现代战伤救治系统概述及其对我军战伤救治的启示

Combat casualty care (CCC) system refers to combining a series of interconnected and constrained elements to form an organic whole to ensure order and high-efficient organization of CCC.U.S army had gradually established a sophisticated CCC system,Joint Theater Trauma System (JTTS) in recent war on terror.JTTS helped to reduce the case fatality rate from 19.1％ in World War Ⅱ to historically lowest level (6.0％) till now.The key components of JTTS include ①) administrative components;② a whole and higheffective CCC chain,of which techniques and strategies had been developed according to the demands in each point of CCC chain,such as CCC strategies,et al;③ studies on CCC,including combat theater-based human research protection program,et al.These experiences are very helpful for the construction and organization of CCC of our armed force.For example,we should further optimize the CCC chain and organization,improve our studies in the combat theater-based aspect,and promote military-civilian integration and collaboration in this subject.Thus,we can build a CCC system of our armed force under the modern war,and then improve the rescue rate of casualties in future war.     

Chinese Medicine in Fighting against Covid-19: Role and Inspiration

Covid-19 pandemic has caused hundreds of thousands deaths and millions of infections and continued spreading violently.Although researchers are racing to find or develop effective drugs or vaccines,no drugs from modern medical system have been proven effective and the high mutant rates of the virus may lead it resistant to whatever drugs or vaccines developed following modern drug development procedure.Current evidence has demonstrated impressive healing effects of several Chinese medicines(CMs)for Covid-19,which urges us to reflect on the role of CM in the era of modern medicine.Undoubtedly,CM could be promising resources for developing drug candidates for the treatment of Covid-19 in a way similar to the development of artemisinin.But the theory that builds CM,like the emphasis of driving away exogenous pathogen(virus,etc.)by restoring self-healing capacity rather than killing the pathogen directly from the inside and the'black-box'mode of diagnosing and treating patients,is as important,yet often ignored,an treasure as CM herbs and should be incorporated into modern medicine for future advancement and innovation of medical science.     

Upper gastrointestinal burns by peroxyacetic acid in children- a review of seven cases

Objective： To study the clinical features of upper gastrointestinal burns by peroxyacetic acid （PA） in children and improve its treatment and outcome. Methods： The clinical materials of 7 cases with upper gastrointestinal burns by PA including clinical presentation, treatment and outcomes were reviewed. Results： There were six boys and one girl. The concentration of the swallowed PA was from 10% to 20% and the amount was 3-10 ml. The mainly bums were located in esophagus in one case, stomach in three cases, both esophagus and stomach in three cases. The gastrostomy and operation of dilating esophagus were performed in the cases with esophageal stricture. The pyloroplasty or gastroduodenostomy was performed in the cases with pyloric obstruction. All the cases were followed up for 12-18 months, dysfunction of esophagus or（and） cardia as well as stiffness and hypodynamia of the stomach was showed in most of the patients. Conclusion： The degree of upper gastrointestinal burns by PA varied according to different concentrations of PA which was swallowed. Correct emergent measures in the acute stage of the burns was very important, gastric tube should be inserted and go through esophagus and pylorus and must be retained for 5-8 weeks to prevent the stricture of esophagus and pylortts, otherwise the tube could act as a passage of nutriment. Prophylaxis of upper gastrointestinal bums by PA is very important because the treatment of the burns is difficulty and the outcomes are not always satisfactory.     

Characteristics of and strategies for patients with severe

Background Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases. Methods Five patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6%±7.2%) of TBSA (full-thickness burns 75%–92% (83.4%±7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test. Results One patient died of septic shock 23 hours after admission (four days after injury), the others survived. Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments. Conclusions Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients’ condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.     

Treatment strategies for mass burn casualties

Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.     

ENDOMETRIOSIS IN ADOLESCENTS──ANALYSIS OF 6 CASES

Objective. To study the characteristics, diagnosis and treatment of endometriosis in adolescent patients.Method. Six cases of adolescent endometriosis in our hospital were reviewed retrospectively.Result. Endometriosis is the most common cause of chronic pelvic pain in adolescents. There may be a natural progression of endometriosis from atypical lesions in adolescents to classic lesions in adults. Congenital abnormalities of the reproductive tract are the main reasons for the adolescent endometriosis.Conclusion. Endometriosis should be strongly suspected in adolescent girls with chronic pelvic pain, especially unresponsive to oral contraceptives and nonsteroidal anti-inflammatory drugs. The treatment involves the operations and medicines.     

Acute inhalation toxicity study of 2-fluoroacetamide in rats

One of the most potent rodenticides is 2-fluoroacetamide)2-FA).Toxicity of this chemical is well documented.However,its inhalation toxicity data is not available in the literature.Hence,acute inhalation toxicity study was carried out by exposing male and female rats to aerosols of 2-FA at different concentrations for 4h in a dynamically operated whole body inhalation exposure chamber.During and after the inhalation exposure the rats were less active,and showed mild tremors and convulsions.At higher concentrations the rats died after2-3 days.The estimated 4-h LC50 for male and female rats was 136.6 and 144.5mg.m^-3 respectively.Exposure to 0.7 LC50 for 4h duration showed an increase in the liver weight of male and female rats 7 days after exposure.Various haematological and biochemical variables determined were within the normal limits.Howerver,histological findings showed injured lung as indicated by desquamtion and necrosis of the epithelium of the respiratory tract.Marked hypertorphy of hepatocytes displaying strong acidophilic granulated cytoplasm was observed.Focal dilatation of renal proximal tubules in kidney with cytoplasmic vacuolation,and irregularly placed pyknotic nuclei were seen.The present study shows that 2-FA is a highly toxic chemical through the inhalation route based on the LC50 value.Consequently necessary precautions should be taken during its handling.     

Association between Polymorphisms of MALAT1 and Blood Lead Levels in Lead-exposed Workers

正Lead,a heavy metal,which is nonessential but may be harmful to the human body,has been widely used to manufacture many products for use in the modern world.Lead-acid batteries have the advantages of low price,high safety,and advanced technology.Presently,our new energy policy is that electricity should replace fuels as an energy source.The use of lead-acid batteries continues to grow     

CT and MR imaging of Spongiform leukoencephalopathy after heroin vapor inhalation： analysis of 13 cases

Objective: To study the CT and MR imagirig features of spongiform leukoencephalopathy after heroin vapor inhalation. Methods: The CT and MR imaging features and pathologic findings of 13 patients with heroin-induced spongiform leukoencephalopathy were analyzed. Results: CT scanning and MR] of all the patients showed diffuse,symmetric lesion in the cercbellar and cerebral white matter, and the cerebellum was invariably involved in all cases.Symmetric round Or butterfly-like lesions lateral to the midline of the cerebellum with clear border was the most distinct feature in CT and MRI examination. The lesions were not found in the anterior limbs of the internal capsules. CT scanning showed low-density changes while MRI TIWI imaging presented low-signal and T2WI high-signal lesions without space-occupying mass. The pathologic findings showed spongiform degeneration of the white matter in the central nervous system, but necrotic lesions were not observed. Condusions: Spongiform leukoencephalopathy should be considered when acute, cerebellar signs are present in patients who admitted a history of heroin inhalation. The CT and MRI manifestation of this disease is typical and the diagnosis can thus be made.     

Studies on the prevention of noise-induced hearing loss among musicians of traditional Chinese opera

<正> The incidence of hearing impairment in musicians of traditional Chinese opera is higher than that in popular music and rock and roll music. The sound levels of different instruments used in traditional Chinese opera measured acoustically showed drums, gongs and cymbols to be hazardous to the ear. The conventional measures of prevention, such as ear plugs are not acceptable by the musicians because of interference to the musician's hearing acuity. A rearrangement of the seats for the musicians was suggested by the authors, the percussive musicians should seat themselves one meter lower than the other musicians. Animal (guinea pigs) experiments by study of AP in EcochG and ul-trastructural observations of the cochlea have confirmed that our suggestion for prevention of noise -induced hearing impairment to be efficient.     

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

Objective To investigate the clinical characteristics of invasive burn wound infection wit h sepsis in patients with major burns and to summarize the successful experience s in the treatment of such patients. Methods Eight patients with major burns, complicated by invasive burn wound infection an d sepsis were consecutively admitted to our hospital from September 1997 to Octo ber 1998.Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock.The plasma concentrations of IL-6, IL-8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical inter vention, as well as when the patient’s vital signs became stable.Results The patients’ conditions usually deteriorated abruptly when extensive invasive b urn wound infection emerged.While multi-microbial infection was usually found , Pseudomonas aeruginosa was the predominant bacteria isolated from the sube schar tissue.The plasma concentrations of IL-6, IL-8, TNFα and LPS before s urgical intervention were significantly higher than those after surgical interve ntion (P&lt;0.05).The lowest levels of the inflammatory mediators were obser ved when the patients’ conditions became stable, and the values were signifi cantly lower than those before surgical intervention (P&lt;0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of i nfected burn wound, they should be excised and covered as early as possible.LP S and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis.Although favorable results should be attributed to comprehensive t reatment, we believe that early, aggressive and thorough surgical excision of in fected burn wounds, followed by sound and complete coverage of the area, play a crucial role.     

Clinical characteristics of 4355 patients with anterior cruciate ligament injury

Background Clinical features of anterior cruciate ligament （ACL） injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients （612 athletes and 3743 non-athletes） were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group （56.05％ vs.24.95％,P＜0.001）.This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes （413.3 days vs.717.5 days,P＜0.001）.Three thousand nine hundred and eight cases were ordered ACL reconstruction （76.04％ single-bundle,18.30％ double-bundle）.Three hundred and forty-five patients （7.92％）were combined with other ligaments injuries,2667 （61.24％） were found with various grades of cartilage lesions,and 3377 （77.54％） were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.     

Dynamic characteristic analysis of HIV mother to child transmission in China

Objective to explore dynamic characteristics of the HIV mother to child transmission （MTCT） epidemic in China.Methods A deterministic dynamic transmission model was used to determine the effect of key parameters on the likely long-term trends of the HIV MTCT epidemic in China.Matlab 7.0 was used to develop the model.Results The number of the susceptibles （S）,the transmission rate （β）,and the screening proportion （α） of HIV positive pregnant women have the greatest impact on the HIV MTCT epidemic in China.The growth of the MTCT epidemic in China could not be controlled only by decreasing the MTCT transmission rate.The prevalence of HIV positive women should be reduced and more pregnant women should be tested for HIV.Conclusion Prevention of MTCT （PMTCT） should focus not only on the reduction of HIV transmission rates and incidences of HIV among women but also on the increase of HIV testing for pregnant women.The most cost-effective PMTCT means for China should be investigated in future studies.     

Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure

Background  Infection due to pandrug-resistant Pseudomonas aeruginosa (PDRPA) has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns (60%–80%) with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.

Methods  We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.

Results  Four patients recovered from burns and one died after therapy.

Conclusions  First, compromised immunity caused by delayed healing of burn wounds in patients with large-area burns and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.

     

THE EVALUATION OF THE LONG-TERM RESULTS IN THE TREATMENT OF SALIVARY GLAND CARCINOMA

This paper summarized the long-term follow-up results and our clinical treatment experience of 426 patients with carcinoma of salivary gland, who had undergone surgical treatment in our department from 1957 to 1976 successively. Our study showed that the 10-year and 15-year survival rates were 63.3% and 59.1% respectively, much higher than the results presented by other researchers. The following four points were concluded: 1. The long-term treatment result of salivary gland carcinoma is determined not only on mode of treatment and clinical stage, but more on its pathologic type. For high malignant salivary carcinoma, comprehensive multidiscipline treatments should be adopted. 2. Management of primary focus." The different operative principle and mode shouht be worked out in advance according to pathologic type and primary site of tumors. 3. Management of lymphonode: For cases with undifferentiated carcinoma, low-differentiated mucoepiderrnoid carcinoma, squamous cell carcinoma, adenocarcinoma and papillary cystadenocarcinoma, elective neck dissection should be performed. 4. Prevention of distant metastasis: Preoperative biopsy should be avoided. Frozen-section should be made during the operation and, diagnosis and treatment be accomplished in the meantime.     

A Clinical Analysis of 1255 Children with Burn Injuries

In a twenty-five year period(1958-1983),there were altogether 4651burn cases admitted to this institute,of whom 1255 were children(26.95%).Themortality rate of this series of young victims was 4.7%(59 cases).The causes ofdeath were septicemia(30 cases),shock(17),cerebral edema and cerebral hernia(4),acute renal failure(4),severe burn wound sepsis(2),and pulmonarycomplications resulting from severe inhalation burns(2).Since the mortality and the incidence of shock and septicemia were closelyrelated to the extensiveness of the burn injuries,a new classification of burninjuries in children is suggested as follows:1.Mild burns:The affected area is less than 10% TBSA.2.Moderate burns:10-29% TBSA is injured.3.Severe burns:30-49% TBSA is injured.4.Extremely severe burns:More than 50% TBSA is injured.     

Minimally invasive surgery in fracture management

Minimally invasive surgery （MIS） is the trend of development in modern surgery. Its research,application and popularization in the field of orthopaedic trauma are well demonstrated in the development of current osteosynthesis. MIS implies that a surgical operation should minimize the damages to the body tissues to reduce the postoperative pain, so as to start rehabilitation exercises earlier, to facilitate functional recovery, and to improve the outcomes of the surgical treatment. The main point of fracture management with MIS is to protect the blood supply of the fragments and the biological environment at the fracture site from destruction, thus to guarantee the callus formation and fracture healing. The operative procedure should follow the principles that denudating the fragment of soft tissue attachment must be avoided as much as possible, the fracture be indirectly reduced and the implant be inserted subcutaneously or beneath the muscle layer. When practiced, the implant should be well selected according to the concrete situation of the fracture, and the tool and technique to be used as well. MIS in osteosynthesis rests mainly on the improvements in both the operative technique and devices for fixation.     

Perioperative treatment for the central type carcinoma of lung by lung resection with bronchus-first cutting off through pericardium

Objective To investigate the perioperative treatment,the cause of death,and complications of the lung resection for therapy of central type carcinoma of lung.Methods we retrospectively analyzed the treatment and prognosis of 136 patients with central type carcinoma of lung using the bronchus-first lung resection through pericardium during May 1993 to December 2006.Results Total amount of complications in this group was 40 cases,among them,5 cases with pulmonary arterial bleeding,4 cases with respiratory dysfunction,3 cases with contralateral lung pneumonia,6 cases with heart dysfunction,15 cases with arrhythmia,2 cases with injury of recurrent laryngeal nerve,3 cases with chylopleura,and 2 cases with leaking of the bronchus nub.The total complication rate was 27.9%.3 cases died during perioperation,and the mortality was 2.2%.The older the patients were,the higher rate of complications occurred.Conclusion In this group of 136 cases of lung carcinoma,the frequent postoperative complications were the complications of respiratory system and cardiovascular system.The leading causes of death were respiratory dysfunction and heart dysfunction.According to our data,we concluded that the prevention and treatment should be performed during perioperation as follows:Airway should be intensively cared and prepared before operation.The ventilation should be kept unblocked after operation.Assistant ventilation should be performed if necessitated.For those with coronary heart disease or pulmonary heart disease active treatment should be given carefully.Efficient acesodyne and sedation and strictly monitoring of cardiograph should be given postoperatively,finding out the cause of arrhythmia for the correct therapy to protect the heart function.In addition,the indication of operation should be strictly predominated and the principle of operation should be kept on.     

Modulation of the Culture Supernatant of Decidual Cells with Exogenous Cytokines on Killing Activity of Natural Killer Cells in Early Pregnancy

Objective To investigate the important function of cytohines in early pregnancy and to provide basic and experimental evidence for understanding the mechanism of their action.Methods Add interferon-γ (IFN-γ) ,interleuhin-2(IL-2) , interleuhin-6(IL-6) andepidermal growth factor(EGF) to the confluent culturing decidual cells with three different concentrations and harvest the culture supernatant after 12, 24 and 48 h separately. Observe the effect of the supernatant on killing activity of NK cells with radioimmunological assay of ^51Cr immersion.Results The culture supernatant of decidual cells can promote the killing activity of NK cells in various degrees, and the effect is independent of the type, concentration and acting time of cytokines.Conclusion In normal pregnancy, decidual cytokine network is in a dynamic equilibri-um. Exogenous cytokines would be harm to normal pregnancy by interfering the equi-librium state, but the exact mechanism needs further study.     

Doctors’ faith

We make some efforts to find some connections between religion and medical science. Medical science can be regarded as sacred and holy as a religion for doctors to believe. The common points between them are the basis to successfully integrate them into doctors’ faith. Furthermore, we explain that doctors need a faith to believe so as to meet the demand of humanitarian traits we should have and to do better in the scientific work and win in the battles with the diseases.