Objective Summarize and analyze surgical treatment experience and clinical application value for severe chest trauma with multiple rib fractures (which has a positive rate of occurrence),the treatment method is to surgically fix titanium plate to ribs at the early stage of the fractures.Methods Adopted 161 severe chest trauma cases require thoracotomy from June,2007 to June,2012.The patients were arranged as two groups according to the doctor's requirements by our fulltiem horses.79 cases of normal thoracotomy operations were recorded as control group ; at the same period 82 cases thoracotomy operation with ribs internally fixed treatment were recorded as the group of internal plate fixing treatment group.Then compare the results of postoperative paradoxical respiration,oxygen concentration,lung function,chest drainage,length of stay and others after operations.Results The treatment results include oxygen saturation of blood,lung function,and length of stay,the complication rate and death rate.The results of ribs intemafly fixed group are better than the control group on average.Conclusion Apply internal plate fixing operation to ribs during the thoracotomy will effectively control thoracic paradoxical respiration and prevent respiratory failure,improve lung function,reduce death rate of chest trauma and the complication and be helpful for rapid recovery.

Background Lewis rat is a commonly used specie in experimental autoimmune uveitis(EAU).However,the characteristics of EAU,especially ocular uhrastructural change,are rarely reported.Objective This study was to investigate the inflammatory characteristics and ocular uhrastructure of EAU models in Lewis rat.Methods EAU models were induced in 12 SPF female Lewis rats(6-8 weeks old)by injection of complete Freund adjuvant(CFA) containing interphotoreceptor retinoid-binding protein (IRBP,1177-1191) and tuberculin (TB) into footpads,napes and back of the body,and 6 normal matched rats were used as normal controls.The diet and drinking,temperature and behavior acts of the rats were recorded during the observational duration.Ocular manifestations were examined under the slit lamp biomicroscope after modeling and scored.Eyeballs were obtained in 12 days after modeling for histopathological examination,and the ultrastructures of eyeballs were observed under the scanning electron microscope and transmission electron microscope.The use and care of the animals complied with Statement of ARVO.Results The food-intake was (190.00± 18.03)g in the model group,and that in the control group was (285.33 ±28.02) g,showing a significant difference between them (t =4.955,P =0.012).The drinking-water volume of rats was (241.67±t 18.56)ml in the model group,which was significantly less than (289.67± 18.18)ml in the control group,showing a significant difference between them (t =3.201,P =0.033).In addition,elevated temperature and tiredness were found in the model rats.Anterior chamber empyema,iris hyperemia and occlusion of the pupil appeared in the models on the 6th day and peaked on the 12nd day after immunized,with the inflammatory scores of 3.83±0.41.The infiltration of inflammatory cells were seen in anterior chamber,ciliary body and vitreous cavity under the optical microscope in the model rats.Scanning electron microscopy found uneven iris texture,coarse ciliary surface and loosen villi of retinal pigment epithelial (RPE) cells in the model rats.Under the transmission electron microscope,the infiltration of macrophagocytes on the iris,wrinkle sparse of ciliary epithelium,myeloid bodies in retinal Müller cells and vacuolus in mitochondria of RPE cells were exhibited.No obvious abnormality was found in the control rats.Conclusions Lewis rats are autoimmune status following injection of CFA with IRBP(1177-1191) and TB.The morphology and ultrastructure of eyeballs in the EAU rats can explain the finding of eyes.

Objective:To explore the risk factors of renal function progression in patients with acute renal injury (AKI) after moderate hypothermic circulatory arrest surgery in acute aortic dissection (AD).Methods:Retrospective analysis was made base on the data of 290 patients with acute AD who underwent surgical treatment from January 2014 to August 2022 in the Affiliated Hospital of Jining Medical University. According to the Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria in 2015, patients with AKI after surgery were selected as the study objects. Patients with progressive deterioration of renal function or required continuous renal replacement therapy after AD operation were defined as the progression group of AKI, the other patients with gradual improvement of renal function after AD operation were defined as the improvement group of AKI. The clinical data of the two groups were compared, and the risk factors for the progression of AKI after AD were analyzed by multivariate logistic regression.Results:A total of 290 AD surgeries were completed, of which 143 cases developed AKI after surgery, including 81 cases in AKI progression group and 62 cases in AKI improvement group. In the progression group of AKI, before surgery the proportion of patients with coronary heart disease: 24.7% (20/81) vs.11.3% (7/62), serum creatinine (Scr) >133 μmol/L: 24.7% (20/81) vs. 3.2% (2/62), pericardial tamponade: 22.2% (18/81) vs. 8.1% (5/62), lower limb ischemia: 25.9% (21/81) vs. 3.2% (2/62) were significantly increased. Postoperative acute physiology and chronic health evaluation Ⅱ (APACHE) score: 14.00 (9.00, 19.75) scores vs. 10.00 (7.00, 12.00) scores, ICU hospitalization days: 8 (5, 13) d vs. 5 (3, 7) d, postoperative mortality: 24.7%(20/81) vs. 1.6%(1/62), the proportion of KDIGO phase 3 ratio: 46.9%(38/81) vs. 3.2%(2/62), postoperative infection: 61.7%(50/81) vs. 38.7% (24/62), low cardiac output syndrome: 29.6% (24/81) vs. 6.5% (4/62), cerebral infarction complications: 38.2%(31/81) vs. 16.1%(10/62), and mortality after surgery were also higher. Compared with improvement group of AKI, all differences were statistically significant ( P<0.05). Multivariate Logistic regression analysis showed that preoperative lower limb ischemia ( OR = 9.430, 95% CI 1.975 to 45.032, P = 0.005), postoperative low cardiac output syndrome ( OR = 5.288, 95% CI 1.543 to 18.126, P = 0.008), and postoperative infection ( OR = 2.273, 95% CI 1.022 to 5.057, P = 0.044) were independent risk factors for the progression of AKI after AD surgery. Conclusions:The independent risk factors of renal function progression in patients with AKI after hypothermic circulatory arrest surgery in acute AD include preoperative lower limb ischemia, postoperative low cardiac output syndrome, and postoperative infection.

Objective:To investigate the perioperative complications and risk factors of postoperative death in patients with acute Stanford type A aortic dissection (ATAAD).Methods:The perioperative data of 228 patients with ATAAD who underwent continuous surgery in the Affiliated Hospital of Jining Medical University from January 2013 to July 2021 were retrospectively analyzed. The complications were analyzed. According to the survival within 30 days after surgery, they were divided into death group (24 cases) and survival group (204 cases). The risk factors of postoperative death were analyzed by univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawed to evaluate the predictive efficacy of various risk factors on postoperative death of ATAAD patients.Results:The first three complications before operation were hypoxemia (10.1%, 23/228), pericardial tamponade (7.9%, 18/228), renal insufficiency (5.3%, 12/228), the first three complications after surgery were hypoxemia (75.8%, 173/228), renal insufficiency (26.8%, 61/228) and liver insufficiency (26.3%, 60/228). A total of 24 patients died, the fatality rate was 10.5%(24/228). Logistic regression analysis showed that age≥55 years old ( OR=7.733, 95% CI: 1.986-30.111, P=0.003), preoperative pericardial tamponade ( OR=5.641, 95% CI: 1.546-20.577, P=0.009), cardiopulmonary bypass time (CBP)≥200 min ( OR=1.008, 95% CI: 1.002-1.014, P=0.007) and postoperative renal insufficiency ( OR=5.875, 95% CI: 1.927-17.907, P=0.002) were independent risk factors for early death after ATAAD. The area under the ROC curves of joint prediction was 0.905 (95% CI: 0.820-0.950, P<0.01). The sensitivity and specificity of joint prediction were 88.4%, 76.5%, respectively. Conclusions:ATAAD has many perioperative complications and high mortality. Age≥55 years old, preoperative pericardial tamponade, CPB time≥200 min, and postoperative renal insufficiency were independent risk factors for postoperative death in ATAAD patients.