Objective: To analyze the effectiveness of musculoskeletal ultrasound in diagnosing rotator cuff injuries. Methods: A total of 80 patients with suspected rotator cuff injuries who were admitted and diagnosed between J...Objective: To analyze the effectiveness of musculoskeletal ultrasound in diagnosing rotator cuff injuries. Methods: A total of 80 patients with suspected rotator cuff injuries who were admitted and diagnosed between January 1, 2020, and December 31, 2024, were selected. Musculoskeletal ultrasound was performed on these patients, and the diagnostic efficacy of musculoskeletal ultrasound was evaluated by comparing the results with those of MRI. Results: The detection rates of musculoskeletal ultrasound for the location and extent of injury were similar to those of MRI (p > 0.05). Based on the MRI diagnosis results, the diagnostic accuracy rate of musculoskeletal ultrasound was 92.50%, with a sensitivity of 93.06% and a specificity of 87.50%. The morphological and signal characteristics, as well as ultrasound indicators, of patients with positive musculoskeletal ultrasound results differed significantly from those of patients with negative results (p < 0.05). Conclusion: Musculoskeletal ultrasound can effectively detect the location and extent of rotator cuff injuries, comprehensively assess the damage, and demonstrate high diagnostic efficacy. Furthermore, the morphological and signal characteristics, as well as ultrasound indicators, of musculoskeletal ultrasound can serve as diagnostic criteria for rotator cuff injuries, improving disease detection efficiency.展开更多
[Objectives]To investigate the clinical effects of implementing structured phased rehabilitation training,in addition to conventional rehabilitation,on shoulder joint function and pain alleviation in patients with rot...[Objectives]To investigate the clinical effects of implementing structured phased rehabilitation training,in addition to conventional rehabilitation,on shoulder joint function and pain alleviation in patients with rotator cuff injuries managed conservatively.[Methods]Eighty patients diagnosed with rotator cuff injury were selected and randomly assigned to either the control group or the experimental group,each comprising 40 individuals.The control group received conventional rehabilitation treatment,whereas the experimental group underwent phased rehabilitation training in addition to the conventional treatment for 6 weeks.Assessments were conducted prior to treatment,6 weeks following treatment,and 8 weeks after the completion of treatment(follow-up period).The visual analogue scale(VAS)was employed to evaluate pain intensity,the Constant-Murley score was utilized to assess shoulder joint function,and the shoulder joint range of motion was measured.[Results]Prior to treatment,no statistically significant differences were observed between the two patient groups across all measured indicators(P>0.05).Following 6 weeks of treatment and throughout the follow-up period,both groups exhibited significant reductions in VAS scores compared to baseline measurements,alongside improvements in Constant-Murley scores and shoulder joint range of motion(P<0.05).Furthermore,the magnitude of improvement in the experimental group was significantly greater than that in the control group(P<0.05).[Conclusions]Phased rehabilitation training can enhance shoulder joint function and alleviate pain in patients with rotator cuff injuries beyond the effects of conventional rehabilitation treatment,demonstrating notable clinical application value.展开更多
The regenerative capacities of organs in adult mammals vary significantly.Unlike the liver,which possesses remarkable regenerative potential,the repair of cardiac injuries has long posed a critical medical challenge.R...The regenerative capacities of organs in adult mammals vary significantly.Unlike the liver,which possesses remarkable regenerative potential,the repair of cardiac injuries has long posed a critical medical challenge.Recent studies have highlighted the pivotal role of the immune microenvironment in repairing damage in these tissues,but the key cell types and their mechanisms of action remain incompletely understood.In this study,we established a model of concurrent physical trauma to the hearts and livers of adult mice,revealing that these two injured tissues drive distinct immune microenvironments.The liver primarily accumulates lymphocytes,whereas the heart recruits macrophages and neutrophils.Notably,CD160^(+)CD8^(+)intraepithelial lymphocytes in the liver were found to suppress fibrosis postliver injury and mitigate cardiac fibrosis when delivered via hydrogel patches.Conversely,in response to heart trauma,recruited inflammatory macrophages not only express proinflammatory cytokines but also coexpress CCRL2.While CCRL2 did not directly alter the intensity of the inflammatory response,it facilitated fibroblast proliferation and migration through its interaction with Na^(+)/K^(+)-ATPase on fibroblasts.These findings elucidated the contrasting immune microenvironments between the heart and liver following injury and provided novel insights and strategies for diagnosing and treating cardiac diseases.展开更多
BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occur...BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.展开更多
BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM ...BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
AIM:To evaluate the prevalence of early post-traumatic stress disorder(PTSD)among young and middle-aged patients who have suffered open globe injuries,and to identify the psychosocial factors influencing PTSD in these...AIM:To evaluate the prevalence of early post-traumatic stress disorder(PTSD)among young and middle-aged patients who have suffered open globe injuries,and to identify the psychosocial factors influencing PTSD in these patients.METHODS:A total of 280 patients who underwent ocular trauma surgery between January 2023 and January 2024 were selected through convenience sampling.Data were collected using a custom-designed demographic questionnaire,the Connor-Davidson Resilience Scale(CDRISC),the Cognitive Emotion Regulation Questionnaire(C-ERRI),and the PTSD Checklist-Civilian Version(PCL-C).Univariate analysis and stepwise multiple linear regression analysis were performed to determine the factors affecting PTSD in these patients.RESULTS:The average PTSD score for the patients was 33.22±13.48.The scores for individual PTSD dimensions,ranked from highest to lowest,were recurrent traumatic experiences,heightened arousal,avoidance reactions,and social dysfunction.Positive PTSD symptoms were observed in 85 patients(30.36%).Univariate analysis indicated that gender,postoperative vision,marital status,psychological resilience,and rumination were significant factors affecting PTSD symptoms(χ^(2)/t=6.53,17.88,8.83,2.17,and 14.1,respectively;all P<0.05).Pearson correlation analysis showed a positive correlation between rumination and PTSD symptoms(r=0.73,P<0.01)and a negative correlation between psychological resilience and PTSD symptoms(r=-0.14,P<0.05).Stepwise multiple linear regression analysis identified postoperative vision(notably eye removal),rumination levels,and psychological resilience(optimism)as major factors influencing PTSD in these patients(R^(2)=0.57,P<0.001).CONCLUSION:Young and middle-aged patients with open globe injuries have a high incidence of PTSD.Significant risk factors for early PTSD include primary enucleation,high levels of rumination,and low psychological resilience(optimism).Conversely,patients with good postoperative vision recovery,low rumination levels,and high levels of optimism are less likely to develop PTSD.Healthcare providers should pay special attention to patients who undergo primary enucleation,strive to reduce their rumination levels,and enhance their psychological resilience,thereby promoting a positive and optimistic attitude towards their condition and reducing the incidence of PTSD.展开更多
BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation...BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.展开更多
AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of c...AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.展开更多
Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychoso...Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities;the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.展开更多
Acute central nervous system injuries,including ischemic stro ke,intracerebral hemorrhage,subarachnoid hemorrhage,traumatic brain injury,and spinal co rd injury,are a major global health challenge.Identifying optimal ...Acute central nervous system injuries,including ischemic stro ke,intracerebral hemorrhage,subarachnoid hemorrhage,traumatic brain injury,and spinal co rd injury,are a major global health challenge.Identifying optimal therapies and improving the long-term neurological functions of patients with acute central nervous system injuries are urgent priorities.Mitochondria are susceptible to damage after acute central nervous system injury,and this leads to the release of toxic levels of reactive oxygen species,which induce cell death.Mitophagy,a selective form of autophagy,is crucial in eliminating redundant or damaged mitochondria during these events.Recent evidence has highlighted the significant role of mitophagy in acute central nervous system injuries.In this review,we provide a comprehensive overview of the process,classification,and related mechanisms of mitophagy.We also highlight the recent developments in research into the role of mitophagy in various acute central nervous system injuries and drug therapies that regulate mitophagy.In the final section of this review,we emphasize the potential for treating these disorders by focusing on mitophagy and suggest future research paths in this area.展开更多
The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingcl...The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])展开更多
Neural injuries can be induced by various neurological disorders and traumas,such as brain and spinal cord injuries,cerebrovascular diseases,and neurodegeneration.Due to the designable physicochemical properties,bioma...Neural injuries can be induced by various neurological disorders and traumas,such as brain and spinal cord injuries,cerebrovascular diseases,and neurodegeneration.Due to the designable physicochemical properties,biomaterials are applied for various purposes in neural repair,including promoting axonal regeneration,reducing glial scar formation,delivering drugs,and providing temporary mechanical support to the injured tissue.They need to match the extracellular matrix(ECM)environment,support threedimensional(3D)cell growth,repair the cellular microenvironment,mimic the tissue's biomechanical forces,and possess biodegradability and plasticity suitable for local intracavity applications.Meanwhile,functionalized biomaterials have been conducted to mimic the structural components of cellular ecological niches and the specific functions of the ECM.They can be engineered to carry a variety of bioactive components,such as stem cells and extracellular vesicles,which are used in neuroscience-related tissue engineering.Researchers also have developed biomaterial-based brain-like organs for high-throughput drug screening and pathological mechanistic studies.This review will discuss the interactions between biomaterials and cells,as well as the advances in neural injuries and engineered microtissues.展开更多
Objective: In the Healthy Child Action Enhancement Program (2021-2025), it is proposed to ensure the safety and health of newborns and to promote high-quality development of health. Our department established risk ass...Objective: In the Healthy Child Action Enhancement Program (2021-2025), it is proposed to ensure the safety and health of newborns and to promote high-quality development of health. Our department established risk assessment criteria for medical adhesives in neonates by applying the best evidence in the management program for the reduction of medical adhesive-associated skin injuries in neonates, in terms of the use and removal of adhesives. Methods: A systematic search and quality assessment of topics related to medical adhesive-related skin injury in neonates was conducted to summarize the best evidence and to conduct a quality review in the neonatal unit. Results: After 2 rounds of review, medical and nursing staff in the neonatal unit had a 98% compliance rate for the knowledge of neonatal medical adhesive-related skin injury and a satisfactory compliance rate for the other 9 indicators;after the application of the evidence, the incidence of neonatal medical adhesive-related skin injury was significantly lower than that before the application of the evidence, and the differences were statistically significant (P Conclusion: The application of the best evidence-based management program in neonatal medical adhesive-associated skin injury can reduce the incidence of neonatal medical adhesive-associated skin injury, reduce neonatal infections, and improve the integrity of the protective skin barrier in neonates.展开更多
Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occu...Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries(PIs).Methods:In this retrospective longitudinal study,we obtained health-related data from the Medical Information Mart for Intensive Care IV database,including sociodemographic,disease-related variables,and ICU treatment variables.The daily CFB adjusted for body weight was calculated,and the occurrence of PIs during the ICU stay was recorded.A group-based trajectory model was used to explore the different CFB trajectories.Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.Results:Among the 4,294 included participants,we identified four distinct trajectories of CFB in ICU patients:the rapid accumulation group(12.5%),the slow accumulation group(28.5%),the neutral balance group(41.7%),and the negative decrease group(17.3%).After adjusting for some sociodemographic,disease-related variables,and ICU treatment variables,the rapid accumulation group had an OR of 1.63(95%CI:1.30,2.04)for all stages of PIs and an OR of 1.36(95%CI:1.08,1.72)for stage II or higher PIs compared to the neutral balance group.Conclusions:Four unique trajectories of CFB were identified among patients in the ICU,including rapid accumulation,slow accumulation,neutral balance,and negative decrease.Rapid accumulation independently increased the risk of PIs during ICU stay.展开更多
In recent years,the issue of pressure injuries prevention and management of in patients with acute respiratory distress syndrome(ARDS)undergoing prone position ventilation.Based on recent domestic and international re...In recent years,the issue of pressure injuries prevention and management of in patients with acute respiratory distress syndrome(ARDS)undergoing prone position ventilation.Based on recent domestic and international research,it comprehensively summarizes the multidimensional risk factors for pressure injuries,including patient conditions,prone ventilation time,individual patient factors,nursing staff,environment,and patient psychological factors,among others.Nursing strategies center on standardized procedures combined with individualized interventions,utilizing graded risk assessment,dynamic skin monitoring,prophylactic dressings,high-performance support surfaces,positional optimization,minimal effective sedation management,standardized management of tubing and pressure points,as well as PDCA cycle-based quality control.These comprehensive measures can effectively reduce the incidence and healthcare burden of pressure injuries while ensuring the therapeutic benefits of oxygenation.展开更多
Traumatic peripheral nerve injuries are a major contributor to long-term disability,accounting for nearly half of all peripheral nervous system disorders.Although autologous nerve grafting remains the clinical gold st...Traumatic peripheral nerve injuries are a major contributor to long-term disability,accounting for nearly half of all peripheral nervous system disorders.Although autologous nerve grafting remains the clinical gold standard,it is limited by donor-site morbidity and often fails to achieve full functional recovery.Biodegradable collagen conduits have emerged as an appealing alternative,providing a scaffold for directed axonal growth without requiring graft harvest.We reported three cases of chronic nerve injuries(6-12 months post-trauma):two involving 2.0-3.5 cm ulnar nerve defects in the forearm and one with a 2.5 cm median nerve defect at the wrist.Under microscopic guidance,each defect was bridged with a tubular type I collagen conduit secured by epineurial sutures,followed by standardized physiotherapy and sensory reeducation.At 12-18 months of follow-up,all patients demonstrated near-complete sensory recovery—two-point discrimination and Semmes-Weinstein thresholds returned to≤6 mm—and motor function improved to Medical Research Council grades 4-5,restoring fine dexterity and grip strength.Patient-reported measures indicated marked reductions in neuropathic pain and paresthesia.No conduit-related adverse events or neuroma formation were observed.This case series highlights the potential of collagen-based conduits to promote robust axonal regeneration and functional restoration even in delayed presentations.By eliminating donor-site morbidity and simplifying the reconstructive procedure,conduit-assisted repair offers a less invasive,reproducible alternative to autologous grafts for both acute and chronic peripheral nerve injuries.展开更多
AIM：To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS： A cross-sectional,multi-center,observational study.Patients with an...AIM：To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS： A cross-sectional,multi-center,observational study.Patients with an injured eye who visited the Emergency Department at one of nine hospitals in Korea were enrolled.All data were prospectively collected between March and September 2010 using a questionnaire.Eye injuries that occurred during risky sports were examined by gender and age.Additionally,the rate of open globe injuries that occurred with and without protective eyewear was examined for each activity.Continuous variables were compared using Student＇s t-test and categorical variables were compared using Chi-square test.RESULTS： A total of 446 patients had sports-related eye injuries.Teenagers（10-19 years old） and young adults（20-29 years old） had the most eye injuries.Eye injuries accounted for 0.2% of Emergency Department patients.Baseball was the most common cause of sports-related eye injuries,followed by soccer and hiking.Protective gear was worn by 9.4% of all patients.Patients that were 30-39 years of age had the highest rate of protective gear use,followed by patients that were 40-49 years of age.The proportion of sports-related eye injuries that were open-globe injuries was highest for soccer and hiking.CONCLUSION： Although injuries were most common in patients below the age of 10 years,these patients had the lowest rate of protective eyewear use.Injuries in adults over 40 years of age most commonly occurred during hiking,but the rate of protective eyewear use was low.Young athletes should be educated on and provided with protective eyewear and policies protective gear use should be established.For older adults,eye protection should be encouraged,especially during hiking.展开更多
BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international inve...BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.展开更多
BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma...BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.展开更多
文摘Objective: To analyze the effectiveness of musculoskeletal ultrasound in diagnosing rotator cuff injuries. Methods: A total of 80 patients with suspected rotator cuff injuries who were admitted and diagnosed between January 1, 2020, and December 31, 2024, were selected. Musculoskeletal ultrasound was performed on these patients, and the diagnostic efficacy of musculoskeletal ultrasound was evaluated by comparing the results with those of MRI. Results: The detection rates of musculoskeletal ultrasound for the location and extent of injury were similar to those of MRI (p > 0.05). Based on the MRI diagnosis results, the diagnostic accuracy rate of musculoskeletal ultrasound was 92.50%, with a sensitivity of 93.06% and a specificity of 87.50%. The morphological and signal characteristics, as well as ultrasound indicators, of patients with positive musculoskeletal ultrasound results differed significantly from those of patients with negative results (p < 0.05). Conclusion: Musculoskeletal ultrasound can effectively detect the location and extent of rotator cuff injuries, comprehensively assess the damage, and demonstrate high diagnostic efficacy. Furthermore, the morphological and signal characteristics, as well as ultrasound indicators, of musculoskeletal ultrasound can serve as diagnostic criteria for rotator cuff injuries, improving disease detection efficiency.
文摘[Objectives]To investigate the clinical effects of implementing structured phased rehabilitation training,in addition to conventional rehabilitation,on shoulder joint function and pain alleviation in patients with rotator cuff injuries managed conservatively.[Methods]Eighty patients diagnosed with rotator cuff injury were selected and randomly assigned to either the control group or the experimental group,each comprising 40 individuals.The control group received conventional rehabilitation treatment,whereas the experimental group underwent phased rehabilitation training in addition to the conventional treatment for 6 weeks.Assessments were conducted prior to treatment,6 weeks following treatment,and 8 weeks after the completion of treatment(follow-up period).The visual analogue scale(VAS)was employed to evaluate pain intensity,the Constant-Murley score was utilized to assess shoulder joint function,and the shoulder joint range of motion was measured.[Results]Prior to treatment,no statistically significant differences were observed between the two patient groups across all measured indicators(P>0.05).Following 6 weeks of treatment and throughout the follow-up period,both groups exhibited significant reductions in VAS scores compared to baseline measurements,alongside improvements in Constant-Murley scores and shoulder joint range of motion(P<0.05).Furthermore,the magnitude of improvement in the experimental group was significantly greater than that in the control group(P<0.05).[Conclusions]Phased rehabilitation training can enhance shoulder joint function and alleviate pain in patients with rotator cuff injuries beyond the effects of conventional rehabilitation treatment,demonstrating notable clinical application value.
基金supported by the National Key Research and Development Program of China(2025YFA1309100)the distinguished Young Scientist Fund of NSFC(82125016)+6 种基金the National Natural Science Foundation of China Key Program(82230061)supported by the National Natural Science Foundation of China,Special Program(82341216)the Zhejiang Provincial Natural Science Foundation of China(LHDMD22H100002)supported by the National Key Research and Development Program of China(2021YFA1101803 and 2021ZD0203304)supported by the Jiangsu Science and Technology Project(Social Development)(BE2019669)the National Natural Science Foundation of China(82071046,82100540)supported by the 111 Program(D20036).
文摘The regenerative capacities of organs in adult mammals vary significantly.Unlike the liver,which possesses remarkable regenerative potential,the repair of cardiac injuries has long posed a critical medical challenge.Recent studies have highlighted the pivotal role of the immune microenvironment in repairing damage in these tissues,but the key cell types and their mechanisms of action remain incompletely understood.In this study,we established a model of concurrent physical trauma to the hearts and livers of adult mice,revealing that these two injured tissues drive distinct immune microenvironments.The liver primarily accumulates lymphocytes,whereas the heart recruits macrophages and neutrophils.Notably,CD160^(+)CD8^(+)intraepithelial lymphocytes in the liver were found to suppress fibrosis postliver injury and mitigate cardiac fibrosis when delivered via hydrogel patches.Conversely,in response to heart trauma,recruited inflammatory macrophages not only express proinflammatory cytokines but also coexpress CCRL2.While CCRL2 did not directly alter the intensity of the inflammatory response,it facilitated fibroblast proliferation and migration through its interaction with Na^(+)/K^(+)-ATPase on fibroblasts.These findings elucidated the contrasting immune microenvironments between the heart and liver following injury and provided novel insights and strategies for diagnosing and treating cardiac diseases.
基金Supported by Nanjing Municipal Special Fund for Health Science and Technology Development Support Project,No.GBX21333.
文摘BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.
文摘BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
文摘AIM:To evaluate the prevalence of early post-traumatic stress disorder(PTSD)among young and middle-aged patients who have suffered open globe injuries,and to identify the psychosocial factors influencing PTSD in these patients.METHODS:A total of 280 patients who underwent ocular trauma surgery between January 2023 and January 2024 were selected through convenience sampling.Data were collected using a custom-designed demographic questionnaire,the Connor-Davidson Resilience Scale(CDRISC),the Cognitive Emotion Regulation Questionnaire(C-ERRI),and the PTSD Checklist-Civilian Version(PCL-C).Univariate analysis and stepwise multiple linear regression analysis were performed to determine the factors affecting PTSD in these patients.RESULTS:The average PTSD score for the patients was 33.22±13.48.The scores for individual PTSD dimensions,ranked from highest to lowest,were recurrent traumatic experiences,heightened arousal,avoidance reactions,and social dysfunction.Positive PTSD symptoms were observed in 85 patients(30.36%).Univariate analysis indicated that gender,postoperative vision,marital status,psychological resilience,and rumination were significant factors affecting PTSD symptoms(χ^(2)/t=6.53,17.88,8.83,2.17,and 14.1,respectively;all P<0.05).Pearson correlation analysis showed a positive correlation between rumination and PTSD symptoms(r=0.73,P<0.01)and a negative correlation between psychological resilience and PTSD symptoms(r=-0.14,P<0.05).Stepwise multiple linear regression analysis identified postoperative vision(notably eye removal),rumination levels,and psychological resilience(optimism)as major factors influencing PTSD in these patients(R^(2)=0.57,P<0.001).CONCLUSION:Young and middle-aged patients with open globe injuries have a high incidence of PTSD.Significant risk factors for early PTSD include primary enucleation,high levels of rumination,and low psychological resilience(optimism).Conversely,patients with good postoperative vision recovery,low rumination levels,and high levels of optimism are less likely to develop PTSD.Healthcare providers should pay special attention to patients who undergo primary enucleation,strive to reduce their rumination levels,and enhance their psychological resilience,thereby promoting a positive and optimistic attitude towards their condition and reducing the incidence of PTSD.
基金Supported by AI For Spinal Surgery Planning and Results Assessment Project under the“Priority 2030”Academic Leadership Initiative,No.6.18-01/240724-15.
文摘BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.
文摘AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.
文摘Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities;the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.
基金supported by the National Natural Science Foundation of China,Nos.81920108017(to YX),82130036(to YX),82371326(to XC),82171310(to XC)the STI2030-Major Projects,No.2022ZD0211800(to YX)Jiangsu Province Key Medical Discipline,No.ZDXK202216(to YX)。
文摘Acute central nervous system injuries,including ischemic stro ke,intracerebral hemorrhage,subarachnoid hemorrhage,traumatic brain injury,and spinal co rd injury,are a major global health challenge.Identifying optimal therapies and improving the long-term neurological functions of patients with acute central nervous system injuries are urgent priorities.Mitochondria are susceptible to damage after acute central nervous system injury,and this leads to the release of toxic levels of reactive oxygen species,which induce cell death.Mitophagy,a selective form of autophagy,is crucial in eliminating redundant or damaged mitochondria during these events.Recent evidence has highlighted the significant role of mitophagy in acute central nervous system injuries.In this review,we provide a comprehensive overview of the process,classification,and related mechanisms of mitophagy.We also highlight the recent developments in research into the role of mitophagy in various acute central nervous system injuries and drug therapies that regulate mitophagy.In the final section of this review,we emphasize the potential for treating these disorders by focusing on mitophagy and suggest future research paths in this area.
文摘The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])
基金supported by the National Natural Science Foundation of China(No.82273487)the Young Medical Scientists Training Program(No.21QNPY051)the Shanghai Integration Achievement Program(No.2022-RH17)。
文摘Neural injuries can be induced by various neurological disorders and traumas,such as brain and spinal cord injuries,cerebrovascular diseases,and neurodegeneration.Due to the designable physicochemical properties,biomaterials are applied for various purposes in neural repair,including promoting axonal regeneration,reducing glial scar formation,delivering drugs,and providing temporary mechanical support to the injured tissue.They need to match the extracellular matrix(ECM)environment,support threedimensional(3D)cell growth,repair the cellular microenvironment,mimic the tissue's biomechanical forces,and possess biodegradability and plasticity suitable for local intracavity applications.Meanwhile,functionalized biomaterials have been conducted to mimic the structural components of cellular ecological niches and the specific functions of the ECM.They can be engineered to carry a variety of bioactive components,such as stem cells and extracellular vesicles,which are used in neuroscience-related tissue engineering.Researchers also have developed biomaterial-based brain-like organs for high-throughput drug screening and pathological mechanistic studies.This review will discuss the interactions between biomaterials and cells,as well as the advances in neural injuries and engineered microtissues.
文摘Objective: In the Healthy Child Action Enhancement Program (2021-2025), it is proposed to ensure the safety and health of newborns and to promote high-quality development of health. Our department established risk assessment criteria for medical adhesives in neonates by applying the best evidence in the management program for the reduction of medical adhesive-associated skin injuries in neonates, in terms of the use and removal of adhesives. Methods: A systematic search and quality assessment of topics related to medical adhesive-related skin injury in neonates was conducted to summarize the best evidence and to conduct a quality review in the neonatal unit. Results: After 2 rounds of review, medical and nursing staff in the neonatal unit had a 98% compliance rate for the knowledge of neonatal medical adhesive-related skin injury and a satisfactory compliance rate for the other 9 indicators;after the application of the evidence, the incidence of neonatal medical adhesive-related skin injury was significantly lower than that before the application of the evidence, and the differences were statistically significant (P Conclusion: The application of the best evidence-based management program in neonatal medical adhesive-associated skin injury can reduce the incidence of neonatal medical adhesive-associated skin injury, reduce neonatal infections, and improve the integrity of the protective skin barrier in neonates.
文摘Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries(PIs).Methods:In this retrospective longitudinal study,we obtained health-related data from the Medical Information Mart for Intensive Care IV database,including sociodemographic,disease-related variables,and ICU treatment variables.The daily CFB adjusted for body weight was calculated,and the occurrence of PIs during the ICU stay was recorded.A group-based trajectory model was used to explore the different CFB trajectories.Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.Results:Among the 4,294 included participants,we identified four distinct trajectories of CFB in ICU patients:the rapid accumulation group(12.5%),the slow accumulation group(28.5%),the neutral balance group(41.7%),and the negative decrease group(17.3%).After adjusting for some sociodemographic,disease-related variables,and ICU treatment variables,the rapid accumulation group had an OR of 1.63(95%CI:1.30,2.04)for all stages of PIs and an OR of 1.36(95%CI:1.08,1.72)for stage II or higher PIs compared to the neutral balance group.Conclusions:Four unique trajectories of CFB were identified among patients in the ICU,including rapid accumulation,slow accumulation,neutral balance,and negative decrease.Rapid accumulation independently increased the risk of PIs during ICU stay.
文摘In recent years,the issue of pressure injuries prevention and management of in patients with acute respiratory distress syndrome(ARDS)undergoing prone position ventilation.Based on recent domestic and international research,it comprehensively summarizes the multidimensional risk factors for pressure injuries,including patient conditions,prone ventilation time,individual patient factors,nursing staff,environment,and patient psychological factors,among others.Nursing strategies center on standardized procedures combined with individualized interventions,utilizing graded risk assessment,dynamic skin monitoring,prophylactic dressings,high-performance support surfaces,positional optimization,minimal effective sedation management,standardized management of tubing and pressure points,as well as PDCA cycle-based quality control.These comprehensive measures can effectively reduce the incidence and healthcare burden of pressure injuries while ensuring the therapeutic benefits of oxygenation.
文摘Traumatic peripheral nerve injuries are a major contributor to long-term disability,accounting for nearly half of all peripheral nervous system disorders.Although autologous nerve grafting remains the clinical gold standard,it is limited by donor-site morbidity and often fails to achieve full functional recovery.Biodegradable collagen conduits have emerged as an appealing alternative,providing a scaffold for directed axonal growth without requiring graft harvest.We reported three cases of chronic nerve injuries(6-12 months post-trauma):two involving 2.0-3.5 cm ulnar nerve defects in the forearm and one with a 2.5 cm median nerve defect at the wrist.Under microscopic guidance,each defect was bridged with a tubular type I collagen conduit secured by epineurial sutures,followed by standardized physiotherapy and sensory reeducation.At 12-18 months of follow-up,all patients demonstrated near-complete sensory recovery—two-point discrimination and Semmes-Weinstein thresholds returned to≤6 mm—and motor function improved to Medical Research Council grades 4-5,restoring fine dexterity and grip strength.Patient-reported measures indicated marked reductions in neuropathic pain and paresthesia.No conduit-related adverse events or neuroma formation were observed.This case series highlights the potential of collagen-based conduits to promote robust axonal regeneration and functional restoration even in delayed presentations.By eliminating donor-site morbidity and simplifying the reconstructive procedure,conduit-assisted repair offers a less invasive,reproducible alternative to autologous grafts for both acute and chronic peripheral nerve injuries.
基金Supported by the Research Program funded by the Korea Centers for Disease Control and Prevention(KCDC)(No.2010-E33005-00)
文摘AIM：To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS： A cross-sectional,multi-center,observational study.Patients with an injured eye who visited the Emergency Department at one of nine hospitals in Korea were enrolled.All data were prospectively collected between March and September 2010 using a questionnaire.Eye injuries that occurred during risky sports were examined by gender and age.Additionally,the rate of open globe injuries that occurred with and without protective eyewear was examined for each activity.Continuous variables were compared using Student＇s t-test and categorical variables were compared using Chi-square test.RESULTS： A total of 446 patients had sports-related eye injuries.Teenagers（10-19 years old） and young adults（20-29 years old） had the most eye injuries.Eye injuries accounted for 0.2% of Emergency Department patients.Baseball was the most common cause of sports-related eye injuries,followed by soccer and hiking.Protective gear was worn by 9.4% of all patients.Patients that were 30-39 years of age had the highest rate of protective gear use,followed by patients that were 40-49 years of age.The proportion of sports-related eye injuries that were open-globe injuries was highest for soccer and hiking.CONCLUSION： Although injuries were most common in patients below the age of 10 years,these patients had the lowest rate of protective eyewear use.Injuries in adults over 40 years of age most commonly occurred during hiking,but the rate of protective eyewear use was low.Young athletes should be educated on and provided with protective eyewear and policies protective gear use should be established.For older adults,eye protection should be encouraged,especially during hiking.
文摘BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.
文摘BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.
