Objective To evaluate the effect of the lactate clearance rate as a guide of the fluid resuscitation in multiple trauma patients with hemorrhage shock .Methods Sixty‐three multiple trauma patients with hemorrhage shock were divided into two groups ,which were group A (32 patients) and group B (31 patients) .In group A ,the central venous pressure (CVP) between8 and 12 mm Hg ,and the mean arterial pressure (MAP) (65 ± 5) mm Hg served as the goals of the fluid resuscitation .The B group ap‐plied the same goals of the CVP and MAP as group A .In addition ,the calculated lactate clearance rate (≥10% ) was used as the treatment target .The percent of patients reaching resuscitation goals and the ratio of the lactate clearance rate (≥10% ) at 2 hours after surgery ,the volume difference of infusion during the first 24 hours ,the incidences of organ dysfunction ,and the average days in ICU were compared between the two groups .Results The percent of patients reaching resuscitation goals at 2 hours after sur‐gery of group A was significantly higher than that of group B(P<0 .01) .The volume of the infusion of 24 hours in group A was less than that in group B(P< 0 .01) .There was no difference in the percent of patients reaching the lactate clearance rate at 24 hours after surgery(≥10% )and the infusin of red blood cells and plasma volume at 24 hours after surgery between the two groups (P>0 .05) .The incidence of organ dysfunction of group A was higher than that of group B (P<0 .05) .The average days in ICU of group A were longer than that of group B(P<0 .01) .Conclusion Based on monitoring CVP and MAP ,fluid resuscitation under the guidance of the lactate clearance rate(≥10% )may decrease the incidences of organ dysfunction and the days of patients in ICU .

OBJECTIVE: To explore the change of nasal ventilation function in a group of SDB patients and its relationship to PSG parameters. METHOD: One hundred twenty-eight controls, 11 habitual snorers, 33 cases of mild-moderate OSAHS and 33 cases of severe OSAHS were examined. NN1 Rhinospirometer was used to measure unilateral nasal respiratory capacity (NC(un)) and bilateral nasal respiratory capacity (NC(bi)), and the nasal partitioning ratio (NPR) can be calculated. NR6 Rhinomanometry was used to measure total nasal inspiratory and expiratory resistance (TNRi, TNRe). A1 acoustic rhinometry was used to measure distances of the two notches to the nostril (MD1, MD2), cross-sectional areas of the two notches (MCA1, MCA2) and nasal volume from 0-5 cm (NV(0-5)). Moreover, make the correlational analysis on different index of nasal functional tests and PSG. RESULT: (1) Significant group differences were shown in NPR (P < 0.01). (2) TNRi and TNRe were statistical different among the groups (P < 0.01 or P < 0.05). (3) There are significant difference on MD1, MCA1, MCA2, NV(0-5) in male, but just on MD1 in female. (4) There was no correlation between PSG parameters and nasal functional parameters in SDB patients. But for certain subgroup analysis in female patients with a body mass index below 25, minimum oxygen saturation correlated significantly with MCA2 (r = 0.688, P < 0.05), arousal index correlated significantly with MCA1 (r = 0.543, P < 0.05). CONCLUSION The nasal anatomical structure and physiological function contribute to the pathogenesis of OSAHS, which may play a larger role in non-obese female patients.
Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Nose ; physiopathology ; Rhinomanometry ; Rhinometry, Acoustic ; Sleep Apnea Syndromes ; physiopathology ; Young Adult

Three-dimensional bioprinting is one of the latest and fastest growing technologies in the medical field. It has been implemented to print part of the transplantable tissues and organs, such as skin, ear, and bone. This paper introduces the application status, challenges, and application prospect of three-dimensional bioprinting in burn and plastic surgery field.

Objective:To explore the clinical effect of bi-layered artificial dermis combined with autologous skin graft in the repair of wounds with exposed bone and/or tendon.Methods:The medical records of 25 patients (aged 3 to 79 years, including 21 males and 4 females) with bone and/or tendon exposed wounds caused by various reasons, admitted to Nanfang Hospital of Southern Medical University from May 2014 to December 2018 were analyzed retrospectively. Of the 25 patients, 7 patients had exposed bone only, 13 patients had exposed tendon only, and 5 patients had exposure of both bone and tendon. The total wound area was 78.0 (53.4, 103.2) cm 2. The widths of bone exposure and tendon exposure were 3.2 (3.0, 3.6) cm and 2.0 (1.7, 2.4) cm, respectively. All wounds were implanted with bi-layered artificial dermis in the first stage after thorough wound debridement. After 2 to 3 weeks of vascularization of artificial dermis, autologous thin-to-medium-thickness skins or split-thickness skins were grafted to repair the wounds in the second stage. The vascularization of artificial dermis and its time, whether or not producing hematoma, the skin graft survival rate on day 7 post autologous skin grafting, whether or not repeating skin grafting, and the time of complete wound healing were observed and recorded. The patients were further followed up and observed for 3 or more months after discharge. Results:The vascularization of artificial dermis was achieved in 24 patients after the first transplantation with vascularization time being 11-21 (16±4) days. No hematoma was observed in the transplanted artificial dermis. Failed vascularization of grafted artificial dermis was observed in one patient who was later treated with negative pressure drainage and skin grafting alone, and was discharged with wound healing. The skin graft survival rate on day 7 post autologous skin grafting was 92.2%-100.0% ( (99.3±1.3)%), with the remaining wound areas recovered later by themselves or healed by dressing changes without repeated skin grafting. The complete wound healing time was 7-19 (11.9±2.8) days after autologous skin grafting. The patients were followed up for 3 to 60 months after discharge. Except for the pigmentation in skin graft area, the skin grafts survived well, being soft in texture and with no repeated ulceration, obvious hypertrophic scar, or contracture deformity.Conclusions:Artificial dermis combined with autologous skin grafting can effectively repair wounds with bone and/or tendon exposure, providing a repair strategy for this type of wounds.

Objective To investigate the feasibility of b value threshold maps based on MRI diffusion weighted imaging ( DWI ) in the diagnosis of pancreatic adenocarcinoma .Methods The preoperative MRI DWI [ b value=0( b0 ) and 1000 ( b1000 ) s/mm2 ] data of 14 patients who were postoperatively histologically confirmed as pancreatic ductal adenocarcinoma from September 2016 to May 2015 admitted in Shanghai Changhai Hospital were retrospectively analyzed .The b value threshold maps were calculated .Computed DWI images at b value of 1500 s/mm2 ( cDWIb1500 ) was calculated based on the scanned DWI images of b 0 and b1000 s/mm2 . The efficacy of DWIb 1000 , b value threshold map and cDWIb 1500 in manifesting pancreatic adenocarcinoma was assessed by a four-point scale .The non-parametric Friedman test was used to compare the three methods , and Conover adjusted method was applied to compare any two of the three methods .Results The conspicuity score of DWIb 1000 , b value threshold map and cDWIb 1500 in showing pancreatic cancer was 2.9 ±0.8, 3.7 ±0.5 and 3.6 ±0.5, respectively, and the differences among the three methods were statistically significant (F=19.5, P value <0.001), but the differences on tumor conspicuity scores of b value threshold map and cDWIb 1500 were not statistically different .Conclusions The calculation of b value threshold map based on DWI images could show pancreatic cancer in high contrast quickly by adjusting window width and window level , and could achieve comparable performance as cDWIb 1500 .