Abdominal increment is applied to patients with abdominal compartment syndrome (ACS) after severe trauma,while for some patients,intra-abdominal volume increment could not close the fascia within the primary stage.For theses patients,abdominal wound skin grafting was conducted,and the planned hernia was formed.Planned abdominal hernia developed over time,and finally huge incisional hernia was formed.This article described a modified sliding myofascial flap of the rectus abdominus muscles for definitive abdominal wall reconstruction for a patient with huge planned abdominal hernia,and a good curative effect was obtained.

Objective To investigate the changes of intestinal barrier function of patients with multiple injuries,and explore the relationship between the changes and Systemic Inflammatory Response Syndrome(SIRS).Methods Fifty two patients with multiple injury admitted to our hospital from Aug.2007 to May 2008 were divided into mild injury group(n=24,ISS0.05),while obvious increasing existed in moderate and severe groups at 1st day after trauma(P

Objective To investigate the effect of damage control laparotomy in multiple trauma care.Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015.Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years).The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case.Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points).All cases presented abdominal injury.Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases.All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery.Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation.Results Twenty-nine cases had primary fascial closure 5-12 d after surgery.Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia.Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD).Hospital length of stay was 21-70 d (mean, 31.4 d).There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment.Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage.All cases were discharged from hospital smoothly.Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury.

Objective To explore the effects and significance of first-aid fast track in the treatment of severe trauma. Methods A retrospective study was done on 60 trauma patients (fast track group)treated by means of first-aid fast track from January 2006 to November 2007 to observe the effect of first-aid fast track. Another 46 trauma patients treated from January 2004 to December 2005 were used as control group. Results There was no statistical difference in aspects of sex, age, injury mechanism, ISS and blood loss in both groups (P ＞0.05). Two patients died in the first track group, with mortality rate of 3% ;while five patients died in the control group, with mortality rate of 11% ( P ＜ 0.05 ). Compared with the control group, there was shorter time in emergency room care, special examination and interval from admission to operating room in fast track group ( P ＜ 0.05 ). Conclusion First-aid fast track can shorten the space and time in treatment of severe trauma, decrease the mortality rate, enhance success rate of treatment and hence guarantee chronergy and integrity of emergency trauma care.

Objective To investigate the effect of intrathecal morphine preconditioning (ITMP) on the excitability of substantia gelatinosa (SG) neurons in the dorsal horn of the spinal cord in a rat model of myocardial ischemia-reperfusion (I/R).Methods Thirty-six adult male Sprague-Dawley rats,weighing 200-300 g,in which intrathecal catheters were successfully placed without complications,were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),group I/R,and group ITMP.Myocardial I/R injury was produced by occlusion of the left anterior descending branch of the coronary artery for 30 min followed by 120 min reperfusion.In group ITMP,the rats received intrathecal morphine 3 μg/kg (10 μl) by three cycles of 5 min infusions interspersed with 5 min infusion-free periods starting from 30 min before ischemia,and the equal volume of normal saline was given instead of morphine in group I/R.At 10 min of reperfusion,6 rats randomly selected in each group were sacrificed,and the T2-6 segments of the spinal cords were acutely isolated to prepare spinal cord slices.The resting potential,threshold of action potential (APT),peak of action potential (APP) and action potential duration in SG neurons in the dorsal horn of spinal cord slices were determined using the whole-cell patch-clamp technique,and the number of action potentials evoked by currents of 40,60,80 and 100 pA was recorded.At 120 min of reperfusion,6 rats randomly selected in each group were sacrificed,and myocardial specimens were obtained for determination of myocardial infarct size (IS) and area at risk (AAR),and IS/AAR ratio was calculated.The expression of c-fos in the T2-5 dorsal horns of the spinal cords was detected by Western blot.Results Compared with group S,the IS/AAR ratio was significantly increased,the expression of c-fos was up-regulated,the number of action potentials in SG neurons in dorsal horns of spinal cord was increased,APT was decreased,and APP was increased in group I/R (P＜0.05).Compared with group I/R,the IS/AAR ratio was significantly decreased,the expression of c-fos was down-regulated,the number of action potentials in SG neurons in dorsal horns of spinal cord was decreased,APT was increased,and APP was decreased in group ITMP (P＜0.05).Conclusion The mechanism by which ITMP attenuates myocardial I/R injury is related to decrease in the excitability of SG neurons in the dorsal horn of the spinal cord and reduction of responses to nociceptive stimuli in rats.

Objective To investigate the effect of intrathecal morphine preconditioning on the expression of nerve growth factor (NGF) in the dorsal root ganglia (DRG) in a rat model of myocardial ischemia-reperfusion (I/R).Methods Thirty healthy adult male Sprague-Dawley rats in which intrathecal catheters were successfully placed without complications,weighing 250-350 g,were randomly divided into 5 groups (n =6 each) using a random number table:sham operation group (S group),I/R group,intrathecal morphine preconditioning group (ITMP group),μ receptor antagonist CTOP + intrathecal morphine preconditioning group (CTOP + ITMP group),and CTOP control group (CTOP group).Myocardial ischemia was induced by 30 min of occlusion of the anterior descending branch of the left coronary artery followed by 120 min of reperfusion in all the groups except S group.Intrathecal morphine preconditioning was produced by 3 cycles of 5 min intrathecal injection of morphine 3 μg/kg (10 μl) at 5 min intervals within 30 min before ischemia in ITMP group.In CTOP+ITMP and CTOP groups,1 μg/μ1 CTOP 10 μl was injected intrathecally at 10 min before morphine preconditioning and 40 min before ischemia,respectively.At 120 min of reperfusion,the rats were sacrificed,and myocardial specimens were obtained for determination of myocardial infarct size,and DRGs were removed for determination of the expression of NGF by using immunohistochemistry and Western blot.Results Compared with S group,the myocardial infarct size was significantly increased,and the expression of NGF in DRGs was significantly up-regulated in I/R group (P＜0.05).Compared with I/R group,the myocardial infarct size was significantly decreased,and the expression of NGF in DRGs was significantly down-regulated in ITMP group (P＜ 0.05),and no significant change was found in the parameters mentioned above in CTOP group (P＞0.05).Compared with ITMP group,the myocardial infarct size was significantly increased,and the expression of NGF in DRGs was significantly up-regulated in CTOP+ITMP and CTOP groups (P＜0.05).Conclusion The mechanism by which intrathecal morphine preconditioning reduces myocardial I/R injury is related to activation of spinal μ receptors,inhibition of NGF expression in DRGs,and reduction of responses to noxious stimulation in the rats.

Objective To investigate the role of p38 mitogen-activated protein kinase (p38MAPK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in the rats with chronic heart failure in vitro.Methods Adult male Sprague-Dawley rats,weighing 200-230 g,aged 6-7 weeks,in which doxorubicin 2 mg/kg was injected via the tail vein once a week for 6 consecutive weeks to induce chronic heart failure,were studied.At the end of 8th week,30 rats with chronic heart failure were randomly divided into 5 groups (n =6 each) using a random number table:sham operation group (group Sham),I/R group,morphine preconditioning group (group MPC),SB203580 (p38MAPK inhibitor) + morphine preconditioning group (group SBM),and SB203580 group (group SB).The hearts were quickly excised and passively perfused in a Langendorff apparatus and subjected to 30 min of occlusion of the anterior descending branch of the left coronary artery followed by 120 min of reperfusion to establish the model of myocardial I/R injury.After equilibration,the hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing morphine 1 μmol/L at 5-min intervals before ischemia in group MPC.In group SBM,the hearts were perfused with K-H solution containing SB203580 (5 μmol/L) for 45 min starting from l0 min before morphine preconditioning until 5 min of ischemia.In group SB,morphine preconditioning was not performed,and the hearts were only perfused with K-H solution containing SB203580 (5 μmol/L) starting from 40 min before ischemia until 5 min of ischemia.At 15 min of equilibration (baseline),5 and 10 min of reperfusion,the coronary effluent was collected to detect the activity of lactate dehydrogenase (LDH) using the chemical colorimetry.At 10 min of reperfusion,the expression of phosphor-p38MAPK (p-p38MAPK) in the myocardium was determined by Western blot in Sham,I/R and MPC groups.At 120 min of reperfusion,the area at risk (AAR),total areas of right and left ventricles (LV+RV),and infarct size (IS) were measured,and the IS/AAR ratio was calculated.Results Compared with group Sham,the LDH activity in coronary effluent during reperfusion and IS/AAR ratio were significantly increased in the other groups,and the expression of p-p38MAPK was significantly up-regulated in I/R and MPC groups (P＜0.05).Compared with group I/R,the LDH activity in coronary effluent during reperfusion was significantly decreased,the expression of p-p38MAPK was significantly up-regulated,and the IS and IS/AAR ratio were significantly decreased in group MPC (P＜0.05),and no significant change was found in the LDH activity in coronary effluent,IS and IS/AAR ratio in SBM and SB groups (P＞0.05).Compared with group MPC,the LDH activity in coronary effluent during reperfusion was significantly increased,and the IS and IS/AAR ratio were significantly increased in group SBM (P＜0.05).Conclusion The mechanism by which morphine preconditioning reduces myocardial I/R injury is related to activation of p38MAPK signaling pathway in the rats with chronic heart failure in vitro.

Background:For patients with liver cirrhosis and acute decompensation(AD),it is of great clinical importance to predict short-term mortality at admission. It has been reported that CLIF-C OF,MELD and MELD-Na score can accurately predict the short-term mortality,but all these scoring systems are complicated and have limits in their application. Aims:To define a simple and objective scoring system -- simplified MELD score for short-term mortality prediction in HBV-related cirrhotic patients with AD. Methods:A total of 890 consecutive HBV-related cirrhotic patients with AD hospitalized during Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled retrospectively. Clinical data and patients’outcome were collected,and simplified MELD score was calculated by using total bilirubin,international normalized ratio and creatinine values at admission. Patients were classified into different prognostic groups according to their 28-day mortalities and simplified MELD score. Kaplan-Meier survival curve was used to analyze the 1-year accumulate survival rate,and ROC curve was used to evaluate the performance of different scoring systems in predicting 28-day mortality. Results:Simplified MELD score at admission could classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups and different long-term prognostic groups;the score of low,moderate and high 28-day mortality group was 0-2,3 and 4-6,respectively,and the corresponding mortality was 5. 5% ,19. 8% and 48. 6% ,respectively. Simplified MELD score had the same good performance as compared with the CLIF-C OF,MELD and MELD-Na scores in predicting 28-day mortality,the area under ROC curve was 0. 828,0. 831,0. 828 and 0. 830,respectively. Conclusions:Simplified MELD score can accurately classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups at admission. It is convenient for using in clinical practice.

To investigate molecular epidemiology of DuCV in Cherry Valley ducks in China,the complete genomes of six DuCV strains,which were detected from Cherry Valley ducks in China between 2007 and 2008,were sequenced.Sequence and phylogenetic analysis were carried out to compare these six strains with another 27DuCV strains from Mulard duck,Muscovy duck,Pekin ducks and Mule duck.The analysis showed that the six DuCV strains exhibited typical genetic features of the family of DuCV,such as a stem-loop structure,three major open reading frames (Rep,Cap and ORF3),four intergenic repeats and the conserved motifs for rolling circle replication and for the dNTP binding domain located in the Rep protein.Phylogenetic analysis of the nucleotide sequences of the complete genome and Cap gene of these strains together with those that have been previously published demonstrated two distinct DuCV genotypes.The DuCV strains with complete genomes containing 1988and 1989 nucleotides clustered in genotype A,whereas the strains with complete genomes containing 1991,1992,1995 and 1996 nucleotides lay in genotype B.The six DuCV strains from Cherry Valley ducks were divided into the two groups.The results of the study provides some insight into the variation of DuCVs in Cherry Valley ducks.

Several specialized branches are inclusive in the department of trauma surgery,and the instruction of medical ethics during the practice of trauma surgery surely contributes to raise the integrated diathesis and capability for medical students.Common ethical issues in trauma surgery practice include ethics of operative principles,conflict between trauma sufferers and accident-makers,privacy preservation,decision making,and the principles of clinical pharmaceutical trials,etc.It is believed that advantageous principles and independence principles should be overall carried out during the instructional course of medical ethics education.