In order to investigate the correlation between traumatic servity and blood cAMP and cGMP levels in the patients with acute trauma and its clinical significance, 120 cases of trauma were randomly selected and divided ...In order to investigate the correlation between traumatic servity and blood cAMP and cGMP levels in the patients with acute trauma and its clinical significance, 120 cases of trauma were randomly selected and divided into 4 groups ( n= 30 in each group): mildly traumatic group (ISS≤9), moderately traumatic group (ISS=10-16), severely traumatic group (ISS=17-25) and dangerously traumatic group (>25). The cAMP and cGMP levels were assayed in sera, leucocytes and platelets respectively in 6 h and 24 h after trauma. The results showed that cAMP and cGMP levels were elevated significantly in sera and platelets ( P< 0.05 or P< 0.01), meanwhile cGMP levels in leucocytes ( P< 0.05). It was concluded that cAMP and cGMP might play an important role in traumatic stress, participate in the cellular signal transducation and promote the immune function of leucocytes and the coagulation founction of platelets. Serum cAMP and cGMP levels were upregulated correspondingly as ISS increased, and positively correlated to the traumatic severity.展开更多
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 activ...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.展开更多
Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely inv...Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely investigated.In addition to their applications in clinical diagnosis and treatment,these biomarkers provide important insights into our understanding of the pathogenesis of ARDS.This review begins with a brief introduction regarding the incidence and pathogenesis of trauma-associated ARDS.Then,we focus on reviewing the clinical trials that have been designed to investigate the value of biomarkers in ARDS after trauma.Biomarkers with a confirmed value in ARDS have been organized on the basis of key pathogenic processes that are central to ARDS and are described in detail.Among these,angiopoietin 2(Ang-2),L-selectin,Clara cell protein 16(CC16),soluable receptor for advanced glycation end products(s RAGE),Surfactant protein D(SP-D),histones,mt DNAs and some biomarker panels had a certain association with the diagnosis and prognosis of trauma-related ARDS.Further investigations are needed regarding the design of trials,the best sampling approaches and the optimal combinations of the biomarker panels.展开更多
BACKGROUND Acute traumatic spinal cord injury(ATSCI)usually results in disability,yet data on contemporary national trends of ATSCI incidence are limited.AIM To provide a systematic and basic theoretical basis for imp...BACKGROUND Acute traumatic spinal cord injury(ATSCI)usually results in disability,yet data on contemporary national trends of ATSCI incidence are limited.AIM To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord injury.METHODS Data from the Peking University Third Hospital Inpatient Sample databases were analyzed.A total of 304 patients with ATSCI were included from 2012 to 2017.The epidemiological data,treatment,complications and clinical outcomes of these patients were reviewed.RESULTS Of the 304 patients,257(84.5%)were male,and 75%of the patients were 55 years old or younger.135 patients had improved follow-up American Spinal Injury Association(ASIA)grades(44.4%).Only 14 patients with ASIA grade A improved.A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed(P<0.05).Surgery within 72 h resulted in better prognosis.The Steroid group and the Non-Steroid group showed a significant difference in outcome among patients with ASIA grades A and B(P<0.05).Patients with pneumonia had a poorer prognosis than patients without pneumonia(P<0.05).Surgery within 72 h resulted in better prognosis.CONCLUSION This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group,but the patients with severe spinal cord injury(ASIA grades A and B)who underwent surgery combined with steroid therapy had a better prognosis than those who underwent surgery alone.The disastrous consequences of ATSCI and lack of consensus on the management strategy are obvious.Further improvements in treatment planns are needed in order to obtain more reliable functional outcomes.展开更多
Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on change...Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on changes in CT,CSA,and CV in subacute or chronic m TBI,and few studies have examined changes in CT,CSA,and CV in acute m TBI.Furthermore,acute m TBI patients typically show transient cognitive impairment,and few studies have reported on the relationship between cerebral morphological changes and cognitive function in patients with m TBI.This prospective cohort study included 30 patients with acute m TBI(15 males,15 females,mean age 33.7 years) and 27 matched healthy controls(12 males,15 females,mean age 37.7 years) who were recruited from the Second Xiangya Hospital of Central South University between September and December 2019.High-resolution T1-weighted images were acquired within 7 days after the onset of m TBI.The results of analyses using Free Surfer software revealed significantly increased CSA and CV in the right lateral occipital gyrus of acutestage m TBI patients compared with healthy controls,but no significant changes in CT.The acute-stage m TBI patients also showed reduced executive function and processing speed indicated by a lower score in the Digital Symbol Substitution Test,and reduced cognitive ability indicated by a longer time to complete the Trail Making Test-B.Both increased CSA and CV in the right lateral occipital gyrus were negatively correlated with performance in the Trail Making Test part A.These findings suggest that cognitive deficits and cortical alterations in CSA and CV can be detected in the acute stage of m TBI,and that increased CSA and CV in the right lateral occipital gyrus may be a compensatory mechanism for cognitive dysfunction in acute-stage m TBI patients.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University,China(approval No.086) on February 9,2019.展开更多
28 health rabbits were divided into electroacupuncture group, and non-elec- troacupuncture. Effect of electrical needling "Neiguan" point on the action potintial and cAMP and cGMP of the ventricular cells of...28 health rabbits were divided into electroacupuncture group, and non-elec- troacupuncture. Effect of electrical needling "Neiguan" point on the action potintial and cAMP and cGMP of the ventricular cells of acute myocardial ischemia were observed.The main results are as follows: The RP, APA and maximun velecity of depolarization(Vmax) decrease, the APD prolongs in the electroacupuncture and non-electroacupuncture group, but the changes of non-electroacupuncture group are more evident than the electroacupuncture group.The attack rates of EAD and DAD in the nonelectroacupuncture group are higher than in elec troacupuncture group. cAMP in the acute myocardial ischemia cells increases, but the changes of which in nonelectroacupuncture group are more marked than the electroacupunct u re.The above mentioned results show that there is a protection effect of electrical needling "Neiguan"point on the action potential of the ventricular cell of acute myocardial ischemia rabbits. The effect might result from decreasing cAMP in the ischemia cells by electrical needling "Neiguan" point.展开更多
Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination thera...Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.展开更多
Objective:Discussion on the protectiion of electroacupuncture"Shenmen"on heart and brain injury induced by acute myocardial ischemia in rats from the perspective of the expression of cyclic adenosine monopho...Objective:Discussion on the protectiion of electroacupuncture"Shenmen"on heart and brain injury induced by acute myocardial ischemia in rats from the perspective of the expression of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP).Methods:Thirty male SD rats were randomly divided into normal group,model group,and electroacupuncture group.The electrocardiogram was recorded by the Powerlab 8-lead physiological recording system.The left anterior descending coronary artery was ligated to replicate the rat myocardial ischemia model.The acupuncture group was treated with electroacupuncture on the second day after the model was replicated.After the last electroacupuncture treatment,rat myocardium,hippocampus tissue and abdominal aortic blood were collected,and enzyme-linked immunosorbent assay was used to detect the levels of cAMP and cGMP in myocardium,hippocampus tissue and serum content.Results:Compared with the normal group,the cAMP content in the myocardial tissue of the model group was significantly increased,and the cAMP content in the hippocampus tissue and serum was significantly reduced;compared with the model group,the cAMP content in the myocardial tissue of the electroacupuncture group was decreased,and the hippocampus tissue Compared with the normal group,the content of cGMP in the myocardial tissue and serum of the model group increased,and the content of cGMP in the hippocampus decreased.Compared with the model group,the content of cGMP in the hippocampus of the electroacupuncture group was increased.The cGMP content increased,the serum cGMP content was significantly reduced,and the difference in the cGMP content in myocardial tissue was not statistically significant.Conclusion:Electroacupuncture at"Shenmen"acupoint can significantly improve the expression of cAMP,cGMP and myocardial cAMP in the serum and hippocampus of model rats with acute myocardial ischemia-induced heart and brain injury,but has a lower effect on myocardial cGMP content.展开更多
BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is ...BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is usually atypical,which easily causes missed diagnosis and misdiagnosis.Currently,there are only a few reports of acute traumatic occlusion of CA.The CA artery gives off branches to dominate the liver,stomach.and spleen;however,occluded CA did not cause significant organ ischemia,and the compensatory blood flow from the superior mesenteric artery(SMA)played a pivotal role.CASE SUMMARY Herein,we report two cases of acute CA occlusion secondary to severe blunt trauma.Case one was a 19-year-old male,suffered from a motorcycle crash.He complained of dyspnea,and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound.Computed tomography(CT)scan revealed hemopneumothorax,multiple rib fractures,right scapular fracture,and liver rupture.Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased,and CA was occluded.Because the hepatic hemorrhage is associated with hepatic artery injury,the CA was retrogradely opened through the SMA,and then,the right hepatic artery was embolized with coils successfully through the conventional pathway.Stent implantation was not performed,and the CA occlusion was managed by conservative treatment.A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded.Case two was a 37-year-old man,suffered injury from fall from height.He complained of lower back and bilateral heel pain.Contrast-enhanced CT examination revealed multiple rib fractures,bilateral pneumothorax,fourth lumbar(L4)vertebral burst fracture,and pelvic fractures.Furthermore,a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected.The reexamination 14 h after admission showed the CA was occluded.The patient was conservatively treated.The symptoms of nausea after meals disappeared about 4 wk later,and abdominal distension was significantly relieved after 6 wk.The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.CONCLUSION Patients with CA occlusion will have different clinical manifestations,and the dominant organ will not have obvious ischemia.Conservative treatment is safe,and the patient’s symptoms will be improved with the establishment of collateral circulation.展开更多
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 pr...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.展开更多
Objective:To investigate the effect of a large number of blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods:A total of 86 cases of traumatic blood transfusion emerg...Objective:To investigate the effect of a large number of blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods:A total of 86 cases of traumatic blood transfusion emergency and hospitalized patients during January 2014 to January 2016 in our hospital, divided into two groups according to the early blood transfusion, acute trauma patients need a lot of blood transfusion for the observation group (47 cases), trauma patients need a small amount of blood transfusion as the control group (39 cases). Statistical analysis and comparison of two groups patients of four blood coagulation [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], platelet count (PLT), protein C (PC) and fiber soluble system index [D dimer (D-D), fibrin degradation products (FDP) levels before and after blood transfusion of 1 d, 5 d'. Results:Before blood transfusion, there was no significant difference between the two groups. There was no significant difference in the level of the observed indexes in the control group before and after transfusion. 1 d after blood transfusion, compared with blood transfusion before and the control group at the same time , the observation group PT[(18.4±4.3) s], APTT[(42.9±7) s], TT[(21.4±4.8) s] were significantly prolonged, D-D[(282.2±115) g/L] and FDP[(6.3±2.1) mg/L] were significantly increased, and FIB[(2.9±1.3) g/L], PLT[(72.5±34.4) 109] and PC[(2.4±1.2) mg/L] levels were significantly decreased. 5 d after blood transfusion, compared with blood transfusion before and the control group at the same time ,the observation indexes showed no significant difference;5 D after blood transfusion compared with 1 D, the observation group PT[(14.8±1.7) s], APTT[(34.7±5.4) s], TT[(14.7±2.5) s] was significantly shortened, D-D[(151.8±62.4) g/L] and FDP[(3.7±1.2) mg/L] were significantly decreased, FIB[(3.7±0.8) g/L], PLT[(179±70.8) 109] and PC[(3.9±1.5) mg/L] levels were significantly higher.Conclusion:Large amount of blood transfusion has great influence on the coagulation function and fibrinolysis system in acute trauma patients. It is necessary to monitor coagulation status in time and avoid complications such as coagulation dysfunction, so as to improve the success rate of implementation of massive transfusion regimen.展开更多
Acute trauma is one of the most commonly seen diseases in the Emergency Department,and it attracts more attention due to the increasing disability rate and mortality.Early rapid and accurate assessment of the severity...Acute trauma is one of the most commonly seen diseases in the Emergency Department,and it attracts more attention due to the increasing disability rate and mortality.Early rapid and accurate assessment of the severity of trauma has a positive significance for improving clinical prognosis.The paper aims to review the characteristics of the severity score based on trauma severity,blood biochemical changes and serum biomarkers,and discuss its prognostic significance.展开更多
文摘In order to investigate the correlation between traumatic servity and blood cAMP and cGMP levels in the patients with acute trauma and its clinical significance, 120 cases of trauma were randomly selected and divided into 4 groups ( n= 30 in each group): mildly traumatic group (ISS≤9), moderately traumatic group (ISS=10-16), severely traumatic group (ISS=17-25) and dangerously traumatic group (>25). The cAMP and cGMP levels were assayed in sera, leucocytes and platelets respectively in 6 h and 24 h after trauma. The results showed that cAMP and cGMP levels were elevated significantly in sera and platelets ( P< 0.05 or P< 0.01), meanwhile cGMP levels in leucocytes ( P< 0.05). It was concluded that cAMP and cGMP might play an important role in traumatic stress, participate in the cellular signal transducation and promote the immune function of leucocytes and the coagulation founction of platelets. Serum cAMP and cGMP levels were upregulated correspondingly as ISS increased, and positively correlated to the traumatic severity.
文摘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.
基金funded by the National Natural Science Foundation of China(Grant No.81370172 and 81570078)China Postdoctoral Science Foundation(2016 T1015)
文摘Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely investigated.In addition to their applications in clinical diagnosis and treatment,these biomarkers provide important insights into our understanding of the pathogenesis of ARDS.This review begins with a brief introduction regarding the incidence and pathogenesis of trauma-associated ARDS.Then,we focus on reviewing the clinical trials that have been designed to investigate the value of biomarkers in ARDS after trauma.Biomarkers with a confirmed value in ARDS have been organized on the basis of key pathogenic processes that are central to ARDS and are described in detail.Among these,angiopoietin 2(Ang-2),L-selectin,Clara cell protein 16(CC16),soluable receptor for advanced glycation end products(s RAGE),Surfactant protein D(SP-D),histones,mt DNAs and some biomarker panels had a certain association with the diagnosis and prognosis of trauma-related ARDS.Further investigations are needed regarding the design of trials,the best sampling approaches and the optimal combinations of the biomarker panels.
文摘BACKGROUND Acute traumatic spinal cord injury(ATSCI)usually results in disability,yet data on contemporary national trends of ATSCI incidence are limited.AIM To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord injury.METHODS Data from the Peking University Third Hospital Inpatient Sample databases were analyzed.A total of 304 patients with ATSCI were included from 2012 to 2017.The epidemiological data,treatment,complications and clinical outcomes of these patients were reviewed.RESULTS Of the 304 patients,257(84.5%)were male,and 75%of the patients were 55 years old or younger.135 patients had improved follow-up American Spinal Injury Association(ASIA)grades(44.4%).Only 14 patients with ASIA grade A improved.A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed(P<0.05).Surgery within 72 h resulted in better prognosis.The Steroid group and the Non-Steroid group showed a significant difference in outcome among patients with ASIA grades A and B(P<0.05).Patients with pneumonia had a poorer prognosis than patients without pneumonia(P<0.05).Surgery within 72 h resulted in better prognosis.CONCLUSION This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group,but the patients with severe spinal cord injury(ASIA grades A and B)who underwent surgery combined with steroid therapy had a better prognosis than those who underwent surgery alone.The disastrous consequences of ATSCI and lack of consensus on the management strategy are obvious.Further improvements in treatment planns are needed in order to obtain more reliable functional outcomes.
基金supported by the National Natural Science Foundation of China,No.81671671 (to JL)。
文摘Morphometric changes in cortical thickness(CT),cortical surface area(CSA),and cortical volume(CV) can reflect pathological changes after acute mild traumatic brain injury(m TBI).Most previous studies focused on changes in CT,CSA,and CV in subacute or chronic m TBI,and few studies have examined changes in CT,CSA,and CV in acute m TBI.Furthermore,acute m TBI patients typically show transient cognitive impairment,and few studies have reported on the relationship between cerebral morphological changes and cognitive function in patients with m TBI.This prospective cohort study included 30 patients with acute m TBI(15 males,15 females,mean age 33.7 years) and 27 matched healthy controls(12 males,15 females,mean age 37.7 years) who were recruited from the Second Xiangya Hospital of Central South University between September and December 2019.High-resolution T1-weighted images were acquired within 7 days after the onset of m TBI.The results of analyses using Free Surfer software revealed significantly increased CSA and CV in the right lateral occipital gyrus of acutestage m TBI patients compared with healthy controls,but no significant changes in CT.The acute-stage m TBI patients also showed reduced executive function and processing speed indicated by a lower score in the Digital Symbol Substitution Test,and reduced cognitive ability indicated by a longer time to complete the Trail Making Test-B.Both increased CSA and CV in the right lateral occipital gyrus were negatively correlated with performance in the Trail Making Test part A.These findings suggest that cognitive deficits and cortical alterations in CSA and CV can be detected in the acute stage of m TBI,and that increased CSA and CV in the right lateral occipital gyrus may be a compensatory mechanism for cognitive dysfunction in acute-stage m TBI patients.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University,China(approval No.086) on February 9,2019.
文摘28 health rabbits were divided into electroacupuncture group, and non-elec- troacupuncture. Effect of electrical needling "Neiguan" point on the action potintial and cAMP and cGMP of the ventricular cells of acute myocardial ischemia were observed.The main results are as follows: The RP, APA and maximun velecity of depolarization(Vmax) decrease, the APD prolongs in the electroacupuncture and non-electroacupuncture group, but the changes of non-electroacupuncture group are more evident than the electroacupuncture group.The attack rates of EAD and DAD in the nonelectroacupuncture group are higher than in elec troacupuncture group. cAMP in the acute myocardial ischemia cells increases, but the changes of which in nonelectroacupuncture group are more marked than the electroacupunct u re.The above mentioned results show that there is a protection effect of electrical needling "Neiguan"point on the action potential of the ventricular cell of acute myocardial ischemia rabbits. The effect might result from decreasing cAMP in the ischemia cells by electrical needling "Neiguan" point.
文摘Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.
基金National Nature Science Foundation of China(No.81574083)Key Project of Natural Science Research in Universities of Anhui Province(No.KJ2017A300)。
文摘Objective:Discussion on the protectiion of electroacupuncture"Shenmen"on heart and brain injury induced by acute myocardial ischemia in rats from the perspective of the expression of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP).Methods:Thirty male SD rats were randomly divided into normal group,model group,and electroacupuncture group.The electrocardiogram was recorded by the Powerlab 8-lead physiological recording system.The left anterior descending coronary artery was ligated to replicate the rat myocardial ischemia model.The acupuncture group was treated with electroacupuncture on the second day after the model was replicated.After the last electroacupuncture treatment,rat myocardium,hippocampus tissue and abdominal aortic blood were collected,and enzyme-linked immunosorbent assay was used to detect the levels of cAMP and cGMP in myocardium,hippocampus tissue and serum content.Results:Compared with the normal group,the cAMP content in the myocardial tissue of the model group was significantly increased,and the cAMP content in the hippocampus tissue and serum was significantly reduced;compared with the model group,the cAMP content in the myocardial tissue of the electroacupuncture group was decreased,and the hippocampus tissue Compared with the normal group,the content of cGMP in the myocardial tissue and serum of the model group increased,and the content of cGMP in the hippocampus decreased.Compared with the model group,the content of cGMP in the hippocampus of the electroacupuncture group was increased.The cGMP content increased,the serum cGMP content was significantly reduced,and the difference in the cGMP content in myocardial tissue was not statistically significant.Conclusion:Electroacupuncture at"Shenmen"acupoint can significantly improve the expression of cAMP,cGMP and myocardial cAMP in the serum and hippocampus of model rats with acute myocardial ischemia-induced heart and brain injury,but has a lower effect on myocardial cGMP content.
文摘BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is usually atypical,which easily causes missed diagnosis and misdiagnosis.Currently,there are only a few reports of acute traumatic occlusion of CA.The CA artery gives off branches to dominate the liver,stomach.and spleen;however,occluded CA did not cause significant organ ischemia,and the compensatory blood flow from the superior mesenteric artery(SMA)played a pivotal role.CASE SUMMARY Herein,we report two cases of acute CA occlusion secondary to severe blunt trauma.Case one was a 19-year-old male,suffered from a motorcycle crash.He complained of dyspnea,and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound.Computed tomography(CT)scan revealed hemopneumothorax,multiple rib fractures,right scapular fracture,and liver rupture.Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased,and CA was occluded.Because the hepatic hemorrhage is associated with hepatic artery injury,the CA was retrogradely opened through the SMA,and then,the right hepatic artery was embolized with coils successfully through the conventional pathway.Stent implantation was not performed,and the CA occlusion was managed by conservative treatment.A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded.Case two was a 37-year-old man,suffered injury from fall from height.He complained of lower back and bilateral heel pain.Contrast-enhanced CT examination revealed multiple rib fractures,bilateral pneumothorax,fourth lumbar(L4)vertebral burst fracture,and pelvic fractures.Furthermore,a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected.The reexamination 14 h after admission showed the CA was occluded.The patient was conservatively treated.The symptoms of nausea after meals disappeared about 4 wk later,and abdominal distension was significantly relieved after 6 wk.The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.CONCLUSION Patients with CA occlusion will have different clinical manifestations,and the dominant organ will not have obvious ischemia.Conservative treatment is safe,and the patient’s symptoms will be improved with the establishment of collateral circulation.
文摘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.
文摘Objective:To investigate the effect of a large number of blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods:A total of 86 cases of traumatic blood transfusion emergency and hospitalized patients during January 2014 to January 2016 in our hospital, divided into two groups according to the early blood transfusion, acute trauma patients need a lot of blood transfusion for the observation group (47 cases), trauma patients need a small amount of blood transfusion as the control group (39 cases). Statistical analysis and comparison of two groups patients of four blood coagulation [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], platelet count (PLT), protein C (PC) and fiber soluble system index [D dimer (D-D), fibrin degradation products (FDP) levels before and after blood transfusion of 1 d, 5 d'. Results:Before blood transfusion, there was no significant difference between the two groups. There was no significant difference in the level of the observed indexes in the control group before and after transfusion. 1 d after blood transfusion, compared with blood transfusion before and the control group at the same time , the observation group PT[(18.4±4.3) s], APTT[(42.9±7) s], TT[(21.4±4.8) s] were significantly prolonged, D-D[(282.2±115) g/L] and FDP[(6.3±2.1) mg/L] were significantly increased, and FIB[(2.9±1.3) g/L], PLT[(72.5±34.4) 109] and PC[(2.4±1.2) mg/L] levels were significantly decreased. 5 d after blood transfusion, compared with blood transfusion before and the control group at the same time ,the observation indexes showed no significant difference;5 D after blood transfusion compared with 1 D, the observation group PT[(14.8±1.7) s], APTT[(34.7±5.4) s], TT[(14.7±2.5) s] was significantly shortened, D-D[(151.8±62.4) g/L] and FDP[(3.7±1.2) mg/L] were significantly decreased, FIB[(3.7±0.8) g/L], PLT[(179±70.8) 109] and PC[(3.9±1.5) mg/L] levels were significantly higher.Conclusion:Large amount of blood transfusion has great influence on the coagulation function and fibrinolysis system in acute trauma patients. It is necessary to monitor coagulation status in time and avoid complications such as coagulation dysfunction, so as to improve the success rate of implementation of massive transfusion regimen.
基金supported by Metallurgical Safety and Health Branch of Chinese Metal Society Health Hygiene Scientific Research Foundation(No.:jkws201828).
文摘Acute trauma is one of the most commonly seen diseases in the Emergency Department,and it attracts more attention due to the increasing disability rate and mortality.Early rapid and accurate assessment of the severity of trauma has a positive significance for improving clinical prognosis.The paper aims to review the characteristics of the severity score based on trauma severity,blood biochemical changes and serum biomarkers,and discuss its prognostic significance.
文摘目的:探讨创伤出血性休克后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素。方法:回顾性研究2012年12月至2021年8月期间共314名创伤出血性休克患者,其中男性患者152名,女性患者162名,年龄中位数为63.00(49.75~82.00)岁。记录患者住院期间的各项临床指标,根据入院7 d内是否发生ARDS将患者分为两组,即ARDS组(n=89)和非ARDS组(n=225),通过判定差异寻找ARDS的危险因素,并建立预测是否出现ARDS的回归模型。结果:创伤出血性休克后ARDS的发生率为28.34%,Logistic回归模型分析发现创伤出血性休克后ARDS的独立危险因素包括男性、冠状动脉粥样硬化性心脏病(简称冠心病)史、高急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、受伤原因为车祸伤和肌钙蛋白Ⅰ升高,各独立危险因素的OR值及95%可信区间(confidence intervals,CI)分别为4.01(95%CI:1.75~9.20)、5.22(95%CI:1.29~21.08)、1.07(95%CI:1.02~1.57)、2.53(95%CI:1.21~5.28)和1.26(95%CI:1.02~1.57),P值分别为0.001、0.020、0.009、0.014和0.034。预测创伤出血性休克后ARDS的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)分别为:男性0.59(95%CI:0.51~0.68)、冠心病史0.55(95%CI:0.46~0.64)、APACHEⅡ评分0.65(95%CI:0.57~0.73)、受伤原因为车祸伤0.58(95%CI:0.50~0.67)、肌钙蛋白Ⅰ0.73(95%CI:0.66~0.80),总体预测值为0.81(95%CI:0.74~0.88)。结论:ARDS在创伤出血性休克患者中发生率较高,男性、冠心病史、高APACHEⅡ评分、受伤原因为车祸伤和肌钙蛋白Ⅰ升高是创伤出血性休克后ARDS的独立危险因素,及时监测这几项指标有利于早期识别和治疗创伤出血性休克后ARDS。