia con el objetivo de recolectar información sobre los casos de heridos por minas antipersona en el país. El propósito de este estudio fue investigar las disparidades de mortalidad entre las víctimas de lesiones por minas antipersona, en función de la pertenencia a una minoría étnica. Métodos. Se hizo una regresión logística multivariable para examinar la asociación entre minorías étnicas y mortalidad en las personas heridas por minas antipersona. Resultados. Se registraron 10.306 casos de lesiones por minas antipersona, de los cuales 430 eran personas pertenecientes a grupos étnicos minoritarios (indígenas o afrodescendientes). De estos, 85 (19,7 %) eran mujeres, 156 (36,2 %) eran menores de 18 años y 427 (99,3%) vivían en áreas rurales. La mortalidad fue significativamente mayor (29,3 %) en comparación con la población mestiza (18,5 %; p < 0,001). Después de ajustar por sexo, edad, soldado en servicio activo, área rural y volumen de casos por departamento, encontramos que las minorías étnicas tenían mayores probabilidades de morir (OR = 2,03; IC95% 1,61- 2,56; p < 0,001). Discusión. Encontramos una asociación entre la pertenencia a una minoría étnica y una mayor probabilidad de mortalidad con lesiones causadas por minas antipersona. Estos hallazgos deberían alentar a los legisladores de las zonas rurales de Colombia a trabajar más diligentemente, para reducir las consecuencias nocivas de las lesiones causadas por estos artefactos en los grupos étnicos minoritarios.

Abstract Introduction. The Colombian Victims of Antipersonnel Mines Injuries registry was launched by the Colombian government with the objective of collecting information on all the cases of injuries caused by antipersonnel landmines in the country. The purpose of this study was to investigate the mortality disparities among ethnic minority victims of antipersonnel landmine injuries. Methods. A multivariate logistic regression was performed to examine the association between ethnic minorities and mortality in people injured by antipersonnel mines. Results. A total of 10,306 cases of injuries caused by antipersonnel landmines were registered, of which 430 were people belonging to minority ethnic groups (indigenous or Afro-descendant). Of these, 85 (19.7%) were women and 156 (36.2%) were under 18 years of age. Almost all people from ethnic minority groups were located in rural areas (n=427, 99.3%) and mortality was significantly higher compared to the mestizo population (mestizo 18.5% vs. individuals from ethnic minorities 29, 3%; p <0.001). After adjusting for sex, age group, active duty soldier status, rural area, and case volume for each geographic department, we found that ethnic minorities were more likely to die after suffering an antipersonnel mine injury (OR = 2.03; 95% CI 1.61-2.56; p <0.001). Discussion. We found an association between belonging to an ethnic minority and a higher probability of mortality with injuries caused by antipersonnel mines. These findings should encourage legislators in rural Colombia to work more diligently to reduce the harmful consequences of injuries caused by these devices in ethnic minority groups.

Ethnic disparities in mortality from landmines: A country-level analysis / Ethnic disparities in mortality from landmines: A country-level analysis

Introducción. El Registro Colombiano de Víctimas de Lesiones por Minas Antipersona fue lanzado por el gobierno de Colombia con el objetivo de recolectar información sobre los casos de heridos por minas antipersona en el país. El propósito de este estudio fue investigar las disparidades de mortalidad entre las víctimas de lesiones por minas antipersona, en función de la pertenencia a una minoría étnica. Métodos. Se hizo una regresión logística multivariable para examinar la asociación entre minorías étnicas y mortalidad en las personas heridas por minas antipersona. Resultados. Se registraron 10.306 casos de lesiones por minas antipersona, de los cuales 430 eran personas pertenecientes a grupos étnicos minoritarios (indígenas o afrodescendientes). De estos, 85 (19,7 %) eran mujeres, 156 (36,2 %) eran menores de 18 años y 427 (99,3%) vivían en áreas rurales. La mortalidad fue significativamente mayor (29,3 %) en comparación con la población mestiza (18,5 %; p < 0,001). Después de ajustar por sexo, edad, soldado en servicio activo, área rural y volumen de casos por departamento, encontramos que las minorías étnicas tenían mayores probabilidades de morir (OR = 2,03; IC95% 1,61- 2,56; p < 0,001).Discusión. Encontramos una asociación entre la pertenencia a una minoría étnica y una mayor probabilidad de mortalidad con lesiones causadas por minas antipersona. Estos hallazgos deberían alentar a los legisladores de las zonas rurales de Colombia a trabajar más diligentemente, para reducir las consecuencias nocivas de las lesiones causadas por estos artefactos en los grupos étnicos minoritarios

Introduction. The Colombian Victims of Antipersonnel Mines Injuries registry was launched by the Colombian government with the objective of collecting information on all the cases of injuries caused by antipersonnel landmines in the country. The purpose of this study was to investigate the mortality disparities among ethnic minority victims of antipersonnel landmine injuries.Methods. A multivariate logistic regression was performed to examine the association between ethnic minorities and mortality in people injured by antipersonnel mines. Results. A total of 10,306 cases of injuries caused by antipersonnel landmines were registered, of which 430 were people belonging to minority ethnic groups (indigenous or Afro-descendant). Of these, 85 (19.7%) were women and 156 (36.2%) were under 18 years of age. Almost all people from ethnic minority groups were located in rural areas (n=427, 99.3%) and mortality was significantly higher compared to the mestizo population (mestizo 18.5% vs. individuals from ethnic minorities 29, 3%; p <0.001). After adjusting for sex, age group, active duty soldier status, rural area, and case volume for each geographic department, we found that ethnic minorities were more likely to die after suffering an antipersonnel mine injury (OR = 2.03; 95% CI 1.61-2.56; p <0.001). Discussion. We found an association between belonging to an ethnic minority and a higher probability of mortality with injuries caused by antipersonnel mines. These findings should encourage legislators in rural Colombia to work more diligently to reduce the harmful consequences of injuries caused by these devices in ethnic minority groups

Salud auditiva en víctimas afrocolombianas del conflicto armado, sobrevivientes de artefacto explosivo improvisado / Hearing health in Afro-Colombian victims of the armed conflict, survivors of improvised explosive device

Introducción: En el año 2002 un artefacto explosivo improvisado estalló sobre la población civil afrocolombiana refugiada en una iglesia y generó una masacre. Los sobrevivientes presentaron importantes afectaciones en la salud, sin un estudio completo hasta la fecha. Objetivo: Establecer el perfil de salud auditiva en la comunidad de sobrevivientes a la masacre de Bojayá, Chocó. Métodos: A partir de evaluaciones clínicas audiológicas con anamnesis, otoscopia, audiometría, logoaudiometría e impedanciometría en 61 personas supervivientes, se efectuó un estudio descriptivo incluyendo variables sociodemográficas, factores de riesgo, signos y síntomas auditivos, y diagnósticos audiológicos. Resultados: Un 72,13 por ciento de los participantes fueron mujeres. Además de la exposición al estallido de artefacto explosivo improvisado, que les afectó tanto en recinto cerrado (78,69 %), como en exteriores adyacentes (3,28 por ciento) o ubicaciones más distantes; los principales factores de riesgo auditivo encontrados fueron la infección de oído previa (26,87 por ciento). Un 70,49 por ciento sufría de tinnitus y 14,75 por ciento de vértigo. El 81,97 por ciento de sobrevivientes (n = 50) presentaron alteraciones en su audición, sin estudio previo. Un 81 por ciento de quienes se encontraron con algún grado de hipoacusia, reportaban el antecedente de exposición al estallido dentro del espacio cerrado de la iglesia. Conclusiones: El perfil de salud auditiva de la comunidad de sobrevivientes a la masacre de Bojayá, Chocó, se caracterizó por la presencia de dificultades auditivas, tinnitus, otalgia, vértigo, antecedentes de trauma acústico y perforaciones timpánicas. El principal diagnóstico encontrado fue hipoacusia conductiva bilateral(AU)

Introduction: In 2002 an improvised explosive device exploded over a church with Afro-Colombian civilians sheltering there, generating a massacre. The survivors presented important health problems without a complete study to date. Objective: To establish the hearing health profile in the community of survivors of the Bojayá Massacre, Chocó. Methods: Based on clinical audiological evaluations with anamnesis, otoscopy, audiometry, speech audiometry and impedance in 61 survivors, a descriptive study was carried out including sociodemographic variables, risk factors, auditory signs and symptoms, and audiological diagnoses. Results: 72.13 percent of the participants were women. In addition to exposure to the explosion of an improvised explosive device, which affected indoors (78.69 percent), and in adjacent outdoors (3.28 percent) or more distant locations, the main auditory risk factors found were previous infection of ears (26.87 percent). 70.49 percent suffered from tinnitus and 14.75 percent from vertigo. 81.97 percent of survivors (n=50) presented alterations in their hearing, without previous study. 81 percent of those who encountered some degree of hearing loss reported a history of exposure to the blast within the closed space of the church. Conclusions: The hearing health profile of the community of survivors of the Bojayá massacre, Chocó, was characterized by the presence of hearing difficulties, tinnitus, earache, vertigo, a history of acoustic trauma, and tympanic perforations. The main diagnosis found was bilateral conductive hearing loss(AU)

Underwater shock wave induced lung and brain injuries in canines / 第二军医大学学报

[Abstract] Objective To explore underwater shock wave-induced injuries of the lung and brain in canines. Methods Eighteen Beagle dogs were randomly divided into six groups according to the distances to the explosion source: control group and 5 experimental groups (5 m, 7 m, 9 m, 11 m and 13 m groups). The animals were exposed to underwater shock wave via a self-designed underwater explosive instrument. The dynamic explosive process was recorded by the underwater high-speed camera. Computed tomography (CT) scans of brain and chest were performed 6 h after injury. Pathological examination and H-E staining for hippocampus and lung were conducted 24 h after injury. The expression levels of interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor α (TNF-α) and transforming growth factor β (TGF-β) in the hippocampus were measured by immunohistochemical staining. Results The underwater high-speed camera showed that the injury process included blast wave and bubble pulsation. The total mortality of the animals was 40.0% (6/15) in the experimental groups. CT examination revealed no major alterations in the brain of the animals, while there were pleural effusion and pneumothorax in the chest of animals in the experimental groups. H-E staining showed inflammatory cells infiltration in the hippocampal tissue and erythrocyte deposition in the alveoli of animals in the experimental groups. The expression levels of IL-6, IL-1β, IL-10, TNF-α, and TGF-β in the hippocampus of animals in the experimental groups were significantly elevated compared with those in control group (all P0.05). Conclusion Brain and chest are damaged significantly after underwater explosion, which may be the main causes for the death of animals. It is important to elucidate the underlying mechanisms of brain injury caused by underwater explosive wave for the protection of underwater blast injuries.

The diathermy scratch pad: A cheap and efficient tool for chemical and explosion-related burns

The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns. The aim of early surgical debridement is to remove all debris and unhealthy tissue, preventing wound infection and thereby expediting wound healing. In chemical burns, there can be stubborn eschars that are resistant to traditional debridement. We would like to present a novel technique using the diathermy scratch pad as a cheap and efficient tool for the dual purpose of surgical debridement and dermabrasion.

Nursing human resource management in the early phase of treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

In August 2nd Kunshan factory aluminum dust explosion accident 2014, 35 severe mass burn patients were admitted to our hospital, including 18 men and 17 women, aged 21 to 50 (38±9) years. Their severe injuries caused much difficulty to the treatment. In the early period of treatment, a series of measures of nursing human resource management were implemented, such as carrying out training program for non-burn speciality nurses of different levels and origin, grouping and task-dividing, organizing work schedule and assigning in a unified way, and establishing monitoring team of speciality quality. Except for 2 cases of deaths in the early period, the other 33 patients were treated and nursed timely and effectively in the early period. The rescue rate arrived at 94.3% (33/35) on the 17th day post burn. In this period, no such nursing adverse event and complication occurred as bed-dropping, unplanned extubation, coagulation in veins of lower limb, catheter-related infection, or cross infection.

Applications of new methods in extraction of flavonoids from Chinese materia medica / 中草药

Flavonoids are widely found in medicinal plants, which have important medical properties. Flavonoids were proved to have many pharmacological activities, such as anti-oxidation, antitumor, antimutation, anti-inflammatory, antibacterial and anti-aging. The extraction of flavonoids is the crucial link in their clinical applications. In recent years, many emerging Chinese medicine extraction methods have also been widely used in the extraction of flavonoids. This paper reviews the current application of new methods for flavonoid extraction, in order to provide references for the extraction, development and utilization of flavonoids. These new extraction methods include supercritical fluid extraction (SFE), ultrasonic assisted extraction (UAE), microwave assisted extraction (MAE), pressurized liquid extraction (PLE), pulsed electric field (PEF) assisted extraction, enzyme assisted extraction (EAE), green solvent extraction, steam explosion assisted extraction, dynamic high pressure microfluidization (DHPM) assisted extraction, etc.

Development and thinking of Chinese radiation medicine / 中华疾病控制杂志

In this paper, we reviewed the initiation and development of radiation medicine in China, field researches on the health effects of nuclear test and the great leap from the final reports, advance in clinical diagnosis and treatment of radiation injury, and research of radiation combined injuries. Nowadays, China makes great efforts to move up further in development and peaceful use of nuclear energy as one nuclear power. So, nuclear development and nuclear safety have ushered in new opportunities and challenges. To this end, we must maintain a clear understanding, grasp new opportunities, meet new challenges, and be prepared for danger. Thus, a bright future for research in radiation medicine will come.

The features and treatment of Xixia "May 17th" explosion accident / 中华危重病急救医学

Objective To retrospectively analyze the injury characteristics of victims and treatment strategies in the explosion accident on the 17th May 2018 in Xixia county (Xixia "May 17th" explosion accident). Methods Based on the practice featured in pre-hospital emergency of Henan province and Nanyang city Emergency Center in the explosion accident, a retrospective analysis for the Level Three medical rescue was conducted, where a total of thirteen survived victims in Xixia "May 17" explosion accident were studied retrospectively. The data included the gender, age, burned extent and depth of the patients, burns complicated by trauma, complication of burn, respiratory function maintenance, resuscitation during shock stage, skin grafting with excision and scab. Furthermore, the data of organ function and the effect of the 90-day comprehensive treatment for the burned victims wereanalyzed. Results completion the Level Three treatment on time, which was depended on the leading role played by the regional trauma centers was the main rescuing mode of the work in Xixia county, where the primary and secondary treatments were the key parts. The three-level treatment model includes: the local hospital acts as a level-one emergency medical institution, county hospitals function as secondary emergency medical institutions, and other higher medical institutions are the tertiary first aid medical institutions. The pre-hospital and in-hospital emergency procedures were initiated immediately after the large-scale explosive burn being identified, the key to the successfully rescue was to set up a comprehensive treatment team for burns and trauma. Rescue team should involve burn department and other related departments, including the departments of emergency, general surgery, orthopedic, thoracic surgery, neurosurgery, plastic surgery, intensive care unit, blood transfusion unit, anesthesiology, and interventional radiology, etc. All the thirteen burned patients were male, with inhalation injury, blast injury, hemopneumothorax, brain injury, bone fractures, and etc. Eight of them (61.54%) had multiple organ dysfunction syndrome (MODS). MODS mainly involved respiratory, circulatory, liver, gastrointestinal tract, kidney and coagulation function. With the multi-discipline treatment, the wound of 6 severely-burned patients started healing and can be discharged after keeping the patency of airway, applying resuscitation fluid and comprehensive treatments such as debridement and dressing change. Among 7 patients with extensive deep burns, one case with skull-based fracture, open craniocerebral, extensive intracranial hemorrhage and hemopneumothorax, died 9 hours later. Another case died within 24 hours after injury due to obvious exudation on the site of early incision and relaxation of wound. The escharotomy, micro-dermis and allograft skin transplantation were carried out for five cases with extensive deep burns from the 4th day after the recovery of shock. One week later, the second stage of microsphere skin transplantation was performed. But all died of sepsis or fungal infection. Conclusions MODS and infection often occur during the course especially for patients with extensive and deep burns due to the great explosion in Xixia county, most of whom were accompanied with MODS and infection. Therefore, assembling multi-discipline team for treating the group of explosively-burned patients can increase the survival rate and reduce the possibility of disability.

Analysis on treatment of extremely severe burn patients with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To summarize the measures and experience in diagnosis and treatment of extremely severe burn patients with severe inhalation injury in dust explosion accident.@*Methods@#The medical records of 13 patients with extremely severe burn complicated with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident who were treated at the First Affiliated Hospital of Soochow University (hereinafter referred to as our hospital) on August 2nd, 2014, were retrospectively analyzed. All the patients were transferred to our hospital 3-8 hours after injury under the condition of inhalation of pure oxygen. Twelve patients underwent tracheotomy within 5 hours after admission, while 1 patient underwent tracheotomy before admission. All the patients were in ventilator-assisted respiration, with synchronized intermittent mandatory ventilation combined with positive end expiratory pressure. All the patients underwent thorax or limbs escharotomy on the second day after admission, so as to reduce the restrictive ventilatory dysfunction caused by the contraction of thorax eschar and the terminal circulation disorder caused by the contraction of limbs eschar. All the patients underwent electronic bronchoscopy within 48 hours after admission, airway secretion were cleared and airway lavage were carried out under electronic bronchoscope according to the patients′ condition, and the sputum, lavage solution, pathological tissue were collected for microbiological culture. All the patients underwent chest X-ray examination on the second day after admission and reexamination as required. Patients were all treated with a combination of broad-spectrum antibiotics early after admission to control lung and systemic infection. One patient was treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome 1 week after admission.@*Results@#One patient suffered from cardiopulmonary arrest during tracheotomy, which recovered autonomous respiration and cardiac impulse after cardiopulmonary resuscitation. Three patients showed decreased pulse oxygen saturation (SpO2) within 48 hours after injury, and the SpO2 returned to normal after sputum aspiration, scab removal and lavage under electronic bronchoscope. During the course of disease, bacteria were cultured from wound exudate of 7 patients, bacteremia occurred in 10 patients, and sputum microbiological culture results of 13 patients were positive. Eight of the 13 patients in this group survived, and 5 died. One patient died 19 days after injury, and 4 patients died 33-46 days after injury. The main cause of death was multiple organ dysfunction syndrome induced by severe septic shock eventually.@*Conclusions@#For this batch of patients with extremely severe burn complicated with severe inhalation injury caused by dust explosion accident, the treatment and cure measures including early definite diagnosis and timely tracheotomy, the application of effective ventilation, the effective treatment of respiratory system complications, and rational use of antibiotics for the control of lung infection obtained quite good curative effect.

Analysis on clinical characteristics of 13 extremely severe burn patients complicated with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To investigate the clinical characteristics of extremely severe burn patients complicated with severe inhalation injury caused by dust explosion.@*Methods@#The medical records of 13 extremely severe burn patients complicated with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident, who were admitted to the First Affiliated Hospital of Soochow University on August 2nd, 2014, were retrospectively analyzed. The following indicators were collected: (1) Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and Sequential Organ Failure Assessment (SOFA) score at post admission hour (PAH) 24. (2) Prognosis, death time, causes of death, and the mortality of patients with different sexes. (3) The number of times of airway electronic bronchoscopy, airway characteristics, and the corresponding onset time. (4) The number and result of microorganism culture of lesion tissue during the leukoplakia formation stage. Detection of Pseudomonas aeruginosa in patients with and without leukoplakia in airway mucosa. Fisher′s exact probability test was used to detect the mortality of patients with different sexes. Kappa test was used to detect the relevancy between leukoplakia and Pseudomonas aeruginosa.@*Results@#(1) The APACHE Ⅱ score of patients of this group at PAH 24 was (19±3) points, and the SOFA score was (12±3) points. (2) Eight patients survived, while 5 patients died, and the time of death was 19-46 (34±10) d after injury. The main cause of death was multiple organ dysfunction syndrome, which was secondary to severe infection. One of the 7 male patients and 4 of the 6 female patients died, but there was no significantly statistical difference in mortality between patients of the two sexes (P>0.05). (3) Airway electronic bronchoscopy was performed 4-25 (10±5) times among patients of this group. Hyperemia and edema were found in the airway mucosa of all the 13 patients 2-3 weeks after injury; ulcer was found in the airway mucosa of 5 patients 2-4 weeks after injury; leukoplakia was found in the airway mucosa of 7 patients 4-14 weeks after injury; granulation formed in the airway mucosa of 7 patients 10-15 weeks after injury, and airway patency was affected, which was solved after local clamping or replacement of lengthened tracheal cannula. (4) During the leukoplakia formation stage, 19 cases of microorganism culture were performed basing on airway lesion tissue, and the results were 15 cases of Pseudomonas aeruginosa, 5 cases of Acinetobacter baumannii, 2 cases of Serratia marcescens, as well as 1 case of Stenotrophomonas maltophilia, Burkholderia cepacia, and Proteus mirabilis each. Among 7 patients with airway mucosa leukoplakia, 6 patients were detected with Pseudomonas aeruginosa. Among 6 patients without airway mucosa leukoplakia, 1 patient was detected with Pseudomonas aeruginosa. The appearance of leukoplakia was consistent with the detection of Pseudomonas aeruginosa (Kappa=0.69, P<0.05).@*Conclusions@#Most of these extremely severe burn patients complicated with severe inhalation injury caused by dust explosion survived, and there was no significant gender difference in mortality. Electronic bronchoscopy showed that the early manifestations of airway mucosa were hyperemia and edema, followed by varying degrees of erosion, ulcer, leukoplakia, and granulation formation, etc. Leukoplakia may be relevant to Pseudomonas aeruginosa infection.

Analysis of effects of discipline cooperation on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident.@*Methods@#On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored.@*Results@#Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)-1·kg-1 electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA-1·kg-1 electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally.@*Conclusions@#After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.

Experience of wound treatment on extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident.@*Methods@#On August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test.@*Results@#The size of residual wound of patients in Meek skin graft group on 28 days post injury was (59±13)% total body surface area (TBSA), which was obviously smaller than that in microskin graft group [(70±14)%TBSA, t=4.379, P<0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum (4 patients), vola (10 patients), and toe or finger web (8 patients).@*Conclusions@#Meek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

Analysis on treatment of eight extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To summarize the measures and experience of treatment in mass extremely severe burn patients.@*Methods@#The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment.@*Results@#Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients.@*Conclusions@#Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.