针刺对重度颅脑损伤患者脑脊液中IL-8、sICAM-1含量的影响

目的:观察针刺对重度颅脑损伤患者脑脊液中白细胞介素-8(IL-8)、可溶性细胞黏附分子-1(sICAM-1)含量的影响,并探讨针刺治疗的脑保护作用机理.方法:将50例重度颅脑损伤患者随机分为对照组24例和治疗组26例.对照组应用西医常规治疗,治疗组在常规治疗基础上加针刺涌泉和厉兑穴.采用酶联免疫吸附方法(ELISA)检测患者伤后1、2、3、5、7 d脑脊液中IL-8、sI-CAM-1含量.结果:①对照组脑脊液中IL-8、sICAM-1含量在伤后1 d升高,2 d达高峰,3 d开始下降,5 d进一步下降,7 d下降到正常水平;②治疗组脑脊液中IL-8、sICAM-1含量在伤后1 d升高,2 d下降,3 d继续下降,5 d下降到正常水平;③治疗组伤后2、3、5 d脑脊液中IL-8、sICAM-1含量均低于对照组(P＜0.05).结论:针刺能减轻重度颅脑损伤后脑内炎症反应,从而减轻因炎症反应引起的继发性脑损害.     

Trauma centre patient volume and inpatient mortality risk reconsidered

BackgroundSeveral studies have examined the relationship between injury volumes and trauma centre outcomes, with varying results attributable to differences in the measurement of volume's effect on mortality and differences in how characteristics are addressed as potential confounders.MethodsThis analysis includes all trauma cases reported to the NTDB 2012. The effect of trauma centre volume on patient mortality risk was measured in three different contexts: as a linear function of trauma centre volume, as a dichotomous function comparing patients in trauma centres with and without 1200 or more cases, and as a non-linear function of trauma centre volume. Multivariable weighted Hierarchical Generalized Linear Models were used to account for the combined effects of facility level and patient level covariates. Patient level mortality risk was assessed using the ACS Trauma Quality Improvement Programme methodology.ResultsTrauma centre volume was not a statistically significant predictor (at the α = 0.01 level) of patient mortality risk, in any of the three models. Comprehensive adjustments for patient level risk were obtained, with excellent discrimination between survivor and decedent cases. The addition of trauma volume to baseline patient mortality risk yielded no improvement in the accuracy of any model. These results were not sensitive to the inclusion of Level II trauma centres. Equivalent results were obtained by repeating the analysis for the Level I subpopulation only.ConclusionsCase volume may be a reasonable standard for determining whether adequate numbers of injured patients are available to support training needs and experience requirements of a Level I trauma centre. However, case volume is not a useful predictor of patient mortality in individual facilities. Trauma centre volume has no independent effect, after accounting for the patient level characteristics that predominantly influence mortality.     

Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports

IntroductionExtreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations.AimOur aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs.MethodsThis is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall.ResultsAmong the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48 h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score ≥ 4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12–L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty.ConclusionsHigh-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12–L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.     

Thoracoabdominal herniation – but not as you know it

Thoracoabdominal hernias are uncommon following blunt trauma. If diaphragmatic rupture does occur, the abdominal viscera can herniate into the thorax through the diaphragm. We report a rare case of thoracoabdominal herniation in which the bowel herniated through the lateral abdominal wall, migrating cranially and entering the thorax through an intercostal defect. This case highlights the need for early and definitive surgical repair.     

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Early life Adversity,functional connectivity and cognitive performance in Schizophrenia: The mediating role of IL-6

ObjectiveExposure to childhood trauma (CT) is associated with cognitive impairment in schizophrenia, and deficits in social cognition in particular. Here, we sought to test whether IL-6 mediated the association between CT and social cognition both directly, and sequentially via altered default mode network (DMN) connectivity.MethodsThree-hundred-and-eleven participants (104 patients and 207 healthy participants) were included, with MRI data acquired in a subset of n = 147. CT was measured using the childhood trauma questionnaire (CTQ). IL-6 was measured in both plasma and in toll like receptor (TLR) stimulated whole blood. The CANTAB emotion recognition task (ERT) was administered to assess social cognition, and cortical connectivity was assessed based on resting DMN connectivity.ResultsHigher IL-6 levels, measured both in plasma and in toll-like receptor (TLR-2) stimulated blood, were significantly correlated with higher CTQ scores and lower cognitive and social cognitive function. Plasma IL-6 was further observed to partly mediate the association between higher CT scores and lower emotion recognition performance (CTQ total: β_indirect −0.0234, 95% CI: −0.0573 to −0.0074; CTQ physical neglect: β_indirect = −0.0316, 95% CI: −0.0741 to −0.0049). Finally, sequential mediation was observed between plasma IL-6 levels and DMN connectivity in mediating the effects of higher CTQ on lower social cognitive function (β_indirect = −0.0618, 95% CI: −0.1523 to −0.285).ConclusionThis work suggests that previous associations between CT and social cognition may be partly mediated via an increased inflammatory response. IL-6′s association with changes in DMN activity further suggest at least one cortical network via which CT related effects on cognition may be transmitted.     

严重创伤患者血清中IL-6、IL-8和TNF-α的动态变化及其临床意义

目的:观察严重创伤后血清中白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)的动态变化,探讨其临床意义。方法:45例严重创伤患者入选创伤组,分别在入院的第1、第3、第5、第10、第15天检测其血清TNF-α、IL-6和IL-8的水平。20名健康体检者为对照组。将检测结果进行统计学分析。结果:与对照组比较,创伤组IL-6在损伤后第1天即升高,第3～5天达到高峰后开始逐渐下降;IL-8在损伤后第1天即升高,第3～5天达到高峰后开始逐渐下降;TNF-α在损伤后第1天即升高,随后即逐渐下降直至恢复到基础水平。结论:动态观察严重创伤患者血清中细胞因子水平的变化有助于病情的评估。