Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury

Introduction  

Retrospective studies have demonstrated a potential survival benefit from transfusion strategies using an early and more balanced ratio between fresh frozen plasma (FFP) concentration and packed red blood cell (pRBC) transfusions in patients with acute traumatic coagulopathy requiring massive transfusions. These results have mostly been derived from non-head-injured patients. The aim of the present study was to analyze whether a regime using a high FFP:pRBC transfusion ratio (FFP:pRBC ratio >1:2) would be associated with a similar survival benefit in severely injured patients with traumatic brain injury (TBI) (Abbreviated Injury Scale (AIS) score, head ≥3) as demonstrated for patients without TBI requiring massive transfusion (≥10 U of pRBCs).     

Thoracic aortic stent-graft devices: problems, failure modes, and applicability

Optimal treatment strategies for pathologies of the descending thoracic aorta are still controversial. Open surgery is complex, while endovascular devices allow nonsurgical access to the thoracic aorta. Endografts can be inserted via a peripheral artery while maintaining aortic blood flow without any need for clamping. Both short- and mid-term outcomes after endografting thoracic aneurysm and type B aortic dissection are encouraging, with significantly lower morbidity and early mortality compared with open surgery. However, despite emerging popularity and growing interest as an alternative to surgery, endograft design and manufacturing have not kept pace with growing clinical ambition. Major challenges associated with endovascular procedures using the current generation of endografts range from the relative rigidity and size of the delivery system to the failure of thoracic endografts to conform snugly to the anatomy of the aortic arch. Nonconformity of grafts may lead to graft instability, endoleak, and procedural failure. Current delivery systems are potentially traumatizing and, at times, too inflexible to track through tortuous, calcified vessels, and often require surgical exposure of the access vessel. Although efforts have been made by the industry to improve conformability and fixation in the aortic arch, given the spiraling movement of the thoracic aorta with each ventricular contraction, much work needs to be done on miniaturization and creation of disease-specific devices. The aim of this work is to give an overview on thoracic aortic stent-graft devices with focus on problems, failure modes and potential improvements.     

右美托咪定用于腹腔镜子宫切除术的效果探讨

目的探讨右美托咪定用于腹腔镜子宫切除术全麻维持的效果。方法选取该院进行腹腔镜子宫切除术患者100例,随机分为两组,研究组气管插管后静脉泵注右美托咪定;对照组不使用右美托咪定。结果研究组的自主呼吸恢复时间、气管导管拔出时间、术后清醒时间优于对照组（P〈0.05）。结论右美托咪定静脉泵注用于全麻维持可缩短患者的全麻复苏时间,效果显著。     

60家医院创建无烟医院对医生控烟知识态度行为的影响

目的：通过创建无烟医院活动,了解医生的吸烟状况和控烟知识、态度与行为,并对干预效果进行评价。方法：在北京、上海、广州选择60家医院创建无烟医院,对全院医生开展控烟干预,在干预前对19580名医生、干预后对20772名医生进行问卷调查,了解医生的吸烟状况和控烟知识、态度与行为的变化。结果：通过一年的控烟干预,医生吸烟率由...     

经关节入路微创钢板固定技术治疗股骨远端C型骨折

目的探讨经关节入路微创钢板固定(MIPPO)技术治疗股骨远端C型骨折的临床疗效。方法2002年4月～2005年2月,应用MIPPO技术治疗股骨远端C型骨折14例,按AO/ASIF分类：C1型3例,C2型6例,C3型5例。先行关节内骨折切开复位、松质骨螺钉固定,再行髁上部分骨折间接复位、经关节内切口插入髁支撑钢板或LISS钢板桥接固定骨折。结果12例患者获得10～32个月(平均18．4个月)随访,骨折均获愈合,愈合时间10周～12个月,平均4．6个月。按Kolmert和Wulff的评价标准：优4例,良5例,可2例,差1例,优良率为75%。结论应用MIPPO技术治疗股骨远端C型骨折实现了微创操作,具有创伤小、软组织干扰少、骨折愈合快等优点,疗效满意。     

抗体介导的排斥反应与临床

随着器官移植体液免疫理论的发展与抗体检测技术的进步,抗体介导的排斥反应(AMR)已逐渐被认识和引起关注。其治疗难度大、逆转率较低,已成为导致移植物失功的重要原因。本文较为系统地介绍了AMR的免疫机制、诊断与防治进展,以及供者特异性抗体的检测技术和临床意义,从而提出供者特异性抗体是引起移植物排斥反应特别是慢性排斥反应的主要原因,移植受者需常规监测抗体以利及时干预和治疗。     

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Objective

Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown—this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR.