Family physicians may be called upon to respond to trauma patients in their clinics or at scene of injury. Managing trauma can be daunting to any physician who encounters it infrequently. The physician first responder needs to shut out the chaos and distractions at scene and focus on a systematic primary survey to assess for injuries with the potential to cause rapid deterioration, institute crucial life-saving interventions and effect rapid evacuation to hospital. This article details a simple approach to guide the family physician to assess and prioritise management of the trauma patient, and augment the work of the paramedics in the pre-hospital phase.

Family physicians may be called upon to respond to trauma patients in their clinics or at scene of injury. Managing trauma can be daunting to any physician who encounters it infrequently. The physician first responder needs to shut out the chaos and distractions at scene and focus on a systematic primary survey to assess for injuries with the potential to cause rapid deterioration, institute crucial life-saving interventions and effect rapid evacuation to hospital. This article details a simple approach to guide the family physician to assess and prioritise management of the trauma patient, and augment the work of the paramedics in the pre-hospital phase.

Animals ; Catalysis ; Cell Adhesion ; drug effects ; radiation effects ; Humans ; Hydrophobic and Hydrophilic Interactions ; Osseointegration ; drug effects ; radiation effects ; Osteoblasts ; cytology ; drug effects ; radiation effects ; Osteogenesis ; drug effects ; radiation effects ; Photochemical Processes ; Surface Properties ; radiation effects ; Time Factors ; Titanium ; chemistry ; pharmacology ; radiation effects ; Ultraviolet Rays

BACKGROUND:Al ogeneic penetrating keratoplasty is the most effective method for treating corneal blindness. However, the incidence of rejections is high after keratoplasty, so it is urgent to develop an immunosuppressive drug with high efficacy and low toxicity. OBJECTIVE:To establish al ogeneic penetrating keratoplasty models and monitor the expression of tumor necrosis factor-αin blank control group and after transforming growth factor-β1 eyedrop during acute rejection period of corneal grafts. METHODS:Al ogeneic penetrating keratoplasty models were established and were randomly divided into blank control group, ciclosporin A group (1%ciclosporin A), and transforming growth factor-β1 group (1μg/ml transforming growth factor-β1 eyedrop). The medications from each group commenced at 1 day after surgery, one eyedrop once, three eyedrops per day. Al the operated eyes were given 0.3%ofloxacin ophthalmic solutions and 0.5%tropicaide ophthalmic solution, three times per day, for 12 days. The corneal grafts were harvested for hematoxylin-eosin staining and immunihistochemical staining (SABC method), to detect tumor necrosis factor-αexpression in corneal grafts. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that, corneal grafts were significantly thickened, a large number of histoleucocytes and lymphocytes infiltrated in the blank control group;corneal grafts showed normal thickness and no inflammatory cel s infiltrated in the transforming growth factor-β1 group. Immunohistochemical staining showed that, there were less cel s positive for tumor necrosis factor-αin the transforming growth factor-β1 group compared with the blank control group (P<0.05). Transforming growth factor-β1 eyedrops can reduce the expression of tumor necrosis factor-αin the corneal grafts during acute rejection period, and reduce the inflammatory cel s infiltration in the corneal grafts, which is probably the mechanism of transforming growth factor-β1 to prevent and treat corneal al ograft rejection.

Objective To investigate the clinical and pathological characteristics of urocpithelial sarcomatoid carcinoma of the urinary system,and improve the diagnosis and treatment of these tumors.Methods We reviewed the pathology comfirmed urinary system caicinoma at the General Hospital of PLA from January 1999 to December 2010 and analyzed the clinical and pathological data of cases with sarcomatoid carcinoma in them retrospectively according to the literatures. Results A total of 4386 urinary system carcinoma were comfirmed,among them 18 (0.41％) cases of sarcomatoid carcinoma were identified,including 13 from bladder,4 from ureter and 1 multiple neoplasm of pelvis and ureter.The patients,11 males and 7 female,had a median age of 63.3 years (41-84 yrs).Gross hematuria (18 cases) were the main presenting symptoms,3 with flank pain,4 with pollakisuria,urgency and dysuria (urinary irritation symptoms] and 5 with urinary obstruction.The patient with multiple neoplasm of pelvis and ureter received allograft renal transplantation 7 years ago and took anti-rejection drugs all the way after operation.17 patients underwent surgical resection,9 radical cystectomy,5 radical nephroureterectomy,3 partial cystectomy and the remain was biopsy.Tumor size ranged from 2.5 to 12 cm (median,5.6 cm).Microscopically,coexisting high grade urothelial carcinoma was present in all the 18 cases,12 with sarcomatoid differentiation,3 with sarcomatoid and squamous carcinoma differentiation and 3 with sarcomatoid and glandular differentiation.Sarcomatoid component occupied 10 -90 percent.Immunohistochemical testing showed the sarcomatoid cells were positive for cytokeratin (CK) and vimentin.12 patients died of disease 20 days to 42 months (median,5.3 months) postoperatively.3 patients have been surviving with tumor free for 3,3 and 17 months respectinely,and the other 3 was failure to be followed. Conclusions Sarcomatoid carcinoma of the urinary bladder is a highly malignant disease,and the prognosis is very poor.The diagnosis depends on histopathologic and immunohistochemical studies.Early diagnosis and cystectomy or nephroureterectomy together with chemotherapy/radiotherapy may improve the curative effect.

[Objective]To investigate the cause precautionary measures and treatment countermeasure of impingement syndrome of the anterior ankle.[Method]From june 2000 to December 2004,18 cases of acute raumatic extravasated blood of the ankle without fracture and disbocating,20 cases of pain in front side and front inboard and front outside with dorsiflexion ache and dysfunction,all the cases were examined and treated under the arthroscope.The effect was analyzed.[Result]Follow-up lasted 6~52 months(mean 28 months).In all the 38 cases there were"excellent"outcomes in 17 cases"good"in 19 cases,"fair" in 0 case,and"poor" in 0 case in the acute traumatic extravasated blood of the ankle group.Impringement syndrome of the anterior ankle group:"excellent" in 15 cases"good" in 3 cases"fair"in 2 cases"poor"in 0 case.[Conclusion]Arthrotrauma and degranding are two reasons of the impingement syndrome of the anterior ankle,the initial stage arthroscope examination and treatment of the acute traumatic extravasated blood of the ankle without fracture and disbocating is the best active method to prevent the impingement syndrome of the anterior anlke,the clearing operation under the arthroscope is the best mininmally invasive treatment countermeasure for the impingement syndrome of the anterior ankle.

Objective To measure von Willebrand factor(vWF)concentrations and von Willebrand factor-cleaving protease(vWF-cp)activity in plasma of lung cancer patients and to evaluate their clinical significance.Methods The vWF:antigen(vWF:Ag)and vWF-cp activity were measured by using ELISA and residual-collagen binding assay(R-CBA),respectively in 78 patients with lung cancer.The serum and pleural fluid(PLF)of carcino-embryonic antigen(CEA)were measured by radioimmunity assay in 23 patients.Results (1)The level of vWF:Ag in lung cancer patients(107.7?43.7)%was significantly higher than that in benign diseases(71.3?49.5)% and normal controls(82.4?41.3)%(P

The effects of spindle afferents activated by stretching gastrocnemius on the nociceptive responses of WDR neurons were recorded extracellularly with microelectrode and observed in paralyzed rats. The results indicated that in 51/80, the spindle afferent activity activated by stretching can inhibit nociceptive responses of neurons. 16 out of 80 neurons no effects can be observed, in 13/80 the effects of spindle afferent activity can excite the nociceptive responses of WDR neurons. Among 51 units, which have inhibitory effects induced by stretching muscle, the inhibitory effects induced by instance and bilateral stretching are stronger than that induced by continuous and unilateral stretching. These results suggested that spindle afferent activity is possesaed of analgesic effects.

Objective To evaluate ischemia preconditioning (IP) and intermittent ischemia (II) in ameliorating the incidence of paraplegia. MethodCross clamping of the infrarenal aorta in New-Zealand rabbit was used to establish a spinal cord ischemia model. 25 rabbits were randomly divided into 3 groups. The continuous ischemia(CS) group (n=10) with the aorta clamped for 40 minutes. While in the IP group (n=6) the aorta was clamped for 3 sessions each lasting for 5 min, with 5 min interval between the sessions before 40 minutes clamping, in the Ⅱ group (n=9) the 40 min clamping was interposed by a 15 min interval. The muscle force of the lower extremity, the excitatory amino acid (EAA) in CSF, the malondiadehyde (MDA)in spinal cord and the pathology were compared between the groups.Result The muscle force of the lower extremity was better in Ⅱ and IP group than that in CS group (3.4?1.0) in Ⅱ, (3.5?0.8) in IP vs (1.3?1.4) in CS, all P

Objective To investigate the relationship between high sensitive C-reactive protein(hs-CRP) and cardiac function in patients with dilated cardiomyopathy(DCM). Methods We compared the differences of NYHA classes,left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter (LVEDD) between normal hs-CRP group and elevated hs-CRP group,and analyzed hs-CRP levels of different NYHA classes,then investigated the correlation between hs-CRP and LVEF and between hs-CRP and LVEDD. Results The NYHA stage,LVEF,LVEDD were 2.06?0.90,(38.58?5.98)% and 58.94?6.14mm respectively in normal hs-CRP group,while those were 2.89?0.88,(33.46?6.55)% and 66.87?9.34mm in elevated hs-CRP group,and there were significant differences between the two groups.The hs-CRP was 2.66?1.80mg/L in NYHAⅠgroup,while that was 5.02?3.27mg/L in Ⅱgroup,5.25?3.18mg/L in Ⅲ group,and 8.84?2.60mg/L in Ⅳ group.Levels of hs-CRP in Ⅱgroup and Ⅲ group were both significantly higher than those inⅠgroup(P