A temporary-sustainable team: A new multidisciplinary team model for severe trauma / 中华创伤杂志(英文版)

The treatment of severe trauma, especially multiple injuries, requires multidisciplinary collaboration. The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team. It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment. The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency. Overall, a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.

Changes of serum anti-schistosome antibody levels in schistosomiasis japoni-ca patients after treatment / 中国血吸虫病防治杂志

Objective To investigate the changes of serum anti-schistosome antibody titers in schistosomiasis japonica pa-tients after treatment,in order to provide the evidence for formulating the schistosomiasis surveillance program in marshland and lake regions.Methods Upon prospective cohort study,the stool examination positive schistosomiasis patients and blood exami-nation positive suspected patients(the titer was more than 1:80,including 1:80)were selected as the research objects in Jian-gling County in 2014,and they received the 2-day praziquantel therapy.Half year,one year and two years after the treatment, their blood samples and fecal samples were collected for IHA anti-schistosome antibody detections and schistosome egg and mira-cidium detections. Results In 2014,the stool examination positives were 251,and the majority of them were over 41 years old,accounting for 93.23%(234/251);581 cases of high antibody titers were detected by the IHA method,and the majority of them were over 41 years old,accounting for 89.16%(518/581).Half year,one year and two years after the treatment,among the stool examination positives,the negative conversion rates of stool positives were 99.60%(250/251),100%(239/239)and 100%(234/234)respectively and the negative conversion rates of antibody positives were 21.91%(55/251),64.11%(156/239)and 76.89%(193/234)respectively.In the high antibody titer positives,the negative conversion rates were 38.04%(221/581),64.11%(359/560),and 77.86%(429/551)respectively,Half year,one year and two years after the treatment.There were statistically significant differences among the antibody negative conversion rates by χ2test(χ2=77.538,183.412,25.469 respectively,all P<0.001).The geometric mean values of antibody titers of different durations between 2 groups were analyzed by 2-independent-samples T test,and the geometric mean values of antibody titers between the 2 groups were different before the treatment(t=23.576,P<0.01),but the geometric mean values of antibody titers between the 2 groups were not different 6 months,1 year and 2 years after the treatment(t=-0.046,1.165, -0.132,P=0.964, 0.245,0.895 respectively). Conclu-sions The levels of serum anti-schistosome antibody degrade slowly in schistosomiasis japonica patients after the treatment, and the results of IHA tests cannot distinguish the current schistosome infection from previous schistosome infection.Therefore, it is necessary to develop the specific diagnostic technology for schistosome infection in order to meet the need of monitoring.

Influencing factors for brain injury in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the incidence of different types of brain injury in preterm infants and their influencing factors.</p><p><b>METHODS</b>The clinical data and head magnetic resonance imaging (MRI) findings of 239 preterm infants were collected, and the influence of antepartum, intrapartum, and postpartum factors on brain injury in preterm infants was analyzed.</p><p><b>RESULTS</b>The incidence rate of brain injury in preterm infants was 25.5%; among these infants, 10.5% had hemorrhagic brain injury, 10.5% had ischemic brain injury, and 4.6% and hemorrhagic and ischemic brain injury. The infants with a lower gestational age had higher incidence rates of hemorrhagic brain injury and overall brain injury (P<0.01). The incidence rates of ischemic brain injury and hemorrhagic and ischemic brain injury were not correlated with gestational age (P>0.05). The incidence rates of hemorrhagic, ischemic, and overall brain injury were not correlated with birth weight (P>0.05). Multiparity (OR=0.292, 95%CI 0.088-0.972) and cesarean section (OR=0.075, 95%CI 0.015-0.368) were protective factors against brain injury in infants with a gestational age of <34 weeks; cesarean section (OR=0.296, 95%CI 0.131-0.672) was the protective factor against brain injury in infants with a gestational age of ≤34 weeks, and severe infection (OR=8.176, 95%CI 1.202-55.617) was the risk factor.</p><p><b>CONCLUSIONS</b>In order to prevent or reduce the occurrence of brain injury in preterm infants. the gestational age of preterm infants should be prolonged as much as possible and the indications for cesarean section should be grasped. Infections should be prevented and if occurring should be treated actively and effectively.</p>

Effect of caffeine citrate on early pulmonary function in preterm infants with apnea / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of caffeine citrate treatment on early pulmonary function in preterm infants with apnea.</p><p><b>METHODS</b>Forty preterm infants with apnea were randomly divided into aminophylline treatment group (20 infants) and caffeine citrate treatment group (20 infants). When the preterm infants experienced apnea after birth, they were given aminophylline or caffeine citrate in addition to assisted ventilation with continuous positive airway pressure (NCPAP). After drug discontinuation, pulmonary function was measured and compared between the two groups.</p><p><b>RESULTS</b>After treatment, compared with the aminophylline treatment group, the caffeine citrate treatment group had significantly higher tidal volume, minute ventilation volume, ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, peak expiratory flow, and breathing flow at 75%, 50%, and 25% of tidal volume (P<0.05). The caffeine citrate treatment group had a significantly shorter time of oxygen use and NCPAP support than the aminophylline treatment group (P<0.01). Compared with the aminophylline treatment group, the caffeine citrate treatment group had a significantly lower frequency of apnea attacks (P<0.01).</p><p><b>CONCLUSIONS</b>In the treatment of apnea in preterm infants, caffeine citrate can improve early pulmonary function and reduce the incidence of apnea.</p>

Association between maternal pre-pregnancy body mass index and adverse outcomes of late preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association between maternal pre-pregnancy body mass index (BMI) and adverse outcomes of late preterm infants (LPI).</p><p><b>METHODS</b>A total of 367 LPI who were born from January 2011 to December 2015 and admitted to the neonatal ward were enrolled. The BMI criteria for Chinese population were used to analyze the factors for maternal pre-pregnancy BMI and its association with adverse outcomes of LPI (1 minute Apgar score ≤7, delivery room resuscitation, hospitalization days after birth >7 days, and ventilation duration ≥6 hours).</p><p><b>RESULTS</b>Of all LPIs, there were 64 LPI (17.4%) in the low maternal pre-pregnancy BMI group, 243 LPI (66.2%) in the normal maternal pre-pregnancy BMI group, and 60 LPI (16.4%) in the high maternal pre-pregnancy BMI group. Low pre-pregnancy BMI was the risk factor for 1 minute Apgar score ≤7 (OR=3.243, 95% CI: 1.102-9.546) and need for delivery room resuscitation (OR=3.492, 95%CI: 1.090-11.190), and high pre-pregnancy BMI was the risk factor for hospitalization days after birth >7 days (OR=1.992, 95%CI: 1.024-3.874).</p><p><b>CONCLUSIONS</b>Abnormal maternal pre-pregnancy BMI has adverse effects on the outcomes of LPI. In order to reduce these adverse outcomes BMI should be controlled within the normal range in pregnant women.</p>

Predictive value of qualitative assessment of general movements for adverse outcomes at 24 months of age in infants with asphyxia / 中国当代儿科杂志

<p><b>OJBECTIVE</b>To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia.</p><p><b>METHODS</b>A total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age.</p><p><b>RESULTS</b>The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%.</p><p><b>CONCLUSIONS</b>Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.</p>

Human umbilical cord blood mononuclear cell transplantation promotes long-term neurobehavioral functional development of newborn SD rats with hypoxic ischemic brain injury / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the effect of human umbilical cord blood mononuclear cells (UCBMC) promoting nerve behavior function and brain tissue recovery of neonatal SD rat with hypoxic ischemic brain injury (HIBI).</p><p><b>METHOD</b>A modified newborn rat model that had a combined hypoxic and ischemic brain injury as described by Rice-Vannucci was used, early nervous reflex, the Morris water maze and walking track analysis were used to evaluate nervous behavioral function, and brain MRI, HE staining to evaluate brain damage recovery.</p><p><b>RESULT</b>Newborn rat Rice-Vannucci model showed significant brain atrophy, obvious hemiplegia of contralateral limbs,e.g right step length [(7.67 ± 0.46) cm vs. (8.22 ± 0.50) cm, F = 1.494] and toe distance [(0.93 ± 0.06) cm vs. (1.12 ± 0.55) cm, F = 0.186] were significantly reduced compared with left side, learning and memory ability was significantly impaired compared with normal control group (P < 0.01); Cliff aversion [(8.44 ± 2.38) s vs.(14.22 ± 5.07) s, t = 4.618] and negative geotaxis reflex time [(7.26 ± 2.00) s vs. (11.76 ± 3.73) s, t = 4.755] on postnatal 14 days of HIBI+ transplantation group were significantly reduced compared with HIBI+NaCl group (P < 0.01) ; the Morris water maze experiment showed escape latency [ (23.11 ± 6.64) s vs. (34.04 ± 12.95) s, t = 3.356] and swimming distance [ (9.12 ± 1.21) cm vs.(12.70 ± 1.53) cm, t = 17.095] of HIBI+transplantation group were significantly reduced compared with those of HIBI+NaCl group (P < 0.01) ; the residual brain volume on postnatal 10 d [ (75.37 ± 4.53)% vs. (67.17 ± 4.08)%, t = -6.017] and 67 d [ (69.05 ± 3.58)% vs.(60.83 ± 3.69)%, t = -7.148]of HIBI+ transplantation group were significantly larger than those of HIBI+NaCl group (P < 0.01); After human UCBMC transplantation, left cortical edema significantly reduced and nerve cell necrosis of HIBI+ transplantation group is not obvious compared with HIBI+NaCl group.</p><p><b>CONCLUSION</b>Human UCBMC intraperitoneal transplantation significantly promoted recovery of injured brain cells and neurobehavioral function development.</p>

Addition of ulinastatin to preservation solution promotes protection against ischemia-reperfusion injury in rabbit lung / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The composition of the lung preservation solution used in lung graft procurement has been considered the key to minimize lung injury during the period of ischemia. Low-potassium dextran glucose (LPDG), an extracellular-type solution, has been adopted by most lung transplantation centers, due to the experimental and clinical evidences that LPDG is superior to intracellular-type solutions. Ulinastatin has been shown to attenuate ischemia-reperfusion (I/R) injury in various organs in animals. We supposed that the addition of ulinastatin to LPDG as a flushing solution, would further ameliorate I/R lung injury than LPDG solution alone.</p><p><b>METHODS</b>Twelve male New Zealand white rabbits were randomly divided into 2 groups. Using an alternative in situ lung I/R model, the left lung in the control group was supplied and preserved with LPDG solution for 120 minutes. In the study group 50,000 U/kg of ulinastatin was added to the LPDG solution for lung preservation. Then re-ventilation and reperfusion of the left lung were performed for 90 minutes. Blood gas analysis (PaO₂, PaCO₂), mean pulmonary artery pressure (MPAP) and serum TNF-α level were measured intermittently. The pulmonary water index (D/W), tissue myeloperoxidase (MPO) activity, tissue malondialdehyde (MDA) content and morphologic changes were analyzed.</p><p><b>RESULTS</b>The study group showed significantly higher PaO₂ and lower MPAP at the end of reperfusion. Serum TNF-α level, left lung tissue MPO and MDA in the study group were significantly lower than those in the control group. D/W and pathologic evaluation were also remarkably different between the two groups.</p><p><b>CONCLUSIONS</b>This study indicated that better lung preservation could be achieved with the use of an ulinastatin modified LPDG solution. Ulinastatin further attenuated lung I/R injury, at least partly by reducing oxidative reactions, inhibiting the release of inflammatory factors and neutrophils immigration.</p>

Clinical research of electroacupuncture combined with acupoint-injection of botulinum toxin A in treating the muscle spasticity by spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical safety and efficiency of electroacupuncture combined with acupoint-injection of botulinum toxin A for the treatment of muscle spasticity by spinal cord injury.</p><p><b>METHODS</b>Thirty-eight patients with muscle spasticity by spinal cord injury were treated from December 2006 to December 2009 including 26 males and 12 females, with an average age of 45.4 years old ranging from 21 to 68 years. The patients were randomly divided into 3 groups according to admission time, 13 patients in group A were treated with electroacupuncture combined with acupoint-injection of botulinum toxin A, and 13 patients in group B were treated with acupoint-injection botulinum toxin A and 12 patients in group C were treated with electroacupuncture. After 6 months these patients were evaluated by improved muscle Ashworth scoring (MAS) and clinical spasticity index (SCI).</p><p><b>RESULTS</b>Thirty-eight patients were followed-up at 6 months after the treatment. The result showed that the MAS scores of group A, B, C before treatment were (3.10 +/- 0.14), (3.20 +/- 0.17), (3.10 +/- 0.16) respectively and the CSI scores were (14.10 +/- 0.14), (14.30 +/- 0.11), (14.20 +/- 0.12) respectively; there were no statistical different among the three groups (P > 0.05). After 6 months of treatment, the MAS scores were (1.10 +/- 0.16), (2.10 +/- 0.13), (2.00 +/- 0.14) respectively and the CSI scores were (9.10 +/- 0.11), (12.10 +/- 0.14), (13.10 +/- 0.12) respectively. The MAS scores and CSI scores of group A were better than the other two groups (P < 0.05).</p><p><b>CONCLUSION</b>The combination of Chinese hydropower needles and acupoints with BTX-A injection can achieve a comprehensive treatment and reduce pain and improve life quality quickly. The electroacupuncture combined with acupoint-inject botulinum toxin A is a noval safe and effective technique for the treatment of muscle spasticity by spinal cord injury.</p>

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Primary non-Hodgkin's lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma (MALToma), whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma.</p><p><b>METHODS</b>The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed.</p><p><b>RESULTS</b>No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection: 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months (mean 71.3 months).</p><p><b>CONCLUSIONS</b>Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.</p>

Histological study of vas deferens following intravasal laser irradiation / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To study the histologic changes of the vas deferens following Nd: YAG laser irradiation.</p><p><b>METHODS</b>Intravasal laser irradiation was given to (i) 52 segments of rabbit (laser dosage: 2 seconds at 40 W approximately 50 W) and 16 segments of human (3 seconds at 45 W approximately 55 W) vas deferens in vitro, (ii) 25 rabbit vasa (2 seconds approximately 2.5 seconds at 40 W approximately 45 W) in vivo and (iii) 2 human vasa (3 seconds at 55 W) in vivo. Segments of vasa were removed from the in vivo irradiated vasa deferentia 15 days approximately 180 days (rabbit) or 15 days (man) after the exposure. All vas segments were embedded in methacrylate resin. Serial sections (thickness 25 microm approximately 30 microm) were obtained and observed under a light microscope.</p><p><b>RESULTS</b>(i) Laser-induced damage reached the muscularis layer in 27% and 94% of the rabbit and human vas segments in vitro, respectively. (ii) Fourteen of the 25 in vivo rabbit vasa were completely occluded by fibrous tissue and the longer the time interval after treatment, the more likely was the vas occluded. Those unoccluded vasa had either a normal histology or a mucosal damage. (iii) One in vivo human vas was almost completely occluded by the fibrous tissue but the other had a relatively large lumen packed with sperm granulomatous tissue and partial destruction of the smooth muscle layer.</p><p><b>CONCLUSION</b>Laser irradiation can induce long-term vas occlusion; for rapid occlusion, laser doses just completely destroying the mucosal layer will be advisable.</p>