Multilocular thymic cysts can be easily misdiagnosed as malignant tumor on computer tomography: A case report.

BACKGROUND: Multilocular thymic cyst (MTC) is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation. It is usually characterized by well-defined cystic density and is filled with transparent liquid. CASE SUMMARY: We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum. Computer tomography (CT) imaging showed that the mass was irregular with unclear boundaries. After injection of contrast agent, there was a slight enhancement of stripes and nodules. According to CT findings, it was diagnosed as thymic cancer. CONCLUSION: After surgery, MTC accompanied by bleeding and infection was confirmed by pathological examination. The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings. Caution is necessary in clinical work to avoid misdiagnosis.

Astragaloside IV targeting autophagy of T cells improves inflammation of asthma.

Astragaloside IV (AST) has been confirmed to have antiasthmatic effects. However, the underline mechanism is unclear. The study aimed to explore the treatment mechanism of AST based on autophagy of memory T cells. AST treatment significantly decreased the number of T effector cells in asthma mice blood and the nude mice that received AST-treated TCMs had relieved inflammation compared with the untreated group; meanwhile, we found that AST significantly decreased the autophagy level and inhibited OX40/OX40L signal pathway of lymphocytes. The results highlighted that AST regulated autophagy to inhibit differentiation of effector T-cell phenotype.

Management and outcome of bronchial trauma due to blunt versus penetrating injuries.

BACKGROUND: The number of patients with bronchial trauma (BT) who survived to hospital admission has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients, whose diagnosis is frequently delayed. AIM: To describe the early recognition and surgical management considerations of blunt and penetrating BTs, and to elaborate the differences between them. METHODS: All patients with BTs during the past 15 years were reviewed, and data were retrospectively analyzed regarding the mechanism of injury, diagnostic and therapeutic procedures, and outcomes. According to the injury mechanisms, the patients were divided into two groups: Blunt BT (BBT) group and penetrating BT (PBT) group. The injury severity, treatment procedures, and prognoses of the two groups were compared. RESULTS: A total of 73 patients with BT were admitted during the study period. The proportion of BTs among the entire cohort with chest trauma was 2.4% (73/3018), and all 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group, and the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group (n = 38) and 34.3% in the PBT group (n = 35). In the BBT group, a delay in diagnosis for over 48 h occurred in 55.3% of patients. In the PBT group, 31 patients underwent emergency thoracotomy due to massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) and 5.7% (2/35) in the BBT group and PBT group, respectively (P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations. CONCLUSION: The difference between blunt and penetrating BTs is obvious. In BBT, patients generally have no vessel injury, and the diagnosis is easily missed, leading to delayed treatment. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax, and delays in diagnosis are infrequent. The leading cause of death is hemorrhagic shock.

The Chinese consensus for surgical treatment of traumatic rib fractures 2021 (C-STTRF 2021).

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.

Blunt Cardiac Injury: A Single-Center 15-Year Experience.

In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition-nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant (P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A (P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases.

BACKGROUND: Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in trauma patients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival. METHODS: All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. RESULTS: A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9. CONCLUSIONS: Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma: a case report.

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from suprasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years follow-up.

[Effects of electroacupuncture of "Zusanli" (ST 36), "Hegu" (LI 4) and/or "Sanyinjiao" (SP 9) on immunofunction in gastric carcinectomy rats].

OBJECTIVE: To study the effect of electroacupuncture (EA) of "Zusanli" (ST 36), "Hegu" (LI 4) and/or "Sanyinjiao" (SP 6) on immune functions in gastric carcinoma rats after operation. METHODS: Wistar rats were randomly divided into normal control, ST36, L14, SP6, ST36 + LI4, ST36 + SP6, LI4 + SP6, ST36 + LI4 + SP6, non-acupoint (about 10 mm lateral to ST36) and model groups, with 6 cases in each. Gastric carcinoma model was made by intraperitoneal injection of Walker-256 cloned strain (0.1 ml, 2 x 10(7) cells). EA (2-100 Hz, 1-3 mA) was applied to these acupoints for 30 min, once daily for 7 days. Serum IgG, IgM, IgA, C3 and C4 contents were detected with simple immunodiffusion method; and CD4+ and CD8+ levels were measured by flow cytometry. RESULTS: In comparison with normal control group, serum IgG, IgM, IgA, C3, C4 and CD8+ contents, and CD4+/CD8+ in model group decreased significantly (P < 0.05, 0.01); while CD8+ content in model group increased remarkably (P < 0.01). Compared with model group, serum IgG, IgM, IgA, C3, C4, CD4+, CD8+ and CD4+/CD8+ in non-acupoint group had no significant changes (P > 0.05), while most of these indexes in EA groups (ST36, LI4, SP6, ST36+ LI4, ST36 + SP6, LI4 + SP6, ST36 + LI4 + SP6) increased considerably (P < 0.05, 0.01) except CD8+ level (decreased significantly, P < 0.05, 0.01). No significant differences were found among 7 EA groups (P > 0.05), but the effects of ST36 + LI4 + SP6 group were slightly better than those of the other 6 EA groups. CONCLUSION: EA of "Zusanli" (ST 36), "Hegu" (LI 4) or "Sanyinjiao" (SP 6) or two of them or these 3 acupoints can obviously enhance the immune function of post-surgery rats with gastric carcinoma.

Analysis on care outcome of patients with polytrauma and coma.

OBJECTIVE: To make further improvement of outcome of patients with polytrauma and coma. METHODS: The data of 3361 patients (2378 males and 983 females, aged from 5-95 years, 38.2 years on average) with severe polytrauma and coma admitted to Chongqing Emergency Medical Center (Level I Trauma Center), Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. RESULTS: The overall survival rate and mortality were 93.2% (3133/3361) and 6.8% (228/3361), respectively. The mortalities in patients with coma duration less than 1 hour and combined with neural dysfunction and in patients with coma duration larger than or equal to 1 hour and combined with or without neural dysfunction were significantly higher than that of those with coma duration less than 1 hour but without neural dysfunction [39.5% (136/344) vs 3.0% (92/3017), P less than 0.01]. There existed significant differences in GCS, ISS, and revised trauma score (RTS) between the death group and the survival group (P less than 0.01). RTS was in good correspondence with patient's pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure (SBP). The mortality in patients with SBP less than 90 mm Hg was significantly higher than that of those with SBP larger than or equal to 90 mm Hg [33.3% (68/204) vs 5.1% (160/3157), P less than 0.01]. The mortality in polytrauma patients combined with serious head injury (AIS larger than or equal to 3) was 8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury (23.9%, 61.1% vs 27.3%, 50.0%). The mortality reached up to 61.9% in patients complicated with severe head, chest and abdomen injuries simultaneously. CONCLUSIONS: It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe polytrauma and coma.