Risk factors and their warning value for the occurrence of sepsis in patients with severe multiple trauma / 中华创伤杂志

Objective:To investigate the risk factors and their warning value for the occurrence of sepsis in patients with severe multiple trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 92 patients with severe multiple trauma admitted to Yuyao People′s Hospital from July 2019 to October 2021. There were 71 males and 21 females, with the age range of 36-55 years [(45.5±13.6)years]. The injury severity score (ISS) was 20-29 points [(25.3±6.4)points]. The patients were divided into sepsis group ( n=32) and non-sepsis group ( n=60) according to whether sepsis occurred during hospitalization. Data were recorded for the two groups, including gender, age, basic diseases, cause of injury, number of injury sites, ISS, post-injury complications, and levels of aryl hydrocarbon receptor (AHR), C-reactive protein (CRP) and procalcitonin (PCT) at 1, 3 and 5 days after injury. The above data were analyzed to identify their correlation with the occurrence of sepsis in patients with severe multiple trauma by univariate analysis. The independent risk factors for sepsis in patients with severe multiple trauma were determined by multivariate Logistic regression analysis. The warning value of the single or combined risk factors for the occurrence of sepsis in patients with severe multiple trauma was evaluated by the receiver operating characteristic (ROC) curve and area under the curve (AUC). Results:By univariate analysis, it was demonstrated that the occurrence of sepsis was correlated with ISS, level of AHR at day 1 after injury, level of CRP at day 3 after injury and level of PCT at day 3 after injury ( P<0.05 or 0.01), but not with age, sex, basic diseases, level of AHR at 3, 5 days after injury, level of PCT at 1, 5 days after injury and level of CRP at 1, 5 days after injury (all P>0.05). By multivariate Logistic regression analysis, higher ISS ( OR=1.12, 95% CI 1.01, 1.24, P<0.05), level of AHR at day 1 after injury ( OR=1.30, 95% CI 1.10, 1.52, P<0.01) and level of PCT at day 3 after injury ( OR=1.81, 95% CI 1.08, 3.03, P<0.05) were found to be strongly correlated with the occurrence of sepsis. ROC curve analysis showed that higher ISS (AUC=0.69, 95% CI 0.57, 0.76) and level of AHR at day 1 after injury (AUC=0.79, 95% CI 0.68, 0.90) had warning value for the occurrence of sepsis, and the warning efficiency of combined panel was much better (AUC=0.86, 95% CI 0.77, 0.95). Conclusions:Higher ISS, level of AHR at day 1 after injury and level of PCT at day 3 after injury are independent risk factors for the occurrence of sepsis in patients with severe multiple trauma. ISS, AHR and combination of both exhibit good warning value for the occurrence of sepsis in patients with severe multiple trauma.

The feasibility of indwelling ureteral stent for a short time after uncomplicated retrograde intrarenal stone surgery / 中华泌尿外科杂志

Objective:To study the feasibility of indwelling ureteral stent for a short time (72 hours) in patients after uncomplicated retrograde intrarenal stone surgery(RIRS).Methods:The clinical data of 58 patients who underwent uncomplicated flexible ureteroscopic lithotripsy in Xuancheng People's Hospital from October 2020 to December 2021 were retrospectively analyzed. According to indwelling time of ureteral stent after surgery, the patients were divided into two groups. There were 26 cases indwelling within 72 hours after operation, named as the observation group, and 32 cases indwelling for about 3 weeks after operation, named as the control group. There was no significant difference in gender [male/female: 14/12 vs. 21/11], age [(43.4 ± 10.2) vs. (43.9 ± 11.9) years old], affected side [left/right: 17/9 vs. 20/12], and maximum diameter of stones [(9.3 ± 1.8) mm vs. (9.7 ± 1.9) mm] between the observation group and the control group. All patients in the two groups underwent unilateral ureteroscopic lithotripsy under general anesthesia. The stone removal rate, recovery of water accumulation and incidence of postoperative complications in the first and third months after the surgery were compared.Results:There was no statistical difference between the observation group and the control group in the stone removal rate [100.0% (26/26) vs. 96.9% (31/32)] and recovery of hydronephrosis [100.0% (26/26) vs. 96.9% (31/32)] at the first month after surgery. All the stones were removed and all the hydronephrosis recovery in the two groups at the 3rd month after surgery. The rates of postoperative lumbar and abdominal pain [3.9% (1/26) vs. 28.1% (9/32)], carnal hematuria [3.9% (1/26) vs. 59.4% (19/32)], urinary tract infection [0 vs. 15.6% (5/32)], and bladder irritation [0 vs. 68.8% (22/32)] in the observation group were significantly lower than those in the control group ( P<0.05). Conclusions:Indwelling a ureteral stent for a short time (72 hours) after uncomplicated RIRS does not affect the surgical effect and does reduce the risk of complications as well as promote rapid postoperative recovery.

Study on the mechanism of resolvin D1 in alleviating brain injury after cardiopulmonary resuscitation through the inhibition of autophagy in pigs / 中华急诊医学杂志

Objective:To investigate the mechanism of resolvin D1 (RvD1) in alleviating brain injury after cardiopulmonary resuscitation (CPR) through regulating autophagy pathway in pigs.Methods:Nineteen male domestic pigs, weighing 30-41 kg, were divided into 3 groups using a random number table method: sham group (S group, n=5), CPR group ( n=7), and RvD1 group ( n=7). In the S group, the animals only experienced general preparation. In the CPR and RvD1 groups, the pig CPR model was established by 8 min of cardiac arrest caused by electrically induced ventricular fibrillation, and followed by 5 min of CPR. At 5 min after resuscitation, a dose of 0.6 μg/kg of resolvin D1 was injected via femoral vein in the RvD1 group, and the same amount of vehicle was similarly administered in the other two groups. At 1, 3, 6, and 24 h after resuscitation, blood samples were collected from the femoral vein to measure serum concentrations of neuron specific enolase (NSE) and S100β protein by ELISA. At 24 h after resuscitation, neurological function was evaluated by neurological deficit score (NDS), and then the animals were euthanized to obtain cerebral cortex for measuring the expressions of phosphorylated AMP-activated protein kinase (p-AMPK), phosphorylated mammalian target of rapamycin (p-mTOR), microtubule-associated protein light chain 3 (LC3 II) and p62 by Western blot. The variables were compared with One-way analysis of variance and then the Bonferroni test among the three groups. Results:During 24 h after resuscitation, the NDS was significantly increased accompanied with significantly greater concentrations of NSE and S100β in serum in the CPR and RvD1 groups compared to the S group (all P<0.05). However, the NDS was significantly decreased at 24 h after resuscitation [(182±34) vs.(124±18), P<0.05], and serum NSE and S100β were significantly reduced starting 3 h after resuscitation in the RvD1 group compared to the CPR group [NSE (ng/mL): (23.1±3.8) vs. (18.0±2.2) at 3 h, (27.3±2.9) vs. (19.8±1.4) at 6 h, and (28.1±1.3) vs. (15.1±2.1) at 24 h; S100B (pg/mL): (1 611±208) vs. (1 322±100) at 3 h, (1 825±197) vs. (1 410±102) at 6 h, and (1 613±138) vs. (1 183±139) at 24 h, all P<0.05]. The expression levels of p-AMPK and LC3 II were significantly increased while the expression levels of p-mTOR and p62 were significantly decreased at 24 h after resuscitation in the CPR and RvD1 groups compared to the S group (all P<0.05). However, the expression levels of p-AMPK and LC3 II were significantly lower and the expression levels of p-mTOR and p62 were significantly higher at 24 h after resuscitation in the RvD1 group compared to the CPR group [p-AMPK: (0.28±0.08) vs. (0.17±0.03); LC3 II: (0.33±0.09) vs. (0.21±0.04); p-mTOR: (0.13±0.02) vs. (0.16±0.02); p62: (0.16±0.05) vs. (0.22±0.02), all P<0.05]. Conclusions:The protective mechanism by which RvD1 alleviates brain injury after CPR in pigs might be related to the inhibition of neuronal autophagy mediated by AMPK/mTOR pathway.

Preliminary exploration on construction of trauma center in Yuyao, Jiangsu Province / 中华创伤杂志

Building highly efficient trauma center is an important measure to reduce the mortality and disability rate of trauma patients. Taking the trauma center of Yuyao People's Hospital as an example, combined with the preliminary achievements, the author summarized the operation mode, space and hardware requirements, in-hospital trauma rescue team, trauma rescue process, trauma database and core competence training, and the continuous improvement of trauma rescue quality so as to provide references for the construction of trauma center at grass-roots level.

Effects of limb ischemic post-conditioning alone or its combination with therapeutic hypothermia on systemic inflammatory response and lung injury after cardiopulmonary resuscitation / 中华危重病急救医学

Objective To investigate the effects of limb ischemic post-conditioning (LIpostC) alone or its combination with therapeutic hypothermia (TH) on systemic inflammatory response and lung injury after cardiac arrest (CA) and resuscitation. Methods Twenty-one healthy male pigs weighing (37±2) kg were randomly divided into 3 groups (n = 7 each): control group, LIpostC group, and LIpostC+TH group. The animal model was established by 10 minutes of untreated CA and then 5 minutes of cardiopulmonary resuscitation (CPR).Coincident with the start of CPR, LIpostC was induced by four cycles of 5 minutes of limb ischemia followed by 5 minutes of reperfusion in the LIpostC and LIpostC+TH groups. After successful resuscitation, TH was implemented by surface cooling to reach a temperature of 32-34℃ until 4 hours post-resuscitation, followed by a re-warming rate of 1 ℃/h for 4 hours in the LIpostC+TH group. Normal temperature was maintained in the control and LIpostC groups. The resuscitation outcomes in each group were recorded during CPR. At 15 minutes prior to CA (baseline) and during 4 hours post-resuscitation, the level of arterial lactate was measured and PaO2/FiO2 was calculated, and extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured meanwhile by a PiCCO monitor. At 15 minutes prior to CA (baseline) and during 24 hours post-resuscitation, the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA). Results Six animals in each group were successfully resuscitated. Coronary perfusion pressure (CPP), duration of resuscitation, number of shocks and epinephrine dosage during CPR were not statistically significant among the three groups. The baseline of arterial lactate, PaO2/FiO2, EVLWI, PVPI and cytokines prior to CA were also not statistically significant among the three groups. The levels of serum TNF-α and IL-6 after resuscitation were gradually increased in all the three groups; however, the values of TNF-αand IL-6 were significantly lower in the LIpostC and LIpostC+TH groups than that in the control group, and they were further decreased in the LIpostC+TH group when compared to the LIpostC group [TNF-α (ng/L): 305±22 vs. 343±26 at 4 hours, 350±29 vs. 389±18 at 24 hours; IL-6 (ng/L): 239±14 vs. 263±19 at 24 hours, all P < 0.05]. The levels of lactate reached the peak at 2 hours post-resuscitation and then gradually decreased in all the three groups; it finally returned to the baseline in the LIpostC and LIpostC+TH groups, which was markedly lower than that in the control group (mmol/L: 1.4±0.7, 1.2±0.3 vs. 3.1±1.7, both P < 0.05). During 4 hours post-resuscitation, PaO2/FiO2 was significantly higher and EVLWI and PVPI were markedly lower in the LIpostC and LIpostC+TH groups than that in the control group; additionally, PaO2/FiO2 and EVLWI were further improved in the LIpostC+TH group than the LIpostC group [4-hour PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 391±26 vs. 361±20; 4-hour EVLWI (mL/kg): 10.1±1.5 vs. 12.1±1.2, both P < 0.05]. Conclusion LIpostC can be used to alleviate systemic inflammatory response and lung injury after porcine CA and CPR, and its combination with TH further enhanced its protective effects.

Effectiveness of distance electrocardiographic consultation network for regional primary medical institutions / 中华全科医师杂志

Objective To evaluate the effectiveness of regional electrocardiographic consultation network for primary medical institutions.Methods A distance electrocardiographic ( ECG ) consultation center was established in Yuyao People′s Hospital in September 2012, which was connected to 56 regional primary medical through internet.The online consultation was provided by ECG specialists in the center for general practitioners in regional primary health care institutions.Additionally, the ECG training course was also conducted monthly for general practitioners.The 2-year data of ECG consultation were retrospectively reviewed and the effectiveness of the consultation network was evaluated.Results During the past two years, 86 593 electrocardiograms were uploaded by primary medical institutions, in which 3 976 were required for consultation. The monthly number of electrocardiograms sent by general practitioners was increased from 3 269 ±290 in the first year to 3 947 ±376 in the second year ( P<0.01 ) .However, the requirements of ECG consultation were not significantly different between two years.Compared to the first year, the rates of consultation requirements, misdiagnosis and missed diagnosis for ECGs of atrial and ventricular premature beats, atrial fibrillation, supraventricular tachycardia, left and right bundle branch blocks,ⅠandⅡdegree atrioventricular blocks and myocardial infarction were significantly decreased ( all P<0.05) in the second year;meanwhile there was a tendency towards the reduction for ECGs of atrial flutter and Ⅲ degree atrioventricular block in the second year.Conclusion The regional electrocardiographic consultation network is effective to improve the capability of primary medical institutions in electrocardiographic diagnosis.

The value of spontaneous gasping associated with duration of cardiac arrest in predicting post-resuscitation myocardial dysfunction in a rat model / 中华急诊医学杂志

Objective To analyze the timing and frequency of spontaneous gasping during cardiopulmonary resuscitation in a rat model,and evaluate its value bearing some relation to duration of cardiac arrest (CA ) in predicting the severity of post-resuscitation myocardial dysfunction.Methods Twenty-seven healthy Sprague-Dawley rats were randomly (random number)divided into 3 groups according to different durations of CA:CA 4 min (n=9),CA 6 min (n=9)and CA 8 min (n=9).CA of rats was electrically induced and untreated for 4,6 or 8 min respectively in the corresponding groups,and then cardiopulmonary resuscitation (CPR)was initiated and continued for 8 min in all animals.The emergence timing and frequency of spontaneous gasping during cardiopulmonary resuscitation and resuscitation outcomes were documented.Myocardial function such as cardiac output,ejection fraction and Tei index was measured by echocardiography prior to CA and at 1 h,2 h and 4 h post-resuscitation.Results The earliest appearance of gasping with highest frequency was observed in the CA 4 min group during CPR.Gasping appeared later with decreased frequency observed following longer duration of CA.There were statistically significant differences in the timing and frequency of gasping among the 3 groups.In the CA 4 min group with frequent gasping,all animals were successfully resuscitated with 8-min CPR with the least number of defibrillation,which was significantly better than that in the CA 8 min group.During the evaluation of post-resuscitation myocardial function,cardiac output,ejection fraction and myocardial work index (Tei index) were better in the CA 4 min group with frequent gasping,worse in the CA 6 min group and worst in the CA 8 min group, showing statistically significant differences in cardiac function among the 3 groups. Conclusions The spontaneous gasping appeared sooner with higher frequency during cardiopulmonary resuscitation indicated shorter duration of CA,and predicted better success of resuscitation and post-resuscitation myocardial function.

Optimal time of decompression for acute pancreatitis combined with abdominal compartment syndrome / 中华急诊医学杂志

Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model.Methods After baseline data were recorded,24 pigs were randomly allocated into three groups as follows:one SAP-alone group,and two SAP + ACS groups (decompression at 6 and 12 hours,respectively).We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium taurocholate to induce severe acute pancreatitis (SAP).Systemic hemodynamic profiles,urine output,systemic oxygenation,and serum biochemical parameters of the animals were obtained.Results After induction of ACS,the hemodynamics and oxygenation of the study animals deteriorated significantly.The survival time of the 12-hour group was significantly shortened (P =0.008 vs.6 hours).Early decompression (6 h) restored systemic hemodynamics,oxygenation,organ function,and inflammatory intensity to a level comparable to that of the SAP-alone group.In contrast,animals in 12-hour group developed more severe hemodynamic suppression,oxygenation and organ dysfunction and inflammatory process.For instance,the cardiac output levels in the three groups were 2.70 ±0.50 for the SAP group,2.75 ±0.48 for the 6 hour-group and 2.19 ±0.43 for the 12 hour-group.Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS,and also improve systemic hemodynamics,organ function and inflammatory intensity.