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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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We constructed the CS1-targeted second- and third-generation CAR-T cells with genetic engineered 4-1BB or/and ICOS as a costimulatory signaling molecule by use of lentiviral platform. The CS1-targeted second-generation CAR-T cells with ICOS or 4-1BB had similar anti-neoplastic activity. When effector/target ratio was 1:1, the CAR-T cells with ICOS showed better killing effect on IM9-lucgfp cells than those with 4-1BB. However, The CS1-targeted third-generation CAR-T cells exihibited lower cytolytic capacity against IM9-lucgfp cells than the CS1-targeted second-generation CAR-T cells when the ratio of effector/target was 1:1, 2:1 or 5:1. When the ratio of effector/target was 10:1, the killing efficacy of both the second- and third-generation CAR-T cells against IM9-lucgfp cells was more than 85%, significantly higher than that of the control T cells. Taken together, both the CS1-targeted second- and third-generation CAR-T cells with ICOS or/and 4-1BB could efficiently kill CS1-positive multiple myeloma cells, but the CS1-targeted second-generation CAR-T cells had more potent killing effect on CS1-positive multiple myeloma cells than the CS1-targeted third-generation CAR-T cells.
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Humanos , Ligante 4-1BB/metabolismo , Linhagem Celular Tumoral , Engenharia Genética , Proteína Coestimuladora de Linfócitos T Induzíveis/metabolismo , Mieloma Múltiplo/terapia , Transdução de Sinais , Linfócitos T/química , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
Objective To compare the effect of video‐assisted thoracoscopic(VAT) surgery and conventional thoracotomy in emergency treatment of multiple rib fracture complicating pulmonary laceration to provide the reference for clinical treatment .Meth‐ods Forty‐seven cases of multiple rib fracture complicating pulmonary laceration in our hospital from April 2013 to April 2014 were selected and divided into the VAT group(n=32) and thoracotomy group(n=15) according to the willingness of patients .The two groups performed the thoracoscopic and traditional thoracotomy titanium nickel alloy rib plate treatment respectively .The sur‐gery situation ,complications and changes of perioperative blood gas levels were compared between the two groups .Results The op‐eration time ,intraoperative bleeding volume ,ICU hospitalization time ,total hospitalization time and postoperative analgesic in the VAT group were lower than those in the thoracotomy group ,the differences were statistically significant (P0 .05) .The excellent rate in the VAT group was 90 .6% ,which was higher than 66 .7% in the thoracotomy group ,and the differ‐ence was statistically significant (P<0 .05) .Conclusion Thoracoscopic internal fixation for the treatment of multiple rib fractures complicating laceration has the advantages of minimal trauma ,convenient operation and high safety ,could effectively alleviate the patient′s sufferring ,improve the living quality ,and be a better way of treatment .
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Objective To observe the effect of clinical first-aid skills training for community doctor. Methods Effect of systematic clinical first-aid skills training and traditional teaching methods were scored by the questionnaire survey in order to compare their difference. Results Through systematic clinical first-aid skills training, the score on contacting the actual work, improving the diagnosis and treatment, analyzing and problem-solving skills, enhancing learning initiative, participation, scientific learning method and self-learning ability, impro-ving clinical thinking, strengthening team spirit and humane education were significantly improved compared to that of the traditional teaching methods (P<0. 01). Conclusion The systematic clinical first-aid skills training is an effective way for community physicians.
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Objective To understand the capacity of application,and discuss the types as well as the mechanism of these dysfunctions.Methods A battery of neuropsychological tests including tool naming,tool naming by function,using of transitive tools,novel task test and naming photographs (living and inanimate) were applied in this study.20 AD patients and 20 healthy controls were enrolled in the study.Results The AD patients performed worse than the controls on the tool naming,tool naming by function,application of transitive tool,novel task test,naming tasks of living and inanimate pictures.The results represented significance in all of the tests (t =-6.54,-5.94,-4.16,-4.81,-2.17,-2.08 ; P ＜ 0.05).There were significant correlations between the performances in application the tasks and the ADAS-cog,MMSE and ADL scores (P ＜ 0.05).Conclusion The findings indicate that AD patients have apraxia,mainly impairment in ideomotor apraxia and ideational apraxia.Additionally,the patients have significantly decreased performance in ideational apraxia.The result suggests that AD patients' apraxia might result from the semantic processing disorder.
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High fidelity human patient simulator has become more and more important in clinical medical practice education.Medical circle has more and more realized that non-technical skill (NTS) is closely associated with the improvement of medical quality.This paper attempted to carry out a preliminary discussion on theory and practice of applying NTS in simulation training of critical care medicine based on their own teaching experiences.
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ObjectiveTo investigate the event-based prospective memory (EBPM) and time-based prospective memory (TBPM) in patients with Alzheimer' s disease (AD). MethodsTwenty patients with AD, 20 adults with amnesia mild cognitive impairment (aMCI) and 30 healthy adults with matched age and education level were assessed with a battery of neuropsychological tests including EBPM and TBPM tasks.ResultsCompared with healthy elders and patients with aMCI on performance of PM (2. 23 + 0. 77,4.83 ±1.09;1.00±1.03,3. 10 ± 1.52) and episodic memory(0. 70 ±0. 12,0.66 +0. 16;0.45 ±0.07,0.54±0. 10), AD patients were all impaired in PM and episodic memory(0.20 +0.41,2.05 ± 1.43;0.33±0. 12,0.32±0. 10), and were impaired in EBPM more significantly (t=-2.792, P＜0.01;t =-10. 761 ,P ＜0. 01 ). ConclusionsThese results suggest that AD patients show deficits of PM, but their EBPM is impaired more significantly. EBPM impairment may be an early diagnostic of AD.
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Objective To investigate the characteristics of memory impairment in patients with amnestic mild cognitive impairment (aMCI). Methods Thirty-five patients with aMCI and 35 healthy adults matched with age and education level were administered with a neuropsychological battery of tests including conception and perception implicit priming tasks (category exemplar, picture identification), as well as explicit memory tasks (immediate recall, delay recall, delay recognition ). Results Compared with healthy elders, patients with aMCI were impaired in the conception implicit priming task(t=-4.33, P<0.01), as well as in explicit memory (immediate recall, t=6.40, P<0.01;delay recall, t=9.29,P<0.01; delay recognition, t=7.65,P<0.01),but not in perception implicit priming task (t=-0.78, P＞0.05).The conception implicit priming is positively correlated with verbal fluency (r=0.74,P<0.01). Conclusions The present results indicate that patients with aMCI are impaired in both explicit memory and conception implicit priming. The conception implicit priming impairment in aMCI may be related to their frontal lobe dysfunction.
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BACKGROUND: Caspase-3 exists in normal cell in form of zymogen and is capable of stimulating cell apoptosis after activated by apoptosis inducing factors.OBJECTIVE: To observe the activity of caspase-3 in hippocampal cytosolic S-100 and neuronal apoptosis in hippocampal regions, so as to discuss the relationship between hippocampal neuronal apoptosis and caspase3 activity during the whole brain ishcemic-reperfuasional injury.DESIGN: Randomized controlled experiment.SETTING: Emergency Department of Southwest Hospital Affiliated to the Third Military Medical University of Chinese PLA.MATERIALS: This experiment was carried out at Southwest Hospital Affiliated to the Third Military Medical University of Chinese PLA from January to April 1999. Totally 182 male Wistar rats were randomly divided into 3 groups: namely sham operation group of 14 rats, cerebral IR group of 84, rats acetyl-asp-glu-val-asp-aldehyde (AC-DEVD-CHO) treatment group of 84 rats, rats in the latter two groups were then subdivided into IR 8, 24, 48, 72, 120 and 168 hours time points subgroups with 14 rats in each.METHODS: The whole brain ischemia 20 minutes and reperfusional model was established on rats in brain IR group and Ac-DEVD-CHO treatment group, and rats were executed separately at post-reperfusional 8, 24,48, 72, 120 and 168 hours for obtaining hippocampal specimen; rats in sham operation group were only underwent anesthesia and operation without common carotid arterial occlusion and burns of vertebral artery, they were executed at 72 hours after operation and hippocampal specimen was obtained. The quantity of amino-methylcoumarin that was produced from the same mass of specimen within same decomposition time was used to reflect the activity of caspase-3. Brain slices that were obtained from different time points were stained and embedded for observing the hippocampal cell apoptosis under fluorescence microscope at 330-350 nm.MAIN OUTCOME MEASURS: ① The caspase-3 activity in hippocampal S-100 in different post-IR time point groups. ② The hippocampal cell apoptosis in different post-IR time point groups. ③ relationship between caspase-3 activity and neuronal apoptosis in hippocampal regions.RESULTS: Totally 182 rats were enrolled in this experiment, 14 rats got lost, thereby date of 168 rats was entered the result analysis. ① The changes of caspase-3 activity in hippocampal S-100 in different post-IR time point groups: There was no change in sham operation group at postoperative 72 hours. In contrast with cerebral IR group, there were obvious reduction in Ac-DEVD-CHO treatment group at post-reperfusional 24, 48,72, 120 and 168 hours [(1.71±0.03, 1.22±0.03; 2.77±0.09, 1.59±0.7;5.54±0.51, 2.3±0.19, 6.28±1.71, 3.43±0.46; 3.11±1.21, 1.73±0.14) nkat/kg;P ＜ 0.05 or 0.01]. ② The hippocampal cell apoptosis in different post-IR time point groups: Under 400× field of vision, the number of apoptotic cells in sham operation group was 1.2±0.4 cells at postoperative 72 hours.It was lower in Ac-DEVD-CHO treatment group at post-reperfusional 24,48, 72, 120 and 168 hours than cerebral IR group [(6.4±1.7, 2.8±0.8;11.8±1.3, 5.8±1.9; 19.8±3.1, 10.0±1.9; 31.2±5.9, 16.4±2.4; 19.8±2.3, 9.0±2.3)cells/400× field of vision; P ＜ 0.01]. ③ Relationship between caspase-3activity and neuronal apoptosis in hippocampal regions: It was proved of linear correlation in cerebral IR group and Ac-DEVD-CHO treatment group,displaying significantly positive correlation r= 0.935 6 or 0.980 0, P ＜ 0.01).CONCLUSION: Caspase-3 activation is one of the major inducer for hippocampal neuronal apoptosis, playing important role in hippocampus neuronal apoptosis in rats during IR injury.
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Objective To investigate the roles of Caspase 3 in neuron apoptosis following cerebral ischemia/reperfusion in the rat hippocampus. Methods A model of rats with global ischemia induced by occlusion of the four vessels according to the method by Pulsinelli et al was used in this study. A total of 182 Wistar rats [(220?20) g] were divided randomly into three groups: control group ( n =14), cerebral ischemia group ( n =84), and cerebral ischemia group treated with acetyl asp glu val asp aldehyde (Ac DEVD CHO, n =84). Time points for observation included 8, 24, 48, 72, 120, and 168 h in the latter two groups. Caspase 3 activity in cytosolic extracts (S 100) of hippocampus and apoptotic neurons in hippocampus following cerebral ischemia/reperfusion were observed at the above mentioned time points, respectively. Results (1) No caspase 3 activity was detected in S 100 from the control group. In S 100 from the ischemia group, weak caspase 3 activity was detected at 8 h, but it increased gradually and peaked at 120 h, and then decreased apparently at 168 h after reperfusion. After treatment with Ac DEVD CHO following cerebral ischemia/ reperfusion, caspase 3 activity was inhibited to some extent at each time point. (2) Apoptotic cells were occasionally observed in hippocampus in the control group, but the apoptotic cells increased apparently at 24 h, peaked at 120 h, and decreased a few at 168 h after reperfusion in ischemia group. After treatment with Ac DEVD CHO following cerebral ischemia/reperfusion, apoptosis decreased to some extent at each time point (except 8 h following cerebral ischemia/ reperfusion). (3) Caspase 3 activity in S 100 from hippocampus was positively correlated with apoptotic neurons in hippocampus following cerebral ischemia/reperfusion at each time point ( r =0.9356 in ischemia group, r =0.980 0 in treatment group). Conclusion Caspase 3 may be one of the key causes resulting in neuron apoptosis in rat hippocampus after cerebral ischemia/reperfusion. It may play an important role in ischemia reperfusion brain injury.
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Objective To construct a retrovirus-mediated expression system containing double strands DNA for RNA interference on human Notch1 gene and study its inhibitory effect on human glioma cell lines U251 and CHG-5 in vitro.Methods A recombinant retroviral vector pSiRNA-Notch1 was generated by cloning a double strands DNA for RNA interference on human Notch1 gene into a retroviral vector Psilencer 5.1-H1 Retro.Human glioma cell lines U251 and CHG-5 were infected with the viral supernatant from the PT67 clones.After 3 d,the viability,Notch1 mRNA and protein of the transfected cells were examined by WST-8 assay,RT-PCR and Western blot.Results The pSiRNA-Notch1 recombinant retroviral vector had been constructed correctly.The titer assayed on NIH3T3 cells was up to 224?104 cfu/ml.Three days after transfection,the viability,Notch1 mRNA and protein of the transfected cells decreased significantly.Conclusion The constructed pSiRNA-Notch1 retroviral vector shows effective inhibition effect on the viability in human malignant glioma cells,with potential utility in the gene therapy for human malignant glioma.
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Objective To investigate the possible role of intercellular adhesion molecule-1 (ICAM-1) in the lung injury induced by mechanical ventilationMethods Twenty-four normal healthy small pigs, ventilated with continuous different tidal volume, were randomly divided into control group, low tidal volume group (group A), middle tidal volume group (group B) and high tidal volume group (group C)The expression of ICAM-1 protein on pulmonary vascular endothelium cells, tumor necrosis factror-? (TNF-?) levels and myloperoxidase (MPO) activities in serum and lung were observed with immunohistochemisty, enzyme linked immunosorbent assay and MPO measurement 1d,3d and 7d following ventilation respectivelyResults The levels of TNF-? and MPO in serum and lung and the number of ICAM-1 protein expression were higher in group A, B and C than those in control group (P