Trauma is a major health and social problem in the US and China, It constitutes the main cause of death in people aged 45 or under in both countries112]. There is clear evidence from clinical studies that a large perc...Trauma is a major health and social problem in the US and China, It constitutes the main cause of death in people aged 45 or under in both countries112]. There is clear evidence from clinical studies that a large percentage of these deaths are needless and preventable if better treatment and prevention programs are available12-3].展开更多
Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventila...Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.展开更多
BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, t...BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.展开更多
BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard t...BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.展开更多
BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of ...BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.展开更多
Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to b...Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.展开更多
Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by re...Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.展开更多
Severe trauma has the characteristics of complicated condition, multiple organs involved, limitq auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to prima hospitals to receive...Severe trauma has the characteristics of complicated condition, multiple organs involved, limitq auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to prima hospitals to receive treatments. But the traditional mode of separate discipline management can easi lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mc tality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospit~ （usually the top general hospital within the administrative region of a county）, can establish a sc entific and comprehensive trauma care system, the success rate of trauma rescue in this region can ] greatly improved. On March 1st, 2013, Tiantai People＇s Hospital of Zhejiang Province, China set up trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedur~ and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patier （injury severity score 〉16） have been treated in this trauma center. The rescue success rate reach~ 95~ and the delayed and]or missed diagnosis rate was less than 5%. Totally 86 severe cases of peK fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospil emergency rescue response time is less than 3 min, and the time from definite diagnosis to surge is within 35 min.展开更多
Purpose:Trauma is well known as one of the main causes of death and disability throughout the world.Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patie...Purpose:Trauma is well known as one of the main causes of death and disability throughout the world.Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patient outcomes,as well as reducing mortality rates.Methods:In this retrospective cohort study,systematic randomization was used to select 849 patients referred to the main trauma center of south of Iran during a period of six months(February 2017-July 2017);the patients case files were evaluated in terms of demographic information,pre-and post-accident conditions,clinical conditions at the time of admission and finally,accident outcomes.A logistic regression model was used to analyze the role of factors affecting mortality among subjects.Results:Among subjects,60.4%were in the age-group of 15-39 years.There was a 10.4%mortality rate among patients and motor-vehicle accide nts were the most comm on mecha nism of injury(66.7%).Aging led to in creased risk of fatality in this study.For each urHt increase in Glasgow coma scale(GCS),risk of death decreased by about 40%(odds ratio(OR)=0.63,95%confidence interval(CI):0.59—0.67).For each unit increase in injury severe score(ISS),risk of death increased by 10%(OR=1.11%,95%Cl:1.08-1.14)and for each unit in crease in trauma revised injury severity score(TRISS),there was 18%decrease in the risk of fatality(OR=0.82,95%CI:0.71-0.88).Conclusion:The most common cause of trauma and the most common cause of death from trauma was traffic accidents.It was also found that an increase in the ISS index increases the risk of death in trauma patients,but the increase in GCS,revised trauma score(RTS)and TRISS indices reduces the risk of death in trauma patients.The TRISS indicator is better predictor of traumatic death than other indicators.展开更多
Purpose:Spine injury is one of the leading causes of death and mortality worldwide.The objective of this study was to determine the incidence,pattern and outcome of trauma patients with spine injury referred to the la...Purpose:Spine injury is one of the leading causes of death and mortality worldwide.The objective of this study was to determine the incidence,pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.Methods:This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran.The data collection form included the age,sex,injury location(cervical,thoracic,and lumbar),cause of injury(traffic accidents,falls,and assaults),length of hospital stay,injured segment of spine injury,severity of injury,and outcome.Statistical analyzes were performed using SPSS software version 24.Results:Totally 776 cases of spine injury were identified.The spine injury rate was 17.0%,and the mortality rate was 15.5%.Cervical spine injury(20.4%)more often occulted in motorcycle accident,and thoracic spine injury(20.1%)occulted in falls.The highest and lowest rates of spine injurys were related to lumbar spine injury(30.2%)and cervical spine injury(21.5%),respectively.There was a statistically significant relationship between the mechanism of injury and the location of spine injury(p<0.001).And patients with lumbar spine injury had the highest mortality rate(16.7%).Injury severity score(OR=1.041,p<0.001)and length of stay(OR=1.018,p<0.001)were strong predictors of mortality in trauma patients with spine injury.Conclusion:The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0%in southern of Iran.Road traffic injury and falls are the common mechanism of injury to spine.It is important to improve the safety of roads,and passengers,as well as work envi-ronment,and improve the quality of cars.Also,paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.展开更多
Objective： Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The...Objective： Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011. Methods： In a prospective study, patients with live- stock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient＇s demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean±standard deviation. Results： A total of 129 patients were included in this study, accounting for 0.3% of all trauma admission （40 273 cases）. The mean age was （55.27±14.45） years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured （n=72）, followed by the head, neck and spine （n=33 for each）. There was one death resulting from livestock-related injury in this study. Conclusion： Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important.展开更多
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modali...BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.展开更多
Objective： Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality. This research was conducted to determine the fall incidence among female population of Kashan cit...Objective： Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality. This research was conducted to determine the fall incidence among female population of Kashan city from the years 2005 to 2008. Methods： This was a retrospective research using existing data from the data bank of trauma center of Kashan University of Medical Sciences. Records of all the female patients treated at local hospitals with complete hospitalisation kept at the center were examined for 4 con- secutive years from 2005 to 2008. Results： A total of 2 094 female patients＇ records were examined. A significantly higher incidence of injuy occurred in 2008 compared to 2005 （P〈0.0001）. In addition, the highest frequency of injury occurred in age group above 65 years （31.9%） and in group with elementary education level （42.8%）. Conclusion： The results showed that fall incidences occurred in the old age group above 65 years. Fall injuries at this age may cause disability. Therefore, preventive measures should be taken, such as increasing the awareness of the aging population about the seriousness of fall incidence and encouraging the aged individuals to get involved in fitness program to remain physical fit and healthy.展开更多
深度学习是人工智能领域的热门研究方向之一,它通过构建多层人工神经网络模仿人脑对数据的处理机制。大型语言模型(large language model,LLM)基于深度学习的架构,在无需编程指令的情况下,能通过分析大量数据以获得理解和生成人类语言...深度学习是人工智能领域的热门研究方向之一,它通过构建多层人工神经网络模仿人脑对数据的处理机制。大型语言模型(large language model,LLM)基于深度学习的架构,在无需编程指令的情况下,能通过分析大量数据以获得理解和生成人类语言的能力,被广泛应用于自然语言处理、计算机视觉、智慧医疗、智慧交通等诸多领域。文章总结了LLM在医疗领域的应用,涵盖了LLM针对医疗任务的基本训练流程、特殊策略以及在具体医疗场景中的应用。同时,进一步讨论了LLM在应用中面临的挑战,包括决策过程缺乏透明度、输出准确性以及隐私、伦理问题等,随后列举了相应的改进策略。最后,文章展望了LLM在医疗领域的未来发展趋势,及其对人类健康事业发展的潜在影响。展开更多
基金supported by grants from Sichuan Department of Science and Technology(No.2011SZ0139,2011SZ0336,2012SZ0181)Chengdu Municipality of Bureau of Science and Technology(No.11PPYB099SF-289,12PPYB181SF-002)grants from Sichuan Department of Health(No.100552 and No.100553)
文摘Trauma is a major health and social problem in the US and China, It constitutes the main cause of death in people aged 45 or under in both countries112]. There is clear evidence from clinical studies that a large percentage of these deaths are needless and preventable if better treatment and prevention programs are available12-3].
文摘Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.
基金supported by a grant from the National Key R&D Program of China(2018YFF0301103).
文摘BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.
文摘BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.
基金supported by the National Natural Science Foundation of China(82102315).
文摘BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.
文摘Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.
基金supported by the U.S.Department of Defense(W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
文摘Severe trauma has the characteristics of complicated condition, multiple organs involved, limitq auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to prima hospitals to receive treatments. But the traditional mode of separate discipline management can easi lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mc tality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospit~ （usually the top general hospital within the administrative region of a county）, can establish a sc entific and comprehensive trauma care system, the success rate of trauma rescue in this region can ] greatly improved. On March 1st, 2013, Tiantai People＇s Hospital of Zhejiang Province, China set up trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedur~ and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patier （injury severity score 〉16） have been treated in this trauma center. The rescue success rate reach~ 95~ and the delayed and]or missed diagnosis rate was less than 5%. Totally 86 severe cases of peK fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospil emergency rescue response time is less than 3 min, and the time from definite diagnosis to surge is within 35 min.
基金This research has been supported with grant number of 98-01-38-19738 by Shiraz University of Medical Sciences in Shiraz,Iran.
文摘Purpose:Trauma is well known as one of the main causes of death and disability throughout the world.Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patient outcomes,as well as reducing mortality rates.Methods:In this retrospective cohort study,systematic randomization was used to select 849 patients referred to the main trauma center of south of Iran during a period of six months(February 2017-July 2017);the patients case files were evaluated in terms of demographic information,pre-and post-accident conditions,clinical conditions at the time of admission and finally,accident outcomes.A logistic regression model was used to analyze the role of factors affecting mortality among subjects.Results:Among subjects,60.4%were in the age-group of 15-39 years.There was a 10.4%mortality rate among patients and motor-vehicle accide nts were the most comm on mecha nism of injury(66.7%).Aging led to in creased risk of fatality in this study.For each urHt increase in Glasgow coma scale(GCS),risk of death decreased by about 40%(odds ratio(OR)=0.63,95%confidence interval(CI):0.59—0.67).For each unit increase in injury severe score(ISS),risk of death increased by 10%(OR=1.11%,95%Cl:1.08-1.14)and for each unit in crease in trauma revised injury severity score(TRISS),there was 18%decrease in the risk of fatality(OR=0.82,95%CI:0.71-0.88).Conclusion:The most common cause of trauma and the most common cause of death from trauma was traffic accidents.It was also found that an increase in the ISS index increases the risk of death in trauma patients,but the increase in GCS,revised trauma score(RTS)and TRISS indices reduces the risk of death in trauma patients.The TRISS indicator is better predictor of traumatic death than other indicators.
基金the Research Vice-Chancellor of Shiraz University of Medical Sciences for inancially supporting the research(Grant No.25125).
文摘Purpose:Spine injury is one of the leading causes of death and mortality worldwide.The objective of this study was to determine the incidence,pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.Methods:This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran.The data collection form included the age,sex,injury location(cervical,thoracic,and lumbar),cause of injury(traffic accidents,falls,and assaults),length of hospital stay,injured segment of spine injury,severity of injury,and outcome.Statistical analyzes were performed using SPSS software version 24.Results:Totally 776 cases of spine injury were identified.The spine injury rate was 17.0%,and the mortality rate was 15.5%.Cervical spine injury(20.4%)more often occulted in motorcycle accident,and thoracic spine injury(20.1%)occulted in falls.The highest and lowest rates of spine injurys were related to lumbar spine injury(30.2%)and cervical spine injury(21.5%),respectively.There was a statistically significant relationship between the mechanism of injury and the location of spine injury(p<0.001).And patients with lumbar spine injury had the highest mortality rate(16.7%).Injury severity score(OR=1.041,p<0.001)and length of stay(OR=1.018,p<0.001)were strong predictors of mortality in trauma patients with spine injury.Conclusion:The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0%in southern of Iran.Road traffic injury and falls are the common mechanism of injury to spine.It is important to improve the safety of roads,and passengers,as well as work envi-ronment,and improve the quality of cars.Also,paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.
文摘Objective： Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011. Methods： In a prospective study, patients with live- stock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient＇s demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean±standard deviation. Results： A total of 129 patients were included in this study, accounting for 0.3% of all trauma admission （40 273 cases）. The mean age was （55.27±14.45） years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured （n=72）, followed by the head, neck and spine （n=33 for each）. There was one death resulting from livestock-related injury in this study. Conclusion： Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important.
文摘BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.
文摘Objective： Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality. This research was conducted to determine the fall incidence among female population of Kashan city from the years 2005 to 2008. Methods： This was a retrospective research using existing data from the data bank of trauma center of Kashan University of Medical Sciences. Records of all the female patients treated at local hospitals with complete hospitalisation kept at the center were examined for 4 con- secutive years from 2005 to 2008. Results： A total of 2 094 female patients＇ records were examined. A significantly higher incidence of injuy occurred in 2008 compared to 2005 （P〈0.0001）. In addition, the highest frequency of injury occurred in age group above 65 years （31.9%） and in group with elementary education level （42.8%）. Conclusion： The results showed that fall incidences occurred in the old age group above 65 years. Fall injuries at this age may cause disability. Therefore, preventive measures should be taken, such as increasing the awareness of the aging population about the seriousness of fall incidence and encouraging the aged individuals to get involved in fitness program to remain physical fit and healthy.
文摘深度学习是人工智能领域的热门研究方向之一,它通过构建多层人工神经网络模仿人脑对数据的处理机制。大型语言模型(large language model,LLM)基于深度学习的架构,在无需编程指令的情况下,能通过分析大量数据以获得理解和生成人类语言的能力,被广泛应用于自然语言处理、计算机视觉、智慧医疗、智慧交通等诸多领域。文章总结了LLM在医疗领域的应用,涵盖了LLM针对医疗任务的基本训练流程、特殊策略以及在具体医疗场景中的应用。同时,进一步讨论了LLM在应用中面临的挑战,包括决策过程缺乏透明度、输出准确性以及隐私、伦理问题等,随后列举了相应的改进策略。最后,文章展望了LLM在医疗领域的未来发展趋势,及其对人类健康事业发展的潜在影响。
