ObjectiveTo investigate the early change of blood coagulation in severe trauma patients and its relationship with plasma levels of thrombomodulin (TM) and protein C.MethodsSixtyfour multiple trauma patients early admitted to the emergency department were divided into two groups according to the injury severity score ( ISS),severe trauma group ( ISS≥16 points) and slight trauma group ( ISS ＜ 16 points).Blood specimens were obtained immediately upon their arrival at hospital to comparatively analyze the changes of prothrombin time (PT) and activated partial thromboplastin time (APTT) in both groups.Meanwhile,plasma levels of TM and protein C were measured and analyzed for discussing their relationship with changes of blood coagulation.Another 30 healthy persons were taken as the control group.Levels of plasma TM and protein C between the death and survival were comparatively analyzed as well.ResultsPT and APTT in the severe traunma group (ISS ≥ 16 points) were significantly longer than those in the slight trauma group ( ISS ＜ 16 points) and the control group ( P ＜ 0.05 ),with significant correlation with plasma TM and protein C levels ( P ＜ 0.05 ).Plasma TM level in the death group was significantly higher than that in the survival group,but protein C level in the death group was significantly lower than that in the survival group.ConclusionsCoagulation abnormalities presenting early after severe trauma are correlated with activation of plasma TM and protein C.Levels of plasma TM and protein C demonstrate significant role in prediction of the prognosis in patients with severe trauma.

Objective To investigate the early changes of plasma levels of angiopoietin2 in patients with multiple trauma and the relationship between plasma levels of angiopoietin2 (Ang2) and endothelial injury as well as prognosis of patients in order to determine their clinical significance. Methods Patients with multiple trauma admitted to emergency department from January 2008 to January 2010 were enrolled. A total of 59 casualties met the criteria(admission within 1 h after trauma and age > 18 years), and were eligible for enrollment. Patients with heart, brain, liver, kidney and other organic diseases, diabetes, hypertension, tumor, acute and chronic infectious diseases , severe brain injury (CCS < 12 points) , anticoagulant and thrombolytic medicine used two weeks before trauma were excluded. Among 59 patients, 36 were males and 23 females. The average age was(32.3 ±11.5) years. Patients were divided into severe trauma group (ISS ≥16 points,n =29) , moderate trauma group (ISS < 16 points, n =30 ) judged by using injury severity score (1SS). Thirty healthy subjects were selected as controls, 19 male and 11 female, with age > 18 years and an average age of(33.5 ±10.6) years. All groups had comparable gender proportion and average age. The 10 mL peripheral blood sanple was collected within 10 minutes after arrival of patients to emergency department and the plasma was separated from blood. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of angiopoietin2, and the plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) were also detected. Data were expressed as mean ± standard deviation and were statistically analyzed by using SPSS version 13.0 statistical software. The differences in plasma levels of angiopoietin2 of patients in each group were analyzed by ANOVA and Newman-Keuls test. Levels of angiopoietin2 in fatal patients and survival patients were also compared by using t test. The relationships between angiopoietin2 and plasma levels of vWF as well as levels of TM were analyzed by Pearson correlation analysis. Changes were considered as statistically significant if P value was less than 0.05. Results The plasma levels of angiopoietin2 in severe trauma group (ISS scored 16 points) were significantly higher than those in moderate trauma group (ISS < 16 points) ( P < 0.05 ), and those in trauma patients of the two groups were both significantly higher than those in control group (P < 0.05). The plasma levels of angiopoietin2 in fatal patients were significantly higher than those in survivors (P < 0.05). Plasma levels of angiopoietin2 were significantly correlated with plasma levels of vWF and TM (P < 0.05). Conclusions The plasma levels of angiopoietin-2 significantly increase after multiple trauma, and correlate with the degree of trauma severity. The plasma levels of angiopoietin2 correlate with endothelial injury after multiple trauma, having important prognosis value in patients with multiple trauma.

Objective:To analyze the value of serum gelsolin (GSN), procalcitonin(PCT), homocysteine (Hcy), cardiac troponin I(cTnI) in diagnosis of multiple trauma severity and prognosis evaluating.Methods:A retrospective analysis of 60 patients with multiple trauma from January 2019 to May 2020 in Liaocheng People′s Hospital were enrolled. According to injury severity score (SSA), the patients were divided into mild group (ISS ≤ 25 scores, 22 cases) and severe group (ISS>25 scores, 38 cases); according to prognosis, the patients were divided into survival group (38 cases) and death group(32 cases); 60 cases (control group) were included in the same period healthy volunteers. The levels of GSN, PCT, Hcy, cTnI were detected by enzyme-linked immunosorbent assay. The patients were followed up to 7 d, and the relationship between the above four serum items andinjury severity and survival rate were analyzed.Results:Before treatment, the level of GSN from low-to-high was severe group, mild group and control group; the levels of PCT, Hcy, cTnI from low-to-high was control group, mild group and severe group, and the differences were statistically significant ( P<0.05). After treatment, the level of GSN in mild group and severe group was increased, and the levels of PCT, Hcy, cTnI were decreased. Compared with those before treatment, the differences were statistically significant ( P<0.05). The level of GSN in the death group was lower than that in the survival group: (137.87 ± 9.54) mg/L vs. (190.32 ± 9.32) mg/L, the levels of PCT, Hcy, cTnI in the death group were higher than those in the survival group: (2.95 ± 0.32) μg/L vs. (0.44 ± 0.12) μg/L, (31.29 ± 8.54) μmol/L vs. (13.95 ± 2.19) μmol/L, (0.081 ± 0.007) μg/L vs.(0.020 ± 0.003) μg/L, and the differences were statistically significant ( P<0.05). The correlation analysis showed that the level of GSN had negative correlation with scale for the assessment of positive symptoms Ⅱ(SAPSⅡ) ( r = - 0.65, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)( r = - 0.74, P<0.05), and the levels of PCT, Hcy, cTnI had positive correlation with SAPSⅡ( r = 6.18, 7.09, 9.15, P<0.05) and APACHEⅡ( r = 6.93, 7.32, 10.03, P<0.05). Multiple-factor analysis showed that serum GSN was a protective factor for survival rate, and serum PCT, Hcy, and cTnI were risk factors for survival rate ( P<0.05). Conclusions:The levels of serum GSN, PCT, Hcy, CTNl can assist in judging the severity and prognosis of multiple trauma. It is recommended to use it in combination with SAPSⅡ and APACHEⅡ.

Objective:To study the relationship between gastric fundus size and postoperative gastroparesis and to find effective ways to prevent postoperative gastroparesis in high-risk patients.Methods:We retrospectively reviewed the clinical data of 276 gastric cancer patients undergoing radical gastrectomy from 2015 to 2016. The gastric fundus volume/total gastric volume (FV/TV) ratio was measured by computed tomography (CT) and comparative study between the gastroparesis group and the non-gastroparesis group was carried out in terms of postoperative gastroparesis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance. Single-factor and multiple-factor analyses were performed to filter clinically significant predictive factors of gastroparesis. Then, we increased the sample size to 304 patients whose FV/TV ratio was >19.4%. The different surgical methods and perioperative management of these patients were analysed. The chi-square test and logistic regression analysis were performed to identify effective independent factors for preventing gastroparesis.Results:The FV/TV ratio in the gastroparesis group was significantly higher than that in the non-gastroparesis group ( P<0.05). A cut-off value of 19.4% was selected by ROC curve analysis, at which the FV/TV ratio had a sensitivity of 76.2% and a specificity of 53.7%. In 304 patients in the second retrospective study, the incidence of gastroparesis was 9.2%. Gastroparesis was significantly reduced in patients with residual gastric size <1/3 ( P<0.05) and early postoperative gastrointestinal decompression ( P<0.05). Conclusions:The FV/TV ratio can effectively predict the risk of postoperative gastroparesis preoperatively. Small residual stomach and early postoperative gastrointestinal decompression are effective measures to prevent gastroparesis in high-risk patients.

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.