Objective To investigate the efficacy of damage control strategy in treating elderly patients with multiple injuries combined with thoracic trauma and evaluate its efficacy.Methods A retrospective case-control study was performed to analyze the data of 877 elderly patients with multiple injuries combined with thoracic trauma admitted from January 2005 to December 2016.There were 574 males and 303 females,aged 65-94 years (mean,70.8 years).The patients were divided into damage control group (n =406) and non-damage control group (n =471),according to the application of damage control strategy.The injury severity score (ISS) of the damage control group and the non-damage control group were (14.4 ± 8.5) points and (13.7 ± 9.4) points,respectively.The emergency operation rate within 24 hours,the blood loss during emergency operation,the thoracic and abdominal surgery,vascular interventional embolization,thoracic fracture and limb pelvic fracture operation within 72 hours,as well as ICU treatment rate,treatment time,complications,and prognosis were compared between the two groups.Results Fifty-one cases (12.6％) in the damage control group and 93 cases (19.7％) in the non-damage control group underwent emergency operation within 24 hours (P ＜ 0.01).The blood loss during emergency operation were (465.2 ± 329.6) ml in the damage control group and (574.4 ± 437.3) ml in the non-damage control group (P ＜ 0.01).Operation time of the two groups were (108.7 ± 57.1)minutes and(123.5 ± 86.4) minutes,respectively(P ＜ 0.01).In the damage control group and the nondamage control group respectively,there were 25 cases (6.2％) and 48 cases (10.2％) of laparotomy (P ＜ 0.05),23 cases (5.7％) and six cases (1.3％) of vascular interventional embolization (P ＜0.01),41 cases (10.1％) and 29 cases (6.2％) of internal fixation for thoracic fracture (P ＜ 0.05),zero and 232 cases (49.3％) of internal fixation for fracture of limbs and pelvis (P ＜0.01),92 cases (22.7％) and 53 cases (11.3 ％) of external fixation for extremity and pelvic fractures (P ＜ 0.01).A total of 271 cases (66.7％)in the damage control group and 256 cases (54.4％)in the non damage control group were admitted to ICU (P ＜ 0.01),and the ICU treatment time was (8.1 ± 6.5) days and (10.5 ±7.4)days,respectively (P ＜ 0.01).The top three complications for the two groups were atelectasis and pulmonary infection,arrhythmia and heart failure,respiratory failure and acute respiratory distress syndrome (ARDS).In the damage control group and the non-damage control group respectively,the incidence of atelectasis and pulmonary infection were 65％ and 64.5％ (P ＞ 0.05),the incidence of arrhythmia and heart failure were 53.4％ and 60.5％ (P ＜ 0.05),and the incidence of respiratory failure and ARDS were 17.7％ and 23.8％ (P ＜ 0.05).A total of 29 cases died in the damage control group (7.1％) and 53 cases died in the non damage control group (11.3 ％) (P ＜ 0.05).Conclusions Damage control strategy should be applied to treating elderly patients with multiple injuries combined with chest injury.By simplifying or reducing emergency surgery,active ICU treatment,and focusing on the fixation of chest fractures,damage control strategy can effectively reduce complications and improve survival rate.

Objective To evaluate the therapeutic methods and effect of pre-hospital and in-hospital inte-grated treatment for severe crush injuries of extremities . Methods The clinical data of 49 patients with severe crush injuries of extremities from May 2008 to Jul.2015 in Chongqing Emergency Medical Center was retrospectively studied.There were 44 males and 5 females,with age ranging from 19 to 82 years (average,43.7 years).There were 5 cases of earthquake injury ,20 cases of traffic accident injury ,17 cases of mining accident injury ,and 7 cases injured by other causes .Injured sites of crushes were as follows: shoulder and upper limbs in 8 cases ( 16.3%) , pelvic and lower limbs in 41 cases(83.7%).Thirty-two cases(65.3%) were associated with fractures and disloca-tion of pelvis and joints,and 44 cases were associated with multiple injuries (89.8%).Results Pre-hospital time was 35min-49h.Venous pathway was established and infusion was applied in 19 cases during on-the-scene rescue and tourniquet was applied in 31 cases (63.3%).Decompressive fasciotomy was performed in 1 case and amputa-tion was performed in 1 case during on-the-scene rescue .Electrocardiogram monitoring was performed in all cases after decompression.In-hospital therapeutic measures included vacuum sealing drainage (VSD) in 14 cases after debridement and 17 cases with decompressive fasciotomy . The effective rate of VSD was 96.8%( 30/31 ) and no case was amputated in this group .The incidence rate of crush syndrome (CS) was 57.1%(28/49),of which 11 cases (22.4%) were combined with hyperkalemia ,and 8 cases with renal failure.Eight cases were treated with ventilator assisted therapy and 8 cases were treated with continuous renal replacement therapy ( CRRT ) . At the end,31 cases(63.3%) were cured,13 cases(26.5%) were improved,and 5 cases(10.2%) were uncured,which included 3 cases ( 6.1%) of amputation and 1 death case ( 2.0%) died from failed cardiopulmonary resuscitation due to hyperkalemia .Conclusion Tourniquet and electrocardiogram monitoring should be emphasized in pre-hos-pital treatment of severe crush injuries of extremities .Application of VSD in in-hospital treatment can reduce the in-cidence rate of amputation of severe crush injuries of extremities .

Objective To summarize the experiences of diagnosis and treatment for chest penetrating injury with foreign body retention and to make further improvement of the outcomes.Methods A retrospective analysis was made on clinical data of 28 patients with chest penetrating injury with foreign body rentention in Chongqing E-mergency Medical Center from Jan.1997 to May 2015.There were 24 males and 4 females,with age ranged from 15-64 years(average,43.5 years old).Admission time after injury ranged from 20 minutes to 37 hours,with an av-erage of 52.4 minutes.Results All these 28 patients accepted both exploratory thoracotomy and foreign body re-moval operation.The surgical approach choices included 14 patients with anterolateral thoracotomy incision(50%), 7 patients with posterolateral thoracotomy incision(25%),3 patients with the thoracotomy incision by collarbone and the 1st and 2nd rib cutting-off(10.72%),2 patients with sternotomy(7.14%),and 2 patients with thoracoabdomi-nal incision(7.14%).There were 51 cases of viscera damage,including 22 cases of lung laceration(43.14%),5 cases of heart and great vascular injury(9.80%),5 cases of intercostal artery injury(9.80%),8 cases of diaphrag-matic muscle injury(15.69%),4 cases of spine and mediastinum injury(7.84%),1 case of ductus thoracicus inju-ry(1.96%),and 6 cases of abdominal viscera injury(11.77%).All the damaged viscera were performed one -stage definitive operation,such as hemostasis and suture repair after pneumonotomy,heart and great vascular lacera-tion suture repair,intercostals arteries hemostasis,mediastinum hematoma removal,diaphragmatic repair,ductus tho-racicus ligation,liver repair,gastrorrhaphy,and splenectomy.In this group,27 cases achieved perfect foreign body removal(96.43%) and 1 case achieved foreign body retention(3.57%).Two cases died(7.14%).Conclusion Proper preoperative life support,targeted incision approach choice,explicit labor division and reasonable operation are keys to the treatment of chest penetrating injury with foreign body retention.

目的：探讨损伤控制外科（DCS）在骨盆骨折合并毗邻脏器伤早期救治中的实施方法和疗效。方法对2008年2月至2013年9月在重庆市急救医疗中心创伤科应用 DCS 方法救治骨盆骨折合并毗邻脏器伤21例的临床资料作回顾性分析。结果初期手术行双侧髂内动脉结扎11例，栓塞4例，骨盆填塞5例；外固定支架使用18例；膀胱造口11例，尿道会师2例；腹膜外直肠及肛管伤做结肠造口4例。本组死亡2例（9．5％）。死因为失血性休克及脑伤各1例。并发症7例，包括深静脉血栓形成2例，直肠膀胱瘘、骨盆感染、腹腔间室综合征、尿道狭窄、下肢短缩各1例。结论髂内动脉断血、稳定骨盆、骨盆填塞是 DCS在骨盆骨折合并毗邻脏器损伤早期救治中控制出血的三大措施；膀胱造口和结肠造口，是急诊治疗时常采用的有效方法；创伤专科化能提高骨盆骨折合并毗邻脏器伤的救治成功率。

Objective To summarize the medical rescue of Chinese Government Medical Team (Chongqing) in Nepal earthquake region in order to explore the work pattern of transnational medical rescue,and improve the rescue efficiency.Methods From the experience about the post-earthquake medical rescue of Chinese Government Medical Team (Chongqing) in Nepal in 2015,several aspects were worthy to summarize such as the establishment of medical team,the layout of camp site,the work algorithm and process,with the analysis of injury feature and outcome of treatment.Results Under the setting of efficient organization and rational assignment of professional work,special working rules,the mutual transfer treatment and multi-disciplinary treatment were employed for 737 emergency patients.Of them,128 patients were hospitalized (including 63 patients completely recovered,56 patients were of clinical improvement,and 9 patients were critically ill transferred to other hospital for advanced treatment),and post-traumatic complication occurred in 48 cases without death.In addition,148 operations were carried out successfully.Conclusions The earthquake disaster has specific feature such as suddenness,a host of casualties and poor rescue conditions,and overseas rescue is with the presence of the language barrier,the difference in living habit,and the lack of coordination with local rescue system,therefore,rationally assigning personnel and resources and establishing work pattern with flexibility,orderly and good communication are the key to promote the efficiency of transnational medical rescue for the injured patients in earthquake region.

Objective To investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.

Objective To investigate the effect and mechanism of tripterygium wilfordii combined with aescine in treatment of acute lung injury (ALI) following trauma.Methods A total of 120 patients with posttraumatic ALI were divided into four groups:tripterygium wilfordii + aescine group (combined group),tripterygium wilfordii group,aescine group,and control group according to random number table,with 30 patients per group.Regardless of the same conventional therapy,the patients in combined group were treated by orally or gastrically administered tripterygium wilfordii multiglycoside as well as aescine intravenously,once a day for 12 days; on the contrary,the same method but only with tripterygium wilfordii or aescine was respectively performed in tripterygium wilfordii and aescine groups.Blood gas analysis before and after treatment,length of ICU stay,fatality rate and incidence of ARDS in each group were observed.Changes in levels of inflammatory mediators (TNF-oα,IL-1,IL-6 IL-8,etc)were detected at days 4,8,and 12 after medication.Results Shorter length of ICU stay and lower ARDS incidence as well as 12-day fatality rate were detected in each treatment group as compared with control group,especially in combined group (P ＜ 0.05).Respiratory rate,PaO2 and oxygenation index (PaO2/FiO2) in each treatment group presented better amelioration than those in control group and especially better results were observed in combined group (P ＜ 0.05).Plasma levels of TNF-α,IL-1,IL-6,and IL-8 in each treatment group were lower than those in control group (P ＜ 0.05).Conclusions Tripterygium wilfordii and aescine havetherapeutic effect on posttraumatic ALI.Moreover,synergetic use of the two drugs achieves synergistic effect and better outcome.

分析41例创伤性十二指肠损伤的临床资料,术前及术中确诊37例,误诊和漏诊4例.行十二指肠Ⅰ期修补21例;十二指肠端端吻合加胃造瘘、空肠造瘘十二指肠内引流3例;带蒂空肠袢修补胃造瘘、逆顺向空肠造瘘3例;修补加十二指肠憩室化4例;十二指肠空肠 Roux-en-Y吻合5例;腹膜后多孔引流1例;十二指肠Ⅰ期修补,胃造瘘、逆顺向空肠造瘘,胆总管引流1例;胰十二指肠切除1例,应用损害控制手术2例.治愈32例(78%),死亡9例(22%).认为早期诊断和恰当术式是提高十二指肠损伤救治成功率的关键.

Objective To explore the early diagnosis, option of the surgical procedures, preven-tion and treatment of the complications in patients with pancreatic trauma.Methods All patients with pancreatic trauma during the past 20 years were studied retrospectively in respect of sex, age, cause of injury, grade by AAST, style of operation, therapeutic efficacy, complications and factors for death etc.Statistical analysis was made with Chi-square test.Results In all 148 cases of the present series, 132 underwent surgical interventions including simple suture or external drainage alone, distal pancre-atectomy, distal pancreaticojejunostomy or other internal drainage, diverticularization, Whipple's pro-cedure, and Damage Control Surgery (DCS) etc.Postoperative morbidity was 27.83% with a signifi-cant difference of the incidence of pancreatic fistula between pancreas grade Ⅲ-Ⅴ injuries and grade Ⅰ-Ⅱ(P＜0.01).The mortality rate was 11.49%.The cause of the deaths was mainly massive bleed-ing due to severe associated injuries(76.47%).Among various grades, the difference of the mortality was not significant (P＞0.05).Conclusion To improve the survival rate, it is important to control massive hemorrhage from associated injuries precedes dealing with pancreas trauma.Selection of surgi-cal procedures should be based on whether the main duct is injured.The removing of devitalized tis-sue, adequate external and internal drainage are essential for treatment of pancreatic injuries.Early recognition of pancreatic injury and correct choice of surgical procedures may obviously decrease the in-cidence of postoperative complications.

SNS,全称Social Networking Services,即社会性网络服务,专指旨在帮助人们建立社会性网络的互联网应用服务。赛迪公司预测2009年中国SNS用户量将实现67.8%的高速增长,达到接近1亿人的规模,到2011年用户规模增长逐步趋于稳定,用户量达到1.7亿人。但是经历了2008年的狂欢之后,打着SNS旗号的各种网站开始坐立不安。雷同的应用、相似的面孔,注册用户经历了最初的热情后,活跃度在降低,而赢利模式尚无定期。SNS给用户提供的核心价值定位成为了目前SNS发展的瓶颈。在Web3.0的网络盛景中,SNS将扮演什么样的角色呢?本文在考察了SNS的整个发展历程后,结合行业动态,分析了SNS在Web3.0时代的真正应用并给出了发展建议。

OBJECTIVE To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries. METHODS A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries. RESULTS Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% (119/804) and 83.5% (710/850) respectively (X(2) equal to 780.683, P less than 0.01). The operation rates of blunt and penetrating thoracic injuries was 6.8% (42/617) and 40.6% (76/187) respectively (X(2) equal to 131.701, P less than 0.01). The operation rates of blunt and penetrating abdominal injuries were 77.1% (434/563) and 96.1% (276/287) respectively (X(2) equal to 50.302, P less than 0.01). The operation rates of blunt thoracio-abdominal injuries were 6.8% (42/617) in thoracic region and 77.1% (434/563) in abdomen respectively (X(2) equal to 544.043, P less than 0.01). Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% (39/41). Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% (62/854) and 2.9% (9/312) (X(2) equal to 6.51, P less than 0.005). The deaths were mainly due to large volume of blood loss. CONCLUSIONS When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

With the new development of web technology,media convergence is not merely the process of report news in different media,but also a reformation of whole industry chain and renovate of the business process.The paper explains three arrangements of media convergence and gives suggestions to the challenges of media operation of these three aspects;this paper attempts to discuss the new operation of media based on the global media convergence background.

Objective To discuss diagnosis and treatment of patients with retroperitoneal hematoma.Methods Clinical data of 48 cases with retroperitoneal hematoma were studied retrospectively.Laparotomy were performed in 41 cases as well as conservative treatments in 17 cases.Twenty-six cases in operative group received exploration of retroperitoneal space.Results Forty-five patients were cured,3 died of hemorrhagic shock due to main vessel injury with a mortality of 6.25%.Conclusion CT and exploratory laparotomy are effective procedures to confirm the diagnosis of retroperitoneal hematoma.Abdominal tap should not be used as a diagnostic method.Decision of exploration for retroperitoneal space is made according to the hemotoma′s location and condition.Satisfactory exposure,effective control and sufficient drainage all should be emphasized.

Objective: To probe the feasibility and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries.Methods: A retrospective analysis was made on the clinical data of 41 patients (31 males and 10 females, aged 18-71 years, mean: 36.4) with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005.Results: As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1%(5/41) with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured.Conclusions: Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.

现代创伤以高能量损伤为特点,多发伤发生率高,并易迅速引起患者严重的生理扰乱而致其死亡,这对创伤急救提出了更高的要求.笔者就1996年1月-2006年10月收治的以胸和(或)腹部损伤为主的严重多发伤患者1 166例的临床资料进行回顾性分析.现报告如下.

> 对腹部创伤应尽量减少非计划性再手术,以提高腹部创伤手术的质量。我科1988年1月-2005年10月手术治疗腹部创伤患者2361例,其中52例(2.2%)接受非计划再手术。现报告如下。1 临床资料本组男45例,女7例;年龄15～71岁,平均31.2岁。钝性伤37例,穿透伤

>严重多发伤患者常因继发MODS而导致不良预后。早期预测MODS的发生对于指导治疗、预判转归及提高创伤患者的生存率具有重要作用。近年来研究发现,创伤后一系列免疫物质的血液浓度变化可能与创伤严重程度及脓毒血

Objective To observe the therapeutic effect of glucosamine in treating traumatic arthritis.Methods 32 patients were treated by oral glucosamine hydrochloride for 6 weeks.Lequesne index was counted respectively before and after the treatment.Statistical methods were used to analyze the Lequesne index.Results The cases of remission,obvious effect and effect were 8,18 and 5,respectively.The total percentage of effect was 96.88% .The Lequesne index before and after the treatment had significance difference (P < 0.01).Conclusion Glucosamine has good effect on traumatic arthritis.

"巴将军"的秘密 从<星球大战>到<黑客帝国>,从<高达>到<变形金刚>,从儿时的塑料玩具到现在的网络游戏,机器人的终极梦想,始终陪伴我们成长.特别是那些热爱科幻故事的翩翩少年,即使成年之后,依然会时常回味1980年代的<终结者>,乐此不疲.

Objective To evaluate operative and perioperative treatment for colorectal injuries.Methods The clinical data of 125 patients with colorectal injuries treated over a period of 19 years were retrospectively studied.Results In 69 patients with perforated colon or intraperitoneal segment of the rectum, 56(81.16 %) were managed with primary repair or anastomosis, 11 cases received a colostomy, and 2 cases had Damage control surgery. In the 18 patients with perforated extraperitoneal segment of the rectum, 14 underwent diverting colostomy of the proximal end of sigmoid with presacral drainage; 4 cases, whose wound was small and contamination was mild, received primary repair without colostomy; and the other 38 cases without full-thickness lesions of the colon and rectum were treated by simple suture. The overall mortality rate was 6.40 %(8/125); 7 patients died of hemorrhagic shock during the operation(n=6) or after the operation(n=1), and the another one died from septic complication of the thoracic cavity. The complications related with operation for colorectal trauma included local infection in 6 and intestinal obstruction in one; all of them were cured. Conclusions In most of the patients with injury of colon or intraperitoneal segment of rectum, primary repair or anastomosis can be carried out safely. Rational use of perioperative antibiotics, especially Metronidazole, is a necessity. Staged operation is used for injuries of extraperitoneal segment of rectum; a completely diverting proximal sigmoid colostomy should be performed, because a loop style colostomy can not interrupt contamination of the distal rectum.