BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBO...BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.展开更多
BACKGROUND： Propofol combined with ischemic preconditioning （IPC） could prevent spinal ischemia/reperfusion injury. However, the effect of this combination remains poorly understood. OBJECTIVE： To measure neuropro...BACKGROUND： Propofol combined with ischemic preconditioning （IPC） could prevent spinal ischemia/reperfusion injury. However, the effect of this combination remains poorly understood. OBJECTIVE： To measure neuroprotection of IPC in combination with propofol in a rabbit model of aorta occlusion-induced spinal injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Laboratory of Anesthesiology, Wuhan University and Central Laboratory of the First Clinical Medical College, China Three Gorges University, from October 2006 to April 2008. MATERIALS： Propofol was purchased from AstraZeneca, UK; malondialdehyde （MDA） and superoxide dismutase （SOD） kits were purchased from Nanjing Jiancheng Bioengineering Institute, China. METHODS： A total of 32 male, Japanese White rabbits, were randomly assigned to model, IPC, propofol, and combination groups, with eight rabbits in each group, using 2×2 factorial experimental design. Spinal ischemiaJreperfusion injury was induced by abdominal aorta occlusion for 40 minutes and reperfusion for 7 days. The IPC group was subjected to IPC treatment for 30 minutes prior to occlusion; the propofol group was treated with propofol for 10 minutes before occlusion; and the combination group underwent IPC treatment for 30 minutes and propofol for 10 minutes prior to occlusion. MAIN OUTCOME MEASURES： Serum MDA levels and SOD activity were detected 35 minutes prior to occlusion, immediately after reperfusion, and 60 minutes and 7 days after reperfusion, respectively. Rabbit hind limb nerve function and spinal pathological changes following injury were observed, and spinal neuronal apoptosis was determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method. RESULTS： Serum MDA levels, spinal neuronal apoptosis, and palsy incidence following injury were greatest in the propofol group, followed by the IPC and combination groups （P 〈 0.01）, while SOD activity and hind limb neurological scores were greatest in the combination group, followed by the IPC and propofol groups. Spinal cord injury in the combination group was slight （P 〈 0.01）. CONCLUSION： IPC and propofol treatment resulted in a synergistic effect for treating spinal ischemia/reperfusion injury. Combined application was superior to IPC or propofol treatment, suggesting that the protection of spinal cord injury may relate with anti-peroxidation.展开更多
It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-...It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-reperfusion injury in rabbits using somatosensory evoked potential detection technology. The results showed that the somatosensory evoked potential latency was significantly prolonged and the amplitude significantly reduced until it disappeared during the period of spinal cord ischemia. After reperfusion for 30-180 minutes, the amplitude and latency began to gradually recover; at 360 minutes of reperfusion, the latency showed no significant difference compared with the pre-ischemic value, while the somatosensory evoked potential amplitude in- creased, and severe hindlimb motor dysfunctions were detected. Experimental findings suggest that changes in somatosensory evoked potentia~ ~atency can reflect the degree of spinat cord ischemic injury, while the amplitude variations are indicators of the late spinal cord reperfusion injury, which provide evidence for the assessment of limb motor function and avoid iatrogenic spinal cord injury.展开更多
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modali...BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.展开更多
Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military a...Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.展开更多
基金supported by military logistics scientific research project(AHJ16J004)。
文摘BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.
文摘BACKGROUND： Propofol combined with ischemic preconditioning （IPC） could prevent spinal ischemia/reperfusion injury. However, the effect of this combination remains poorly understood. OBJECTIVE： To measure neuroprotection of IPC in combination with propofol in a rabbit model of aorta occlusion-induced spinal injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Laboratory of Anesthesiology, Wuhan University and Central Laboratory of the First Clinical Medical College, China Three Gorges University, from October 2006 to April 2008. MATERIALS： Propofol was purchased from AstraZeneca, UK; malondialdehyde （MDA） and superoxide dismutase （SOD） kits were purchased from Nanjing Jiancheng Bioengineering Institute, China. METHODS： A total of 32 male, Japanese White rabbits, were randomly assigned to model, IPC, propofol, and combination groups, with eight rabbits in each group, using 2×2 factorial experimental design. Spinal ischemiaJreperfusion injury was induced by abdominal aorta occlusion for 40 minutes and reperfusion for 7 days. The IPC group was subjected to IPC treatment for 30 minutes prior to occlusion; the propofol group was treated with propofol for 10 minutes before occlusion; and the combination group underwent IPC treatment for 30 minutes and propofol for 10 minutes prior to occlusion. MAIN OUTCOME MEASURES： Serum MDA levels and SOD activity were detected 35 minutes prior to occlusion, immediately after reperfusion, and 60 minutes and 7 days after reperfusion, respectively. Rabbit hind limb nerve function and spinal pathological changes following injury were observed, and spinal neuronal apoptosis was determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method. RESULTS： Serum MDA levels, spinal neuronal apoptosis, and palsy incidence following injury were greatest in the propofol group, followed by the IPC and combination groups （P 〈 0.01）, while SOD activity and hind limb neurological scores were greatest in the combination group, followed by the IPC and propofol groups. Spinal cord injury in the combination group was slight （P 〈 0.01）. CONCLUSION： IPC and propofol treatment resulted in a synergistic effect for treating spinal ischemia/reperfusion injury. Combined application was superior to IPC or propofol treatment, suggesting that the protection of spinal cord injury may relate with anti-peroxidation.
基金supported by the National Natural Science Foundation of China,No.81101370,81101399,81272018the Natural Science Foundation of Jiangsu Province in China,No.BK2011303+2 种基金Jiangsu Province Science and Technology Support Program(Social Development)in China,No.BE2011672University Natural Science Research Foundation of Jiangsu Province for Higher Education,No.12KJB320008College Graduate Research and Innovation Plan of Jiangsu Province in China,No.CXZZ11_0126
文摘It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-reperfusion injury in rabbits using somatosensory evoked potential detection technology. The results showed that the somatosensory evoked potential latency was significantly prolonged and the amplitude significantly reduced until it disappeared during the period of spinal cord ischemia. After reperfusion for 30-180 minutes, the amplitude and latency began to gradually recover; at 360 minutes of reperfusion, the latency showed no significant difference compared with the pre-ischemic value, while the somatosensory evoked potential amplitude in- creased, and severe hindlimb motor dysfunctions were detected. Experimental findings suggest that changes in somatosensory evoked potentia~ ~atency can reflect the degree of spinat cord ischemic injury, while the amplitude variations are indicators of the late spinal cord reperfusion injury, which provide evidence for the assessment of limb motor function and avoid iatrogenic spinal cord injury.
文摘BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.
文摘Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.
