救治人员总协调制度在严重多发伤早期救治中的作用

目的 探讨院内救治人员总协调制度对严重多发伤早期救治的作用,以进一步优化创伤病患救治流程。方法 选取2013—2014年在苏州市立医院救治的严重多发伤病人共130例为研究组,同时回顾2011—2012年苏州市立医院救治的严重多发伤病人共123例为对照组,比较研究组与对照组在院内术前时间、在院监护时间、早期漏诊率、早期死亡率及并发症发生率等指标的变化。结果 研究组病人的院内术前时间、在院监护时间较对照组显著缩短,早期漏诊率、早期死亡率和并发症发生率均显著降低。结论 院内救治人员总协调制度的执行可有效提高严重多发伤早期救治效率。     

Robust human body model injury prediction in simulated side impact crashes

This study developed a parametric methodology to robustly predict occupant injuries sustained in real-world crashes using a finite element (FE) human body model (HBM). One hundred and twenty near-side impact motor vehicle crashes were simulated over a range of parameters using a Toyota RAV4 (bullet vehicle), Ford Taurus (struck vehicle) FE models and a validated human body model (HBM) Total HUman Model for Safety (THUMS). Three bullet vehicle crash parameters (speed, location and angle) and two occupant parameters (seat position and age) were varied using a Latin hypercube design of Experiments. Four injury metrics (head injury criterion, half deflection, thoracic trauma index and pelvic force) were used to calculate injury risk. Rib fracture prediction and lung strain metrics were also analysed. As hypothesized, bullet speed had the greatest effect on each injury measure. Injury risk was reduced when bullet location was further from the B-pillar or when the bullet angle was more oblique. Age had strong correlation to rib fractures frequency and lung strain severity. The injuries from a real-world crash were predicted using two different methods by (1) subsampling the injury predictors from the 12 best crush profile matching simulations and (2) using regression models. Both injury prediction methods successfully predicted the case occupant's low risk for pelvic injury, high risk for thoracic injury, rib fractures and high lung strains with tight confidence intervals. This parametric methodology was successfully used to explore crash parameter interactions and to robustly predict real-world injuries.     

体外反搏治疗小儿急性脑外伤的临床应用分析

目的:探讨以体外反搏为主的综合康复治疗对脑外伤后偏瘫患儿运动功能和日常生活活动能力(ADL)的影响。方法:选择2015年7月至2017年7月我院神经外科收治的脑外伤后偏瘫患儿46例,将其随机分为对照组和治疗组。两组患者均采用常规的康复治疗和护理,对照组采取常规的物理治疗(PT治疗),治疗组患者给予以体外反搏为主的综合康复治疗。于治疗1、3个月后,评价和比较两组患者粗大运动能力(GMFM)评分、精细运动能力(FMFM)评分和日常生活能力(ADL)评分的变化。结果:治疗1、3个月后,两组患儿GMFM、FMFM评分均较治疗前明显增加(均P0.01),而治疗组治疗后GMFM、FMFM评分均明显高于对照组(均P0.01)。两组治疗一个月后ADL总有效率(显效率与有效率之和)分别为90.48%和76.19%,治疗三个月后分别为95.24%和85.71%,治疗组均显著高于对照组(均P0.05)。结论:以体外反搏为主的综合康复治疗有利于促进脑外伤后偏瘫患者ADL及部分运动功能的提高。     

Evaluation of helmet and goggle designs by modeling non-penetrating projectile impacts

Despite the progress in developing personal combat-protective gear, eye and brain injuries are still widely common and carry fatal or long-term repercussions. The complex nature of the cranial tissues suggests that simple methods (e.g. crash-dummies) for testing the effectiveness of personal protective gear against non-penetrating impacts are both expensive and ineffective, and there are ethical issues in using animal or cadavers. The present work presents a versatile testing framework for quantitatively evaluating protective performances of head and eye combat-protective gear, against non-penetrating impacts. The biomimetic finite element (FE) head model that was developed provides realistic representation of cranial structure and tissue properties. Simulated crash impact results were validated against a former cadaveric study and by using a crash-phantom developed in our lab. The model was then fitted with various helmet and goggle designs onto which a non-penetrating ballistic impact was applied. Example data show that reduction of the elastic and shear moduli by 30% and 80% respectively of the helmet outer Kevlar-29 layer, lowered intracranial pressures by 20%. Our modeling suggests that the level of stresses that develop in brain tissues, which ultimately cause the brain damage, cannot be predicted solely by the properties of the helmet/goggle materials. We further found that a reduced contact area between goggles and face is a key factor in reducing the mechanical loads transmitted to the optic nerve and eye balls following an impact. Overall, this work demonstrates the simplicity, flexibility and usefulness for development, evaluation, and testing of combat-protective equipment using computational modeling.

• Highlights

• A finite element head model was developed for testing head gear.

• Reduced helmet’s outer layer elastic and shear moduli lowered intracranial stresses.

• Gear material properties could not fully predict impact-related stress in the brain.

• Reduced goggles-face contact lowered transmitted loads to the optic nerve and eyes.

     

重症创伤患者ICU后综合征心理障碍影响因素分析

摘要 目的：探究重症创伤患者ICU后综合征（PICS）心理障碍影响因素。方法：本次研究纳入60例重症创伤患者,按照是否存在PICS分为对照组（20例）和PICS组（40例）。进行不同治疗情况PICS心理障碍影响因素单因素分析。PICS心理障碍患者急性生理与慢性健康状况评分系统（APACHEII）和医院焦虑和抑郁量表（HADS）评分、Ogawa改良创伤评分系统、匹兹堡睡眠质量指数量表（PSQI）评分进行单因素分析,并进行PICS心理障碍的相关性分析,PICS心理障碍影响因素Logistic回归分析。结果：（1）PICS组年龄<30比例较对照组升高,30-50患者比例较对照组降低（P<0.05）。PICS组文化程度文盲和小学患者比例较对照组升高,初中和高中及以上患者比例较对照组降低（P<0.05）。（2）PICS组手术、手术时间1~3 h和＞3 h、ICU时间10~14 d、镇静药物和有创机械通气患者比例较对照组升高（P<0.05）。（3）PICS组APACHEII评分<20和20~25患者比例较对照组降低,APACHEII评分25~30和＞30患者比例较对照组升高（P<0.05）;PICS组HADS评分<5和5~15患者比例较对照组降低,HADS评分15~25和≥25患者比例较对照组升高（P<0.05）;PICS组得分低于9分的轻度损伤者和得分10~16分的中度损伤的患者比例较对照组降低,得分≥17分为重度损伤的患者比例较对照组升高（P<0.05）;PICS组得分≤7分的睡眠质量较好的患者比例较对照组降低（P<0.05）,得分>7分的睡眠障碍的患者比例较对照组升高（P<0.05）。（4）PICS组年龄、手术时间、ICU时间、APACHEII评分、HADS评分、PSQI得分以及创伤指数评分较对照组升高（P<0.05）;（5）PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关（P<0.05）。结论：PICS组年龄、手术时间、ICU时间、APACHEII评分和HADS评分较对照组升高;PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关。     

吻合皮下静脉的带蒂皮瓣修复四肢皮肤软组织缺损的效果分析

摘要 目的：探讨与分析吻合皮下静脉的带蒂皮瓣修复四肢皮肤软组织缺损的效果。方法：选择2018年12月到2021年12月在本院创伤造成的四肢皮肤软组织缺损60例患者作为研究对象,将其随机分为吻合皮下静脉带蒂皮瓣组与传统带蒂皮瓣组各30例。吻合皮下静脉带蒂皮瓣组给予吻合皮下静脉的带蒂皮瓣修复治疗,传统带蒂皮瓣组给予常规直接覆盖创面修复治疗。结果：所有患者都顺利完成手术,吻合皮下静脉带蒂皮瓣组围手术指标时间均较传统带蒂皮瓣组少（P<0.05）。吻合皮下静脉带蒂皮瓣组术后3个月的总有效率为96.7 %,高于传统带蒂皮瓣组的76.7 %（P<0.05）。吻合皮下静脉带蒂皮瓣组术后3个月的并发症发生率较传统带蒂皮瓣组低（P<0.05）。吻合皮下静脉带蒂皮瓣组术后6个月的感觉功能恢复情况好于传统带蒂皮瓣组（P<0.05）。结论：吻合皮下静脉的带蒂皮瓣能促进患者的创面愈合,提高治疗效果,减少并发症,加快恢复患者的四肢皮肤软组织缺损。     

Interpersonal violence between 18th century Native Americans and Europeans in Ohio

During the winter of 1778-1779, a garrison of 176 individuals lived within the walls of a Revolutionary era stronghold named Ft. Laurens on the banks of the Tuscarawas River, near the present-day town of Bolivar, Ohio. At least 21 individuals were buried in the fort's cemetery during its occupation, 13 of whom were supposedly killed and scalped by Native Americans while gathering firewood and foraging horses. The purpose of this study is to build on previous work by Sciulli and Gramly ([1989] Am J. Phys. Anthropol. 80:11-24) by adding a more detailed analysis of the traumatic lesions, in order to better understand what happened to the victims. Lesions were analyzed based on type, location, and dimensions, as well as their overall pattern on the skeleton. Results indicate that multiple blows to the cranium were common. Out of 12 observable crania, the order of blows could be determined in only one case. Eleven of 12 of the observable crania from ambush victims and four of the seven nonambush victims exhibited lesions consistent with scalping. Evidence of postcranial trauma was noted on four individuals: one was an ambush victim, and the other three were killed at other times. No evidence of gunshot wounds was found.     

Differential Response of Neural Cells to Trauma-Induced Free Radical Production In Vitro

CNS trauma has been associated with an increase in free radical production, but the cellular sources of this increase or the mechanism involved in the production of free radicals are not known. We, therefore, investigated the effects of trauma on free radical production in cultured neurons, astrocytes and BV-2 microglial cells. Free radicals were measured with the fluorescent dye DCFDA following in vitro trauma. At 30 and 60 min following trauma, there was a 132% and 64% increase, respectively, in free radical production in neurons when compared to controls. In astrocytes, there was a 94% and 133% increase at 30 and 60 min, respectively. Microglial cells, however, displayed no significant increase in free radicals at 30, 60 or 120 min following trauma. Since trauma can induce the mitochondrial permeability transition (MPT), a process associated with mitochondrial dysfunction, we further investigated whether cyclosporin A (CsA), an agent known to block the MPT, could prevent free radical formation following trauma. In neurons CsA did not block free radical production at 30 min but blocked it by 90% at 60 min. In contrast, in astrocytes CsA completely blocked free radical production at 30 min but did not block it at 60 min. Our results indicate that a differential sensitivity to trauma-induced free radical production exists in neural cells; that the MPT may be involved in the production of free radical post-trauma; and that the CsA-sensitive phase of free radical production is different in neurons and astrocytes.     

Dental and general health in a population of wild ring-tailed lemurs: a life history approach

Data are presented on dental and general health for seven groups of wild ring-tailed lemurs, Lemur catta, from the Beza Mahafaly Reserve, in southern Madagascar. As part of a study of population demography, adults were captured, collared, and tagged, and biometric measurements, dental casts, and analyses of dental and general health were made. Results indicate that patterns of dental health vary by individual, age, sex, and habitat. Prime adults show more dental attrition than young adults. Prime males living in more marginal habitats show greater mean attrition than those living in richer habitats. Dental damage, specifically to the toothcomb, indicates that mechanical stresses to this region may include the initial harvesting of foods, in addition to grooming. Males exhibit more evidence of past trauma, including scars and chipped teeth. These results indicate that environmental as well as social factors, such as female dominance, may lead to sex differences in health patterns among lemurs.     

Synthesis and Characterization of N,N-Dichlorinated Amino Acids: Taurine,Homotaurine, GABA and L-Leucine

Epilepsy, trauma and other circumstances leading to hyperexcitable conditions in the CNS tend neurochemically to be associated with excessive stimulated release of glutamic acid and/or a failure of GABA modulated inhibition. Somewhat to a lesser extent, taurine and its homologue homotaurine, have also been shown to antagonize the excitatory actions of glutamic acid. Here we report the successful synthesis and isolation in pure form of N,N-dichlorinated GABA, taurine, homotaurine and leucine. These compounds are much more lipophilic than their parent compounds and may therefore more readily penetrate the blood-brain barrier systems into the neural tissue, where they can be easily dechlorinated. Very preliminary biological testing shows that this may indeed occur. The synthesis and purification methodology will likely also be applicable to a number of other amino acids as well as certain peptides or selected proteins.