OBJECTIVE: To explore the early changes in various liver function indicators in critically injured trauma patients assessed by intelligent calculation method, aiming to develop more advantageous diagnostic and treatment strategies for traumatic liver injury. METHODS: A retrospective study was conducted. Critically injured trauma patients [injury severity score (ISS) ≥ 16, age > 18 years old] admitted to the Emergency Medical Center of Tianjin Fifth Central Hospital from January 1, 2022, to December 1, 2023 were enrolled. ISS score and acute physiology and chronic health evaluation II (APACHE II) assessed by intelligent calculation method were collected upon patient admission to the emergency medical center. Trends in liver function indicators in fasting venous serum were analyzed at 6, 24 and 72 hours after admission, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), lactate dehydrogenase (LDH), albumin (ALB), total bilirubin (TBil), prothrombin time (PT). Patients were grouped based on APACHE II scores into those with APACHE II < 15 and APACHE II ≤ 15, and liver function indicators within 6 hours of admission were compared between the two groups. RESULTS: A total of 112 critically injured trauma patients were included, with 83 males and 29 females, an average age of (47.78±14.84) years old. The median ISS score was 21.0 (18.0, 26.0). The most common cause of injury for critically injured trauma patients was road traffic accidents (68 cases, accounting for 60.71%), followed by falls from heights, compression injuries, heavy object injuries, knife stabs, and explosion injuries. The most common injured areas was the limbs and pelvis (97 cases, accounting for 86.61%), followed by chest injuries, surface skin and soft tissue injuries, abdominal and pelvic organ injuries, head injuries, and facial injuries. The proportion of elevated LDH, AST, and ALT within 6 hours of admission was 77.68%, 79.46%, and 52.68%, respectively, while the proportion of decreased ALB was 75.89%, the abnormal rates of ALP, GGT, TBil, and PT were all below 50%. The ALT and AST levels of patients at 24 hours and 72 hours after admission were significantly lower than those at 6 hours after admission [ALT (U/L): 37.0 (22.0, 66.0), 31.0 (21.2, 52.0) vs. 41.0 (25.0, 71.0), AST (U/L): 55.5 (30.0, 93.5), 40.0 (27.0, 63.2) vs. 69.5 (39.0, 130.8), all P < 0.05]. There was no statistically significant difference in ISS score between APACHE II > 15 group (45 cases) and APACHE II ≤ 15 group [67 cases; 21.0 (18.5, 26.5) vs. 20.0 (17.0, 22.0), P > 0.05]. Nevertheless, compared with patients with APACHE II ≤ 15, patients with APACHE II > 15 have a higher abnormality rate of ALT and AST within 6 hours of admission [ALT abnormal rate: 66.44% (29/45) vs. 44.78% (30/67), AST abnormal rate: 93.33% (42/45) vs. 70.15% (47/67), both P < 0.05], and the levels of ALT and AST were higher [ALT (U/L): 56.0 (30.0, 121.0) vs. 35.0 (21.0, 69.0), AST (U/L): 87.0 (48.0, 233.0) vs. 52.0 (31.0, 117.0), both P < 0.05]. CONCLUSIONS Severe trauma patients frequently exhibit a high incidence of reversible early liver function impairment. Based on intelligent calculation method, the utilization of both the ISS and APACHE II scores demonstrates a distinct advantage in the assessment of their early liver injury.
Humans ; Retrospective Studies ; Liver/physiopathology* ; Risk Assessment ; APACHE ; Wounds and Injuries ; Adult ; Injury Severity Score ; Male ; Middle Aged ; Female ; Liver Function Tests ; Alanine Transaminase/blood* ; Young Adult ; Aspartate Aminotransferases/blood*

Objective To explore the influence of longitudinal and oblique hollow lag screw internal fixation on interphalangeal range of motion,metacarpal range of motion and complications in patients with transverse fractures of proximal phalanges.Methods Retrospective analysis was performed on 102 patients with transverse fractures of proximal phalanges admitted to department of orthopedics of our hospital from June 2021 to February 2022.According to treatment methods,the patients were divided into longitudinal group and oblique group.The longitudinal group was given longitudinal hollow lag screw internal fixation while the oblique group was treated with oblique hollow lag screw internal fixation.The baseline data of the enrolled subjects were excluded from the influence of confounding factors according to the propensity matching scoring method(caliper value=0.02),and 51 patients with comparable baseline data were obtained in each group.The surgical status(surgical time and healing time),ranges of motions of interphalangeal and metacarpal joints,excellent and good rate of hand function(total active movement,TAM)and complications at 18 months after surgery were compared between the two groups.Results All patients successfully completed the surgery,and at least 18 months of follow-up data were obtained.There was no statistical significance in the surgical time or follow-up time between the two groups(P＞0.05).The healing time in oblique group(6.57±1.22)weeks,was significantly shorter than that in longitudinal group(7.82±1.54)weeks(P＜0.05).At 18 months after surgery,the interphalangeal range of motion was significantly higher in oblique group(82.62±3.41)° than that in longitudinal group(77.45±7.46)°(P＜0.05),but there was no statistical difference in metacarpal range of motion between the two groups(P＞0.05).The excellent and good rate of hand function in oblique group(94.12％)at 18 months after surgery was significantly higher than that in longitudinal group(80.39％)(P＜0.05).The incidence of complications revealed no statistical significance between oblique group(1.96％)and longitudinal group(3.92％)(P＞0.05).Conclusion In the hollow lag internal screw fixation treatment of patients with transverse fractures of proximal phalanges,both longitudinal and oblique screw methods have good effects,but the oblique screw method is more beneficial to the recovery of hand function.

Objective:To explore the effects of lateral finger flap and micro free venous flap on the replantation repair of skin defect type severed fingers and their impact on finger function recovery.Methods:A retrospective selection was conducted on the clinical data of 94 patients (94 fingers) with skin defect type finger amputation admitted to Affiliated Hospital of Jiangnan University from January 2020 to September 2022. According to the different design methods of the skin flap, there were 48 cases in the observation group (micro free venous flap) and 46 cases in the control group (finger side flap). We compared the repair effects, blood circulation, finger function recovery, and complications between two groups.Results:Two months after surgery, there was no statistically significant difference ( P>0.05) in the total effective rate of repair between the observation group [79.17%(38/48)] and the control group [76.09%(35/46)]. The blood flow velocity, skin temperature, and skin redness ratio of the observation group were higher than those of the control group, and the capillary filling time was shorter than that of the control group, with statistical significance (all P<0.05). There was no statistically significant difference (all P>0.05) in the scores of joint autonomy, daily living activities, and recovery between the two groups. The subjective sensation and appearance scores of the observation group were lower than those of the control group, and the differences were statistically significant (all P<0.05). The incidence of complications in the observation group was 10.42%(5/48), and there was no statistically significant difference ( P>0.05) compared to the incidence of complications in the control group [13.04%(6/46)]. Conclusions:For patients with severed fingers with skin defects, the lateral finger flap and mini free vein flap are effective methods for replantation. In clinical practice, reasonable skin flap repair methods can be flexibly selected based on the patient′s actual situation.

Objective:To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap.Methods:A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis.Results:All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] ( P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant ( P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant ( P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively ( P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion:For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

Objective:To investigate the clinical effect of two-stage auricular reconstruction combined with Bonebridge implantation in the treatment of congenital microtia.Methods:The clinical data of 52 patients with congenital microtia and hearing impairment were retrospectively analyzed. The patients were admitted to the Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Beijing Tongren Hospital Affiliated to Capital Medical University from June 2017 to August 2019. There were 35 males and 17 females, aged 6-12 years. All patients received the two-stage surgery. The first stage surgery was Nagata’s technique described as follows: rib cartilage harvest and framework implantation. The second stage surgery combined auricle elevation with Bonebridge implantation. Postoperative follow-up was conducted to evaluate the effect of the operation through auricular morphology and auditory evaluation. The auricular morphology was subjectively evaluated by the patient and the patient’s family members. The audiometric evaluation mainly included the comparisons of the pure tone audiometry results and speech recognition rate of the patients before and after the operation. SPSS 19.0 software was used for data analysis. The measurement data were showed as Mean±SD, and the comparison results were analyzed by paired t test. P<0.05 was considered statistically significant. Results:After follow-ups of 3-10 months, with an average of 6 months, the spatial three-dimensional structure and local subunit morphology of the reconstructed ears were satisfactory in 47 patients (90.4%). Four patients had obvious scarring or keloid in retroauricular region, which affected the aesthetic outcome. The results of pure tone audiometry at 3 weeks after surgery showed that the postoperative air conduction threshold was (38.8±7.2) dB HL, which decreased by (33.6±6.2) dB HL compared to that before surgery (72.4±9.0) dB HL, and the difference was statistically significant ( t=38.13, P<0.001). The speech recognition rate was increased by 24%-67%, which was improved from 31.9% before surgery to 85.0% after surgery. The difference was statistically significant ( t=-40.15, P<0.001). Conclusions:Auricular reconstruction and Bonebridge implantation were carried out in one stage of surgery, so that the patients with congenital microtia could obtain good auricular morphology and improve their hearing significantly.

Objective:To investigate the clinical effect of two-stage auricular reconstruction combined with Bonebridge implantation in the treatment of congenital microtia.Methods:The clinical data of 52 patients with congenital microtia and hearing impairment were retrospectively analyzed. The patients were admitted to the Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Beijing Tongren Hospital Affiliated to Capital Medical University from June 2017 to August 2019. There were 35 males and 17 females, aged 6-12 years. All patients received the two-stage surgery. The first stage surgery was Nagata’s technique described as follows: rib cartilage harvest and framework implantation. The second stage surgery combined auricle elevation with Bonebridge implantation. Postoperative follow-up was conducted to evaluate the effect of the operation through auricular morphology and auditory evaluation. The auricular morphology was subjectively evaluated by the patient and the patient’s family members. The audiometric evaluation mainly included the comparisons of the pure tone audiometry results and speech recognition rate of the patients before and after the operation. SPSS 19.0 software was used for data analysis. The measurement data were showed as Mean±SD, and the comparison results were analyzed by paired t test. P<0.05 was considered statistically significant. Results:After follow-ups of 3-10 months, with an average of 6 months, the spatial three-dimensional structure and local subunit morphology of the reconstructed ears were satisfactory in 47 patients (90.4%). Four patients had obvious scarring or keloid in retroauricular region, which affected the aesthetic outcome. The results of pure tone audiometry at 3 weeks after surgery showed that the postoperative air conduction threshold was (38.8±7.2) dB HL, which decreased by (33.6±6.2) dB HL compared to that before surgery (72.4±9.0) dB HL, and the difference was statistically significant ( t=38.13, P<0.001). The speech recognition rate was increased by 24%-67%, which was improved from 31.9% before surgery to 85.0% after surgery. The difference was statistically significant ( t=-40.15, P<0.001). Conclusions:Auricular reconstruction and Bonebridge implantation were carried out in one stage of surgery, so that the patients with congenital microtia could obtain good auricular morphology and improve their hearing significantly.

Objective:To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods:According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group ( n = 12) and seawater drowning group ( n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO 2/FiO 2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. Results:① Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05].② Respiratory parameters: compared with values before drowning, PaO 2/FiO 2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO 2/FiO 2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH 2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH 2O, 1 cmH 2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO 2/FiO 2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline.③ Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured.④ Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01).⑤ HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. Conclusion:The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

Acute aortic dissection (AAD) is a potentially catastrophic cardiovascular disease,with significant morbidity and mortality,and it remains a challenge to diagnose and treat.Survival rate has been shown to be directly related to prompt diagnosis and precise management,it is necessary for early diagnosis and treatment.However,diagnosis of the disease relies heavily on various imaging techniques,remaining time-consuming and difficult to obtain.Nevertheless,the application of biomarkers provides a new direction for the diagnosis of AAD.Therefore,the application of biomarkers with high specificity and sensitivity contribute to optimal treatment to reduce the mortality rate is the current research direction.This article was to summarize the domestic and abroad research advances which focused on the biomarkers and progress of aortic dissection.

Objective To analyze the clinical,radiological features and risk factors of diplopia in patients with acute lacunar infarction (ALI).Methods Retrospectively retrieved patients of ALI (lesion diameter was less than 1.5 cm in DWI sequence)diagnosed by MR and clinical.We further summarized 13 ALI patients with diplopia and randomly selected 13 ALI patients without diplopia as the control group. SPSS22.0 statistical software was used for statistical analysis.The general clinical data such as sex and age was compared by Ch-i square test and t-test.The risk factors were primarily analyzed by one-way ANOVA and then the risk factors with statistical significance were brought into the logistic regression model for multivariate analysis.Results The incidence of diplopia in ALI patients was about 2.7%(13/489). The infarct sites were all located in the brain stem of the oculomotor-related brain nucleus and the dorsolateral medulla oblongata.Hypertension and hematocrit were negatively correlated with diplopia after infarction (P＜0.05 ).Conclusion The incidence of diplopia is low in ALI patients.The medial longitudinal tract of the dorsolateral medulla is an important area causing diplopia.Hypertension and hematocrit are non-risk factors for diplopia after ALI.