Narrative Review of Systemic Inflammatory Response Mechanisms in Cardiac Surgery and Immunomodulatory Role of Anesthetic Agents

Although surgical techniques and perioperative care have made significant advances, perioperative mortality in cardiac surgery remains relatively high. Single? or multiple?organ failure remains the leading cause of postoperative mortality. Systemic inflammatory response syndrome (SIRS) is a common trigger for organ injury or dysfunction in surgical patients. Cardiac surgery involves major surgical dissection, the use of cardiopulmonary bypass (CPB), and frequent blood transfusions. Ischemia?reperfusion injury and contact activation from CPB are among the major triggers for SIRS. Blood transfusion can also induce proinflammatory responses. Here, we review the immunological mechanisms of organ injury and the role of anesthetic regimens in cardiac surgery

Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study / 中华创伤杂志(英文版)

PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Pharmacological Analysis of Xuanfei Huazhuo Prescription in Treatment of Coronavirus Disease-2019 / 中国实验方剂学杂志

Objective:The targets and signaling pathways of Xuanfei Huazhuo prescription (XFHZP) for the treatment of coronavirus disease-2019 (COVID-19) were explored, and its possible action mechanisms were described through network pharmacology and basic analysis of modern pharmacology. Method:The compounds and targets in XFHZP were collected through TCMSP and BATMAN-TCM databases. The targets of COVID-19 were studied by GeneCards, NCBI and CTD databases. The PPI network was constructed through STRING database. The networks of "herb-meridian" and "traditional Chinese medicines-compounds-targets-disease" were generated by Cytoscape 3.7.0. Then, Kyoto Encyclopedia of Genes and Genomes（KEGG） analysis and Gene Ontology（GO） analysis were made for shared targets through the Omicshare platform. In addition, the disease targets of multiple organ injury, immune injury and severe acute respiratory syndrome (SARS) were retrieved and then mapped with XFHZP. The ratio of intersection targets to XFHZP's targets was calculated. Result:XFHZP has 10 traditional Chinese medicines in total, including 6 medicines with the meridian tropism to lung, 5 medicines with the meridian tropism to the spleen and 5 medicines with the meridian tropism to the stomach. There were 409 compounds and 2 271 targets. There were 8 same inflammatory factors in targets between XFHZP and COVID-19, and each inflammatory factor corresponded to multiple compounds. XFHZP and COVID-19 had 135 intersection targets, and 36 key targets were screened out. A total of 172 signaling pathways were screened out through KEGG signal pathway enrichment (P<0.05). There were 4 000 biological processes, 254 cell components, and 408 molecular functions (P<0.05) according to GO analysis. XFHZP had many common targets with various organ damage targets and immune damage targets, with the ratio of about 7.6%-97.8%. XFHZP had 173 intersection targets with SARS. Conclusion:XFHZP may treat COVID-19 through anti-inflammatory, organ protecting and immune effects. It will provide a certain theoretical basis for the development of drugs for COVID-19.

The Distribution of Angiotensin-Converting Enzyme 2 (ACE2) and the Intervention Strategies Targeting the Binding Process of SARS-CoV-2 and ACE2 / 中国药学杂志

SARS-CoV-2, which is similar to SARS-CoV, can bind to human cell surface receptor ACE2 through its S-protein, sequentially infecting human cells such as respiratory epithelial cells or corneal and conjunctival tissues, thereby invading the human body. Recent studies have shown that organs with high expression levels of ACE2 protein, such as kidneys and lungs, are more vulnerable to virus damage. Therefore, lots of efforts have been devoted to the development of drugs targeting the combination of SARS-CoV-2 and ACE2. This paper reviewed the most recently published literatures that related to ACE2 and coronavirus infection, with an emphasis on ACE2, especially its distribution in vivo and organ damages of the patients with SARS-CoV-2 infection, as well as recent progress of drug development targeting the binding process of SARS-CoV-2 and ACE2. This paper aimed to shed some light on clinically fight against SARS-CoV-2 infection.

A Clinical Study Of Blunt Injury Abdomen In Tertiary Care Hospital

BACKGROUND : Blunt abdominal trauma is the 3rd most common form of injury in road traffic accidents after orthopaedic injuries and head injuries and the victims mostly are young, productive adults and hence it has got enormous 8 socio-economic impact. METHOD : Aprospective detailed study and analysis of 125 cases of abdominal trauma those admitted in this tertiary care centre over a period of 2 years from 2017 -2019 was undertaken with the review of the medical literature. RESULTS : Blunt injury abdomen is a major cause of morbidity and mortality in young age patients with Road traffic accident being the most commoncause.Males are affectedmore thanfemales.Inourstudy,Liverismost commonlyinvolvedorganthanspleenwhichis contrasttoliterature. CONCLUSION : Early diagnosis reduces the mortality rates and safety measures in roads prevent the injuries , both play a major role in good outcome.

Retrospective study on the characteristics of early organ injury in elderly patients with severe burns / 中华烧伤杂志

Objective@#To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients.@*Methods@#From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author′s affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author′s affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction.@*Results@#(1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ2=13.676, P<0.05 or P<0.01).@*Conclusions@#In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.

Advances in Mechanisms of Perioperative Organ Injury and Organ Protective Strategies of Liver Transplantation / 中山大学学报(医学科学版)

@#Anesthesiology in China is transforming from traditional anesthesia only to perioperative medicine. Perioperative medicine has a more comprehensive idea from the perspective of being patient- oriented ，regarding comfort and aponia，rapid recovery and good prognosis of patients as the goal. It also requires individualized perioperative treatment scheme. Since organ protection is a critical issue in perioperative medicine ，patients benefit from maintaining favorable organ function and preventing failure induced by injury. Organ transplantation will become one of the hotspots in future medicine with the development of surgery. Liver transplantation ，as the main type of transplantation ，causes multiple organ dysfunctions during the perioperative period. It is an urgent and key point of perioperative medicine to illustrate its mechanisms and establish relevant protections.

Role of estrogen in alleviating hemorrhagic shock-induced organ injury / 中国病理生理杂志

Estrogen has many biological activities and extensive clinical applications.Hemorrhagic shock-in-duced major organ dysfunction and injury,which are related to sex differences,play a triggering role in irreversible shock. The present article reviews the role of estrogen in alleviating hemorrhagic shock-induced organ injury by analyzing and sum-marizing the recent studies,thus expanding the clinical application of estrogen and providing a novel approach for treatment of severe hemorrhagic shock.

Clinical study of extra intestinal damage after rotavirus infection in infants / 国际儿科学杂志

Objective To investigate the incidence of extra intestinal organ damage in infants with acute rotavirus (RV) infection,the relative risk factors in patients with extra intestinal organ damage,the significance of procalcitonin(PCT)in those infants with multiple organ injury.Methods One hundred and three infants with acute diarrhea whose rotavirus antigens were positive and 65 negative ones were divided into two groups.The differences between these two groups in incidences of extra intestinal organ damage were analyzed.Meanwhile,variables from the clinical data that may lead to extra intestinal organ damage were analyzed.Then,the relationship of multiple organ damage and serum concentration of PCT was also analyzed.Results There were significant differences between positive group and negative group in the rates of respiratory system injury,myocardial damage and hepatic involvement (P ＜ 0.05).High fever was the only high risk factor in myocardial damage through multi factor Logistic regression analysis.There were also significant differences among the group with multiple organ damage and only one extra intestinal organ damage and no extra intestinal organ damage in serum concentration of PCT(P ＜ 0.05).Conclusion It is common to be attacked by extra intestinal organ damage in infants with acute rotavirus infection.High fever is the risk factor for RV enteritis complicated with myocardial damage.The elevation of PCT concentration suggest that multiple organ injury out of the intestinal tract may take place in infants with acute RV infection.

Cause analysis and nursing of organ damage after in vitro fertilization and embryo transfer / 中国实用护理杂志

Objective Through retrospective analysis of the causes of organ damage after in vitro fertilization embryo transfer,we put forward targeted prevention and take corresponding nursing measures to promote the prognosis of patients. Methods Selected 14 patients who suffered from organ damage after paracentes is in vitro fertilization and embryo transfer in our hospital.The causes were analyzed,and the treatment and nursing protocols were determined according to the kind and severity of the injured organs. Results 14 cases of organ injury patients with treatment and nursing gauze to stop bleeding, antibiotics, conservative treatment, hemostatic anti shock, indwelling catheter bladder irrigation, ureteral catheter and surgery were given symptomatic, were cured, hospitalization time was 3- 10 days. Conclusions The reasons for such patients, clinical observation and analysis of nursing treatment, let clinical nurses accumulate nursing experience in such patients, can timely take corresponding nursing measures,In order to improve the related nursing level of assisted reproductive technology.

Intra-abdominal Organ Injuries in Blunt Injury Abdomen in SRM Medical College, Potheri: A Prospective Study.

Introduction: Blunt Abdominal trauma is the most common caused by road traffi c accidents (RTA). It also occurs as a result of fall from a height, assault with blunt objects, industrial mishaps, sports injuries, bomb blast. Investigative modality can only supplement the clinical evaluation and cannot replace it in the diagnosis of blunt abdominal trauma. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. Purpose: To estimate the frequency of various intra-abdominal organ involved, assess the various mode of blunt abdominal trauma and clinical presentation and various available investigation, treatment and complications. Methods: This a prospective study conducted in SRM Medical College among patients presenting to the casualty and general surgery outpatient department with a sample size of 72. Results: Males (91.6%) outnumbered females (8.33%). RTA forms the most common mode of injury. The most common age group affected is 21-30 years. Majority of the population presented with pain abdomen. Focused assessment with sonography for trauma has picked up solid organ injury in 46 cases. Computed tomography abdomen was performed in 100% of the population and forms the core investigation of choice and becomes more important in dealing operative versus conservative management. For splenic injury, the most common surgery performed was splenectomy (26 cases). Multiple intra-abdominal organs were involved accounting for 9.7%. Wound infection is the most common post-operative complication. The study showed a mortality of 19%. Conclusion: Blunt injury abdomen with solid organ injury forms a considerable load of patients in our society and is usually less obvious. Early diagnosis, repeated clinical examination and use of appropriate investigations form the key in the management.

Establishment of rat model of organ injury caused by cardiopulmonary bypass / 局解手术学杂志

Objective A easier and faster rat model of organ injury caused by cardiopulmonary bypass was developed to provide a stable and economical experimental platform for the research of CPB ( cardiopulmonary bypass ) .Methods Twenty male Sprague-Dawley rats weight between (288.8 ±26.1)g were randomly divided into sham group and CPB group .The right external jugular vein and bilateral femoral arteries were punctured in sham group ,while the rats in CPB group underwent 60 minutes cardiopulmoanry bypass with the perfusion flow no less than 120 mL· kg-1· min-1 .And the weight ,blood pressure ,blood gas and electrolytes were monitored and analyzed throughout the experi -ment.The serum,lung,liver and kidney were collected at 72 h after the operation for further detection .Results The rat model of cardiopul-monary bypass was established successfully with 90%survival rate .The changes of blood gas during intraoperative and postoperative were in accordance with clinical reality and the injury of lung ,liver and kidney were confirmed by serum results and pathological changes .Conclu-sion The model has the characteristics of lower weight ,less priming solution ,no need for endotracheal intubation and easier to assemble the bypass line ,furthermore the methods of puncture and CPB were exhibited through a large number of pictures .As a consequence ,the difficul-ties of establishing the rat model of CPB were reduced significantly .The changes of pathophysiology during intraoperative and postoperative were similar to clinical realities ,the survival rate and organ injury were satisfactory .So it can be used as an effective tool for the research of organ injury and the evaluation of therapeutic strategies associated with CPB .

Urine examination for early diagnosis of neonatal multiple organ injury / 国际儿科学杂志

Neonatal visceral injury have high clinical incidence and it is hard to make clinical diagnosis early by routine inspection. In recent years,researches have shown that neonatal multiple organs damage can be diagnosed early by analyzing some special components in urine. Besides,urine analysis is a noninvasive examina-tion method and it is suitable for clinical promotion. This paper enumerates the application of neonatal urine ex-amination in the early diagnosis of kidney damage,bronchial pulmonary displasia,patent ductus arteriosus,hy-poxic ischemic encephalopathy and metabolic disease.

Effects of Chronic Carvedilol administration on blood Pressure Variability and target Organ injury in rats with sinoaortic Denervation / Efectos de la administración crónica de carvedilol sobre la variabilidad de la presión arterial y el daño de órgano blanco en ratas con desnervación sinoaórtica

background: Increased blood pressure variability is a novel risk factor for the development of target organ injury both in hyperten-sive and normotensive subjects, so its reduction should be considered as a new therapeutic goal. Objective: The aim of this study was to evaluate the effect of long-term oral carvedilol treatment on blood pressure, blood pressure variability and target organ injury in the left ventricle and thoracic aorta in a model of blood pressure liability. Methods: Twelve male Wistar rats submitted to sinoaortic denervation were treated during 8 weeks with a single dose of carvedilol 30 mg/kg or vehicle. At the end of treatment, echocardiographic evaluation and blood pressure and short-term variability measure-ments were performed. Left ventricular and thoracic aortic weights were determined and histological samples were prepared from both tissues. Metalloproteinase MMP-2 and transforming growth factor β (TGF-β) were quantified in the left ventricle and thoracic aorta. results: Carvedilol reduced systolic blood pressure and its variability in sinoaortic-denervated rats compared with the control group (126±5 vs. 142±11 mmHg, p<0.05; SD: 2.9±0.5 vs. 6.0±0.5 mmHg; p<0.05). A lower amount of connective tissue was found in carvedilol-treated animals. The expression of TGF-β decreased in both organs after carvedilol treatment. Conclusions: Chronic carvedilol treatment significantly reduces systolic blood pressure and its short-term variability in sinoaortic-denervated rats, decreasing the degree of left ventricular fibrosis.

introducción: El incremento en la variabilidad de la presión arterial resulta un nuevo factor de riesgo para el desarrollo de daño de órgano blanco en individuos tanto hipertensos como normotensos, por lo que se postula que su reducción debe considerarse una posible nueva meta terapéutica. Objetivos: Evaluar el efecto del tratamiento a largo plazo con carvedilol sobre la presión arterial, su variabilidad y el daño de órgano blanco en el ventrículo izquierdo y la aorta torácica en el modelo de la labilidad de presión. Material y métodos: Se incluyeron 12 ratas Wistar macho sometidas a desnervación sinoaórtica, las cuales fueron tratadas durante 8 semanas con una única administración diaria de carvedilol 30 mg/kg o vehículo. Finalizado el tratamiento se realizó la medición de la presión arterial y de la variabilidad a corto plazo y la evaluación ecocardiográfica. Se determinó el peso del ventrículo y de la aorta torácica y se realizaron preparados histológicos sobre ambos tejidos. Se cuantificó la expresión de metaloproteinasa 2 (MMP-2) y factor de crecimiento transformante β (TGF-β) en el ventrículo izquierdo y la aorta torácica. resultados: El carvedilol redujo la presión arterial sistólica y su variabilidad en las ratas con desnervación sinoaórtica en comparación con el grupo control (126 ± 5 vs. 142 ± 11 mm Hg, p < 0,05; DE: 2,9 ± 0,5 vs. 6,0 ± 0,5 mm Hg; p < 0,05). Se evidenció menor cantidad de tejido conectivo en los animales tratados con carvedilol. La expresión de TGF-β se encuentra disminuida en ambos órganos luego del tratamiento con carvedilol. Conclusiones: El tratamiento crónico con carvedilol reduce significativamente la presión arterial y su variabilidad a corto plazo en ratas con desnervación sinoaórtica, disminuyendo el grado de fibrosis del ventrículo izquierdo.

Effect of normal mesenteric lymph on multiple organ injury in mice with endotoxic shock / 中国病理生理杂志

AIM:To observe the effects of normal mesenteric lymph (NML) on the lung, heart and liver inju-ries and the phosphorylation levels of p 38 mitogen-activated protein kinase ( MAPK) , extracellular signal-regulated kinase (ERK) 1/2 and c-Jun N-terminal kinase (JNK) in the mice with endotoxic shock (ES).METHODS: The NML was drained form health male BALB/c mice for the intervention of ES after the removal of cellular constituent .Lipopolysaccha-ride (LPS, 35 mg/kg) was intraperitoneally injected into the mice for the establishment of ES model .After 60 min of LPS injection, the administration of NML (1/15 of whole blood volume) was performed through the femoral artery in NML +ES group.Meanwhile, the mean arterial pressure (MAP) was monitored during the experiment .At 6 h after intraperitoneal in-jection of LPS or the corresponding time point , blood samples were harvested from the heart through apical centesis for de-termination of the biochemical indexes to reflect myocardial and hepatocyte injuries .Simultaneously , the lung , heart and liver tissue specimens from a fixed location were harvested for the observation of histomorphology and the measurement of phosphorylation levels of p38 MAPK, ERK1/2 and JNK.RESULTS:Compared with sham shock (SS) group, MAP in ES group and NML+ES group remarkably decreased at multiple time points after intraperitoneal injection of LPS .However, MAP in NML+ES group at 80 min, 90 min, 190 min, 210 min, 240 min, 250 min, 340 min, 350 min, and 360 min were significantly increased compared with ES group .There were normal structures in the lung , liver and myocardium of the mice in SS group, while the morphological damages of these tissues appeared in ES group .Meanwhile, the damages were attenuated in the mice of NML +ES group.The activities of AST , ALT and CK-MB in the plasma in ES group were remark-ably higher than those in SS group .The CK-MB activity in NML+ES group was also increased compared with SS group , and the activities of AST and LDH-1 were lower than those in ES group .At 6 h after LPS injection , the phosphorylation levels of p38 MAPK, ERK1/2 and JNK in the lung tissues were remarkably increased .Meanwhile , no statistical difference of these indexes between the myocardial and hepatic tissues was observed .NML intervention decreased the phosphorylation levels of p38 MAPK in the lung tissues , and p38 MAPK, ERK1/2 and JNK in the myocardial tissues .CONCLUSION:The NML administration alleviates multi-organ injuries and reduces the phosphorylation level of p 38 MAPK in the lung tis-sues in the mice subjected to ES .

A prospective study of conservative management in cases of hemoperitoneum in solid organ injuries at tertiary care hospital in western India.

Background: Blunt abdominal trauma is one of the most common causes among solid organ injuries. Morbidity and mortality in blunt abdominal injuries is major cause of concern for surgeons. Aims & Objective: This study was carried out to analyse patient profile, investigations and management of such patients. Material and Methods: 50 patients, who admitted to civil hospital Surat were studied prospectively. Age and gender distribution, Mode of injury, clinical presentation, solid organs injured, and investigations carried out, length of hospital stay, management – conservative or operative and their outcome were studied. Results: Out of 50 patients 46 were male, and 4 female patients. 60% patients are from 20-40 year age group. Majority are due to road traffic accidents (54%), and abdominal pain is the most common mode of presentation. Spleen (46%) and liver (38%) are the 2 most common organs involved. 88% patients are managed conservatively, remaining have to undergo laparotomy. Length of hospital stay (1-10 days in 37 patients) is lower patients who are managed by conservative management in comparison to operative management (11-20 days in 4 patients). 54% patients required 1 or more units of blood during hospital stay. Conclusion: Non penetrating abdominal injuries are major cause of concern. Ultrasonography and CT scan play major role in detecting solid organ injuries. Conservative management is safer and reliable mode of management in solid organ injuries due to blunt abdominal trauma.

Analysis of the Management of Children with Abdominal Solid Organ Injuries

PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.

Effect of hemoperfusion on dearance of organophosphorus in rabbits poisoned by methamidophos / 中华急诊医学杂志

Objective To evaluate the clearance efficacy of resin hemoperfusion(HP) on the removal of organophosphorus in the rabbits poisoned by methamidophos(MAP) and its effects on organ injury. Method Six-teen healthy Japanese white rabbits were randomly divided into HP group and non-HP group. MAP was given through gastric tube in a dosage of 20 mg/kg to rabbits of both groups. Rabbits of liP group received resin hemop-ersion plus conventional treatment including early gastric lavage, atropine and pralidoxime. Rabbits of non-HP group received only conventional treatment. The plasma concentration of MAP was determined by using gas chro-matography before and after rabbits were poisoned at different intervals. Serum choline esterase (ChE),lactic de-hydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) of rabbits of both groups were assayed 6 hours after rabbits poisoned. Pathological changes in lung, liver, kidney and muscle were investigated simutaneously. SPSS 10.0 software was used for statistical analysis. The comparison between groups was carried out by using t -test. Results ① The typical symptoms of organophospborus poisoning were occurred in rabbits within 5 - 10 minutes after ingestion of MAP. In HP group, the plasma levels of rabbits before,and 30 min,60 min,90 min and 120 min after hemoperfu-sion were (11.43±1.56),(7.82±1.54),(4.97±1.58),(5.66±1.75) ,(5.49±1.68) μg/mL, respectively (P <0.01). After hemoperfusion, the plasma MAP levels of rabbits in HP group were lower than those in non-HP groups (P < 0.01). The improveme, nt of clinical presentation of rabbits was observed shortly after HP. ② The blood choline esterase activity of rabbits were depressed in hoth groups without significant difference. In contrast, the blood levels of ALT, AST,LDH,CK and CK-MB of rabbits in non-HP group elevated significantly than in HP group (P < 0.01). ③ The more severe injury of muscle, liver, kidnet and lung of rabbits can could be seen in non-HP group. Conclusions ① HP can effectively eliminate the plasma MAP and has the potential to improve the clinical presentation of intoxication in rabbits. ② Early intervention of Hp exerts a protection from organ dam-age of organophosphorus pesticide.

Analysis of Anti-hypertension Therapy of 208 Elderly Patients with Essential Hypertension and Target Organ Injury / 药物流行病学杂志

Objective:To analyze the anti-hypertension drugs used by elderly patients with essential hypertension and target organ injury in the inpatient department of the hospital.Method:A statistical and review analysis of anti-hyper- tension therapy planned for 208 patients aged 60 years and over with essential hypertension of 3rd grade,extreme high risk group and target organ injury.Result:The most common combinative treatment plan and drug option frequency(%)were as follows:cerebral infarction group:angiotensin-converting enzyme inhibitor (ACEI) (87.77%)+long-acting calcium channel blocker (CCB) (79.58%)+diuretic (77.55%),diabetes mellitus group:CCB(86.26%)+ACEI (68.18%)+diuretic(56.82%),renal insufficiency group:CCB(87.67%)+ACEI(45.45%) or angiotensinⅡre- ceptor blocker (ARB)(45.45%)+diuretic(60.61%),heart failure group:ACEI (86.67%)+diuretic(96.67%) +?-blocker(66.67%) and coronary heart disease group:CCB(84.73%)+ACEI(86.53%)+?-blocker(77.12%). Conclusion:The essential hypertension of 3rd grade,extreme high risk group of the aged should adopt a combinative treat- ment plan and concise indication drugs in term of the target organ injury of patients.