Objective:To conduct a visual analysis of the literature on burn-related coagulation dysfunction and to explore the current research status, evolution process, hot topics, and future research trends in burn-related coagulation dysfunction at home and abroad.Methods:The bibliometrics method was used. The literature on burn-related coagulation dysfunction which were published in Web of Science and China National Knowledge Internet databases from January 1, 1950 to May 1, 2022, and met the inclusion criteria were retrieved for publication volume analysis. The literature on burn-related coagulation dysfunction were retrieved as above in the core collection of Web of Science and China National Knowledge Internet databases, and CiteSpace 5.8.R3 software was used to perform co-occurrence analysis, cluster analysis, and literature co-citation analysis of key words. Results:A total of 501 and 235 literature on burn-related coagulation dysfunction were retrieved from Web of Science database and China National Knowledge Internet database, respectively. The literature on burn-related coagulation dysfunction emerged from 1975 and 1950, respectively, in China and abroad, which were gradually increased later. The frequency and centrality of Chinese key words such as 烧伤, 凝血功能, 血小板 were high in 235 literature in China National Knowledge Internet database, and the frequency and centrality of key words such as burn, coagulation, and deep vein thrombosis were high in 340 literature in the core collection of Web of Science database. In China National Knowledge Internet database, the top 6 Chinese key words in terms of burst intensity were 烧伤患者, 临床意义, 烧伤面积, 凝血功能, 预后, 血小板, and the first 3 among which were burst key words in the early stage; and in the core collection of Web of Science database, the key words with higher burst intensity were disseminated intravascular coagulation and pulmonary embolism, which were the burst key words in the early stage. The representative clustering labels in China National Knowledge Internet database were #0 烧伤, #1 休克, and #2 并发症, etc., and the representative clustering labels in the core collection of Web of Science database were #0 risk, #1 surgical patient, and #2 sepsis. Early researches in China National Knowledge Internet database and the core collection of Web of Science database focused on the presence of burn-related coagulation dysfunction itself, while the late researches focused on the relationship between burn-related coagulation dysfunction and inflammation, immunity, coagulation in general, and wounds. From 2010 onwards, there were a large number of core cited literature in the core collection of Web of Science database, and the prevention and treatment of vein thromboembolism was the most popular research direction in recent years. The researches on optimization and standardization of diagnostic methods and the overall mechanism of burn-related coagulation dysfunction would be the main research directions in the future. Conclusions:The research hotspots and evolution processes of burn-related coagulation dysfunction at home and abroad have both similarities and differences, and the current research hotspot is the relationship between coagulation and inflammation, immunity. With researches increasingly deepening, the researches on optimization and standardization of diagnostic methods and the overall mechanism of burn-related coagulation dysfunction will be the main research directions in the future.

Objective:To investigate the clinical effect of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fracture.Methods:Clinical data of 58 patients suffering from old osteoporotic vertebral bodies with endplate fractures from January 2018 to January 2020 were analyzed retrospectively. All patients had a single vertebral body fracture and were treated with bilateral injection of bone cement with percutaneous kyphoplasty (PKP). According to the shape of the puncture device, the patients were divided into a curved needle group and a ordinary group. There were 28 cases in the curved needle group, including 7 males and 21 females, aged 60-84 years old, with an average age of 71.8±7.8 years. The distribution of vertebral bodies with fractures: T 11 3 cases, T 12 5 cases, L 1 6 cases, L 2 5 cases, L 3 3 cases, L 4 4 cases, and L 5 2 cases. In the ordinary group, there were 30 cases, 8 males and 22 females, with an average age of 73.2±8.4 years (range, 61-88 years). The vertebral body distribution of fracture: T 11 3 cases, T 12 5 cases, L 1 7 cases, L 2 4 cases, L 3 4 cases, L 4 5 cases, and L 5 2 cases. The surgery time, amount of bone cement injection, and bone cement leakage rate were compared between the two groups, as well as the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 week, 6 months, and 1 year after surgery. Preoperative and postoperative vertebral midpoint height and kyphosis Cobb angle were measured. Results:All patients were followed up for 12-24 months, with an average of 14.7±2.9 months. The bone cement leakage rate in curved needle group (18%, 5/28) was lower than that in ordinary group (23%, 7/30), but there was no significant statistical difference (χ 2=0.27, P=0.607). The amount of bone cement injection and surgery time in curved needle group (5.0±0.5 ml, 55.2±6.9 min) were significantly higher than those in ordinary group (3.4±0.6 ml, 42.9±3.6 min, P<0.05) . The scores of VAS (2.3±1.0, 2.6±1.5) and ODI (27.5%±9.7%, 28.7%±11.3%) in curved needle group were lower than those in ordinary group (2.7±1.0, 4.5±1.1 and 31.8%±10.5%, 43.1%±13.4%) at 6 months after surgery and at the last follow-up after surgery. In the curved needle group, the Cobb angle was 25.5°±3.5° preoperatively, 18.4°±1.6° postoperatively, and 20.5°±4.9°at the last follow-up. The height of the vertebral body was 14.2±1.9 mm before surgery, 21.5±2.2 mm after surgery, and 20.1±3.6 mm at the last follow-up. Compared with the preoperative results, the kyphosis Cobb angle decreased and the height of the fractured vertebral body increased at the last follow-up, and the differences were statistically significant ( P<0.05). In the ordinary group, the Cobb angle was 24.4°±3.6° preoperatively, 23.1°±4.0° postoperatively, and 27.8°±2.9° at the last follow-up. The height of the vertebral body was 14.5±1.8 mm before surgery, 15.4±2.0 mm after surgery, and 12.7±1.0 mm at the last follow-up. At the last follow-up, the kyphosis Cobb angle increased and the height of the fractured vertebral body decreased compared with preoperative and postoperative 1 week, and the differences were statistically significant ( P<0.05). At 1 week after surgery, 6 months after surgery and the last follow-up, the Cobb angle of curved needle group was lower than that of ordinary group ( P<0.05), the height of vertebral body was higher than that of ordinary group ( P<0.05). Conclusion:Flexible application of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fractures can effectively increase the riveting force of bone cement in the vertebral body, restore the height of endplate, and reduce the occurrence of kyphosis and chronic low back pain.

Objective : To investigate the effects of SETDB1 on the proliferation and apoptosis of human colon cancer cells. Methods : The senescence of colon cancer cells was induced by doxorubicin, and the protein expression of SETDB1 in the senescent cells was detected by Western blot.Colon cancer cell models with low expression of SETDB1 and overexpression of SETDB1 were constructed by using shRNA(shSETDB1#1 and shSETDB1#2) of SETDB1 and overexpression plasmid, respectively.Western blot was used to detect the expression of SETDB1,the CCK8 assay was performed to detect cell proliferation while a Senescence β-Galactosidase Staining Kit was used to detect senescent cells, and Western blot was used to detect the changes of p53 and p21.The reverse experiment was carried out with p53 overexpression plasmid. Results : Cell senescence evoked by doxorubicin could down-regulate the protein expression of SETDB1.After low expression of SETDB1,the proliferation ability of colonic cancer cells decreased, and the proportion of senescent cells increased from(22.00±4.35)% to(54.00±5.56)% and(53.33±4.93)%(P<0.001).After overexpression of STEDB1,the proliferation ability of colon cancer cells increased, and the ratio of senescent cells decreased from(43.33±6.11)% to(21.33±3.51)%(P<0.01).Through GSE56496 enrichment and analysis, it was found that SETDB1 was related to p53 signal pathway, silencing SETDB1 could increase the levels of p53 and p21 protein, while overexpression of SETDB1 could decrease the level of p53 and p21 protein, and overexpression of p53 reversed the decrease of cell senescence caused by overexpression of SETDB1. Conclusion SETDB1 inhibits the senescence of colon cancer cells by inhibiting p53/p21 signal pathway, which provides a potential target for individualized tumor therapy.

ObjectiveTo investigate the correlation between systemic immune-inflammation index (SII) and prognosis in patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SII was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SII; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. ResultsThe Spearman correlation analysis showed that SII was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P＜0.001). The ROC curve showed that the optimal cut-off value of SII before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SII (SII ≤758.92) group with 126 patients and high SII (SII ＞758.92) group with 116 patients. The low SII group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 6610%, respectively, and the high SII group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SII group had a cumulative survival rate of ＞50% and a mean survival time of 55.584 months (95% confidence interval［CI］: 53550-57.617), while the high SII group had a cumulative survival rate of ＜50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SII group had a significantly better survival rate than the high SII group, and there was a significant difference in overall survival rate between the two groups (χ2=46.979, P＜005). The univariate analysis showed that SII ＞758.92 (hazard ratio ［HR］=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SII (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. ConclusionPreoperative SII level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SII before surgery, the worse the prognosis of patients.

Objective:To study the coagulation characteristics of adult patients with extensively severe burn in shock stage and its alarming value.Methods:Retrospective cohort study was performed on medical records of 37 adult patients with extensively severe burn who were admitted to the First Affiliated Hospital of Naval Medical University from January 2014 to December 2019 and met the inclusion criteria. The patients were divided into survival group ( n=23, 17 males and 6 females, aged 41 (31, 51) years) and death group ( n=14, 11 males and 3 females, aged 50 (43, 58) years) according to the prognosis of within 60 d after burn. Basic data of patients in the two groups and their routine coagulation indexes during shock period including prothrombin time (PT), thrombin time, activated partial thromboplastin time (APTT), D-Dimer, fibrinogen degradation product (FDP), fibrinogen, platelet, and international normalized ratio (INR) were recorded. Data were statistically analyzed with Wilcoxon rank sum test and Fisher′s exact probability test, prognosis-related factors was analyzed with single factor and multivariate logistic regression analysis (α selected=0.05, α excluded=0.1), and receiver operating characteristic (ROC) curve analysis were established to screen out the risk factors. All the patients were grouped into high score group and low score group according to the optimal threshold value, Kaplan-Meier method was used for survival analysis and Log-rank test was performed between the two groups. Results:Total burn surface area (TBSA) of patients in death group was obviously larger than that in survival group ( Z=2.980, P<0.01), while there were no statistically significant difference in the other indexes between the two groups ( P>0.05). Compared with those in survival group (16.10 (14.30, 16.90) s, 40.80 (36.20, 42.80) s, 1.30 (1.10, 1.40)), PT (18.70 (16.30, 22.70) s), APTT (46.45 (41.00, 57.10) s) and INR (1.55 (1.30, 1.96)) of patients in death group were significantly increased ( Z=2.540, 2.330, 2.300, P<0.05), there were no statistically significant difference in the other indexes between the two groups ( P>0.05). Single factor logistic regression analysis showed TBSA, PT, and APTT were factors related to death of adult patients with extensively severe burn within 60 d after burn (odds ratio (OR)=1.190, 1.214, 1.109, 95% confidence interval (CI)=1.053-1.346, 1.008-1.461, 1.012-1.215, P<0.05 or P<0.01). FDP and INR were potential factors related to death of adult patients with extensively severe burn within 60 d after burn (OR=1.040 and 4.559, 95% CI =0.998-1.083 and 0.918-22.641, P<0.1). Multivariate logistic stepwise regression was used to build models of APTT+ FDP+ TBSA and APTT+ FDP. Area under the curve (AUC) of APTT+ FDP+ TBSA model score was 0.944 (95% CI= 0.873-1.000), which was higher than AUC of APTT+ FDP model score (0.843, 95% CI=0.713-0.973) by ROC curve analysis. Optimal threshold value of APTT+ FDP+ TBSA model score was -0.879 4 with sensitivity of 100% (95% CI=100%-100%) and specificity of 87% (95% CI=74%-100%). Survival ratio of patients in high score group with optimal threshold value higher than -0.879 4 was significantly lower than that in low score group with optimal threshold value lower than -0.879 4, χ2=27.090, P<0.01. Conclusions:The coagulation state of adult patients with extensively severe burn in shock stage is characterized with procoagulant and hemostatic dysfunctions accompanied by enhanced fibrinolytic activity. The risk of death is significantly increased in adult patients with extensively severe burn with APTT+ FDP+ TBSA model score higher than -0.879 4.

Objective: To build risk prediction models for acute kidney injury (AKI) in severely burned patients, and to compare the prediction performance of machine learning method and logistic regression model. Methods: The clinical data of 157 severely burned patients in August 2nd Kunshan factory aluminum dust explosion accident conforming to the inclusion criteria were collected. Patients suffering AKI within 90 days after admission were enrolled in group AKI, while the others were enrolled in non-AKI group. Single factor analysis was used to choose independent factors associated with AKI, including sex, age, admission time, features of basic injuries, initial score on admission, treatment condition, and mortality on post injury days 30, 60, and 90. Data were processed with Mann-Whitney U test, chi-square test, and Fisher′s exact test. Variables with P<0.1 in single factor analysis and those with possible clinical significance were brought into the establishment of prediction model. Logistic regression and XGBoost machine learning algorithm were used to build the prediction model of AKI. The area under receiver operating characteristic curve (AUC) was calculated, and the sensitivity and specificity for optimal threshold value were also calculated for each model. Nonparametric resampling test was used to compare the significance of difference of AUC of the two models. Results: (1) Eighty-nine (56.7%) patients developed AKI within 90 days from admission. Compared with 68 patients in non-AKI group, 89 patients in group AKI were older (Z=-2.203, P<0.05), with larger total burn area and full-thickness burn area (Z=-5.200, -6.297, P<0.01), worse acute physical and chronic health evaluation (APACHE) Ⅱ score, abbreviated burn severity index score, and sequential organ failure assessment (SOFA) score on admission (Z=-7.485, -4.739, -4.590, P<0.01), higher occurrence rate of sepsis (χ²=33.087, P<0.01), higher rates of accepting tracheotomy, mechanical ventilation, and continuous renal replacement therapy (χ²=12.373, 17.201, 43.763, P<0.01), larger first excision area (Z=-2.191, P<0.05), and higher mortality on post injury days 30, 60, and 90 (χ²=7.483, 37.259, 45.533, P<0.01). There were no statistically significant differences in sex, open decompression, admission time, 24-hour fluid volume after admission, 48-hour fluid volume after admission, the first 24-hour urine volume, the second 24 hour urine volume, the first excision time, and inhalation injury (χ²=0.529, 3.318, Z=-1.746, -0.016, -1.199, -1.824, -0.625, -1.747, P>0.05). The rates of deep vein catheterization of patients in the two groups were both 100%. (2) There were twenty possible prediction variables for preliminary establishment of model according to the difference results of single factor analysis and clinical significance of variables. (3) The logistic regression prediction model had three variables: APACHE Ⅱ score [odds ratio (OR)=1.36, 95% confidence interval (CI)=1.20-1.53, P<0.001], sepsis (OR=2.63, 95% CI=0.90-7.66, P>0.05), and the first 24-hour urine volume (OR=0.71, 95% CI=0.50-1.01, P>0.05). The AUC of the logistic regression prediction model was 0.875 (95% CI=0.821-0.930), with the specificity and sensitivity of optimal threshold value 84.4% and 77.7%, respectively. (4) XGBoost machine learning model had seven main predictive variables: APACHE Ⅱ score, full-thickness burn area, 24-hour fluid volume after admission, sepsis, the first 24-hour urine volume, SOFA score, and 48-hour fluid volume after admission. The AUC of machine learning model was 0.920 (95% CI=0.879-0.962), higher than that of logistic regression model (P<0.001), with the specificity and sensitivity of optimal threshold value 89.7% and 82.0%, respectively. Conclusions Sepsis and fluid resuscitation are two important predictive variables that can be intervened for AKI in severely burned patients. Machine learning method has a better performance and can provide more accurate prediction for individuals than logistic regression prediction model, and therefore has good clinical application prospect.

Objective To investigate the clinical characteristics of posterior malleolar ankle fracture, and the selection of the surgical approach. Methods From January 2013 to September 2015, 83 cases of posterior malleolar fractures were retrospectively analyzed. Haraguchi typing was performed based on the three-dimensional CT. There were 54 cases with HaraguchiⅠtype, 16 cases with HaraguchiⅡtype, and 13 cases with HaraguchiⅢtype. The patients who were HaraguchiⅠand Haraguchi Ⅲtypes accepted the operation with posterolateral approach. The patients who were HaraguchiⅡtype and combined medial malleolus fracture accepted the operation with medial approach. The HaraguchiⅡpatients who were not combined medial malleolus fracture were used the medial paraachilles approach. Images of the ankle joint were filmed 2 weeks, 4 weeks, 12 weeks, 6 months and 12 months after the surgery. The healing time, complications and corresponding record outcome were determined by X-ray and clinical examination. At the last follow-up, ankle function and quality of life of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and SF-36. Results Eighty-three patients were follow-up for 6-24 (mean 15.4± 6.2) months. The fractures healed on X-ray. The average X-ray healing time was from 12 to 24 (mean 18.6±4.2) weeks. AOFAS score was 71 to 100 (mean 88.4±8.4) points. Sixty-seven cases were excellent, 14 cases were good, 2 cases were moderate, and good rate was 97.59%. SF-36 physiological score was 31.6-69.2 points(mean 48.4 ± 4.8 points);SF-36 psychological score 28.6-64.5 points(mean 45.8 ± 3.5 points). Chronic ankle pain was complained by one patient. He was diagnosed traumatic arthritis, oral non-steroidal drugs was used to relief his ankle pain. One patient wound infected, and healed after treatment. No instrument failure and fracture displacement were found. Conclusion According to fracture morphology and clinical features after posterior malleolar ankle fracture, different surgical approaches are selected, which will be satisfied with the outcome.

Objective To study the effect of blood coagulation function and nerve function of beraprost in the treatment of acute cerebral infarction.Methods 80 cases of acute cerebral infarction were randomly divided into 2 groups, 40 cases in the control group and 40 cases in the experiment group.The control group received routine treatment, the experiment group were treated with the same as the control group combined with beraprost.Changes of coagulation function and nerve function were compared pre-and post-treatment between two groups.Results Compared with pre-treatment, APTT, PT, Fib level, serum NGF level, Barthel score increased post-treatment of the two groups, D-D, serum NSE, S100b, NIHSS score decreased, compared with the control group, APTT, PT, Fib level, serum NGF level, Barthel score were higher in the experiment group, the total effective rate was higher than the control group, two D-D, serum NSE, S100β, NIHSS scores were lower than the control group, the differences were statistically significant (P<0.05).Conclusion Beraprost can reduce the high coagulation state in patients with acute cerebral infarction, improve the degree of neurological impairment, and has good clinical efficacy.

Objective To explore the early clinical efficacy of posteromedial approach for treatment of posterior bicondylar tibial plateau fractures.Methods From October 2010 to December 2013,data of 13 patients of posterior bicondylar tibial plateau fracture who were treated with plate and screw fixation through posteromedial approach were retrospectively analyzed.There were8 males and 5 females,in which 7 cases located in the left knee and 6 cases located in the right knee,with an average age of 41.5±6.6 years.An inverted L shaped posteromedial incision was made in the operation.If the fracture line was involving the posteromedial condyle,a locking anatomical plate or L shaped compression plate was used.A 3.5 mm T shaped plate was used to support the posterolateral condyle.Allogeneic bone was used to support the articular surface in the cases with obvious bone defect.Rasmussen score was used for radiological assessment,and HSS knee score was used for efficacy assessment 12 months postoperative.An anteroposterior view and lateral view of the knee were obtained 2,4,12 weeks,6 months and 12 months postoperation.The fracture healing time was judged by X-ray and clinical examinations,additionally,the complications and corresponding outcomes were also recorded.Results All 13 patients had obtained an average of 20.8±9.4 months follow-up (range,8-34 months),and all fractures were healed.The healing time in terms of X-ray was 12 to 24 weeks (mean,15.6±5.2 weeks).After surgery,the Rasmussen score was 1-18 points (mean 15.8 points).7 cases achieved excellent results,4 good,and 2 fair.The excellent and good rate was 84.6％.HSS knee score improved significantly from 38.2±7.8 points (range,26-48 points) to 85.2±7.8 points (range,56-92 points) 12 months postoperation,and the results was excellent in 9 cases,good in 2,fair in 1 and poor in 1,with total excellence and good result of 84.6％.The range of knee activity was 95°-130°.None of the skin and soft tissue complications such as infection,breakage of screw loosening occurred at the time of the latest follow-up,but two cases got chronic pain in the knee postoperation.In the follow-up period,a mild knee gap narrows had been observed in one patient and traumatic arthritis was diagnosed.The pain was partial relieved by oral non-steroidal drugs and intra-articular injection of Sodium Hyaluronate.The other one's pain was significantly relieved by oral non-steroidal drugs,and X ray film shows the knee joint gap has no obvious narrow.Conclusion Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures can obtain a satisfactory therapeutic effect.

Objective To study the effects of radical surgical treatment for early esophageal cancer, and to investigate the prevention and cure of their complications,cancer recurrence and metastasis.Methods Treatments of 240 patients with early esophageal cancer of Chinese PLA General Hospital from January 2005 to January 2009 were retrospectively analyzed.The patients were treated by left thoracotomy,thoracic or cervical mechanical anastomosis surgical methods of treatment.Their postoperative adverse reactions,complications and 1 -,3-,5-year survival rates were observed and analyzed.Results The surgical resection rate was 1 00.00%. Complications included postoperative pulmonary infection (1 2 patients,5.00%), cardiac arrhythmias (1 patient,0.42%),delayed gastric emptying (2 patients,0.83%),pleural hemorrhage (1 patient, 0.42%),recurrent laryngeal nerve injury (2 patients,0.83%)and anastomotic fistula (1 patient,0.42%). One-year,3-year and 5-year survival rates after surgery were 1 00.00% (240 /240),97.9% (235 /240)and 95.8% (230 /240)respectively.The main causes of postoperative death were tumor recurrence and metastasis. Conclusion Timely surgery for early esophageal cancer can bring in good effect and long-term outcome,with little complication,which can obtain a good forward curative effect.