This study aimed to develop and evaluate a remote damage control surgery (DCS) real-time guidance system based on HoloLens 2 for low-speed network environments. The system design follows a layered architecture model where the core logic is divided into network, data, service, and user layers. Data transmission in low-speed network environments is realized through multidimensional injury data encoding technology, combined with a WebSocket long-link protocol and fragmentation transmission technology. Multi-modal deep learning and decision tree algorithms are used to build an intelligent auxiliary model for injury assessment. Based on this, the HoloLens 2 immersive head-mounted display device is integrated via the Wi-Fi communication protocol to achieve multi-modal, real-time interactive surgical guidance. After the system development was completed, it was applied to four surgical teams composed of 28 students who were randomly divided into remote and control groups. An animal injury platform was used to construct a cranial trauma model for practical assessment. The remote and control groups used a guidance system and video call methods, respectively, to perform simulated remote surgery guidance. The differences in injury judgment, surgical operations, overall effectiveness scores, surgical time, and animal survival time between the two groups were compared. After the assessment, a self-made questionnaire was used for a satisfaction survey. In the remote group, the surgery operation scores were higher and the surgical time was shorter than in the control group (both P < 0.05). There were no significant differences between the two groups in injury assessment, overall effectiveness scores, or animal survival time (P > 0.05). The students scored the system’s necessity, effectiveness, compatibility, and deployment environment above 5 points. The remote DCS guidance system based on HoloLens 2 can provide remote real-time interactive guidance for DCS using mixed reality technology. The proposed method can mitigate data transmission delays in low-speed, complex network environments. In addition, the surgical guidance system can assist surgeons in improving their ability in DCS and provide real-time, efficient decision-making support, making it worthy of further application and popularization.

Background A high activation level is a normal characteristic of lyophilized platelets (LPs); however, the effects of this activation level on the efficacy and safety of LPs after transfusion are debated.Objectives We aimed to test the efficacy and safety of pre-activated LPs (PLPs) in rabbits with traumatic bleeding and shock.Methods In vitro characteristics of PLPs, including activation level, aggregation, migration, and thromboelastography parameters, were evaluated. Limb soft tissue injury accompanied by seawater immersion and controlled hemorrhagic shock was induced in 50 rabbits, which were then divided into five groups: A (no resuscitation), B (resuscitation with Lactated Ringer’s solution, LR), C (resuscitation with LR and fresh platelets), D (resuscitation with LR and LPs), and E (resuscitation with LR and PLPs pre-activated by thrombin). Blood loss, platelet count, blood urea nitrogen and lactic acid concentrations, and in vivo thromboelastography R value and maximum amplitude were recorded. Biotin-X-N-hydroxysuccinimide labeling and flow cytometry were used to measure the number of infused platelets left in circulation. Histology was used to assess whether aberrant thrombi were formed in the kidney, lung, or liver.Results PLPs exhibited an increased P-selectin level, enhanced aggregation, and shortened R values, with no obvious changes in migration ability or maximum amplitude. PLPs transfusion had a non-inferior effect on all in vivo parameters compared with fresh platelet transfusion, and the circulation time of PLPs was much shorter than that of fresh platelets. No obvious thrombi were found.Conclusions PLPs transfusion demonstrated non-inferior efficacy and safety compared with fresh platelet transfusion.

PURPOSE:To compare the effects of empirical and modified hemostatic resuscitation for liver blast injury combined with seawater immersion. METHODS:Thirty rabbits were subjected to liver blast injury combined with seawater immersion, and were then divided into 3 groups randomly (n = 10 each): group A (no treatment after immersion), group B (empirical resuscitation with 20 mL hydroxyethyl starch, 50 mg tranexamic acid, 25 IU prothrombin complex concentrate and 50 mg/kg body weight fibrinogen concentrate), and group C (modified resuscitation with additional 10 IU prothrombin complex concentrate and 20 mg/kg body weight fibrinogen concentrate based on group B). Blood samples were gathered at specified moments for assessment of thromboelastography, routine coagulation test, and biochemistry. Mean arterial pressure, heart rate, and survival rate were also documented at each time point. The Kolmogorov-Smirnov test was used to examine the normality of data distribution. Multigroup comparisons were conducted with one-way ANOVA. RESULTS:Liver blast injury combined with seawater immersion resulted in severe coagulo-fibrinolytic derangement as indicated by prolonged prothrombin time (s) (11.53 ± 0.98 vs. 7.61 ± 0.28, p＜0.001), activated partial thromboplastin time (APTT) (s) (33.48 ± 6.66 vs. 18.23 ± 0.89, p＜0.001), reaction time (R) (min) (5.85 ± 0.96 vs. 2.47 ± 0.53, p＜0.001), decreased maximum amplitude (MA) (mm) (53.20 ± 5.99 vs. 74.92 ± 5.76, p＜0.001) and fibrinogen concentration (g/L) (1.19 ± 0.29 vs. 1.89 ± 0.32, p = 0.003), and increased D-dimer concentration (mg/L) (0.38 ± 0.32 vs. 0.05 ± 0.03, p = 0.005). Both empirical and modified hemostatic resuscitation could improve the coagulo-fibrinolytic states and organ function, as indicated by shortened APTT and R values, decreased D-dimer concentration, increased fibrinogen concentration and MA values, lower concentration of blood urea nitrogen and creatine kinase-MB in group B and group C rabbits in comparison to that observed in group A. Further analysis found that the R values (min) (4.67 ± 0.84 vs. 3.66 ± 0.98, p = 0.038), APTT (s) (23.16 ± 2.75 vs. 18.94 ± 1.05, p = 0.001), MA (mm) (60.10 ± 4.74 vs. 70.21 ± 3.01, p < 0.001), and fibrinogen concentration (g/L) (1.68 ± 0.21 vs. 1.94 ± 0.16, p = 0.013) were remarkably improved in group C than in group B at 2 h and 4 h after injury. In addition, the concentration of blood urea nitrogen (mmol/L) (24.11 ± 1.96 vs. 21.00 ± 3.78, p = 0.047) and creatine kinase-MB (U/L) (85.50 ± 13.60 vs. 69.74 ± 8.56, p = 0.013) were lower in group C than in group B at 6 h after injury. The survival rates in group B and group C were significantly higher than those in group A at 4 h and 6 h after injury (p < 0.001), however, there were no statistical differences in survival rates between group B and group C at each time point. CONCLUSIONS:Modified hemostatic resuscitation could improve the coagulation parameters and organ function better than empirical hemostatic resuscitation.

PURPOSE:To construct a decision-making app for pre-hospital damage control resuscitation (PHDCR) for severely injured patients, and to make a preliminary trial test on the effectiveness and usability aspects of the constructed app. METHODS:Decision-making algorithms were first established by a thorough literature review, and were then used to be learned by computer with 3 kinds of text segmentation algorithms, i.e., dictionary-based segmentation, machine learning algorithms based on labeling, and deep learning algorithms based on understanding. B/S architecture mode and Spring Boot were used as a framework to construct the app. A total of 16 Grade-5 medical students were recruited to test the effectiveness and usability aspects of the app by using an animal model-based test on simulated PHDCR. Twelve adult Bama miniature pigs were subjected to penetrating abdominal injuries and were randomly assigned to the 16 students, who were randomly divided into 2 groups (n = 8 each): group A (decided on PHDCR by themselves) and group B (decided on PHDCR with the aid of the app). The students were asked to complete the PHDCR within 1 h, and then blood samples were taken and thromboelastography, routine coagulation test, blood cell count, and blood gas analysis were examined. The lab examination results along with the value of mean arterial pressure were used to compare the resuscitation effects between the 2 groups. Furthermore, a 4-statement-based post-test survey on a 5-point Likert scale was performed in group B students to test the usability aspects of the constructed app. RESULTS:With the above 3 kinds of text segmentation algorithm, B/S architecture mode, and Spring Boot as the development framework, the decision-making app for PHDCR was successfully constructed. The time to decide PHDCR was (28.8 ± 3.41) sec in group B, much shorter than that in group A (87.5 ± 8.53) sec (p < 0.001). The outcomes of animals treated by group B students were much better than that by group A students as indicated by higher mean arterial pressure, oxygen saturation and fibrinogen concentration and maximum amplitude, and lower R values in group B than those in group A. The post-test survey revealed that group B students gave a mean score of no less than 4 for all 4 statements. CONCLUSION:A decision-making app for PHDCR was constructed in the present study and the preliminary trial test revealed that it could help to improve the resuscitation effect in animal models of penetrating abdominal injury.

Introduction: To establish a blast-and fragment-induced pelvic injury animal model in rabbits, observe its injury characteristics, and explore the effects of hemostatic resusci-tation combined with damage control surgery (DCS) with respect to this injury model.Methods: Forty-eight rabbits were randomly allocated to four groups: group A rabbits were subjected to pelvic injury, group B rabbits to pelvic injury + DCS, group C rabbits to pelvic injury + DCS + resuscitation with Hextend, and group D rabbits to pelvic injury + DCS + Hextend + hemostatic resuscitation with tranexamic acid, fibrinogen concentrate, and prothrombin complex concentrate. Simulated blast and fragment -induced pelvic injury was produced by a custom-made machine. We implemented CT scanning and necropsy to assess the injury state and calculated the coefficient of variation (CV) of the cumulative abbreviated injury scale (AIS) to assess the reproducibility of the animal model. Immediately after instrumentation (0 h), and 1 h, 2 h, 4 h, and 8 h after injury, blood samples were taken for laboratory tests.Results: We found that severe pelvic injury was produced with an AIS CV value of 10.32%, and the rabbits demonstrated severe physiologic impairment and coagulo-fibrinolytic de-rangements with high mortality. In rabbits of group D, however, physiologic and coagulo-fibrinolytic parameters were significantly enhanced with improved organ function and lowered mortality when compared with the other three groups.Conclusions: We herein established in rabbits a blast-and fragment-induced pelvic injury animal model that exhibited high reproducibility, and we demonstrated that hemostatic resuscitation plus DCS was effective in improving the outcome.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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.

Purpose: To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries.Methods: With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre-and post-training performances were compared. Post-training survey using 7 -point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.Results: Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 +/- 1.49, and the feasibility score was 7.50 +/- 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.Conclusions: Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.(c) 2022 Chinese Medical Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

OBJECTIVE:Resuscitation with whole blood is known to be better than that with saline in attaining the return of spontaneous circulation (ROSC) and improving the short-term survival rate for hemorrhage-induced traumatic cardiac arrest (HiTCA). However, the resuscitation with whole blood alone fails to address the pathophysiological abnormalities, including hyperglycemia, hyperkalemia and coagulopathy, after HiTCA. The present study aimed to determine whether the modified glucose-insulin-potassium (GIK) therapy can ameliorate the above-mentioned pathophysiological abnormalities, enhance the ROSC, improve the function of key organs, and reduce the mortality after HiTCA.METHODS:HiTCA was induced in rabbits (n=36) by controlled hemorrhage. Following arrest, the rabbits were randomly divided into three groups (n=12 each): group A (no resuscitation), group B (resuscitation with whole blood), and group C (resuscitation with whole blood plus GIK). The GIK therapy was administered based on the actual concentration of glucose and potassium. The ROSC rate and survival rate were obtained. Hemodynamical and biochemical changes were detected. Thromboelastography (TEG) was used to measure coagulation parameters, and enzyme-linked immunosorbent assay to detect parameters related to inflammation, coagulation and the function of brain.RESULTS:All animals in groups B and C attained ROSC. Two rabbits died 24-48 h after HiTCA in group B, while no rabbits died in group C. The GIK therapy significantly reduced the levels of blood glucose, potassium, and biological markers for inflammatory reaction, and improved the heart, kidney, liver and brain function in group C when compared to group B. Furthermore, the R values of TEG were significantly lower in group C than in group B, and the maximum amplitude of TEG was slightly lower in group B than in group C, with no significant difference found.CONCLUSION:Resuscitation with whole blood and modified GIK therapy combined can ameliorate the pathophysiological disorders, including hyperglycemia, hyperkalemia and coagulopathy, and may improve the function of key organs after HiTCA.

Explosions are more common in wartime, while in peacetime they often occur in terrorist attacks and accidents, which are a physical reaction process caused by rapid changes in pressure and temperature, directly or indirectly acting on the human body through shock waves, projectiles, heating power, toxic gases, etc. In addition to common lung and auditory injuries, it can also cause life-threatening conditions such as airway damage and massive hemorrhage, which need effective first aid in the shortest time to save the lives of the wounded. This chapter discusses on-site first aid assessment and first aid techniques for blast injury.

Zhong, Xin, Wenqiong Du, Zhaowen Zong, Renqing Jiang, Yijun Jia, Zhao Ye, and Haoyang Yang. Features of coagulo-fibrinolytic derangement due to bleeding in nonacclimatized rabbits acutely exposed to high altitude. High Alt Med Biol. 24:68-75, 2023.Background: The present study aimed to observe the time course of coagulo-fibrinolytic derangement due to bleeding in rabbits acutely exposed to high altitude (HA).Materials and Methods: Forty-eight rabbits were randomly divided into four groups and were subjected to minor bleeding at low altitude, major bleeding at low altitude, minor bleeding after acute exposure to HA, and major bleeding after acute exposure to HA. To produce minor and major bleeding, 10% and 30% of the total blood volume was removed, respectively. At designated time points, samples were taken for laboratory examination.Results: While minor bleeding at low altitude led to minor coagulo-fibrinolytic derangements, it led to complicated derangements at HA, which presented as an early hypercoagulable state and transition to hypocoagulable and hyperfibrinolytic states with lower clot firmness. Major bleeding at HA resulted in greater derangements of the R time, K values, the D-dimer concentration, the alpha angle, maximum amplitude, and the concentration of fibrinogen than were observed at low altitude.Conclusions: The extent of coagulo-fibrinolytic derangements due to bleeding in rabbits after acute exposure to HA was more severe and complicated than that at low altitude. Therefore, proper resuscitation should be applied based on these changes.

从战伤救治课程特点出发,根据不同专业培养要求,探讨战伤救治课程蕴含的思政元素及其教学切入点、教学实例以及评价反馈机制,旨在通过精心的教学设计建立基于专业特点的战伤救治课程思政教学体系.

目的 观察模拟战时复苏策略救治失血性心跳骤停的初步效果.方法 本文为前瞻性研究.50只家兔[雌雄不拘,重量(2.6±0.4)kg,兔龄(8.9±0.4)个月]随机分为A～E 5组,每组10只.通过从股动脉置管中以2mL/(kg·min)的速度抽取血液,制备失血性心跳骤停模型.制模成功(收缩压<10mmHg,持续20s以上)后10min,5组动物分别接受羟乙基淀粉+1h后全血输注(模拟战时复苏组,A组)、羟乙基淀粉(B组)、乳酸钠林格液(C组)、生理盐水(D组)和全血复苏(E组),输注剂量为失血量等体积的对应液体.观察指标:自主循环恢复率、24h生存率、平均动脉压、血常规、凝血相和血生化指标.结果 制模后1h各组的生存率分别为100％、100％、50％、40％和100％,24h各组的生存率分别为90％、50％、0、0和100％.因死亡导致统计数量不足,B组和C组未纳入生理指标等统计.在制模后1、4和8h,E组各项指标优于A组和B组,分别为相差显著(P<0.05)和非常显著(P<0.01);A组优于B组,相差显著(P<0.05).以制模后8h为例,A组乳酸浓度为(5.79±0.65)mmol/L、红细胞计数为(3.45±0.19)×1012/L、血小板计数为(245.30±14.36)×109/L、氧饱和度为(82.32±6.73)％、国际标准化比值为1.32±0.08、尿素氮为(7.92±0.89)mmol/L、肌酐为(122.54±12.36)μmol/L、谷丙转氨酶为(42.62±5.66)U/L、谷草转氨酶为(56.83±4.32)U/L、肌酸激酶同工酶-MB为(8.91±0.81)U/L,明显优于B组[B组各项指标分别为:(11.23±1.36)mmol/L、(1.92±0.13)×1012/L、(198.72±12.54)×109/L、(63.83±5.77)％、2.19±0.15、(11.62±0.87)mmol/L、(234.72±14.52)μmol/L、(56.82±7.76)U/L、(94.72±8.76)U/L、(22.52±3.23)U/L];相比于B组,A组与E组指标值[E组各项指标值分别为:(4.15±0.23)mmol/L、(4.36±0.48)×1012/L、(328.62±18.45)×109/L、(91.42±5.55)％、1.05±0.07、(6.23±0.54)mmol/L、(89.41±8.21)μmol/L、(30.41±5.67)U/L、(33.82±3.76)U/L、(6.53±0.74)U/L]更为接近.结论 模拟战时复苏策略可有效促进失血性心跳骤停的自主循环恢复,提高其生存率和重要脏器功能.

研究建立贴近实战、适用基层的战伤自救互救师资培训课程.方法调研基层部队自救互救师资现状,围绕师资培养和质量提升进行课程设计;开展专家咨询,进一步完善课程;在培训班中实际应用验证效果.结果建立了战伤自救互救师资培训课程.通过德尔菲法对课程内容进行了优化筛选;专家对课程框架设计的合理性和可行性评分平均值高于9.0,变异系数低于15％.结论战伤自救互救师资培训课程设计合理且可行,初步结果显示其可有效提高受训者的自救互救授课能力.

Background Although battlefield first aid (BFA) training shares many common features with civilian training, such as the need to address technical skills and nontechnical skills (NTSs), it is more highly scenario-dependent. Studies into extended reality show clear benefits in medical training; however, the training effects of extended reality on NTSs, including teamwork and decision-making in BFA, have not been fully proven. Objective The current study aimed to create and test a scenario-based, mixed-reality platform suitable for training NTSs in BFA. Methods First, using next-generation modeling technology and an animation synchronization system, a 10-person offensive battle drill was established. Decision-making training software addressing basic principles of tactical combat casualty care was constructed and integrated into the scenarios with Unreal Engine 4 (Epic Games). Large-space teamwork and virtual interaction systems that made sense in the proposed platform were developed. Unreal Engine 4 and software engineering technology were used to combine modules to establish a mixed-reality BFA training platform. A total of 20 Grade 4 medical students were recruited to accept BFA training with the platform. Pretraining and posttraining tests were carried out in 2 forms to evaluate the training effectiveness: one was knowledge acquisition regarding the NTS and the other was a real-world, scenario-based test. In addition, the students were asked to rate their agreement with a series of survey items on a 5-point Likert scale. Results A battlefield geographic environment, tactical scenarios, scenario-based decision software, large-space teamwork, and virtual interaction system modules were successfully developed and combined to establish the mixed-reality training platform for BFA. The posttraining score of the students’ knowledge acquisition was significantly higher than that of pretraining (t=−12.114; P≤.001). Furthermore, the NTS score and the total score that the students obtained in the real-world test were significantly higher than those before training (t=−17.756 and t=−21.354, respectively; P≤.001). However, there was no significant difference between the scores of technical skills that the students obtained before and after training. A posttraining survey revealed that the students found the platform helpful in improving NTSs for BFA, and they were confident in applying BFA skills after training. However, most trainees thought that the platform was not helpful for improving the technical skills of BFA, and 45% (9/20) of the trainees were not satisfied with the simulation effect. Conclusions A scenario-based, mixed-reality platform was constructed in this study. In this platform, interaction of the movement of multiple players in a large space and the interaction of decision-making by the trainees between the real world and the virtual world were accomplished. The platform could improve the NTSs of BFA. Future works, including improvement of the simulation effects and development of a training platform that could effectively improve both the technical skills and NTSs of BFA, will be carried out.

PurposeIt is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries.MethodsThe training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results.ResultsThe high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees’ score improved significantly after training.ConclusionThe platform established in this study was useful for CDCS training.

军事专业课的课程思政是当前摆在专业课教师面前的一项重要的课题,目前正处于探索阶段.课程思政需要从本专业角度出发理解其真实内涵才能引起足够重视,并通过综合考虑思政元素与专业课的结合方式、讲解手段和方法、考核与激励机制,才能获得可持续的好的教育效果.实施战救课程思政,需要从提升教员自身政治素养出发,提炼课程思政元素并找准切入点,优选思政方法,从而达到好的课程思政效果.

Objective To observe the effects of myocardial energy metabolism-promoted resuscitation strategy on hemorrhagic induced cardiac arrest (HiTCA) in rabbits. Methods Twenty 9-month-old rabbits were randomly divided into 2 groups(n=10), and HiTCA model was prepared by controlled hemorrhage. Then the rabbits received whole blood infusion and whole blood infusion+adenosine triphosphate + polarization liquid, respectively. Mean arterial pressure was detected by common carotid artery intubation; Blood routine was examined by automatic blood cell count analyzer; Coagulogram was detected by automatic coagulation analyzer; Blood biochemical indexes was detected by automatic dry biochemical analyzer; Arterial blood gas was determined by arterial blood gas analyzer; S100β, C-reactive protein and Syndecan-1 were detected by ELISA. Results The rates of restoration of spontaneous circulation (ROSC) were 100% in both groups, and the 24 h survival rate of each group was 80% and 100%. After HiTCA blood glucose and blood potassium in group B were significantly lower than that of group A(P < 0.05); INR values were significantly increased in both groups(P < 0.05);Compared with group A, group B showed a lower level in lactic acid, creatinine, urea nitrogen, glutamic-pyruvic transaminase, glutamic-oxalacetic transaminase, creative kinase isoenzyme-MB, CRP and Syndecan-1(P < 0.05)in every time point after 4 h of HiTCA. In the 2 time pointa (8 and 24 h after HiTCA), group B displayed a lower concentration level of S100β, compared with group A(P < 0.05). Conclusion Resuscitation strategy based on promoting energy metabolism could improve organs function with hemorrhage induced cardiac arrest through improving energy metabolism of viscera and coagulation function.

目的 建立家兔骨盆冲击破片伤模型,并观察其早期伤情特点.方法 多功能致伤机器在冲击波压强为10 kPa和1个模拟破片条件下致伤.伤后给予填塞包扎及有创血压监测,并在致伤前,伤后5 min、30 min、1 h、2 h、3 h、6 h和12 h等时相点采血检测血常规、动脉血气和血栓弹力图.影像学和尸检检查损伤情况.结果 致伤后可见严重骨盆骨折伴有多发脏器损伤,伤后5 min后出现严重休克,伴有碱剩余、纤维蛋白原浓度、红细胞和血小板计数降低.伤后3 h内死亡率达36％.凝血系统呈现动态紊乱:凝血反应时间(R)值在致伤后5 min内迅速缩短至(5.67±1.63)min,逐渐延长并在致伤后1 h延长至(7.60±3.30)min,再次缩短(P<0.05);凝血形成时间(K)值和血栓最大振幅(MA)值各时相点比较差异无统计学意义(P>0.05).结论 成功地建立家兔骨盆冲击破片伤模型,其早期伤情重且变化快,需要采用综合性复苏策略.

OBJECTIVE: Damage control surgery (DCS) is a life-saving procedure for explosion-induced abdominal injury (EIAI). We aimed to establish an augmented reality (AR)-based t raining platform for training on the key DCS procedures for EIAI and to test whether it can improve the non-technical skills (NTSs) involved in DCS and for the transfer of training to real practice.METHODS: The key procedures and the list of NTSs involved in DCS for EIAI were established. Subsequently, videos and images relevant to the key procedures were extracted to generate the animation, and the NTSs list was incorporated into the animation. Then training software was developed and installed in AR glasses. Thirty-two trainees were divided into four groups (n = 8 per group): trainees in group A and group C were novice surgeons that received traditional training and training with the AR simulator respectively, and trainees in group B and group D were experienced surgeons that received traditional training and training with the AR simulator respectively. After training, the effectiveness of transfer into real practice was tested using an animal model-based test. The trainees were asked to rate their attitude toward the platform with a questionnaire.RESULTS: An AR platform containing the established key procedures and the NTSs list was successfully constructed. Group C trainees had higher total scores and higher scores on NTSs and technical skills than those in group A in the test. However, Group D trainees only got higher scores on NTSs than those in group B. The survey revealed that trainees were satisfied with the platform, although the experienced surgeons didn’t agree that the platform was helpful in improving technical skills.CONCLUSION: We constructed an AR training platform for DCS following EIAI, which improved the NTSs of all participants, in addition to improving the technical skills of novices.

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.