Isolated non-compaction of ventricular myocardium in a victim of the Wenchuan earthquake with crush syndrome and acute renal failure

Non-compaction of the ventricular myocardium （NVM） is a rare congenital genetic heart defect that was initially reported 17 years ago by means of autopsy; few cases have been published since then. It has been classified as the primary inherited cardiomyopathy by the American Heart Association Scientific Statement in 2006 under contemporary definitions and classification of cardiomyopathies. It is caused by an arrested development of muscle fiber compaction, a process that normally takes place dunng early embryogenesls, which is characterized by numerous sinusoids or trabeculae that are excessive in number and abnormal in prominence and by deep intratrabecular recesses covered by endothelium that exhibits continuity with ventricular endocardium. It usually involves one and/or more segments of the left ventricle, while the clinical manifestations are highly variable,

Infectious complications in patients with crush syndrome following the Wenchuan earthquake

Objective： To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China. Methods： Atotal of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically. Results： In the obtained database, 112 out of the 147 （75.7%） patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infec- tion （P=0.013, odds ratio 2.25;P=0.017, odds ratio 2.31）. Sep- sis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not （P=O.O01 ）. Conclusion： Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital-acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment de- compression incisions may decrease the incidence of in- fection and ameliorate the prognosis.

Magnetic resonance imaging and magnetic resonance angiography in severe crush syndrome with consideration of fasciotomy or amputation： a novel diagnostic tool

Three cases of severe crush syndrome after the Wenchuan earthquake in China are presented. The patients, 2 males and one female ranging in age from 18-45 years were studied via 1.5 T magnetic resonance imaging （MRI） and magnetic resonance angiography （MRA）. MRI examinations were performed more than twice on two patients within 60 days of the earthquake. All the patients had acute renal failure （ARF） with plasma myoglobin concentrations above 17 000 pg/L. The T2-weighted and short time inversion recovery （STIR） sequences revealed high intensity lesions in the affected muscles, and enhanced Tl-weighted images showed enhancement of partial affected muscles. MRA revealed no signs of arterial occlusion, artedostenosis, or filling defects of main arteries. All patients were managed medically with continuous venous-venous hemofiltration and other supportive care, and none required fasciotomy or amputation. Repeat MR studies showed that the high intensity lesions seen on the T2-weighted and STIR sequences resolved in parallel with improvement of laboratory studies and clinical course.

Severe crush syndrome complicated with acute pancreatitis： a case report and review of the literatures

Earthquake is one of the most catastrophic natural disasters. As we know, crush syndrome is the secondmost frequent cause of mortality after the direct impact of trauma.1-3 It is a serious clinical case that develops among casualties of earthquakes or other catastrophic events that may also result in a variety of ensuing uncommon complications. Cases of crush syndrome complicated with acute pancreatitis （AP） following the earthquakes are seldom reported.

RIG-I,a novel DAMPs sensor for myoglobin,activates NF-κB/caspase-3 signaling in CS-AKI model

Background:Acute kidney injury(AKI)is the main life-threatening complication of crush syndrome(CS),and myoglobin is accepted as the main pathogenic factor.The pattern recognition receptor retinoicacid-inducible gene I(RIG-I)has been reported to exert anti-viral effects function in the innate immune response.However,it is not clear whether RIG-I plays a role in CS-AKI.The present research was carried out to explore the role of RIG-I in CS-AKI.Methods:Sprague-Dawley rats were randomly divided into two groups:the sham and CS groups(n=12).After administration of anesthesia,the double hind limbs of rats in the CS group were put under a pressure of 3 kg for 16 h to mimic crush conditions.The rats in both groups were denied access to food and water.Rats were sacrificed at 12 h or 36 h after pressure was relieved.The successful establishment of the CS-AKI model was confirmed by serum biochemical analysis and renal histological examination.In addition,RNA sequencing was performed on rat kidney tissue to identify molecular pathways involved in CS-AKI.Furthermore,NRK-52 E cells were treated with 200μmol/L ferrous myoglobin to mimic CS-AKI at the cellular level.The cells and cell supernatant samples were collected at 6 h or 24 h.Small interfering RNAs(siRNA)was used to knock down RIG-I expression.The relative expression levels of molecules involved in the RIG-I pathway in rat kidney or cells samples were measured by quantitative real-time PCR(qPCR),Western blotting analysis,and immunohistochemistry(IHC)staining.Tumor necrosis factor-α(TNF-α)was d etected by ELISA.Co-immunoprecipitation(Co-IP)assays were used to detect the interaction between RIG-I and myoglobin.Results:RNA sequencing of CS-AKI rat kidney tissue revealed that the different expression of RIG-I signaling pathway.qPCR,Western blotting,and IHC assays showed that RIG-I,nuclear factor kappa-B(NF-κB)P65,p-P65,and the a poptotic marker caspase-3 and cleaved caspase-3 were up-regulated in the CS group(P<0.05).However,the levels of interferon regulatory factor 3(IRF3),p-IRF3 and the antiviral factor interferon-beta(IFN-β)showed no significant c hanges between the sham and CS groups.Co-IP assays showed the interaction between RIG-I and myoglobin in the kidneys of the CS group.Depletion of RIG-I could alleviate the myoglobin induced expression of apoptosis-associated molecules via the NF-κB/caspase-3 axis.C onclusions:RIG-I is a novel damage-associated molecular patterns(DAMPs)sensor for myoglobin and participates in the NF-κB/caspase-3 signaling pathway in CS-AKI.In the development of CS-AKI,specific intervention in the RIG-I p athway might be a potential therapeutic strategy for CS-AKI.

Protective effects of ischemic postconditioning on intestinal mucosa barrier function in rabbits with crush injury of hind limb： an experimental study

Objective： To explore the protective effects of two types of ischemic postconditioning （IP） on intestinal mucosa barrier in rabbits with crush injury of the hind limb. Methods： This study was conducted between August and December 2008 in the Department of Trauma Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. The model of crush injury to the hind limb of rabbits was firstly developed by a 25 kg object with the right hind limbs fixed by wooden splints, and then two types of IP were established, including occluding/opening the common iliac artery and vein alternatively （traditional IP, IP A） and binding/loosening the proximum of the injured hind limb altematively （modified IP, IP B）. Thirty-six male New Zealand white rabbits were randomly divided into three groups： IP A group, IP B group and control group, with 12 rabbits in each group. The serum levels of diamine oxidase （DAO） and intestinal fatty acid-binding protein （I-FABP） were detected at 2, 6, 12 and 24 hours after injury. Pathologi- cal changes of ileum were examined at 24 hours after injury. Results： The serum levels of I-FABP at 2, 6, 12 and 24 hours after injury in both IPA and IP B groups had a significant decrease, compared with control group. DAO levels also showed the same change trend at 2 and 6 hours after injury, but showed no significant difference between two IP groups. No difference in pathological changes of ileum was found among the three groups. Conclusions： IP can protect intestinal mucosa barrier function on the model of hind limb crush injury in rabbits. Meanwhile the modified IP B shows the same protection as the traditional IP A, and is worth applying in clinic.

Challenges for rear hospital care of Wenchuan Earthquake casualties： experience from West China Hospital

To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital （WCH） were retro- spectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome （MODS） was 39.6%, 20,7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.