Objective To detect the correlation of serum myoglobin (Mb) and creatine kinase (CK) levels in multiple trauma patients with outcome and renal failure and compare the prognostic value of the two predictors.Methods Forty-one patients with multiple trauma (ISS ≥ 16 points) were analyzed at days 1,3,7,and 14 posttrauma,for serum Mb and CK concentrations.Moreover,simplified acute physiology score Ⅱ (SAPS Ⅱ),injury severity score (ISS),as well as Glasgow coma score (GCS)at day 1 postrauma,final outcome,and presence or absence of renal failure were recorded.Correlation of serum Mb and CK with ISS,GCS,and SAPS Ⅱ was analyzed.Predictive values of Mb and CK for outcome and development of renal failure after multiple trauma were measured and compared at days 1,3,and 7 posttrauma,according to receiver operating characteristic (ROC) curve.Results Serum Mb concentration revealed a positive correlation with SAPS Ⅱ at each time point and with ISS at days 7 and 14,but a negative correlation with GCS at days 3,7,and 14.Similarly,serum CK concentration presented a positive correlation with SAPS Ⅱ at days 3,7,and 14 and with ISS at days 7 and 14,but a negative correlation with GCS at days 7 and 14.To predict outcome of the multiple trauma patients,area under the ROC curve for serum Mb at days 1,3,and 7 was 0.542,0.900,and 0.981 respectively and for serum CK was 0.232,0.771,and 0.968 respectively.To predict development of renal failure,area under the ROC curve for serum Mb at days 1,3,and 7 was 0.864,0.949,and 0.955 respectively and for serum CK was 0.480,0.889,and 0.939 respectively.Conclusions Serum Mb and CK are both predictive of outcome and development of renal failure following multiple trauma.Whereas in co；rast with CK,serum Mb appears to be a more sensitive marker.

Objective: To explore the mediating effect of parental hostile attribution bias on depression and anxiety between parents and children, so as to provide the reference for the promotion of children's mental health. Methods: Students of grades 2-6 in two public primary schools in Linping District, Hangzhou City and their parents were investigated using stratified sampling method in November 2022. Emotions of children were surveyed using Depression Self-Rating Scale for Child (DSRSC) and Screen for Child Anxiety Related Emotional Disorders (SCARED), while emotions and hostile attribution bias of parents were surveyed using Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Social Cognitive Screening Questionnaire (SCSQ). Mediating effect of parental hostile attribution bias on depression and anxiety between parents and children was analyzed using a structural equation model. Results: Totally 300 questionnaires were allocated, and 263 valid questionnaires were recovered, with an effective rate of 87.67%. There were 137 boys (52.09%), and 126 girls (47.91%), with a mean age of (9.95±1.44) years. There were 69 fathers and 194 mothers investigated. The prevalence of depression among parents was 27.00%, the prevalence of anxiety among parents was 4.18%, and the median score of hostile attribution bias was 1.00 (interquartile range, 2.00). The prevalence of depression among children was 11.03%, and the prevalence of anxiety among children was 29.66%. Parents' depression and anxiety affected children's depression and anxiety directly (effect value=0.270, 95%CI: 0.131-0.436), and also indirectly affected children's depression and anxiety by increasing their hostile attribution bias (effect value=0.028, 95%CI: 0.004-0.082), with the mediating effect contributed 9.40% of the total effect. Conclusion Parents' depression and anxiety affect children's depression and anxiety directly or indirectly through hostile attribution bias.

ObjectiveTo detect the serum NT-proBNP level in patients with severe trauma 24 hours after injury in order to find the possible correlated factors for the evaluation of the clinical application.MethodsSixty patients with severe trauma admitted to the emergency ICU were enrolled. Serum NTproBNP level was detected 24 hours after injury for comparison between survivors and nonsurvivors. The validity of NT-proBNP for predicting outcome was analyzed by receiver operating characteristic ( ROC )curve. The factors with significant correlation between NT-proBNP level and the length of ICU stay as well as the duration of mechanical ventilation support were determined in those survivors with correlation and stepwise linear regression analysis. These factors included injury severity score (ISS), head abbreviated injury score (AIS), acute physiology and chronic health evaluation Ⅱ ( APACHE I ), Glasgow coma score (GCS), creatine kinase-MB (CK-MB), cardiac troponin-I (cTn-I) and central venous pressure. Results The median NT-proBNP levels were 762 pg/ml (IQR, 400-1131 pg/mL) in nonsurvivors versus 200 pg/ml (IQR, 80-383 pg/mL) in survivors (Z =-3. 972, P ＜0.01 ). The area under ROC curve of NTproBNP was not statistically different to that of ISS and that of APACHE Ⅱ. The best threshold value of NTproBN to predict the outcome was 384 pg/ml ( sensitivity 0. 846, specifity 0. 766). A positive correlation was found between NT-proBNP and the length of ICU stay ( r =0. 32, P ＜ 0. 05 ) as well as the duration of mechanical ventilation ( r =0. 37, P ＜ 0. 05 ) in survivors. Stepwise linear regression analysis indicated there were significant correlations between APACHE Ⅱ, CK-MB and NT-proBNP.ConclusionsSerum NT-proBNP level 24 hours after injury is correlated with the severity and outcome of patients with severe trauma. It may be used as a complementary biomarker for the rapid assessment of the severity of trauma.

Objective To investigate the dynamic change of serum myoglobin and assess its relation with injury severity in multiple trauma patients. Methods The concentration of serum myoglobin in 41 multiple trauma patients (ISS ≥16 points) was detected at days 1,3,7 and 14 after injury. In the meantime, injury severity score ( ISS), Glasgow coma score ( GCS), simplified acute physiology score Ⅱ( SAPS Ⅱ ), percentage of the injured muscle and soft tissue to entire body, shock on admission and ultimate outcomes were recorded at day 1 after injury. All patients were divided into ISS ≥25 group or ISS ＜ 25 group, survival group or death group based on the injury severity and ultimate outcomes. The dynamic changes of the serum myoglobin were observed and compared between the groups. The correlation of the serum myoglobin concentration with ISS, GCS, SAPS Ⅱ score, shock and the percentage of injured muscle and soft tissue was investigated. Results The serum myoglobin concentration in ISS ≥ 25group was decreased more slowly than that in the ISS ＜ 25 group, with higher concentration of the serum myoglobin concentration in the ISS ≥ 25 group than that in the ISS ＜ 25 group at all time points. The serum myoglobin concentration in the death group was increased first, then slowly declined and reached peak at day 3. While in survival group, the serum myoglobin concentration was continuously decreased, with lower serum myoglobin concentration than that in the death group at all time points. The serum myoglobin concentrations were positively correlated with the SAPS Ⅱ score at all time points, with ISS at days 7 and 14, with the percentage of the injured area at day 1 and with the shock at days 1 and 3, while the serum myoglobin concentration was negatively correlated with GCS at days 3,7 and 14. Conclusions The dynamic changes of the serum myoglobin concentration in multiple trauma patients may reflect the severity,trends and prognosis of the injury, and hence can be used as effective index for monitoring the disease.

Objective To detect the dynamic change of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with major trauma and measure its relation to the outcome.Methods Sixty patients with major trauma were measured with serum NT-proBNP level at 1,3,and 7 days postinjury.According to the prognosis,the patients were allocated to survival group (n =47) and death group (n =13).Changes in NT-proBNP was detected and compared between the two groups.Correlation of NT-proBNP level with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and ISS was analyzed at each time point.Receiver operating characteristic curve (ROC) was developed to determine the prognostic value of NT-proBNP.Results Overall NT-proBNP level revealed no statistical difference at each time point and kept within normal reference range.NT-proBNP level in death group increased gradually,whereas in survival group the increase was followed by a reduction.Moreover,NT-proBNP level was higher in death group than in survival group at each time point.Area under the ROC of NT-proBNP had no statistical difference with that of APACHE Ⅱ and ISS at each time point.Conclusions Obviously high or continuously increased NT-proBNP level may indicate an unfavorable prognosis of major trauma patients.NT-proBNP can be used as a marker to dynamically predict prognosis of major trauma patients.

Objective To establish a model of multiple trauma combined with uncontrolled hemorrhagic shock so as to provide basis for basic study of multiple trauma.Methods Forty New Zealand male rabbits were equally and randomly divided into four groups,ie,sham group (Group A,with no bloodletting or resuscitation),uncontrolled group (Group B,with bloodletting alone),aggressive fluid resuscitation and limited fluid resuscitation groups (Groups C and D,with bloodletting,hemostasis and resuscitation).Fractures of the right hind limb in rabbits of each group were induced by free drop of a 3 kg hammer from a height of 45 cm.An estimated 30％ of total blood was withdrawn from the right common carotid artery in 20 minutes in bloodletting groups (Groups B,C and D).Successively,the uncontrolled bleeding was caused via acupuncture bloodletting from ileocecal artery branch at 30 minutes in bloodletting groups.Progressive and limited fluid resuscitation using lactated Ringer' s solution (LR) were performed for Groups C and D in the next one hour respectively.Blood transfusion was performed in Groups C and D after ligation of bleeding artery branch at 90 minutes.In addition,LR of three folds more than blood loss was administered in Group D.Survivorship of rabbits in each group was observed at 150 minutes to seven hours.Arterial blood sample was taken at each time point for blood gas analysis and coagulation test.Fracture type,fluid requirements,intra-abdominal blood loss,and rabbits' survival rate at seven hours were recorded.Results Closed comminuted tibiofibular fractures were founded in all groups.Bloodletting groups showed an obvious reduction of MAP,heart rate and pH value and significantly increased levels of K+,blood glucose and lactic acid at 30 minutes (P ＜0.01),whereas MAP and heart rate were returned to baseline level at 150 minutes.Progressive fluid resuscitation significantly increased the intra-abdominal blood loss and fluid requirements (P＜0.01),decreased erythrocrit (P ＜ 0.05),prolonged prothrombin time and activated partial thromboplastin time (P ＜0.05).Survival rate of rabbits was improved significantly by fluid resuscitation at 7 hours (P ＜ 0.01).Conclusion The model is of high stability and reproducibility and therefore is fit for study of multiple trauma combined with uncontrolled hemorrhagic shock.

Objective To explore the determinant factors influencing the constituent parts of radiological examination in severe trauma patients so as to provide scientific basis for optimized strategy of radiological examination. Methods A prospective study was carried out from April to July 2010 in a tertiary hospital. Clinical data of 60 severe trauma patients admitted to emergency department and ICU were recorded. The type, number and site of trauma under radiological examination were described and compared among different stages of treatment. The correlation between number of radiological examinations and age, number of injured site, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU stay and overall length of hospital stay were analyzed. Results (1) The majority of radiological examinations in 60 patients were radiography and CT, with a corresponding median number of 6.0(3.0～ 11.0, IQR)and 10.0(8.0 ～ 13.8, Qr) times per patient. (2) The numbers of radiography examinations requested in emergency room, emergency ICU and general ward were quite approximately equal (x2 =4.043 ,P =0. 132), while CT examinations were mainly requested in emergency room and emergency ICU (x2 = 20. 274 , P < 0. 001). (3) The numbers of radiological examinations requested for different sites of injury were quite significantly different between radiography and CT during different stages of treatment (x2 = 114.609, 75.932, P < 0.01). (4 ) The number of CT scan requested was positively correlated with number of injured site, ISS, ICU and overall length of hospital stay (r =0.273,0.369,0.523,0.417,all P <0.05). Conclusions The sum of radiological examinations in severe trauma patients was great mainly in radiography and CT, and CT was more predominantly requested. The number of CT scans examinations was positively correlated with severity of injury and length of ICU stay. Further study is warranted to optimize radiological examination in severe trauma patients.

ObjectiveTo evaluate the implication of ultrasonographic features of primary breast cancer tumors and axillary lymph nodes in predicting axillary lymph nodes metastasis in patients with breast cancer.MethodsA total of 108 patients with breast cancer were underwent examination of primary breast tumors and axillary lymph nodes by high frequency linear-array probes of ultrasound.The ages of patients,locations of primary tumors,numbers of tumors,maximum diameters of tumors,the longitudinal transverse axis ratio of tumors,mass boundary,ultrasonic patterns,micro-calcification,classification of blood supply,color pixel density(CPD),peak systolic velocity,resistance index,the longitudinal transverse axis ratio of axillary lymph nodes and maximum cortical thickness of axillary lymph nodes were recorded.ResultsOut of 108 patients with breast cancer,the longitudinal transverse axis ratio of tumor were greater than 1 in 75 (69.4 ％ ),micro-calcification in 57(52.8 ％ ),classification of blood supply were Ⅱ - Ⅲ in 57 (52.8％ ),CPD were greater than or equal to 10％ in 48 (44.4％),maximum cortical thickness of axillary lymph node were greater than or equal to 3 mm in 51 (47.2％),and longitudinal transverse axis ratio of lymph nodes were less than 1.5 in 59 (54.6％).Univariate analysis revealed that these six parameters were correlated to the axillary lymph node metastasis in breast cancer ( P ＜0.05).However,ages of patients,location of tumor in the breast,numbers of tumors,maximum diameters of tumors,mass boundary,ultrasonic patterns,peak systolic velocity and resistance index were not related to the axillary lymph node metastasis( P ＞0.05).Multivariate logistic regression analyses showed that CPD (OR:16.337,95％ CI:4.537- 58.826),longitudinal transverse axis ratio of lymph nodes (OR:3.754,95％ CI:1.269- 11.108) and microcalcificationand (OR:3.033,95 ％ CI:1.040 - 8.840) were risk factors of axillary lymph nodes metastasis in patients with breast cancer.ConclusionsThe application of ultrasonography in patients with breast cancer is useful in predicting axillary lymph nodes metastasis.

Objective To investigate the characteristics of patient throughput in emergency room (ER),and the factors causing increase in ER length of stay in order to improve the quality of emergency service.Methods Data of critically ill patients presented to an emergency room in a tertiary teaching hospital in 2010 were retrospectively studied,and the characteristics of patient throughput including patients referred to different departments with different outcomes,and variation in number of patients round the clock in workdays and weekends were analyzed.Results ( 1 ) The median length of stay (LOS) of 7966 critical patients in emergency room (ER) was 11 h,and of them,56.6％ stayed in ER for more than 6 h,and 21.6％ over 24 h.(2) There were significant differences in LOS in ER among patients treated by different departments leading to no shorter length of time consumed for treatment by many departments other than the following specialties of emergency department,neurosurgery,neurology and general medicine department in sequence from less time required to the longest length of time consumed.( 3 ) There were significant differences in LOS in ER among patients with different courses after disposition leading to the longest length of time consumed by those discharged by patients 'own decision and admitted into the hospital,and the shortest time required in patients after emergency operation.(4) There were also significant differences in specialty,outcomes and time needed for throughput between workdays and weekends,and during different time intervals round the clock.Conclusions The situation of patient throughput of critical illness in emergency room in this hospital was not ideal.The factors associated with prolonged stay in ER included different specialties in charge of patients,different courses and outcomes after disposition,severity of illness,different time intervals round the clock,and this investigation deserves a further study.

Objective To explore factors associated with prolonged emergency room (ER) stay of critically ill patients admitted so as to accelerate throughput of emergency patients.Methods Data of critically ill patients admitted into the emergency room of a tertiary teaching hospital in 2010 were retrospectively studied.Stepwise Cox regression analysis was used to determine factors likely associated with prolonged stay in ER.Results ( 1 ) A total of 6246 critical illnesses were admitted into emergency room,the ER length of stay [M (Qr)] was 11 h (3 ～23 h).Of them,56.6％ patients stayed in ER more than 6 h and 21.6％ over 24 h.(2) Univariate analysis showed the major factors contributing to prolonged stay in ER were insufficient inpatient bed capacity,followed by poor family finances,complicated diseases needed care from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of critical care,age,gender and arrival time to ER.(3) Multivariate analysis showed that the main factors contributing to prolonged stay were insufficient inpatient beds,poor family finances,complicated diseases needed treatment from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of treatment,gender and arrival time to ER.Age was not an independent factor.Conclusions Plenty of critically ill patients admitted to this hospital had prolonged stay in emergency room with variety of factors.The possible factors contributing to this were insufficient inpatient bed capacity,poor family finances and complicated diseases needed care from multiple departments,and this investigation deserves a further study.