SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHILDREN: REPORT OF 2 CASES AND REVIEW OF LITERATURES

Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiactrauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricularseptal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect re-pair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture ofposterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association (NYHA) class echocardiographyshowed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second pa-tient is in NYHA class echocardiography showed mild mitral regurgitation. Conclusion Blunt traumaticheart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is ad-vocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up isnecessary.

Enhancement of matrix metalloproteinases 2 and 9 accompanied with neurogenesis following collagen glycosaminoglycan matrix implantation after surgical brain injury

Surgical brain injury may result in irreversible neurological deficits. Our previous report showed that partial regeneration of a traumatic brain lesion is achieved by implantation of collagen glycosaminoglycan（CGM）. Matrix metalloproteinases（MMPs） may play an important role in neurogenesis but there is currently a lack of studies displaying the relationship between the stimulation of MMPs and neurogenesis after collagen glycosaminoglycan implantation following surgical brain trauma. The present study was carried out to further examine the expression of MMP2 and MMP9 after implantation of collagen glycosaminoglycan（CGM） following surgical brain trauma. Using the animal model of surgically induced brain lesion, we implanted CGM into the surgical trauma. Rats were thus divided into three groups：（1） sham operation group： craniotomy only;（2） lesion（L） group： craniotomy ＋ surgical trauma lesion;（3） lesion ＋ CGM（L ＋ CGM） group： CGM implanted following craniotomy and surgical trauma lesion. Cells positive for SOX2（marker of proliferating neural progenitor cells） and matrix metalloproteinases（MMP2 and MMP9） in the lesion boundary zone were assayed and analyzed by immunofluorescence and ELISA commercial kits, respectively. Our results demonstrated that following implantation of CGM after surgical brain trauma, significant increases in MMP2^＋/SOX2^＋ cells and MMP9^＋/SOX2^＋ cells were seen within the lesion boundary zone in the L ＋ CGM group. Tissue protein concentrations of MMP2 and MMP9 also increased after CGM scaffold implantation. These findings suggest that implantation of a CGM scaffold alone after surgical brain trauma can enhance the expression of MMP2 and MMP9 accompanied by neurogenesis.

EVALUATION ON FACTORS INFLUENCING LIVER CANCER METASTASIS AFTER LIVER SURGERY BY A MOUSE MODEL

Objective: To evaluate the influence of surgical trauma on liver cancer metastasis. Methods: A mouse model of experimental liver cancer metastasis was established by subcapsule injecting hepatoma ascites tumor cells (H22) into spleen of NIH mice. Simple intrasplenic inoculation, with sham operation, partial hepatectomy, total occlusion of hepatic blood inflow and blood loss and re-perfusion were performed and metastatic effects were observed. Results: There were significant higher metastasis-augmenting effects in sham operation and partial hepatectomy groups. Compared with no-blood transfusion, blood transfusion group was found to be potent to increase intrahepatic metastases. But, neither inhibition nor enhancement with total occlusion of hepatic blood inflow for 20 and 30 minutes was seen. Conclusions: Surgical trauma, especially partial hepatectomy and blood transfusion, are involved in enhancing metastasis, but total occlusion of hepatic blood inflow is not responsible for enhanced liver metastasis in the experimental metastasis model.

Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas

BACKGROUND Colon cancer is associated with a higher incidence among residents in highaltitude areas.Hypoxic environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes,thereby increasing the inflammatory factors,inhibiting the body’s innate immunity and increasing the risk of colon cancer.AIM To examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas.METHODS Ninety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method,with 46 patients in each group.Minimally invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy group.Operative conditions,inflammatory index pre-and post-surgery,immune function index and complication probability were measured.RESULTS Operative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less(all P<0.05)in the minimally invasive group than in the laparotomy group.The number of lymph nodes dissected was not significantly different.Before surgery,there were no significant differences in serum C-reactive protein,interleukin-6 and tumor necrosis factor-αlevels between the groups,whereas after surgery,the levels were significantly higher in the minimally invasive group(26.98±6.91 mg/L,146.38±11.23 ng/mL and 83.51±8.69 pg/mL vs 41.15±8.39 mg/L,186.79±15.36 ng/mL and 110.65±12.84 pg/mL,respectively,P<0.05).Furthermore,before surgery,there were no significant differences in CD3+,CD4+and CD4+/CD8+levels between the groups,whereas after surgery,the levels decreased in both groups,being significantly higher in the minimally invasive group(55.61%±4.39%,35.45%±3.67%and 1.30±0.35 vs 49.68%±5.33%,31.21%±3.25%and 1.13±0.30,respectively,P<0.05).Complication probability was significantly lower in the minimally invasive group(4.35%vs 17.39%,P<0.05).CONCLUSION Laparoscopic minimally invasive procedures reduce surgical trauma and alleviate the inflammatory response and immune dysfunction caused by invasive operation.It also shortens recovery time and reduces complication probability.

Observations on the Preventive Effects of Anti-infective Treatment on Wound Infection in Emergency Surgery

Objective:To explore the preventive effects of anti-infective treatment on wound infection in emergency surgical trauma.Methods:180 patients in our hospital from 2019 to June to May 2020 were selected as subjects.The 180 patients were randomly divided into two groups.The control group had 90 cases and adopted the conventional treatment method,and the experimental group received anti-infective treatment.The wound healing,infection status,and patient satisfaction of the two groups of patients were analyzed.Results:The wound healing,infection status,and patient satisfaction of the experimental group were better than those of the control group.Conclusion:The application of anti-infective treatment to the prevention of wound infection in emergency surgical trauma can reduce the infection rate of the patients'incision and promote the recovery of patients.It is suitable for clinical applications.

The use of virtual surgical planning and navigation in the treatment of orbital trauma

Virtual surgical planning （VSP） has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three- dimensional （3D） printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

Prehospital care for multiple trauma patients in Germany

For the German speaking countries, Tscherne＇s definition of ＂polytrauma＂ which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The ＂Primary Survey＂ is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support （PHTLS）-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis （＂treat-first-what-kills-first＂）. If no immediate treatment is necessary, a ＂Secondary Sur- vey＂ follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay （＂work and go＂） to TR-DGU certified trauma centers of the local trauma networks. Due to the difficult prehospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline ＂Polytrauma/Schwerstverletzten Behandlung＂, the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.