Predictive value of thromboelastography combined with conventional coagulation tests for deep vein thrombosis in preoperative trauma patients / 中华急诊医学杂志

Objective:To analyze the relationship between preoperative deep vein thrombosis (DVT) and parameters of conventional coagulation tests (CCTs) and thromboelastography (TEG) in patients with acute trauma, and to establish a prediction model to screen out high-risk patients with preoperative DVT.Methods:The clinical data of patients with acute traumatic fracture admitted to the Emergency Intensive Care Unit of Shanghai Sixth People’s Hospital from January 2021 to June 2021 were retrospectively collected. According to whether preoperative DVT occurred, the patients were divided into the DVT group and non-DVT group. The differences of CCTs and TEG parameters at the same time were compared between the two groups. Logistic regression analysis was applied to identify independent risk factors for DVT after trauma. The receiver-operating characteristic curve analysis was employed to analyze the clinical value of those parameters to predict preoperative DVT.Results:Among 123 patients with acute traumatic fracture, 101 patients were treated with anticoagulation before operation, and 51 patients were diagnosed with DVT. There were significant differences in activated partial thromboplastin time, fibrinogen (Fib), D-Dimer, fibrinogen degradation products (FDPs), reaction time, clotting time, α angle, maximum amplitude (MA) and coagulation index between the DVT and non-DVT groups. D-Dimer and MA were independent risk factors for preoperative DVT in patients with traumatic fracture. Logistic regression equation was used to establish a prediction model: the predicting index = 0.101×D-Dimer +0.241×MA + (-18.190). The α angle (AUC=0.833, P<0.001), MA (AUC=0.904, P<0.001), coagulation index (AUC=0.914, P<0.001) of TEG versus Fib (AUC=0.684, P=0.001), D-Dimer (AUC=0.685, P<0.001) and FDPs (AUC=0.656, P=0.003) of CCTs had a higher diagnostic efficacy in developing DVT of lower extremity in patients with traumatic fracture, and of all the coagulation index was the best. However, the predictor of D-Dimer combined with MA had a better predictive value (AUC=0.926, P<0.001), and the best cut-off value was 0.32 with a sensitivity and specificity of 90.2% and 79.8%, respectively. Conclusions:Compared with CCTs, TEG has more advantages in predicting preoperative DVT in patients with traumatic fracture, and the predictor of D-Dimer combined with MA can screen out patients with high risk of DVT, which can be recommended for clinical application.

Clinical significance of changes of inflammatory cytokines level in trauma patients / 中华急诊医学杂志

Objective:To explore the clinical significance and underlying mechanism of changes in serum IL - 18 and IL - 1 beta after trauma.Methods:Enzyme-linked immunosorbent assay was used to detect the levels of IL-18 and IL-1β in trauma patients and healthy controls. The differences in serum IL-18 and IL-1β levels were compared between the two groups, and the levels of IL-18 and IL-1β in the traumatic subgroups were further compared.Results:The serum levels of IL-1β and IL-18 of trauma patients were 80±2.0 pg/mL and 27±3.0 pg/mL, respectively, which were significantly higher than those in healthy controls ( P < 0.01). Serum levels of IL-1β and IL-18 showed an upward trend on the 3rd day after trauma. There were also statistically significant differences within the trauma subgroups ( P < 0.01). Conclusions:The serum levels of IL-18 and IL-1β of post-traumatic patients are increased, indicating that NLRP3 inflammasomes are activated in peripheral blood cells in the early stage of trauma, which aggravates the inflammatory response. The AIS-ISS score is positively correlated with the expression levels of IL-18 and IL-1β in serum, indicating that the more severe the injury, the more severe the inflammatory response.

Relationships between serum osteocalcin levels and C-peptide in post-traumatic male patients / 中华急诊医学杂志

Objective To investigate the relationships between serum osteocalcin (OC) levels and glycometabolism markers in nondiabetic post-traumatic male patients.Methods Populaitons were selected at the Department of Emergency Medicine of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from October 2017 to February 2019.The age,injury severity score (ISS),and characteristic indicators were recorded.The inclusion criteria were age ≥ 18 years and blood collection time ＜ 24 h after the injury.The exclusion criteria were emergency surgery,acute brain trauma,and hemoglobin A1c (HbA1c) ≥ 6.0％.The patients were divided into two groups by fasting plasma glucose (FPG):stress hyperglycemia (SH) (FPG＞7.8 mmol/L) and nonstress hyperglycemia (NO-SH) (FPG ≤ 7.8 mmol/L) groups.The fasting venous blood samples were collected and examined.The characteristics and biochemical indicators in the two groups were compared statistically by LSD-t test,rank sum test and ANOVA,and the relationships between serum OC levels and glycometabolism markers were analyzed by partial correlation analysis.Results A total of 395 traumatic patients were enrolled and divided into the SH group (n=182) and NO-SH group (n=213).There were no differences in ISS,fasting insulin (FINS),and C-peptide (C-P) levels between groups.Age,HbAlc and FPG were higher (P=0.041,P=0.037,P＜0.01),while the OC level was lower (P=0.023),in the SH group than those in the NO-SH group.The serum OC level did not correlate with HbAlc,FPG,and FINS,but negatively correlated with C-P by partial correlation analysis (r=-0.262,P=0.008).The multivariate linear regression analysis showed that C-P was an independent factor affecting serum OC levels after trauma (β=-0.655,P=0.043).Conclusion A correlation existed between the serum OC level and glycometabolism markers in nondiabetic post-traumatic male patients.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective@#To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.@*Methods@#We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018. The definition of TIC is prothrombin time (PT) 18 s, international normalized ratio (INR) 1.5, activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100×109/L. The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.@*Results@#A total of 242 patients were included, including 62 patients in the TIC group and 180 patients in the non-TIC group. The differences in TEG between the two groups were statistically significant. The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest, 0.779 and 0.786 respectively, and the sensitivity were greater than 80% and NPV were greater than 90%. The sensitivity, PPV and NPV of reaction time (R) were minimal. After confounders were controlled, all TEG values were correlated with blood volumes within the first 24 h and massive transfusion, of which R had the highest odds ratio and regression coefficient.@*Conclusions@#MA and CI have the highest diagnostic value, while R has little diagnostic value but a relatively large blood therapeutic significance of TIC. MA < 52.9 mm or CI < -1.0 can be used as a threshold for identifying TIC. The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.Methods We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018.The definition of TIC is prothrombin time (PT) 18 s,international normalized ratio (INR) 1.5,activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100 x 109/L.The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve,area under the curve (AUC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV),and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.Results A total of 242 patients were included,including 62 patients in the TIC group and 180 patients in the non-TIC group.The differences in TEG between the two groups were statistically significant.The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest,0.779 and 0.786 respectively,and the sensitivity were greater than 80％ and NPV were greater than 90％.The sensitivity,PPV and NPV of reaction time (R) were minimal.After confounders were controlled,all TEG values were correlated with blood volumes within the first 24 h and massive transfusion,of which R had the highest odds ratio and regression coefficient.Conclusions MA and CI have the highest diagnostic value,while R has little diagnostic value but a relatively large blood therapeutic significance of TIC.MA ＜ 52.9 mm or CI ＜-1.0 can be used as a threshold for identifying TIC.The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

The Long March of TCM Development Overseas--Review the World Congress of Chinese Medicine in the Last Ten Years / 世界科学技术-中医药现代化

The international road of Chinese medicine can be comparable to the Long March of the Red Army. The article reviews the history, global impact and achievements of the World Congress of Chinese Medicine (WCCM) on its way to the TCM's globalization in the past decade. It also discusses the great significance of WCCM's effort. The article concludes by bringing up a scheme for further developing the WCCM and envisioning its promising future.