Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective:To understand knowledge, belief, practice level of insulin injection and influencing factors of behavior of clinical nurses in tertiary general hospitals, so as to provide the basis for formulating targeted training programs for insulin injection.Methods:Using the convenient sampling method, a total of 169 clinical nurses in the adult ward of a tertiary general hospital were selected as the research objects in May 2020. The self-made basic information questionnaire and Insulin Injection Knowledge, Belief and Practice Questionnaire were used for investigation. Binary Logistic regression analysis was used to investigate the influencing factors of insulin injection behavior of clinical nurses.Results:Among 169 clinical nurses, the awareness rate of guidelines was 82.84% (140/169) , 95.86% (162/169) of nurses had patient education experience, the incidence rate of insulin injection needle stab injury was 14.79% (25/169) , and 90.53% (153/169) of nurses had the need to receive insulin injection system training. The total scores of knowledge, belief and practice dimensions of the Insulin Injection Knowledge, Belief and Practice Questionnaire for clinical nurses were respectively 60.00 (45.00, 70.00) , 50.00 (49.00, 50.00) and 85.00 (82.00, 85.00) , and the total score of the questionnaire was 189.00 (178.50, 200.50) . The results of binary Logistic regression analysis showed that knowing the guidelines, receiving insulin injection operation training and insulin injection needle stick experience were the influencing factors of insulin injection behavior ( P<0.05) . Conclusions:Clinical nurses in tertiary general hospitals have a high level of insulin injection beliefs and behaviors and there are still deficiencies in insulin injection knowledge. In the training work related to clinical insulin injection, attention should be paid to strengthening and maintaining the belief and behavior of standardized insulin injection, emphasizing the safety of insulin injection, and combining with the technical guidelines and specifications of insulin injection, improving the knowledge reserve and application ability of insulin injection of clinical nurses.

Objective: To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI). Methods: All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed. Results: Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05). Conclusions For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.

Objective: To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury. Methods: 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7). Results: Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly.

OBJECTIVE: To investigate the rapid and accurate method for the detection of dengue virus (DENV) by using nicking enzyme assisted strand-displacement amplification (SDA) combined with gold nanoparticles-based lateral flow strip. METHODS: Total RNA of the virus was extracted by using magnetic beads method and transcribed to cDNA for SDA detection system. Nicking enzyme-assisted method was used for detecting DENV, and agarose gel electrophoresis was used for analyzing the sensitivity of SDA amplification products. A gold nanoparticles-based lateral flow strip was developed based on the principle of nucleic acid base complementary pairing to design the test line and control line. The gold particles were prepared by using sodium citrate reduction method for gold nanoparticles-based lateral flow strip construction. RESULTS: The sensitivity of the SDA method was 10 fmol/L, and the sensitivity of gold nanoparticles-based lateral flow strip based on SDA method was also 10 fmol/L. In a linear range from 10 fmol/L to 10 fmol/L, the corresponding linear correlation coefficient () of DENV was 0.98. The specificity of nanoparticles-based lateral flow strip based on SDA for DENV detection was high, which was no crossing with other control groups. CONCLUSIONS A gold nanoparticles-based lateral flow strip based on SDA method for DENV detection has been established, which is convenient, fast, and the result is visible to naked eyes.
Dengue ; diagnosis ; Dengue Virus ; isolation & purification ; Gold ; Humans ; Metal Nanoparticles ; Reproducibility of Results ; Sensitivity and Specificity

A target molecule affinity-ultrafiltration liquid chromatography-electrospray ionization tandem mass spectrometric (LC-ESI-MSn) method was established for rapid screening acetylcholinesterase (AChE) inhibitors from total alkaloids of fibraurea recisa Pierre.A total of 12 potential inhibitors were screened from Fibraurea recisa Pierre.and 6 compounds were identified including palmatine,berberine,jatrorrhizine,palmatrubine,7,8-dihydro-8-hydroxyberberine and groenlandicine.The AChE inhibitory activity of these 6 compounds was validated in vitro.Palmatine showed the strongest inhibitory activity for AChE,which was stronger than that of donepezil hydrochloride,demonstrating the potential of palmatine as anti-Alzheimer's drug.This method is simple,rapid,and accurate for directly screening active ingredients which can inhibit AChE from complex extract of traditional Chinese medicines.

Objective: To explore prognostic factors of acute paraquat poisoning (APP) , analyze the correlation between base excess (BE) and plasma concentration of paraquat (C-PQ) and discuss BE level in evalua-tion of prognosis of acute paraquat poisoning patients. Methods: We retrospectively selected 84 APP patients who admitted to Emergency Intensive Care Unit (EICU) of our hospital from 2009.9.1 to 2015.8.31.Clinical data from 84 APP patients were analyzed. BE、C-PQ、time of gastric lavagesince ingestion、time of hemoperfusion since ingestion、severity index of paraquat poisoning (SIPP) 、white blood cell (WBC) 、percentage of neutrophils (N%) 、hemoglobin (HB) 、creatinine (Cr) 、alanine aminotransferase (ALT) 、aspartate aminotransferase (AST) 、partial pressure of oxygen (PaO₂) 、partial pressure of carbon dioxide (PaCO₂) and other laboratory parameters were measured. A total of 41 patients in non-survivors died during the 30 days after admission and 43 patients in survivors survived during the 30 days. The factors of prognosis in paraquat poisoining and the role of BE in evalu-ating prognosis was analyzed, as well as the correlation between BE and C-PQ. Results: 1.Logistic regression analyses showed BE、C-PQ、ALT、AST、Cr was of prognostic significance[odds ratio (OR) of BE: 0.511, 95%CI 0.267, 0.978; C-PQ:-=0.999, 95%CI 0.999, 1.000; both P<0.05] ; 2.The area under the receiver operating characteristic curve (ROC curve) of BE、C-PQ and prognosis were 0.775、0.927 respectively, BE≤-1.7 mmol/L was the best cut-off value, the sensitivity、specificity for predicting were 82.9%、62.8%, the evaluation value was lower to C-PQ>3 273.935 ng/ml (AUC 0.927, 78.0%、95.3%) ; 3.BE negative correlated with C-PQ[-1.100 (-4.100, -0.200) , -5.900(-8.650, -2.500) , both P<0.05]. (r=-0.4, P<0.01). Conclusion These results suggest that BE may be useful for the prediction of prognosis in PQ poisoning and BE negative correlated with C-PQ.

Objective To sum up the experience on diagnosis and treatment of blunt bronchial injuries .Methods From January 2002 to December 2009 ,18 patients with blunt broncheal injuries were admitted .The definitive diagnosis was confirmed by fibro-bronchoscopy .Twelve patients suffered from main bronchial injuries and the remaining 6 patients from lobe bronchial injuries .All patients managed with surgical therapies .Emergent operation was performed in 15 patients and elective operation in 3 patients .End to end bronchial anastomosis was performed in 15 patients and primary repair in 3 patients .Results There was no death in this group .One patient after emergent primary repair developed ischic necrosis in the repair site on 3 the postoperative day and under-went resection of the necrotic tissue followed by end to end anastomsis .Thirteen patients had no complications and were able to take part in normal activities .Anastomotic stricture occurred in 5 patients and managed with granulation tissue resection and cryothera-py .Four patients were healed but one patient underwent lobectomy 6 months later as a result of recurrent stricture and severe dysp-nea .Conclusion Fibrobronchoscopy is able to define the blunt bronchial injuries immediately .Early surgery after trauma can im-prove the successful rate of treatment .

Objective To investigate the standards for management of traumatic intrapulmonary hematoma and hematocele.Methods A retrospective study was conducted on the data of 21 patients with traumatic pulmonary hematoma or hematocele (AIS≥4 points) treated at Chongqing Emergency Medical Center from August 1999 to August 2010.Results The overall mortality was 14％ (3/21)and death causes were respiratory passage hemorrhea and asphyxia.About 67％ of patients ( 14/21 ) were associated with hemoptysis,which lasted for 1-240 days (mean,15.8 days).The duration of hemoptysis due to traumatic intrapulmonary hematoma hematocele was about 3.4 times longer than that due to simple traumatic pneumatocele.The hematoma or cyst disappeared at average 61.6 days,with 3.4 times longer than the disappearance time of intrapulmonary hematoma or hematocele in comparison with that of simple pneumatocele.The size and position of traumatic pulmonary hematoma or pneumatocele influenced the treatment methods,outcomes and prognosis.Conclusions Standardized treatment for traumatic pulmonary hematoma or hematocele is key to improving the cure rate.Early emergency definitive surgery is required for patients with traumatic intrapulmonary hematoma or hematocele greater than 6.0 cm in diameter and for those with pneumatocele greater than 6.0 cm in diameter combined with incapability of keeping breathing due to severe air leakage.

Objective To investigate the role of ISS and new injury severity score (NISS) in evaluation of complications and treatment outcomes in the multiple trauma patients combined with severe chest trauma.Methods AIS-2005 was used to carry out retrospective analysis of the 1 377 multiple trauma patients combined with severe chest trauma (thoracic AIS≥3 points) treated at Chongqing Emergency Medical Center from January 2005 to January 2011.In the meantime,the related NISS and ISS were calculated and their relations with mortality were analyzed.Results The overall healing,mortality and complication rate were 93.2％,6.8％ and 28.5％ respectively.Both the ISSN and ISS had positive correlation with morbidity of complications ( r =0.569,P ＜0.01 ;r =0.442,P ＜0.01 ) and mortality (r =0.693,P ＜ 0.01 ; r =0.774,P ＜ 0.01 ),but a stronger relevance was demonstrated between NISS and morbidity of complications and between ISS and mortality rate.NISS showed a higher sensitivity but less specificity than ISS in prediction of morbidity of complications (P ＜ 0.01 ),and NISS was not superior to ISS in prediction of mortality ( P ＞ 0.05 ).Conclusions Both NISS and ISS work well in evaluating the complications and treatment outcomes in multiple trauma patients combined with severe chest trauma.Thus,NISS should be applied for prediction of complication occurrence and ISS for treatment outcomes to maximize the prediction accuracy.