下腔静脉损伤的救治经验:附12例报告

目的探讨下腔静脉损伤的修复方法。方法对12例下腔静脉损伤患者临床资料进行回顾性分析。结果闭合性损伤9例,开放性损伤3例。入院时均伴有休克。均诊断为腹腔内脏损伤,无1例诊断为下腔静脉损伤。12例均手术治疗,直视下修复5例,大网膜填塞后肝实质大块褥式缝合2例,纱布填塞5例。术后并发症7例(58.3%):胆漏1例,隔下脓肿合并反应性右侧胸腔积液2例,创伤性肝囊肿1例,腔静脉血栓形成1例,大出血2例;死亡3例,病死率25.0%。结论腔静脉损伤病情凶险,处理困难,病死率高,改良的全肝血流阻断下行纱布填塞止血效果好,抢救成功率高,值得推广。

Relationship between subsurface damage and surface roughness of ground optical materials

A theoretical model of relationship between subsurface damage and surface roughness was established to realize rapid and non-destructive measurement of subsurface damage of ground optical materials.Postulated condition of the model was that subsurface damage depth and peak-to-valley surface roughness are equal to depth of radial and lateral cracks in brittle surface induced by small-radius(radius≤200 μm)spherical indenter,respectively.And contribution of elastic stress field to the radial cracks propagation was also considered in the loading cycle.Subsurface damage depth of ground BK7 glasses was measured by magnetorheological finishing spot technique to validate theoretical ratio of subsurface damage to surface roughness.The results show that the ratio is directly proportional to load of abrasive grains and hardness of optical materials,while inversely proportional to granularity of abrasive grains and fracture toughness of optical materials.Moreover,the influence of the load and fracture toughness on the ratio is more significant than the granularity and hardness,respectively.The measured ratios of 80 grit and 120 grit fixed abrasive grinding of BK7 glasses are 5.8 and 5.4,respectively.

Significance of endothelial dysfunction in the pathogenesis of early and delayed radiation enteropathy

This review summarizes the current state of knowledge regarding the role of endothelial dysfunction in the pathogenesis of early and delayed intestinal radiation toxicity and discusses various endothelial-oriented interventions aimed at reducing the risk of radiation enteropathy. Studies published in the biomedical literature during the past four decades and cited in PubMed, as well as clinical and laboratory data from our own research program are reviewed. The risk of injury to normal tissues limits the cancer cure rates that can be achieved with radiation therapy. During treatment of abdominal and pelvic tumors, the intestine is frequently a major close-limiting factor. Microvascular injury is a prominent feature of both early （inflammatory）, as well as delayed （fibroproliferative） radiation injuries in the intestine and in many other normal tissues. Evidence from our and other laboratories suggests that endothelial dysfunction, notably a deficiency of endothelial thrombomodulin, plays a key role in the pathogenesis of these radiation responses. Deficient levels of thrombomodulin cause loss of vascular thromboresistance, excessive activation of cellular thrombin receptors by thrombin, and insufficient activation of protein C, a plasma protein with anticoagulant, anti-inflammatory, and cytoprotective properties. These changes are presumed to be critically involved in many aspects of early intestinal radiation toxicity and may sustain the fibroproliferative processes that lead to delayed intestinal dysfunction, fibrosis, and clinical complications. In conclusion, injury of vascular endothelium is important in the pathogenesis of the intestinal radiation response. Endothelial-oriented interventions are appealing strategies to prevent or treat normal tissue toxicity associated with radiation treatment of cancer.

Endoscopic ultrasonographic appearance of gastric emphysema

Emphysematous gastritis (or phlegmonous gastritis) and gastric emphysema (or gastric pneumatosis) are variations of conditions associated with the presence of intramural air in the stomach. The presence of air in the gastric wall is a very rare clinical condition, associated with bacterial infection, increased intragastric pressure from gastric outlet obstruction, gastric mucosal disruption or air dissection from the mediastinum. In adults, this can occur in the setting of instrumentation-related injury, gastric outlet obstruction by gastric, duodenal or pancreatic malignancies or bowel ischemia. Here we describe a case of gastric emphysema related to repeated biliary stenting and partial duodenal obstruction in a patient with inoperable periampullary cancer, and provide the first description of the endoscopic ultrasonographic findings of gastric emphysema in the literature. In our case, endoscopic ultrasound showed a band of bright echogenicity arising from the submucosa layer, representing air in the gastric wall.

Characterization of deep ground geothermal field in Jiahe Coal Mine

Research into the characteristics of geothermal fields is important for the control of heat damage in mines. Based on measured geothermal data of boreholes from 200 m to 1200 m in a Jiahe Coal Mine, we demonstrate non-linear but increasing relations of both geo-temperatures and geothermal gradients with increases depth. Numerically, we fitted the relationship between geo-temperatures and depth, a first-order exponential decay curve, formulated as: T(h) = 4.975 + 23.08 exp(h/1736.1).

AMPUTATION FOR SEVERELY INJURED LOWER EXTREMITIES

Objective. To investigate the role of amputation in management of severely injured extremities and factors that may influence decision making. Methods. Thirty six patients with amputations following severe injuries of the lower extremities were retrospectively reviewed. Results. There was one death from multiple organ failure. Among the remaining 35 cases, primary and delayed wound healing was achieved in 22 and 13 patients, respectively. Conclusion. Amputation is an important means for management of severely injured lower extremities. When salvage is unlikely to lead to the functional reconstruction of the limb, amputation should be indicated.

室间隔缺损合并下腔静脉上段缺如介入封堵1例分析

本文对室间隔缺损合并下腔静脉上段缺如介入封堵1例分析如下。1病历摘要女,29岁。因发现心脏杂音20 a余于2006-04-18入院。入院查体：一般情况可,BP 110/60 mm Hg,HR 65次/min,律齐,胸骨左缘3～4肋间可闻及4/6级收缩期杂音。腹部查体异常。心电图示：大致正常心电图。经胸心脏彩超示：先天性心脏病,室间隔缺损（膜部瘤型,直径约5 mm）。入院后完善术前准备在局麻下行经导管VSD封堵术。

Reconstruction of caprine mandibular segmental defect by tissue engineered bone reinforced by titanium reticulum

Objective ：To investigate the feasibility of using natural poritos as scaffolds in bone tissue engineering （TE） and repair of caprine mandibular segmental defect with titanium reticulum reinforced. Methods： Natural poritos with a pore of 190-230 μm in size and porosity of about 50 %-65 % was molded into the shape of granules 5 mm × 5 mm × 5 mm in size. Expanded autologous caprine marrow mesenchymal stem cells were induced by recombinant human morphogenetic protein-2 （rhBMP2） to improve osteoblastic phenotype. Then marrow derived osteoblasts were seeded into poritos in density of 4 × 10^7/ml and incubated in vitro for 48 hours prior to implantation. Then osteoblastic cells/poritos complexes were implanted into mandibular defect and the defect was reinforced by titanium reticulum. Implantation of poritos alone acted as the control. Bone regeneration was assessed 4, 8, 16 weeks after implantation using roentgenographie analysis and histological observation was done after 16 weeks. Results： New bone could be observed histologically on the surface and in the pores of natural coral in all specimens in the cell-seeding group, whereas in the control group there was no evidence of osteogenesis process in the center of the construction. The results showed that new bone grafts were successfully restored 16 weeks after implantation. Conclusions： This study suggests the feasibility of using porous coral as scaffold material transplanted with marrow derived osteoblasts by TE method. By means of titanium reticulum reinforcement, mandibular defect could be successfully restored. It shows the potentiality of using this method for the reconstruction of bone defect in cfinic.

Comparison of standard large trauma craniotomy with routine craniotormy in treatment of acute subdural hematoma

Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group. The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow up after operation were compared between the two groups. Results: Fifteen patients ( 15.6 %) died in the standard large trauma craniotomy group and 30 ( 27.7 %) in the routine craniotomy group. The postoperative mean ICP was 3.75 kPa±1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa±1.57 kPa in the routine craniotomy group. The pupil rebound was found in 47 patients ( 61.0 %) in the standard large trauma craniotomy group and in 41 patients ( 46.1 %) in the routine craniotomy group (P< 0.01 ). The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long term therapeutic effect was found between the two groups. Conclusions: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma . The incidence of complication can also be decreased. But the long term life quality of the patients can not be improved.

Express,on of GLUT4 mRNA of peripheral tissues and insulin resistance in rats with severe traumatic brain injury

Objective： To evaluate the expression of glucose transporter-4 （GLUT4） mRNA in skeletal muscle and subcutaneous adipose tissues and investigate the mechanism of posttraumatic insulin resistance. Methods： Sixteen adult male Wistar rats were randomly divided into 2 group （ n = 8 in each group）, i.e., severe traumatic brain injury （TBI） group due to falls from a height and normal control group. Blood glucose and serum insulin were measured at 0.5 h before trauma and 3 h, 24 h, 72 h, 7 d after trauma, respectively. And insulin sensitivity was calculated by insulin activity index （IAI） formula. Skeletal muscle and subcutaneous adipose tissue samples were collected at the same time when blood was sampled. The changes of expression of GLUT4 mRNA were observed using reverse transcription-polymerase chain reaction （RT-PCR）. Results： Accompanied by the decrease of insulin sensitivity, the expression of GLUT4 mRNA was significantly decreased in adipose tissues at 24 h and 72 h after trauma （ P 〈 0. 01 ）, however, such phenomena did not appear in skeletal muscle samples. Conclusions： To some extent, the development of posttraumatic insulin resistance is related to the abnormality of transcription activity of GLUT4 gene. Adipose tissues show some difference in the transcriptional level of GLUT4 gene after trauma as compared with skeletal muscle tissues.

Patterns of extremity traumas leading to amputation in Iran： results of Iranian National Trauma Project

Objective： To determine the patterns of traumatic extremity injuries leading to amputation in Iran. Methods： Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004. Results： Of 17 753 traumatic patients, 164 （0.92%） had injuries to the extremities that resulted in the limb amputation. Of these, 143 （87.2%） were men. The patient＇s mean age was 29.0 years ± 15.4 years and the highest incidence was seen in the age group of 21 to 30 years （34.1%）. One hundred and four cases were occupational accidents （63.4%）. Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings （37.8%） and crush injuries （31.7%）. Amputation of hand fingers was the most frequent type of amputation （125 cases, 76,2 %）. One patient died from severe associated iniuries. Conclusions： This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.

Traumatic subdural hydroma developing into chronic subdural hematoma

Objective: To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH). Methods: We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature. Results: 16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage. Conclusions: TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.

Effect of electroacupuncture pretreatment on the protein expression of c-fos in fastigial nucleus and lateral hypothalamus area in rats with acute myocardial ischemia-reperfusion injury

Objective:To observe the effect of electroacupuncture(EA)pretreatment on the protein expression of c-fos in fastigial nucleus(FN)and lateral hypothalamus area(LHA)in rats with acute myocardial ischemia-reperfusion injury(MIRI),and to explore the role and mechanism of FN and LHA in EA at the Heart Meridian fighting against acute MIRI reaction.Methods:Seventy Sprague-Dawley rats were randomly divided into a sham operation group,a model group,an EA-Heart Meridian group and an EA-Lung Meridian group,with 14 rats in each group;an LHA lesion plus EA-Heart Meridian group(LHA+EA-Heart Meridian group)and a FN lesion plus EA-Heart Meridian group(FN+EA-Heart Meridian group),with 7 rats in each group.Except the sham operation group,the left anterior descending branch of coronary artery was ligated to establish acute MIRI rat models in the other 5 groups.In the three groups with EA-Heart Meridian treatment,Shenmen(HT 7)and Tongli(HT 5)were selected;Taiyuan(LU 9)and Lieque(LU 7)were selected in the EA-Lung Meridian group.All the EA groups received EA stimulation prior to modeling,with 1 mA in current intensity and 2 Hz in frequency,20 min each time,once a day for a total of 7 d.The sham operation group and the model group did not receive EA stimulation.The electrocardiogram was observed in the rats to analyze the ST-segment deviation and cardiac arrhythmia score.The expression of c-fos protein in FN and LHA was detected by immunohistochemistry method.Results:Compared with the sham operation group,the ST-segment deviation,cardiac arrhythmia score and the expression of c-fos protein in the FN and LHA increased significantly in the model group(all P<0.05).Compared with the model group,the ST-segment deviation,cardiac arrhythmia score and the expression of c-fos protein in FN and LHA decreased significantly in the EA-Heart Meridian group(all P<0.05).Compared with the EA-Heart Meridian group,the ST-segment deviation and cardiac arrhythmia score increased significantly in the EA-Lung Meridian group,LHA+EA-Heart Meridian group and FN+EA-Heart Meridian group(all P<0.05);the expression of c-fos in FN increased significantly in the EA-Lung Meridian group and LHA+EA-Heart Meridian group(both P<0.05);the expression of c-fos in LHA increased significantly in the EA-Lung Meridian group and FN+EA-Heart Meridian group(both P<0.05).Conclusion:FN and LHA are involved in the mechanism of EA at Heart Meridian to improve the acute MIRI reactions,and the cerebellum may participate in the improvement of cardiac function by EA through the cerebellum-hypothalamus projection.

Wind estimation around the shipwreck of Oriental Star based on field damage surveys and radar observations

Based on observational analyses and on-site ground and aerial damage surveys, this work aims to reveal the weather phenomena--especially the wind situation--when Oriental Star capsized in the Yangtze River on June 1, 2015. Results demonstrate that the cruise ship capsized when it encountered strong winds at speeds of at least 31 m s ^-1 near the apex of a bow echo embedded in a squall line. As suggested by the fallen trees within a 2-kin radius around the wreck location, such strong winds were likely caused by microburst straight-line wind and/or embedded small vortices, rather than tomadoes.

Multiple bilateral lower limb fractures in a 2-year-old child： previously unreported injury with a unique mechanism

Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.

Finite element simulation of lower limb injuries to the driver in minibus frontal collisions

Purpose： This study aims to explore the biomechanical mechanism of lower limb injuries to the driver by establishing a finite element （FE） simulation model of collisions. Methods： First a minibus FE model was integrated with a seat belt system. Then it was used to rebuild two collisions together with the total human model for safety （THUMS） provided by Toyota Motor Corporation： a rear-end collision between a minibus and a truck and a head-on collision of a minibus to a rigid wall. The impact velocities of both collisions were set at 56 km/h. The vehicle dynamic response, vehicle deceleration, and dashboard intrusion in the two collisions were compared. Results： In the minibus rear-end truck collision, the peak values of the yon Mises equivalent stress at the tibia and the femur were 133 MPa and 126 MPa respectively; while in the minibus head-on rigid wall collision, the data were 139 MPa and 99 MPa. Compared with the minibus head-on rigid wall collision, the vehicle deceleration was smaller and the dashboard intrusion was larger in the minibus rear-end truck collision. Conclusion： The results illustrate that a longer dashboard incursion distance corresponds to a higher yon Mises equivalent stress at the femur. The simulation results are consistent with the driver＇s autopsy report on lower limbs injuries. These findings verify that FE simulation method is reliable and useful to analyze the mechanisms of lower limb iniuries to the driver in minibus frontal collisions.

Pattern of rubber bullet injuries in the lower limbs： A report from Kashmir

Purpose： Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature. Methods： From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered. Results： All patients were males with an age range of 11-32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot. Conclusion： Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest, The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified_

Effects of neuro-immuno-modulation on healing of wound combined with local radiation injury in rats

Purpose： To investigate effects of neuro-immuno-modulation on wound healing by observing changes of cytokines and hypothalamic-pituitary-adrenal （HPA） axis hormones in acute stress reaction in rats with wound and combined local radiation injury. Methods： Sixty female Wistar rats （weighting 200 ± 20 g） were randomly divided into normal control group, wound group and combined wound-local radiation （CWR） group （25 Gy local radiation post wound）, 20 rats in each group. Contents of IL-1β, IL-6 and IFN-γ and IL-4 in serum were measured and changes of adrenocorticotropic hormone （ACTH） and glucocorticoid （GC） in serum were analyzed by using enzyme-linked immunosorbent assay and radioimmunologic assay, respectively at different time points post wound and radiation. Results： （1） The level of IFN-γ, one of the Thl cell cytokines increased significantly at 14 d post CWIL which was markedly higher than that in control group and wound group. However, the level of IL-4, IL-1β and IL-6, one of the Th2 cell cytokines, did not show obvious change. （2） Ratio of Thl/Th2 （IFN-γ/IL-4） in wound group and CWR group increased significantly at 7 d after wound and radiation, which suggested that Thl/Th2 balance drifted to Thl immune response. The ratio of Thl/Th2 in wound group returned to the normal level up to 14 d after the wound and radiation, while the Thl/Th2 ratio in CWR group increased persistently and was much higher than that in control and wound groups. （3） Level of serous ACTH and CC in CWR group increased at 3 d post wound and radiation, and among them, level of CC showed statistically significant increase, which was much higher than that in control and wound groups. Conclusion： Level of serous neurohormone CC in rats increased significantly immediately after wound and radiation; while the level of IFN-γ showed significant increase only up to 14 d after wound and radiation, and the Th1/Th2 imbalance sustained till 28 d post wound and radiation. In order to reduce acute damage caused by CWR, organic immune system and nerve system showed up a marked regulate effects simultaneously and mutually. Nonetheless, the excessive stress induced by CWR causes distur- bance of immunoregulation, which is one of the key reasons for delayed wound healing in CWR.