BACKGROUND:The transfusion of uncross-matched O-type red blood cells(URBCs)is the global standard of care for emergency resuscitation in trauma.However,its application in China remains limited due to concerns over safety and resource availability.This study aimed to evaluate the clinical efficacy and safety of URBCs in patients with severe pelvic fractures. METHODS:In this multicenter,retrospective cohort study(2019-2023),patients with severe pelvic fractures(Abbreviated Injury Scale[AIS]≥3)transfused within 24 h of admission were stratified into the URBC and non-URBC groups.Propensity score overlap weighting(PSOW)was used to address confounding factors.The primary outcome was 30-day in-hospital mortality.Secondary outcomes included length of stay(LOS),24-hour blood product consumption,and in-hospital complications. RESULTS:A total of 526 patients were included(URBC group,n=57;non-URBC group,n=469).After PSOW adjustment,there was no significant difference in 30-day mortality(21.4%vs.21.3%,P=0.989)between the URBC and non-URBC groups.However,the URBC group received significantly lower volumes of plasma,platelets,and cryoprecipitate within the first 24 h(all P<0.05).No clinically significant acute hemolytic transfusion reactions were observed during the study period.Furthermore,subgroup analysis of non-O-type blood recipients(57.1%)showed no significant differences in mortality compared with their O-type counterparts,and no acute hemolytic transfusion reactions were observed. CONCLUSION:Early administration of URBCs for severe pelvic fractures is safe.While not associated with increased mortality or hemolytic transfusion reactions,early use of URBCs was linked to a significant reduction in coagulation-related blood product consumption.This study provides evidence supporting the implementation of URBC within resource-constrained trauma setting to improve resuscitation efficiency.

BACKGROUND:Internal iliac artery embolization (IIAE) is a critical hemostatic intervention for controlling hemorrhage in patients with hemodynamically unstable pelvic fractures (HUPF). However, the optimal technique-nonselective versus selective embolization-and the choice of embolic materials remain debated. This study compares the efficacy, safety, and clinical outcomes of nonselective embolization (NSE) and selective embolization (SE) techniques in patients with HUPF. A secondary analysis examined the impact of different embolic materials on patient outcomes. METHODS:This multicenter retrospective study included patients aged 16 and older with HUPF who underwent IIAE. Patients were categorized into NSE or SE groups. Key outcomes included 24-h red blood cell (RBC) transfusion volume, duration of angioembolization (AE), complications, mortality, and infection rates. Propensity score overlap weighting (PSOW) was used for comparisons, with validation via propensity score matching (PSM). Subgroup analyses also employed PSOW to assess outcomes based on embolic materials. RESULTS:A total of 296 patients with HUPF met the inclusion criteria, with 214 undergoing NSE and 82 receiving SE. After PSOW, near-perfect comparability between the two groups was achieved (SMDs = 0). The NSE group had significantly lower 24-h RBC transfusion volumes (2.00 vs. 4.00 units, MD, -2 units; 95% CI, -2.0 to 0; and p = 0.018) and shorter AE duration (65 vs. 80 min, MD, -15 min; 95% CI, -20 to -5.16; and p < 0.001). NSE group also required less 24-h plasma transfusion. Although the NSE group showed higher rates of deep vein thrombosis and urinary tract infection in PSOW analysis, subsequent PSM analysis revealed no significant differences between groups. Similarly, both groups showed comparable rates of other complications, hospital costs, and mortality rates. Subgroup analysis showed that the gelatin sponge (GS) group had higher 24-h RBC transfusion volumes and longer AE durations, though these were not statistically significant. Notably, the GS group had significantly higher rates of pulmonary infections and incision/pin tract infections. CONCLUSION:Nonselective embolization appeared to be associated with reduced RBC transfusion needs and provide faster hemorrhage control, though this did not translate to a survival benefit. The evidence regarding NSE's effect on specific complication risks was inconclusive. Subgroup analysis showed coils were associated with fewer complications than GS. Further prospective studies are needed to clarify the optimal technique and materials.

The bone fixation implants in the clinic are prone to inflammation and thrombosis that result in efficacy and patient health risks. This paper introduces chitosan microsphere-enhanced poly(sulfobetaine) (CSM/PSBMA) zwitterionic hydrogel coated on the surface of polylactic acid (PLA) fracture fixation devices through interfacial autocatalytic polymerization and in situ gelation. CSM as a disperse phase improves both the mechanical strength and swelling resistance of the PSBMA matrix of the continuous phase. The CSM/PSBMA hydrogel coating keeps the superhydrophilicity and excellent antifouling properties of the pure PSBMA hydrogel coating. In particular, the CSM/PSBMA hydrogel coating still exhibits good stability after 30 days of PBS immersion, 7 days of PBS shearing, 30 min of PBS ultrasonication, and 30 min of water flushing. Furthermore, the CSM/PSBMA hydrogel-coated PLA implants can alleviate foreign body reaction and accelerate the bone repair in the rat femoral fracture model. This brings a promising path for devising zwitterionic hydrogel coatings for implantable medical devices.

BackgroundHemodynamically unstable pelvic fractures (HUPF) in skeletally immature children and adolescents carry significant mortality. While internal iliac artery embolization (IIAE) is a cornerstone of management for HUPF in adults, data on its application and outcomes in this truly pediatric population, particularly in China, are scarce. This study aimed to evaluate the feasibility, safety, and clinical outcomes of IIAE for HUPF in this specific, vulnerable group.MethodsThis multicenter, retrospective case series included patients aged 15 years or younger who presented with HUPF and underwent IIAE at three major Chinese trauma centers between 2019 and 2023. Key outcomes included immediate hemorrhage control, in-hospital mortality, and long-term complications.ResultsA total of seven patients underwent IIAE. The cohort demonstrated severe trauma, with a median Pelvic Abbreviated Injury Scale (AIS) of 5 and a median Injury Severity Score (ISS) of 36. Of the six patients who underwent contrast-enhanced computed tomography (CECT), active arterial extravasation was identified in four. However, subsequent angiography confirmed life-threatening arterial injuries in all seven patients, including the two with negative CECT scans. Immediate and sustained hemodynamic stability was achieved in six patients (85.7%). The single mortality occurred in a patient with refractory hemorrhagic shock who required a massive transfusion of 28.5 units of red blood cells, whereas the median for the six survivors was 4 units. At a median follow-up of 22 months, all survivors were ambulatory and no major procedure-related ischemic complications were observed.ConclusionIIAE is a feasible and effective life-saving intervention for HUPF in skeletally immature patients. A negative CECT scan does not rule out significant arterial injury, underscoring the vital role of prompt angiography. We recommend a low threshold for early intervention, with consideration of non-selective embolization as a primary damage control tactic in these critically injured children.

Background This study aimed to determine the incidence and influencing factors of venous thromboembolism (VTE) in patients with traumatic rib fractures. Methods The retrospective study analyzed medical records of patients with traumatic rib fractures from 33 hospitals. Results The overall incidence of VTE in hospitalized patients with traumatic rib fractures was 8.1%. Patients with isolated traumatic rib fractures had a significantly lower incidence of VTE (4.4%) compared to patients with rib fractures combined with other injuries (12.0%). Multivariate analysis identified the number of rib fractures as an independent risk factor for thrombosis. Surgical stabilization of isolated rib fractures involving three or more ribs was associated with a lower VTE incidence compared to conservative treatment. Conclusions Patients with rib fractures have a higher incidence of VTE, positively correlated with the number of rib fractures. However, the occurrence of thrombosis is relatively low in isolated rib fractures. Targeted thromboprophylaxis strategies should be implemented for these patients, and surgical stabilization of rib fractures may be beneficial in reducing the risk of VTE.

目的 探讨超声引导胸椎旁神经阻滞对单侧多发肋骨骨折非手术治疗患者镇痛的疗效.方法 回顾性分析2015 年1 月—2019 年12 月联勤保障部队第九〇九医院心胸外科收治的156 例单侧多发肋骨骨折非手术治疗患者的临床资料,男性92 例,女性64 例;年龄25～72 岁,平均49.4 岁.根据镇痛模式分为超声引导胸椎旁神经阻滞镇痛组(神经阻滞组)71 例和静脉自控镇痛组(静脉自控组)85 例.比较两组患者镇痛前5min及镇痛后1、6、24、48、72h静息和咳嗽咳痰时疼痛数字评分量表(numerical rating scale,NRS)评分,相应时间点第1 秒用力呼气容量(forced expiratory volume in the first second,FEV1)和FEV1 占用力肺活量百分比(FEV1/forced vital capacity,FEV1%),白细胞计数、住院期间并发症发生率,总住院时间及随访6个月患者健康状况调查量表(36-item short form health survey,SF-36)评分.结果 患者均获6 个月随访.镇痛前5min,静息时和咳嗽咳痰时NRS评分、FEV1、FEV1%、白细胞计数两组比较,差异均无统计学意义(P>0.05),而镇痛后1、6、24、48、72h,神经阻滞组均优于静脉自控组,差异有统计学意义(P<0.05).胸椎旁神经阻滞组住院期间并发症发生率为5.6%,低于静脉自控镇痛组的11.8%(P<0.05);胸椎旁神经阻滞组镇住院时间(8.1±1.5)d,短于静脉自控镇痛组的(11.4±2.3)d(t =3.586,P<0.005);与静脉自控组比较,出院后1 个月NRS评分[(2.3±0.4)分 vs.(3.1±0.6)分]、2 个月NRS评分[(1.7±0.6)分 vs.(2.2±0.5)分]、3 个月NRS评分[(0.6±0.3)分 vs.(1.5±0.4)分]比较,差异均有统计学意义(P<0.05).两组出院后1 个月SF-36 评分[(83.76±11.24)分 vs.(72.68±9.86)分]、2 个月SF-36 评分[(88.76±8.83)分 vs.(84.57±9.67)分]、3 个月SF-36 评分[(94.76±3.23)分 vs.(89.54±5.78)分]比较,差异均有统计学意义(P<0.05);3 个月后两组患者NRS评分及SF-36 评分比较,差异均无统计学意义(P>0.05).结论 超声引导胸椎旁神经阻滞对单侧多发肋骨骨折非手术治疗患者具有镇痛效果好、加速肺功能恢复、降低早期应激反应、减少并发症发生和缓解慢性疼痛的优点,提高患者的生活质量.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Background: Camrelizumab has been demonstrated to be a feasible treatment option for locally advanced esophageal squamous cell carcinoma (ESCC) when combined with neoadjuvant chemotherapy. This trial was conducted to investigate the effectiveness and safety of camrelizumab-containing neoadjuvant therapy in patients with ESCC in daily practice.Methods: This prospective multicenter observational cohort study was conducted at 13 tertiary hospitals in Southeast China. Patients with histologically or cytologically confirmed ESCC [clinical tumor-node metastasis (cTNM) stage I-IVA] who had received at least one dose of camrelizumab-containing neoadjuvant therapy were eligible for inclusion.Results: Between June 1, 2020 and July 13, 2022, 255 patients were enrolled and included. The median age was 64 (range, 27 to 82) years. Most participants were male (82.0%) and had clinical stage III-IVA diseases (82.4%). A total of 169 (66.3%) participants underwent surgical resection; 146 (86.4%) achieved R0 resection, and 36 (21.3%) achieved pathological complete response (pCR). Grades 3-5 adverse events (AEs) were experienced by 14.5% of participants. Reactive cutaneous capillary endothelial proliferation occurred in 100 (39.2%) of participants and all were grade 1 or 2. Conclusions: Camrelizumab-containing neoadjuvant therapy has acceptable effectiveness and safety profiles in real-life ESCC patients.

目的 分析肺癌合并结核分枝杆菌(MTB)感染患者外周血微小RNA(miR)-20a、细胞周期蛋白D1(CCND1)表达水平及与预后的关系.方法 选取2016年2月-2019年2月在中国人民解放军联勤保障部队第909医院诊治的120例肺癌患者为研究对象,根据痰液MTB培养结果分为MTB感染组(56例)和未感染组(64例).采用实时荧光定量聚合酶链式反应检测所有患者外周血miR-20a、CCND1、转化生长因子-β1(TGF-β1)、Toll样受体4(TLR4)表达水平,分析miR-20a、CCND1表达与临床特征的关系.并对所有患者进行3年内随访,记录患者生存状态,Kaplan-Meier生存曲线分析miR-20a、CCND1与MTB感染肺癌患者及非MTB感染肺癌患者预后的关系.结果 感染组肺癌患者外周血miR-20a、CCND1、TGF-β1、TLR4表达均高于未感染组(P＜0.05),Pearson相关性结果显示,外周血miR-20a、CCND1表达均与TGF-β1、TLR4表达呈正相关(P＜0.05).外周血miR-20a、CCND1表达与MTB感染、临床分期、组织学分级有关(P＜0.05),与组织学类型无关.MTB感染与未感染肺癌患者外周血miR-20a、CCND1高表达患者3年生存率均低于低表达患者(P＜0.05).结论 MTB感染肺癌患者预后情况较非MTB感染肺癌患者恶化,miR-20a、CCND1的高表达可能是导致上述结果的重要机制.

目的 探讨切开复位内固定手术治疗胸骨骨折合并肋软骨骨折的疗效.方法 回顾性分析2013 年 10 月—2021 年 9 月联勤保障部队第九〇九医院心胸外科收治的胸骨骨折合并肋软骨骨折患者 78例,男性 43 例,女性 35 例;年龄 18～60 岁,平均 42.0 岁.胸骨角骨折 14 例,胸骨体骨折 64 例;单侧肋软骨骨折 42 例,双侧肋软骨骨折 36 例;患者均合并纵隔挫伤.受伤至手术时间 0～2d,平均 1.1d.根据胸部固定方式不同分为治疗组(46 例)和对照组(32 例),治疗组行骨折切开复位内钢板固定手术,对照组行胸部护板胸壁外固定术.比较术前5min和术后1～7d静息和咳嗽咳痰时疼痛数字评分量表(numerical rating scale,NRS)评分,相应时间点第一秒用力呼气容量(forced expiratory volume in the first second,FEV1)和FEV1 占用力肺活量百分比(forced expiratory volume in the first second/forced vital capacity,FEV1%),疼痛持续时间,总住院时间,骨痂形成时间,术后肺部感染并发症发生率以及术前 5min及术后 1、3、6 个月和末次随访健康状况调查简表(short-form 36 health survey scale,SF-36)评分.结果 患者均获随访 12 个月,两组患者术前5min静息时NRS评分[(8.8±0.3)分 vs.(8.7±0.4)分],咳嗽咳痰时NRS评分[(9.0±0.5)分vs.(9.1±0.4)分],差异无统计学意义(P＞0.05).术后 1～7d静息和咳嗽咳痰时NRS评分比较差异有统计学意义(P＜0.001).两组患者术前 5min FEV1[(1.8±0.2)L vs.(1.7±0.3)L],FEV1%[(56.3±7.7)%vs.(55.6±8.5)%]比较差异无统计学意义(P＞0.05).术后 1～7d相应时间点FEV1、FEV1%比较差异有统计学意义(P＜0.001).治疗组较对照组疼痛持续时间短[(7.9±0.8)d vs.(16.9±0.5)d],总住院时间短[(7.5±1.8)d vs.(10.7±1.9)d],骨痂形成时间短[(2.5±0.4)周 vs.(3.2±0.8)周],术后肺部感染发生率低(6.5%vs.21.8%),差异有统计学意义(P＜0.001).两组术前 5min SF-36 评分[(53.3±2.7)分 vs.(54.6±3.5)分],差异无统计学意义(P＞0.05).与对照组比较,治疗组术后 1 个月[(73.4±10.9)分 vs.(64.7±11.6)分]、3 个月[(85.6±8.7)分 vs.(78.2±11.4)分]、6 个月[(87.6±5.1)分 vs.(82.5±7.8)分]、末次随访[(88.6±5.4)分 vs.(84.3±3.9)分]患者生活质量评分均提升,差异有统计学意义(P＜0.001).结论 切开复位内固定手术治疗胸骨骨折合并肋软骨骨折可缓解疼痛,促进肺功能恢复,缩短总住院时间及术后骨痂形成时间,降低术后肺部感染的发生率,改善患者的生活质量.

目的 评估不同机械通气模式治疗重度肺爆震伤致顽固性低氧血症的效果,为重度肺爆震伤的救治提供科学依据.方法 回顾性分析2010年8月—2018年7月联勤保障部队第九〇九医院心胸外科符合纳入标准的36例重度肺爆震伤致顽固性低氧血症患者,男性24例,女性12例;年龄15～65岁,平均36.5岁;致伤原因:锅炉爆震伤9例,化工厂爆震伤8例,粉尘爆震伤1例,煤气罐爆震伤15例,地下矿井瓦斯爆震伤2例,炮弹爆震伤1例.按机械通气模式分为辅助/控制模式组(A/C通气模式组)20例、辅助/控制并逐渐改为间歇辅助通气(SIMV)和压力支持通气(PSV)模式组(A/C→SIMV→PSV通气模式组)16例.分析对比两组患者的肺动脉压(PAP)、肺动脉楔压(PAWP)、心输出量(CO)、心脏指数(CI)、外周循环阻力(SVR)、肺循环阻力(PVR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血pH值(pH)、混合静脉血氧分压(PvO2)、混合静脉血二氧化碳分压(PvCO2)、氧供给(DO2)、氧消耗(VO2)、氧摄取率(O2 ER)、氧合指数(PaO2/FiO2)、肺静态顺应性(Cst)、气道峰值压(PIP)和相关并发症发生情况.结果 A/C通气模式组呼气末正压通气(PEEP)在5～10cmH2O范围内,PaO2、PaO2/FiO2、DO2和Cst随着PEEP的增高而逐渐增加(P<0.05).PEEP增加到15cmH2O时CO和Cst下降,SVR、PVR和PIP增加(P<0.05).A/C→SIMV→PSV通气模式组SIMV与A/C模式组相比可增加DO2(P<0.05),PSV与A/C相比可降低PIP并使Cst增加(P<0.05).SIMV和PSV方式均可降低SVR.两组相关并发症发生率比较差异无统计学意义(P>0.05).结论 重度肺爆震伤致顽固性低氧血症患者早期采用A/C模式通气治疗,PaO2稳定后改为SIMV或PSV模式,可提高机体氧合,减少对呼吸、血流动力学的影响.

The principle of early treatment for severe cardiopulmonary trauma is to correct respiratory and circulatory insufficiency, especially for the type of injury caused by various types of trauma such as severe alveolar oxygen exchange dysfunction, intrapulmonary hemorrhage, massive pulmonary atelectasis and extensive subendocardial hemorrhage. Conventional treatment is not effective, and the timely use of cardiopulmonary replacement function of extracorporeal membrane oxygenation (ECMO) can better overcome this problem. ECMO is a life-support technology for patients with severe cardiopulmonary insufficiency, which can partially replace the functions of heart pumping and lung oxygenation for a longer period of time so as to creat opportunities for waiting for organ function recovery and providing bridging therapy. The author discusses the mechanism of action and clinical application of ECMO and the application, deficiencies and countermeasures of ECMO in severe cardiopulmonary trauma so as to provide some theoretical and practical references for improving the quality and process of ECMO treatment.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

现代战伤中爆炸伤伤情复杂、危重,救治难度大,而胸部爆炸伤则是最常见也是致死率最高的伤类之一,能否及时、有效地维持呼吸、循环功能稳定是关键.因和平时期少见等因素,医护人员常缺乏救治经验,从而导致救治不规范、效果不佳.鉴于此,中华医学会创伤学分会组织专家撰写发布了《胸部爆炸伤紧急救治临床指南》(简称"临床指南"),本文就"临床指南"的主要观点作一解读,供可能参与胸部爆炸伤救治的医护人员借鉴和参考.

Objective:To compare effect of internal fixation of ribs assisted by complete thoracoscopy and thoracotomy for flail chest.Methods:A retrospective cohort study was used to analyze the clinical data of 86 patients with flail chest treated at No.2 Hospital of Nanping City and 900th Hospital of Joint Logistics Support Force between January 2019 and December 2020, including 58 males and 28 females; aged 25-69 years [(42.9±9.5)years]. A total of 45 patients underwent internal fixation of ribs assisted by complete thoracoscopy (thoracoscopy group), and 41 patients by thoracotomy (thoracotomy group). The operation time, number of fixed ribs, intraoperative blood loss, ventilation time, postoperative length of hospital stay, hemodynamic indicators [partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2)] before surgery and at 1 day after surgery, respiratory function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal voluntary ventilation (MVV)] at 1, 3, 6 and 12 months after surgery and postoperative complications were compared between the two groups. Results:All patients were followed up for 12-18 months [(14.1±1.9)months]. Thoracoscopy group showed prolonged operation time [(139.5±36.4)minutes vs. (114.8±32.5)minutes], reduced intraoperative blood loss [(124.6±42.4)ml vs. (198.6±62.6)ml] as well as shortened ventilation time [(4.0±1.1)days vs. (6.7±1.6)days] and postoperative length of hospital stay [(14.9±2.4)days vs. (17.9±3.7)days] when compared with thoracotomy group (all P<0.01). There was no statistical significance in the number of fixed ribs between the two groups ( P>0.05). There were no statistical differences in PaO 2, PaCO 2 or PaO 2/FiO 2 between the two groups before surgery (all P>0.05). At day 1 after surgery, the PaO 2 and PaO 2/FiO 2 in thoracoscopy group were (86.2±5.4)mmHg and 321.4±36.1, higher than (80.1±6.2)mmHg and 286.0±29.3 in thoracotomy group (all P<0.01); the PaCO 2 was (37.4±2.4)mmHg in thoracoscopy group, lower than (40.0±3.1)mmHg in thoracotomy group ( P<0.01). At 1 month, 3 months, 6 months and 12 months after surgery, the FVC was (75.5±10.9)%, (84.5±10.5)%, (93.1±12.8)% and (102.6±17.5)% in thoracoscopy group, higher than (69.2±9.9)%, (78.3±8.9)%, (86.2±10.4)% and (92.4±14.8)% in thoracotomy group; the FEV1 was (76.9±9.3)%, (88.4±12.9)%, (92.4±13.9)% and (98.5±10.6)% in thoracoscopy group, higher than (72.9±8.5)%, (82.8±11.4)%, (86.4±12.7)% and (93.5±11.9)% in thoracotomy group; the MVV was (78.3±13.4)L/min, (87.5±13.5)L/min, (94.6±14.7)L/min and (100.1±11.9)L/min in thoracoscopy group, higher than (72.5±11.6)L/min, (80.5±12.7)L/min, (86.5±13.5)L/min and (92.8±10.3)L/min in thoracotomy group (all P<0.05). There were no thoracic deformities in the two groups after surgery. There was no statistical significance in incision infection rate between the two groups ( P>0.05). The incidence rate of pulmonary infection, atelectasis and pleural effusion was 11.1% (5/45), 6.7% (3/45) and 11.1% (5/45) in thoracoscopy group, lower than 29.3% (12/41), 24.4% (10/41) and 31.7% (13/41) in thoracotomy group (all P<0.05). Conclusion:Although internal fixation of ribs with complete thoracoscopy has longer surgical time than thoracotomy in the treatment of flail chest, it can decrease intraoperative blood loss, ventilation time and length of hospital stay and is more conducive to improving the respiratory function and reducing complication rate.

Objective:To investigate the effect of timing of rib internal fixation on early curative effect of patients with severe rib fracture complicated with respiratory failure.Methods:A retrospective cohort study was conducted on clinical data of 33 patients with multiple rib fracture complicated with respiratory failure admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xiamen University Medical College) from January 2018 to October 2019.There were 26 males and 7 females; aged 60-87 years [(67.9±6.7)years]. The time interval from injury to open reduction and internal fixation was within 3 days in 16 patients (early operation group) and over 3 days in 17 patients (later operation group). The number of fixed ribs, operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and lenghth of hospital stay were compared in the two groups. The numeric rating scale (NRS) pain score was assessed at postoperative 1, 3 and 7 days. Postoperative complications were detected as well.Results:All patients were followed up for 8-24 months [(16.5±4.3)months]. Number of fixed ribs was not statistically different between the two groups ( P>0.05). The operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and length of hospital stay in early operation group [(67.3±11.2)minutes, (103.9±28.2)hours, (5.2±1.9)days, (6.4±2.8)days, (12.5±3.5)days] were shorter than those in late operation group [(108.4±18.4)minutes, (160.8±89.3)hours, (10.1±2.3)days, (9.5±2.2)days, (18.0±4.5)days] ( P<0.05 or 0.01). The NRS score was (6.6±0.6)points, (3.3±0.6)points and (2.7±0.8)points in early operation group at postoperative 1, 3 and 7 days, significantly lower than those in late operation group [(7.4±1.1)points, (4.9±1.1)points, (3.9±0.7)points] ( P<0.05 or 0.01). The total complication rate was 25.0%(4/16) in early operation group, lower than 70.6%(12/17) in late operation group ( P<0.05). Conclusion:For severe rib fracture complicated with respiratory failure, early open reduction and internal fixation can effectively reduce operation time, duration of mechanical ventilation, lenghth of ICU stay, chest tube indwelling time and lenghth of hospital stay, early relieve pain and decrease complications rate when compared with late operation.

250 Background: Camrelizumab, a fully humanized monoclonal anti-PD-1 antibody, has shown promising efficacy with good tolerance in neoadjuvant therapy of resectable locally advanced esophageal cancer (EC). The present study aimed to investigate the effectiveness and safety of camrelizumab-based neoadjuvant therapy in a comparatively larger number of resectable EC patients in a real-world setting and initial results were reported here. Methods: In this prospective multicenter observational study (ChiCTR2000039170), patients with histologically confirmed resectable EC who were scheduled for camrelizumab-based neoadjuvant therapy at the discretion of treating physicians/ oncologists were included. Eligible patients were aged ≥ 18 years, had ECOG PS of 0-1, measurable disease per RECIST v1.1, adequate organ function, and expected survival time of ≥ 3 months, as well as provided written informed consent. The primary endpoint was safety. The secondary endpoints were major pathologic response (MPR), pathologic complete response (pCR), R0 resection rate, overall response rate (ORR), one-year overall survival (OS) rate, and disease-free survival (DFS). Results: At total of 166 patients (62.9 ± 9.2 years, and 84.2% male) were enrolled between October 20 2020 and August 26 2021. All patients received neoadjuvant camrelizumab plus chemotherapies (primarily nab-paclitaxel and nedaplatin) except one receiving camrelizumab alone. Overall, 109 patients (65.7%) experienced treatment-related adverse events (TRAEs), most commonly reactive cutaneous capillary endothelial proliferation (RCCEP, 45.3%), cough (10.4%), and pneumonia (8.5%). Thirteen (7.8%) patients experienced grade 3-4 TRAEs. There was no grade 5 toxicity. At the data cutoff, 141 (84.9%) patients were evaluable for radiological response, 82 (69.5%) patients underwent surgical resection. The ORR was 70.9% (100/141) and the R0 resection rate was 97.5% (79/82). Among the 81 patients available for pathologic assessment, 51 (63.0%) patients achieved MPR and of which, 15 (18.5%) had pCR. The median survival times have not been reached at the time of data analysis. Conclusions: The real-world data of our resectable EC patients showed effectiveness and safety profiles of camrelizumab-based neoadjuvant therapy consistent with those observed in previous trials.

Objective:To compare the efficacy of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 192 patients with multiple rib fracture treated in 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2020 to January 2022. There were 101 males and 91 females; aged 32-94 years [(51.5±16.6)years]. The patients underwent open reduction and internal fixation with nickel-titanium shape memory alloy embracer via standard incision such as anterior axillary longitudinal incision (standard incision group, n=96) or conventional incision such as posterolateral incision (conventional incision group, n=96). The incision length, operation time, intraoperative blood loss, number of fixed fractures, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time and length of hospital stay were compared in the two groups. The visual analogue scale (VAS) was used to evaluate pain at 1 month after operation. Postoperative complications were recorded. Results:All patients were followed up for 1-16 months [4.0(3.0, 10.5)months]. The operation time, intraoperative blood loss, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time, length of hospital stay and VAS at postoperative 1 month in standard incision group [(12.1±1.6)cm, (51.4±13.0)minutes, (191.5±16.8)ml, (2.8±0.6)days, (568.9±109.0)ml, (4.1±0.7)days, (11.4±1.7)days, (2.5±0.7)points] were better than those in conventional incision group [(13.7±1.9)cm, (62.0±8.8)minutes, (248.9±65.4)ml, (4.8±1.1)days, (655.9±121.9)ml, (5.2±0.9)days, (15.3± 1.7)days, (3.5±0.7)points] ( P<0.05 or 0.01). There was no statistical difference in the number of fixed fractures between standard incision group and conventional incision group (5.1±0.8 vs. 5.4±0.9) ( P>0.05). In standard incision group, there were 3 patients with poor wound healing, 5 with pulmonary infection, 3 with atelectasis and 3 with small pleural effusion. In conventional incision group, there were 11 patients with poor wound healing, 9 with pulmonary infection, 7 with atelectasis and 7 with small pleural effusion. The incidence of postoperative complications was 14.6% (14/96) in standard incision group and 35.4% (34/96) in conventional incision group ( P<0.01). Conclusion:For multiple rib fracture, standard incision is superior to conventional incision reduction in shortening the incision length, operation time, indwelling time of drainage tube, postoperative spontaneous ambulation time and length of hospital stay, reducing the intraoperative blood loss and postoperative thoracic drainage volume, alleviating the pain and reducing the postoperative complications.

Objective:To compare the clinical efficacy of extracorporeal membrane oxygenation (ECMO) and ventilation therapy in the treatment of severe blast lung injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with severe blast lung injury admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2000 to December 2021, including 23 males and 14 females; aged 26-50 years [(36.3±11.1)years]. The chest abbreviated injury score (AIS) was 3-5 points. In all, 16 patients were treated with ECMO from January 2017 to December 2021 (ECMO group) and 21 with ventilator from January 2000 to December 2016 (ventilator group). Blood gas analysis indexes [arterial pH, partial pressure of carbon dioxide (PaCO 2), partial pressure of oxygen (PaO 2), blood lactate (Lac)] and hemodynamics indexes [central venous pressure (CVP), cardiac output index (CI), pulmonary arterial systolic pressure (PASP), pulmonary capillary wedge pressure (PAWP)] were compared in the two groups at 30 minutes before treatment and at 2, 4, 6 hours after treatment. The mechanical ventilation time, ICU length of stay, acute physiology and chronic health evaluation II (APACHE II) score and mortality were measured at 7 days after treatment. Results:All patients were followed up for 24-48 months [(33.6±8.2)months]. The blood gas analysis and hemodynamic indexes were significantly improved in the two groups at 2, 4, 6 hours after treatment when compared with those at 30 minutes before treatment (all P<0.05), and the improvements were still statistically significant in ECMO group at 4, 6 hours after treatment when compared with those at 2 hours after treatment (all P<0.05), while not in ventilator group (all P>0.05). There was no significant difference in blood gas analysis indexes or hemodynamic indexes between the two groups at 30 minutes before treatment (all P>0.05). After treatment for 2, 4, 6 hours, blood gas analysis indexes and hemodynamic indexes in ECMO group were statistically different from those in ventilator group (all P<0.05). After treatment for 7 days, the mechanical ventilation time, ICU length of stay, APACHE II score and mortality were (3.2±1.2)days, (5.4±1.3)days, (14.1±3.3)points and 12.5% (2/16) in ECMO group, significantly different from (5.1±1.6)days, (7.6±1.6)days, (10.2±2.6)days and 28.6% (6/21) in ventilator group (all P<0.05). Conclusion:For severe blast lung injury, ECMO can attain rapid and continuous improvement of refractory hypoxemia and dyspnea, shorten the duration of mechanical ventilation and ICU length of stay and reduce the mortality rate when compared with ventilator therapy.

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.