Clinical features and mortality-related factors of extensive burns among young adults: the Kunshan disaster experience.

BACKGROUND: The aim of the study was to identify the clinical features and the factors associated with burn induced mortality among young adults after exposure to indoor explosion and fire. METHODS: This is an observational study which included burn patients who were admitted to eighteen ICUs after a fire disaster. Epidemiologic and clinical characteristics, as well as therapy were recorded. The primary outcome was 90-day mortality. The mortality-related factors were also analyzed. RESULTS: There were 167 burn patients enrolled in the study, the median age was 38 years, 62 (37.1%) patients died within 90 days. Seventy-one percent of patients had a burn size ≥90% TBSA, and 73.7% of patients had a full-thickness burn area above 50% TBSA. The survivors had lower Baux scores, and received earlier escharectomy and autologous skin grafts. The 50% mortality rates (LA50s) for burn size and full-thickness burn area were 95.8% and 88.6% TBSA, respectively. The multivariate analysis showed that full-thickness burn area over 50% TBSA and residual burned surface area (RBSA)/TBSA at 28 days were strong predictors of mortality among burn patients (odds ratio 2.55; 95% CI, 1.01 to 6.44, P=0.047; odds ratio 1.07; 95% CI, 1.04 to 1.09, P<0.001). The ROC curve-based cut-off values of RBSA/TBSA at 28 days for predicting 90-day mortality were 62.5%. CONCLUSIONS: Burn size and full-thickness burn area were the main risk factors for poor outcome in patients with extensive burns. Earlier escharectomy and autologous skin grafts may improve outcomes.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study.

BACKGROUND: Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS. METHODS: We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality. RESULTS: Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ±â€Š6.3 in the ECMO group and 24.8 ±â€Š8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ±â€Š3.4 in the ECMO group and 13.7 ±â€Š3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001-1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264-8.609; P = 0.034). CONCLUSIONS: This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Phosphoinositide 3-kinase/Akt pathway is involved in pingyangmycin­induced growth inhibition, apoptosis and reduction of invasive potential in EOMA mouse hemangioendothelioma cells.

Pingyangmycin (PYM), a glycopeptide antibiotic, has been recommended as a stand treatment for hemangioma. However, the underlying mechanisms of its anti­tumor effects have remained elusive. The purpose of the present study was to explore the effects of PYM on the biological behavior of the EOMA mouse hemangioendothelioma cell line and investigate the possible mechanisms. The effects of PYM on EOMA cell viability were determined by an MTT assay, apoptosis was evaluated by Annexin V/propidium iodide staining and flow cytometric analysis, and cell invasion ability was determined using a Transwell invasion assay. In order to investigate the underlying mechanism of action of PYM, the expression of angiogenic signaling proteins was determined by western blot analysis. PYM treatment (0.5­500 µg/ml) inhibited cell growth in a time- and dose­dependent manner. PYM at 100 µg/ml significantly induced apoptosis and reduced the invasive ability of EOMA cells. Effects of PYM on cell viability, apoptosis and invasion ability were completely blocked by co­treatment with phosphoinositide 3­kinase (PI3K) activator insulin­like growth factor­1 (IGF­1). Furthermore, treatment with PYM reduced the expression of PI3K and phosphorylated Akt. In conclusion, the present study indicated that the PI3K/Akt pathway is likely to be involved in the anti-cancer effects of PYM on EOMA cells.

[Treatment of dislocation of shoulder with manipulation of proneposition modified hippocrates method].

OBJECTIVE: To explore the method of reduction of anterior dislocation of shoulder joint, evaluate the clinical effects of proneposition modified Hippocrates methods. METHODS: From February 1998 to April 2011, 1 028 patients, 689 males and 339 females, with anterior dislocation of shoulder joint were treated with manipulation of proneposition modified Hippocrates methods. The average age was 38.3 years (ranged from 11 to 86 years). Thirty-two cases by Hippocrates method failure to reset success, 86 cases combined with geater tuberosity tore of humerus. RESULTS: One thousand and twenty-seven example applications, it took average 50 s, 1 case was cured due to a combination of humerus surgical neck fracture. Eighty-six cases combined with greater tuberosity tore of humerus, 84 cases reached anatomical reattachment or nearly anatomical reattachment, 2 cases of large bone pieces instability were reduced by percutaneous needle. According to Neer score, there are 1 012 excellent cases, 15 good cases. CONCLUSION: Proneposition modified Hippocrates method is better than Hippocrates. It has the advantage of anesthesia, lower expense, short replacement, less pain, easier to master, and worth applying widely.

[Effects of 25 Gy gamma-ray irradiation on the expression of CD62p in manually enriched human platelets].

This study was purposed to investigate the effects of 25 Gy gamma-ray irradiation on the CD62p expression, platelet count and the mean platelet volume (MPV) of manually enriched platelet suspension in different time of shelf life at 22 degrees C. Each of 16 bags with plasma-rich platelet was divided into two bags, one of which was exposed to 25 Gy gamma-ray of 137Cs and the other ones was not exposed. 16 bags then were preserved for 72 hours according to AABB standards. The irradiated platelets were regarded as the observation group, and the other ones were regarded as the control group, the expression of p-selectin (CD62p) in the above 2 groups was detected by flow cytometry before irradiation and at 24, 72 hours after irradiation respectively; at the same time, the platelet count and MPV were assayed by using blood cell counter. The results showed that the expression level of CD62p on platelet in irradiated and control groups increased along with the prolonging of preservation time, the expression rate of CD62p on the platelets preserved for 24 hours was higher than that on fresh platelets with significant difference (p<0.05); the expression rate of CD62p on the platelets preserved for 72 hours obviously was enhanced as compared with platelets preserved for 24 hours (p<0.01). There were no significant differences in CD62p expression rate, platelet count and MPV between irradiated and control groups preserved for 24 and 72 hours (p>0.05), however the MPV of irradiated and control groups preserved for 72 hours was higher than that of fresh platelets (p<0.05). It is concluded that the gamma-ray irradiation does not affect the quantity and quality of platelets, but the preservation time for manually enriched platelet suspension should be shortened as far as possible.