AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures ...AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.展开更多
Air temperature feedback results from the thermal-radiative coupling between the atmosphere and the surface and plays an important role in surface energy balance. This paper reveals the contribution of air temperature...Air temperature feedback results from the thermal-radiative coupling between the atmosphere and the surface and plays an important role in surface energy balance. This paper reveals the contribution of air temperature feedback to the global warming from 1980 to 2000. The air temperature feedback kernel, evaluated using the ERA-Interim reanalysis data, is used to discuss the physical mechanism for air temperature feedback, the dependency of the strength of air temperature feedback on the climatological spatial distributions of air temperature, water vapor and cloud content, and the contributions of air temperature feedback to rapid global warming. The coupling between temperature feedback and each of the external forcings and individual feedback processes will amplify the anomaly of direct energy flux convergence at the surface induced by the external forcings and individual processes. The air temperature feedback amplifies the initial surface warming due to the increase in CO2 concentration, ice and snow melting, increase in water vapor, and change in ocean heat storage. It also amplifies the surface warming due to the longwave radiaitve forcing associated with the increase in cloud cover, which acts to suppress the cooling of the shortwave effect of cloud forcing. Overall, temperature feedback plays an important role in the global warming from 1980 to2000, as the net positive contribution to the perturbation of global mean energy flux at the surface from the air temperature feedback is larger than the net negative contribution from external forcing and all non-temperature feedbacks.展开更多
Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units （ICU）, resulting in delayed withdrawal of mechan...Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units （ICU）, resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors. Narcotic or psychoactive medication is one of the major risk factors that contribute to ICU delirium. Surveys conducted in several countries indicated that delirium in ICU was inad- equately monitored, underdiagnosed and lacked standardized treatment. In order to improve the prevention and treatment of ICU delirium, it is imperative that the ICU professionals should enrich their knowledge about this comorbidity, familiarize themselves with its screening and management, as well as standardize the administration of narcotic and psychoactive medications.展开更多
基金Supported by The Fund of the People's Liberation Army Gen-eral Hospital of Chengdu Command,No.2011YG-B24
文摘AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.
基金supported by the National Key Scientific Research Plan of China (Grant No. 2014CB953900)the Natural Science Foundation of Guangdong Province (Grant No. 2017A030310571)the Fundamental Research Funds for the Central Universities (Grant No. 17LGPY21)
文摘Air temperature feedback results from the thermal-radiative coupling between the atmosphere and the surface and plays an important role in surface energy balance. This paper reveals the contribution of air temperature feedback to the global warming from 1980 to 2000. The air temperature feedback kernel, evaluated using the ERA-Interim reanalysis data, is used to discuss the physical mechanism for air temperature feedback, the dependency of the strength of air temperature feedback on the climatological spatial distributions of air temperature, water vapor and cloud content, and the contributions of air temperature feedback to rapid global warming. The coupling between temperature feedback and each of the external forcings and individual feedback processes will amplify the anomaly of direct energy flux convergence at the surface induced by the external forcings and individual processes. The air temperature feedback amplifies the initial surface warming due to the increase in CO2 concentration, ice and snow melting, increase in water vapor, and change in ocean heat storage. It also amplifies the surface warming due to the longwave radiaitve forcing associated with the increase in cloud cover, which acts to suppress the cooling of the shortwave effect of cloud forcing. Overall, temperature feedback plays an important role in the global warming from 1980 to2000, as the net positive contribution to the perturbation of global mean energy flux at the surface from the air temperature feedback is larger than the net negative contribution from external forcing and all non-temperature feedbacks.
文摘Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units （ICU）, resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors. Narcotic or psychoactive medication is one of the major risk factors that contribute to ICU delirium. Surveys conducted in several countries indicated that delirium in ICU was inad- equately monitored, underdiagnosed and lacked standardized treatment. In order to improve the prevention and treatment of ICU delirium, it is imperative that the ICU professionals should enrich their knowledge about this comorbidity, familiarize themselves with its screening and management, as well as standardize the administration of narcotic and psychoactive medications.
