A study of damage control theory in the treatment of multiple trauma mainly represented by emergency abdominal trauma.

OBJECTIVE: This study aimed to explore the measures of damage control theory (DCT) in the treatment of multiple trauma mainly represented by emergency abdominal trauma. PATIENTS AND METHODS: A total of 76 patients with severe multiple trauma in the Yiwu Central Hospital were selected. Among them, 37 patients with severe multiple trauma were treated with DCT (DCT group), and 39 patients were treated with traditional methods (control group). The prothrombin time (PT), the inflammation index, the duration of mechanical ventilation, the length of stay in the Intensive Care Unit (ICU), and the incidence of sepsis were compared between the two groups. RESULTS: A total of 60 cases (78.95%) were cured and discharged, and 4 cases (10.81%) died in the DCT group, while 12 cases (30.77%) died in the control group. There were 6 cases (16.22%) of sepsis in the DCT group and 15 cases (38.46%) of sepsis in the control group. This indicates that the mortality and the incidence of sepsis in the DCT group were lower than those in the control group (p<0.05 in all comparisons). The PT activated partial thromboplastin time (APTT), the length of stay in the ICU, and mechanical ventilation in the DCT group were notably shorter than those in the control group. The levels of serum tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), C-reactive protein (CRP), and IL-10 went up remarkably in both groups (p<0.05), but the levels of serum TNF-α, IL-6, and CRP in the DCT group were lower than those in the control group, while the IL-10 level in the former was significantly higher than that in the latter (p<0.05). CONCLUSIONS: It is feasible to apply DCT to rescue patients with multiple trauma, which can effectively reduce the mortality and complications, and shorten the length of stay in the ICU.

Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression.

BACKGROUND: Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success. OBJECTIVE: To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve the prevention strategy. SEARCH STRATEGY: Pubmed, Scopus, Cochrane, and cross-references were searched. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention. DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data. A random-effects model was used to analyse the relative risk (RR) and 95% confidence interval (95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness. MAIN RESULTS: Forty-seven RCTs involving 15 745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI 0.69-0.87). Four key aspects were identified to improve the preventive effect: targeting the high-risk population; an early initiation of the intervention; the correct intensity and frequency of exercise; and gestational weight gain management. Although 24 RCTs targeted women who were overweight or obese, body mass index (BMI) failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence populations rather than simply in women who are overweight or obese. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to an approximately 24% reduction in GDM. CONCLUSION: The best strategy to prevent GDM is to target the high-risk population predicted by risk evaluation models and to control the gestational weight gain of women through intensified diet and exercise modifications early in their pregnancy. TWEETABLE ABSTRACT: Four key effectiveness moderators of lifestyle interventions for GDM prevention.

[The relationship between accommodative accuracy at different near-work distances and early-onset myopia].

OBJECTIVE: To observe the accommodative accuracy of children with early-onset myopia at different near-work distances, and discuss the relationship between accommodative accuracy and early-onset myopia. METHODS: This was a case-control study. Thirty-seven emmetropic children, 41 early-onset myopic children without correction, and 39 early-onset myopic children with spectacles, aged 7 to 13 years, were included. Measures of refractive errors and accommodative accuracy at four near-work distances, including 50 cm, 40 cm, 30 cm, and 20 cm, were made using the binocular fusion cross cylinder (FCC) of an automatic phoropter. RESULTS: Most candidates showed accommodative lags, including the children with emmetropia. The ratio of lags in all candidates at different near-work distances was 75.21% (50 cm), 87.18% (40 cm), 92.31% (30 cm), and 98.29% (20 cm), respectively. All accommodative accuracies became worse, and the accommodative lag ratio and values of FCC increased, along with the shortening of the distance. The difference in accommodative accuracy among groups was statistically significant at 30 cm (χ(2)=7.852, P= 0.020) and 20 cm (χ(2)=6.480, P=0.039). The values of FCC among groups were significantly different at 30 cm (F=3.626, P=0.030) and 20 cm (F=3.703, P=0.028), but not at 50 cm and 40 cm (P>0.05). In addition, the FCC values of 30 cm and 20 cm had a statistically significant difference between myopic children without correction [(1.25±0.44) D and (1.76±0.43) D] and emmetropic children [(0.95±0.52) D and (1.41±0.58) D] (P=0.012, 0.008). The correlation between diopters of myopia and accommodative accuracy at different nearwork distances was not statistically significant (P>0.05). However, the correlation between diopters of myopia and the accommodative lag value (FCC) at 20 cm was statistically significant (r=0.246, P=0.028). CONCLUSIONS: The closer the near-work distance is, the worse the accommodative accuracy is. This is more significant in early-onset myopia, especially myopia without correction, than emmetropia. Wearing spectacles may improve the threshold and sensitivity of accommodations, and the accommodative accuracy at near-work distances (<30 cm) to some extent. The poor accommodative accuracy at near-work distances may be not related to early-onset myopia, but the value of FCC (20 cm) is related to early-onset myopia. The higher the FCC value is, the higher the diopter is. (Chin J Ophthalmol, 2016, 52: 520-524).

[Clinical study on effect of ginsenoside in inducing rectal cancer cell apoptosis].

OBJECTIVE: To explore the effect of ginsenoside in inducing rectal cancer cell apoptosis. METHODS: Fifty patients of rectal cancer diagnosed by pathological examination were randomly divided into two groups, 35 in the treated group and 15 in the control group. The treated group received retention enema with 84.5% ginsenoside for 4-6 hrs every day, 6-8 days consecutively before surgical operation. The control group also received retention enema in the same way but with normal saline instead of ginsenoside. Fresh sample was taken during the operation and examined by electron microscopy. RESULTS: Symptoms, such as frequent defecation, hematochezia and tenesmus, were palliated in most patients (25/35) and abdominal pain relieved in all the 7 cases of incomplete intestinal obstruction in the treated group. Electron microscopic examination showed that cell apoptosis was observed in cancer sample of 23 cases among the 35 cases of the treated group, amounting to 65.7%. While in the control group, above-mentioned changes were not observed at all. CONCLUSION: Ginsenoside has the effect of inducing apoptosis in rectal cancer patients.

Use of selective embolization of the bilateral cavernous arteries for posttraumatic arterial priapism.

Nonischemic arterial high flow priapism caused by traumatic laceration of a branch of the penile cavernous artery is rare. We report a case of laceration of the left and right branches of the intracavernous artery, which was confirmed by selective internal pudendal arteriography. Bilateral cavernous artery embolization was performed using gelatin sponge and detumescence occurred immediately. Normal potency was evident 4 months later. Our case demonstrates that selective cavernous arterial embolization is a safe and effective therapy for arterial priapism and that erectile function can return to normal.