The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication wer...The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication were investigated. Sixty-four cases of severe trauma （injury severity score 〉20） with stress hyperglycemia （blood glucose 〉9 mmol/L） were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient grada- tion one-step process were used to determine plasma VEGF, endothelin-1 （ET-1）, and the number of circulating endothelial cells （CECs） at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF （ng/L）, 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P〈0.05, 0.01, 0.05, 0.05 respectively; for ET-1 （ng/L）, 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P〈0.05, 0.01, 0.01, 0.01 respectively; for CRP （mg/L）, 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P〈0.05; for CECs （/0.9 μL）, 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P〈0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.展开更多
<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available informatio...<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. <strong>Review Findings:</strong> Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. <strong>Conclusion:</strong> This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.展开更多
Objective To determine the prevalence of ocular trauma and the proportion of blindness and visua impairment due to trauma in a rural population in northern China. Methods The Handan Eye Study is a population-based cro...Objective To determine the prevalence of ocular trauma and the proportion of blindness and visua impairment due to trauma in a rural population in northern China. Methods The Handan Eye Study is a population-based cross-sectional study that surveyed 6830 Chinese people aged 30＋ years from 13 randomly selected villages in Yongnian County, city of Handan, Hebei Province, in July, 2006. All participants underwent a standardized interview and extensive examinations. A structured questionnaire was used to collect information on ocular trauma. Results Of the 5837 participants who filled out the questionnaire, 124 subjects [2.1%; 95% confidence interval （CI）, 1.8%-2.5%] reported a history of ocular trauma in either eye, including 19 （0.3%） persons reporting trauma in both eyes. Men were more likely to have an eye injury than women [odds ratio （OR）, 3.3; 2.2-4.9]. In multiple logistic regression models, ocular trauma was significantly more frequent among normotensive participants when compared with hypertensive participants （hypertensive vs. normotensive＂ OR, 0.6; 0.4-0.9） and among participants who had a history of falls （OR, 2.4; 1.2-4.8）. The proportion of unilateral visual impairment and unilateral blindness due to trauma were 10.5% （13 subjects） and 21.0% （26 subjects）, respectively. Conclusion Our study reports the prevalence of severe ocular trauma among adults in rural China, revealing a high proportion of blindness and visual impairment due to trauma. These findings suggest the need for educational strategies to increase eye health awareness in this rural population with focus on providing at least appropriate first aid care to reduce blindness due to trauma.展开更多
Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and ...Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and fungi in opthalmology operating rooms.Methods:Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied.Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated.The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease,lipase,urease,phosphatase and catalase.Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied.Results:Results showed that bacteria and fungi were responsible for infection in 10 and 6 cases of endophthalmitis,respectively and only 2 cases produced a mixture of bacteria and fungi.Trauma was the most prevalent risk factor of endophthalmitis where 58.1%of the 31 cases were due to trauma.In ophthalmology operating rooms,different bacterial and fungal species were isolated.8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins.Terbinafine showed the highest effect against most isolates in vitro.Conclusions:The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.展开更多
Introduction: Home accidents (HA) are often unknown in Benin compared to infectious pathologies. The aim of this work was to determine the prevalence and the factors associated with HA in children admitted to the CHUD...Introduction: Home accidents (HA) are often unknown in Benin compared to infectious pathologies. The aim of this work was to determine the prevalence and the factors associated with HA in children admitted to the CHUD-OP. Method: This was a cross-sectional study conducted from August 1<sup>st</sup> to October 31<sup>th</sup> 2021. We studied children aged 0 to 18 who presented with HA to the pediatrics and emergency reception and triage departments at CHUD-OP. We defined HA as “any event occurring inside the home or in the immediate vicinity of the home that resulted in an injury which was not done deliberately. Results: The hospital frequency of HA was 8.4% (61/725). The median age was 5 years with a male to female ratio of 1.6. Trauma was the leading cause of HA (59%) followed by poisoning (23%). Falling was the main mechanism of trauma (80.6%). The toxins causing poisoning were dominated by caustics (28.6%). The age of the children (p = 0.02), the level of education of the mothers (p , and the area they occur (kitchen with p = 0.04 and on the stairs with p = 0.03) were statistically associated with the occurrence of trauma. Conclusion: HA are common among children admitted at CHUD-OP and factors associated with HA are identified. Measures to prevent home accidents among children in the community should be considered.展开更多
There is a considerable amount of interest in the futurerole of bone marrow-derived stem cells(BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue an...There is a considerable amount of interest in the futurerole of bone marrow-derived stem cells(BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies.展开更多
目的基于健康服务领域研究成果应用的整合性行动促进框架(integrated-promoting action on research implement action in health services framework,i-PARIHS)模式构建创伤骨科患者手术部位感染(surgical site infection,SSI)防控的...目的基于健康服务领域研究成果应用的整合性行动促进框架(integrated-promoting action on research implement action in health services framework,i-PARIHS)模式构建创伤骨科患者手术部位感染(surgical site infection,SSI)防控的审查指标,分析临床实践障碍因素并提出改进策略。方法成立循证团队、文献检索、总结最佳证据、制定审查指标,于2024年7—8月开展基线调查,调查创伤骨科医护、麻醉手术中心医护执行率及患者知晓率,从“变革、接受者、组织环境”3个要素识别障碍因素,拟定变革策略。结果根据最佳证据评估并裁剪审查指标共23项,涵盖评估与监测、内外环境优化、术中关注重点、跟踪与随访和环境因素控制5个方面,涉及创伤骨科医生的14个指标平均执行率为72.14%,涉及病房护士的14个指标平均执行率为74.11%,涉及麻醉医生的5个指标平均执行率为60.50%,涉及手术室护士的10个指标平均执行率为61.75%,涉及患者知晓的5个直接指标平均知晓率为44.54%;障碍因素分析后拟定相应促进因素8条,拟定变革策略17条。结论临床实践与循证证据存在差距,基于i-PARIHS模式构建的审查指标与障碍分析为SSI防控提供了系统化改进框架,但需进一步验证策略的临床效果。展开更多
基金supported by the National Natural Science Foundation of China (No. 30700869)
文摘The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication were investigated. Sixty-four cases of severe trauma （injury severity score 〉20） with stress hyperglycemia （blood glucose 〉9 mmol/L） were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient grada- tion one-step process were used to determine plasma VEGF, endothelin-1 （ET-1）, and the number of circulating endothelial cells （CECs） at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF （ng/L）, 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P〈0.05, 0.01, 0.05, 0.05 respectively; for ET-1 （ng/L）, 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P〈0.05, 0.01, 0.01, 0.01 respectively; for CRP （mg/L）, 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P〈0.05; for CECs （/0.9 μL）, 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P〈0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.
文摘<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. <strong>Review Findings:</strong> Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. <strong>Conclusion:</strong> This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.
基金supported by the National Basic Research Program of China(973 Program)grant 2007CB512201 from the Ministry of Science and Technology of the People’s Republic of China+2 种基金the Program of Health Policy for Blindness Prevention from the Ministry of Health of the People’s Republic of Chinapartially funded by the Key Technologies R&D Program.No.2006-10903 from the Bureau of Science and Technology of Handan City,Hebei Province,Chinaprovided from Beijing Tongren Hospital and a key discipline fund from the Bureau of Health,city of Handan,Hebei Province,China
文摘Objective To determine the prevalence of ocular trauma and the proportion of blindness and visua impairment due to trauma in a rural population in northern China. Methods The Handan Eye Study is a population-based cross-sectional study that surveyed 6830 Chinese people aged 30＋ years from 13 randomly selected villages in Yongnian County, city of Handan, Hebei Province, in July, 2006. All participants underwent a standardized interview and extensive examinations. A structured questionnaire was used to collect information on ocular trauma. Results Of the 5837 participants who filled out the questionnaire, 124 subjects [2.1%; 95% confidence interval （CI）, 1.8%-2.5%] reported a history of ocular trauma in either eye, including 19 （0.3%） persons reporting trauma in both eyes. Men were more likely to have an eye injury than women [odds ratio （OR）, 3.3; 2.2-4.9]. In multiple logistic regression models, ocular trauma was significantly more frequent among normotensive participants when compared with hypertensive participants （hypertensive vs. normotensive＂ OR, 0.6; 0.4-0.9） and among participants who had a history of falls （OR, 2.4; 1.2-4.8）. The proportion of unilateral visual impairment and unilateral blindness due to trauma were 10.5% （13 subjects） and 21.0% （26 subjects）, respectively. Conclusion Our study reports the prevalence of severe ocular trauma among adults in rural China, revealing a high proportion of blindness and visual impairment due to trauma. These findings suggest the need for educational strategies to increase eye health awareness in this rural population with focus on providing at least appropriate first aid care to reduce blindness due to trauma.
文摘Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and fungi in opthalmology operating rooms.Methods:Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied.Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated.The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease,lipase,urease,phosphatase and catalase.Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied.Results:Results showed that bacteria and fungi were responsible for infection in 10 and 6 cases of endophthalmitis,respectively and only 2 cases produced a mixture of bacteria and fungi.Trauma was the most prevalent risk factor of endophthalmitis where 58.1%of the 31 cases were due to trauma.In ophthalmology operating rooms,different bacterial and fungal species were isolated.8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins.Terbinafine showed the highest effect against most isolates in vitro.Conclusions:The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.
文摘Introduction: Home accidents (HA) are often unknown in Benin compared to infectious pathologies. The aim of this work was to determine the prevalence and the factors associated with HA in children admitted to the CHUD-OP. Method: This was a cross-sectional study conducted from August 1<sup>st</sup> to October 31<sup>th</sup> 2021. We studied children aged 0 to 18 who presented with HA to the pediatrics and emergency reception and triage departments at CHUD-OP. We defined HA as “any event occurring inside the home or in the immediate vicinity of the home that resulted in an injury which was not done deliberately. Results: The hospital frequency of HA was 8.4% (61/725). The median age was 5 years with a male to female ratio of 1.6. Trauma was the leading cause of HA (59%) followed by poisoning (23%). Falling was the main mechanism of trauma (80.6%). The toxins causing poisoning were dominated by caustics (28.6%). The age of the children (p = 0.02), the level of education of the mothers (p , and the area they occur (kitchen with p = 0.04 and on the stairs with p = 0.03) were statistically associated with the occurrence of trauma. Conclusion: HA are common among children admitted at CHUD-OP and factors associated with HA are identified. Measures to prevent home accidents among children in the community should be considered.
文摘There is a considerable amount of interest in the futurerole of bone marrow-derived stem cells(BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies.
文摘目的基于健康服务领域研究成果应用的整合性行动促进框架(integrated-promoting action on research implement action in health services framework,i-PARIHS)模式构建创伤骨科患者手术部位感染(surgical site infection,SSI)防控的审查指标,分析临床实践障碍因素并提出改进策略。方法成立循证团队、文献检索、总结最佳证据、制定审查指标,于2024年7—8月开展基线调查,调查创伤骨科医护、麻醉手术中心医护执行率及患者知晓率,从“变革、接受者、组织环境”3个要素识别障碍因素,拟定变革策略。结果根据最佳证据评估并裁剪审查指标共23项,涵盖评估与监测、内外环境优化、术中关注重点、跟踪与随访和环境因素控制5个方面,涉及创伤骨科医生的14个指标平均执行率为72.14%,涉及病房护士的14个指标平均执行率为74.11%,涉及麻醉医生的5个指标平均执行率为60.50%,涉及手术室护士的10个指标平均执行率为61.75%,涉及患者知晓的5个直接指标平均知晓率为44.54%;障碍因素分析后拟定相应促进因素8条,拟定变革策略17条。结论临床实践与循证证据存在差距,基于i-PARIHS模式构建的审查指标与障碍分析为SSI防控提供了系统化改进框架,但需进一步验证策略的临床效果。
