Objective To investigate the function of glymphatic system in patients with mild traumatic brain injury via diffusion tensor imaging analysis along the perivascular space(DTI-ALPS)index and its relationship with clinical features.Methods The clinical and imaging data from 163 patients with mild traumatic brain injury were retrospectively collected,including 31 cases with MRI-negative findings and 132 cases with MRI-positive findings.In addition,29 healthy individuals underwent physical examinations were included as a control group.The differences in DTI-ALPS index and clinical features between mild traumatic brain injury and control group,as well as among subgroups of traumatic brain injury were analyzed.Results The DTI-ALPS index in patients with mild traumatic brain injury were significantly higher than those in control group(P＜0.05).Subgroup analysis showed that DTI-ALPS index of traumatic brain injury patients with MRI-negative findings and MRI-positive findings were all significantly higher than those of control group(P=0.023 and 0.004,respectively).Compared to control group,DTI-ALPS index in mild traumatic brain injury patients gradually increased with the progression of injury,and the difference was statistically significant(P=0.008).Conclusion Patients with mild traumatic brain injury exhibit increased functional activity of glymphatic system,as indicated by increased DTI-ALPS index,which further increase with the progression of injury.

Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons. This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak. This patient had experienced prolonged sepsis and multiple surgical traumas. Upon admission to our department, exploratory surgery revealed extensive bowel edema and adhesions, an anastomotic leak, and abdominal contamination with infection. In accordance with the principles of damage control surgery, the anastomotic leak was exteriorized, the abdomen was left open, and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection. Negative pressure wound therapy was used to manage the open abdomen, and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula. After granulation of the abdominal wound, split-thickness skin grafting was performed. The enteroatmospheric fistula was converted into an enterocutaneous fistula. A 3D-printed stoma baseplate was used to manage the digestive fistula. Concurrently, enhanced parenteral and enteral nutritional support was provided. Six months later, the patient successfully underwent definitive fistula resection and abdominal wall defect repair.

Objective:To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE).Methods:This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data.Results:A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment.Conclusions:VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Objective To investigate the function of glymphatic system in patients with mild traumatic brain injury via diffusion tensor imaging analysis along the perivascular space(DTI-ALPS)index and its relationship with clinical features.Methods The clinical and imaging data from 163 patients with mild traumatic brain injury were retrospectively collected,including 31 cases with MRI-negative findings and 132 cases with MRI-positive findings.In addition,29 healthy individuals underwent physical examinations were included as a control group.The differences in DTI-ALPS index and clinical features between mild traumatic brain injury and control group,as well as among subgroups of traumatic brain injury were analyzed.Results The DTI-ALPS index in patients with mild traumatic brain injury were significantly higher than those in control group(P＜0.05).Subgroup analysis showed that DTI-ALPS index of traumatic brain injury patients with MRI-negative findings and MRI-positive findings were all significantly higher than those of control group(P=0.023 and 0.004,respectively).Compared to control group,DTI-ALPS index in mild traumatic brain injury patients gradually increased with the progression of injury,and the difference was statistically significant(P=0.008).Conclusion Patients with mild traumatic brain injury exhibit increased functional activity of glymphatic system,as indicated by increased DTI-ALPS index,which further increase with the progression of injury.

Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons. This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak. This patient had experienced prolonged sepsis and multiple surgical traumas. Upon admission to our department, exploratory surgery revealed extensive bowel edema and adhesions, an anastomotic leak, and abdominal contamination with infection. In accordance with the principles of damage control surgery, the anastomotic leak was exteriorized, the abdomen was left open, and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection. Negative pressure wound therapy was used to manage the open abdomen, and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula. After granulation of the abdominal wound, split-thickness skin grafting was performed. The enteroatmospheric fistula was converted into an enterocutaneous fistula. A 3D-printed stoma baseplate was used to manage the digestive fistula. Concurrently, enhanced parenteral and enteral nutritional support was provided. Six months later, the patient successfully underwent definitive fistula resection and abdominal wall defect repair.

Objective:To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE).Methods:This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data.Results:A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment.Conclusions:VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To assess the prevalences of hypertension, rates of medication recommendations and failure rates of blood pressure(BP)control in Chinese elderly patients(≥65 years old).Methods:We used data from the 2011 China Health and Nutrition Survey(CHNS). A total of 2, 391 Chinese adults aged≥65 years with complete information comprising BP measurements repeated three times and antihypertensive medication use were included for analysis.Results:The mean age of subjects was 72.6±6.2 years, and females accounted for 53.1%.The numbers of patients with hypertension were 1784(74.6%)and 1221(51.1%)according to the definitions from 2017 ACC/AHA guideline and the 2010 Chinese guideline, respectively.There was a significant difference in the prevalence of hypertension in the subgroup with a cardiovascular disease(CVD)history according to the definitions from the two guidelines( χ2=23.70, P<0.01). The BP thresholds for drug therapy recommendations were the same as those set in the diagnostic criteria of hypertension based on the two guidelines.Therefore, the rates for medication recommendations were 74.6% and 51.1%, respectively.The numbers of patients with BP above the target levels were 622(88.2%)and 346(49.1%), respectively, according to the definitions from the two guidelines.There was no significant difference in failure rate of BP control due to age( χ2=5.36, P>0.05), gender( χ2=0.12, P>0.05)or a CVD history( χ2=0.07, P>0.05)according to analyses using the definitions from the two guidelines. Conclusions:Compared with the 2010 Chinese hypertension guideline, the prevalence of hypertension and rate of medication recommendations are higher in the Chinese elderly population when the 2017 ACC/AHA hypertension guideline is used.Hypertension management and antihypertensive drug treatment should be reinforced to improve the control rate of hypertension.

We analyzed the project results of preventive medicine from the National Natural Science Foundation of China (NSFC) finished in 2017 based on the project-ending reports and data on science fund sharing service network. A total of 406 projects in this field were completed in 2017. A total of 3 122 published articles supported by these projects, including 1 789 articles in science citation index (SCI) journals and 525 articles in Chinese core journals. In addition, there were 224 patent application/software copyright and 589 trained postgraduates. The top three sub-disciplines of project were non-communicable disease epidemiology, human nutrition and hygienic toxicology, accounting for 45.32% of the total number of completed projects. There were 12 institutions which had more than 10 finished projects, accounting for 41.87%. During the recent 5 years, the number of SCI articles and patents/software copyrights per project showed a general uptrend. It should be noted that the number of articles in Chinese core journals and postgraduates decreased in recent two years. Our analyses demonstrated that the project results should be guided by the new era policy of science fund to promote sustainable development of scientific research.

Objective To analyze projects completed at the end of 2017 and funded by National Natural Science Foundation of China (NSFC) in the field of skin and its appendages,in order to provide references for preparing concluding reports and making discipline development strategies in the future.Methods The concluding reports of projects completed at the end of 2017 and funded by National Natural Science Foundation of China in the field of skin and its appendages were collected from the Internet-based Science Information System.The achievements were analyzed,including journal articles,patents,talent training and monographs.Results A total of 91 projects were completed at the end of 2017 in the field of skin and its appendages,and the total cost of funds was 43.51 million RMB Yuan.A total of 452 journal articles were published,including 324 articles in the Science Citation Index (SCI)-indexed journals and 42 in the A Guide to the Core Journal of China-indexed journals.Additionally,0.74 SCI journal article and 0.10 Chinese core journal article could be produced per 100 000 RMB Yuan.The average impact factor of journals publishing these SCI articles was 3.972,and in average,100 000 RMB Yuan yielded 1 article in the journal with an impact factor of 2.92.Of the 324 published articles,46 and 102 were published in journals ranked within the first (Q1) and second (Q2) quartile,respectively,by Chinese Academy of Sciences.In all the SCI articles,14 were published in journals with impact factor of ＞ 10.There were 4 institutions with more than 5 completed projects,and a total of 129 (39.84％) SCI articles were published.Published SCI articles in the field of immune skin diseases accounted for the highest proportion (148/324,45.68％).A total of 152 talents were trained.Conclusions The support of NSFC in basic researches in the field of skin and its appendages has led to substantial achievements.More attention should be paid to the writing of concluding reports.Innovation consciousness should be raised,and project leaders should make more original and leading achievements in the future.