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.

Analysis on prevalence survey of healthcare-associated infections in Tianjin Chest Hospital from 2014 to 2016 / 天津医药

Objective To investigate the infection state and tendency in Tianjin Chest Hospital from 2014 to 2016,and provide scientific basis for making strategy to prevent and control nosocomial infection. Methods With bedside investigation and medical case review,one day every year was selected as the day of investigation to survey the healthcare-associated infections in our hospital during 2014-2016. Data of operative incision, infection condition, the usage of anti-bacterial agents and bacteria detection were collected and organized for further study. Results A total of 2 285 patients were investigated during 2014 to 2016, in which nosocomial infection was found in 55 cases. The total prevalence of healthcare-associated infections was 2.41%. The prevalence rates of healthcare-associated infections in each year were 2.62%,2.63% and 2.05% respectively,and no significant differences between them(χ2=0.750,P>0.05).In the three years, the highest prevalence rates were found in Department of Cardiac Surgery(13.79%),Department of Cardiac Surgery(7.48%) and Department of Endocrine (7.41%) respectively. The lower respiratory tract infection was the main infection site of nosocomial infection (61.11%-78.95%), followed by upper respiratory tract infection, urinary tract infection and blood infection. In 2014-2016, pathogenic detection rates for specimens were 77.78%, 85.71% and 88.89% from patients with nosocomial infection (χ2=0.735,P>0.05). Forty-five strains of pathogen were isolated from 2014 to 2016. The main pathogen was the gram-negative bacteria,and 32 strains were isolated during the three years,which accounted for 71.11%. Six strains of gram-positive bacteria were isolated,which accounted for 13.33%.Seven strains of fungus were isolated,which accounted for 15.56%. The predominant pathogens were Klebsiella pneumonia (10 isolates), Pseudomonas aeruginosa (8 isolates) and Acinetobacter baumannii (5 isolates). The antibiotic utilization rates were 28.40%, 29.17% and 23.74% respectively from 2014 to 2016 (χ2=7.175,P<0.05). In the three years, most of antibiotics were used therapeutically, accounting for 83.39%,14.17% received for prophylactic use,and 2.44% received for both prophylactic use and treatment (χ2=29.151,P<0.05). The rates of bacteria detection in patients who received therapeutic use were 77.02%, 74.42% and 75.77% respectively(χ2=0.306,P>0.05).Conclusion The prevalence of healthcare-associated infection of Tianjin Chest Hospital is maintained at a stable level.The monitoring and prevention of key departments,sites and predominant pathogens should be strengthen, and effective measures for preventing and controlling nosocomial infection should be formulated scientifically,so as to reduce the incidence of nosocomial infection.

An open air research study of blast-induced traumatic brain injury to goats / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>We once reported blast-induced traumatic brain injury (bTBI) in confined space. Here, bTBI was studied again on goats in the open air using 3.0 kg trinitrotoluene.</p><p><b>METHODS</b>The goats were placed at 2, 4, 6 and 8 m far from explosion center. Trinitrotoluene (TNT) was used as the source of the blast wave and the pressure at each distance was recorded. The systemic physiology, electroencephalogram, serum level of S-100 beta, and neuron specific enolase (NSE) were determined pre and post the exposure. Neuroanatomy and neuropathology were observed 4 h after the exposure.</p><p><b>RESULTS</b>Simple blast waveforms were recorded with parameters of 702.8 kPa-0.442 ms, 148.4 kPa-2.503 ms, 73.9 kPa-3.233 ms, and 41.9 kPa-5.898 ms at 2, 4, 6 and 8 m respectively. Encephalic blast overpressure was on the first time recorded in the literature by us at 104.2 kPa-0.60 ms at 2 m, where mortality and burn rate were 44% and 44%. Gross examination showed that bTBI was mainly manifested as congestive expansion of blood vessels and subarachnoid hemorrhage, which had a total incidence of 25% and 19% in 36 goats. Microscopical observation found that the main pathohistological changes were enlarged perivascular space (21/36, 58%), small hemorrhages (9/36, 25%), vascular dilatation and congestion (8/36, 22%), and less subarachnoid hemorrhage (2/36, 6%). After explosion, serum levels of S-100b and NSE were elevated, and EEG changed into slow frequency with declined amplitude. The results indicated that severity and incidence of bTBI is related to the intensity of blast overpressure.</p><p><b>CONCLUSION</b>Blast wave can pass through the skull to directly injure brain tissue.</p>