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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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.

Diagnosis and treatment strategies of portopulmonary hypertension / 中华消化外科杂志

Portopulmonary hypertension is a rare and serious complication of portal hypertension, which is very easy to miss diagnosis in clinic, and relatively difficult to treat. The authors elaborate in depth of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of portopulmonary hypertension.

Construction and application of information platform for pre-hospital and in-hospital synergic treatment in trauma emergency center / 中华创伤杂志

In order to provide timely and effective treatment and reduce the rate of death and disability for trauma patients,the National Health Construction Commission issued a document to promote the construction of trauma centers and achieve centralized hospitalization for trauma patients.Pre-hospital first aid is the most important part of the modem emergency medical system,and it is especially important for the successful treatment of trauma patients.In order to achieve close coordination,efficient docking,emergency clinic advancement in the front yard,and improve the success rate of trauma patients,Nanchang Emergency Center proposed an integrated treatment mode for pre-hospital first aid and trauma emergency center,and developed a pre-hospital collaborative treatment information platform.The authors explore the application of the information platform in the integrated treatment mode of pre-hospital first aid and trauma emergency center and realize information sharing in the front yard of trauma patients,prehospital teleconsultation and seamless docking in the front yard,so as to provide a foundation for fast,efficient and full-coverage medical treatment system for trauma.

Construction and application of information platform for pre-hospital and in-hospital synergic treatment in trauma emergency center / 中华创伤杂志

In order to provide timely and effective treatment and reduce the rate of death and disability for trauma patients, the National Health Construction Commission issued a document to promote the construction of trauma centers and achieve centralized hospitalization for trauma patients. Pre-hospital first aid is the most important part of the modern emergency medical system, and it is especially important for the successful treatment of trauma patients. In order to achieve close coordination, efficient docking, emergency clinic advancement in the front yard, and improve the success rate of trauma patients, Nanchang Emergency Center proposed an integrated treatment mode for pre-hospital first aid and trauma emergency center, and developed a pre-hospital collaborative treatment information platform. The authors explore the application of the information platform in the integrated treatment mode of pre-hospital first aid and trauma emergency center and realize information sharing in the front yard of trauma patients, pre-hospital teleconsultation and seamless docking in the front yard, so as to provide a foundation for fast, efficient and full-coverage medical treatment system for trauma.

Serum level of miR-126 in patients with hypertensive intracerebral hemorrhage and its clinical significance / 中国基层医药

Objective:To investigate the serum level of miR-126 in patients with hypertensive intracerebral hemorrhage and to elucidate its clinical significance in hypertensive cerebral hemorrhage.Methods:From January 2015 to December 2018, 60 patients with hypertensive cerebral hemorrhage were selected as observation group, and 60 healthy subjects were selected as control group in the People's Hospital of Lin'an Affiliated to Hangzhou Medical College.The serum levels of miR-126 were determined by reverse transcription-polymerase chain reaction (RT-PCR). The serum levels of C-reactive protein (CRP), tumor necrosis factor-ɑ (TNF-ɑ) and nuclear factor kappa B (NF-κB) were measured by enzyme-linked immunosorbent assay (ELISA).Results:The serum level of miR-126 in the observation group was lower than that in the control group [(0.46±0.11) vs.(1.00±0.13), t=24.562, P<0.05], and the serum levels of CRP, TNF-ɑ and NF-κB were higher than those in the control group[(8.74±0.69)mg/L vs.(3.98±0.61)mg/L, (62.43±8.26)μg/L vs.(31.28±6.54)μg/L, (19.73±1.02)μmol/L vs.(4.92±0.87)μmol/L, t=40.034, 22.902, 85.570, all P<0.05]. There were statistically significant differences in serum miR-126, CRP, TNF-ɑ, NF-κB levels among patients with different severity of hypertensive intracerebral hemorrhage[(0.57±0.09) vs.(0.44±0.12) vs.(0.36±0.11), (6.91±0.72)mg/L vs.(8.63±0.67)mg/L vs.(9.14±0.75)mg/L, (53.16±8.19)μg/L vs.(62.57±8.33)μg/L vs.(70.38±8.09)μg/L, (12.49±0.97)μmol/L vs.(19.58±1.11)μmol/L vs.(25.64±1.05)μmol/L, F=14.433, 41.379, 17.796, 623.893, all P<0.05], with the severity increased, the serum miR-126 level decreased, serum CRP, TNF-ɑ and NF-κB levels increased.The serum miR-126 level in patients with hypertensive cerebral hemorrhage of the poor prognosis group was lower than that of the good prognosis group [(0.53±0.10) vs.(0.38±0.12), t=5.279, P<0.05], and the serum levels of CRP, TNF-ɑ and NF-κB in the poor prognosis group were higher than those in the good prognosis group[(7.85±0.64)mg/L vs.(9.16±0.73)mg/L, (51.07±8.32)μg/L vs.(73.26±8.17)μg/L, (14.73±1.08)μmol/L vs.(26.52±0.99)μmol/L, t=7.392, 10.317, 43.424, all P<0.05]. The area of brain edema in patients with hypertensive intracerebral hemorrhage was negatively correlated with serum miR-126 ( r=-0.623, P<0.05), and positively correlated with serum CRP, TNF-ɑ and NF-κB ( r=0.581, 0.618, 0.642, all P<0.05). The serum miR-126 level was negatively correlated with CRP, TNF-ɑ and NF-κB in patients with hypertensive intracerebral hemorrhage ( r=-0.593, -0.624, -0.618, all P<0.05). Conclusion:The serum level of miR-126 is reduced in patients with hypertensive intracerebral hemorrhage, which may participate in the pathogenesis of hypertensive cerebral hemorrhage by participating in inflammatory reaction.The detection of serum miR-126 level has great value in evaluation of the severity and prognosis of hypertensive cerebral hemorrhage.

PSORI-CM02 ameliorates psoriasis in vivo and in vitro by inducing autophagy via inhibition of the PI3K/Akt/mTOR pathway.

BACKGROUND: Psoriasis is an inflammatory skin disease that affects an estimated 3% of the world's population. PSORI-CM02 is an empirically developed Chinese medicine formula optimised from Yin Xie Ling, summarised by national medical master Guo-Wei Xuan, that has been used for decades to treat psoriasis in the Guangdong Provincial Hospital of Chinese Medicine. However, its anti-psoriatic mechanisms are still poorly understood. In this study, we explored the effects of PSORI-CM02 on autophagy and the underlying mechanisms in TNF-α-stimulated HaCaT cells and in a mouse model of imiquimod-induced psoriasis. METHODS: Cell viability was assessed by MTT assay. Apoptosis was detected by annexin V-FITC/PI double-staining and caspase-3 assays. Autophagy was detected by electron microscopy, RT-PCR and western blotting. The PI3K/Akt/mTOR pathway was analysed by western blotting and immunochemical analysis. RESULTS: PSORI-CM02 induced autophagy and thus inhibited the proliferation of HaCaT cells via suppression of the PI3K/Akt/mTOR pathway. In mice with IMQ-induced psoriasis, PSORI-CM02 relieved psoriasis symptoms, induced autophagy and inhibited the phosphorylation of the PI3K/AKT/mTOR pathway in the skin. CONCLUSION: These results suggest that PSORI-CM02 treats psoriasis by inducing autophagy via inhibition of the PI3K/Akt/mTOR pathway.

Clinical effect of minimally invasive removal of intracranial hematoma in the treatment of patients with hypertensive intracerebral hemorrhage and its influence on inflammatory factors / 中国基层医药

Objective@#To investigate the clinical effect of minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage (HICH) and its influence on inflammatory factors.@*Methods@#From December 2015 to December 2018, 80 patients with HICH admitted to Linan People's Hospital Affiliated to Hangzhou Medical College were divided into minimally invasive group (40 cases) and control group (40 cases) by random number table method.After admission, the control group was treated with dehydration of intracranial pressure, blood pressure control, hemostasis, oxygen inhalation and infection prevention.The minimally invasive group was treated with minimally invasive intracranial hematoma clearance on the basis of the control group.The degree of neurological deficit (NIHSS) score, ADL score, hemorrhage volume, edema around hematoma and inflammatory factors were compared before and 2 weeks after treatment, and the prognosis after 3 months of treatment was compared between the two groups.@*Results@#After 2 weeks of treatment, the NIHSS score of the minimally invasive group[(6.42±1.29)points] was lower than that of the control group[(11.08±1.65)points], while the ADL score of the minimally invasive group[(68.39±8.97)points] was higher than that of the control group[(54.26±7.41)points], the differences were statistically significant between the two groups (t=14.072, 7.681, all P<0.05). The amount of bleeding [(8.34±1.29)mL] and the amount of edema around the hematoma [(5.78±1.09)mL] in the minimally invasive group were lower than those in the control group [(19.67±3.29)mL and (8.91±1.75)mL] (t=20.277, 9.602, all P<0.05). The serum levels of IL-6 [(12.65±3.87)ng/L], hs-CRP [(6.52±1.29)mg/L] and TNF- α[(35.64±4.08)g/L] in the minimally invasive group were lower than those in the control group [(27.38±6.41)ng/L, (10.84±2.04)mg/L, (47.34±6.23)mg/L] (t=12.442, 11.320, 9.936, all P<0.05). The rate of recovered well in the minimally invasive group at 3 months after treatment (42.50%) was higher than that in the control group (20.00%) (χ2=4.713, P<0.05).@*Conclusion@#Minimally invasive removal of intracranial hematoma has good clinical effect in the treatment of patients with HICH.It can alleviate inflammation, reduce the amount of hemorrhage and edema around the hematoma, and promote the recovery of nerve function.

Analysis on key points for construction of trauma emergency center of Jiangxi Province / 中华创伤杂志

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators.

Analysis on key points for construction of trauma emergency center of Jiangxi Province / 中华创伤杂志

Trauma is the leading cause of death for people under 40 years old in the world.At present,the rescue and treatment system of trauma patients in China is not yet well established,and the mortality of trauma patients is higher than those in the developed countries.Improving the treatment system is the key to reducing the trauma mortality.In order to innovate the service mode of trauma first aid,further promote the establishment of regional trauma first aid system,improve the ability of trauma treatment,reduce the mortality and disability rate of trauma patients in Jiangxi Province,recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center.In order to provide reference for the construction of trauma treatment system,the author analyzes the following aspects including functional positioning,basic requirements,organization management,and evaluation of core indicators.

Clinical effect of minimally invasive removal of intracranial hematoma in the treatment of patients with hypertensive intracerebral hemorrhage and its influence on inflammatory factors / 中国基层医药

Objective To investigate the clinical effect of minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage (HICH) and its influence on inflammatory factors.Methods From Decem-ber 2015 to December 2018,80 patients with HICH admitted to Linan People's Hospital Affiliated to Hangzhou Medi-cal College were divided into minimally invasive group (40 cases) and control group (40 cases) by random number table method.After admission,the control group was treated with dehydration of intracranial pressure ,blood pressure control,hemostasis,oxygen inhalation and infection prevention.The minimally invasive group was treated with mini-mally invasive intracranial hematoma clearance on the basis of the control group .The degree of neurological deficit (NIHSS) score,ADL score,hemorrhage volume,edema around hematoma and inflammatory factors were compared before and 2 weeks after treatment , and the prognosis after 3 months of treatment was compared between the two groups.Results After 2 weeks of treatment ,the NIHSS score of the minimally invasive group [(6.42 ±1.29)points] was lower than that of the control group [(11.08 ±1.65)points],while the ADL score of the minimally invasive group [(68.39 ±8.97) points] was higher than that of the control group [(54.26 ±7.41) points],the differences were statistically significant between the two groups (t＝14.072,7.681,all P＜0.05).The amount of bleeding [(8.34 ± 1.29)mL] and the amount of edema around the hematoma [(5.78 ±1.09)mL] in the minimally invasive group were lower than those in the control group [(19.67 ±3.29) mL and (8.91 ±1.75) mL] ( t＝20.277,9.602,all P＜0.05).The serum levels of IL-6 [( 12.65 ±3.87 ) ng／L], hs-CRP [( 6.52 ±1.29 ) mg／L] and TNF-α [(35.64 ±4.08) g／L] in the minimally invasive group were lower than those in the control group [(27.38 ± 6.41)ng／L,(10.84 ±2.04)mg／L,(47.34 ±6.23)mg／L] ( t＝12.442,11.320,9.936,all P＜0.05).The rate of recovered well in the minimally invasive group at 3 months after treatment (42.50%) was higher than that in the control group (20.00%) (χ2 ＝4.713,P＜0.05).Conclusion Minimally invasive removal of intracranial hemato-ma has good clinical effect in the treatment of patients with HICH.It can alleviate inflammation,reduce the amount of hemorrhage and edema around the hematoma ,and promote the recovery of nerve function.

Cardioprotection induced by combination of dexmedetomidine and limb ischemic preconditioning in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the cardioprotection induced by combination of dexmedetomidine and limb ischemic preconditioning in the patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Eighty American Society of Anesthesiologists physical starus Ⅱ or Ⅲ patients of both sexes,aged 52-64 yr,weighing 51-78 kg,with New York Heart Association Ⅱ or Ⅲ,scheduled for elective CABG with CPB,were divided into 4 groups (n =20 each) using a random number table method:control group (group C),limb ischemic preconditioning group (group L),dexmedetomidine group (group D) and dexmedetomidine plus limb ischemic preconditioning group (group DL).Limb ischemic preconditioning was induced by 3 cycles of 5-min unilateral lower limb ischemia followed by 5-min reperfusion starting from 30 min before aortic clamping in L and DL groups.Dexmedetomidine was injected via the central vein in a loading dose of 1 μg/kg after induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of operation in D and DL groups.Venous blood samples were obtained immediately before aortic clamping,at the end of CPB and at the end of operation for determination of plasma concentrations of cardiac troponin Ⅰ (cTnI) by enzyme-linked immunosorbent assay.Myocardial tissues were obtained from the right auricle immediately before aortic clamping and at the end of CPB for determination of the expression of Bcl-2 and Bax (by immunohistochemistry) and apoptosis index (AI) (using TUNEL).The restoration of spontaneous heart beat was recorded.Bcl-2/Bax ratio was calculated.Results Compared with group C,the plasma cTnI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in the other three groups (P＜0.05).Compared with L and D groups,the plasma cT-nI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in group DL (P＜0.05).The rate of restoration of spontaneous heart beat was significantly increased in group DL as compared with the other three groups (P＜0.05).Conclusion Combination of dexmedetomidine and limb ischemic preconditioning can mitigate myocardial injury,it provides better efficacy than either alone,and the mechanism is related to inhibiting cell apoptosis in the patients undergoing CABG with CPB.

Effect of intrathecal dexmedetomidine pretreatment on myocardial ischemia-reperfusion injury in rats / 中华麻醉学杂志

Objective To investigate the effect of intrathecal dexmedetomidine pretreatment on my-ocardial ischemia-reperfusion (I∕R) injury in rats. Methods Forty-five adult Sprague-Dawley rats of both sexes, weighing 200-250 g, in which intrathecal catheters were successfully placed without complications, were divided into 3 groups (n= 15 each) using a random number table: sham operation group (group S), group I∕R and intrathecal dexmedetomidine pretreatment group ( group DEX). Myocardial I∕R injury was produced by occlusion of the left anterior descending branch of the coronary artery for 30 min followed by 120 min reperfusion. Dexmedetomidine 1 μg∕kg (diluted to 10 μl in normal saline) was intrathecally injec-ted at 30 min before ischemia in group DEX. The equal volume of normal saline was given in group I∕R. Blood samples were collected from the cardiac apex at the end of reperfusion for measurement of plasma nor-epinephrine (NE) and cardiac troponin I ( cTnI) concentrations. Then all the rats were sacrificed, and myocardial tissues were obtained for determination of myocardical infarct size, and the spinal cord was isola-ted to detect the expression of c-fos in the spinal dorsal horn by Western blot. Results Compared with group S, the myocardical infarct size, plasma NE and cTnI concentrations were significnatly increased, and the expression of c-fos in the spinal dorsal horn was up-regulated in I∕R and DEX groups (P<0. 05). Compared with group I∕R, the myocardical infarct size, plasma NE and cTnI concentrations were signific-natly decreased, and the expression of c-fos in the spinal dorsal horn was down-regulated in group DEX (P<0. 05). Conclusion Intrathecal dexmedetomidine pretreatment can reduce myocardial I∕R injury in rats, and the mechanims may be related to decreasing plasma NE levels and inhibiting c-fos expression in the spinal dorsal horn.

Performance verification of Hitachi 7600 automatic biochemical analyzer / 国际检验医学杂志

Objective To verify the performance of Hitachi 7600 automatic biochemical analyzer .Methods According to labora‐tory accreditation criteria and the performance verification documents of American CLIA′88 ,the precision ,accuracy ,reference inter‐val ,linear range and clinical reportable range were verified for the tests of 19 conventional biochemical indicators performed on Hita‐chi 7600 biochemical analyzer most often .Results The precision ,accuracy ,reference interval ,linear range and clinical reportable range were all acceptable .Conclusion Hitachi 7600 automatic biochemical analyzer could fully meet the reqirements in clinical ap‐plication .

Effect of ulinastatin on expression of aquaporin-4 during cerebral ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of ulinastatin on the expression of aquaporin-4 (AQP4) during focal cerebral ischemia-reperfusion (I/R) in rats.Methods One hundred and thirty-five male adult SpragueDawley rats,weighing 230-280 g,were randomly divided into 3 groups (n =45 each):sham operation group (S group),I/R group and ulinastatin group (group U).The rats were anesthetized with intraperitoneal 10％ chloral hydrate 3.5 ml/kg.Focal cerebral ischemia was induced by 2 h middle cerebral artery occlusion followed by 24 repeffusion.In U group,ulinastatin 100000 U/kg was injected immediately after beginning of reperfusion,while the equal volume of normal saline was injected in S and I/R groups.The rats were sacrificed at 6,24 and 48 h of repeffusion and brains were removed for determination of infract volume (by TTC),brain water content and expression of AQP4 (by immunohistochemistry) in brain tissues.Results Compared with S group,the infarct volume and brain water content were significantly increased,and the expression of AQP4 was up-regulated at each time point in I/R and U groups (P ＜ 0.05).Compared with I/R group,the infarct volume and brain water content were significantly decreased,and the expression of AQP4 was down-regulated at each time point in U group (P ＜0.05).Conclusion The mechanism by which ulinastatin mitigates focal cerebral I/R injury is related to down-regulation of AQP4 expression in brain tissues.

Myocardial Protective Effect of Adenosine Preconditioning Against Ischemia-reperfusion Injury in Patients with Valve Replacement Surgery / 医学研究杂志

Objective To investigate the myocardial protective effect of adenosine preconditioning against ischemia-reperfusion injury in patients who were undergone valve replacement during cardiac pulmonary bypass.Methods 42 patients scheduling for valve replacement operation were divided randomly into two groups:experiment group(n=23) and control group(n=19).Adenosine preconditioning were performed in experiment group before cardiac pulmonary bypass.To estimate the plasma level of cardiotroponin I (cTnI),creatine kinase isoenzyme (CK-MB ),radialis arterial blood was drown at following time points respectively: before operation,30 minutes before and after aortic clamp,1 hour and 3 hours after aortic opened.Meanwhile the rate of heart spontaneous rebeating,defibrillation,arrhythmia and cardiac inotropic agents used and its duration were recorded.Results The elevated range of plasm cTnI and CK-MB in experiment group were obviously lower than that in control group.In experiment group,the rate of heart spontaneous rebeating were higher,but the frequency of defibrillation,arrhythmia and the cardiac inotropic agents used and its duration were lower than those of control group.Conclusion Adenosine preconditioning has notable clinical protective effects on myocardial ischemia-reperfusion injury in patients undergone valve replacement during cardiac pulmonary bypass.

Powder X-ray Diffraction Analysis with Fourier Pattern on Baiziyangxin Pills / 中成药

Objective:To analyze geometry topography and the characteristic diffraction peaks of powder X-ray diffraction Fourier pattern for Baiziyangxin Pills and establish its quality standard.Methods:X-ray diffraction Fourier patterns for Baiziyangxin Pills have been analyzed and calculated by powder X-ray diffraction methods.Results:The standard X-ray diffraction Fourier pattern and characteristic diffraction peaks of Baiziyangxin Pills were obtained. Conclusion:The powder X-ray diffraction Fourier pattern analysis is able to be used for the identification of Chinese Patent medicine.