Chinese expert consensus on emergency surgery for severe trauma and infection prevention during corona virus disease 2019 epidemic (version 2023) / 中华创伤杂志

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Which T1 lung cancers require "radical therapy"? / 中国胸心血管外科临床杂志

@#Stage T1 lung cancer refers to the tumor with maximum diameter≤3 cm, surrounded by the pleural membrane of the lung or viscera, and does not exceed the lobar bronchus under the bronchoscope. The prognosis is generally good, but some of them are more invasive, and more aggressive treatments are needed to achieve the best prognosis. This article reviews which T1 lung cancers are susceptible to metastasis and their risk factors. It is hoped that such patients will receive the attention of relevant scholars, and when they are encountered clinically, a more aggressive approach will be taken to extend their life expectancy．

The value of echocardiography in evaluating left cardiac function in patients with restrictive cardiomyopathy / 中华超声影像学杂志

Objective:To evaluate the application value of conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI) in assessing the left ventricular systolic and diastolic functions in patients with restrictive cardiomyopathy (RCM).Methods:Fifteen patients confirmed as RCM by cardiac magnetic resonance imaging or pathological biopsy in Fuwei Cardiovascular Hospital of Yunnan Province from September 2017 to June 2020 were selected. According to left ventricular ejection fraction(LVEF), they were divided into LVEF retention group(LVEF≥50%, 8 cases) and LVEF reduction group (LVEF<50%, 7 cases). Meanwhile, 20 healthy volunteers were selected as the control group. Conventional echocardiography and 2D-STI were used to evaluate left ventricular systolic and diastolic function, including left ventricular end-diastolic diameter (LVEDd), LVEF, mitral valve blood flow spectrum peak E/peak A, peak E deceleration time (EDT), tissue Doppler mitral valve ring average early diastolic peak velocity (e′), E/e′ ratio, isovolumetric relaxation time (IVRT), left atrial volume index (LAVI) and speed of tricuspid regurgitation (TVR), tricuspid annular plane systolic excursion (TAPSE), left ventricular longitudinal strain (LS) and circumferential strain (CS). Then the differences and similarities between the two RCM groups and the control group were compared.Results:There was no significant difference of LVEF between LVEF retention group and the control group ( P>0.05), and LVEF in LVEF reduction group was significantly lower than that in control group ( P<0.05). LVEDd in LVEF retention group was significantly smaller than that of LVEF reduction group ( P<0.05), but was not statistically different from the control group ( P>0.05). Values of E/A, E/e′, LAVI and TVR in LVEF retention group and LVEF reduction group were significantly greater than the control group (all P<0.05), and there was no statistically significant difference between the two RCM groups ( P<0.05). Values of e′, EDT, IVRT and TAPSE in LVEF retention group and LVEF reduction group were significantly lower than the control group (all P<0.05), and there was no statistically significant difference between the two RCM groups (all P>0.05). The global LS and LS of AP4, AP3, and AP2 showed significantly different among the 3 groups (all P<0.05). The global and basal, middle, apical segmental CS in LVEF retention group were significantly larger than those in LVEF reduction group (all P<0.05), but they were not significantly different from the control group (all P>0.05). Conclusions:All patients with RCM show left ventricular diastolic dysfunction in conventional echocardiography, and show gradually reduced left ventricular systolic function and left ventricular remodeling. RCM patients with normal LVEF demonstrate decreased myocardial systolic function, and left ventricular global LS could be used as a sensitive indicator to predict myocardial systolic function.

Efficacy evaluation of China trauma care training program / 中华创伤杂志

Objective@#To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training (CTCT)" by investigating the trainees who participated in the course.@*Methods@#A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study. Through questionnaires, the general information (gender, occupation, professional title, discipline source, length of time engaged in trauma treatment), the situation of trauma treatment in their hospitals (hospital level, trauma treatment mode, number of severe trauma cases each year), the recommended model of trauma treatment, learning methods of trauma treatment knowledge, and the trauma training interval were obtained. The trainees took tests before and after the training, and the test results were used to evaluate the training effect and analyze the influencing factors.@*Results@#(1) There were 1 230 males (74.10%), 1 356 physicians (81.93%), 1 247 with intermediate title or lower levels (75.12%), 756 from emergency department/emergency surgery (45.54%), and 899 who were engaged in trauma treatment for more than five years (54.16%). (2) There were 1 068 trainees from tertiary hospitals (64.34%). The main mode of severe trauma treatment in hospitals was "emergency+ consultation+ triage" (1 198 trainees, 72.17%). A total of 1014 trainees treated less than 200 severe trauma patients each year (61.08%). A total of 1210 trainees recommended emergency/emergency surgery (72.89%) and 350 trainees recommended trauma surgery/trauma hospital (21.08%) as the main mode of treatment. (3) There were various approaches to acquire trauma treatment knowledge, including 1 029 person-times (61.99%) through department internal guidelines, 924 person-times (55.66%) through case discussion, 879 person-times (52.95%) through self-teaching, 767 person-times (46.20%) through lectures, 382 person-times (23.01%) through trauma courses and 285 person-times through further studies at home and abroad (17.17%). A total of 951 trainees recommended 1-2 years as the training interval (57.3%). (4) The average test score before training was (67.5±14.5)points, which were influenced by the hospital level, discipline source, title of trainees, length of time engaged in trauma treatment, and amount of severe trauma cases each year in their hospitals. The hospital level and discipline source were the main effect factors. (5) The average test score after training was (83.8±11.6)points, which was significantly higher than that before training (P<0.01), and the scores of trainees in different subgroups were all improved. The main factors influencing the test score included hospital level, number of severe trauma cases each year, discipline source, professional title, number of severe trauma cases each year treated in the hospital. The major effect factor was the amount of severe trauma cases each year.@*Conclusions@#The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+ decentralized treatment" . Few trainees have received systematic trauma treatment training, and their trauma treatment knowledge level and the test scores before training is influenced by hospital level, the case number of severe trauma treatment, discipline source, and trainees’qualifications. After the standardized and standardized trauma treatment training course "CTCT" , the scores of students from different backgrounds have been significantly improved, and the gap between students has been significantly narrowed.

Efficacy evaluation of China trauma care training program / 中华创伤杂志

Objective To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training(CTCT)" by investigating the trainees who participated in the course.Methods A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study.Through questionnaires,the general information(gender,occupation,professional title,discipline source,length of time engaged in trauma treatment),the situation of trauma treatment in their hospitals(hospital level,trauma treatment mode,number of severe trauma cases each year),the recommended model of trauma treatment,learning methods of trauma treatment knowledge,and the trauma training interval were obtained.The trainees took tests before and after the training,and the test results were used to evaluate the training effect and analyze the influencing factors.Results(1)There were 1 230 males(74.10％),1 356 physicians(81.93％),1 247 with intermediate title or lower levels(75.12％),756 from emergency department/emergency surgery(45.54％),and 899 who were engaged in trauma treatment for more than five years(54.16％).(2)There were 1 068 trainees from tertiary hospitals(64.34％).The main mode of severe trauma treatment in hospitals was "emergency+consultation+triage"(1 198 trainees,72.17％).A total of 1014 trainees treated less than 200 severe trauma patients each Year(61.08％).A total of 1210 trainees recommended emergency/emergency surgery(72.89％)and 350 trainees recommended trauma surgery/trauma hospital(21.08％)as the main mode of treatment.(3)There were various approaches to acquire trauma treatment knowledge,including 1 029 person-times(61.99％)through department internal guidelines,924 person-times(55.66％)through case discussion,879 person-times(52.95％)through self-teaching,767 person-times(46.20％)through lectures,382 person-times(23.01％)through trauma courses and 285 person-times through further studies at home and abroad(17.17％).A total of 951 trainees recommended 1-2 years as the training interval(57.3％).(4)The average test score before training was(67.5±14.5)points,which were influenced by the hospital level,discipline source,title of trainees,length of time engaged in trauma treatment,and amount of severe trauma cases each year in their hospitals.The hospitallevel and discipline source were the main effect factors.(5)The average test score after training was(83.8±11.6)points,which was significantly higher than that before training(P＜0.01),and the scores of trainees in different subgroups were all improved.The main factors influencing the test score included hospital level,number of severe trauma cases each year,discipline source,professional title,number of severe trauma cases each year treated in the hospital.The major effect factor was the amount of severe trauma cases each year.Conclusions The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+decentralized treatment".Few trainees have received systematic trauma treatment training,and their trauma treatment knowledge level and the test scores before training is influenced by hospital level,the case number of severe trauma treatment,discipline source,and trainees' qualifications.Mter the standardized and standardized trauma treatment training course "CTCT",the scores of students from different backgrounds have been significantly improved,and the gap between students has been significantly narrowed.

Atomic oxygen effects on silvered polyimide films and their surface modification by poly(siloxane amic acid) ammonium salts.

The tolerance of silvered polyimide films synthesized by an in situ self-metalization method against atomic oxygen (AO) was evaluated. The results showed that the mass loss of R-Ag/PI was markedly increased as the AO fluence increased; Ag/PI showed an identical trend. SEM data showed that the silver particles on the surfaces of R-Ag/PI and Ag/PI disappeared. The surfaces achieved a "carpet condition" that was more obvious as the AO fluence increased. Poly(siloxane amic acid) ammonium salt was synthesized and made via imidization to produce a flexible organic coating that was characterized by ATR-FTIR, 1HNMR, TGA, and XPS. This could be used to improve the tolerance of silvered polyimide films against AO. The AO resistance and the impacts on mass loss, surface morphology, and surface compositions were also evaluated after surface modification by poly(siloxane amic acid) ammonium salts. 20 wt% Foc/Ag/PI had a lower mass loss and smoother surface than the others due to the formation of a compact surface-SiO2-type layer. This flexible organic coating can be produced via an environmentally-friendly method, and it maintains the inherent thermal stability of the polyimide which cannot be achieved by other anti-AO coatings.

Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1) / 中国肺癌杂志

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Syk expression in non-small-cell lung cancer and its relation with angiogenesis.

OBJECTIVE: To study the expression of spleentyrosine kinase (Syk) gene in non--small--cell lung cancer and the relationship between Syk mRNA and microvessel density (MVD) in the tumor cells. MATERIALS AND METHODS: The expression of Syk gene in 70 cases of lung tumor tissues, adjacent tissues, and normal lung tissues were examined with reverse transcription polymerase chain reaction (RT--PCR). The expression of MVD was examined with immunohistochemical streptavidin--biotin complex (SABC). The relation between them was analyzed. RESULTS: Syk mRNA expression rates were 5.7, 95.7, and 100% in tumor, adjacent lung cells, and normal lung cells, respectively. The expression rate in tumor cells was significantly lower compared with those in normal lung tissue and adjacent lung tissue (P < 0.05), expression rate among different pathologic types, differentiation and clinical stages did not reveal any statistically significant differences (P > 0.05). The positive rate of CD34 in tumor was higher than that in adjacent tissues and normal lung tissues. The expression of Syk mRNA and MVD were negatively correlated. CONCLUSIONS: The lack of Syk mRNA expression in lung cancer play an important role in angiogenesis.

Advances of malignant pleural mesothelioma / 国际肿瘤学杂志

Malignant pleural mesothelioma (MPM)is a malignant cancer originated from pleural meso-thelial cell.The diagnosis of MPMis based on biopsy of pleura and immunohistochemistry.The current treat-ment of MPM is multimodality therapy including surgery,radiotherapy,chemotherapy and immunotherapy. There are two major surgical procedures:extrapleural pneumonectomy and pleurectomy/decortication.The main of radiotherapy is three-dimensional conformal radiotherapy.Cisplatinum combined with pemetrexed is the first-line chemotherapy for the patients with MPM.The principal targets for immunotherapy include regulatory T cells,cytotoxic T lymphocyte-associated antigen-4 and PD-1 .

Cytokeratin 14 and cancer / 国际肿瘤学杂志

Cytokeratin 1 4 (CK1 4)has a different degree of expression in NSCLC,breast cancer,cer-vical cancer,esophageal cancer and other tumors,except in the normal basal cells.CK1 4 is mainly expressed in the peripheral part of the tumor,which is rarely expressed in the non-aggressive part.Usually the higher malignant of the tumor has the more expression of CK1 4.Given all that,CK1 4 gene plays an important role in the tumor progression and metastasis in a variety of tumors,which can be considered as an biomarker being used in the diagnosis,treatment and prognosis evaluation.

Establishment of a model of multiple trauma combined with uncontrolled hemorrhagic shock / 中华创伤杂志

Objective To establish a model of multiple trauma combined with uncontrolled hemorrhagic shock so as to provide basis for basic study of multiple trauma.Methods Forty New Zealand male rabbits were equally and randomly divided into four groups,ie,sham group (Group A,with no bloodletting or resuscitation),uncontrolled group (Group B,with bloodletting alone),aggressive fluid resuscitation and limited fluid resuscitation groups (Groups C and D,with bloodletting,hemostasis and resuscitation).Fractures of the right hind limb in rabbits of each group were induced by free drop of a 3 kg hammer from a height of 45 cm.An estimated 30％ of total blood was withdrawn from the right common carotid artery in 20 minutes in bloodletting groups (Groups B,C and D).Successively,the uncontrolled bleeding was caused via acupuncture bloodletting from ileocecal artery branch at 30 minutes in bloodletting groups.Progressive and limited fluid resuscitation using lactated Ringer' s solution (LR) were performed for Groups C and D in the next one hour respectively.Blood transfusion was performed in Groups C and D after ligation of bleeding artery branch at 90 minutes.In addition,LR of three folds more than blood loss was administered in Group D.Survivorship of rabbits in each group was observed at 150 minutes to seven hours.Arterial blood sample was taken at each time point for blood gas analysis and coagulation test.Fracture type,fluid requirements,intra-abdominal blood loss,and rabbits' survival rate at seven hours were recorded.Results Closed comminuted tibiofibular fractures were founded in all groups.Bloodletting groups showed an obvious reduction of MAP,heart rate and pH value and significantly increased levels of K+,blood glucose and lactic acid at 30 minutes (P ＜0.01),whereas MAP and heart rate were returned to baseline level at 150 minutes.Progressive fluid resuscitation significantly increased the intra-abdominal blood loss and fluid requirements (P＜0.01),decreased erythrocrit (P ＜ 0.05),prolonged prothrombin time and activated partial thromboplastin time (P ＜0.05).Survival rate of rabbits was improved significantly by fluid resuscitation at 7 hours (P ＜ 0.01).Conclusion The model is of high stability and reproducibility and therefore is fit for study of multiple trauma combined with uncontrolled hemorrhagic shock.

Methylation of the promoter of human leukocyte antigen class I in human esophageal squamous cell carcinoma and its histopathological characteristics.

OBJECTIVE: The downregulation of human leukocyte antigen class I (HLA-I) has been proposed to contribute to the immune evasion of cancer cells in some cancers. Meanwhile, transcriptional silencing by means of promoter methylation is now believed to be an important mechanism of carcinogenesis. The aim of this study was (1) to examine the expression of HLA-I antigen and the antigen-processing machinery components in patients with esophageal squamous cell carcinoma lesions and (2) to detect the methylation pattern of the HLA-I gene in patients with esophageal squamous cell carcinoma and assess its association with histopathological characteristics. METHODS: A total of 87 formalin-fixed and paraffin-embedded esophageal squamous cell carcinoma lesions were collected. HLA-I and antigen-processing machinery component expression was investigated by means of immunohistochemistry with anti-HLA-I monoclonal antibody, and methylation changes in the promoter region of HLA-1 genes were determined by using methylation-specific polymerase chain reaction. RESULTS: HLA-I, transporter associated with antigen processing 1, and low molecular weight protein were lost or downregulated in 67%, 29.8%, and 47.0% of the esophageal squamous cell carcinoma lesions, respectively. The positive rates of gene promoter hypermethylation of HLA-I was 70.1% (61/87) in tumor tissues compared with 3.6% in normal tissue (P < .01). Also, the higher methylation rates and the HLA-I expression were significantly associated with tumor grade, including lymph node metastasis (P < .05). CONCLUSIONS: HLA-I promoter hypermethylation was associated with loss of HLA-I antigen, which frequently occurred in primary tumors, especially in metastatic lymph node lesions, and was associated with patients' prognoses.

Effects of breathing booster training and inhalation of terbutaline and ambroxol aerosol on pulmonary function in postoperative lung cancer patients / 中华物理医学与康复杂志

Objective To study the effects of.breathing booster training and aerosol inhalation with terbutaline and ambroxol on pulmonary function in postoperative lung cancer patients. Methods A total of 84 patients requiring resection operations for lung cancer were randomly divided into treatment and control groups.In the peri-operative period,breathing booster training and terbutaline and ambroxol aerosol inhalation were given to the treatment group,while only aerosol inhalation was given to the control group.Therapeutic effects were evaluated according to patients pulmonary function and postoperative complications 2 weeks and 1 day before the operation,and again 2 weeks after the operation.Postoperative quality of life (QOL) was evaluated with St.George's respiratory questionnaire (SGRQ) 1 month after the operation. Results There was no statistically significant difference in average pulmonary function between the two groups 2 weeks before the operation.Two weeks after the operation,pulmonary function had decreased in both groups,but it was significantly better in the treatment group than in the control group.The treatment group also had significantly fewer pulmonary complications.The QOL of patients in the treatment group had improved significantly 1 month after the operation. Conclusion Breathing booster training and inhalation of terbutaline and ambroxol aerosol during the peri-operative period can significantly improve pulmonary function,reduce respiratory complications and improve the QOL of patients requiring lung cancer resection operations.This is most important for promoting their early recovery.

Expression of vascular endothelial growth factors C and D correlates with lymphangiogenesis and lymph node metastasis in lung adenocarcinoma.

BACKGROUND: Vascular endothelial growth factors (VEGF)-C and -D have been reported to be lymph-specific growth factors. In this study we analyzed the intra- and peritumoral microlymphatic vessel density (MLVD) and the expression of VEGF-C and -D in lung adenocarcinoma. METHODS: Tissue samples were obtained from 48 patients who underwent surgery for lung adenocarcinoma. The expression of VEGF-C, -D and MLVD was examined by immunohistochemistry, and the correlation with lymph node metastasis and clinicopathological features was evaluated. RESULTS: Immunohistochemical analysis revealed the presence of VEGF-C and -D immunoreactivity in 70.8 % (34/48) and 58.3 % (28/48) of the tissue samples, respectively. The group with a high expression of VEGF-C and -D in the tumor margins had a higher incidence of lymph node metastasis. MLVD in both the VEGF-C and the VEGF-D positive groups was higher than that in the negative groups, and the lymph node metastasis was likewise higher. CONCLUSION: VEGF-C and -D may play important roles in lymphangiogenesis and lymph node metastasis in lung adenocarcinoma.

Change in kidney morphology after ischemia/reperfusion in a sheep model of acute heart failure supported by pulsatile catheter pump / 中国组织工程研究

BACKGROUND: Acute renal failure following heart failure assisted circulation have been extensively reported. However, little data have been available concerning morphological analysis of kidney tissues under that condition.OBJECTIVE: To observe morphological change of ischemia/reperfusion kidney in a sheep pulsatile catheter (PUCA) pump short-term support for heart failure model and explore causes of acute renal failure in assisted circulation patients.DESIGN, TIME AND SETTING: Self-contrast animal experiment was performed at the laboratory of Department of Cardiothoracic Surgery, Renji Hospital of Shanghai Second Medical University between July 2003 and April 2004.MATERIALS: PUCA pump was provided by Gerhard Rakhorst, Professor of Biomedical Engineering, University of Groningen.METHODS: After ischemic heart failure in 10 sheep was induced successfully and subsequently ischemia/reperfusion kidney was developed, PUCA pump was activated to support the hemodynamics for 3 hours.MAIN OUTCOME MEASURES: Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 45 minutes after the support. Kidney biopsy specimens for light and electron microscopy were obtained 3 hours after support.RESULTS: PUCA pump support was successful in 7 of 10 sheep for 3 hours. During support with the PUCA pump,Hemodynamic parameters gradually restored to normal and stable condition, and blood pressure was close to baseline at the end of experiment. On both light and electron microscopy examination, mild acute kidney change was observed after ischemia/reperfusion. Cytosis in renal glomerulus associated with vasodilatation hyperemia, endepidermis in renal tubules hydropic degeneration, vasodilatation hyperemia and Interstitial edema in renal medulla were the main findings.CONCLUSION: PUCA pump could successfully maintain the hemodynamics for 3 hours in a sheep acute heart failure model,but pathological change in ischemia/reperfusion kidney was remained. It is impossible to predict prognosis of renal function on hemodynamic data alone during support.

The analysis of risk factors for mortality in multiple trauma patients with acute respiratory distress syndrome / 中华急诊医学杂志

Objective To retrospectively demonstrate risk factors for mortality in multiple trauma patients with acute respiratory distress syndrome(ARDS).Method This wes a retrospective cohort stuay regarding multi-ple trauma as a single cause for intensive care unit admission.Patients identified multiple trauma with ARDS en-rolled in prospectively maintained database between May 2003 and April 2008 were observed,and 23 items of po-tential risk factors of impacting mortality were calculated by univariate and multivariate logistic analyses in order to find distinctive items in these multiple trauma patients.Information on patients demographics characteristics,treat-ment procedures and injury severity were collected at the time of EICU admission.The criteria used for ARDS met definition of the guideline(2006)of Chinese medical association.The commonly accepted definition of multiple injuries was consistent with both several injury sites(generated from two or more than two anatomic sites)and in-jury in one anatomic site at least threatening life.Severity of injury was quantified by injury severity seore and the simplified acute physiology score and chronic health evaluation score (APACHE Ⅱ)in EICU admission.We in-cluded adult patients(age≥18 years),those with an EICU length of stay longer than 48 hours,and those accept-ing mechanical ventilation more than 24 hours.Patients who were readmitted to EICU by virtue of non-traffic injury or transferred to EICU from other hospitals after long-term treatment were excluded.Mortality was assessed at the 28th clay after trauma.Results There were 269 multiple trauma patients with posttranmatic ARDS admitted to ICU during the study period,the unadjusted odds ratio(OR)and 95% confidence intervals(CI)of mortality were associated with six risk factors(APACHE Ⅱ score,duration of tratuna factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation)out of 23 items.The adjusted Odds Ratios(ORs) with 95% CI were denoted with respect to surviving beyond 96 hours ICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 ICU admission(duration of trauma factor,scpsis,duration of mechanical ventilation)and mechanical ventilation beyond 7 days ICU admission(dura-tion of trauma factor and sepsis).Conclusions Impact of pulmonary contusion and APACHE Ⅱ score contribut-ing to prediction of mortality may exist in prophase after multiple trauma.Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome,infection,and secondary multiple organs dysthnetion.Aspiration of gastric contents could lead to incremental mortality due to scvere ventilation associated pneumonia.Duration of trauma factor determined degree of injury and outcomes,longer duration generally manifested higher mortality.Long-standing mechanical ventilation should be constrained on account of occurring severe refractory complications.

Therapeutic effect and quality of life of anastomotic stenosis patients after bougienage of esophagus combined with deglutition training / 中华物理医学与康复杂志

Objective To assess the therapeutic effect and quality of life (QOL) of patients with anastomotic stenosis after bougienage of esophagus following resection of esophagus with esophageal and of cardiac carcinoma.Methods A total of 135 patients suffering from anastomotie stenosis after resection operations were divided into a treatment group and a control group at random. All patients were given an esophageal dilator under gastroseope. In treatment group, deglutition training was given additionally, twice daily, 10 to 20 trials in each session. Therapeutic effect was evaluated according to patients' food intake and gastroscopy results of diameter of stenosis before treatment and 2,4,8 weeks after treatment. QOL was evaluated with Chinese version of SF-36 instrument. Results The food intake of all the patients improved. There was no difference of diameter of stenosis in degree Ⅰ stenosis patients be-tween two groups (P > 0.05 ) ; but the differences were statistically significant in degree Ⅱ and Ⅲ stenosis patients (P < 0.05). In treatment group, the degree and duration of improvement were more obvious. QOL of patients with degree Ⅱ and Ⅲ stenosis in both groups improved significantly after treatment ( P < 0.05 ), but compared with con-trol group the improvement was significantly greater in treatment group (P < 0.05). Conclusion The therapeutic effect of bougienage of esophagus can be strengthened with deglutition training. This combinative therapy is safe and effective.

The application of pulsatile catheter pump support on cardiac resuscitation in sheep / 中华急诊医学杂志

Objective To assess the effect of the pulsatile catheter (PUCA) pump support on cardiac resuscitation in sheep,and to provide a new approach for saving cardiac arrest patients. Methods Cardiac arrest was induced by ventricular fibrillation in 11 sheep. These sheep were divided into three groups including no support (n=3), delayed support (n=2) and immediate support (n=6). Time for cardiac resuscitation and the ratio of success to failure in each group were recorded. Hemodynamic parameters including heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure(CVP),right ventricular end-diastolic pressure (RVEDP),left atrial pressure (LAP), and left ventricular end-diastolic pressure (LVEDP) were monitored and recorded at 5, 60 and 180 min after cardiac resuscitation with PUCA pump. Results Time for cardiac resuscitation in no support group, delayed support group and immediate support group was (38.3±5.8),(43.5±9.2) and (48.7±23.8)minutes, respectively(P＞0.05),and the ratio of success to failure was 0/3,0/2 and 5/1, respectively ( P＜0.05). After cardiac resuscitation with the PUCA pump support, MAP, SBP and DBP increased gradually(P＜0.05).Conclusions PUCA pump can maintain the hemodynamic stability in a sheep model of cardiac arrest,and can thus increase the success rate of cardiac resuscitation. It may be suitable for resuscitating cardiac arrest patients.