Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective To analyze the predictive value of dynamic changes of multiple inflammatory factors in early screening of sepsis risk in patients with abdominal trauma.Methods A total of 360 patients with abdominal trauma admitted to the Department of Surgery of Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force from January 2018 to January 2022 were studied.Patients were divided into sepsis group and control group according to whether sepsis occurred.The general data and dynamic changes of inflammatory indicators were compared between the two groups.Multivariate Logistic regression was used to analyze the related factors of sepsis in patients with abdominal trauma,and ROC curve was used to analyze the value of dynamic changes of multiple inflammatory factors in predicting sepsis in patients with abdominal trauma.Results Among the patients included in the study,13 cases fell out,leaving 347 cases,of which 51 patients with sepsis were classified as sepsis group,and the remaining 296 cases were classified as control group.The incidence of sepsis was 14.70％.There was no significant difference in age,blood glucose and white blood cell at admission between the two groups(P＞0.05).But the SOFA score in sepsis group(1.86±0.45)was higher than that in control group(1.54±0.36).In sepsis group,the difference of C-reactive protein(CRP)was(5.67±1.17)mg/L,the PCT was(0.12±0.05)ng/ml,the PCT variation rate was(36.43±8.02)％,and the difference of serum amylase A protein(SAA)was(8.62±1.05)m g/L,the difference of neutrophil percentage was(9.31±1.09)％,which was higher than that of control group[(4.79±0.63)mg/L,(0.10±0.04)ng/ml,(28.04±6.21)％,(7.11±0.84)mg/L,(8.41±0.92)％],the difference was statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that:SOFA score(OR=1.648),CRP change difference(OR=2.338),PCT variation rate(OR=1.096),SAA change difference(OR=6.043),neutrophil percentage change difference(OR=3.355)were independent risk factors for sepsis in patients with abdominal trauma.ROC curve showed that SAA difference was more effective in predicting the risk of sepsis in patients with abdominal trauma than CRP difference,PCT variation rate,neutrophil percentage change difference and SOFA score.Conclusion Dynamic analysis of multiple inflammatory factors is valuable for early screening of sepsis risk in patients with abdominal trauma,and monitoring the changes of inflammatory factors is helpful for early adjustment of treatment.

Objective To analyze the predictive value of dynamic changes of multiple inflammatory factors in early screening of sepsis risk in patients with abdominal trauma.Methods A total of 360 patients with abdominal trauma admitted to the Department of Surgery of Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force from January 2018 to January 2022 were studied.Patients were divided into sepsis group and control group according to whether sepsis occurred.The general data and dynamic changes of inflammatory indicators were compared between the two groups.Multivariate Logistic regression was used to analyze the related factors of sepsis in patients with abdominal trauma,and ROC curve was used to analyze the value of dynamic changes of multiple inflammatory factors in predicting sepsis in patients with abdominal trauma.Results Among the patients included in the study,13 cases fell out,leaving 347 cases,of which 51 patients with sepsis were classified as sepsis group,and the remaining 296 cases were classified as control group.The incidence of sepsis was 14.70％.There was no significant difference in age,blood glucose and white blood cell at admission between the two groups(P＞0.05).But the SOFA score in sepsis group(1.86±0.45)was higher than that in control group(1.54±0.36).In sepsis group,the difference of C-reactive protein(CRP)was(5.67±1.17)mg/L,the PCT was(0.12±0.05)ng/ml,the PCT variation rate was(36.43±8.02)％,and the difference of serum amylase A protein(SAA)was(8.62±1.05)m g/L,the difference of neutrophil percentage was(9.31±1.09)％,which was higher than that of control group[(4.79±0.63)mg/L,(0.10±0.04)ng/ml,(28.04±6.21)％,(7.11±0.84)mg/L,(8.41±0.92)％],the difference was statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that:SOFA score(OR=1.648),CRP change difference(OR=2.338),PCT variation rate(OR=1.096),SAA change difference(OR=6.043),neutrophil percentage change difference(OR=3.355)were independent risk factors for sepsis in patients with abdominal trauma.ROC curve showed that SAA difference was more effective in predicting the risk of sepsis in patients with abdominal trauma than CRP difference,PCT variation rate,neutrophil percentage change difference and SOFA score.Conclusion Dynamic analysis of multiple inflammatory factors is valuable for early screening of sepsis risk in patients with abdominal trauma,and monitoring the changes of inflammatory factors is helpful for early adjustment of treatment.

Objective:To investigate clinical significance and related factors of magnetic resonance hyperintense vessel sign (HVS).Methods:The clinical data and related imaging parameters of 109 patients with acute anterior circulation occlusion cerebral infarction, who admitted to Northern Theater Command General Hospital of People′s Liberation Army from April 2017 to August 2019, were analyzed retrospectively. Brain magnetic resonance imaging (MRI) examinations including fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI) and three dimensional time of flight magnetic resonance angiography (3D TOF MRA) sequences within 24 hours of onset were performed. According to the distribution range of HVS in FLAIR sequence, the patients were divided into four grades (0, 1, 2 and 3), grades 0 and 1 belonging to HVS low grade group, and grades 2 and 3 HVS high grade group. Univariate and multivariate analyses were made to explore related factors of HVS. Fifty-two patients who completed baseline CT within six hours of onset before MRI examination were performed CT-Alberta Stroke Program Early CT Score (CT-ASPECTS) and DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS).The difference between CT-ASPECTS and DWI-ASPECTS was calculated. When the difference of ASPECTS ≤1, they were categorized as ASPECTS unchanged group (AN group); when the difference of ASPECTS>1, they were categorized as ASPECTS changed group (AY group). These two groups were compared to explore whether there was any difference in HVS grade, and Spearman correlation analysis was performed to investigate the relationship between HVS grade and the difference of ASPECTS.Results:The difference of hyperlipidemia, TOAST classification (large artery atherosclerosis (LAA), other etiology (SOE) or undetermined etiology (SUE)) and Willis circle classification (types Ⅰ, Ⅱ, Ⅲ and Ⅳ) between HVS groups were remarkable (58.6% (34/58) vs 37.3% (19/51), χ2=4.959, P=0.026; 23/5/23 vs 43/1/14, P=0.004; 3/14/12/22 vs 7/29/14/8, χ2=13.124, P=0.004). Other clinical factors and the locations of vessel occlusion did not show significant difference ( P>0.05). Multivariate Logistic regression analysis indicated that LAA in TOAST classification (LAA vs SOE or SUE, OR=3.054, 95% CI1.257-7.422, P=0.014), Willis circle type Ⅰ (type Ⅰ vs type Ⅳ, OR=5.494, 95% CI1.074-28.091, P=0.041), and type Ⅱ (type Ⅱ vs type Ⅳ, OR=5.571, 95% CI1.895-16.372, P=0.002) were independent related factors to stimulate wide distribution of HVS. The grades of HVS were significantly different between the AN group and the AY group (1/15 vs18/18, χ2=9.114, P=0.002). Spearman correlation analysis showed that HVS grade was negatively correlated with the difference of ASPECTS ( r=-0.573, P<0.001). Conclusions:Both TOAST and Willis circle classifications are crucial factors affecting HVS distribution. HVS distribution range reflects the status of collateral compensatory. Recognizing HVS may help to evaluate the progress of early cerebral infarction volume.