During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To investigate the imaging characteristics of uncomplicated acute type B aortic dissection (uATBAD) and the short-term and mid-term outcomes treated with thoracic endovascular aortic repair (TEVAR).Methods:One hundred and forty uATBAD patients treated by TEVAR at Zhejiang Provincial People's Hospital from Jan 2015 to Aug 2021 were retrospectively analyzed. Patients were divided into non-high-risk characteristics group (uATBAD group, 22 cases) and high-risk characteristics group (high-risk uATBAD group, 118 cases) according to the presence or absence of high-risk characteristics. The clinical and follow-up data were analyzed, and the incidence of complications, re-intervention rate, and mortality in the perioperative period and 5-year follow-up were evaluated.Results:The aortic diameter, false lumen diameter and the proportion of laceration in lesser curvature in the high-risk group were higher than those in the non-high-risk group ( P<0.05). There was no significant difference in the incidence of perioperative complications and 30 day mortality between two groups ( P>0.05). The follow-up time ranged from 6 to 83 months (mean 38.3 months). The 5-year mid-term follow-up showed that there was no significant difference in the incidence of aorta-related complications, re-intervention rate, and mortality between two groups ( P>0.05). Conclusions:The imaging characteristics of different typing uATBAD were significantly different. The short- and mid-term clinical effects of TEVAR were similar between the two groups.

Objective To evaluate the long-term follow-up results of foam sclerosing agent in the treatment ofincompetent perforating vein.Methods 153 cases (316 incompetent perforating veins)received the treatment of foam sclerotherapy.The closure of perforating branches was followed up by ultrasound.Results 12 cases (27 incompetent perforating veins) were lost to follow up.289 incompetent perforating veins got follow up,The median follow-up time was 17 months (11-36 months).Closure rate was 100％ in vessels less than 3 mm in diameter,while that was 76％ invessels with the diameter between 3-5 mm.Closure rate was 16％ in vessels larger than 5 mm in diameter.Conclusion The long-term efficacy of the foam sclerosing agent in the treatment of incompetent perforating vein depends on the diameter of the vein.

OBJECTIVE: To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis. METHODS: Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed. RESULTS: Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed. CONCLUSIONS Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.
Aortic Aneurysm, Abdominal ; surgery ; Aortic Valve Stenosis ; surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Stents ; Treatment Outcome

Objective To evaluate the effect of antiplatelet drugs and ischemic-events-free duration by thromboelastography (TEG) in patients undergoing peripheral endovascular treatment.Methods From Mar 2015 to Oct 2016,38 patients undergoing initial successful peripheral stenting and then coming back for recurrent ischemic events.TEG was used to evaluate the platelet inhibition rate induced by arachidonic acid (AA％) approach,the platelet inhibition rate induced by adenosine diphosphate (ADP％) approach,and the ADP-induced platelet-fibrin clot strength (MAADP).Clinical feature differences between patients with MAADP ＞ 47 mm and MAADP ≤ 47 mm were compared.Results AA％ less than 50％ was found in 9 patients(23.9％),and ADP％ less than 30％ in 14 patients(36.8％).5 patients met the two conditions.Patients with MAADp ＞ 47 mm had a significantly lower ADP％ (x2 =10.755,P ＜ 0.001),compared to patients with MAADP ≤47 mm.Univariate survival analysis showed ADP％ ＜ 30％ and MAADP ＞47 mm were risk factors for getting shorter ischemic-events-free duration,compared to patients with ADP％ ≥ 30 (P ＜ 0.001),with MAADP ≤47 mm (x2 =4.408,P =0.036).Conclusions TEG may detect those patients who has a low response to antiplatelet drugs,and some TEG parameters may have a ischemic predictive value.

Objective To discuss the curative effect and clinical significance of sclerosing foam agent in the treatment of chronic venous diseases (CVD) with incompetent perforating veins.Methods 65 cases of C4,C5,C6 CVD (a total of 84 limbs) underwent foam sclerotherapy closure for incompetent perforating vein.Patients were followed-up for 3 months,ultrasonography was used to observe the closure of perforating veins and the curative effect.Results 7 patients (9 limbs) were lost to follow-up,all with grade C4.In the 66 (C4,C5) limbs,pigmentation significantly subsided in 45,partial regression in 9,no change in 2.In the 9 limbs with grade C6,complete healing of ulcer in 5,partially healed in 3.Ultrasound observed satisfactory perforating vein closure.Conclusion Foam sclerotherapy closure for incompetent perforating vein has satisfactory effect,with good short-term curative result.

Objective:To explore the Immunoprotection of gastric mucosa in newborn mice after oral immunization with inactived H.pylori.Methods:Thirty-two BALB/c mice were randomly divided into four groups, including PBS control group ( groupⅠ) ,the group of inactivated H.pylori ( groupⅡ) , the group of inactivated H.pylori and Escherichia cole heat-labile enterotoxin B subunit( LTB) ( groupⅢ) ,and normal group( groupⅣ).Newborn BLAB/c mice within 24 hours were immunized through oral gavage with corresponding antigen,Two weeks after final immunization,the mice were challenged with 1×108CFU live H.pylori strain SS1, twice once day,for 2 days.The twenty-eighth day post-challenge,all of mice were sacrificed and stomachs were removed for grades of in-flammation and The counting of H.pylori colonizing.Results:The mean scores of stomach tissue inflammation of groupⅠ,Ⅱ,Ⅲ andⅣwere 2.25±0.46,2.12±0.35,1.5±0.53,0.25±0.46,respectively,and the score of inflammatory activity of the above four groups were 2.12±0.35,2.12±0.35,1.37±0.52,0.25±0.46.Among these four groups,the results were statistically significant between any two groups except the result between groupⅠand groupⅡ.Finally,H.pylori colonization quantity in the stomachs of groupⅢwas lower than groupⅠand group Ⅱ( P<0.05 ) , as expected, the H.pylori colonization was undetectable in group Ⅳ.Conclusion: The oral gavage with inactived H.pylori plus LTB to newborn mice may be associate with the lightening of inflammation and the decrease of H.pylori colonizing number.

Objective To investigate the mechanism of therapeutic action of dexamethasone on asthmatic mice by detecting the levels of IL-25 and IFN-γ in bronchoalveolar lavage fluid (BALF). Methods Balb/c mice with SPF grade were randomly divided into normal control group, asthma group and dexamethasone group. Asthma group and dexamethasone group were sensitized and challenged with ovalbumin ( OVA) . Dexamethasone group was intraperitoneally injected with dexamethasone one hour before challenging. The mice were executed 24 hours after the last challenge, and the HE stained pathological sections of the right lung were made. Pathological sections of lung were observed. BALF in the left lung was also collected. The total white blood cell count and absolute eosinophile ( EOS) count were observed, and the percentage of EOS was calculated. The levels of IL-25 and IFN-γwere measured with ELISA, and correlation analyses were made. Results The counts of total white blood cell and EOS, and the percentage of EOS were significantly higher in the asthma group than in the normal control group and dexamethasone group (P<0. 05). No differences were found between the normal control group and dexamethasone group. The IL-25 level was higher in the asthma group than in the normal control group and dexamethasone group (P<0. 05), and its level in the dexamethasone group was also higher than that in the normal control group. The IFN-γlevel was lower in the asthma group than in the normal control group and dexamethasone group (P<0. 05), while there was no significant difference between the normal control group and dexamethasone group. IL-25 was negatively correlated with IFN-γin each group. Conclusion Part of the mechanisms of dexamethasone acting on asthma are related to its inhibition on the pulmonary inflammation and promotion on the expression of IFN-γ, and possible inhibition of IL-25 expression.

Objective To access the alterations of ischemic myocardial regional motion time caused by different extent of coronary artery stenosis by 2D-strain technique. Methods Two-dimensional images were acquired of the standard parasternal and apical (4-chamber,2-chamber and long-axis) views and short-axis views (mitral annulus, papillary muscle and apex) in 140 patients with coronary artery disease. All left ventricular segments were divided into 5 groups according to coronary stenosis seen on angiography:normal,25% -49% ,50% -74% ,75% -99% and 100%. The time to segmental systolic peak strain, systolic peak strain rate, end systolic strain, early diastolic peak strain rate and late diastolic peak strain rate in longitudinal, radial, circumferential directions and the systolic peak rotation, systolic peak rotation rate, early diastolic rotation rate,late diastolic rotation rate were analyzed with EchoPAC offline software. Results In longitudinal direction,compared with normal group,the time to early diastolic peak strain rate of segments with 75% - 99% coronary stenosis increased significantly, the time to systolic peak strain rate, early diastolic peak strain rate of segments with occluded artery were significantly delayed compared with the other 4 groups (P ＜0.05). In radial, circumferential directions, the time to systolic peak strain, systolic peak strain rate,late diastolic peak strain rate of segments with 25% - 49% was shorter than that of normal segments. Those indices for segments with 50% - 74% coronary stenosis were delayed compared with segments with 25% - 49% stenosis, however, those for segments with 75% - 99% coronary stenosis showed some improvement in the comparison with segments with 50% - 74% stenosis. All time indices for segments with occluded arteries were delayed ( P ＜0.05). About rotation, the time to the systolic peak rotation,systolic peak rotation rate,early diastolic peak rotation rate with 25% -49% stenosis was shorter than those of normal segments, the time to systolic peak rotation and early diastolic peak rotation rate for segments with 75% - 99% stenosis improved compared with segments with 50% - 74% stenosis.Conclusions 25% -49% coronary stenosis could lead to alterations of peak myocardial systole and diastole motion time in radial,circumferential and rotation directions,and ≥75% coronary stenosis caused the all 4 directions motion delays. Also the time indices for segments with 75% - 99% coronary stenosis showed some improvement in the comparison with segments with 50% -74% coronary stenosis.

Objective To study the protective effects of the coronary collateral circulation to ischemic myocardial regional function with coronary artery stenosis≥75%using 2D-strain technique.Methods Two-dimensional images of apical four-,two-chambers,long-axis views and LV short-axis views were obtained in 121 patients.According to the results of coronary angiogram,all the 121 patients were divided into 3 groups:group 1,with normal coronary artery;group 2,with stenosis≥75%in≥1 main coronary artery involved right coronary artery,left anterior descending branch and left circumflex branch and with the presence of coronary collateral circulation(CCC);group 3,with stenosis≥75% in≥1 main coronary artery but with no presence of CCC.The segments' systolic peak strain(Sps),strain rate (SRs),end systolic strain (Yes),early diastolic strain rate (SRe) and late diastolic strain rate (SRa) in longitudinal (L),radial (R),circumficial (C) directions and the rotation (Rot),rotation rate were analyzed with EchoPAC offline software.Results Compared with 1 group,LSps,LSes,LSRs,LSRa,RSRe,RSRa,CSRe,Rotsre,Rotsra of 2 group,LSps,LSes,LSRs,LSRa,LSRe,RSes,RSRs,RSRe,RSRa,CSps,CSes,CSRs,CSRe,CSRs,Rotps,Rotsrs,Rotsre,Rotsra of 3 group decreased significantly (P＜0.05) ;compared with 2 group,LSps,LSes,LSRs,RSes,RSRs,CSps,CSes,CSRs,CSRa,Rotps,Rotsrs,Rotsre of 3 group decreased markedly (P＜0.05).Conclusions Coronary collateral circulation provides a protection effection to ischemic myocardial regional function.2D-strain technique may serve as an efficient method to assess ischemic myocardial regional function.