Efforts to improve the survival rates of patients with severe hemorrhage are highly dependent on hemostatic materials to achieve rapid and timely hemostasis. Zeolites have demonstrated their superb procoagulant properties and been made into various forms of commercial hemostatic dressings, including zeolite granules, zeolite-cotton gauze, and zeolite-cotton balls. In this work, a zeolite-polyvinyl alcohol (PVA) composite sponge was fabricated without using any additional organic binders via an in situ hydrothermal synthesis method. This spongiform zeolite-based hemostatic material conforms well to irregular wound surfaces and provides sustained pressure on the entire surface, making it more applicable to hemostasis of wounds with irregular concave-convex surfaces compared with current zeolite hemostatic materials. In a rabbit model of lethal massive hemorrhage, the hemostasis time of the zeolite-PVA group (195 s) was significantly shorter than that of the reference cotton gauze group (307 s). And the blood loss in the zeolite-PVA group (13.0 g) was approximately half of that in the cotton gauze group (23.8 g). Consequently, the zeolite-PVA group achieved 100% survival rate in this severe hemorrhage model, while the survival rate in the cotton gauze group was only 75%. This new zeolite-based hemostatic material expands the practical usage of zeolite composite materials and provides a promising solution for massive hemorrhage control in pre-hospital trauma treatment.

Background The real-world clinical impact of mNGS on BALF in the respiratory intensive care unit (RICU) is not yet fully understood. Methods We investigated the clinical impact of mNGS on BALF samples obtained from 92 patients admitted to the RICU over a 2-year period. We utilized both mNGS and culture methods to evaluate the effectiveness of mNGS in diagnosing pulmonary infections. The clinical impact of mNGS were evaluated by the clinician committees. Results Among the 92 diagnosed patients, 78 cases (84.7%) were determined to have infectious diseases caused by pathogenic microorganisms, and the bacterial infections constituted the most prevalent diagnostic category. For mixed infection, the most common type was the Pneumocystis jironecii and cytomegalovirus co-infection. The mNGS results had a positive impact on the clinical management of 43 cases (46.7%). Moreover, 19 cases (44.2%) of positive clinical impacts were solely based on new diagnoses made possible by mNGS results. These new diagnoses were particularly helpful for identifying rare pathogens, which could not be detected by conventional diagnostic methods. Conclusions The BALF mNGS has a positive real-world impact in RICU. Clinician committee play a critical role in ensuring the appropriate use of mNGS.

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control traumatic bleeding. However, its prolonged use potentially leads to ischemia-reperfusion injury (IRI). Partial REBOA (pREBOA) can alleviate ischemic burden; however, its security and effectiveness prior to operative hemorrhage control remains unknown. Hence, we aimed to estimate the efficacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control (no aortic occlusion) (n=5), intervention with complete REBOA (cREBOA) (n=5), continuous pREBOA (C-pREBOA) (n=5), and sequential pREBOA (S-pREBOA) (n=5) groups. In the cREBOA and C-pREBOA groups, the balloon was inflated for 60 min. The hemodynamic and laboratory values were compared at various observation time points. Tissue samples immediately after animal euthanasia from the myocardium, liver, kidneys, and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group, the survival rate of the REBOA groups was prominently improved (all P<0.05). The total volume of blood loss was markedly lower in the cREBOA group (493.14±127.31 mL) compared with other groups (P<0.01). The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups (P<0.05). At 120 min, the S-pREBOA group showed higher alanine aminotransferase (P<0.05) but lower blood urea nitrogen compared with the cREBOA group (P<0.05).CONCLUSION:In this trauma model with liver injury, a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure, despite persistent hemorrhage. Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures, and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

Abstract BACKGROUND The presence of coagulopathy after bleeding negatively affects the hemostatic effects of gauze. In this study, we compared the hemostatic effects of bio-zeolite gauze (BZG) and QuickClot Combat Gauze (QCG) on massive hemorrhage complicated by coagulopathy. Methods In 30 rabbits, diluted coagulopathy was prepared by extraction of blood at a dose of 15 mL/kg body weight following infusion with saline three times the volume of blood loss. Then, simulated blast-induced pelvic injury was initiated to produce massive hemorrhage using a custom-made machine, as previously reported. The rabbits were then randomly allocated to three groups, namely A, B, and C, in which BZG, QCG, and ordinary gauze were used to prevent bleeding, respectively. The primary outcomes, including the immediate hemostasis rate, blood loss, and survival rate, were recorded at designated time points. Additionally, blood samples were taken for laboratory examinations, including conventional coagulation, thromboelastography, full blood count, blood biochemistry, and enzyme-linked immunosorbent assay. Results Animal models of diluted coagulopathy and major bleeding were successfully developed with decreased concentrations of coagulation factors XII and X. The overall effects of BZG were better than those of QCG and ordinary gauze, with a higher immediate hemostatic rate, less blood loss at 10 min and 30 min after gauze application, and higher red blood cell and platelet counts, higher maximum amplitude, lower R values, lower levels of creatinine, and lower levels of alanine aminotransferase at 30 min after gauze application. Furthermore, a higher survival rate was found in group A rabbits than in group B and group C rabbits at 90 min after gauze application. Conclusions BZG demonstrated better hemostatic performance than QCG and normal gauze for massive hemorrhage complicated by coagulopathy. BZG is a suitable hemostatic gauze for control of massive hemorrhage complicated by coagulopathy.

Background Despite improved supportive care, posttraumatic acute respiratory distress syndrome (ARDS) mortality has improved very little in recent years. Additionally, ARDS diagnosis is delayed or missed in many patients. We analyzed co-differentially expressed genes (co-DEGs) to explore the relationships between severe trauma and ARDS to reveal potential biomarkers and therapeutic targets for posttraumatic ARDS. Methods Two gene expression datasets (GSE64711 and GSE76293) were downloaded from the Gene Expression Omnibus. The GSE64711 dataset included a subset of 244 severely injured trauma patients and 21 healthy controls. GSE76293 specimens were collected from 12 patients with ARDS who were recruited from trauma intensive care units and 11 age- and sex-matched healthy volunteers. Trauma DEGs and ARDS DEGs were identified using the two datasets. Subsequently, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and protein–protein interaction network analyses were performed to elucidate the molecular functions of the DEGs. Then, hub genes of the co-DEGs were identified. Finally, to explore whether posttraumatic ARDS and septic ARDS are common targets, we included a third dataset (GSE100159) for corresponding verification. Results 90 genes were upregulated and 48 genes were downregulated in the two datasets and were therefore named co-DEGs. These co-DEGs were significantly involved in multiple inflammation-, immunity- and neutrophil activation-related biological processes. Ten co-upregulated hub genes (GAPDH, MMP8, HGF, MAPK14, LCN2, CD163, ENO1, CD44, ARG1 and GADD45A) and five co-downregulated hub genes (HERC5, IFIT2, IFIT3, RSAD2 and IFIT1) may be considered potential biomarkers and therapeutic targets for posttraumatic ARDS. Through the verification of the third dataset, posttraumatic ARDS may have its own unique targets worthy of further exploration. Conclusion This exploratory analysis supports a relationship between trauma and ARDS pathophysiology, specifically in relationship to the identified hub genes. These data may serve as potential biomarkers and therapeutic targets for posttraumatic ARDS.

氨甲环酸(tranexamic acid,TXA)作为一种抗纤溶药物,在20世纪60年代就已面世,然而随着对该药物的药理作用、临床应用和安全性方面的广泛研究,发现它在创伤患者的救治中起着越来越重要的作用,近年来关于TXA应用的相关研究呈指数级增长,但到目前为止TXA在出血中发挥的确切作用仍不是非常清楚,其在临床上的使用仍存在一些争议与不足.文章综述了近年来氨甲环酸在创伤救治中的应用进展.

Background Massive hemorrhage is the main cause of preventable death after trauma. This study aimed to establish prediction models for early diagnosis of massive hemorrhage in trauma. Methods Using the trauma database of Chinese PLA General Hospital, two logistic regression (LR) models were fit to predict the risk of massive hemorrhage in trauma. Sixty-two potential predictive variables, including clinical symptoms, vital signs, laboratory tests, and imaging results, were included in this study. Variable selection was done using the least absolute shrinkage and selection operator (LASSO) method. The first model was constructed based on LASSO feature selection results. The second model was constructed based on the first vital sign recordings of trauma patients after admission. Finally, a web calculator was developed for clinical use. Results A total of 2353 patients were included in this study. There were 377 (16.02%) patients with massive hemorrhage. The selected predictive variables were heart rate (OR: 1.01; 95% CI: 1.01–1.02; P <0.001), pulse pressure (OR: 0.99; 95% CI: 0.98–0.99; P = 0.004), base excess (OR: 0.90; 95% CI: 0.87–0.93; P <0.001), hemoglobin (OR: 0.95; 95% CI: 0.95–0.96; P <0.001), displaced pelvic fracture (OR: 2.13; 95% CI: 1.48–3.06; P <0.001), and a positive computed tomography scan or positive focused assessment with sonography for trauma (OR: 1.62; 95% CI: 1.21–2.18; P = 0.001). Model 1, which was developed based on LASSO feature selection results and LR, displayed excellent discrimination (AUC: 0.894; 95% CI: 0.875–0.912), good calibration ( P = 0.405), and clinical utility. In addition, the predictive power of model 1 was better than that of model 2 (AUC: 0.718; 95% CI: 0.679–0.757). Model 1 was deployed as a public web tool ( http://82.156.217.249:8080/ ). Conclusions Our study developed and validated prediction models to assist medical staff in the early diagnosis of massive hemorrhage in trauma. An open web calculator was developed to facilitate the practical application of the research results.

简要回顾了国内外心肺复技术、自动体外除颤科学技术发展历程,分析了心肺复苏与心脏除颤基本概念和主要理念,提出建立和发展我国心肺复苏医学较完整的思路.

Abstract Background: This study aimed to develop and to validate dynamic predictive models for trauma-associated severe hemorrhage based on vital signs to register early warning and dynamic prediction of severe hemorrhage in trauma patients.Methods: The MIMIC-IV cohort was collected retrospectively. The inclusion criteria were trauma patients aged ≥16 years with complete clinical data. Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation were extracted as predictive variables. Based on logistic regression, support vector machine, random forest, adaptive boosting, gated recurrent unit, and gated recurrent unit-d, predictive models for trauma-associated severe hemorrhage were developed and validated to dynamically predict whether severe hemorrhage will occur in trauma patients in the next 1 h/2 h/3 h. This study was based on the Trauma database of the General Hospital of the People's Liberation Army for external validation. The models were developed and validated using Python 3.8.5 software. SPSS.21 software was used for statistical analysis.Results: Of the 7522 trauma patients in the MIMIC-IV cohort, 283 (3.76%) had a severe hemorrhage. The area under the curve of the gated recurrent unit-d model was the best in the 1 h (0.946±0.029), 2 h (0.940±0.032), and 3 h groups (0.943±0.034), and there was no significant difference among the three groups. In the Trauma cohort, the area under the curve of the gated recurrent unit-d model also achieved the best performance in the 1 h (0.779±0.013), 2 h (0.780±0.008), and 3 h groups (0.778±0.009), and there was no significant difference among the three groups. When comparing the gated recurrent unit-d model with the traditional scoring systems, the gated recurrent unit-d model still has advantages. Moreover, we have developed a web-based predictive system to help clinicians use our models.Conclusions: This study developed and validated dynamic predictive models for trauma-associated severe hemorrhage based on vital signs to assist pre-hospital or in-hospital emergency personnel to make decisions, and the gated recurrent unit-d model performed best.Trial registration: The MIMIC-IV database was previously de-identified and reviewed by the institutional review board (IRB) of its host organization and determined to be exempted from subsequent IRB. We obtained the administrative permissions to use the database (Certification Number: 27959316) for our research, after completing the National Institutes of Health web-based training course: Protecting Human Research Participants. We were reviewed and approved by the Ethics Committee of Chinese PLA General Hospital to use the Trauma database. The ethical batch number is S2021-466-01. Moreover, the informed consent of subjects was waived by the Ethics Committee of Chinese PLA General Hospital.

Background Given the reported effects of nuclear paraspeckle assembly transcript 1 (NEAT1) on kidney injury, a study is worth formulating to investigate whether and how NEAT1 impacts podocytes.Materials and methods A mouse podocyte injury model was established using the adriamycin (ADR)-induced mouse podocyte cell line (MPC5). The target relationships between NEAT1 and microRNA (miR)-23b-3p and between miR-23b-3p and Bcl-2 interacting protein 3 like (BNIP3L) were verified by dual-luciferase reporter assay and RNA immunoprecipitation assay. After ADR-induced MPC5 cells were transfected with NEAT1 overexpression plasmid (oe-NEAT1) or shNEAT1, the viability and apoptosis of MPC5 cells were evaluated by Cell Counting Kit-8 (CCK-8) assay and flow cytometry, respectively. The expressions of MPC5, miR-23b-3p, BNIP3L and the factors related to podocyte injury, apoptosis and epithelial-mesenchymal transition were determined using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot.Results NEAT1 was high-expressed in ADR-induced cell model. After transfection with oe-NEAT1, the expression of NEAT1, the levels of marker (Desmin) and apoptosis were promoted, while the viability and the levels of podocyte injury markers (WT1, Nephrin) were inhibited in ADR-induced cells. However, shNEAT1 generated the effects opposite to oe-NEAT1. Besides, miR-23b-3p competitively bound to NEAT1 and targeted BNIP3L. MiR-23b-3p inhibitor reversed the effect of shNEAT1, while its effect could be further offset by shBNIP3L. Furthermore, miR-23b-3p inhibitor affected mouse podocyte injury through downregulating Bcl-2 and E-cadherin levels and upregulating Cleaved-caspase-3, Bax, N-cadherin, Vimentin and Snail levels, but shBNIP3L did oppositely.Conclusion NEAT1 promotes the podocyte injury via targeting miR-23b-3p/BNIP3L axis.

Objective: Hemostatic gauze application is an effective way to control major bleeding, which is the most common cause of death in trauma in both civilian and military settings. Coagulation derangement after acute exposure to high altitude might alter the effects of hemostatic gauzes. The present study aimed to observe the hemostatic effects of bio-zeolite gauze (BZG) and QuikClot Combat Gauze® (QCG) on major bleeding in rabbits acutely exposed to high altitude.Methods: Sixty rabbits were randomly and evenly divided into six groups. Animal models of simulated blast- and fragment-induced inguinal major bleeding were prepared in lower altitude and high-altitude areas, and BZG, QCG, and ordinary gauze without hemostatic material were used to control bleeding. The primary outcomes included immediate hemostasis rate, blood loss, and survival rate, while the secondary outcomes included hemodynamic parameters, laboratory examinations, and coagulation-relevant markers.Results: The overall effects of BZG and QCG were better than those of ordinary gauze, with a higher immediate hemostatic rate, less blood loss, and higher survival rate at 90 min after gauze application and higher red blood cell and platelet counts and lower creatinine level at 30 min after gauze application in lower altitude. The concentrations of coagulation factor XII and factor X in rabbits acutely exposed to high altitude were significantly lower than those in lower altitude. At high altitude, the hemostatic effects of BZG did not decrease significantly compared to those in the lower altitude, whereas those of ordinary gauze and QCG decreased significantly at high altitude compared to those in the lower altitude.Conclusions: Coagulation derangement after acute exposure to high altitude has negative effects on ordinary gauze and QCG but has no significant negative hemostatic effects on BZG.

OBJECTIVE To establish a stable fragment-induced penetrating liver injury model in landrace pigs and evaluate the characteristics of deep tissue injury. METHODS According to the different positioning methods of aiming points, twelve healthy adult landrace pigs were divided into group A (the relative height "h" of the aiming point and the highest point of the body surface on the tracing line was set to 5 cm) and group B ("h" was set to 6 cm). Ultrasonography was used to determine the direction of fragment projection, and an experimental ballistic gun was used to project high-velocity fragments to cause injury to animals. The vital signs of the two groups were monitored, and whole blood cell count, blood gas analysis, and liver and renal function were tested. Damages to the liver and adjacent organs, as well as the amount of bleeding and survival time were analyzed. RESULTS For the overall analysis of the two groups, the liver hit rate of fragment simulating projectiles was 100% (right anterior lobe and right lateral lobe injury), the hit rate of other organs in the abdominal cavity was 25% (3/12), and the incidence of hemothorax or pneumothorax was 8% (1/12). The wounds were mainly characterized by liver lacerations, with total or partial disconnection of the distal liver lobe. There was no significant difference in wound length and bleeding amount between groups A and B [wound length (cm): 9.8±1.7 vs. 11.2±3.8, bleeding amount (g): 597.0±477.1 vs. 1 032.0±390.3, both P > 0.05]. The depth of liver parenchymal laceration in group B with the aiming point closer to the anterior median line was significantly longer than that in group A (cm: 2.8±0.4 vs. 1.9±0.6, P = 0.015). Mean arterial pressure (MAP), pH value, residual arterial blood base (BE), hemoglobin (Hb) and hematocrit (HCT) levels decreased after the fragment-induced injury, and then reached a trough level [MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 87.0±33.6, pH: 7.26±0.15, BE (mmol/L): -6.65±8.48, Hb (g/L): 9.86±1.10, HCT: 0.309±0.029, all P < 0.05] in the first hour. Blood lactate (Lac), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels increased over time, and reached a peak level [Lac (mmol/L): 10.21±4.40, LDH (U/L): 1 417.0±223.3, AST (U/L): 234.5 (162.5, 357.5), both P < 0.05] at 1 hour after injury. Pearson's correlation analysis showed that the total amount of bleeding was correlated with the depth of liver parenchyma laceration (r = 0.684,P = 0.014). The Kaplan-Meier survival curve showed that the 3 hours survival rate in group A was higher than that in group B, but the difference was not statistically significant [83.3% (5/6) vs. 33.3% (2/6), P > 0.05]. CONCLUSIONS The high-velocity fragment-induced penetrating liver injury model established by striking landrace pigs closer to the anterior median line with fragment simulating projectiles is reproducible and the degree of damage is controllable, and the model is applicable to further relevant research of hepatic ballistic trauma.

Objectives . Early warning prediction of massive hemorrhages can greatly reduce mortality in trauma patients. This study aimed to develop and validate dynamic prediction models for massive hemorrhage in trauma patients. Methods . Based on vital signs (e.g., heart rate, respiratory rate, pulse pressure, and peripheral oxygen saturation) time-series data and the gated recurrent unit algorithm, we characterized a group of models to flexibly and dynamically predict the occurrence of massive hemorrhages in the subsequent T hours (where T  = 1, 2, and 3). Models were evaluated in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F 1 score, and the area under the curve (AUC). Results . Results show that of the 2205 trauma patients selected for model development, a total of 265 (12.02%) had a massive hemorrhage. The AUCs of the model in the 1-h-group, 2-h-group, and 3-h-group were 0.763 (95% CI: 0.708–0.820), 0.775 (95% CI: 0.728–0.823), and 0.756 (95% CI: 0.715–0.797), respectively. Finally, the models were used in a web calculator and information system for the hospital emergency department. Conclusions . This study developed and validated a group of dynamic prediction models based on vital sign time-series data and a deep-learning algorithm to assist medical staff in the early diagnosis and dynamic prediction of a future massive hemorrhage in trauma.

BackgroundHigh-quality real war trauma data are important, but they are still lacking. Using the database to realize the networked, systematic, standardized, and dynamic management of war injury animal experimental data can provide a real and reliable supplement for the research of war injury treatment.MethodsThrough demand analysis, module design, architecture design, compilation and debugging, and other processes, JAVA language development tools were used to develop a time-effect assessment database for experiments on war-traumatized animals, where the browser/server architecture (B/S architecture) is used as the technical architecture and SQL Server as the database management system.ResultsA time-effect assessment database for experiments on war-traumatized animals that features reasonable structural design, rich data resources, and convenient use has been established, in which case efficient collection, storage, display, retrieval, and management of animal experimental data have been achieved. At present, the database is running well and has good data quality.

A high proportion of critically ill patients with coronavirus disease 2019 (COVID-19) experience thrombosis, and there is a strong correlation between anticoagulant therapy and the COVID-19 survival rate, indicating that common COVID-19 and thrombosis targets have potential therapeutic value for severe COVID-19.Gene expression profiling data were downloaded from Gene Expression Omnibus (GEO), and common differentially expressed genes (co-DEGs) were identified. The potential biological functions of these co-DEGs were explored by functional enrichment analysis, and protein-protein interaction (PPI) networks were constructed to elucidate the molecular mechanisms of the co-DEGs. Finally, hub genes in the co-DEG network were identified, and correlation analysis was performed.We identified 8320 upregulated genes and 7651 downregulated genes from blood samples of COVID-19 patients and 368 upregulated genes and 240 downregulated genes from blood samples of thrombosis patients. The enriched cellular component terms were mainly related to cytosolic ribosomes and ribosomal subunits. The enriched molecular function terms were mainly related to structural constituents of ribosomes and electron transfer activity. Construction of the PPI network and identification of hub genes ultimately confirmed that RPS7, IGF1R, DICER1, ERH, MCTS1, and TNPO1 were jointly upregulated hub genes, and FLNA and PXN were jointly downregulated hub genes.The identification of novel potential biomarkers provides new options for treating COVID-19-related thrombosis and reducing the rate of severe COVID-19.

Early warning prediction of traumatic hemorrhagic shock (THS) can greatly reduce patient mortality and morbidity. We aimed to develop and validate models with different stepped feature sets to predict THS in advance. From the PLA General Hospital Emergency Rescue Database and Medical Information Mart for Intensive Care III, we identified 604 and 1,614 patients, respectively. Two popular machine learning algorithms (i.e., extreme gradient boosting [XGBoost] and logistic regression) were applied. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the models. By analyzing the feature importance based on XGBoost, we found that features in vital signs (VS), routine blood (RB), and blood gas analysis (BG) were the most relevant to THS (0.292, 0.249, and 0.225, respectively). Thus, the stepped relationships existing in them were revealed. Furthermore, the three stepped feature sets (i.e., VS, VS + RB, and VS + RB + sBG) were passed to the two machine learning algorithms to predict THS in the subsequent T hours (where T = 3, 2, 1, or 0.5), respectively. Results showed that the XGBoost model performance was significantly better than the logistic regression. The model using vital signs alone achieved good performance at the half-hour time window (AUROC = 0.935), and the performance was increased when laboratory results were added, especially when the time window was 1 h (AUROC = 0.950 and 0.968, respectively). These good-performing interpretable models demonstrated acceptable generalization ability in external validation, which could flexibly and rollingly predict THS T hours (where T = 0.5, 1) prior to clinical recognition. A prospective study is necessary to determine the clinical utility of the proposed THS prediction models.

OBJECTIVE:To develop a grading prediction model of traumatic hemorrhage volume based on deep learning and assist in predicting traumatic hemorrhage volume.METHODS:A retrospective observational study was conducted based on the experimental data of pig gunshot wounds in the time-effect assessment database for experiments on war-traumatized animals constructed by the General Hospital of the Chinese People's Liberation Army. The hemorrhage volume data of the study population were extracted, and the animals were divided into 0-300 mL, 301-600 mL, and > 600 mL groups according to the hemorrhage volume. Using vital signs indexes as the predictive variables and hemorrhage volume grading as the outcome variable, trauma hemorrhage volume grading prediction models were developed based on four traditional machine learning and ten deep learning methods. Using laboratory test indexes as predictive variables and hemorrhage volume grading as outcome variables, trauma hemorrhage volume grading prediction models were developed based on the above fourteen methods. The effect of the two groups of models was evaluated by accuracy and area under the receiver operator characteristic curve (AUC), and the optimal models in the two groups were mixed to obtain hybrid model 1. Feature selection was conducted according to the genetic algorithm, and hybrid model 2 was constructed according to the best feature combination. Finally, hybrid model 2 was deployed in the animal experiment database system.RESULTS:Ninety-six traumatic animals in the database were enrolled, including 27 pigs in the 0-300 mL group, 40 in the 301-600 mL group, and 29 in the > 600 mL group. Among the fourteen models based on vital signs indexes, fully convolutional network (FCN) model was the best [accuracy: 60.0%, AUC and 95% confidence interval (95%CI) was 0.699 (0.671-0.727)]. Among the fourteen models based on laboratory test indexes, recurrent neural network (RNN) model was the best [accuracy: 68.9%, AUC (95%CI) was 0.845 (0.829-0.860)]. After mixing the FCN and RNN models, the hybrid model 1, namely RNN-FCN model was obtained, and the performance of the model was improved [accuracy: 74.2%, AUC (95%CI) was 0.847 (0.833-0.862)]. Feature selection was carried out by genetic algorithm, and the hybrid model 2, namely RNN-FCN∗ model, was constructed according to the selected feature combination, which further improved the model performance [accuracy: 80.5%, AUC (95%CI) was 0.880 (0.868-0.893)]. The hybrid model 2 contained ten indexes, including mean arterial pressure (MAP), hematocrit (HCT), platelet count (PLT), lactic acid, arterial partial pressure of carbon dioxide (PaCO2), Total CO2, blood sodium, anion gap (AG), fibrinogen (FIB), international normalized ratio (INR). Finally, the RNN-FCN∗ model was deployed in the database system, which realized automatic, continuous, efficient, intelligent, and grading prediction of hemorrhage volume in traumatic animals.CONCLUSIONS:Based on deep learning, a grading prediction model of traumatic hemorrhage volume was developed and deployed in the information system to realize the intelligent grading prediction of traumatic animal hemorrhage volume.

Death from massive hemorrhage represents a global problem. It is a challenging task to design hemostatic materials with significant efficacy, good biocompatibility, reliable safety, and high stability. In this study, we demonstrate an effective bio-inorganic hybrid hemostat fabricated by stepwise procedures of on-site growth of zeolite gauze and immobilization of trypsin on the zeolite gauze. The as-synthesized hybrid hemostat catalyzes the transition of prothrombin-to-thrombin and exhibits excellent procoagulant performance in the both normal plasma and FX-deficient plasma. The hemostatic treatment of junctional femoral artery rupture in the porcine model confirms that this hybrid hemostat manifests itself with superior hemostatic performance over commercial hemostatic dressings, in terms of a reduced time to hemostasis and blood loss. The stability of the hybrid hemostat is validated through high temperature and violent shaking evaluation. This bio-inorganic hybrid hemostat displays high procoagulant activity, low cytotoxicity, and extended shelf life which may achieve the "Platinum Ten Minutes" rescue in battlefield and traffic accident medicine.

Airway obstruction is one of the crucial causes of death in trauma patients during the first aid. It is extremely challenging to accurately treat a great deal of casualties with airway obstruction in hospitals. The diagnosis of airway obstruction in an emergency mostly relies on the medical experience of physicians. In this paper, we propose the feature selection approach genetic algorithm-mean decrease impurity (GA-MDI) to effectively minimize the number of features as well as ensure the accuracy of prediction. Furthermore, we design a multi-modal neural network, called fully convolutional network with squeeze-and-excitation and multilayer perceptron (FCN-SE + MLP), to help physicians to predict the severity of airway obstruction. We validate the effectiveness of the proposed feature selection approach and multi-modal model on the emergency medical database from the Chinese General Hospital of the PLA. The experimental results show that GA-MDI outperforms the existing feature selection algorithms, while it is also validated that the model FCN-SE + MLP can effectively and accurately achieve the prediction of the severity of airway obstruction, which can assist clinicians in making treatment decisions for airway obstruction casualties.

目的 系统评价控温毯用于热射病降温的效果.方法 采用计算机检索The Cochrane Li-brary、Web of Science、PubM ed、Ovid、EMBASE、中国知网(CNKI)、维普资讯中文期刊服务平台(VIP)、万方医学网等数据库,搜集控温毯用于热射病患者降温治疗的随机对照试验,检索时限均从建库至2019年6月.由2名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险后采用RevM an5.3软件进行meta分析.结果 共纳入8篇随机对照试验,438例患者.控温毯降温组患者治疗30 min,1.0、1.5、2.0、3.0 h后体温下降幅度均明显高于常规方法降温组,差异均有统计学意义(均数差=0.47、0.67、1.09、0.58、0.45,95％可信区间:0.28～0.65、0.33～1.01、0.65～1.52、0.10～1.06、0.30～0.59,P=0.001、0.001、0.001、0.020、0.001);控温毯治疗组患者并发症发生率明显低于常规方法降温组,差异有统计学意义(风险比=0.31,950％可信区间:0.18～0.54,P=0.001).结论 联合应用控温毯对热射病患者进行降温治疗优于传统降温方法,有利于快速降温和降低并发症发生率.