OBJECTIVETo investigate the risk factors of mortality in patients with severe chest trauma (SCT).

METHODSThe clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors.

RESULTSSeven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001).

CONCLUSIONSAge, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thoracic Injuries ; mortality ; Young Adult

OBJECTIVETo analyze the epidemiological features of severe chest trauma (SCT) and investigate the risk factor of its mortality in the Three Gorges Area of China.

METHODSThe clinical data of 1834 SCT patients who were admitted in three hospitals in this area from January 1990 to December 2009 were retrospectively reviewed. Th epidemiological features of SCT were analyzed using a database. Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality.

RESULTSThe morbidity rates of blunt trauma (68.5% vs. 74.7%,p=0.006) and sharp instrument injury (12.2% vs. 15.9%,p=0.039) showed significant differences before and after 2000. The pre-hospital time [(3.45±2.38)h vs. (2.20±4.39)h,p<0.01] and transfer rate (32.39% vs. 36.80%,p=0.01) significantly improved. The thoracic Abbreviated Injury Scale (AIS)(3.56±0.71vs. 3.43±0.58,p<0.01)score and Revised Trauma Score (RTS)(7.14±2.18 vs. 6.93±1.07,p<0.01) significantly increased. Treatment for pulmonary infection (12.63±4.79 vs. 17.16±6.41,p=0.019) and hemorrhagic shock (2.4±0.75 vs. 3.4±1.34,p=0.008 )was significantly improved. The leading cause of death was hypovolemic shock (59.41%). The independent rik factors of death among these SCT patients included: hemorrhagic shock (B=1.710,OR=1.291,p=0.001), multiple organ dysfunction syndrome (B=3.453,OR=1.028,p<0.001), pulmonary infection(B=2.396,OR=10.941,p<0.001), abdominal organ injury(B=1.542,OR=1.210,p=0.005), and thorax AIS(B=0.487,OR=1.622,p<0.001).

CONCLUSIONSThe prevalence of SCT shows an increasing trend in the Three Gorges Area in recent years, but with a decreased rate of complications and improved treatment. Age, complications, thorax AIS, and GCS are useful prognostic indicators.

China ; epidemiology ; Humans ; Logistic Models ; Retrospective Studies ; Thoracic Injuries ; epidemiology ; mortality

OBJECTIVETo investigate the polymorphisms of cluster of differentiation 14(CD14)gene promoters and explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome(MODS) in Chongqing population.

METHODSThe single nucleotide polymorphisms of the promoter region of CD14 gene at position -1145 and -159 were detected using polymerase chain reaction-restriction fragment length polymorphism method in 106 patients with severe chest trauma, among whom 47 were with MODS.

RESULTSTrauma patients carrying G allele tended to have a higher risk of MODS than those carrying A allele at position-1145, the MODS scores in trauma patients carrying G allele were significantly higher than those carrying A allele (P=0.217 for dominant effect and P=0.037 for recessive effect), and the MODS scores in trauma patients carrying T allele were significantly higher than those carrying C allele at position -159 (P=0.048 for dominant effect and P=0.198 for recessive effect). The genotypes of CD14 gene at positions -1145 and -159 were significantly correlated with the MODS scores (P=0.043,P=0.046). Compare with single-point mutation, simultaneous two-point mutation had significantly higher risk of MODS (Pü0.01), while the difference of MODS scores showed no statistical significance (P=0.239).

CONCLUSIONThe polymorphisms of CD14 gene promoters are associated with MODS after severe chest trauma in Chongqing population.

Adult ; Female ; Genotype ; Humans ; Lipopolysaccharide Receptors ; genetics ; Male ; Multiple Organ Failure ; etiology ; genetics ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Promoter Regions, Genetic ; Thoracic Injuries ; complications

BACKGROUNDChromosomal abnormalities have been shown to play an important prognostic role in multiple myeloma (MM). Interphase fluorescence in situ hybridization (i-FISH) has been much more effective to identify cytogenetic aberrations in MM than conventional cytogenetic technique (CC). To clearly determine the cytogenetic features of Chinese MM patients and identify their prognostic implications, we designed a multicenter study based on i-FISH including 672 patients from 52 hospitals in China.

METHODSAll 672 patients were systematically screened for the following genomic aberrations: del(13q), IgH rearrangement, del(p53) and 1q21 amplifications.

RESULTSThe analysis showed that the chromosomal changes were detected in 22.1% patients by CC and in 82.3% patients by i-FISH. The most common abnormalities by CC were chromosome 1 aberrations (48.4%), -13/13q- (37.6%), hyperdiploidy (36.6%), hypodiploidy (30.1%) and IgH rearrangements (23.7%). The most frequent abnormalities by FISH was del(13q), which was found in 60.4% patients, whereas IgH rearrangement, 1q21 amplification and p53 deletions were detected in 57.6%, 49.0% and 34.7% cases, respectively. By statistical analysis, -13/13q- by CC was associated with low level of platelet (P = 0.015), hyperdiploidy was associated with low level of serum albumin (P = 0.028), and IgH rearrangement by FISH was associated with high level of β2 microglobulin (P = 0.019). Moreover, 1q21 amplification and del(p53) by FISH conferred a high incidence of progressive disease (PD) after initial therapy. Metaphase detection of IgH rearrangements and chromosome 1 aberrations concurrently was associated with a short progression free survival (PFS) (P = 0.036). No significant prognostic implications of other cytogenetic abnormalities were found associated with overall survival and PFS.

CONCLUSIONSChinese MM patients had similar cytogenetic abnormalities compared with the previous reported studies. However, the prognostic significance of FISH aberrations were not clearly determined and further study is required.

Adult ; China ; Chromosome Aberrations ; Chromosomes, Human, Pair 1 ; genetics ; Cytogenetic Analysis ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Male ; Middle Aged ; Multiple Myeloma ; genetics ; pathology