BACKGROUND Frostbite is becoming increasingly common in urban environments,and severe cases can lead to tissue loss.The treatment goal is to preserve tissue and function;the sooner appropriate treatment is administere...BACKGROUND Frostbite is becoming increasingly common in urban environments,and severe cases can lead to tissue loss.The treatment goal is to preserve tissue and function;the sooner appropriate treatment is administered,the more tissue can be saved.However,not every patient with deep frostbite seeks medical care promptly.CASE SUMMARY We report the case of a 73-year-old male patient who was lost in the wilderness for 2 d due to trauma and confusion.He experienced deep frostbite on multiple fingers.Treatment should not be discontinued for patients with deep frostbite who present after the optimum treatment timing.Bullae that no longer form(bloody)blisters within 24 h of aspiration should be removed.Mucopolysaccharide polysulfate cream has clinical value in frostbite treatment.The patient was transferred to Chinese Academy of Medical Sciences and Peking Union Medical College Hospital 12 h after being rescued.The patient had contraindications for thrombolysis,the most effective treatment,due to intracranial hemorrhage and presenting past the optimum treatment timing.We devised a comprehensive treatment plan,which involved delayed use vasodilators and high-pressure oxygen therapy at day 49 post-injury.We experimented with mucopolysaccharide polysulfate cream to treat the frostbite.The aim of the treatment was to safeguard as much tissue as possible.In the end,the fingers that suffered from frostbite were able to be partially preserved.CONCLUSION The case indicated that patients with severe frostbite who missed the optimal treatment time and had contraindications for thrombolysis could still partially preserve the affected limbs through comprehensive treatment.展开更多
The start of World War Ⅱ(WWⅡ) led to the deployment of combat troops in several continents. Destruction and many casualties among both the military and civilians became an inevitable consequence. A large amount of p...The start of World War Ⅱ(WWⅡ) led to the deployment of combat troops in several continents. Destruction and many casualties among both the military and civilians became an inevitable consequence. A large amount of people injured were in need of life-saving treatment and a speedy return to duty. Intensive studies of the specific issues of diagnosis and treatment of thermal injury were conducted in the Soviet Union before the war. The first special units for patients with burn injuries were created, and the first specialists received their first clinical experience. The contributions of famous Soviet scientists in the development of the treatment of burns and frostbite in WWⅡ are studied in this article. The structure of thermal injuries among military personnel and the results of their treatment are shown. Treatment, classification and quantity frostbite in the structure of sanitary losses during the WWⅡ are studied in this article.展开更多
The objective of this study was to prepare nanostructured lipid carrier(NLC)-based topical gel of Ganoderma Triterpenoids(GTs) and evaluate their effects on frostbite treatment. GT-NLCs was prepared by the high pressu...The objective of this study was to prepare nanostructured lipid carrier(NLC)-based topical gel of Ganoderma Triterpenoids(GTs) and evaluate their effects on frostbite treatment. GT-NLCs was prepared by the high pressure homogenization method and then characterized by morphology and analyses of particle size, zeta potential, entrapment efficiency(EE), and drug loading(DL). The NLCs was suitably gelled for skin permeation studies in vitro and pharmacodynamic evaluation in vivo, compared with the GT emulgel. The GT-NLC remained within the colloidal range and was uniformly dispersed after suitably gelled by carbopol preparation. Transmission electron microscopy(TEM) study showed GT-NLCs was spherical in shape. The EE(%) and DL(%) could reach up to(81.84 ± 0.60)% and(2.13 ± 0.12)%, respectively. The result of X-ray diffractograms(XRD) showed that GTs were in an amorphous state in the NLC-gel. In vitro permeation studies through rat skin indicated that the amount of GTs permeated through skin of GT-NLCs after 24 h was higher than that of GT emulsion, and GT-NLCs increased the accumulative amounts of GTs in epidermis 7.76 times greater than GT emulsion. GT-NLC-gel was found to possess superior therapeutic effect for frostbite, compared with the GT emulgel. The NLC based topical gel of GTs could improve-their therapeutic effect for frostbite.展开更多
Frostbite in Southwestern China has been overlooked due to its low incidence,relatively mild temperature and lack of literature published before.However,it needs to be further studied for religious diversity and disti...Frostbite in Southwestern China has been overlooked due to its low incidence,relatively mild temperature and lack of literature published before.However,it needs to be further studied for religious diversity and distinct geomorphology.In this article,we reported an 18-year-old Tibetan girl who suffered from blizzard attack during pilgrimage.Her feet and several fingers showed mummified gangrene upon physical examination with poor movement.She was diagnosed with 3rd to 4th degree of frostbite.The girl was given oral ibuprofen,debridement and other regular treatment daily,but she was eventually amputated due to insufficient thrombolytic management in primary hospital,delayed informing consent in the referral hospital and ethnic conflict between religion and guidelines.This case enriched the experience of managing complex frostbite in Tibetan population and alarms that efforts should be integrated to protect pilgrims and mountaineers in the Tibetan region.展开更多
Background:Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability.Despite the complexity of these patients,diagnostic and treatment practices lack standardization.Th...Background:Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability.Despite the complexity of these patients,diagnostic and treatment practices lack standardization.Thrombolytic therapy has emerged as a promising treatment modality,demonstrating impressive digit salvage rates.We review our experience with thrombolytic therapy for severe upper extremity frostbite.Methods:Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected.A subgroup of patients with severe frostbite treated with intraarterial thrombolytic therapy(IATT)were analysed.Results:Of the 17 frostbite patients treated at our institution,14(82%)were male and the median age was 31(range:19–73).Substance misuse was involved in a majority of the cases(58.8%).Five(29.4%)patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively.Angiography demonstrated a 74.5%improvement in perfusion after tissue plasminogen activator thrombolysis.When comparing phalanges at risk on initial angiography to phalanges undergoing amputation,the phalangeal salvage rate was 83.3%and the digit salvage rate was 80%.Complications associated with IATT included groin hematoma,pseudoaneurysm and retroperitoneal hematoma.Conclusions:Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive,protocoled thrombolytic therapy.A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.展开更多
Objective:The current study aimed to profile the demographics,hematological index,and extrinsic factors of patients treated for frostbite in a single center in Southwest China.Methods:We collected the clinical data of...Objective:The current study aimed to profile the demographics,hematological index,and extrinsic factors of patients treated for frostbite in a single center in Southwest China.Methods:We collected the clinical data of patients with frostbite admitted to a regional hospital from January 1st,2009 to January 1st,2019.The baseline information was summarized,and the causes and hematological indexes of frostbite were analyzed.Results:The study cohort comprised 27 patients.The median patient age was 22 years(range 14-81 years).All frostbite injuries occurred between September 22nd and April 27th.Half of the patients were Tibetans.Cold injuries in Tibetan patients were associated with pilgrimage(70%,9/13)and grazing(15%,2/13),while the leading causes of frostbite in Han residents of the Southwest China basin were mandatory fieldwork without protection(36%,5/14)and loss of consciousness(36%,5/14).The hematological examination findings did not significantly differ between amputees and those who did not undergo amputation.Several hematological indexes significantly differed between patients with good outcomes versus those with poor outcomes.Conclusion:To avoid severe frostbite damage,routine mandatory activities like pilgrimage should be conducted under proper protection in extreme weather.Hematological indexes such as the red blood cell count,hematocrit,and hemoglobin level should be monitored closely by first-line medical personnel during hospitalization,as these indexes might indicate the outcome of frostbite.Further research is needed to improve the management of patients with frostbite in Southwest China.展开更多
BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.METHODS...BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances(such as avalanches) while others have a broader scope(such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study.RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals.CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.展开更多
基金National High Level Hospital Clinical Research Funding,No.2022-PUMCH-C-005.
文摘BACKGROUND Frostbite is becoming increasingly common in urban environments,and severe cases can lead to tissue loss.The treatment goal is to preserve tissue and function;the sooner appropriate treatment is administered,the more tissue can be saved.However,not every patient with deep frostbite seeks medical care promptly.CASE SUMMARY We report the case of a 73-year-old male patient who was lost in the wilderness for 2 d due to trauma and confusion.He experienced deep frostbite on multiple fingers.Treatment should not be discontinued for patients with deep frostbite who present after the optimum treatment timing.Bullae that no longer form(bloody)blisters within 24 h of aspiration should be removed.Mucopolysaccharide polysulfate cream has clinical value in frostbite treatment.The patient was transferred to Chinese Academy of Medical Sciences and Peking Union Medical College Hospital 12 h after being rescued.The patient had contraindications for thrombolysis,the most effective treatment,due to intracranial hemorrhage and presenting past the optimum treatment timing.We devised a comprehensive treatment plan,which involved delayed use vasodilators and high-pressure oxygen therapy at day 49 post-injury.We experimented with mucopolysaccharide polysulfate cream to treat the frostbite.The aim of the treatment was to safeguard as much tissue as possible.In the end,the fingers that suffered from frostbite were able to be partially preserved.CONCLUSION The case indicated that patients with severe frostbite who missed the optimal treatment time and had contraindications for thrombolysis could still partially preserve the affected limbs through comprehensive treatment.
文摘The start of World War Ⅱ(WWⅡ) led to the deployment of combat troops in several continents. Destruction and many casualties among both the military and civilians became an inevitable consequence. A large amount of people injured were in need of life-saving treatment and a speedy return to duty. Intensive studies of the specific issues of diagnosis and treatment of thermal injury were conducted in the Soviet Union before the war. The first special units for patients with burn injuries were created, and the first specialists received their first clinical experience. The contributions of famous Soviet scientists in the development of the treatment of burns and frostbite in WWⅡ are studied in this article. The structure of thermal injuries among military personnel and the results of their treatment are shown. Treatment, classification and quantity frostbite in the structure of sanitary losses during the WWⅡ are studied in this article.
基金supported by Beijing Natural Science Foundation of China(No.7122176)National Natural Science Foundation of China(No.81102821)National Key New Drugs Innovation Foundation(Nos.2014ZX09J14106-01A and CWS11J165)
文摘The objective of this study was to prepare nanostructured lipid carrier(NLC)-based topical gel of Ganoderma Triterpenoids(GTs) and evaluate their effects on frostbite treatment. GT-NLCs was prepared by the high pressure homogenization method and then characterized by morphology and analyses of particle size, zeta potential, entrapment efficiency(EE), and drug loading(DL). The NLCs was suitably gelled for skin permeation studies in vitro and pharmacodynamic evaluation in vivo, compared with the GT emulgel. The GT-NLC remained within the colloidal range and was uniformly dispersed after suitably gelled by carbopol preparation. Transmission electron microscopy(TEM) study showed GT-NLCs was spherical in shape. The EE(%) and DL(%) could reach up to(81.84 ± 0.60)% and(2.13 ± 0.12)%, respectively. The result of X-ray diffractograms(XRD) showed that GTs were in an amorphous state in the NLC-gel. In vitro permeation studies through rat skin indicated that the amount of GTs permeated through skin of GT-NLCs after 24 h was higher than that of GT emulsion, and GT-NLCs increased the accumulative amounts of GTs in epidermis 7.76 times greater than GT emulsion. GT-NLC-gel was found to possess superior therapeutic effect for frostbite, compared with the GT emulgel. The NLC based topical gel of GTs could improve-their therapeutic effect for frostbite.
基金National Natural Science Foundation of China,No.81872535Sichuan Province Pharmaceutical Administration,No.2018HJZX022.
文摘Frostbite in Southwestern China has been overlooked due to its low incidence,relatively mild temperature and lack of literature published before.However,it needs to be further studied for religious diversity and distinct geomorphology.In this article,we reported an 18-year-old Tibetan girl who suffered from blizzard attack during pilgrimage.Her feet and several fingers showed mummified gangrene upon physical examination with poor movement.She was diagnosed with 3rd to 4th degree of frostbite.The girl was given oral ibuprofen,debridement and other regular treatment daily,but she was eventually amputated due to insufficient thrombolytic management in primary hospital,delayed informing consent in the referral hospital and ethnic conflict between religion and guidelines.This case enriched the experience of managing complex frostbite in Tibetan population and alarms that efforts should be integrated to protect pilgrims and mountaineers in the Tibetan region.
文摘Background:Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability.Despite the complexity of these patients,diagnostic and treatment practices lack standardization.Thrombolytic therapy has emerged as a promising treatment modality,demonstrating impressive digit salvage rates.We review our experience with thrombolytic therapy for severe upper extremity frostbite.Methods:Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected.A subgroup of patients with severe frostbite treated with intraarterial thrombolytic therapy(IATT)were analysed.Results:Of the 17 frostbite patients treated at our institution,14(82%)were male and the median age was 31(range:19–73).Substance misuse was involved in a majority of the cases(58.8%).Five(29.4%)patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively.Angiography demonstrated a 74.5%improvement in perfusion after tissue plasminogen activator thrombolysis.When comparing phalanges at risk on initial angiography to phalanges undergoing amputation,the phalangeal salvage rate was 83.3%and the digit salvage rate was 80%.Complications associated with IATT included groin hematoma,pseudoaneurysm and retroperitoneal hematoma.Conclusions:Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive,protocoled thrombolytic therapy.A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.
基金The study was supported by the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYJC21036)National Natural Science Foundation of China(No.82003373).
文摘Objective:The current study aimed to profile the demographics,hematological index,and extrinsic factors of patients treated for frostbite in a single center in Southwest China.Methods:We collected the clinical data of patients with frostbite admitted to a regional hospital from January 1st,2009 to January 1st,2019.The baseline information was summarized,and the causes and hematological indexes of frostbite were analyzed.Results:The study cohort comprised 27 patients.The median patient age was 22 years(range 14-81 years).All frostbite injuries occurred between September 22nd and April 27th.Half of the patients were Tibetans.Cold injuries in Tibetan patients were associated with pilgrimage(70%,9/13)and grazing(15%,2/13),while the leading causes of frostbite in Han residents of the Southwest China basin were mandatory fieldwork without protection(36%,5/14)and loss of consciousness(36%,5/14).The hematological examination findings did not significantly differ between amputees and those who did not undergo amputation.Several hematological indexes significantly differed between patients with good outcomes versus those with poor outcomes.Conclusion:To avoid severe frostbite damage,routine mandatory activities like pilgrimage should be conducted under proper protection in extreme weather.Hematological indexes such as the red blood cell count,hematocrit,and hemoglobin level should be monitored closely by first-line medical personnel during hospitalization,as these indexes might indicate the outcome of frostbite.Further research is needed to improve the management of patients with frostbite in Southwest China.
文摘BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances(such as avalanches) while others have a broader scope(such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study.RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals.CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
