Dietary pattern and precocious puberty risk in Chinese girls: a case-control study.

BACKGROUND: The role of dietary intake on precocious puberty remains unclear. This study aimed to investigate the association between the amount and frequency of dietary intake and the risk of precocious puberty in Chinese girls. METHODS: In this case-control study, we enrolled 185 precocious puberty girls and 185 age-matched controls. Their dietary intake was assessed through a semi-quantitative food frequency questionnaire. Their sociodemographic and lifestyle data were collected. The associations between dietary intake and risk of precocious puberty were assessed by conditional logistic regression models. RESULTS: After multivariate adjustment, consuming a higher amount of red meat was associated with higher precocious puberty risk (OR = 2.74, 95% CI: 1.25-6.02), while a higher frequency of fruit ( P for trend = 0.024) and amount of vegetable intake was associated with a lower risk of precocious puberty (P for trend = 0.002). The high vegetable and protein dietary pattern was significantly negatively associated with precocious puberty (OR = 0.78, 95% CI: 0.63-0.97), whereas the high animal food and fruits dietary pattern was remarkably positively associated with precocious puberty (OR = 1.36, 95% CI: 1.09-1.69), after adjusting for age and body mass index. CONCLUSIONS: High vegetable and protein dietary pattern is a protective factor against precocious puberty, while high animal food and fruits dietary pattern is a risk factor for precocious puberty in Chinese girls. Attentions should be paid to a reasonable intake of red meat, eggs, and fruits in children's daily diet, increase their intake of vegetables, in order to reduce the risk of precocious puberty.

Chain mediating effect of gratitude and meaning in life between nurses' psychological response and emergency capability-a multicenter cross-sectional study.

BACKGROUND: Clinical nurses face high-pressure situations requiring rapid decision-making and skilled intervention, impacting their psychological responses and emergency capabilities. Understanding the relationships between psychological factors like gratitude and meaning in life is crucial for improving nurses' performance in emergencies. This study explores the mediating role of gratitude and meaning in life in the impact of psychological responses on clinical nurses' emergency capabilities, aiming to enhance their effectiveness in such situations. METHODS: This study is a multi-center cross-sectional survey. A questionnaire survey was conducted among 1833 clinical nurses in five tertiary hospitals in Anhui Province, China including general information questionnaire, nurses' emergency capability scale, Meaning in life scale, Gratitude scale and Psychological response questionnaire. According to the results of the questionnaire survey, a chain mediating model was constructed and tested. RESULTS: The total score of emergency capability of 1833 clinical nurses was (71.65 ± 10.77), the total score of meaning in life was (50.67 ± 9.04), the total score of gratitude was (30.96 ± 3.57), and the total score of psychological response was 13.00 (6.00, 20.00). The emergency capability of subjects was positively correlated with the meaning in life, the total score of gratitude scale and the scores of each dimension of the two scales, and negatively correlated with the total score of psychological response scale and each dimension of this scale (all P < 0.05). The total effect coefficient, direct effect coefficient and indirect effect coefficient of psychological response on nurses' emergency capability are - 0.230, -0.110 and - 0.120 respectively, that is, the indirect effect accounts for 52.17% of the total effect. Among the indirect effects, the specific mediating effects of gratitude and meaning in life account for 22.50% and 62.50% respectively, and the chain mediating effects of gratitude and meaning in life account for 15.00%. CONCLUSION: Gratitude and meaning in life have multiple mediating roles in the mechanism of psychological response that affecting clinical nurses' emergency capability. Therefore, it is very important to pay attention to dynamically evaluating the psychological response level of clinical nurses, and strive to improve their gratitude and meaning in life, so as to further enhance their emergency response ability.

Clinical utiliy of a model-based piperacillin dose in neonates with early-onset sepsis.

AIMS: Early-onset sepsis (EOS) is a common disease in neonates with a high morbidity and mortality rate. Piperacillin/tazobactam has been used extensively and empirically for EOS treatment without clinically validated dosing regimens, although the population pharmacokinetics (PPK) of piperacillin in neonates has been reported. Therefore, we wanted to study the effectiveness and tolerance of a PPK model-based dosing regimen of piperacillin/tazobactam in EOS patients. METHODS: A prospective, single-centre, phase II clinical study of piperacillin/tazobactam in neonates with EOS was conducted. The dosing regimen (90 mg·kg-1 , q8h) was determined based on a previous piperacillin PPK model in young infants using NONMEM v7.4. The pharmacodynamics (PD) target (70%fT > MIC, free drug concentration above MIC during 70% of the dosing interval) attainment was calculated using NONMEM combined with an opportunistic sampling design. The clinical treatment data were collected. RESULTS: A total of 52 neonates were screened and 49 neonates completed their piperacillin/tazobactam treatment course and were included in this analysis. The median (range) values of postmenstrual age were 33.57 (range 26.14-41.29) weeks. Forty-seven (96%) neonates reached their PD target. Eight (16%) neonates experienced treatment failure clinically. The mean (SD, range) duration of treatment and length of hospitalization were 100.1 (62.2, 36.2-305.8) hours and 31 (30, 5-123) days. There were no obvious adverse events and no infection-related deaths occurred in the first month of life. CONCLUSIONS: A model-based dosing regimen of piperacillin/tazobactam was evaluated clinically, was tolerated well and was determined to be effective for EOS treatment.

Enhanced Crude Oil Sorption by Modified Plant Materials in Oilfield Wastewater Treatment.

The treatment of oilfield wastewater with high crude oil content and complex composition is a problem requiring considerable attention. In order to effectively remove crude oil contained in wastewater, in this work, rice straw, as an oil-absorbing material, was modified and used as a sorbent for crude oil. Rice straw was modified with alkali and cetyltrimethylammonium chloride (CTAC) by simple substitution reaction. The adsorption capacity of modified rice straw for oil was evaluated. The results illustrate that the adsorption rate of rice straw for crude oil was increased from 0.83 to 8.49 g/g, with the optimal conditions of 18% NaOH reacted for 90 min at 50 °C and 2% CTAC reacted for 60 min at 20 °C. The proposed modification method could be used for different materials to enhance the adsorption rate. The results of the contact angle test show that the modified straw changed from hydrophilic to hydrophobic, which may be the main reason for the improvement in the oil absorption rate. Finally, the surface structure of rice straw was characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and N2 adsorption-desorption isotherms, which further confirmed the hydrophobicity of the modified rice straw.

Microenvironment-Responsive Delivery of the Cas9 RNA-Guided Endonuclease for Efficient Genome Editing.

Successful and efficient delivery of Cas9 protein and gRNA into cells is critical for genome editing and its therapeutic application. In this study, we developed an improved supercharged polypeptide (SCP) mediated delivery system based on dithiocyclopeptide linker to realize the effective genome editing in tumor cells. The fusion protein Cas9-linker-SCP (Cas9-LS) forms positively charged complexes with gRNA in vitro to provide possibilities for gRNA delivery into cells. Under the microenvironment of tumor cells, the dithiocyclopeptide linker, containing matrix metalloproteinase 2 (MMP-2) sensitive sequence and an intramolecular disulfide bond, can be completely disconnected to promote the release of Cas9 protein with the nuclear localization sequence (NLS) in the cytoplasm and transfer to the cell nucleus for highly efficient genome editing, resulting in an obvious increase of indel efficiency in comparison to fusion protein without dithiocyclopeptide linker (Cas9-SCP). Furthermore, Cas9-LS shows no significant cytotoxicity and minimal hemolytic activity. We envision that the microenvironment-responsive Cas9 protein delivery system can facilitate more efficient genome editing in tumor cells.

Potent Protein Delivery into Mammalian Cells via a Supercharged Polypeptide.

The efficient delivery of proteins into cells is needed to fully realize the potential of protein-based therapeutics. Current protein delivery strategies generally suffer from poor endosomal escape and low tolerance for serum. Here, the genetic fusion of a supercharged polypeptide, called SCP, to a protein provides a generic method for intracellular protein delivery. It allows efficient protein endocytosis and endosomal escape and is capable of potently delivering various proteins with a range of charges, sizes, and bioactivities into the nucleus of living cells. SCP is discovered to bind directly to the nuclear import protein importin ß1 and gains access to the nucleus. Furthermore, SCP shows minimal hemolytic activity and stability in serum and lacks toxicity and immunogenicity in vivo. Effective gene editing can be achieved by SCP-mediated delivery of Cas9 protein and guide RNA. This study may provide an efficient and useful tool for the design and development of cell-nuclear-targeted drug delivery.

Hepatocyte nuclear factor 4α suppresses the aggravation of colon carcinoma.

Hepatocyte nuclear factor 4-α (HNF4α), a nuclear receptor, is expressed at lower levels in colon carcinoma tissues than in adjacent normal tissues. However, the relation between HNF4α and colon cancer progression and the underlying molecular mechanisms remain unclear. Here, we investigated the role of HNF4α in the progression of colon carcinoma. We showed that HNF4α mRNA and protein were downregulated in colon carcinoma specimens. HNF4α expression was related to pT classification (P < 0.001), lymph node metastasis (P = 0.002), distant metastasis (P < 0.001) and clinical stage (P < 0.001) in colon carcinoma patients. Patients with low or negative HNF4α expression had worse 3-year progression-free survival (PFS, P = 0.006) and overall survival (OS, P = 0.005) than patients with high HNF4α expression. Low HNF4α expression was an independent prognostic factor for 3-year PFS (hazard ratio 2.94; 95% confidence interval 1.047-8.250; P = 0.041). Ectopic expression of HNF4α inhibited colon carcinoma cell (HT29, LoVo, and SW480) proliferation, migration, and invasion, induced G2/M phase arrest and promoted apoptosis. Ectopic expression of HNF4α upregulated E-cadherin and downregulated vimentin in vitro, and suppressed SW480 xenograft tumor growth and liver metastasis in vivo. Furthermore, HNF4α overexpression downregulated the expression of snail, slug and twist. HNF4α inhibited EMT through its effect on the Wnt/ß-catenin signaling pathway, and HNF4α downregulation may be mediated by promoter methylation in cancer tissues. Our results suggest that downregulation of HNF4α plays a critical role in the aggravation of colon carcinoma possibly by promoting EMT via the Wnt/ß-catenin signaling pathway and by affecting apoptosis and cell cycle progression.

Cd(II)-coordination framework: synthesis, anion-induced structural transformation, anion-responsive luminescence, and anion separation.

A series of Cd(II) coordination frameworks that are constructed from a new oxadiazole-bridged ligand 3,5-bis(3-pyridyl-3-(3'-methylphenyl)-1,3,4-oxadiazole (L) and CdX2 (X = NO3(-), Cl(-), Br(-), I(-), N3(-), and SCN(-)) were synthesized. The NO3(-) anion of the solid CdL2(NO3)2·2THF (1) is able to be quantitatively exchanged with Cl(-), Br(-), I(-), SCN(-), and N3(-) in the solid state. For Cl(-) and Br(-), the anion exchange resulted in a anion-induced structural transformation to form the structures of 2 and 3, respectively. In addition, the Cd(II) structure herein exhibits the anion-responsive photoluminescence, which could be a useful method to monitor the anion-exchange process. Notably, compound 1 can recognize and completely separate SCN(-)/N3(-) with similar geometry.

2,5-Bis[4-methyl-3-(pyridin-3-yl)phenyl]-1,3,4-oxadiazole and its one-dimensional polymeric complex with ZnCl2.

2,5-Bis[4-methyl-3-(pyridin-3-yl)phenyl]-1,3,4-oxadiazole (L), C26H20N4O, forms one-dimensional chains via two types of intermolecular π-π interactions. In catena-poly[[dichloridozinc(II)]-µ-2,5-bis[4-methyl-3-(pyridin-3-yl)phenyl]-1,3,4-oxadiazole], [ZnCl2(C26H20N4O)]n, synthesized by the combination of L with ZnCl2, the Zn(II) centres are coordinated by two Cl atoms and two N atoms from two L ligands. [ZnCl2L]n forms one-dimensional P (plus) and M (minus) helical chains, where the L ligand has different directions of twist. The helical chains stack together via interchain π-π and C-H···π interactions.

[Clinical significance of arthritis treatment guidelines revealed by outpatients prescriptions].

OBJECTIVE: To investigate the current status of osteoarthritis medications of outpatients for arthritis treatment guidelines, and provide references for the promotion and popularization of traditional Chinese and western medicine in treatment of arthritis. METHODS: The outpatient prescriptions for the treatment of osteoarthritis from all the rheumatology and orthopedics specialists from 2007 February to May in Peking University People's Hospital were chosen and analyzed statistically. RESULTS: There were a total of 2 145 osteoarthritis prescription in this study, including 8 categories: joint lubricants, non-steroid anti-inflammatory drugs (NSAIDs), local anesthetics, cartilage protective agent, adrenal corticosteroids, vitamin AD, analgesic drugs and traditional Chinese medicine. The Chinese medicines were among the drugs with the most species amounted up to 35. The most common route of medication was oral administration (73.2%), which was used more in the department of rheumatology and immunology than in orthopedics. And in oral drugs, the biggest consumption was NSAIDs, accounting for 29.9%. There was no significantly difference between the rheumatology and orthopedic specialists when using non-specific cyclooxygenase (COX) inhibitors. But orthopedic specialists prescribed more COX-1 specific inhibitor than rheumatology specialists. CONCLUSION: Recently the arthritis treatment guidelines have been issued one after another. Many experts have already accepted the treatment of pain. However, in the implementation, the large differences still exist. The use of the Chinese medicine is still very chaotic; there are no clear-cut norms to be followed. Therefore, the implementation of the arthritis treatment guidelines and treatments of arthritis by traditional Chinese medicine are urgent to be standardized.

Generation of an induced pluripotent stem cell line (SHETi004-A) from a Chinese Han child with left bundle branch block.

Desmin (DES) is an important intermediate filament protein associated with the extrasarcomeric cytoskeleton and cellular function that was first reported to be associated with cardiac conduction disease and cardiomyopathy in 1998. We generated an induced pluripotent stem cell (iPSC) line from the left bundle branch block (LBBB) patient's peripheral blood mononuclear cells using Sendai virus-mediated reprogramming. The iPSCs exhibited stable amplification, expressed pluripotent markers, and spontaneously differentiated into three layers in vitro. Additionally, it showed a normal diploid karyotype and maintained the pathogenic mutation in DES. Hence, the iPSC line provided a platform for exploring LBBB mechanisms associated with DES mutations.

Identification and characterization of an unexpected isomerization motif in CDRH2 that affects antibody activity.

Aspartic acid (Asp) isomerization is a spontaneous non-enzymatic post-translation modification causing a change in the structure of the protein backbone, which is commonly observed in therapeutic antibodies during manufacturing and storage. The Asps in Asp-Gly (DG), Asp-Ser (DS), and Asp-Thr (DT) motifs in the structurally flexible regions, such as complementarity-determining regions (CDRs) in antibodies, are often found to have high rate of isomerization, and they are considered "hot spots" in antibodies. In contrast, the Asp-His (DH) motif is usually considered a silent spot with low isomerization propensity. However, in monoclonal antibody mAb-a, the isomerization rate of an Asp residue, Asp55, in the aspartic acid-histidine-lysine (DHK) motif present in CDRH2 was found to be unexpectedly high. By determining the conformation of DHK motif in the crystal structure of mAb-a, we found that the Cgamma of the Asp side chain carbonyl group and the back bone amide nitrogen of successor His were in proximal contact, which facilitates the formation of succinimide intermediate, and the +2 Lys played an important role in stabilizing such conformation. The contributing roles of the His and Lys residues in DHK motif were also verified using a series of synthetic peptides. This study identified a novel Asp isomerization hot spot, DHK, and the structural-based molecular mechanism was revealed. When 20% Asp55 isomerization in this DHK motif occurred in mAb-a, antigen binding activity reduced to 54%, but the pharmacokinetics in rat was not affected significantly. Although Asp isomerization of DHK motif in CDR does not appear to have a negative impact on PK, DHK motifs in the CDRs of antibody therapeutics should be removed, considering the high propensity of isomerization and impact on antibody activity and stability.

Case Report: Novel LIM domain-binding protein 3 (LDB3) mutations associated with hypertrophic cardiomyopathy family.

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant cardiomyopathy, which is one of the most common reasons for cardiac arrest in children or adolescents. It is characterized by ventricular hypertrophy (usually left ventricle), small ventricular cavity, and reduced ventricular diastolic compliance found by echocardiography in the absence of abnormal load (such as hypertension or aortic stenosis). HCM is usually caused by mutations in genes encoding sarcomere or sarcomere-related genes. Whole exome sequencing (WES) is performed to identify probable causative genes. Through WES, we identified LIM domain-binding protein 3 (LDB3) mutations (R547Q and P323S) respectively in an 11-year-old HCM girl and a 6-year-old HCM boy. Neural network analyses showed that the LDB3 (R547Q and P323S) mutation decreased its protein stability, with confidence scores of -0.9211 and -0.8967. The STRUM server also confirmed that the mutation decreased its protein stability. Thus, LDB3 mutation may be associated with heritable HCM. To our knowledge, this is the first time to report LDB3 heterozygous variants (R547Q and P323S) responsible for heritable HCM.

[Composition analyses of urinary microcrystalline in urine of magnesium ammonium phosphate stones formers and its relationship with the stones formation].

By means of X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), nano-particle size analyzer, scanning electron microscopy (SEM) and transmission electron microscopy (TEM), the composition, morphology, particle size and zeta potential of urinary microcrystalline in urine of magnesium ammonium phosphate stone formers were investigated. The components of stones were also analyzed. The results showed that there was a close relationship among stone components, urinary microcrystalline composition and urine pH. A high pH value of 6.5 or more usually appeared in the urine of magnesium ammonium phosphate stone formers. The main component of urine microcrystalline was magnesium ammonium phosphate crystals with different crystal water such as monohydrate or hexahydrate. Magnesium ammonium phosphate crystals are mainly petal-shaped, crosswise shape. These microcrystalline have an uneven particle size distribution, a wider distribution range, and apparent aggregation. There is no significant difference in the zeta potential between the magnesium ammonium phosphate stone formers (mean (-9.83 +/- 0.66) mV) and healthy control subjects (mean (-10.74 +/- 0.25) mV). This study can help predict the occurrence of urolithiasis, and provide inspiration to the prediction of the type of urinary stones.

[The property changes of urine crystallites of calcium oxalate stone formers before and after taking medicine].

The property changes of urine crystallites of six cases of calcium oxalate stone formers before and after taking medicine were comparatively studied using X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, nanoparticle size analyzer, and transmission electron microscopy (TEM). The results showed that the urinary pH increases after taking medicine (before taking 5.87 +/- 0.51, after taking 6.23 +/- 0.74.) Before taking medicine the main components of urine crystallites were uric acid, calcium oxalate monohydrate (COM) and biphosphate. The types and quantities of urine crystallites after taking medicine were less than that of before. The average size of urine crystallite before taking medicine was (579 +/- 326) nm, and it reduced to (404 +/- 338) nm after taking medicine. After taking medicine the zeta potential was also decreased to (-7.29 +/- 4.16) mV from (-4.28 +/- 2.55) mV. The decrease in zeta potential is beneficial to preventing urinary crystallites deposition. The edges and corners of urine crystallite were sharp with significant aggregation before taking medicine, while they became blunt and less aggregation after taking medicine. The analysis of the property changes of urine crystallites of calcium oxalate stone patients before and after taking medicine by using modern equipments has important clinical significance to the clinical prevention and treatment of urinary stones.

[Medium and long-term clinical results of using Zweymüller cup to treat protrusio acetabuli].

OBJECTIVE: To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli. METHODS: From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component loosening 10 cases 10 hips. During all operations, Zweymüller cup was used to fix the acetabular part. RESULTS: All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7.4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84.7 (from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removal prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component, but the patient had no pain with good hip function. All other cases had good hip functions and were very satisfied with clinical results. CONCLUSION: Using Zweymüller cup to treat protrusion acetabuli can get strong fixations and perfect medium and long-term clinical results for over 7.4 years.

LTB4 can stimulate human osteoclast differentiation dependent of RANKL.

Our previous study showed that Leukotriene B4 can directly stimulate osteoclast differentiation independent of RANKL. In order to determine whether Leukotriene B4 could indirectly stimulate human osteoclast differentiation through increasing RANKL expression of rheumatoid arthritis fibroblast-like synoviocytes, we utilize the coculture model of rheumatoid arthritis fibroblast-like synoviocytes and monocyte, which were stimulated in the presence of 2.5 ng/ml M-CSF in the control group, 2.5 ng/ml M-CSF+10(-8)M LTB4 in the experimental group a, and 2.5 ng/ml M-CSF+10(-8)M LTB4+100 ng/ml OPG in the experimental group b. After culture for 3 weeks, the number of multinucleated TRAP staining positive osteoclast-like cells stained with TRAP was counted to evaluate the differentiation effect in each group. There was almost no osteoclast-like cell in the control group and the experimental group b. There were many osteoclast-like cells in the experimental group a. These results indicated that Leukotriene B4 is capable of inducing osteoclast differentiation by a RANKL-dependent mechanism.

[Primary study of relationship between lumbar degenerative disease and morbidity of primary knee osteoarthritis].

OBJECTIVE: To study the relationship between lumbar degenerative disease and morbidity of primary unilateral knee osteoarthritis. METHODS: The clinical data of 115 unilateral knee osteoarthritis patients and 119 bilateral knee osteoarthritis patients undergoing TKR (total knee replacement) at our hospital in 2008 were retrospectively analyzed. According to clinical signs of lumbar degenerative disease and radiological changes, these patients were divided into upper/lower/whole/none lumbar degenerative disease group respectively. chi(2) test was performed to compare the difference of lumbar degenerative conditions between unilateral knee osteoarthritis and bilateral knee osteoarthritis patients. RESULTS: The morbidity side of lumbar intervertebral disc protrusion or nerve root canal stenosis in primary unilateral osteoarthritis patients was the same as the morbidity side of primary unilateral osteoarthritis. Lumbar degenerative disease morbidity [(34 + 20 + 15)/115 = 60%] of primary unilateral knee osteoarthritis was higher than that [(3 + 5 + 4 + 6 + 19)/119 = 31.1%] of primary bilateral knee osteoarthritis (chi(2) = 19.723, P = 0.000);Upper lumbar degenerative disease morbidity (34/115 = 29.6%)of primary unilateral knee osteoarthritis was higher than that [(3 + 5)/119 = 6.7%] of primary bilateral knee osteoarthritis, (chi(2) = 20.720, P = 0.000); lower lumbar degenerative disease morbidity (20/115 = 17.4%)of primary unilateral knee osteoarthritis was higher than that [(4 + 6)/119 = 8.4%] of primary bilateral knee osteoarthritis (chi(2) = 4.227, P = 0.040); there was no difference for whole lumbar degenerative disease morbidity between primary unilateral and bilateral knee osteoarthritis patients (chi(2) = 0.402, P = 0.526). CONCLUSION: The primary unilateral knee osteoarthritis morbidity is correlated with lumbar degenerative disease for the same elder patient. Upper lumbar degenerative disease can induce the incidence and aggravation of primary unilateral knee osteoarthritis; the flexion deformity of primary knee osteoarthritis may cause the aggravation of lower lumbar degenerative disease, even upper lumbar degenerative disease.

Injury Patterns and Outcomes of Victims After the 2016 Jiangsu Tornado in China: A Retrospective Analysis of Injuries Treated at a Teaching Hospital.

OBJECTIVE: The aim of this study is to characterize the injury profiles and outcomes of victims of a tornado in Jiangsu Province, China. METHODS: This study retrospectively investigated the clinical records of 144 patients treated at a teaching hospital due to a tornado. Each patient's demographic data, diagnosis, injury types, causes of injury, infection status, and outcomes were all reviewed. RESULTS: Of the 144 patients, 64 (44.4%) were male, and 80 (55.6%) were female. The patients' ages ranged from 2 months to 94 years; 91 (63.19%) were admitted within the first 12 h after the disaster. The most frequently injured sites were the body surfaces (24.48%), followed by the limbs and pelvis (21.79%) and chest (20.3%). Soft-tissue injuries and fractures were the most frequent injuries. Traumatic brain injuries were the main causes of death. Tornado-related injuries were primarily caused by flying/falling bricks, wood, and glass. Twenty-three (15.9%) patients suffered from infections, which consisted mainly of skin/soft tissue infections and pneumonia. CONCLUSIONS: Destructive tornadoes often cause heavy casualties with little warning. Medical aid agencies must be prepared to accommodate the massive numbers of injured patients after a catastrophe. Proper triage and prompt treatment of injured victims may decrease mortality. (Disaster Med Public Health Preparedness. 2019;xx:xxx-xxx).

Profile of Chest Injuries and Oxygen Therapy in Trauma Patients with Acute Respiratory Failure after the Jiangsu Tornado in China: A Retrospective Study.

BACKGROUND: The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China. METHODS: The clinical records of 144 patients referred to Yancheng City No.1 People's Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed. RESULTS: Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%. CONCLUSIONS: Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.