Traumatic main bronchus rupture is a relatively rare injury in thoracic trauma, which is extremely critical, with a mortality rate as high as 70% – 80%. The complete rupture and displacement of the traumatic cervical trachea can lead to asphyxia, hypoxia, and cardiac arrest, even death of the patient in a short time. We performed emergency surgery with the support of extracorporeal membrane oxygenation for a case of traumatic cervical tracheal trunk complete rupture and displacement combined with cardiac arrest and achieved a successful rescue. We summarized our experience and found that timely surgical reconstruction of the airway is the key to increasing the traumatic main bronchus rupture survival of patients.

本文报道1例体外膜肺氧合（ECMO）支持抢救成功的16岁男性青少年严重胸部挤压伤患者，经传统机械通气治疗无效，予以早期实施静脉-静脉ECMO，辅以支气管镜下肺泡灌洗、抗感染、稳定内环境、输血、胸腔镜下手术等治疗，最终痊愈出院。

急性脑梗死(ACI)是一种急性缺血性脑血管疾病,具有高发病率、高致残率和高病死率等特点[1-2].研究指出,miRNA在脑血管疾病的发生和预后中起着重要的作用,但其确定的基因靶标和信号通路仍不十分清楚[3].miR-122是一种机体组织特异性miR-NA,参与调节机体神经发育过程,并在脑组织缺血、缺氧、脑梗死的发生发展过程中扮演重要角色,并与脑梗死病情及预后密切相关[4].miR-206属于miR-1家族成员之一,具有调控细胞生长、增殖及凋亡等作用[5].本研究旨在探讨ACI患者血清miR-206、miR-122表达水平及其诊断价值,报道如下.

目的 探讨体外膜肺氧合(ECMO)救治严重创伤患者的适应证及抗凝方案并复习文献.方法 选择 2019 年 8 月至 2022 年 8 月嘉兴市第一医院ECMO团队救治的 8 例严重创伤所致呼吸衰竭、心力衰竭及心搏骤停患者作为研究对象.收集患者一般资料、受伤机制、伤情资料、ECMO支持情况、抗凝方案和出院存活率等,结合文献分析ECMO在救治严重创伤患者中的价值.结果 8 例严重创伤患者中,男性 7 例,中位年龄 45.5(16.0～77.0)岁,中位创伤严重度评分(ISS)24.5(16.0～75.0)分.受伤原因包括交通事故伤和挤压伤.4 例患者因严重呼吸衰竭使用静脉-静脉ECMO(VV-ECMO),其中 3 例为严重肺挫裂伤,1 例为支气管断裂合并肺挫裂伤;4例使用静脉-动脉ECMO(VA-ECMO),其中1例心源性休克,1例心脏破裂,2例心搏骤停.在严密监测下选择抗凝时机:1 例全程(8 d)无肝素抗凝,4 例短期(72h内)无肝素抗凝,2 例在 24h内开始低剂量肝素抗凝;8 例均未出现不可控大出血情况,3 例出现下肢肌间静脉血栓,2 例出现腓静脉血栓,1 例发生股动脉血栓.8 例全部成功撤机,7 例存活出院(存活率为 87.5%).结论 ECMO在严重创伤中可作为最后的救治手段,严重肺挫裂伤、心脏挫伤及心搏骤停可作为ECMO的适应证,应在密切监测下选择个体化抗凝方案.

Objective:To evaluate the effect of immersive virtual reality(IVR) combined with high simulation makeup technology in the training of emergency medical rescue in disaster scene.Methods:From April 2021 to December 2021, a total of 97 undergraduates from five-year program of clinical medicine enrolled in 2018 in Jiaxing University College of Medicine received the training of emergency medical rescue in disaster scene .They were divided into traditional teaching group (49 students) and IVR teaching group (48 students). PBL method was adopted in the traditional teaching group and IVR combined with high simulation makeup technology was adopted in the IVR teaching group .By the end of the course, the teaching effect has been evaluated by the final exam results of the two groups and the questionnaire survey of the IVR teaching group. The final results between the two groups were compared using the t-test or the chi-square test. Results:The questionnaire survey in IVR teaching group showed that 93.6% (44/47) students recognized the teaching method of IVR combined with high simulation makeup technology which provided a good environmental experience in disaster scene, 83.0% (39/47) students believed that this teaching method had a good sensory experience and 83.0% (39/47) of them experienced encouragement to their active learning. The average exam score related to emergency medical rescue in IVR teaching group were significantly higher than that in the traditional teaching group [(9.10±2.36) vs. (7.11±1.65), P<0.001]. Conclusions:IVR combined with high simulation makeup technology can improve students' environmental experience and sensory experience in the training of emergency medical rescue in disaster scene, which meet the needs from students and thus improve the quality of teaching.

1 资料与方法 患者男性,55岁,2021-08-21 06:50被卡车撞击并挤压胸腹部,当即感胸腹部剧烈疼痛,伴有胸闷气急,无昏迷,无头痛,无咯血,无呕吐呕血,无便血,无血尿,无肢体活动障碍等,30 min后送入入当地医院急诊科,查体示意识模糊,体温36.8℃,血压52/31 mmHg,呼吸19次/min,脉搏78次/min,双侧瞳孔2.5 mm,对光反射迟钝,胸背部可见散在淤青,胸廓无明显畸形,双肺呼吸音粗糙,未闻及干湿性啰音,心率78次/min,律不齐,心音偏低,未闻及病理性杂音,腹平软,上腹部压痛,无明显反跳痛,移动性浊音可疑,肠鸣音2～3次/min,骨盆挤压痛阴性,余查体正常.

Objective:To investigate the value of regional collaborative multi-hospital teamwork (MHT) in the treatment of patients with hemodynamically unstable pelvic fracture.Methods:A retrospective analysis was performed on 78 patients with hemodynamically unstable pelvic fractures treated by Jiaxing Regional Advanced Trauma Center from January 2018 to June 2021, including 40 patients treated by MHT mechanism as MHT group and 38 patients treated by multi-disciplinary teamwork (MDT) as MDT group. The general information, main injury mechanism, severity of trauma, main laboratory results, time nodes, hospitalization indicators and prognosis of the two groups were observed and compared.Results:There were no significant differences in gender, age, TI score and ISS score between two groups (P>0.05). Traffic accident was the main injury mechanism in both groups (42.5%vs60.5%), and the difference was not statistically significant (χ2=3.899, P>0.05). The proportion of patients who underwent surgery and operation treatment in both groups had no statistical significance (P>0.05). Compared with MDT group, MHT group had lower blood HGB (87.7±21.9 g/L vs 110.3±28.5 g/L), but Lac level (3.5±2.1 mmol/L vs 5.3±3.4 mmol/L) was also lower; the differences were statistically significant (P<0.05). There was no significant difference in BE and PT between the two groups (P>0.05). In MHT group, the time from admission to check-up was (19.5±7.7 min vs. 33.8±18.0 min), the time from decision to operation [25(18.3, 36.0)min vs 31(20.0, 41.3)min], and the stay time in the emergency room [45(31.3, 63.3)min vs 78(52.8, 92.5) min] were significantly shortened compared with MDT group, and the difference was statistically significant (P<0.05). There were no significant differences in length of hospital stay and ICU cost between the two groups, and the mortality rates were 15.0% and 15.8%, respectively, with no statistical significance (P>0.05).Conclusion:Regional collaborative MHT integrated treatment can improve the treatment level of patients with hemodynamically unstable pelvic fractures.

Oral feeding of water cannot be accomplished in some critical patients due to coma, mouth-breathing or long-term indwelling of gastric tube, causing dry mouth which results in oral pain, ulcer, or infection, aggravating patients' discomfort and even affecting the prognosis. To solve this problem, the medical staff of the First Hospital of Jiaxing developed a novel oral humidifier and obtained the National Utility Model Patent of China (ZL 2019 2 0066979.0). The oral humidifier consists of a spraying device and a fixation device. The spraying device is a spraying housing with a water tank, and a spraying port where nanometer water mist can be emitted. The spraying housing is also equipped with a flashlight with a switch, and a schematic diagram of pupil size, which can be used to assess the pupil size conveniently. The fixing device is composed of a fixing frame, an adjustable rod and a clamp. The two ends of the adjustable rod are connected to the fixing frame and the clamp respectively, and can be adjusted to proper shape. The spraying housing can be placed on the fixing frame and installed on the bed and adjusted to the proper position quickly. This novel oral humidifier is a simple device which combines a spraying system with a pupil evaluation tool, implying significant clinical application in improving the convenience of nursing and alleviating dry mouth of critical patients.

目的:观察手动胸外按压复苏仪在院前急救心肺复苏（cardiopulmonary resuscitation, CPR）中对胸外按压质量的影响，并评价其在院前心肺复苏中的临床价值。方法:选取2018年1月至2020年1月，通过120院前急救中心派遣执行的心脏骤停患者抢救任务，根据是否应用手动心肺复苏仪进行救治，分为器械组和徒手组，分析两者之间的按压频率、按压移动、胸外按压比例（chest compression fraction, CCF）优秀率及患者自主循环恢复（return of spontaneous circulation, ROSC）和预后等情况。正态分布的计量资料组间比较采用独立样本 t检验；非正态分布计量资料的比较采用Mann-Whitney U检验。 结果:共收集51例院外心搏骤停患者，器械组和徒手组基线资料比较，性别、年龄、是否存在目击者、是否除颤、外伤史、有无冠心病史以及按压时间和心搏停止估计时间两组间差异均无统计学意义（均 P>0.05）；两组患者复苏效果比较，使用手动胸外按压复苏仪的器械组，ROSC恢复率、CCF优秀率、按压频率达标率以及按压部位是否移动情况均好于徒手组，且ROSC恢复、按压频率达标情况及按压部位移动情况差异有统计学意义（均 P<0.05），而最终器械组和徒手组生存率7/28 vs 4/23，差异无统计学意义（ P>0.05）。 结论:院前急救中采用手动胸外按压复苏仪救治心脏骤停患者，在保证胸外按压质量、提高自主循环恢复方面有良好的价值，同时具有操作简便、方便携带等特点，值得推广。

Airway humidification is an important treatment for tracheotomy patients. At present, the commonly used methods of humidification are atomization inhalation, intra-tracheal drip, etc., but most of them have the disadvantages of interrupted humidification, inadequate humidification, repeated exposure of airway, increased nursing workload, etc. An improved disposable atomizer was designed by the emergency department of Jiaxing First Hospital in Zhejiang Province, which solved the above problems and obtained the National Utility Model Patent of China (ZL 2014 2 0406688.9). In the traditional atomizer, a make-up pipeline is added to run through the liquid container. The replenishing pipe is connected with an external infusion device. At the end of the pipeline inside the liquid container, a buoy with a guide rod is designed to continuously add liquid and automatically control the make-up speed. The device is driven by oxygen to perform airway humidification. The design can keep sufficient airway humidification, avoid frequent addition of humidification fluid, achieve the effect of increasing humidification, reducing the occurrence of complications, increasing the comfort of patients, and reducing the workload of nursing, and has a certain clinical value.

OBJECTIVE:In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.

1 | P a g e 7. PELVIC ORGANS/WOMAN’S HEALTH Non-Hodgkin’s lymphoma Reproductive factors, exogenous hormone use and risk of B-cell non-Hodgkin lymphoma in a cohort of women from the European Prospective Investigation into Cancer and Nutrition American Journal of Epidemiology — Costas L, et al. | November 30, 2018 Researchers intended to gain clarity regarding the role of hormonal factors in lymphoid neoplasms. They used the European Prospective Investigation into Cancer and Nutrition cohort and using comprehensive data collected at baseline (1992–2000), they acquired information on reproductive factors and exogenous hormone use among 343,458 women, including 1,427 incident B-cell nonHodgkin lymphomas (NHL) and its major subtypes identified after a mean follow-up of 14 years (through 2015). Findings revealed no statistically significant links between parity, age at first birth, breastfeeding, oral contraceptive use or ever use of postmenopausal hormone therapy and risk of B-cell NHL or its subtypes. A 51% higher risk of B-cell NHL was observed in women who had a surgical menopause vs natural menopause. These data offer little support for the hypothesis that sex hormones play a role in lymphomagenesis.

Cognitive impairment is commonly observed in patients with Hashimoto thyroiditis (HT). Low levels of vitamin D have been correlated with cognitive impairment in non-HT population. We examined the association of vitamin D levels with cognitive impairment in patients with HT.

目的 探讨亚低温治疗对心肺复苏成功患者免疫功能、肺功能的影响.方法 选择心肺复苏成功患者62例.随机分为常温组和亚低温组,每组各31例.分别于治疗第1、3、7天检测所有患者的体液免疫功能指标:IgA、IgG、IgM及补体C3,及细胞免疫指标:T淋巴细胞转化率(T-LTR)、CD3、CD4、CD8、CD4/CD8比值.于治疗前及治疗后24h内,监测患者的肺顺应性指标:气道峰压、平台压、肺静态顺应性及肺动态顺应性,并比较两组差异.结果 治疗后第1、3、7天,两组患者血清IgG、IgA、IgM水平及补体C3水平比较,差异均无统计学意义(P>0.05);两组IgG和补体C3水平均随治疗时间的延长而显著降低(亚低温组:FIgG=6.836,F补体C3=6.526,P<0.05;常温组:FIgG=5.559,F补体C3=5.231,P<0.05);两组患者血清T-LTR及CD3、CD4、CD8和CD4/CD8比较差异均无统计学意义(P>0.05).治疗后,常温组气道峰压、平台压、肺静态顺应性及肺动态顺应性与治疗前比较差异无统计学意义(P>0.05);亚低温组气道峰压较治疗前显著降低(P<0.05),肺动脉顺应性显著升高(P<0.01);亚低温组气道峰压显著低于常温组(P<0.05),肺动脉顺应性显著高于常温组(P<0.05).结论 相比常温治疗,亚低温治疗可以更显著得改善患者肺功能,对肺起到保护作用.

Background The study of the experiment was to display the therapeutic function of insulin-loaded chitosan (insulin/chitosan) on mesenteric microcirculation via down-regulating cyclooxygenase-2 (COX-2) and vascular cell adhesion molecule (VCAM-1) expressions in rats with diabetes mellitus (DM) as compared to free insulin. Methods Diabetic rats were administrated with 24 U/kg insulin or 120 U/kg insulin/chitosan compounds. The blood and mesenteriums were collected, blood glucose levels, arteriole velocity, arteriole diameter, venular diameter, and hemodiapedesis were measured, and COX-2, VCAM-1 expressions were measured in mesenteriums tissues. Results Both insulin and insulin/chitosan administration decreased blood glucose and improved the state of mesenteric microcirculation through down-regulating COX-2 and VCAM-1 expressions as compared to DM groups, while insulin/chitosan remarkably augmented this functions. Conclusion Chitosan-microcapsulated insulin alleviates mesenteric microcirculation dysfunction via modulating COX-2 and VCAM-1 expressions in rats with DM.

在院前急救工作中对于皮肤擦伤和割伤可采用纱布覆盖止血并胶带黏贴固定或小型敷贴保护伤口,但存在易污染、不防水、操作繁琐、需要多次换药、胶带损伤皮肤、小型敷贴无法覆盖大伤口等缺点.本院研制出一种新型防水止血器,有操作简便、防水、重复换药无需撕拉皮肤等优点,方便医护人员使用,特别适合院前急救、户外探险等野外救护中的应用,具有较高的实用价值.