Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To evaluate three-stage induced membrane technique combined with anterior and posterior double-plate fixation in the treatment of a total talus defect after infection.Methods:Included in this study were 11 patients with talus infection who had been treated at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2014 to December 2018. They were 8 males and 3 females, aged from 23 to 63 years (mean, 37.0 years). The infection followed re-implantation after open dislocation of total talus in 4 cases, internal fixation for open talus fracture of Gustilo type Ⅲa in 3 cases and surgery of open ankle fracture of Gustilo type Ⅲc in 2 cases, and was complicated with ankle intraarticular tuberculosis in 2 cases. The three-stage operations consisted of debridement, total talus resection, implantation of antibiotic bone cement and vacuum sealing drainage at the first stage, change of bone cement, re-debridement, wound closure or flap covering at the second stage 7 to 10 days later, and reconstruction after infection control using anterior and posterior double-plate fixation and induced membrane technique at the third stage 6 to 12 weeks later. Assessment of lower limb shortening was performed by comparing the full length of the leg between the normal and affected sides; the functions were assessed by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) between preoperation and the final follow-up.Results:The 11 patients were followed up for an average of 24.3 months (from 12.2 to 37.5 months). Superficial skin necrosis was observed in 2 patients and injury to superficial peroneal nerve in one. Absolute calcification of the autograft area was observed in all patients, leading to ankle fusion. The final follow-ups observed no significant difference in the full length of the leg between the normal and affected sides [(380.4±35.5) mm versus (376.3±32.8) mm] ( P>0.05) , a significant increase in the ankle-hindfoot AOFAS scores from preoperative 28.0±3.4 to 72.8±5.4, and a significant decrease in VAS scores from preoperative 5(5,6) to 0(0,1) (all P<0.05). Slight varus developed in 2 patients and slight ankle stiffness in 3; recurrence of infection or breakage of implants was found in none of the patients. Conclusion:Three-stage induced membrane technique combined with anterior and posterior double-plate fixation can effectively control infection of the talus, maintain the length and reconstruct the function of the lower limb after a total talus defect.

Objective To investigate the effect of hypertension on white matter microstructure and its correlation with cognitive function using automated fiber-tract quantification.Methods Consecutive subjects visited Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between January 2017 and July 2018 were collected.They were divided into hypertension without cognitive impairment (HTN-nonCI) group (n =44),hypertension with cognitive impairment (HTN-CI) group (n =50),and control group (n =25).The imaging data and neuropsychological scale test results of the subjects were collected.The automated fiber-tract quantification was used to obtain the diffusion parameters of 100 nodes on 20 fiber tracts in the whole brain.The differential segments of each fiber tract diffusion parameter between the control group and HTN-nonCI group,and the HTN-nonCI group and HTN-CI group were compared.Correlation analysis was performed in white matter fiber tracts with significant differences and each cognitive domain between the HTN-nonCI group and the HTN-CI group.Results The fractional anisotropy (FA) of white matter fiber tracts in 3 groups showed a decreasing trend,and the mean diffusion diffusivity (MD) showed an increasing trend.The comparison between the control group and the HTN-nonCI group showed that there were significant differences in the FA values of the midpoint of left thalamic radiation tract partial to brainstem,the genus of corpus callosum near brainstem,and frontal part and and proximal ventricle of splenium of corpus callosum (all P＜0.05);there were significant differences in the MD values of the middle part of left thalamic radiation tract and near the brainstem,the right thalamic radiation tract near the brainstem,the top of left corticospinal tract and near brainstem,the middle hippocampus of right cingulate tract,the middle part of genu of corpus callosum,the splenium of the corpus callosum near the lateral ventricle,the left uncinate tract near the forehead (all P ＜ 0.05).A comparison between the HTN-nonCI group and the HTN-CI group showed that there was significant difference in the FA value between the distributed segments of cingulate gyrus of left cingulate tract and the left inferior fronto-occipital tract near the occipital lobe,in which cingnlate gyrus of left cingulate tract was significantly correlated with the Montreal Cognitive Assessment Scale score (standardized3 =0.268,P =0.029);there were significant differences in the right thalamic radiation tract near the brainstem,the forehead and proximal ventricle of splenium of the corpus callosum,and the scattered distribution segments of the right inferior longitudinal fasciculus,in which the right inferior longitudinal fasciculus was significantly correlated with memory (standardizedβ=-0.243,P=0.047) and executive function (standardizedβ=-0.284,P=0.021).Conclusions Microstructural integrity of white matter was generally destroyed in patients with hypertension,but some segments were more susceptible to hypertension.The integrity of cingnlate gyrus of cingulate tract was significantly correlated with the overall cognitive function.The integrity of inferior iongitudinal fasciculus was significantly correlated with the executive function and memory.

Objective To explore the association between white matter hyperintensities volume and cognitive function in patients with hypertension.Methods Eighty-two patients with hypertension enrolled from the Department of Neurology of Nanjing Drum Tower Hospital from January 2017 to December 2017 were recruited in this study sequentially,who aged between 50 and 80 years.All subjects used automatic white matter quantitative technique to get their personal whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume.Neuropsychological scales were used to evaluate their global cognitive function,memory function,fluency,executive function and processing speed.The association between white matter hyperintensities volume and cognitive function via linear regression analysis was assessed.To explore whether the association between white matter hyperintensities volume and cognitive function be affected by the duration of hypertension,stratification analyses were conducted using the median of the duration of hypertension as separation.Results After adjusting for age,sex,education,lacunar infarctions and global cortical atrophy grade,the Trail Marking Test (2-1) score which reflects executive function was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.268,P=0.019),periventricular white matter hyperintensities volume (standardized beta-value=0.243,P=0.037) and deep white matter hyperintensities volume (standardized beta-value=0.243,P=0.021).Victorial Snoop Test-2 score which reflects processing speed was found to be related to periventricular white matter hyperintensities volume (standardized beta-value=0.270,P=0.023).After additional adjusting for the duration of hypertension,the Trail Marking Test (2-1) score was still found to be related to whole white matter hyperintensities volume (standardized beta-value=0.277,P=0.016),periventricular white matter hyperintensities volume (standardized beta-value=0.251,P=0.032) and deep white matter hyperintensities volume (standardized beta-value=0.248,P=0.019).The Victorial Stroop Test-2 score was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.237,P=0.041) and periventricular white matter hyperintensities volume (standardized beta-value=0.290,P=0.013).Conclusion Whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume are related to executive function,periventricular white matter hyperintensities volume is also related to processing speed in patients with hypertension,and the association between white matter hyperintensities volume and cognitive domain is not influenced by the duration of hypertension.

Objective To investigate the correlation between white matter lesions (WMLs) score and volume and cerebral microbleeds (CMBs) in patients with cerebral small vessel disease (CSVD).Methods Patients with non-acute lacunar infarction from the CSVD Follow-up Cohort Study in the Affiliated Drum Tower Hospital of Nanjing University from January 2017 to December 2017 were enrolled.The relevant clinical data were collected and 3.0 T cranial MRI examinations were performed,including T1-weighted imaging,T2-weighted imaging,fluid attenuated inversion recovery (FLAIR) sequence,susceptibility-weighted imaging,and diffusion-weighted imaging.W2MHS software was used to quantify the volume of WMLs.Fazekas method was used to score periventricular and deep WMLs separately.The number of CMBs was counted visually.Multivariate logistic regression analysis was used to determine the independent influencing factors of CMBs.Multivariate linear regression equation (stepwise method) was used to analyze the independent influencing factors of the number of CMBs.Medcalc 18.6 was used to deseribe receiver operating characteristic (ROC) curve.The predictive value of WMLs Fazekas scores and volumes for CMBs was evaluated.Results A total of 82 patients were enrolled,including 31 (37.8％) in CMBs group and 51 (62.2％) in non-CMBs group.The comparison between the two groups showed that smoking,use of antiplatelet agents,history of transient ischemic attack (TIA) or lacunar infarction,larger WMLs volume,higher levels of triacylglycerol,and lower levels of high-density lipoprotein cholesterol might be the risk factors for CMBs.Multivariate logistic regression analysis showed that higher Fazekas score (odds ratio 1.908,95％ confidence interval 1.210-3.009;P=0.005) and larger WMLs volume (odds ratio 4.620,95％ confidence interval 1.279-16.683;P =0.019) were the independent risk factors for CMBs.Multiple linear regression analysis showed that Fazekas score (r =0.379,P =0.001) and WMLs volume (r =0.260,P =0.023) were independently and positively correlated with the number of CMBs.The ROC curve analysis showed that the area under the curve of Fazekas scores predicting CMBs was 0.768 (95％ confidence interval 0.654-0.881).The optimal cut-off value was 3,the sensitivity was 61.29％,and the specificity was 90.20％.The area under the curve of WMLs volume predicting CMBs was 0.783 (95％ confidence interval 0.677-0.867).The optimal cut-off value was the volume of WMLs reaching 2 137.96 mm3.The sensitivity was 73.33％,and the specificity was 84.00％.Conclusion WMLs and CMBs had significant correlation in patients with CSVD.The WMLs Fazekas score and volume quantification are expected to serve as the alternative indicators for the urgent assessment of CMBs.

Objective To investigate the correlation between total MRI cerebral small vessel disease (SVD) score and overall cognitive functions and different cognitive domains.Methods Form January 2017 to June 2018,subjects aged 45-80 years and without dementia were recruited from the Neurology clinic,wards,Nanjing Drum Tower Hospital,the Affdiated Hospital of Nanjing University Medical School and communities.The overall cognitive function,executive function,processing speed,working memory,language function,visual-spatial ability,and depression were assessed with the related scale in all subjects.3.0 T MRI (T1-weighted imaging,T2-weighted imaging,diffusion-weighted imaging,liquid-attenuated inversion recovery sequence,and susceptibility-weighted imaging) was used to identify white matter hyperintensities,lacunar foci,microbleeds,and enlargement of perivascular space.The total SVD score was calculated.Results A total of 217 subjects were enrolled,including 24 normal middle-aged and elderly,65 at risk of cerebrovascular disease,128 with SVD changes in imaging findings.Multivariate linear regression analysis showed that after adjusting for possible confounding factors,the total SVD score and overall cognitive function (β =-0.105,95％ confidence interval [CI]-0.201--0.010;P =0.030),executive function (β =-0.135,95 ％ C!-0.216--0.054;P =0.001),and language function (β =-0.095,95％ CI-0.182--0.008;P =0.032) showed a significantly independent negative correlation.Conclusion The total SVD score was negatively correlated with the overall cognitive function,executive function,and impairment of language function.

Hypertension has become one of the most common chronic diseases that endanger the physical and mental health of elderly populations.The relationship between hypertension and cognitive impairment has become a hot research topic in recent years.Not only does systolic pressure,diastolic pressure and pulse pressure affect cognitive function,but also blood pressure fluctuation and related genetic factors can lead to cognitive decline.However,the relationship between hypertension and cognitive impairment,the related mechanisms,and whether antihypertensive therapy can delay the progression of cognitive impairment are not fully understood.This article reviews the above problems in order to provide a reference for the prevention of cognitive impairment in patients with hypertension.

Objective To observe the therapeutic efficacy and action mechanism of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain. Method Eighty patients were randomized into a muscle-region alignment needling group and a conventional acupuncture group. The Short-form McGill Pain Questionnaire (SF-MPQ), and serum levels of IL-6, TNF-?, and NO were majorly observed before and after the treatment. Result The muscle-region alignment electroacupuncture and conventional acupuncture both obviously reduced the SF-MPQ score and down-regulated the serum levels of IL-6, TNF-?, and NO, and the decreases by the muscle-region alignment electroacupuncture were more significant than that by the conventional acupuncture. Conclusion The action of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain is plausibly by down-regulating serum levels of IL-6, TNF-?, and NO, reducing or inhibiting the production of inflammatory factors and restraining inflammation.

Objective To evaluate the effect of MRI in reflecting the pathological changes of VX2 carcinoma in rabbits after radiofrequency ablation (RFA) . Methods RFA was performed in the livers of 24 rabbits with planted VX2 carcinoma. The rabbits were divided into 4 groups. After RFA, the rabbits were killed after MR imaging on 0, 1, 2, and 4 weeks, respectively. The correlation between MRI and pathological findings was analyzed. Results In the acute phase, coagulative necrosis of the ablated tumors and inflammatory reaction with hyperemia around were detected at microscopic examination. The ablated tumor showed as hypointensity on T1WI and hyperintensity on T2WI, while rim of high signal intensity on T1WI and low signal intensity on T2WI was found. Gadolinium-enhanced MRI showed a thin high signal rim surrounding the central coagulative necrosis. In the subacute phase, extensive coagulative necrosis and marked infiltration by neutrophils, lymphocytes, macrophages and a peripheral fibrous generation rim were observed microscopically on the ablated tumor. The ablated tumor showed iso-or hyperintensity on T1WI and hypointensity on T2WI, while the periphery of ablated lesions was hypointensity on T1WI and hyperintensity on T2WI. There was prominent rim enhancement along the ablated margin. In the chronic phase, peripheral fibrous rim became obvious, more regular and thicker than at subacute phase as hypointensity on T1WI and T2WI, and unenhancement was observed. Residual or recurrence of tumor was found in 17 rabbits as hypointensity on T1WI and hyperintensity on T2WI, and irregular, thicker rim or nodular enhancing abnormalities. Conclusion MRI can effectively show the histopathological tissue changes of rabbit VX2 carcinoma after ablation and demonstrate the residual or recurrence of tumor.

Objective:To study the long-term inhibitory effect of external stent on atherosclerosis of autologous vein graft in hypercholesterolemic rabbit and the possible mechanism.Methods:Hypercholesterolemic model was established in 15 rabbits and their bilateral jugular veins were anastomosed with bilateral carotid arteries.One jugular vein graft was stented with a polytetrafluoroethylene tube(external stent group)and the other receiving no stenting served as control(unstent group).Ultrasound was used to evaluate the haemodynamics 12 weeks after operation.The grafts were harvested to examine the thickness and area of intima and media,the deposition of lipid in the vessel wall,and the distribution of VCAM-1 positive cells.Scanning electron microscope(SEM)was used to evaluate the regeneration of endothelium.Results:Ultrasound results showed that the stent group was laminar blood flow and the control group had vortex flow.The thickness and areas of intima and media were significantly lower in the stent group than in the control group(P