C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

Objective C-reactive protein(CRP)/albumin ratio(CAR)is a new inflammation-based index for predicting the prognosis of various diseases.The CAR determined on admission may help to predict the prognostic value of multiple trauma patients.Methods A total of 264 adult patients with severe multiple trauma were included for the present retrospective study,together with the collection of relevant clinical and laboratory data.CAR,CRP,albumin,shock index and ISS were incorporated into the prognostic model,and the receiver operating characteristic(ROC)curve was drawn.Then,the shock index for patients with different levels of CAR was analyzed.Finally,univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients.Results A total of 36 patients had poor survival outcomes,and the mortality rate reached 13.6%.Furthermore,after analyzing the shock index for patients with different levels of CAR,it was revealed that the shock index was significantly higher when CAR was≥4,when compared to CAR<2 and 2≤CAR<4,in multiple trauma patients.The multivariate logistic analysis helped to identify the independent association between the variables CAR(P=0.029)and shock index(P=0.019),and the 28-day mortality of multiple trauma patients.Conclusion CAR is higher in patients with severe multiple trauma.Furthermore,CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients.The shock index was significantly higher when CAR was≥4 in multiple trauma patients.

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

Background:Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging.Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries.Bowel anastomosis after traumarelated resection is associated with a high rate of leakage.The ability of the surgeon’s bare eye to determine bowel viability remains limited,and the need for a more standardized objective assessment has not yet been fulfilled.Hence,there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize traumaassociated complications.Indocyanine green(ICG)coupled with fluorescence angiography is a potential solution for this problem.ICG is a fluorescent dye that responds to near-infrared irradiation.Methods:We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery.Discussion:ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance.However,there is a paucity of information regarding the use of this technology to treat traumas.Recently,angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions,leading to fewer cases of anastomotic insufficiency.This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety.However,there is no consensus on the ideal dose,time,and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings.Conclusions:There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection.This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’operative care and safety in the field of trauma surgery.

Altered Nutrition State in the Severe Multiple Trauma Patients Undergoing Adjuvant Recombinant Human Growth Hormone Nutritional Support Therapy

In order to observe the nutrition state in the severe multiple trauma patients undergoing adjuvant recombinant human growth hormone (rhGH) nutritional support therapy, 45 patients with severe multiple traumas (ISS>25) were randomly divided into 3 groups. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two rhGH-treated groups in which rhGH was 0.2 and 0.4 U/(kg·d) respectively, and the resting group served as control one. The levels of nitrogen balance, prealbumin and safety variables (blood sugar, Na+, TT3 and TT4) were observed and com- pared among the three groups. The levels of nitrogen balance on the postoperative day (POD) 3 and 5 in the rhGH-treated groups were -1.28±3.19, 5.45±2.00 and -0.18±2.55, 6.11±1.60, respectively, which were significantly higher than those in the control group (-5.17±1.68 and -1.08±3.31, P<0.01). The values of prealbumin on the POD 3 and 5 in the rhGH-treated groups were 180.19±27.15, 194.44±50.82 and 194.94±29.65, 194.11±16.17, respectively, which were significantly higher than those in the control group (117.42±19.10 and 135.63±28.31, P<0.01). There was no sig- nificant difference between the rhGH 0.2 U/(kg·d) group and rhGH 0.4 U/(kg·d) group in both of the levels of nitrogen balance and prealbumin. It is concluded that the nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple trauma. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 and 0.4 U/(kg·d).

Ten-year retrospective analysis of multiple trauma complicated by pulmonary contusion

Background: This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome(ARDS). Methods: We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Military Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. Results: We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1±14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant(P=0.199, P=0.200). Separate univariate analysis of those who died and those who survived found that shock on admission(P=0.000), coagulation disorders(P=0.000), gastrointestinal bleeding(P=0.02), the need for emergency surgery on admission(P=0.000), pre-hospital intubation(P=0.000), blood transfusion within 24 hours(P=0.006), the use of mechanical ventilation(P=0.000), and concurrent ARDS(P=0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score(OR=0.708, 95%CI 0.516-0.971, P=0.032), ISS score(OR 1.135, 95%CI 1.006-1.280, P=0.039), and concurrent ARDS(OR=15.814, 95%CI 1.819-137.480, P=0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock(OR=9.121, 95%CI 0.857-97.060, P=0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P=0.039), infection(P=0.005), shock(P=0.004), coagulation disorders(P=0.006), emergency surgery(P=0.01), pre-hospital intubation(P=0.000), chest tube insertion(P=0.004), blood transfusion(P=0.000), usage of hormones(P=0.002), phlegm(P=0.000), ventilation(P=0.000) were at a significantly increased risk for ARDS complications. Conclusions: Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE Ⅱ, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score<5.5, APACHE Ⅱ score>16.5, and ISS score>20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.

Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND:To analyze early changes in white blood cells(WBCs),C-reactive protein(CRP)and procalcitonin(PCT)in children with multiple trauma,before secondary inflammation develops.METHODS:This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU).According to the prognostic outcome of 28 d after admission to the PICU,patients were divided into survival group(n=141)and non-survival group(n=36).Characteristics between the two groups were compared.Receiver operation characteristic(ROC)curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.RESULTS:The percentages of children with elevated WBC,CRP,and PCT levels were 81.36%,31.07%,and 95.48%,respectively.Patients in the non-survival group presented a statistically significantly higher injury severity score(ISS)than those in the survival group:37.17±16.11 vs.22.23±11.24(t=6.47,P<0.01).WBCs were also higher in non-survival group than in the survival group([18.70±8.42]×109/L vs.[15.89±6.98]×109/L,t=2.065,P=0.040).There was no significant difference between the survival and non-survival groups in PCT or CRP.The areas under the ROC curves of PCT,WBC and ISS for predicting 28-day mortality were 0.548(P=0.376),0.607(P=0.047)and 0.799(P<0.01),respectively.CONCLUSIONS:Secondary to multiple trauma,PCT levels increased in more patients,even if their WBC and CRP levels remained unchanged.However,early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Effect of ω-3 Polyunsaturated Fatty Acid on Toll-like Receptors in Patients with Severe Multiple Trauma

This study examined the effects of ω-3 polyunsaturated fatty acid（ω-3PUFA） on the expression of toll-like receptor 2（TLR2）,toll-like receptor 4（TLR4） and some related inflammatory factors in peripheral blood mononuclear cells（PBMCs） of patients with early-stage severe multiple trauma.Thirty-two patients who were admitted to the Department of Traumatic Surgery,Tongji Hospital（Wuhan,China） between May 2010 and November 2010,and diagnosed as having severe multiple trauma with a injury severity score（ISS） no less than 16,were enrolled in the study and divided into two groups at random（n=16 in each）：ω-3PUFA group and control group in which routine parenteral nutrition supplemented with ω-3PUFA or not was administered to the patients in two groups for consecutive 7 days.Peripheral blood from these patients was collected within 2 h of admission（day 0）,and 1,3,5 and 7 days after the nutritional support.PBMCs were isolated and used for detection of the mRNA and protein expression of TLR2 and TLR4 by using real-time PCR and flow cytometry respectively,the levels of NF-κB by quantum dots-based immunofluorescence assay,the levels of TNF-α,IL-2,IL-6 and COX-2 by ELISA,respectively.The results showed that the mRNA and protein expression of TLR2 and TLR4 in PBMCs was significantly lower in ω-3PUFA group than in control group 5 and 7 days after nutrition support（both P0.05）.The levels of TNF-α,IL-2,IL-6 and COX-2 were found to be substantially decreased in PBMCs in ω-3PUFA group as compared with control group at 5th and 7th day（P0.05 for all）.It was concluded that ω-3PUFA can remarkably decrease the expression of TLR2,TLR4 and some related inflammatory factors in NF-κB signaling pathway in PBMCs of patients with severe multiple trauma,which suggests that ω-3PUFA may suppress the excessive inflammatory response meditated by the TLRs/NF-κB signaling pathway.

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.

DNA damage and cell death assessment in patients with severe multiple trauma using comet assay

Purpose: To determine the DNA strand breaks, oxidative DNA damage and cell death in blood and plasma total antioxidant status (TAOS) in 22 patients with severe multiple trauma. Materials and methods: The DNA comet assay was used to measure DNA strand breakage, 8-oxoguanine levels and apoptotic and necrotic nuclei in after admission (day 0) and on days 3, 5, 7 and 15. TAOS was determined by colorimetric method. Results: Trauma patients had high DNA damage at admission (p < 0.01), that further increased with maximum value on day 5 (p < 0.001). On day 15 the degree of DNA damage remained significantly elevated (p < 0.01). No significant difference in the 8-oxoguanine levels at all days examined was found. Patients had a high percentage of apoptotic and necrotic comets at admission, with maximum values on days 3 and 5. A significantly lower TAOS was observed in patients on admission and days 3, 5, 7 and 15 (p < 0.001 in all cases). A decreasing of TAOS on days 7 and 15 compared to that on admission (p < 0.05) was observed. Conclusions: Blood cells from severe trauma patients’ display increased DNA damage associated with apoptosis and necrosis. Reduced plasma TAOS and a tendency to increase of 8-oxoguanine in DNA was observed.

Management of Penetrating Cranioencephalic Trauma Caused by Sharp Metal Objects—Therapeutic and Evolutionary Aspects: 12 Cases at the Renaissance University Hospital in N’Djamena

Introduction: Cranioencephalic trauma caused by bladed weapons is rare, and that caused by sharp objects is exceptional. The aim of our study was to describe the clinical, therapeutic and evolutionary aspects. Materials and method: This was a descriptive and analytical study over a 48-month period at CHU la Renaissance from January 1, 2018 to December 31, 2021, concerning patients admitted for penetrating cranioencephalic trauma by pointed object. Results: Twelve cases, all male, of penetrating cranioencephalic sharp-force trauma were identified. The mean age was 34 ± 7 years, with extremes of 11 and 60 years. Farmers and herders accounted for 31% and 25% of cases respectively. The average admission time was 47 hours. Brawls were the circumstances of occurrence in 81.2% of cases. Knives (33%), arrows (25%) and iron bars (16.6%) were the objects used. Altered consciousness was present in 43.8% of cases, and focal deficit in 50%. Scannographic lesions were fracture and/or embarrhment (12 cases), intra-parenchymal haematomas (6 cases) and presence of object in place (4 cases). Surgery was performed in 11 patients. Postoperative outcome was favorable in 9 patients. After 12 months, 2 patients were declared unfit. Conclusion: Penetrating head injuries caused by sharp objects are common in Chad. Urgent surgery can prevent disabling after-effects.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

Early changes of plasma angiopoietin-2 in patients with multiple trauma

BACKGROUND： This study was undertaken to investigate the early changes of plasmalevels of angiopoietin-2 （Ang-2） in patients with multiple trauma and the relations of plasma Ang-2,endothelial injury, and prognosis.METHODS： This study comprised 59 patients with multiple trauma who had been treated at theemergency department of Liao Cheng People!s Hospital from January 2008 to January 2010. Amongthem, 36 were male and 23 female. Their average age was 32.3±11.5 years. The 59 patients weredivided into a severe trauma group （ISS＂16 points, 29 patients） and a slight trauma group （ISS〈16points, 30 patients） by injury severity score （ISS）. Thirty healthy people aged more than 18 years withan average of 33.5±10.6 years served as controls （19 male and 11 female）. Peripheral blood （10 mL）was collected within 10 minutes after the patients arrived at the emergency department, and plasmawas separated from the blood. Enzyme-linked immunosorbent assay （ELISA） was applied to detectthe levels of angiopoietin 2, thrombomodulin （TM）, and Von willebrand factor （vWF）.RESULTS： The level of Ang-2 in the severe trauma group （ISS score＂16 points） was signifi cantlyhigher than that in the slight trauma group （ISS score〈16 points） （P〈0.05）. The levels in the twogroups were signifi cantly higher than those in the control group （P〈0.05）. The levels of angiopoietin-2in deaths were signifi cantly higher than those in survivors （P〈0.05）. The levels of angiopoietin-2 weresignifi cantly correlated with the levels of vWF and TM （P〈0.05）.CONCLUSIONS： The plasma levels of Ang-2 are significantly higher after multiple trauma,and correlated with the degree of trauma severity. The levels of angiopoietin-2 are correlated withendothelial injury after multiple trauma, and are important values for the prognosis of patients withmultiple trauma.

Does Gender Affect the Outcomes of Multiple Valve Heart Surgery?

Background: Multiple valve surgery exposes patients to major morbidity and mortality. Little is known about the effect of gender on the outcomes of multiple valve surgery. Methods: In 69 patients who had multiple valve surgery for rheumatic valvular heart disease, 51 patients had mitral and aortic valve replacement, 9 patients had mitral and aortic valve replacement and tricuspid valve repair, 4 patients had mitral valve replacement and tricuspid valve repair, 4 patients had mitral and tricuspid valve repair, and 1 patient had mitral and tricuspid valve replacement. Outcomes were evaluated with univariate analysis. Results: Women had significantly smaller body surface area and smaller left ventricular end-systolic area than men. Women and men had similar left ventricular ejection fraction and New York Heart Association functional class. Univariate analysis showed that in women (but not men), older age, atrial fibrillation, lower left ventricular ejection fraction, and New York Heart Association functional class II and III were associated with longer hospital and intensive care unit stay. In men (but not women), longer cardiopulmonary bypass time was associated with increased left ventricular end-systolic area at 12 months after surgery. Longer aortic cross-clamp time was associated with increased left ventricular end-systolic area in men but only weakly in women. Conclusion: We concluded that gender is an independent predictor of outcomes after multiple valve heart surgery.

Advances in laparoscopy for acute care surgery and trauma

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers,for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a laparoscopic approach to the treatment of the most common emergency surgical conditions.

Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis

BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.

Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.

Damage control surgery for severe pancreatic trauma

Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS

Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma

Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.

Influence of Psychological Intervention before Emergent Ocular Trauma Surgery on Patients' Negative Emotions

Purpose:.To investigate the effect of preoperative psychological intervention on alleviating negative emotions in patients undergoing emergent ocular trauma surgery.Methods:..A total of 100 patients undergoing emergent ocular trauma surgery were selected using convenience sampling and randomly divided into control(n=49) and experimental(n =51) groups. Patients in the control group received conventional nursing and their counterparts in the observation group were treated with individualized psychological interventions including psychological support, relaxation training, and humanistic care based on conventional nursing care..Self-rating anxiety scale(SAS), self-rating depression scale(SDS), and fear visual analog scale(FVAS) scores were statistically compared between the two groups.Results:.The scores of SAS, SDS, and FAVS were significantly lower in the experimental group than in the control group(all P<0.001).Conclusion:.Comprehensive psychological intervention effectively eliminates negative emotions in patients undergoing emergent ocular trauma surgery and accelerates their physical and mental recovery.

Multiple left ventricular myxomas combined with severe rheumatic valvular lesions: A case report

BACKGROUND Primary cardiac tumors are uncommon,of which cardiac myxoma accounts for 50%-80%.Left ventricular myxoma has been rarely reported,accounting for only 3%-4%of all cardiac myxomas.Multiple left ventricular myxomas are,relatively,even rarer.CASE SUMMARY In this report,we present a case of multiple left ventricular myxomas combined with severe rheumatic valve lesions.Symptomatically,the patient presented with fatigue,shortness of breath,and palpitation after activities.The patient underwent complete surgical resection of multiple left ventricular myxomas combined with mechanical replacement of the mitral and aortic valves,tricuspid valvuloplasty.The patient recovered well after the operation,with no obvious related complications.CONCLUSION Multiple left ventricular myxomas may coexist with severe rheumatic valve disease.Operation is an effective treatment.