Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

目的 总结手术治疗混合型完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)的经验.方法 2006～ 2018年,我院共完成51例混合型TAVPC患者(排除合并单心室、法洛四联症等患者)的外科治疗,其中男35例、女16例,中位年龄102.0 (59.0,181.0)d,中位体重5.0 (4.1,6.4)kg.根据解剖形态将患者分为3类:“3+1”型(38例,3支肺静脉回流入同一个部位,而另一支肺静脉回流另一侧部位);“2+2”型(9例,两侧的肺静脉分别回流入不同的位置);怪异型(4例,无法归入以上两类的怪异解剖类型).结果 无患者院内死亡,中位随访时间41.0 (18.0,86.5)个月.术后发生肺静脉梗阻10例.Kaplan-Meier生存曲线示3种类型术后肺静脉梗阻率差异无统计学意义(P=0.239).Cox分析发现术前肺静脉梗阻与术后肺静脉梗阻明显相关(P=0.024).结论 混合型TAPVC解剖形态多变,需要个体化手术方法.

目的 比较无内膜接触缝合(Sutureless)手术和传统手术纠治心下型完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)的效果.方法 回顾性分析2014年6月至2019年4月于我院行手术纠治的46例心下型TAVPC患者的临床资料,排除合并单心室、法洛四联症等患者.根据手术方式将患者分为传统手术组和Sutureless手术组.传统手术组35例,男28例(80.0％)、女7例(20.0％),中位年龄21(8,42)d,中位体重3.6 (3.0,4.0) kg.Sutureless手术组11例,男8例(72.7％)、女3例(27.3％),中位年龄14(6,22)d,中位体重3.5 (2.9,3.6) kg.比较两组手术疗效.结果 传统手术组死亡5例(10.9％),其中院内死亡4例(8.7％),晚期死亡1例(2.2％).传统手术组死亡率(14.3％,5/35)高于Sutureless手术组(0.0％,0/11),但差异无统计学意义(P-0.317).Cox回归模型分析发现性别(P=0.042)、年龄(P=0.028)、体外循环时间(P=0.007)、主动脉阻断时间(P=0.018)、气管插管时间(P=0.042)是术后死亡的危险因素.中位随访时间为18.00 (5.00,37.75)个月.术后发生肺静脉梗阻22例,均为传统手术组患者,两组差异有统计学意义(P=0.000).结论 对于心下型TAPVC,与传统手术相比,Sutureless手术可以降低术后肺静脉梗阻发生率.

目的 探讨外周血涂片检查在婴儿型庞贝病(IOPD)筛查和诊断中的价值.方法 回顾分析2013—2017年根据酶学和基因检测确诊的29例IOPD患儿的外周血涂片检查结果,并以同期诊断的12例非IOPD的肥厚型心肌病患儿的血涂片结果作为对照.结果 IOPD组血涂片中可见到大量含空泡的淋巴细胞,含空泡淋巴细胞中位百分比为36％(19％～67％);而对照组中几乎观察不到含空泡的淋巴细胞,含空泡淋巴细胞中位百分比为0％(0％～6.7％).IOPD组血涂片中可见到大量过碘酸雪夫氏(PAS)染色阳性的淋巴细胞,PAS染色阳性淋巴细胞的中位百分比为36％(19％～66％);而对照组患儿中几乎观察不到PAS染色阳性的淋巴细胞,PAS染色阳性淋巴细胞的中位百分比为0％(0％～6.0％).两组之间含空泡淋巴细胞以及PAS染色阳性淋巴细胞的百分率差异有统计学意义(P<0.01),且在散点图上的分布无重叠.结论 外周血涂片检查快速、简单、易行,通过观察和计算含空泡和PAS染色阳性的淋巴细胞百分率有助于IOPD的筛查和早期诊断.

脂肪酸是心肌最重要的能量来源,脂肪酸氧化代谢病(FAOD)可导致线粒体能量生成不足,同时可造成心肌细胞内脂质和长链酰基肉碱等中间代谢产物蓄积,从而导致心肌病变.FAOD主要包括肉碱依赖的脂肪酸转运障碍和线粒体内的脂肪酸β-氧化异常,缺陷可发生于脂肪酸氧化过程中的任何酶或转运蛋白.尽管FAOD是引起儿童心肌病的少见病因之一,但部分FAOD通过早期纠正脂肪酸代谢紊乱后,心肌病有望得到改善,生存质量可显著提高.

BACKGROUND: Endothelin-1, as a paracrine cytokine derived from endocardium and vascular endothelial cells, can promote the differentiation and maturation of cardiac conduction cells. OBJECTIVE:To explore the effect of endothelin-1 on P19 cells differentiating into cardiac conduction cells in vitro. METHODS: P19 cells were cultured with 1% dimethyl sulfoxide or 100 nmol/L endothelin-1. Afterwards, the changes of early cardiomyocyte transcription factors MEF2C and GATA4, differentiation markers MHC-α and cTnT, important conduction cell transcription factors Nkx2.5 and Tbx5, and differentiation markers Cx40 and ANP were identified by western blot assay, immunofluorescence and real-time PCR. Specific antagonists of endothelin-1 receptors, and blocking PI3K-AKT-mTOR signaling pathway on the differentiation of P19 cells induced by endothelin-1 were evaluated by real-time PCR. RESULTS AND CONCLUSION: Endothelin-1 significantly up-regulated the levels of early cardiac transcription factors, cardiomyocyte structure factors and characteristic conduction system markers. Compared with dimethyl sulfoxide, endothelin-1 was prone to enhance the differentiation of cardiac conduction cells derived from P19 cells. Up-regulation of Nkx2.5 and Cx40 by endothelin-1 was mainly attributed to the ETAsignaling pathway. ETBsignaling pathway may be also involved in a negative feedback regulation pathway. The PI3K-AKT-mTOR signaling pathway can play an important role in the differentiation from P19 cells to cardiac conduction cells triggered by endothelin-1.

Inborn errors of metabolism (IEMs)are a large group of rare genetic diseases that generally result from a defect in an enzyme or transport protein which results in a block in a metabolic pathway.In recent years,with the development of clinical molecular genetics,increasing evidence shows that IEMs are one of the important causes of car-diomyopathy in children.By precise intervention at an early stage and rectifying metabolic disorders for the cause,myo-cardial lesions are expected to be ameliorated and the quality of life may be significantly improved in some patients with IEMs.Therefore,it is of great importance to raise the awareness of metabolic cardiomyopathy in clinical practice.

[目的]探讨体位变化对高血压脑出血术后病人颅内压和脑灌注压的影响。[方法]2012年8月—2016年12月选择在我院诊治的高血压脑出血病人66例,根据随机数字表法分为观察组与对照组,所有病人都行开颅去大骨瓣减压手术,对照组给予传统手术体位干预,观察组给予抬高体位干预,记录颅内压和脑灌注压的变化情况。[结果]观察组开骨瓣时与清除血肿后的颅内压和脑灌注压均低于对照组（P＜0.05）,术后第14天观察组总有效率为97.0%,高于对照组（81.8%,P＜0.05）,且观察组卒中量表（NIHSS）评分为2.22分±0.84分,对照组NIHSS评分为4.11分±0.52分,均低于术前的7.30分±1.11分和7.33分±1.19分。[结论]术中抬高手术床头30°,有利于降低高血压脑出血术后病人颅内压和脑灌注压,从而提高预后疗效,促进神经功能恢复。

Objective To assess the long-term outcomes of different surgical procedures for tracheal stenosis with congenital heart defects in infants.Methods Retrospective review of our surgical experience with tracheal stenosis and congenital heart defects from August 2001 to April 2015 was conducted.86 patients were identified in our database,including 48 boys and 38 girls.At the time of operation,the mean age was (20.49 ± 18.06) months (range:2-102 months) and the mean weight was (10.22 ± 4.51) kg(range 3.5-36.5 kg).Among patients,35 had short-segmental tracheal stenosis and 51 had long-segmental tracheal stenosis.According to results of CT scan before operation,the average diameter of tracheal stenosis was (2.31 ±0.55) mm(rang:1-3 mm).All patients were performed tracheoplasty and corrective surgery of congenital heart defects under low temperature and cardiopulmonary bypass at the same time.Repaired with autologous tracheal were performed in 11 patients,resection and end-to-end anastomosis in 17 patients,and slide tracheoplasty in 58 patients.All patients were fol-lowed up regularly after operation and the tracheal diameter was surveyed by CT.Results There were 7 deaths and the mortality was 8.14％.2 patients died of heart failure and other 5 patients died of respiratory failure associated with the formation of granulation tissue postoperatively.58 patients were followed-up for 6-167 months and 21 cases lost follow-up,so the follow-up rate and the missing rate was 67.44％ and 24.42％ respectively.Recovery of 58 surviving patients was satisfactory and clinical symptoms of tracheal stenosis disappeared.The results of CT showed the average of tracheal diameter postoperatively was (4.80 ±0.95) mm(range 3-7 mm),which had great improvement in comparison with preoperative situation.Conclusion Surgical treatment is currently the best option for patients with combined tracheal stenosis and congenital heart defects.Resection and end-to-end anastomosis is mainly suitable for short-segmental tracheal stenosis,and for long-segmental tracheal stenosis,slide tracheoplasty is the mainstream method.Furthermore,slide tracheoplasty is available to treating bridging bronchus and bronchial stenosis.

Objective:To study the differentiation potential of Sca-1+cells from adult mouse heart in vitro.Methods:We isolate Sca-1+ cells derived from mouse heart by means of immunomagnetic cell sorting.By using three different kinds of differentiation inducing factors,including BMP-2/FGF-4,TGF-β1 and VEGF165 ,to induce Sca-1+ cells to differentiated into the heart"three lines"invitro.The differentiation potential of the cells was identified from the changes of cell morphology, RT-PCR and immunofluorescence staining.Results:After BMP-2/FGF-4 induction,the mouse cardiac Sca-1+cells underwent morphological changes,up regulation of the mRNA expression ofα-MHC,β-MHC,MLC-2a and MLC-2v,and the protein expression of cTNT and cMHC,which were the specific markers of cardiomyocytes.After TGF-β1 induction,these Sca-1+cells also had morphological changes,up regulation of mRNA expression ofα-SMA and Calponin,and the protein expression of SMA,sMHC,and Calponin,which were the specific markers of smooth muscle cells.After VEGF165 induction,the Sca-1+cells also underwent morphological changes,up regulation of endothelial cell specific gene CD31,vWF,and VE-Cadherin expression,and the expression of endothelial cell specific antigen CD3 1 .Conclusions:Adult mouse cardiac Sca-1+ cells can differentiate into cardiomyocyte-like cells,smooth muscle-like cells and endothelial-like cells under different inducing factors in vitro,which suggest these cells have multi-lineage differentiation potential as cardiac stem cells.

目的 通过对进展性脑挫伤患者的凝血指标进行动态检测,探讨在进展过程中关键凝血指标的变化.方法 对95例进展性脑挫伤患者进行临床资料分析,检测伤后24h～7d内格拉斯哥昏迷评分(GCS)、凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、纤维蛋白原含量(FIB)、D-二聚体浓度(D-dimer)、纤维蛋白降解产物(FDP)以及其变化趋势.分析其中与死亡率、格拉斯哥预后评分(GOS)相关的危险因素.结果 进展性脑挫伤各组患者中入院评分、D-二聚体及纤维蛋白原含量与死亡率、GOS评分相关.结论 凝血指标对进展性脑挫伤患者预后判断具有临床指导意义,入院评分越低,D-二聚体浓度越高,纤维蛋白原含量越高预后越差.其中以双额叶及颞叶部位进展性脑挫伤预后较差.

Objective To discuss the feasibility and efficiency of craniotomy through analyzing the effect of craniotomy in aged patients with severe craniocerebral trauma in Shanghai No.6 People's Hospital.Method According to the medical records,the data from 11 cases of patients with severe craniocerebral trauma,their average ages were beyond 70 years old,were sorted and analyzed.Within two days after the admission,all patients received the craniocerebral craniotomy,at the same time,they were given the decompression and suture treatment,and the tracheotomy.Results The analysis of the data from 11 patients who received craniotomy showed that the primary postoperative complications were lung infection and upper gastrointestinal hemorrhage,and 11 patients survived,suggesting that more attention should be paid to the relevant examination and prevention after the surgery.Conclusion For the aged patients with severe craniocerebral trauma,the craniocerebral craniotomy could be considered to be a choice for them,and according to the data and documents,the surgery has showed obviously curative effect and may prevent the secondary brain damage,suggesting that the surgery may be popularized in the clinical treatment.

Objective To explore the clinical significance of continuous intracranial pressure(ICP) monitoring in the treatment of hypertensive cerebral hemorrhage.Methods Clinical data of 120 patients with hypertensive cerebral hemorrhage were analyzed retrospectively.All the patients received intraventricular ICP monitoring and ICP was decreased in a stepwise approach.Results The patients were continuously monitored of ICP for 3 to 14 d with a mean period of 5.2 d.There was no intracranial hemorrhage caused by probe.The infection occurred in 3 patients who recovered after symptomatic treatment.The patients were evaluated by GOS 6 months after hemorrhage,65 patients(54.17%) achieved good recovery with mild disability,25(20.83%) suffered severe disability and vegetative state,and 30(25.00%) died.Conclusions Continuous ICP monitoring in hypertensive cerebral hemorrhage can effectively develop the measures for decreasing ICP,early find the change of patient's condition,reduce complications and improve prognosis.

Objective To investigate the necessity of routine repeat CT after traumatic brain injury.Methods One hundred and three patients with traumatic brain injury without emergency operations at admission were selected and randomly divided into routine repeat CT group(n=53) and non-routine repeat CT group(n=50).Age,gender,score of Glasgow coma scale(GCS) at admission,mechanism of injury,time between first CT scan and injury(HCT1),type and location of injury,volume of hematoma,blood coagulation function at admission,length of stay at intensive care unit(ICU),length of hospital stay,score of GCS at discharge and hospital charge were compared between groups.Related factors of progressive hemorrhage were investigated by Logistic regression analysis.Patients in routine-repeat CT group were subdivided into three groups according to GCS scores(3 to 8 points group,9 to 12 points group and 13 to 15 points group),and the necessity for routine repeat CT was evaluated.Results There were significant differences in score of GCS at discharge,length of stay at ICU and length of hospital stay between these two groups(P0.01).There was no significant difference in hospital charge between these two groups(P0.05).Logistic regression analysis indicated that age,fibrin degradation products(FDP),international normalized ratio(INR) and D-dimer concentration(DD) were risk factors for progressive hemorrhage(OR1,P0.05).Lower GCS score at admission,HCT1 and platelet count(PLT) were associated with a greater likelihood of developing progressive hemorrhage(OR1,P0.05).In routine repeat CT group,53 patients underwent 161 times of repeat CT,1(4%) of the 25 patients with mild traumatic brain injury(13 to 15 points group) developed progressive injury and changed the therapy,and 18(64.3%)of the 28 patients with moderate and severe traumatic brain injury(3 to 8 points group and 9 to 12 points group) changed the therapy.Conclusion Routine repeat CT has definite value in patients with moderate and severe traumatic brain injury.

Objective To investigate the necessity of routine repeat CT after traumatic brain injury. Methods One hundred and three patients with traumatic brain injury without emergency operations at admission were selected and randomly divided into routine repeat CT group (n = 53) and non-routine repeat CT group (re = 50). Age, gender, score of Glasgow coma scale (GCS) at admission, mechanism of injury 7, time between first CT scan and injury (HCT1), type and location of injury, volume of hematoma, blood coagulation function at admission, length of stay at intensive care unit (ICU), length of hospital stay, score of GCS at discharge and hospital charge were compared between groups. Related factors of progressive hemorrhage were investigated by Logistic regression analysis. Patients in routine-repeat CT group were subdivided into three groups according to GCS scores (3 to 8 points group, 9 to 12 points group and 13 to 15 points group), and the necessity for routine repeat CT was evaluated. Results There were significant differences in score of GCS at discharge, length of stay at ICU and length of hospital stay between these two groups (P < 0. 01). There was no significant difference in hospital charge between these two groups (P > 0. 05). Logistic regression analysis indicated that age, fibrin degradation products (FDP), international normalized ratio (INR) and D-dimer concentration (DD) were risk factors for progressive hemorrhage (OR > 1, P < 0. 05). Lower GCS score at admission, HCT1 and platelet count (PLT) were associated with a greater likelihood of developing progressive hemorrhage (OR < 1, P < 0. 05). In routine repeat CT group, 53 patients underwent 161 times of repeat CT, 1 (4%) of the 25 patients with mild traumatic brain injur;' (13 to 15 points group) developed progressive injur;' and changed the therapy, and 18 (64. 3%) of the 28 patients with moderate and severe traumatic brain injury (3 to 8 points group and 9 to 12 points group) changed the therapy. Conclusion Routine repeat CT has definite value in patients with moderate and severe traumatic brain injury.

Objective To develop and validate prognostic models for mortality within 30 d after traumatic brain injury and for 6-month unfavorable prognosis after traumatic brain injury.Methods The clinical data of 1 016 patients with moderate to severe traumatic brain injury were collected to develop prognostic models.The relationship between admission-related risk factors and prognosis was systematically analysed,different prognostic models were established with Logistic regression analysis,and the performance of these models was assessed with goodness-of-fit test and C statistic(area under the receiver operating characteristic curve).These models were internally and externally validated,the ultimate prognostic model was determined to serve as the tool of prognostic evaluation for patients with traumatic brain injury.Results Logistic regression analysis revealed that old age,loss of pupillary light reflex,decreased motor Glasgow Coma Score,abnormal CT features and abnormal routine laboratory findings were independent risk factors for unfavorable prognosis in patients with traumatic brain injury.The prognostic model based on the risk factors of admission had favorable performance(P0.05 for goodness-of-fit test,0.709-0.882 for C statistic).No overoptimism was revealed by internal validation,and the external validity was proved to be better by external validation(P0.05 for goodness-of-fit test,0.844-0.922 for C statistic).Conclusion The established model,which is convenient to manage,can timely and accurately predict the prognosis of patients with traumatic brain injury,and can help in decision-making in clinics.

Notch signaling pathway participates in extensive cellular processes such as cell proliferation,differentiation and apoptosis.Notch plays a crucial role in cardiovascular development.Furthermore,Notch could be important for cardiac homeostasis regulation and tissue renewal by protecting the heart from an excessive and detrimental hypertrophic response and controlling the maintenance of stem cell pools.The paper emphatically reviews the current knowledge of the versartility of Notch signaling in fetal and postnatal development and finally,discusses the impact on maintenance of cardiac integrity and the potential for regenerative therapies.

心脏传导系统(CCS)由几部分功能截然不同的亚单位在信号分子内皮素-1、神经调节蛋白-1和转导因子Nkx2.5、Tbx等参与的一系列精确的时空调节机制所组成,确保了正常心律和机体的血液流动;CCS分化过程的意外缺陷可能会导致严重的节律紊乱发生。对CCS各成分起源和诱导分化机制的深入研究将有助于在治疗中运用组织工程的有效方法来修复或重建心脏传导系统。

创伤性脑损伤后继发脑组织缺血缺氧,能够促进局部血管再生,加速缺血区侧枝循环建立,改善局部血液供应,促进受损脑组织的结构重塑,从而加速缺损神经功能的修复。目前已发现多种血管再生调节因子在创伤后脑组织中表达增加,这将有助于进一步阐明脑外伤后血管再生的机制,为有效防治外伤后继发性脑损害,促进神经和血管功能修复提供新的思路和方法。