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.

Firework-related ocular trauma in Pernambuco, Brazil / Trauma ocular por fogos de artifício em Pernambuco, Brasil

ABSTRACT Purpose: This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. Methods: We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. Results: Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). Conclusions: Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness

RESUMO Objetivos: Descrever as características demográficas e clínicas das vítimas de trauma ocular por fogos de artifício atendidas nas emergências oftalmológicas de dois centros de referência em Pernambuco e identificar fatores relacionados a mau prognóstico visual. Métodos: Avaliação retrospectiva dos prontuários de pacientes admitidos na emergência oftalmológica com história de trauma por fogos de artifício entre janeiro de 2012 e dezembro de 2018. A coleta de dados incluiu idade, gênero, procedência, mês e ano do acidente, estruturas oculares acometidas e características das lesões, além do tipo de tratamento a que os pacientes foram submetidos. Naqueles pacientes acompanhados por mais de 30 dias, analisou-se a acuidade visual final e a associação com sua procedência. Resultados: Foram incluídos 370 olhos de 314 pacientes. Destes, 248 (79,0%) vítimas eram do sexo masculino e 160 (51,0%) da região metropolitana do Recife, com uma média de idade de 25.6 ± 18.8 anos. Em 56 (17,8%) dos casos o trauma foi bilateral. No mês de junho ocorreu um total de 152 (48,4%) casos. Os sítios mais acometidos foram pálpebras em 91 (24,6%) olhos e superfície ocular em 252 (68,1%). O tratamento cirúrgico foi necessário em 87 (23,5%) olhos. Após manejo clínico-cirúrgico, 37 (10.0%) olhos desenvolveram visão pior do que 20/400. Destes, 34 (91,9%) olhos eram de pacientes do interior do estado de Pernambuco ou de outro estado. Os pacientes provenientes do interior do estado apresentaram maior chance de desenvolver cegueira quando comparados aos que eram provenientes da região metropolitana (Odds Ratio de 5,46). Conclusões: As vítimas de trauma ocular por fogos de artificio foram em sua maioria do sexo masculino, procedentes da região metropolitana do estado e das faixas etárias pediátrica e economicamente ativa. Aqueles provenientes do interior ou de outros estados apresentaram maior chance de desenvolver cegueira.

Fluid management strategies for patients with severe blast injury / 中国实用护理杂志

Objective:To summarize the precision fluid management of patients with severe blast injury in the emergency intensive care unit, so as to help patients smoothly pass through the dangerous period and recover smoothly.Methods:Based on the experience of fluid management in 6 patients admitted to the Second Affiliated Hospital Zhejiang University School of Medicine in the tanker truck explosion on 14 June, 2020. The main measures included: fluid volume management and dynamic adjustment; assessment of intake, output and urine volume, and dynamic adjustment of infusion volume and speed; monitoring of pulmonary oxygenation and timely adjustment of fluid resuscitation strategies; monitoring indexes and providing nursing care strategies for fluid management.Results:Finally, among 6 patients with severe blast injury, 5 patients were discharged from the hospital with follow-up treatment after they suffered from the shock and infection phases and refined fluid management, 1 patient died due to severe injury and ineffective rescue.Conclusions:Adopting individualized, phased, and refined liquid management strategy has clinical significance for patients with severe blast injury to smoothly pass the risk period.

Efficacy of Tyrosine Kinase Inhibitor Combined with Decitabine, Homoharringtonine, Interferon in the Maintenance Therapy of Blast Phase Chronic Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explore the efficacy of tyrosine kinase inhibitor (TKI) combined with decitabine, homoharringtonine, and interferon regimen as maintenance therapy for blast phase chronic myeloid leukemia (CML-BP).@*METHODS@#The clinical data of CML-BP patients who received the first major hematological response after induction therapy at The Affiliated Cancer Hospital of Zhengzhou University from June 2015 to December 2021 were analyzed retrospectively. The event-free survival, duration of remission, and overall survival of patients in TKI combined with decitabine, homoharringtonine, interferon group(n=18) and TKI combined with conventional chemotherapy group(n=10) were compared by log-rank test.@*RESULTS@#A total of 28 patients were included, with a median age of 46 (24-58) years old. Kaplan-Meier survival analysis showed that patients in TKI combined with decitabine, homoharringtonine, interferon group had longer event-free survival (7.4 vs 4.3 months, P=0.043, HR＝0.44, 95% CI: 0.17-1.14), duration of overall remission (16.1 vs 6.6 months, P=0.005, HR＝0.32, 95% CI: 0.11-0.89), overall survival (34.3 vs 13.5 months, P=0.006, HR＝0.29, 95% CI: 0.10-0.82) compared with patients in TKI combined with conventional chemotherapy group.@*CONCLUSION@#The TKI combined with decitabine, homoharringtonine and interferon regimen can significantly prolong the survival of CML-BP patients who obtained the major hematological response compared with TKI combined with conventional chemotherapy regimen.

Effects of orientation and distance of goats on blast lung injury characteristics on a plateau above 4500-meter / 中华创伤杂志(英文版)

PURPOSE@#High explosives are used to produce blast waves to study their biological effects. The lungs are considered as the critical target organ in blast-effect studies. The degree of lung hemorrhaging is related to both the explosive power and the increased lung weight. We studied the characteristics of the biological effects from an air explosion of a thermobaric bomb in a high-altitude environment and the lethality and lung injury severity of goats in different orientations and distances.@*METHODS@#Goats were placed at 2.5, 3, 4, and 5 m from the explosion center and exposed them to an air blast at an altitude of 4700-meter. A group of them standing oriented to the right side and the other group seated facing the explosion center vertically. The lung injuries were quantified according to the percentage of surface area contused, and using the pathologic severity scale of lung blast injury (PSSLBI) to score the 4 injury categories (slight, moderate, serious and severe) as 1, 2, 3, and 4, respectively. The lung coefficient (lung weight [g]/body weight [kg]) was the indicator of pulmonary edema and was related to lung injury severity. Blast overpressure data were collected using blast test devices placed at matching locations to represent loadings to goats. All statistical analyses were performed using SPSS, version 26.0, statistical software (SPSS, Inc., Chicago, IL, USA).@*RESULTS@#In total, 127 goats were involved in this study. Right-side-standing goats had a significantly higher mortality rate than those seated vertical-facing (p < 0.05). At the 2.5 m distance, the goat mortality was nearly 100%, whereas at 5 m, all the goats survived. Lung injuries of the right-side-standing goats were 1 - 2 grades more serious than those of seated goats at the same distances, the scores of PSSLBI were significantly higher than the seated vertical-facing goats (p < 0.05). The lung coefficient of the right-side-standing goats were significantly higher than those of seated vertical-facing (p < 0.05). Mortality, PSSLBI, and the lung coefficient results indicated that the right-side-standing goats experienced severer injuries than the seated vertical-facing goats, and the injuries were lessened as the distance increased. The blast overpressure was consistent with these results.@*CONCLUSION@#The main killing factors of the thermobaric bomb in the high-altitude environment were blast overpressure, blast wind propulsions and burn. The orientation and distances of the goats significantly affected the blast injury severity. These results may provide a research basis for diagnosing, treating and protecting against injuries from thermobaric explosions.

Clinical characteristics and prognostic factors of patients with Philadelphia-negative myeloproliferative neoplasm accelerated/blast phase / 中华血液学杂志

Objective: To evaluate the clinical characteristics and prognostic factors of patients with Philadelphia-negative myeloproliferative neoplasm-accelerated phase/blast phase (MPN-AP/BP) . Methods: A total of 67 patients with MPN-AP/BP were enrolled from February 2014 to December 2021 at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences. Their clinical features and prognostic factors were analyzed retrospectively. Results: ① Sixty-seven patients with MPN-AP/BP with a median age of 60 (range, 33-75) years, including 31 males (46.3% ) and 36 females (53.7% ) , were analyzed. Forty-eight patients progressed from primary myelofibrosis (PMF) , and 19 progressed from other myeloproliferative neoplasms (MPNs) , which included polycythemia vera, essential thrombocythemia, and MPN unclassifiable. Patients who progressed from PMF had higher lactate dehydrogenase (LDH) levels than those who progressed from other MPNs (925.95 vs. 576.2 U/L, P=0.011) , and there were higher proportions of patients who progressed from PMF with splenomegaly (81.4% vs. 57.9% , P=0.05) , a myelofibrosis grade of ≥2 (93.6% vs. 63.2% , P=0.004) , and a shorter duration from diagnosis to the transformation to AP/BP (28.7 vs. 81 months, P=0.001) . ② JAK2V617F, CALR, and MPLW515 were detected in 41 (61.2% ) , 13 (19.4% ) , and 3 (4.5% ) patients, respectively, whereas 10 (14.9% ) patients did not have any driver mutations (triple-negative) . Other than driver mutations, the most frequently mutated genes were ASXL1 (42.2% , n=27) , SRSF2 (25% , n=16) , SETBP1 (22.6% , n=15) , TET2 (20.3% , n=13) , RUNX1 (20.3% , n=13) , and TP53 (17.2% , n=11) . The ASXL1 mutation was more enriched (51.1% vs. 21.1% , P=0.03) , and the median variant allele fraction (VAF) of the SRSF2 mutation (median VAF, 48.8% vs. 39.6% ; P=0.008) was higher in patients who progressed from PMF than those who progressed from other MPNs. ③ In the multivariate analysis, the complex karyotype (hazard ratio, 2.53; 95% confidence interval, 1.06-6.05; P=0.036) was independently associated with worse overall survival (OS) . Patients who received allogeneic stem cell transplantation (allo-HSCT) (median OS, 21.3 vs. 3 months; P=0.05) or acute myeloid leukemia-like (AML-like) therapy (median OS, 13 vs. 3 months; P=0.011) had significantly better OS than those who received supportive therapy. Conclusion: The proportions of patients with PMF-AP/BP with splenomegaly, myelofibrosis grade ≥2, a higher LDH level, and a shorter duration from diagnosis to the transformation to AP/BP were higher than those of patients with other Philadelphia-negative MPN-AP/BP. The complex karyotype was an independent prognostic factor for OS. Compared with supportive therapy, AML-like therapy and allo-HSCT could prolong the OS of patients with MPN-AP/BP.

Pediatric chronic myeloid leukemia in myeloid blast crisis

ABSTRACT Chronic myeloid leukemia (CML) accounts for 2-3% of childhood leukemias. About 5% of cases present in a blastic phase of CML which clinically and morphologically mimics more common acute leukemias of childhood. We report a case of a 3-year-old male who presented with gradual onset swelling of the abdomen and extremities along with generalized weakness. Examination revealed massive splenomegaly, pallor, and pedal edema. Initial workup showed anemia, thrombocytopenia, and leukocytosis (120,000/uL) with a blast percentage of 35%. Blasts were positive for CD13, CD33, CD117, CD34 and HLA-DR, and stained negative for Myeloperoxidase and Periodic Acid Schiff. Fluorescence in situ hybridization was positive for b3a2/e14a2 junction BCR-ABL1 transcript and negative for RUNX1-RUNX1T1/t(8;21), clinching the diagnosis of CML in myeloid blast crisis. The patient expired within 17 days of diagnosis and initiation of therapy.

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.

Efficacy comparison of extracorporeal membrane oxygenation and ventilation therapy in the treatment of severe blast lung injury / 中华创伤杂志

Objective:To compare the clinical efficacy of extracorporeal membrane oxygenation (ECMO) and ventilation therapy in the treatment of severe blast lung injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with severe blast lung injury admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2000 to December 2021, including 23 males and 14 females; aged 26-50 years [(36.3±11.1)years]. The chest abbreviated injury score (AIS) was 3-5 points. In all, 16 patients were treated with ECMO from January 2017 to December 2021 (ECMO group) and 21 with ventilator from January 2000 to December 2016 (ventilator group). Blood gas analysis indexes [arterial pH, partial pressure of carbon dioxide (PaCO 2), partial pressure of oxygen (PaO 2), blood lactate (Lac)] and hemodynamics indexes [central venous pressure (CVP), cardiac output index (CI), pulmonary arterial systolic pressure (PASP), pulmonary capillary wedge pressure (PAWP)] were compared in the two groups at 30 minutes before treatment and at 2, 4, 6 hours after treatment. The mechanical ventilation time, ICU length of stay, acute physiology and chronic health evaluation II (APACHE II) score and mortality were measured at 7 days after treatment. Results:All patients were followed up for 24-48 months [(33.6±8.2)months]. The blood gas analysis and hemodynamic indexes were significantly improved in the two groups at 2, 4, 6 hours after treatment when compared with those at 30 minutes before treatment (all P<0.05), and the improvements were still statistically significant in ECMO group at 4, 6 hours after treatment when compared with those at 2 hours after treatment (all P<0.05), while not in ventilator group (all P>0.05). There was no significant difference in blood gas analysis indexes or hemodynamic indexes between the two groups at 30 minutes before treatment (all P>0.05). After treatment for 2, 4, 6 hours, blood gas analysis indexes and hemodynamic indexes in ECMO group were statistically different from those in ventilator group (all P<0.05). After treatment for 7 days, the mechanical ventilation time, ICU length of stay, APACHE II score and mortality were (3.2±1.2)days, (5.4±1.3)days, (14.1±3.3)points and 12.5% (2/16) in ECMO group, significantly different from (5.1±1.6)days, (7.6±1.6)days, (10.2±2.6)days and 28.6% (6/21) in ventilator group (all P<0.05). Conclusion:For severe blast lung injury, ECMO can attain rapid and continuous improvement of refractory hypoxemia and dyspnea, shorten the duration of mechanical ventilation and ICU length of stay and reduce the mortality rate when compared with ventilator therapy.

Study on injury parameters of severe blast injury in mice at plain and plateau based on equivalent trauma / 中华危重病急救医学

Objective:To explore the establishment of the interconvertible injury parameters of same severe blast injury in mice at plain and plateau.Methods:A total of 157 C57BL/6 male mice were randomly divided into plain control group (8 mice), plain injury group (77 mice), plateau control group (8 mice) and plateau injury group (64 mice) according to random number table method. The mice in plateau control group and plateau blast injury group had been placed in animal experimental low-pressure oxygen chamber to simulate 4 000 meters plateau environment for 5 days in advance. Then the mice in plain blast injury group and plateau blast injury group were put into biological shock tube, respectively. Different pressures of the driving section were selected to establish the severe blast injury models in mice at plain and 4 000 meters plateau to reach approximately 70% mortality within 72 hours. The equivalent traumatic condition at 24 hours after blast injury in different groups was verified by the series of experiments including gross autopsy, lung wet/dry weight ratio (W/D), hematoxylin-eosin (HE) staining and histological scoring.Results:The mice mortality were basically consistent between the plain injury group (65%) and plateau injury group (75%) when 5.4 MPa and 4.0 MPa of the driving section pressures were chosen, respectively. Compared with the corresponding control groups, the lungs showed massive hemorrhage (patchy and diffuse) with significant pulmonary edema in both plain 5.4 MPa-injured group and the plateau 4.0 MPa-injured group at 24 hours after blast injury. Compared with the plateau control group, the pulmonary W/D ratio were significantly increased in the plateau injury group (5.579±0.646 vs. 4.476±0.076, P < 0.05), while the difference between plateau injury group and the plain control group was not statistically significant (5.303±1.020 vs. 4.015±0.144, P > 0.05). Also, compared with the corresponding control groups, the analysis of lung histopathological sections showed that there were several pathological changes including large alveolar rupture and fusion, thickened alveolar walls, and a small amount of inflammatory cell infiltration in the alveolar lumen in the groups of plain 5.4 MPa and plateau 4.0 MPa. In addition, the histopathological scores of lung in the groups of plain 5.4 MPa and plateau 4.0 MPa were significantly higher than that in corresponding control group (8.67±0.82 vs. 1.67±0.52, 9.00±1.10 vs. 2.17±0.41, both P < 0.05), however, there was no statistical difference for the above score between plain blast injury group and plateau blast injury group. Conclusions:The pressures of driving section 5.4 MPa and 4.0 MPa are injury parameters to establish equivalent severe blast injury in mice at plain and plateau, respectively, which can be converted to each other. This study provides support for the application and evaluation of prevention and treatment technology for severe blast injury in special environment.

Clinical guideline on first aid for blast injury of the chest (2022 edition) / 中华创伤杂志

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

MicroRNA-125b Accelerates and Promotes PML-RARa-driven Murine Acute Promyelocytic Leukemia / 生物医学与环境科学（英文）

Objective@#Most acute promyelocytic leukemia cases are characterized by the PML-RARa fusion oncogene and low white cell counts in peripheral blood.@*Methods@#Based on the frequent overexpression of miR-125-family miRNAs in acute promyelocytic leukemia, we examined the consequence of this phenomenon by using an inducible mouse model overexpressing human miR-125b.@*Results@#MiR-125b expression significantly accelerates PML-RARa-induced leukemogenesis, with the resultant induced leukemia being partially dependent on continued miR-125b overexpression. Interestingly, miR-125b expression led to low peripheral white cell counts to bone marrow blast percentage ratio, confirming the clinical observation in acute promyelocytic leukemia patients.@*Conclusion@#This study suggests that dysregulated miR-125b expression is actively involved in disease progression and pathophysiology of acute promyelocytic leukemia, indicating that targeting miR-125b may represent a new therapeutic option for acute promyelocytic leukemia.

Changes of cognitive function in non-fatal drowning rats after blast-induced traumatic brain injury / 中华创伤杂志

Objective:To investigate the changes of cognitive function in non-fatal drowning rats after blast-induced traumatic brain injury (bTBI).Methods:Eighty SD rats were divided into normal group, bTBI group, drowning group and bTBI plus drowning group according to the random number table, with 20 rats per group. Rats in normal group were not injured. In bTBI group, bTBI was established in a BST-I biological shock tube with a pressure of 4.0 MPa in the driving section. In drowning group, rats were subjected to non-fatal drowning by falling into the water with temperature of 18 ℃ and depth of 30 cm from the height of 1 m and were taken out quickly after swimming to exhaustion. After being injured in a biological shock tube, rats in bTBI plus drowning group were immediately forced to drowning using the same method. On day 3 post-injury, the neurocognitive function was evaluated by elevated plus maze and Morris water maze tests. Morphological changes of neurons in CA1 and CA3 regions of hippocampus were observed by Nissl staining, and the number of surviving neurons were counted. The concentrations of hippocampal neurotransmitters glutamate, γ-aminobutyric acid (GABA), glycine and endoplasmic reticulum stress (ERS) related glucose-regulated protein 78 (GRP78) and caspase-12 were examined by ELISA analysis. Levels of B-cell lymphoma-2 (Bcl-2), Bcl-2 associated protein (Bax) and caspase-3 were detected by Western blotting. The ratio of Bcl-2 to Bax was calculated as well.Results:In elevated plus maze test, the percentage of open arm entry and number of head-dipping behaviour were decreased in bTBI plus drowning group compared with normal and bTBI groups at 3 days after injury ( P<0.05 or 0.01), with no statistical difference from those in drowning group ( P>0.05). The number of head-dipping behaviour in drowning group was lower than that in bTBI group ( P<0.05). In Morris water maze test, bTBI plus drowning group showed increased target latency on the third and fourth days of spatial acquisition training and decreased number of crossing the target area and percentage of swimming time in the target quadrant during probe trials as compared with normal group ( P<0.05 or 0.01), but there was no statistical difference among bTBI, drowning and normal groups (all P>0.05). Nissl staining showed that the neurons in the CA1 and CA3 regions of hippocampus in normal group were arranged neatly with clear Nissl bodies at 3 days after injury, while the other groups showed different degrees of injury. In contrast with normal group, the neurons in the CA1 and CA3 regions of hippocampus in all other groups were decreased with the lowest number in bTBI plus drowning groups ( P<0.05 or 0.01). In ELISA analysis, the level of hippocampal glutamate in bTBI plus drowning group was higher than that in all other groups at 3 days after injury and the level in bTBI injury and drowning groups was higher than that in normal group ( P<0.05 or 0.01); the level of hippocampal glycine in bTBI plus drowning group was lower than that in normal group ( P<0.05), but there was no statistical difference among bTBI, drowning or normal groups (all P>0.05); the concentration of hippocampal GABA had no statistical difference among all groups (all P>0.05). In addition, the concentration of GRP78 in bTBI injury, drowning and bTBI injury plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but did not statistically differ from each other (all P>0.05). The concentration of caspase-12 in drowning and bTBI plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but was not statistically different from each other ( P>0.05), and its concentration in bTBI plus drowning group was increased compared with bTBI group ( P<0.05). In Western blotting, the level of Bcl-2 in bTBI plus drowning group was decreased compared with all other groups at 3 days after injury, and the level in bTBI and drowning groups were decreased compared with normal group, but a much lower level was observed in drowning group than that in bTBI group ( P<0.05 or 0.01); the level of Bax in bTBI plus drowning group was increased compared with all other groups at 3 days after injury, and the level in drowning group was increased compared with normal group ( P<0.05 or 0.01), with no statistical difference between bTBI and drowning groups ( P>0.05). The ratio of Bcl-2 to Bax in bTBI plus drowning group was decreased compared with all other groups, while the ratio in bTBI and drowning groups were decreased compared with normal group, showing a much lower level in drowning group than that in bTBI group ( P<0.05 or 0.01). Also, the level of caspase-3 in drowning and bTBI plus drowning groups were increased compared with normal and bTBI groups ( P<0.05 or 0.01), but there was no statistical difference between drowning and bTBI plus drowning groups ( P>0.05). Conclusions:Non-fatal drowning can aggravate hippocampal neuron damage in bTBI rats and cause memory, emotion and other cognitive dysfunction. The mechanism may involve the imbalance of hippocampal neurotransmitters glutamate and glycine, which activates the downstream pro-apoptotic pathway through ERS in the early stage of injury to induce hippocampal neuron apoptosis.

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

Advances in the treatment for blast phase myeloproliferative neoplasm / 中国肿瘤临床

Blast phase myeloproliferative neoplasm (MPN-BP) represent a type of secondary acute leukemia and are associated with a poor patient prognosis worldwide. Currently, there is no standardized treatment regimen for MPN-BPs, and treatment remains a major clinical challenge. In recent years, significant progress has been made in understanding the biological mechanisms of MPNs, especially the abnormal activation of the JAK-STAT signaling pathway caused by driver gene mutations; this has opened up a new avenue in exploring the mechanism and treatment of MPN-BP. However, in terms of disease pathogenesis, MPN-BP are different from primary acute leukemia, and different therapeutic strategies for MPN-BP have also been investigated. This article focuses on the advances made in MPN-BP treatment.

Changes of arterial blood gas indexes of free-field primary blast lung injury of pigs and its application value / 中华危重病急救医学

Objective:To observe the changes of arterial blood gas indexes in pigs with the free-field primary blast lung injury (PBLI) model, and to explore the value of arterial blood gas indexes in predicting moderate to severe PBLI.Methods:Nine adult healthy Landrace pigs were selected to construct the pig free-field PBLI model. Arterial blood samples were taken 15 minutes before the explosion (before injury) and 10, 30, 60, 120, and 180 minutes after the explosion (after injury). Arterial blood gas indexes and pulse oxygen saturation (SpO 2) were measured, compare the changes of blood gas analysis indexes and SpO 2 levels at different time points, and observe the changes of gross injury scores and pathological injury scores of lung tissue. Analyze the correlation between the blood gas indicators. Results:As time prolonged, at each time point, pH, arterial partial pressure of oxygen (PaO 2), and SpO 2 were lower than those before the injury, and blood lactic acid (Lac) and arterial partial pressure of carbon dioxide (PaCO 2) were higher than those before the injury. Compared with that before the injury, the pH value in the blood decreased significantly 10 minutes after the injury (7.39±0.06 vs. 7.46±0.02, P < 0.05), and the Lac increased significantly (mmol/L: 3.61±2.89 vs. 1.10±0.28, P < 0.05), and lasts until 180 minutes after injury (pH value: 7.37±0.07 vs. 7.46±0.02, Lac (mmol/L): 2.40±0.79 vs. 1.10±0.28, both P < 0.05); while PaO 2 and SpO 2 decreased significantly at 180 minutes after injury [PaO 2 (mmHg, 1 mmHg = 0.133 kPa): 59.40±10.94 vs. 74.81±9.39, P < 0.05; SpO 2: 0.75±0.11 vs. 0.89±0.08, P < 0.05], PaCO 2 increased significantly (mmHg: 56.17±5.38 vs. 48.42±4.93, P < 0.05). Correlation analysis showed that the gross injury score of lung blast injury animals was positively correlated with the pathological injury score ( r = 0.866, P = 0.005); PaO 2 and SpO 2 were positively correlated ( r = 0.703, P = 0.000); pH value and Lac were negative Correlation ( r = -0.400, P = 0.006); pH value is negatively correlated with PaCO 2 ( r = -0.844, P = 0.000). Conclusion:This study successfully established a large mammalian free-field PBLI model, arterial blood gas analysis is helpful for the early diagnosis of PBLI, whether SpO 2 can be used to evaluate the severity of lung injury remains to be further verified.

Screening of fluorescent bacteria for growth promotion and biocontrol potential against Pyricularia oryzae on aerobic rice (MARDI Aerob 1)

Aims@#This study aimed to screen the plant growth-promoting fluorescent bacteria (FLB) which isolated from the healthy rice rhizophere and to evaluate its biocontrol and growth promotion properties against Pyricularia oryzae on aerobic rice seedling of MARDI Aerob 1. @*Methodology and results@#King’s B agar with glycerol was used as the selective medium to isolate FLB from the healthy rice rhizosphere soil. All FLB obtained were in vitro screened for antagonistic activities against P. oryzae using dual culture, volatile substances and hydrogen cyanide productions. The potential FLB isolates were further evaluated on rice seedling early growth promotion before identified using 16S rRNA gene sequencing. A total of 24 FLB were isolated from the healthy rice rhizosphere soil in Setiu, Terengganu, Malaysia. Isolates: FLB4, FLB5, FLB7 and FLB10 scored the total of percentage inhibition radial growth (PIRG) values ranged 99.5-105.0%. Further seedling growth promotion screening revealed that FLB4, FLB7 and FLB10 were significantly improved seedling growth with vigor index of 378.32%, 461.53% and 335.60% over control (133.31%). 16S rRNA sequencing identified that FLB7 as Bacillus subtilis and the FLB4 and FLB10 as Pseudomonas putida.@*Conclusion, significance and impact of study@#The selected FLB isolates (FLB4, FLB7 and FLB10) are potential to be developed as biological control agents against P. oryzae with growth promoting property on aerobic rice seedling.

Variables del rendimiento de los bateadores del béisbol cubano utilizando el sensor Blast Motion Baseball / Variáveis do desempenho dos batedores do basebol cubano utilizando o Sensor de Basebol de Movimento de Explosão / Variables in the Cuban baseball batter's performance using the Blast Motion Baseball sensor

Resumen La introducción de las nuevas tecnologías en el béisbol ha optimizado los sistemas para el registro y análisis de información, tanto en el entrenamiento como en el juego, contribuyendo a un control más exacto del rendimiento de un jugador. En el presente trabajo, se aplica el sensor Blast Motion Baseball cuyo objetivo es identificar las variables significativamente influyentes en el rendimiento de los bateadores en el béisbol cubano. Se eligieron bateadores (N=24) pertenecientes a la Serie Nacional de béisbol LIX debido a que constituye el evento nacional de mayor nivel del béisbol cubano. La información fue registrada en prácticas de bateo, mientras el bateador ejecutaba la tarea de conectar bolas lanzadas por el entrenador de frente (front toss), por encima del brazo a una distancia de 30 pies y a una velocidad inferior a las 50 mph. Posteriormente, se compararon los resultados del Blast Motion Baseball con las estadísticas oficiales de la Serie Nacional de Béisbol LIX. Se demostró que los bateadores con mayor velocidad del bate, mayor velocidad máxima de las manos y mayor potencia lograron un mayor rendimiento ofensivo. Por tanto, conocer en tiempo real estas características del swing contribuyen a perfeccionar el proceso de entrenamiento y predecir el rendimiento deportivo de un bateador.

Resumo A introdução de novas tecnologias no basebol otimizou os sistemas de gravação e análise de informação, tanto no treino como no jogo, contribuindo para um controlo mais preciso do desempenho de um jogador. No presente trabalho, é aplicado o Sensor de basebol Blast Motion. O seu objetivo é identificar as variáveis que influenciam significativamente o desempenho dos batedores no basebol cubano. Os batedores (N=24) pertencentes à Série Nacional de basebol LIX foram escolhidos porque constitui o evento nacional de mais alto nível do basebol cubano. A informação foi registada durante o treino de batedores, enquanto o batedor executava a tarefa de ligar bolas lançadas pelo treinador a partir do lançamento frontal, sobre o braço a uma distância de 30 pés e a uma velocidade inferior a 50 mph. Os resultados do Blast Motion Baseball foram então comparados com as estatísticas oficiais da Série Nacional de Basebol LIX. Foi demonstrado que batedores com maiores velocidades de taco, maiores velocidades de mão superior, e mais potência alcançaram um maior desempenho ofensivo. Portanto, conhecer estas características do balanço em tempo real ajuda a refinar o processo de treino e a prever o desempenho atlético de um batedor.

Abstract The introduction of new technologies in baseball has optimized the systems for recording and analyzing information, both in training and in the game, contributing to a more accurate control of a player's performance. In this work, it is applied the Blast Motion Baseball sensor which objective is to identify the variables significantly influencing the performance of batters in Cuban baseball. There were chosen batters (N=24) belonging to the National Baseball Series LIX because it constitutes the national event of higher level in Cuban baseball. The information was recorded during batting practice, while the batter was performing the task of connecting balls thrown by the coach from the front toss, over the arm at a distance of 30 feet and at a speed of less than 50 mph. The results of Blast Motion Baseball were then compared with the official statistics of the LIX National Baseball Series. It was shown that batters with higher bat speed, higher top hand speed and more power achieved greater offensive performance. Therefore, knowing these characteristics of the swing in real time helps to perfect the training process and predict the sports performance of a batter.

Molecular profiling of blast resistance genes and evaluation of leaf and neck blast disease reaction in rice

In the present investigation, phenotypic evaluation of blast disease reaction was conducted at Ponnampet and Mandya districts of Karnataka, India, which indicated that the rice varieties such as IR64, Jaya, KMP153, IR30864, Mandya Sona-1, Mandya Sona-2, KCP1, Dodda Byra, and Malgudi Sanna were susceptible to both leaf and neck blasts. Further, the rice varieties that were resistant to leaf blast such as KMP200, DHMAS70Q164-1b, Karibatta, Coimbatore Sanna and others showed susceptible reaction to neck blast only. In contrast, the varieties such as JyothixBR2655, Punkutt Kodi, Sirsi, 222 and Gangadale which were resistant to neck blast were found to be susceptible to leaf blast also. Only one variety, BR2655 showed resistance to both leaf and neck blast diseases. The genotypic studies using simple sequence repeat markers showed that the analysis of the distribution of resistance genes and genotyping of the selected rice varieties, and traditional rice varieties from different ecological regions with allele specific markers helped to identify 20 major blast resistance genes. The individual gene frequencies of the 20 major rice blast resistance genes varied from 10.34 to 100%. Less and more frequency of resistance gene distribution occurred in Pi9 and Pizt gene, respectively. The result of this study would help to create strategies for improving rice blast resistance through genetic studies and plant–pathogen interaction.