Novel applications of therapeutic hypothermia: report of three cases

Therapeutic hypothermia can provide neuroprotection in various situations where global or focal neurological injury has occurred. Hypothermia has been shown to be effective in a large number of animal experiments. In clinical trials, hypothermia has been used in patients with postanoxic injury following cardiopulmonary resuscitation, in traumatic brain injury with high intracranial pressure, in the perioperative setting during various surgical procedures and for various other indications. There is thus evidence that hypothermia can be effective in various situations of neurological injury, although a number of questions remain unanswered. We describe three patients with unusual causes of neurological injury, whose clinical situation was in fundamental aspects analogous to conditions where hypothermia has been shown to be effective.     

Management of blunt peripheral arterial injury

The recognition of blunt vascular injury has increased in recent years due to an improved understanding of blunt mechanical forces, mechanisms of injury, and awareness that such injuries are often occult. This has been aided by improved quality and expanded availability of noninvasive studies. As a result, outcomes following blunt vascular injury have improved. Compared to penetrating vascular injury and other vascular disease processes, blunt vascular injury has unique features that make it useful to consider as a distinct clinical entity. Manifestations of blunt vascular injury may develop in a delayed fashion and present with more subtle findings, such as a pulse deficit or diminished ankle-brachial pressure index. The objective of this review is to present a brief historical perspective on blunt vascular injury as well as an appraisal of current diagnostic and treatment strategies. Blunt vascular injury will be discussed in distinct anatomic regions, including cervical and upper and lower extremity and evidence-based management strategies developed.     

Early diagnosis of acute kidney injury

PURPOSE OF REVIEW: The early detection of acute kidney injury may allow for timely preventive or therapeutic measures. This review discusses the role of traditional and novel biomarkers in early acute kidney injury diagnosis. RECENT FINDINGS: Detection of acute kidney injury relies on changes in serum creatinine and urea. These are not ideal and do not reflect genuine injury or real-time changes in kidney function. Several novel biomarkers have emerged for early detection of acute kidney injury. Cystatin C is sensitive to early and mild changes to kidney function. Neutrophril gelatinase-associated lipocalin is expressed early after injury and has value in predicting acute kidney injury after kidney transplant and cardiopulmonary bypass. Interleukin-18 has been detected early in acute kidney injury after kidney transplant, cardiopulmonary bypass and sepsis. Kidney injury molecule-1 is upregulated after ischemic/toxic injury and has the ability to predict the need for renal replacement therapy and mortality. While heterogeneous in their expression, these biomarkers may have value as a sequential 'panel' to aid in detecting, classifying and predicting the clinical course of acute kidney injury. SUMMARY: The early detection of acute kidney injury is a clinical and research priority. Traditional measures may contribute to delayed acute kidney injury diagnosis. Recent biomarkers have promise for earlier detection and for research into novel interventions.     

Lung injury after cardiopulmonary bypass: Alternative treatment prospects

Although the lung injury caused by cardiopulmonary bypass (CPB) has been extensively investigated, the incidence and mortality of lung injury after CPB remain a prominent clinical problem. The poor outcome has been attributed to multifactorial etiology, including the systemic inflammatory response and ischemia reperfusion (I/R) injury during CPB. Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease. Which is associated with prognosis. To alleviate this lung injury, interventions that address the pathogenesis are particularly important. This review summarizes the pathogenesis, mechanism and treatment options of lung injury after CPB, such as lung protection with intralipid.     

Nursing care of patients with minor head injury

During the past two decades the subject of severe head injury has received much time, attention, and research funding. Although the number of persons in the United States suffering minor head injury is at least four times greater than the number with severe head injury, it has received less attention and resource allocation. The patient with minor head injury presents a clinically different picture as compared to severe head injury; posttraumatic problems also differ. Nursing care differs accordingly and will be the focus of this article.     

On the relation of injury to pain. The John J. Bonica lecture.

Pain is better classified as an awareness of a need-state than as a sensation. It serves more to promote healing than to avoid injury. It has more in common with the phenomena of hunger and thirst than it has with seeing or hearing. The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.     

转化生长因子β1与骨形态发生蛋白2对关节软骨损伤修复的价值

关节软骨损伤的修复,一直是医学界及运动损伤领域所关注的问题.随着分子生物技术的应用和发展,生长因子在关节软骨损伤中的作用显得尤为重要.文章通过分析关节软骨损伤修复难的原因,阐述众多生长因子中转化生长因子β1与骨形态发生蛋白2对关节软骨损伤修复的作用及机制,并对存在的问题进行了归纳,为今后的实验研究提供重要的参考依据.     

Neuropathy from household electric shock

While neuropathy following electric shock has been well documented, this complication has always been associated with coexisting soft tissue injury. Two cases are reported of neuropathy following accidental household electric shock to the hand in which there was no associated soft tissue injury. These resulted in pain and disability for up to six months. Emergency physicians should be aware of the potential for this injury and that it has a good prognosis.     

Biologic markers for the early detection of acute kidney injury

PURPOSE OF REVIEW: This review discusses the current status of several biomarkers as potential diagnostic tools in patients with acute kidney disease. RECENT FINDINGS: Although the term "acute renal failure" has generally been used to describe acute kidney dysfunction that runs the spectrum from mild prerenal azotemia with no renal pathologic changes and no functional failure to severe oliguric renal dysfunction associated with tubular necrosis with failure of function, this spectrum is better described by the term "acute kidney injury." The mortality rate of hospitalized patients with severe acute kidney disease has not decreased significantly over the past 50 years despite advances in supportive care. The absence of sensitive and specific biomarkers for detecting injury early, grading the severity of the injury, and monitoring the response to therapy has impaired progress in the field and has had a very detrimental effect on the design and outcome of clinical trials in acute kidney disease. As a result of reliance on serum creatinine as a marker for injury and diagnosis, the institution of therapy is markedly delayed. SUMMARY: The search for new biomarkers for acute kidney injury is evolving rapidly with advancement in modern technologies. With better biomarkers we will have the ability to detect injury earlier, identify subclinical injury, provide prognostic information on the course of renal impairment, identify the nephron segments most affected, provide a rationale for segmentation of patients for clinical studies, guide timing of therapy, assess response to therapy, and screen patients at risk for renal injury.     

2016年广东省18家医院伤害监测点流动人口伤害流行特征分析

目的了解和分析2016年广东省18家医院伤害监测点流动人口伤害监测病例的流行特征。方法收集2016年广东省18家医院伤害监测点伤害监测流动人口伤害病例数据,分析其伤害流行特征。结果2016年广东省共收集流动人口伤害病例167230例,男性107488例,女性59742例,性别比为1.80∶1,伤害高发年龄在20~49岁之间。伤害病例的职业多为商业、服务业(28.39%)和生产运输设备操作(18.17%)。伤害发生原因前3位依次为跌倒/坠落(28.96%)、动物伤(19.58%)和钝器伤(17.90%)。伤害发生地点主要为家中(29.27%)、公路/街道(23.23%)和公共居住场所(15.99%)。伤害发生时的活动以休闲活动(42.01%)、工作(19.65%)和驾乘交通工具(9.20%)最为常见。流动人口在公共居住场所、公路/街道和工业/建筑场所发生伤害的比例比本地人口高,在家中、学校与公共场所、体育和运动场所及农场/农田的伤害比本地人口比例低。流动人口在工作中发生伤害的比例是本地人口的3倍,在驾乘交通工具、步行时发生的伤害比例也高于本地人口。伤害发生的部位中,流动人口发生在下肢、躯干和全身广泛损伤的比例高于本地人口。在伤害发生意图中,流动人口发生故意伤害是本地人口的1.66倍。结论流动人口伤害发生比例超过本地人口,伤害已经对广东省流动人口健康构成威胁。因此,做好流动人口伤害预防工作刻不容缓,应尽快对该人群开展有针对性分类干预,减少伤害的发生,提高流动人口生活质量,维护社会稳定。     

Roles of the neutrophil and other mediators in adult respiratory distress syndrome

The adult respiratory distress syndrome (ARDS) and transfusion-related acute lung injury (TRALI) are characterized by diffuse, acute lung injury. Most likely, TRALI is a type of ARDS although it is associated with a much lower morbidity and mortality than found with classic ARDS. For years, the pathogenesis of ARDS has been explained by the complement hypothesis in which pulmonary neutrophilic sequestration and degranulation follow complement-mediated neutrophil chemotaxis. A definitive role for the neutrophil in diffuse, acute lung injury, however, has not been established. Although numerous chemoattractants for neutrophils are generated in the lungs and, through degranulation and formation of toxic oxygen free radicals, the neutrophil is fully capable of causing tissue injury, substantial evidence refutes the requirement for neutrophils in diffuse, acute lung injury. Other potential factors in the pathogenesis of ARDS include primary endothelial cell injury, alveolar macrophage activity, and hemostatic disorders.     

Ventilator-induced lung injury

The clinical relevance of experimental ventilator-induced lung injury has recently received a resounding illustration by the Acute Respiratory Distress Syndrome Network trial that showed a 22% reduction of mortality in patients with acute respiratory disease syndrome when lung mechanical stress was lessened by tidal volume reduction during mechanical ventilation. This clinical confirmation of the concept of ventilator-induced lung injury has also undisputedly substantiated the experimental observation that excessive tidal volume and/or end-inspiratory lung volume is the main determinant of ventilator-induced lung injury. More recently, attention has focused on the roles and implication in the pathogenesis of ventilator-induced lung injury of inflammatory cells and mediators that may be activated and released either in the alveolar space or in the systemic circulation because of the rupture of the alveolar-capillary barrier and on the cellular response to mechanical stress.     

干细胞移植在急性肾损伤中的应用及研究进展

背景：干细胞移植治疗急性肾损伤是近年来研究的热点,不同来源的干细胞在治疗急性肾损伤方面都取得了很大的进展。目的：对干细胞生物学特性、干细胞的临床研究、不同来源的干细胞治疗急性肾损伤的实验性研究、存在问题及前景进行综述。方法：应用计算机检索中国学术期刊全文数据库（CNKI）和Pubmed数据库2001-01/2012-02关于干细胞移植治疗急性肾损伤的文章,检索主题词＂干细胞,移植,肾脏疾病,急性肾损伤＂或＂stem cell,transplantation,kidney disease,acute kidney injury＂。初检索到205篇文献,据纳入标准保留41篇进行分析、综述。结果与结论：干细胞移植是一种尝试用于急性肾损伤治疗的新方法,可以改善肾功能的损伤,加快肾脏修复。虽然仍存在不少有待解决的问题,但干细胞移植仍以其传统方法无法比拟的优势在急性肾损伤领域展现了诱人的应用前景。     

神经再生、多模态神经调制治疗脊髓损伤的研究进展

脊髓损伤在临床上具有较高致残率,依据不同的损伤节段和严重程度可将其分为完全性脊髓损伤和不完全性脊髓损伤。治疗的主要目的是保护神经,目前急性脊髓损伤主要采用外科减压手术、神经营养、激素治疗、低温治疗以及康复干预等临床综合治疗。近年来内、外源性神经干细胞研究领域有所突破,干细胞移植的基础研究已取得重要进展。从长远来看,神经...     

RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis

Introduction  

The lack of a standard definition for acute kidney injury has resulted in a large variation in the reported incidence and associated mortality. RIFLE, a newly developed international consensus classification for acute kidney injury, defines three grades of severity – risk (class R), injury (class I) and failure (class F) – but has not yet been evaluated in a clinical series.     

重型创伤性颅脑损伤患者自发性过度通气的研究进展

预防和减轻继发性脑损伤是重型创伤性颅脑损伤（sTBI）患者重症监护治疗过程中的重点和难点。诱导性过度通气（IHV）可通过减少脑血容量快速降低颅内压,但由于脑血管收缩带来的脑血流减少会加重脑组织的缺血缺氧,目前已不再推荐用于sTBI患者的常规治疗。与此同时,以不同程度的低碳酸血症为特征的自发性过度通气（SHV）在急性创伤性脑损伤患者中较为常见,且由于与患者的神经功能不良转归具有明显的相关性,近年来逐渐受到重视。本文从流行病学、病理生理学效应、临床预后及干预措施等角度对SHV在sTBI中的研究现状进行综述,以期提高重症医师的认知水平,进而重视并推动相关临床及基础研究的开展。     

Body mass index and injury severity in adolescent males

Childhood obesity's relationship to injury severity has not been determined. This study examined the relationship between obesity and injury severity, differences in injury severity between weight groups, and injury predictors. The sample included 611 adolescent males treated for injury at a 10-day camping event in Virginia. Findings indicate a significant relationship between body mass index percentile and injury severity (r = .08, p = .04) and less injury severity in normal-weight adolescents, F(2, 608) = 5.27, p < .01. Predictors of injury severity were cause, place injury occurred and injury type, R(2) change = .07, F(5, 601) = 6.52, p < .01. Implications are that overweight/obese adolescents may have increased risk of serious injuries. Examining predictors may decrease incidence of injuries at future events.     

伤害监测系统质量评估的方法及其应用

伤害已成为重要的公共卫生问题,给世界各国带来巨大的损失。而伤害监测是制定长期伤害预防控制计划的基础,世界上很多国家都认识到伤害的严重性,建立了相应的伤害监测系统。随着伤害监测系统的建立,伤害监测质量的评估就显得尤为重要。本文概述目前伤害监测系统质量评估的方法及应用,旨在为中国伤害监测系统的建立与评估提供建议。     

Pretreatment with bone morphogenetic protein-7 (BMP-7) mimics ischemia preconditioning following intestinal ischemia/reperfusion injury in the intestine and liver

Intestinal ischemia/reperfusion (I/R) injury has been shown to cause intestinal mucosal injury and adversely affect function. Ischemic preconditioning (IPC) has been shown to protect against intestinal I/R injury by reducing polymorphonuclear leukocyte infiltration, intestinal mucosal injury, and liver injury, and preserve intestinal transit. Bone morphogenetic protein 7 (BMP-7) has been shown to protect against I/R injury in the kidney and brain. Recently, microarray analysis has been used to examine the possible IPC candidate pathways. This work revealed that IPC may work through upregulation of BMP-7. The purpose of this study was to examine if pretreatment with BMP-7 would replicate the effects seen with IPC in the intestine and liver after intestinal I/R. Rats were randomized to six groups: sham, I/R (30 min of superior mesenteric artery occlusion and 6 h of R), IPC+R (three cycles of superior mesenteric artery occlusion for 4 min and R for 10 min), IPC+I/R, BMP-7+R (100 microm/kg recombinant human BMP-7), or BMP-7+I/R. A duodenal catheter was placed, and 30 min before sacrifice, fluorescein isothiocyanate-Dextran was injected. At sacrifice, dye concentrations were measured to determine intestinal transit. Ileal mucosal injury was determined by histology and myeloperoxidase activity was used as a marker of polymorphonuclear leukocyte infiltration. Serum levels of aspartate aminotransferase were measured at sacrifice to determine liver injury. Pretreatment with BMP-7 significantly improved intestinal transit and significantly decreased intestinal mucosal injury and serum aspartate aminotransferase levels, comparable to animals undergoing IPC. In conclusion, BMP-7 protected against intestinal I/R-induced intestinal and liver injury. Bone morphogenetic protein 7 may be a more logical surrogate to IPC in the prevention of injury in the setting of intestinal I/R.