Advances of mechanism of mesenchymal stem cells in animal experiments with bronchial asthma / 中华实用儿科临床杂志

Bronchial asthma is a common chronic airway inflammatory disease in children characterized by hyper-responsiveness, airway inflammation, and airway remodeling caused by immune responses.Currently, some limitations of glucocorticoid and allergen-specific immunotherapy restrict their application to asthma treatment.Based on the results of many animal experiments, mesenchymal stem cells (MSCs) are validated to reduce airway inflammation, improve airway hyper-responsiveness, and reverse airway remodeling through immunomodulation.Therefore, it has great application prospects as an effective therapeutic strategy for children with asthma.To explore the value of MSCs in the treatment of asthma, its underlying mechanisms are reviewed in the present study.

Correlation study between quantitative characteristics of CT lung opacification based on machine learning and clinical subtypes and severity of lung injury of COVID-19 / 中华放射学杂志

Objective:To investigate the value of chest CT quantitative index in clinical classification and lung injury severity evaluation of COVID-19.Methods:The current study retrospectively analyzed the clinical and CT data of 438 patients with COVID-19 between January 2020 and March 2020 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology. The clinical types included common type ( n=146), severe type ( n=247) and critical type ( n=45). The chest CT indexes of all patients were quantitatively analyzed by artificial intelligence (AI) deep learning, including whole lung volume, CT lung opacification, ground glass opacification volume (GGO volume; CT value<-300 HU), solid opacification volume (SO volume; CT value ≥-300 HU) and the ratio of volume to the whole lung volume, the ratio of SO volume to GGO volume (SO volume/GGO volume). Kruskal-Wallis test was used to conduct statistical analysis of the differences in quantitative parameters among clinical types, and multiple ordered logistic regression was used to analyze the correlation between quantitative parameters and clinical types. Results:Among the 438 patients diagnosed with COVID-19, severe and critical patients were older ( P<0.05), and most of the critical patients were male ( P<0.05). The main clinical manifestations of all clinical types were fever, followed by cough, fatigue, chest tightness, dyspnea, gastrointestinal symptoms and so on. GGO volume was the main CT manifestation of all the three clinical subtypes. The whole-lung opacification volume, GGO volume, SO volume and their proportions in whole-lung volume significantly increased from common, severe to critical types (all P<0.05). SO volume/GGO volume increased with the severity of clinical type [common type 0.12 (0.03, 0.34), severe type 0.29 (0.11, 0.59), critical type 0.61 (0.39, 0.97)]. Multiple ordered logistic regression analysis showed that whole-lung opacification volume (OR=1.009), SO volume/GGO volume (OR=1.866), GGO volume (OR=1.008) and SO volume (OR=1.016) had a significant positive effect on the severity of clinical typing ( P<0.01). Conclusion:Quantitative indicators of chest CT based on deep learning algorithm (SO volume, GGO volume, SO volume/GGO volume) are closely related to the clinical severity of COVID-19.

Application of three-dimensional SPACE magnetic resonance imaging in accurate measurement of implant volume in breast surgery / 中华整形外科杂志

Objective@#The study is to assess the accuracy and reliability of three-dimensional simulated magnetic resonance imaging with silicone-excitation SPACE (sampling perfection with application optimized contrast using different flip angle evolutions) sequence for estimating implant volume.@*Methods@#(1) MRI examinations of 10 silicone implants (Wuhan Tongji Hospital from October 2018 to December 2018) were performed with T2, H2O-excitation SPACE sequence (T2-spc-H2O) and silicone-excitation SPACE sequence (T2-spc-Silicone) to find the most accurate method to estimate implant volume by ITK-SNAP. The effect of implant deformation and slice thickness of T2-spc-Silicone on volume measurement were investigated. (2) 13 normal patients and 6 patients with implant complications (Wuhan Tongji Hospital from March 2017 to May 2019) were enrolled for testing the accuracy and reliability of T2-spc-Silicone for volume measurement in vivo. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. One-way ANOVA was used to compare the difference of multiple groups. P<0.05 was considered statistically significant.@*Results@#The absolute volume differences of T2, T2-spc-H2O, T2-spc-Silicone were (42.19±2.31) ml, (23.27±1.55) ml and (6.28±1.22) ml. The absolute volume differences of T2-spc-Silicone group was significantly less than T2-spc-H2O and T2 group in vitro(F=195.3, P<0.001). No significant difference(F=1.36, P=0.22)was shown between the normality group and the deformation group for estimating the volume of implants with the slice thickness of SPACE increased from 0.5 mm×0.5 mm×0.5 mm to 5.0 mm×5.0 mm×5.0 mm. Besides, the slices thickness of SPACE from 0.5 mm×0.5 mm×0.5 mm to 5.0 mm×5.0 mm×5.0 mm did not significantly affect the accuracy of volume measurement of the implants in deformation state(F=1.22, P=0.29). The measurement error of SPACE was (8.82±0.99) ml in normal patients. Moreover, there was no significant difference between measured volume[(226.4±12.76)ml] and actual volume of implants[(225.9±11.94) ml](t=0.31, P=0.76)in patients with implant complications. The result showed excellent intraobserver reliability (ICC=0.997) and internal consistency ranged from 0.986 to 0.997 (P<0.001).@*Conclusions@#The method to measure implant volume by silicone-excitation SPACE sequence had desirable accuracy and reliability. The deformation of the implant and the slice thickness of the SPACE sequence did not exhibit a significant effect on the accuracy of volume measurement.

Diagnostic value of diffusion kurtosis imaging in differentiating indeterminate solitary pulmonary nodules:comparison with diffusion weighted imaging / 中华放射学杂志

Objective To investigate the role of diffusion kurtosis imaging (DKI) in indeterminate solitary pulmonary nodules (SPN) diagnosis and to compare with conventional diffusion weighted imaging (DWI). Methods From March 2016 to Dec 2017, forty-three consecutive patients (30 male, 13 female, age: 56 ± 11 years) with indeterminate SPNs were included. All patients underwent axial multi-b factor DWI (with b values=0, 50, 200, 400, 800, 1400, 2000 s/mm2) examination and were divided into benign group (19 cases) and malignant group (24 cases) according to pathological results of SPN. ADC Kurtosis (K) and Diffusivity (Dk) values were compared between malignant and benign group and among different subtypes of lung cancer using independent t test (normal distribution and homogeneity of variance) and Mann-Whitney U test (skewed distribution or variance). Receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic performance. Results K values were significantly higher for malignant SPNs than for benign SPNs (0.839 ± 0.197 vs. 0.718 ± 0.120;t=2.359, P=0.023). ADC values were found to be significantly higher in benignity than malignant SPNs [(1.605 ± 0.422) × 10-3mm2/s vs. (1.278 ± 0.210) × 10-3mm2/s; t=-3.089, P=0.005). No difference was observed in Dk between the two groups (P=0.922). All parameters cannot differentiate subtypes of lung cancer. The ADC value had higher AUC (area under ROC curve) than that of K value. The sensitivity (70.8％) and accuracy (72.1％) of ADC value was higher than K value, the specificity of both methods was equal. Conclusion DKI is a feasible non-invasive tool which has comparable capability of conventional DWI in SPNs differentiation, although with lower sensitivity and accuracy. DKI can provide additional information for SPNs characterization and has a potential to be a robust way in SPNs interpretation.

Surgical management of 86 patients with duodenal injuries / 中华肝胆外科杂志

Objective To study the early diagnosis,surgical treatment options,prevention and management of complications in patients with duodenal trauma.Methods All patients with duodenal trauma treated operatively from January 2009 to December 2018 were studied retrospectively.Factors including sex,age,cause of injury,AAST grading,diagnostic method,operative procedure,therapeutic effectiveness,complications,and factors related to death were analyzed.The "double-tube gastrostomy" technique consisting of duodenal decompression and jejunal feeding as recommend by the authors were used in severe cases.Results Blunt trauma occurred in 66 of 86 patients (76.7％).The diagnosis of duodenal trauma was made preoperatively based on abdominal signs,peritoneocentesis,and imaging in 32 patients (37.2％).The remaining 54 patients (62.8％),with duodenal injury was detected during emergency laparotomy.All the 86 patients underwent surgical intervention which included simple suturing,pedicled jejunal flap,segmental resection and anastomosis,Roux-en-Y duodenojejunostomy,diverticularization,and Whipple's procedure using the principle of Damage Control Surgery (DCS).Postoperative morbidity occurred in 15 patients (17.4％).There was a high incidence of duodenal (or pancreatic,biliary) fistulae.The overall mortality rate was 12.8％ (in 11 patients).The causes of deaths were mainly massive bleeding and poly-trauma.Conclusions To decrease morbidity and mortality rates,early diagnosis and surgical intervention were critical.The choice of surgical treatment procedures should be based on the duodenal trauma grading and whether there were associated injuries.For patients with a combined pancreaticoduodenal trauma,DCS is a wise procedure to adopt.The double-tube gastrostomy technique as recommended by the authors is beneficial to severe cases in decreasing the incidences of postoperative duodenal and jejunal obstruction.

Clinic significance of fractional exhaled nitric oxide in childhood bronchial asthma / 中国医师进修杂志

Objective To investigate the clinical significance of fraction exhaled nitric oxide (FeNO) in the diagnosis and monitoring of childhood bronchial asthma (asthma). Methods The FeNO levels of 204 children with acute asthma attack, 148 children with asthma clinical remission, 107 children with cough variant asthma (CVA) and 250 children with pneumonia from March 2016 to March 2017 were retrospectively analyzed and compared. Results The FeNO levels of acute asthma attack, asthma clinical remission, CVA and pneumonia were 18 (10, 37), 16 (10, 38), 18 (9, 31) and 13 (8, 20) nmol/L, and there was statistical difference (P<0.05). The FeNO levels of acute asthma attack, asthma clinical remission and CVA were significantly higher those of pneumonia, and there were statistical differences (P<0.05). There was no statistical difference in the FeNO levels among acute asthma attack, asthma clinical remission and CVA (P>0.05). Conclusions FeNO has clinical significance in the diagnosis of asthma in children, and its clinical significance in monitoring asthma and the prediction of acute attack needs further observations.

Analysis of ultrasonographic features of pulmonary ultrasound in children′s community acquired pneu-monia / 中国小儿急救医学

Objective To investigate the lung ultrasonography characteristics of community acquired pneumonia ( CAP) in children and to compare the value of lung ultrasonography in the diagnosis of CAP in children. Methods A total of 173 patients with CAP ( CAP group) were diagnosed by chest radiograph in our hospital,and 64 healthy children were treated with lung ultrasonography as the control group. The sono-graphic features of two groups were compared,and the positive rates of diagnosis of lung ultrasonography and chest radiograph in CAP group were also compared. Results It showed A-line disappearance ( 100%) , B-line presence ( 88. 4%) , pleural line abnormalities ( 98. 3%) , pulmonary consolidation ( 46. 2%) , bronchial sign(42. 8%),pleural effusion(9. 2%),lung sliding signs(97. 7%) in CAP group (P<0. 001). In the con-trol group,except the A-line disappearance,scattered in the B-line (34. 4%),the others were not present. The difference of the two groups was statistically significant (P<0. 001). A-line disappearance,B-line (or even fusion) ,pleural line abnormalities were the main signs of ultrasound in children with CAP, sensitivity and specificity were both 100%. The sensitivity of chest X radiograph was 100% and the specificity was 78. 0%. Conclusion The lung ultrasonic imaging features of CAP in children include A-line disappearance, with varying numbers and lengths of B-line, pleural line abnormalities, consolidation, bronchial signs, pleural effusion and so on. LUS can diagnose CAP accurately and reliably,with high sensitivity and specificity. It is simple and noninvasive, and has the advantage of being detected at any time and avoiding the damage of X-ray. So it is worth clinical application for children with respiratory tract diseases.

Analysis of ultrasonographic features of pulmonary ultrasound in children′s community acquired pneu-monia / 中国小儿急救医学

Objective To investigate the lung ultrasonography characteristics of community acquired pneumonia ( CAP) in children and to compare the value of lung ultrasonography in the diagnosis of CAP in children. Methods A total of 173 patients with CAP ( CAP group) were diagnosed by chest radiograph in our hospital,and 64 healthy children were treated with lung ultrasonography as the control group. The sono-graphic features of two groups were compared,and the positive rates of diagnosis of lung ultrasonography and chest radiograph in CAP group were also compared. Results It showed A-line disappearance ( 100%) , B-line presence ( 88. 4%) , pleural line abnormalities ( 98. 3%) , pulmonary consolidation ( 46. 2%) , bronchial sign(42. 8%),pleural effusion(9. 2%),lung sliding signs(97. 7%) in CAP group (P<0. 001). In the con-trol group,except the A-line disappearance,scattered in the B-line (34. 4%),the others were not present. The difference of the two groups was statistically significant (P<0. 001). A-line disappearance,B-line (or even fusion) ,pleural line abnormalities were the main signs of ultrasound in children with CAP, sensitivity and specificity were both 100%. The sensitivity of chest X radiograph was 100% and the specificity was 78. 0%. Conclusion The lung ultrasonic imaging features of CAP in children include A-line disappearance, with varying numbers and lengths of B-line, pleural line abnormalities, consolidation, bronchial signs, pleural effusion and so on. LUS can diagnose CAP accurately and reliably,with high sensitivity and specificity. It is simple and noninvasive, and has the advantage of being detected at any time and avoiding the damage of X-ray. So it is worth clinical application for children with respiratory tract diseases.

Multicenter prospective epidemiological studies on Haemophilus influenzae infection among hospitalized children with lower respiratory tract infections / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand epidemiological characteristics of Haemophilus influenzae (Hi) infection in hospitalized children with lower respiratory tract infection (LRTI) in west Sichuan China.</p><p><b>METHOD</b>The multicenter prospective cross-sectional design was used; four hospitals in west Sichuan China were chosen as research field, sputum bacterial culture was done and biological typing, PCR identification and drug sensitivity test of Hi epidemic strains were carried out among 0-17y hospitalized patients with LRTI in four hospitals located in west Sichuan China.</p><p><b>RESULT</b>Totally 5 748 cases with LRTI in four hospitals were investigated in west Sichuan from Nov. 2013 to April 2014 and the rate of sputum culture was 46.96% (2,699/5 748). The total pathogenic bacteria positive rate of sputum culture was 43.53% (1,175/2 699), and 279 Haemophilus influenzae (Hi) strain in 272 cases were isolated, the Hi positive rate was 10.08% (272/2 699). All the strains (100%) were non-typeable Haemophilus influenzae (NTHi ) indentified by PCR. The main biotype of 279 strains was type Ⅰ with 39.07% (109/279) and type Ⅳ with 50.90% (142/279) ; 272 cases were enrolled in this survey, 12.50% (34/272) had broncheolitis, the rest of lower respiratory infection was 87.50 % (238/272), and 2.57% (7/272) was neonatal pneumonia, 2.21%(6/272)was pneumonia complicated with sepsis; in four hospitals the overall positive rate of Hi in inpatients with lower respiratory infection was 10.21%, 28.96%, 4.80%, 10.21% (χ(2) = 112.561, P = 0.000) and the positive rate of Hi inpatients with broncheolitis was 11.92%, 20.93%, 4.76%, and 66.67% (Fisher exact probability P = 0.001), with the rest lower respiratory infection was 9.96%, 30.90%, 4.81%, 9.85% (χ(2) =108.876, P = 0.000); 2.87% (8/279) bacterial strains of β-lactamase-nonproducing-ampicillin-intermediary (BLNAI) distributed in four hospitals, and 1.79% (5/279) bacterial strains of β-lactamase-nonproducing-ampicillin-resistant (BLNAR), 0.72% (2/279) bacterial strains of β-lactamase-positive amoxicillin-clavulanate-resistance (BLPACR) were found in two hospitals respectively.</p><p><b>CONCLUSION</b>All the Hi isolated from sputum were non-typeable among 0-17y inpatients with LRTI and the main biotype were type Ⅰ and type Ⅳ in west Sichuan China. Much attention should be paid to BLNAR and BLPACR strains found in the west Sichuan region.</p>

Study on the relationship between fractional exhaled nitric oxide level and asthma predictive index in recurrent wheezing infants under 3 years of age / 中国医师进修杂志

Objective To investigate the relationship between fractional exhaled nitric oxide (FENO) and asthma predictive index (API) in infants under 3 years of age. Methods Totally 62 cases (under 3 years of age) who were hospitalized from June 2015 to June 2016 and had more than 3 times wheezing over the past year were enrolled in this study. They were divided into two groups according to API:API positive group with 37 cases and API negative group with 25 cases. FENO levels and peripheral blood eosinophil levels were detected and skin prick allergy test (inhalation and ingestion of allergens)was done in all selected children, did skin prick allergy test (inhalation and ingestion of allergens), simultaneous detected peripheral blood eosinophil levels. The parents of the children were investigated by questionnaire to know the children′ history about atopic dermatitis (such as urticaria, eczema, etc) and parents′ wheezing history. Above information was recorded and statistics analysis was made. Results There were no significant differences between two groups in atopic dermatitis inhalation and ingestion of allergens (P<0.01 or <0.05). The level of FENO in API positive group and API negative group was (16.70 ± 11.07), (13.52 ± 11.01) ppb(1 ppb=1 × 10- 9 mol/L), and there was significant difference (P<0.01). Conclusions There are associations between FENO and API, and they have good reference value in predicting the risk of asthma.

Application of double-tube gastrostomy in the repair of duodenal rupture / 中华消化外科杂志

Objective To investigate the application value of double-tube gastrostomy in the duodenal rupture repair.Methods The retrospective cohort study was adopted.The clinical data of 41 patients who underwent duodenal rupture repair at the Chongqing Emergency Medical Center from January 2005 to January 2015 were collected.Twenty-five patients using Hassan triple-tube gastrostomy technique between January 2005 and December 2009 were divided into the triple-tube (TT) group and 16 patients using double-tube gastrostomy technique between January 2010 and January 2015 were divided into the double-tube (DT) group.Duodenal rupture repair included suture repair,pedicled ileal flap to repair duodenal defect and end to end anastomosis.Patients underwent the regular treatments of anti-infection,antishock,somatostatin inhibition,nutritional support and complications prevention.Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation,and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube.The postoperative complications (duodenal fistula,intraperitoneal infection,incision infection,pulmonary infection and intestinal obstruction),operation method,operation time,volume of blood loss,euteral nutritional tube removal time and duration of hospital stay were observed.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using an independent sample t test.Comparison of count data was analyzed using chi-square test or Fisher exact probability.Results All the 41 patients underwent duodenal rupture repair,including 28 using suture repair of duodenal rupture,8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis,with the intraoperative duodenal decompression and placement of intestinal feeding tube.The operation time was (184 ± 38)minutes in the TT group and (153 ± 37)minutes in the DT group,with a significant difference between the 2 groups (t =2.566,P ＜0.05).The volume of intraoperative blood loss was (1 112 ± 707)mL in the TT group and (1 011 ± 595)mL in the DT group,with no significant difference between the 2 groups (t =0.476,P ＞ 0.05).The proportions of duodenal fistula,intraperitoneal infection,incision infection and pulmonary infection in the TT and DT groups were 3/25 and 1/16,8/25 and 5/16,9/25 and 4/16,10/25 and 6/16,respectively,showing no significant difference between the 2 groups (x2=0.003,0.545,0.026,P ＞ 0.05).Eleven patients were complicated with postoperative early intestinal obstruction,including 10 (3 with partial duodenal stenosis and 7 with incomplete small intestinal obstruction) in the TT group and 1 (partial duodenal stenosis) in the DT group,showing a significant difference in the incidence of postoperative early intestinal obstruction between the 2 groups (P ＜ 0.05).Patients with early intestinal obstruction had remission after conservative treatment of gastrointestinal decompression and fasting.The time of intestinal feeding tube indwelling and duration of hospital stay were (25 ±9)days and (29 ± 9)days in the TT group,(19 ± 9)days and (23 ± 8) days in the DT group,with significant differences between the 2 groups (t =2.188,2.120,P ＜ 0.05).Conclusion Double-tube gastrostomy technique for duodenal rupture repair can simplify the operation procedures and reduce operation time,recovery time and risk of postoperative intestinal obstruction,with a reliable efficacy.

Analysis of electronic bronchoscopy results of 400 children with respiratory disease / 中国医师进修杂志

Objective To investigate the value of electronic bronchoscopy in the diagnosis of children respiratory diseases. Methods The electronic bronchoscopy results in 400 children with respiratory disease were retrospectively analyzed. Results In 400 children, there were 246 cases with simple endobronchial inflammation, 67 cases with bronchial malacia, 38 cases with bronchial stenosis, 23 cases with bronchial foreign , 4 cases with tracheal bronchus, 4 cases with epiglottic cyst, 3 cases with bronchiectasis, 3 cases with endobronchial granulation, 3 cases with laryngomalacia, 2 cases with vascular ring compression of the trachea, 2 cases with laryngeal web, 1 case with subglottic cyst, 1 case with subglottic neoplasm, 1 case with tracheoesophageal fistula, 1 case with bronchial atresia (left) and 1 case with trachea cyst. All the children had no serious complications. Conclusions Electronic bronchoscopy can effectively improve the level of diagnosis and treatment of children' s respiratory system disease, and it is worth of clinical promotion.

Influence of Iron Supplementation on DMT1 (IRE)-induced Transport of Lead by Brain Barrier Systems in vivo / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the potential involvement of DMT1 (IRE) protein in the brain vascular system in vivo during Pb exposure.</p><p><b>METHODS</b>Three groups of male Sprague-Dawley rats were exposed to Pb in drinking water, among which two groups were concurrently administered by oral gavage once every other day as the low and high Fe treatment group, respectively, for 6 weeks. At the same time, the group only supplied with high Fe was also set as a reference. The animals were decapitated, then brain capillary-rich fraction was isolate from cerebral cortex. Western blot method was used to identify protein expression, and RT-PCR to detect the change of the mRNA.</p><p><b>RESULTS</b>Pb exposure significantly increased Pb concentrations in cerebral cortex. Low Fe dose significantly reduced the cortex Pb levels, However, high Fe dose increased the cortex Pb levels. Interestingly, changes of DMT1 (IRE) protein in brain capillary-rich fraction were highly related to the Pb level, but those of DMT1 (IRE) mRNA were not significantly different. Moreover, the consistent changes in the levels of p-ERK1/2 or IRP1 with the changes in the levels of DMT1 (IRE).</p><p><b>CONCLUSION</b>These results suggest that Pb is transported into the brain through DMT1 (IRE), and the ERK MAPK pathway is involved in DMT1 (IRE)-mediated transport regulation in brain vascular system in vivo.</p>

Segmental Quantitative MR Imaging Analysis of Diurnal Variation of Water Content in the Lumbar Intervertebral Discs

OBJECTIVE: To investigate the changes in water content in the lumbar intervertebral discs by quantitative T2 MR imaging in the morning after bed rest and evening after a diurnal load. MATERIALS AND METHODS: Twenty healthy volunteers were separately examined in the morning after bed rest and in the evening after finishing daily work. T2-mapping images were obtained and analyzed. An equally-sized rectangular region of interest (ROI) was manually placed in both, the anterior and the posterior annulus fibrosus (AF), in the outermost 20% of the disc. Three ROIs were placed in the space defined as the nucleus pulposus (NP). Repeated-measures analysis of variance and paired 2-tailed t tests were used for statistical analysis, with p < 0.05 as significantly different. RESULTS: T2 values significantly decreased from morning to evening, in the NP (anterior NP = -13.9 ms; central NP = -17.0 ms; posterior NP = -13.3 ms; all p < 0.001). Meanwhile T2 values significantly increased in the anterior AF (+2.9 ms; p = 0.025) and the posterior AF (+5.9 ms; p < 0.001). T2 values in the posterior AF showed the largest degree of variation among the 5 ROIs, but there was no statistical significance (p = 0.414). Discs with initially low T2 values in the center NP showed a smaller degree of variation in the anterior NP and in the central NP, than in discs with initially high T2 values in the center NP (10.0% vs. 16.1%, p = 0.037; 6.4% vs. 16.1%, p = 0.006, respectively). CONCLUSION: Segmental quantitative T2 MRI provides valuable insights into physiological aspects of normal discs.

Diagnosis and treatment of 521 cases of abdominal trauma / 重庆医学

Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to thelethal triadprecursor,and terminate the operation quickly when it happens.

Application of emergency thoracotomy in treatment of chest trauma / 重庆医学

Objective To discuss the application indications of emergency thoracotomy (ET) and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score (ISS) was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases (80 .00% ) manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room (6 cases) and the operative room (29 cases) .The time of admission to surgery in all cases was<30 min .12 cases (34 .29% ) died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases (65 .71% ) survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% (18/23) and 41 .67% (5/12) respectively .The occurrence rate of complications in the survivals was 39 .13% (9/23) .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .

Diagnosis and treatment of duodenal trauma / 中华消化外科杂志

Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.

Posttraumatic biloma in 46 cases / 中华普通外科杂志

Objective To probe the causes,early recognition and effective therapy of posttraumatic biloma.Methods The data of all patients with the injury of the liver and bile duct treated in our center during the past 10 years were reviewed.Patients,diagnosed with biloma were retrospectively analyzed in respects of sex,age,cause of biloma,methods and efficacy of diagnosis and treatment.Results There were 46 patients with biloma.Of them,40 were found after liver trauma of grade Ⅲ-Ⅴ.The incidence of biloma was 15.2％ (40/263).In grade Ⅳ,Ⅴ,and Ⅲ,it was 22.6％ (31/137) and 7.1％ (9/126) respectively (x2 =12.20,P ＜ 0.01) and in blunt and penetrating injury,it was 19.3％ (35/181) and 6.1％ (5/82) respectively (x2 =7.67,P ＜ 0.01).Of these 40,36 were found during the course of conservative therapy of severe liver trauma; and 4 were found after laparotomy for the liver trauma.The remaining 6 cases of biloma had a history of injury to extrahepatic bile duct with a incidence of 18.8％(6/32).All 46 patients received spiral CT scaning plus MRI in 9,and ERCP in 11.Of those 40 with biloma after severe liver trauma,28 were cured by ultrasound-guided or computed tomography scan-guided pigtail drainage; and the remaining 12,in whom the biloma volume ＜ 30 cm3 resolved spontaneously.Six patients in whom the biloma as a result of injury to extrahepatic bile duct were cured by surgical intervention.There was no death and complication related with the therapy of biloma.Conclusions Attention should be given to biloma formation,when nonoperative therapy is exercised for severe liver trauma.Ultrasound-or CT scan-guided pigtail drainage is an effective option,but those due to injury of extrahepatic bile duct require surgical intervention.

Detection of peak expiratory flow in 446 healthy children in Chengdu / 中国医师进修杂志

Objective To explore the reference values of peak expiratory flow (PEF) for 4.0-14.0 years old children in Chengdu.Methods From November 2011 to May 2012,a total of 446 healthy children were enrolled in this study.PEF was measured using expiratory peak velocimeter and lung function meter.Children's age,sex,height and weight were recorded.Impact factors for PEF were investigated by multiple stepwise regression analysis.Results The PEF detected by expiratory peak velocimeter and lung function meter had a good correlation (r =0.920,P ＜ 0.01).Boys own higher peak expiratory flow rate than girls.The level of PEF had the best correlation with height,next was weight and age.The level of PEF increased with the increase of height,age.Some children PEF value was less than 80％ lower limits of lower limits of normal.The PEF could be obtained from height and age.Conclusions Males and females PEF can be calculated according to children's height.Set up the PEF equation about the expiratory peak velocimeter and lung function meter.

The diagnosis and surgical treatment of colorectal injuries / 中华普通外科杂志

Objective To assess early diagnosis and treatment experience of colorectal injuries.Methods We retrospectively analyzed the clinical data of 72 patients with colorectal injuries in January 2001 to December 2001.Results In this group of 72 cases,ISS score was 29 ± 18.Forty-five suffered from blunt injuries,27 cases from penetrating wounds,Peritoneal colorectal injuries in 57 cases,extraperitoneal rectal injury in 15 cases.Hemorrhagic shock existed in 28 patients at admission.69 were with multiple injuries.Diagnosis:injury tract probing in 13 cases,digital rectal inspection in 3 cases,microscopy in 1 case,the contrast examination in 2 cases,laparotomy in 53 cases.Treatment:repairment in 46 cases,injuried bowel excision anastomosis in 6 cases,18 cases underwent colostomy.5 cases died postoperatively with ISS score of 43 ± 7,among those 3 cases died of uncontrolled hemorrhagic shock,one of severe craniocerebral injury,one of postoperative SIRS and MODS.Other nonlethal postoperative complications occurred in 13％ (9/67),all were cured.Conclusions Early diagnosis and emergency operation is the key to successful treatment for colorectal injuries.The indication of one stage operation should be strict and accurate.Staged operation should be adopted in cases of extra-abdominal rectal injury.