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Obana KK, Lind DR, Mastroianni MA, Rondon AJ, Alexander FJ, Levine WN, Ahmad CS. What are our patients asking Google about acromioclavicular joint injuries?-frequently asked online questions and the quality of online resources. JSES Rev Rep Tech 2024; 4:175-181. [PMID: 38706686 PMCID: PMC11065754 DOI: 10.1016/j.xrrt.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Management of acromioclavicular (AC) joint injuries has been an ongoing source of debate, with over 150 variations of surgery described in the literature. Without a consensus on surgical technique, patients are seeking answers to common questions through internet resources. This study investigates the most common online patient questions pertaining to AC joint injuries and the quality of the websites providing information. Hypothesis 1) Question topics will pertain to surgical indications, pain management, and success of surgery and 2) the quality and transparency of online information are largely heterogenous. Methods Three AC joint search queries were entered into the Google Web Search. Questions under the "People also ask" tab were expanded in order and 100 results for each query were included (300 total). Questions were categorized based on Rothwell's classification. Websites were categorized by source. Website quality was evaluated by the Journal of the American Medical Association (JAMA) Benchmark Criteria. Results Most questions fell into the Rothwell Fact category (48.0%). The most common question topics were surgical indications (28.0%), timeline of recovery (13.0%), and diagnosis/evaluation (12.0%). The least common question topics were anatomy/function (3.3%), evaluation of surgery (3.3%), injury comparison (1.0%), and cost (1.0%). The most common websites were medical practice (44.0%), academic (22.3%), and single surgeon personal (12.3%). The average JAMA score for all websites was 1.0 ± 1.3. Government websites had the highest JAMA score (4.0 ± 0.0) and constituted 45.8% of all websites with a score of 4/4. PubMed articles constituted 63.6% (7/11) of government website. Comparatively, medical practice websites had the lowest JAMA score (0.3 ± 0.7, range [0-3]). Conclusion Online patient AC joint injury questions pertain to surgical indications, timeline of recovery, and diagnosis/evaluation. Government websites and PubMed articles provide the highest-quality sources of reliable, up-to-date information but constitute the smallest proportion of resources. In contrast, medical practice represents the most visited websites, however, recorded the lowest quality score. Physicians should utilize this information to answer frequently asked questions, guide patient expectations, and help provide and identify reliable online resources.
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Affiliation(s)
- Kyle K. Obana
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Dane R.G. Lind
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A. Mastroianni
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander J. Rondon
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Frank J. Alexander
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Blumenthal A, Caparos S, Blanchette I. Understanding the structure of autobiographical memories: A study of trauma memories from the 1994 Rwandan genocide. Mem Cognit 2024:10.3758/s13421-024-01565-0. [PMID: 38693323 DOI: 10.3758/s13421-024-01565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
How do we remember traumatic events, and are these memories different in individuals who experience post-traumatic stress? Some evidence suggests that traumatic events are mnemonically enhanced, or include more episodic detail, relative to other types of memories. Simultaneously, individuals with post-traumatic stress disorder (PTSD) have more non-episodic details in all of their memories, a pattern hypothesized to result from impairment in executive function. Here, we explore these questions in a unique population that experienced severely traumatic events more than 20 years ago - individuals who lived through the 1994 genocide in Rwanda. Participants recalled events from the genocide, negative events unrelated to the genocide, neutral events, and positive events. We used the Autobiographical Interview method to label memory details as episodic or non-episodic. We found that memories from the genocide showed robust mnemonic enhancement, with more episodic than non-episodic details, and contained more details overall than any other memory type. This pattern was not impacted by post-traumatic stress. Overall, this study provides evidence that traumatic events create vivid long-lasting episodic memories, in this case even more than 20 years later.
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Affiliation(s)
- Anna Blumenthal
- Université Laval, Pavillon Félix-Antoine-Savard Local 1144, Québec, Canada
- CERVO Brain Research Center, Québec, Canada
| | - Serge Caparos
- Université Paris 8, DysCo lab, Paris, France
- Institut Universitaire de France, Paris, France
| | - Isabelle Blanchette
- Université Laval, Pavillon Félix-Antoine-Savard Local 1144, Québec, Canada.
- CERVO Brain Research Center, Québec, Canada.
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Hosseinpour H, Anand T, Hejazi O, Colosimo C, Bhogadi SK, Spencer A, Nelson A, Ditillo M, Magnotti LJ, Joseph B. The Role of Whole Blood Hemostatic Resuscitation in Bleeding Geriatric Trauma Patients. J Surg Res 2024; 299:26-33. [PMID: 38692185 DOI: 10.1016/j.jss.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/17/2024] [Accepted: 03/21/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Whole blood (WB) has recently gained increased popularity as an adjunct to the resuscitation of hemorrhaging civilian trauma patients. We aimed to assess the nationwide outcomes of using WB as an adjunct to component therapy (CT) versus CT alone in resuscitating geriatric trauma patients. METHODS We performed a 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program. We included geriatric (age, ≥65 y) trauma patients presenting with hemorrhagic shock (shock index >1) and requiring at least 4 units of packed red blood cells in 4 h. Patients with severe head injuries (head Abbreviated Injury Scale ≥3) and transferred patients were excluded. Patients were stratified into WB-CT versus CT only. Primary outcomes were 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications. Multivariable regression analysis was performed, adjusting for potential confounding factors. RESULTS A total of 1194 patients were identified, of which 141 (12%) received WB. The mean ± standard deviation age was 74 ± 7 y, 67.5% were male, and 83.4% had penetrating injuries. The median [interquartile range] Injury Severity Score was 19 [13-29], with no difference among study groups (P = 0.059). Overall, 6-h, 24-h, and in-hospital mortality were 16%, 23.1%, and 43.6%, respectively. On multivariable regression analysis, WB was independently associated with reduced 24-h (odds ratio, 0.62 [0.41-0.94]; P = 0.024), and in-hospital mortality (odds ratio, 0.60 [0.40-0.90]; P = 0.013), but not with major complications (odds ratio, 0.78 [0.53-1.15]; P = 0.207). CONCLUSIONS Transfusion of WB as an adjunct to CT is associated with improved early and overall mortality in geriatric trauma patients presenting with severe hemorrhage. The findings from this study are clinically important, as this is an essential first step in prioritizing the selection of WB resuscitation for geriatric trauma patients presenting with hemorrhagic shock.
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Affiliation(s)
- Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Omar Hejazi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Audrey Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Sarblah SR, Rachman P, Antwi WK, Anudjo MNK, Botwe BO, Akudjedu TN. Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review. Radiography (Lond) 2024; 30:1001-1013. [PMID: 38692168 DOI: 10.1016/j.radi.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients. METHODS A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis. RESULTS The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI. DISCUSSION Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate. IMPLICATIONS FOR PRACTICE MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.
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Affiliation(s)
- S R Sarblah
- Radiology Department, Hereford County Hospital, Wye Valley NHS Foundation Trust, Hereford, UK; Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - P Rachman
- Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - W K Antwi
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana
| | - M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK; School of Radiology, AECC University College, Bournemouth, UK
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana; Department of Midwifery and Radiography Division School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
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Krause S, Radomsky AS. 'Things that shouldn't be': a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories. Behav Cogn Psychother 2024:1-15. [PMID: 38679952 DOI: 10.1017/s1352465824000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of 'violation' and identification of specific violation misappraisals is limited. AIMS This study's aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps. METHOD Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts. DISCUSSION Three categories emerged, each with several themes - qualities of violation, violation-related appraisals, and violation-related behaviours. Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences; self-worth; responsibility, self-blame and regret) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.
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Affiliation(s)
- Sandra Krause
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
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Raffali MAAF, Azmi MI, Muhammad SF, Che Hassan HH. Delayed acute myocardial infarction in a young man with traumatic multivessel coronary artery dissection after blunt chest injury. BMJ Case Rep 2024; 17:e260649. [PMID: 38684352 DOI: 10.1136/bcr-2024-260649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
A man in his 20s with no medical illness sustained a blunt chest injury with pneumothorax and lung contusion after involving in a motorbike accident. Five days postadmission, he subsequently had myocardial infarction with cardiac arrest, in which coronary angiogram and intravascular ultrasound showed diffused multivessel coronary artery dissection.
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Affiliation(s)
- Mohd Asyiq Al-Fard Raffali
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Malaysia
| | - Mohd Imree Azmi
- Department of Radiology, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandr Tun Razak, Malaysia
| | - Syawal Faizal Muhammad
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Malaysia
| | - Hamat Hamdi Che Hassan
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Malaysia
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Fani N, Fulton T, Botzanowski B. The Neurophysiology of Interoceptive Disruptions in Trauma-Exposed Populations. Curr Top Behav Neurosci 2024. [PMID: 38678141 DOI: 10.1007/7854_2024_469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
In the aftermath of psychological trauma, many individuals experience perturbations in interoception, a term that broadly references the ability to accurately detect body signals and integrate these signals with emotional states. These interoceptive disruptions can manifest in different ways, including blunting or amplification of sensitivity to internal physiological signals. In this chapter we review extant neurophysiological research on interoception in trauma-exposed populations, with a particular focus on the effects of chronic interpersonal trauma, such as childhood maltreatment and racial discrimination. We explore research that used different types of interoceptive assays, from self-report measures to electrophysiological and neuroimaging tools to characterize the disruptions in pain perception, interoceptive acuity, and physiological responses that may arise after a traumatic event. Finally, we discuss interventions that are designed to target interoceptive mechanisms, from exposure-based therapies to mindfulness-based practices, as well as future directions in trauma interoception research.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Travis Fulton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Boris Botzanowski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Schmidt V, Mukka S, Bergdahl C, Ekholm C, Brüggemann A, Wolf O. Epidemiology, Treatment, and Mortality of 3,983 Scapula Fractures from the Swedish Fracture Register. J Shoulder Elbow Surg 2024:S1058-2746(24)00305-7. [PMID: 38688421 DOI: 10.1016/j.jse.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population. METHODS This observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality. RESULTS We included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year. CONCLUSIONS Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.
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Affiliation(s)
- Viktor Schmidt
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå,.
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg
| | - Carl Ekholm
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg
| | - Anders Brüggemann
- Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden
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Jamshaid S, Rotimi O, Tanna R, Elmiyeh B. Complicated penetrating foreign body neck injury. BMJ Case Rep 2024; 17:e259396. [PMID: 38677718 PMCID: PMC11057282 DOI: 10.1136/bcr-2023-259396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Penetrating neck injury is associated with significant morbidity due to the several structures (neurological, vascular and aerodigestive) within close proximity to one another. This case highlights an uncommon presentation of an embedded foreign body following penetrating neck trauma and the decision-making required during management.
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Costello L, Ogunbowale A, Ekanayake K. Maxillofacial fractures among non-indigenous ethnic groups in the Irish national maxillofacial unit: a review. Ir J Med Sci 2024:10.1007/s11845-024-03681-x. [PMID: 38676900 DOI: 10.1007/s11845-024-03681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND This study investigates maxillofacial fractures in non-indigenous ethnic groups who were reviewed in the national maxillofacial unit in Ireland. The aim of this study was to highlight any potential trends in presentation of facial fractures in non-indigenous groups in comparison to previous reports which have included all ethnicities. This unique study is based on the fact that Ireland has only recently transformed into a diverse, multi-cultural country. This is unlike countries such as the UK and USA which have a long history of multicultural integration. MATERIALS AND METHODS This retrospective study evaluated the trauma database of 4761 patients with 5038 fractures who attended the national maxillofacial unit over a 5-year period from 2015 to 2019. Parameters included age, gender, mechanism of injury, fracture sustained, time of the day, day of the week, month of injury, and the referral source were obtained from patient records. RESULTS The study identified 456 patients who did not identify as being born in Ireland, with 384 males and 72 females. The most common fracture seen was of the zygomatic bone, and the most common mechanism of injury was alleged assault for this cohort. Most injuries occurred in late afternoon with Friday being the most common day of the week. CONCLUSION This study shows how maxillofacial units need to adapt to the changing trends in Irish demographics with increased demand for resources such as translation services. A further study could evaluate the rapidly changing demographic with mass migration of people currently seeking refuge in Western Europe.
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Affiliation(s)
- Liam Costello
- National Oral and Maxillofacial Unit, St. James' Hospital Dublin, Dublin, Ireland
| | - Akinsola Ogunbowale
- Dept. of Oral and Maxillofacial Surgery, University Hospital Limerick, Limerick, Ireland.
| | - Kumara Ekanayake
- National Oral and Maxillofacial Unit, St. James' Hospital Dublin, Dublin, Ireland
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Zimmer Z, Akbulut-Yuksel M, Young Y, Toan TK. The long-term association between exposure to wartime bombing earlier in life and post- traumatic stress later in life among today's older Vietnamese population. Acta Psychol (Amst) 2024; 246:104293. [PMID: 38670044 DOI: 10.1016/j.actpsy.2024.104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.
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Affiliation(s)
| | | | - Yvette Young
- Max-Planck Institute for Demographic Research, Rostock, Germany.
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Zagaria A, Fiori V, Vacca M, Lombardo C, Pariante CM, Ballesio A. Inflammation as a mediator between adverse childhood experiences and adult depression: A meta-analytic structural equation model. J Affect Disord 2024; 357:85-96. [PMID: 38677656 DOI: 10.1016/j.jad.2024.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
Exposure to adverse childhood experiences (ACEs) confers a higher risk of developing depression in adulthood, yet the mediation of inflammation remains under debate. To test this model, we conducted a systematic review and two-stage structural equation modelling meta-analysis of studies reporting correlations between ACEs before age 18, inflammatory markers and depression severity in adulthood. Scopus, Pubmed, Medline, PsycInfo, and CINAHL were searched up to 2 October 2023. Twenty-two studies reporting data on C-reactive protein (CRP, n = 12,935), interleukin-6 (IL-6, n = 4108), tumour necrosis factor-α (TNF-α, n = 2256) and composite measures of inflammation (n = 1674) were included. Unadjusted models revealed that CRP (β = 0.003, 95 % LBCI 0.0002 to 0.0068), IL-6 (β = 0.003, 95 % LBCI 0.001 to 0.006), and composite inflammation (β = 0.009, 95 % LBCI 0.004 to 0.018) significantly mediated the association between ACEs and adult depression. The mediation effects no longer survived after adjusting for BMI; however, a serial mediation model revealed that BMI and IL-6 sequentially mediated the association between ACEs and depression (β = 0.002, 95 % LBCI 0.0005 to 0.0046), accounting for 14.59 % and 9.94 % of the variance of IL-6 and depressive symptoms, respectively. Due to the cross-sectional nature of assessment of inflammation and depression findings should be approached with caution; however, results suggest that complex interactions of psychoneuroimmunological and metabolic factors underlie the association between ACEs and adulthood depression.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Valeria Fiori
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Mariacarolina Vacca
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
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Collie BL, Emami S, Lyons NB, Ramsey WA, O'Neil CF, Meizoso JP, Ginzburg E, Pizano LR, Schulman CI, Parker BM, Namias N, Proctor KG. Survival of In-Hospital Cardiopulmonary Arrest in Trauma Patients. J Surg Res 2024; 298:379-384. [PMID: 38669784 DOI: 10.1016/j.jss.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Relative to other hospitalized patients, trauma patients are younger with fewer comorbidities, but the incidence and outcomes of in-hospital cardiopulmonary arrest (IHCA) with cardiopulmonary resuscitation (CPR) in this population is unknown. Therefore, we aimed to investigate factors associated with survival in trauma patients after IHCA to test the hypothesis that compared to other hospitalized patients, trauma patients with IHCA have improved survival. METHODS Retrospective review of the Trauma Quality Improvement Program database 2017 to 2019 for patients who had IHCA with CPR. Primary outcome was survival to hospital discharge. Secondary outcomes were in-hospital complications, hospital length of stay, intensive care unit length of stay, and ventilator days. Data were compared with univariate and multivariate analyses at P < 0.05. RESULTS In 22,346,677 admitted trauma patients, 14,056 (0.6%) received CPR. Four thousand three hundred seventy-seven (31.1%) survived to discharge versus 26.4% in a national sample of all hospitalized patients (P < 0.001). In trauma patients, median age was 55 y, the majority were male (72.2%). Mortality was higher for females versus males (70.3% versus 68.3%, P = 0.026). Multivariate regression showed that older age 1.01 (95% confidence interval (CI) 1.01-1.02), Hispanic ethnicity 1.21 (95% CI 1.04-1.40), and penetrating trauma 1.51 (95% CI 1.32-1.72) were risk factors for mortality, while White race was a protective factor 0.36 (95% CI 0.14-0.89). CONCLUSIONS This is the first study to show that the incidence of IHCA with CPR is approximately six in 1000 trauma admissions and 31% survive to hospital discharge, which is higher than other hospitalized patients. Age, gender, racial, and ethnic disparities also influence survival.
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Affiliation(s)
- Brianna L Collie
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
| | - Shaheen Emami
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicole B Lyons
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Walter A Ramsey
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Christopher F O'Neil
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Jonathan P Meizoso
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Enrique Ginzburg
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Louis R Pizano
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Carl I Schulman
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Brandon M Parker
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Kenneth G Proctor
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
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Li RF, Gong XF, Xu HB, Lin JT, Zhang HG, Suo ZJ, Wu JL. Age affects vascular morphology and predictiveness of anatomical landmarks for aortic zones in trauma patients: implications for resuscitative endovascular balloon occlusion of the aorta. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02512-z. [PMID: 38656432 DOI: 10.1007/s00068-024-02512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Understanding the vascular morphology is fundamental for resuscitative endovascular balloon occlusion of the aorta. This study aimed to evaluate the effect of aging on length and diameter of aorta and iliac arteries in trauma patients, and to investigate the predictiveness of anatomical landmarks for aortic zones. METHODS A total of 235 patients in a regional trauma center registry from September 1, 2018, to January 3, 2024, participated in the study. Reconstruction of computed tomography was applied to the torso area. The marginal diameter and length of aorta and iliac arteries were measured. Anatomical landmark distances and aortic marginal lengths were compared. RESULTS The length and diameter of aorta and iliac arteries increased with age, and a tortuous and enlarged morphology was observed in older patients. There was a good regression between age and diameter of the aorta. Neither the jugular notch, the xiphisternal joint, nor the umbilicus could reliably represent specific margins of aortic zones. The distance between the mid-sternum and femoral artery (427 ± 25 to 442 ± 25 mm for right, and 425 ± 28 to 440 ± 26 mm for left) was predictive for zone 1 in all groups. The distance between the lower one-third junction of the xiphisternum to the umbilicus and femoral artery (232 ± 19 to 240 ± 17 mm for right, and 229 ± 20 to 237 ± 19 mm for left) was predictive for zone 3 aorta. CONCLUSION Aging increases the length and diameter of aorta and iliac arteries, with a tortuous and enlarged morphology in geriatric populations. The mid-sternum and the lower one-third junction of the xiphisternum to the umbilicus were predictive landmarks for zone 1 and zone 3, respectively.
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Affiliation(s)
- Rui-Fa Li
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Xue-Fang Gong
- Department of Pulmonary and Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Hong-Bo Xu
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Jin-Tuan Lin
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Hai-Gang Zhang
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Zhi-Jun Suo
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China
| | - Jing-Lan Wu
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China.
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Bertulli L, Pileggi M, Marchi F, Scarone P, Cianfoni A. 'Armed kyphoplasty' with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series. J Neurointerv Surg 2024; 16:436-442. [PMID: 38262730 DOI: 10.1136/jnis-2023-021114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Complex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we assessed the feasibility, safety, and results of 'armed kyphoplasty' (AKP) and surgical posterior stabilization (PS). METHODS A total of 24 consecutive patients were treated with combined AKP and PS. Minimally invasive and open surgery techniques were used for PS. AKP was performed with C-arm or biplane fluoroscopic guidance, and screws were placed under navigation or fluoroscopic guidance. A postoperative CT scan and standing plain films were obtained. Patients were followed up according to clinical standards. Kyphosis correction (measured with regional Cobb angle), pain (measured with the Numeric Rating Scale), neurological status (measured with Frankel grade) were assessed. RESULTS A total of 25 fractures of neoplastic (40%), traumatic (32%), and osteoporotic (28%) nature were treated. Open surgery and minimally invasive techniques were applied in 16/24 and 8/24 patients, respectively. Decompressive laminectomy was performed in 13 cases. No intraprocedural complications occurred. Two patients (8%) died due to underlying disease complications and three complications (12%) required re-intervention (one surgical site infection, one adjacent fracture, and one screw pull-out) in the first month. The mean Cobb angle was 20.14±6.19° before treatment and 11.66±5.24° after treatment (P<0.0001). No re-fractures occurred at the treated levels. CONCLUSIONS Combined AKP and PS is feasible and effective in the treatment of complex thoracolumbar fractures of all etiologies. AKP avoided highly invasive corpectomy. Anterior and posterior support ensured stability, preventing implant failure and re-fracture. The complication rate was low compared with more invasive traditional 360° open surgical approaches.
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Affiliation(s)
- Lorenzo Bertulli
- Department of Neurosurgery, KSW Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Francesco Marchi
- Department of Neurosurgery, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Pietro Scarone
- Centre of Spine Surgery, Clinica Santa Chiara, Locarno, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
- Department of Neuroradiology, Inselspital Bern, University of Bern, Bern, Switzerland
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Yu B, Cho J, Kang BH, Kim K, Kim DH, Chang SW, Jung PY, Heo Y, Kang WS. Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study. Sci Rep 2024; 14:9164. [PMID: 38644449 PMCID: PMC11033263 DOI: 10.1038/s41598-024-59861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) had been introduced as an innovative procedure for severe hemorrhage in the abdomen or pelvis. We aimed to investigate risk factors associated with mortality after REBOA and construct a model for predicting mortality. This multicenter retrospective study collected data from 251 patients admitted at five regional trauma centers across South Korea from 2015 to 2022. The indications for REBOA included patients experiencing hypovolemic shock due to hemorrhage in the abdomen, pelvis, or lower extremities, and those who were non-responders (systolic blood pressure (SBP) < 90 mmHg) to initial fluid treatment. The primary and secondary outcomes were mortality due to exsanguination and overall mortality, respectively. After feature selection using the least absolute shrinkage and selection operator (LASSO) logistic regression model to minimize overfitting, a multivariate logistic regression (MLR) model and nomogram were constructed. In the MLR model using risk factors selected in the LASSO, five risk factors, including initial heart rate (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.98-1.00; p = 0.030), initial Glasgow coma scale (aOR, 0.86; 95% CI 0.80-0.93; p < 0.001), RBC transfusion within 4 h (unit, aOR, 1.12; 95% CI 1.07-1.17; p < 0.001), balloon occlusion type (reference: partial occlusion; total occlusion, aOR, 2.53; 95% CI 1.27-5.02; p = 0.008; partial + total occlusion, aOR, 2.04; 95% CI 0.71-5.86; p = 0.187), and post-REBOA systolic blood pressure (SBP) (aOR, 0.98; 95% CI 0.97-0.99; p < 0.001) were significantly associated with mortality due to exsanguination. The prediction model showed an area under curve, sensitivity, and specificity of 0.855, 73.2%, and 83.6%, respectively. Decision curve analysis showed that the predictive model had increased net benefits across a wide range of threshold probabilities. This study developed a novel intuitive nomogram for predicting mortality in patients undergoing REBOA. Our proposed model exhibited excellent performance and revealed that total occlusion was associated with poor outcomes, with post-REBOA SBP potentially being an effective surrogate measure.
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Affiliation(s)
- Byungchul Yu
- Traumatology, Gachon University College of Medicine, Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jayun Cho
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou School of Medicine, Suwon, Republic of Korea
| | - Kyounghwan Kim
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, 65, Doryeong-ro, Jeju-si, Jeju-do, Republic of Korea
| | - Dong Hun Kim
- Division of Trauma Surgery, Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Pil Young Jung
- Department of Trauma and Acute Care Surgery, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Yoonjung Heo
- Division of Trauma Surgery, Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Wu Seong Kang
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, 65, Doryeong-ro, Jeju-si, Jeju-do, Republic of Korea.
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Bullmann T, Stucki C, Kaiser N, Ziebarth K. [Fractures of the lateral condyle of the humerus in children : High risk of secondary dislocation with conservative treatment]. Unfallchirurgie (Heidelb) 2024:10.1007/s00113-024-01432-2. [PMID: 38649639 DOI: 10.1007/s00113-024-01432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Fractures of the lateral condyle of the humerus in children are articular fractures with difficult diagnostics due to the incompletely ossified elbow joint. The aim of this study was to evaluate the method of treatment at initial presentation and to analyze the frequency of subsequent displacement during follow-up. MATERIAL AND METHOD Retrospective analysis of the frequency of primary fracture dislocation and subsequent displacement of fractures of the lateral condyle of the humerus in children under 16 years of age between 2004 and 2021. Conventional radiographs in two planes at the time of the accident and in the follow-up after 5-7 days were evaluated. RESULTS A total of 285 fractures of the lateral condyle of the humerus were evaluated. The average age was 5.3 years. Of the fractures 109 (38.3%) were directly surgically treated in cases of primary displacement and 176 fractures (61.7%) were not primarily displaced and were initially treated conservatively. During follow-up, subsequent displacement was evident in 46 fractures (26.1%). A total of 130 fractures (45.6%) were treated conservatively and 155 fractures (54.4%) were treated surgically using open joint visualization and screw osteosynthesis or K‑wire osteosynthesis. CONCLUSION Fractures of the lateral condyle of the humerus occur more frequently in a certain age group and require targeted radiological diagnostics. Nondisplaced fractures can be treated conservatively but essential radiological follow-up shows a high number of subsequent displacements, so that open surgical stabilization is often necessary.
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Affiliation(s)
- T Bullmann
- Abteilung Kinderorthopädie, Kinderchirurgische Universitätsklinik, Inselspital Bern, Freiburgstraße 15, 3010, Bern, Schweiz.
| | - C Stucki
- Abteilung Kinderorthopädie, Kinderchirurgische Universitätsklinik, Inselspital Bern, Freiburgstraße 15, 3010, Bern, Schweiz
| | - N Kaiser
- Abteilung Kinderorthopädie, Kinderchirurgische Universitätsklinik, Inselspital Bern, Freiburgstraße 15, 3010, Bern, Schweiz
| | - K Ziebarth
- Abteilung Kinderorthopädie, Kinderchirurgische Universitätsklinik, Inselspital Bern, Freiburgstraße 15, 3010, Bern, Schweiz
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Shastri P, Abelardo E, Prabhu V. Trivial trauma to the cheek: significant complications in the chest. BMJ Case Rep 2024; 17:e252705. [PMID: 38649240 PMCID: PMC11043695 DOI: 10.1136/bcr-2022-252705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.
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Affiliation(s)
| | - Edgardo Abelardo
- ENT-HNS, Hywel Dda University Health Board, Carmarthen, UK
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
| | - Vinod Prabhu
- Hywel Dda University Health Board, Carmarthen, Carmarthenshire, UK
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Rafieezadeh A, Zangbar B, Zeeshan M, Gandhi C, Al-Mufti F, Jehan F, Kirsch J, Rodriguez G, Samson D, Prabhakaran K. Predictors of mortality after craniotomy for geriatric traumatic brain injury. Injury 2024:111585. [PMID: 38704345 DOI: 10.1016/j.injury.2024.111585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND With a sustained increase in the proportion of elderly trauma patients, geriatric traumatic brain injury (TBI) is a significant source of morbidity, mortality and resource utilization. The aim of our study was to assess the predictors of mortality in geriatric TBI patients who underwent craniotomy. METHODS We performed a 4-year analysis of ACS-TQIP database (2016-2019) and included all geriatric trauma patients (≥65y) with isolated severe TBI who underwent craniotomy. We calculated 11- point modified frailty index (mFI) for patients. Our primary and secondary outcomes were mortality and unfavorable outcome, respectively. Multivariate regression analysis was performed to identify the predictors of outcomes. Patients with mFI ≥ 0.25 were defined as Frail, whereas patient with mFI of 0.08 or higher (<0.25) were identified as pre-frail; Non-frail patients were identified as mFI of <0.08. RESULTS We analyzed data from 20,303 patients. The mortality rate was 17.7 % (3,587 patients). Having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 2.251, p < 0.001), and pre-hospital anticoagulant use (OR = 1.306, p < 0.001) increased the risks of mortality. Frailty, as a continuous variable, was not considered as a risk factor for mortality (p = 0.058) but after categorization, it was shown that compared to non-frails, patients with pre-frailty (OR = 1.946, p = 0.011) and frailty (OR = 1.786, p = 0.026) had increased risks of mortality. Higher mFI (OR = 4.841), age (OR = 1.034), ISS (OR = 1.052), having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 1.758), and use of anticoagulants (OR = 1.117) were significant risk factors for unfavorable outcomes (p < 0.001, for all). CONCLUSIONS Having more than two types of intra-cranial hemorrhage and pre-hospital anticoagulant use were significant risk factors for mortality. The study's findings also suggest that frailty may not be a sufficient predictor of mortality after craniotomy in geriatric patients with TBI. However, frailty still affects the discharge disposition and favorable outcome. LEVEL OF EVIDENCE Level III retrospective study.
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Affiliation(s)
- Aryan Rafieezadeh
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Bardiya Zangbar
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States.
| | - Muhammad Zeeshan
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Chirag Gandhi
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Fawaz Al-Mufti
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Faisal Jehan
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Jordan Kirsch
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Gabriel Rodriguez
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - David Samson
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Kartik Prabhakaran
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
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Xie J, Liu T, Dai F, Lin J. A case of primary repair and reconstruction of local ear defects in children with emergency ear trauma. Asian J Surg 2024:S1015-9584(24)00650-X. [PMID: 38644118 DOI: 10.1016/j.asjsur.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Jinpeng Xie
- Medical Cosmetology Department, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Tao Liu
- Medical Cosmetology Department, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Fan Dai
- Medical Cosmetology Department, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Jie Lin
- Medical Cosmetology Department, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China.
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Scroger M, Draper RS, McQuillan B. Online sexual abuse and exploitation of children in the Philippines: An exploratory study of outcomes after reintegration into the community. Child Abuse Negl 2024; 152:106805. [PMID: 38642514 DOI: 10.1016/j.chiabu.2024.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND This study examined psychosocial outcomes for Filipino survivors of online sexual abuse and exploitation of children (OSAEC). OBJECTIVE This study aimed to identify relationships between demographic variables, self-reported and caregiver-reported trauma symptoms, and psychosocial functioning among Filipino youth who have experienced OSAEC. PARTICIPANTS AND SETTING This study utilized inclusion criteria of survivors of OSAEC between ages 12 and 18 who received residential care and were reintegrated into the community for at least one year (N = 48). Participants were in care at shelters associated with Project PAVE in the Philippines. METHODS As measured by three assessment tools, relationships between demographic variables and psychosocial functioning were explored for risk and protective factors of trauma symptoms and psychosocial functioning to better understand this population's needs post-integration. RESULTS Results suggest survivors continue to experience psychosocial symptoms after reintegration. Caregivers reported survivors reintegrated outside the home had significantly higher externalizing symptoms (MR = 6.67; H(3) = 14.85, p = .002, η2 = 0.27) compared to survivors reintegrated within the home and survivors who trafficked themselves to have higher internalizing symptoms (MR = 16.79; H(3) = 11.80; p = .008, η2 = 0.20) than survivors trafficked by a relative. Caregivers reported survivors who resided in the shelter for one month or less to have higher internalizing symptoms (MR = 20.12; H(2) = 11.06; p = .004; η2 = 0.20) than survivors who resided in the shelter for six months or longer. CONCLUSION This study highlights the importance of further research to better understand the needs of this vulnerable population in order to guide the most effective intervention, aftercare, and reintegration programs to support survivors and their caregivers.
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Affiliation(s)
- Megan Scroger
- Department of Psychology, Roberts Wesleyan University, 2301 Westside Dr., Rochester, NY 14624, United States.
| | - Rebecca S Draper
- Department of Social Work, Roberts Wesleyan University, 2301 Westside Dr., Rochester, NY 14624, United States.
| | - Brenda McQuillan
- Department of Social Work, Roberts Wesleyan University, 2301 Westside Dr., Rochester, NY 14624, United States.
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Moreno-Blanco D, Alonso E, Sanz-García A, Aramendi E, López-Izquierdo R, García RP, Vegas CDP, Martín-Rodríguez F. Spanish vs USA cohort comparison of prehospital trauma scores to predict short-term mortality. Clin Med (Lond) 2024:100208. [PMID: 38643832 DOI: 10.1016/j.clinme.2024.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/07/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND This study aimed to evaluate three prehospital early warning scores (EWSs): RTS, MGAP and MREMS, to predict short-term mortality in acute life-threatening trauma and injury/illness by comparing United States (US) and Spanish cohorts. METHODS A total of 8854 patients, 8598/256 survivors/nonsurvivors, comprised the unified cohort. Datasets were randomly divided into training and test sets. Training sets were used to analyze the discriminative power of the scores in terms of the area under the curve (AUC), and the score performance was assessed in the test set in terms of sensitivity (SE), specificity (SP), accuracy (ACC) and balanced accuracy (BAC). RESULTS The three scores showed great discriminative power with AUCs>0.90, and no significant differences between cohorts were found. In the test set, RTS/MREMS/MGAP showed SE/SP/ACC/BAC values of 86.0/89.9/89.6/87.1%, 91.0/86.9/87.5/88.5%, and 87.7/82.9/83.4/85.2%, respectively. CONCLUSIONS All EWSs showed excellent ability to predict the risk of short-term mortality, independent of the country.
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Affiliation(s)
- Diego Moreno-Blanco
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain; Biomedical Engineering and Telemedicine Centre, ETSI de Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Erik Alonso
- Department of Applied Mathematics, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla - La Mancha (UCLM), Talavera, Spain.
| | - Elisabete Aramendi
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain; Emergency Department. Hospital Universitario Rio Hortega. Valladolid, Spain
| | - Rubén Pérez García
- Emergency Department. Hospital Universitario Rio Hortega. Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; Emergency Department. Hospital Clínico Universitario. Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Zhu R, Liu X, Li X, Ye L. Massive retroperitoneal hematoma caused by intercostal artery bleeding after blunt trauma: a case report. J Cardiothorac Surg 2024; 19:248. [PMID: 38632604 PMCID: PMC11025240 DOI: 10.1186/s13019-024-02739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The occurrence of massive retroperitoneal hematoma caused by intercostal artery bleeding is exceedingly uncommon. CASE PRESENTATION A middle-aged male presented to the hospital after a fall. Computed tomography scan revealed a massive retroperitoneal hematoma without any evidence of organ or major vessel rupture. The angiogram revealed extravasation from a branch of the twelfth intercostal artery, and successful transcatheter arterial embolization was performed on this specific artery. CONCLUSIONS The possibility of intercostal artery rupture should be considered in cases of retroperitoneal hematomas, and accurate diagnosis can be achieved through imaging studies. Transcatheter arterial embolization represents an effective treatment modality.
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Affiliation(s)
- Ran Zhu
- Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiangtian Liu
- Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaoli Li
- Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Liping Ye
- Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
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74
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司 筱, 赵 秀, 朱 凤, 王 天. [Risk factors for acute respiratory distress syndrome in patients with traumatic hemorrhagic shock]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:307-312. [PMID: 38595249 PMCID: PMC11004962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To investigate the risk factors of acute respiratory distress syndrome (ARDS) after traumatic hemorrhagic shock. METHODS This was a retrospective cohort study of 314 patients with traumatic hemorrhagic shock at Trauma Medicine Center, Peking University People's Hospital from December 2012 to August 2021, including 152 male patients and 162 female patients, with a median age of 63.00 (49.75-82.00) years. The demographic data, past medical history, injury assessment, vital signs, laboratory examination and other indicators of these patients during hospitalization were recorded. These patients were divided into two groups, ARDS group (n=89) and non-ARDS group (n=225) according to whether there was ARDS within 7 d of admission. Risk factors for ARDS were identified using Logistic regression. The C-statistic expressed as a percentage [area under curve (AUC) of the receiver operating characteristic (ROC) curve] was used to assess the discrimination of the model. RESULTS The incidence of ARDS after traumatic hemorrhagic shock was 28.34%. Finally, Logistic regression model showed that the independent risk factors of ARDS after traumatic hemorrhagic shock included male, history of coronary heart disease, high acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, road traffic accident and elevated troponin Ⅰ. The OR and 95% confidence intervals (CI) were 4.01 (95%CI: 1.75-9.20), 5.22 (95%CI: 1.29-21.08), 1.07 (95%CI: 1.02-1.57), 2.53 (95%CI: 1.21-5.28), and 1.26 (95%CI: 1.02-1.57), respectively; the P values were 0.001, 0.020, 0.009, 0.014, and 0.034, respectively. The ROC curve was used to analyze the value of each risk factor in predicting ARDS. It was found that the AUC for predicting ARDS after traumatic hemorrhagic shock was 0.59 (95%CI: 0.51-0.68) for male, 0.55 (95%CI: 0.46-0.64) for history of coronary heart disease, 0.65 (95%CI: 0.57-0.73) for APACHE Ⅱ score, 0.58 (95%CI: 0.50-0.67) for road traffic accident, and 0.73 (95%CI: 0.66-0.80) for elevated troponin Ⅰ, with an overall predictive value of 0.81 (95%CI: 0.74-0.88). CONCLUSION The incidence of ARDS in patients with traumatic hemorrhagic shock is high, and male, history of coronary heart disease, high APACHE Ⅱ score, road traffic accident and elevated troponin Ⅰ are independent risk factors for ARDS after traumatic hemorrhagic shock. Timely monitoring these indicators is conducive to early detection and treatment of ARDS after traumatic hemorrhagic shock.
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Affiliation(s)
- 筱芊 司
- 北京大学人民医院重症医学科,创伤救治中心,北京 100044Department of Critical Care Medicine, Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- 北京大学基础医学院,北京 100191Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - 秀娟 赵
- 北京大学人民医院重症医学科,创伤救治中心,北京 100044Department of Critical Care Medicine, Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
| | - 凤雪 朱
- 北京大学人民医院重症医学科,创伤救治中心,北京 100044Department of Critical Care Medicine, Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
| | - 天兵 王
- 北京大学人民医院创伤救治中心,国家创伤医学中心,创伤救治与神经再生教育部重点实验室(北京大学),北京 100044Trauma Medicine Center, Peking University People's Hospital; National Center for Trauma Medicine of China; Key Laboratory of Trauma and Neural Regeneration (Peking University) of Ministry of Education; Beijing 100044, China
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Zahra W, Nayar SK, Bhadresha A, Jasani V, Aftab S. Safety of tranexamic acid in surgically treated isolated spine trauma. World J Orthop 2024; 15:346-354. [PMID: 38680673 PMCID: PMC11045465 DOI: 10.5312/wjo.v15.i4.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma. AIM To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively. METHODS This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom. RESULTS We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150-300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA. CONCLUSION Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.
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Affiliation(s)
- Wajiha Zahra
- Trauma and Orthopedics Department, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Sandeep Krishan Nayar
- Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
| | - Ashwin Bhadresha
- Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
| | - Vinay Jasani
- Craniospinal Services, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Syed Aftab
- Spine Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
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76
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Follows A, Round A. Impact of ABO blood group on mortality in trauma patients: A systematic review. Transfus Apher Sci 2024:103925. [PMID: 38653629 DOI: 10.1016/j.transci.2024.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Hemorrhage is a significant cause of death in trauma patients. There is evidence that individuals with blood group O have higher rates of non-traumatic haemorrhage. It has been suggested that blood group O may be associated with higher mortality in trauma, however existing evidence is limited and conflicting. OBJECTIVE A systematic review was conducted to evaluate the impact of ABO blood group on mortality in trauma patients. METHODS MEDLINE via OVID, the Cochrane library and grey literature were searched to identify studies investigating the effect of ABO blood group on mortality of trauma patients admitted to hospital. PRISMA guidelines were followed throughout, study quality was assessed using CASP checklists and certainty of evidence was evaluated using GRADE. Meta-analysis was precluded by significant study heterogeneity. RESULTS 180 relevant records were screened and seven studies met inclusion criteria, representing 12,240 patients. Two studies found that there was a higher mortality in blood group O compared to other ABO groups. Included studies had substantial variability in methods and population. Study quality was variable with certainty of evidence rated as very low. CONCLUSIONS There is insufficient evidence to definitively establish an association between mortality and ABO group in trauma patients. In an age of increasingly individualised care, there is a need to determine the existence and cause for any association through further studies across multiple settings, trauma mechanisms and populations.
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Affiliation(s)
- Andrew Follows
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, United Kingdom
| | - Antonia Round
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, United Kingdom; University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, United Kingdom.
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Cavaillé M, Martin G, Poignet B, Chapron T, Dureau P, Metge F, Caputo G. Intraocular foreign bodies in children: A retrospective case series. J Fr Ophtalmol 2024; 47:104188. [PMID: 38636198 DOI: 10.1016/j.jfo.2024.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.
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Affiliation(s)
- M Cavaillé
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France.
| | - G Martin
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - B Poignet
- Ophthalmology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - T Chapron
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - P Dureau
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - F Metge
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - G Caputo
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France
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Boccatonda A, Balletta M, D'Ardes D, Cocco G, Piscaglia F, Serra C, Vicari S, Schiavone C. Ultrasound diagnosis of a pseudoaneurysm of the internal right mammary artery. J Ultrasound 2024:10.1007/s40477-024-00889-6. [PMID: 38632171 DOI: 10.1007/s40477-024-00889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
One of the principles of managing trauma patients is that of their continuous re-evaluation over the hours and days. Even if the execution of the computed tomography method is classically recommended, especially in the most serious cases and in polytraumas with major dynamics, the clinician can use or request an ultrasound examination, especially in subsequent re-evaluations. Here we report a clinical case demonstrating how an ultrasound re-evaluation after the acute event can lead to a correct diagnosis of a rare complication of thoracic trauma. The findings were suggestive for a pseudoaneurysm of the internal right mammary artery. Subsequently, an ultrasound-guided injection of thrombin was carried out until complete interruption of the flow within the formation. At subsequent follow-up, no arterial or venous blush was highlighted.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Via Marconi 35, Bentivoglio, Bologna, Italy.
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Marco Balletta
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging Science, Institute of "Clinica Medica", "G. d'Annunzio" University of Chieti, 66100, Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. D'Annunzio" University, 66100, Chieti, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Via Marconi 35, Bentivoglio, Bologna, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. D'Annunzio" University, 66100, Chieti, Italy
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Ubhi H, Ferro A, Ebelthite C, Fan K. Predictive risk factors of adverse mental health outcomes in the facial trauma patient. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00089-4. [PMID: 38637181 DOI: 10.1016/j.ijom.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
Patients with facial trauma often experience a psychological burden from their injuries. This study aimed to identify risk factors for adverse mental health outcomes in patients affected by facial trauma, using the 'Integrating Mental and Physical Healthcare: Research, Training and Services' (IMPARTS) screening tool. All patients >18 years of age who completed more than one IMPARTS screening tool in the Oral and Maxillofacial Trauma Clinic between 2019 and 2021 were included in this study. This tool was used to assess the risk of post-traumatic stress disorder (PTSD), generalized anxiety disorder, and depression. Included patients completed the IMPARTS questionnaire at initial follow-up (mean 18 days post-trauma) and one subsequent time point (mean 82 days). 167 patients were included in the study. On multivariable analysis, a history of psychiatric illness (P = 0.015) and interpersonal violence as the mechanism of injury (P = 0.010) were identified as predictive of risk of PTSD. Risk of PTSD was lower in zygomatic injuries (P = 0.001), while nasal involvement increased at-risk status for depression (P = 0.009). 47.3% of patients screened positive on initial IMPARTS assessment, while 35.3% screened positive on follow-up IMPARTS assessment. This study supports the IMPARTS tool in allowing the prompt identification of mental health adversity in facial trauma.
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Affiliation(s)
- H Ubhi
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - A Ferro
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - C Ebelthite
- IMPARTS Mind and Body Programme, Psychological Medicine and Integrated Care Clinical Academic Group, King's College London, London, UK
| | - K Fan
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
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Agrest M, Tapia-Muñoz T, Encina-Zúñiga E, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for a person after a potentially traumatic event: A Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2024; 24:291. [PMID: 38632577 PMCID: PMC11025165 DOI: 10.1186/s12888-024-05631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/22/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context. METHODS A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important". RESULTS Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists. CONCLUSIONS The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.
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Affiliation(s)
- Martín Agrest
- Proyecto Suma. Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Thamara Tapia-Muñoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Esteban Encina-Zúñiga
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Isidora Vidal-Zamora
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Rubén Alvarado
- Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A Leiderman
- Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Baas MAM, Stramrood CAI, Molenaar JE, van Baar PM, Vanhommerig JW, van Pampus MG. Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns). BMC Psychiatry 2024; 24:286. [PMID: 38627649 PMCID: PMC11022402 DOI: 10.1186/s12888-024-05678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support. METHODS In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5). RESULTS The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient. CONCLUSIONS The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.
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Affiliation(s)
- Melanie A M Baas
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, 9700 RB, Groningen, PO box 30.001, The Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Beval Beter, 1000 AH, Amsterdam, PO box 345, The Netherlands
| | - Jolijn E Molenaar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Petra M van Baar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands.
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Lechner-Meichsner F, Comtesse H, Olk M. Prevalence, comorbidities, and factors associated with prolonged grief disorder, post traumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review. Confl Health 2024; 18:32. [PMID: 38627778 PMCID: PMC11020800 DOI: 10.1186/s13031-024-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. METHOD We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. RESULTS A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. CONCLUSION The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
- Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands.
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstraße 26, 85072, Eichstätt, Germany
| | - Marie Olk
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
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Ota M, Motomiya M, Watanabe N, Shimoda K, Iwasaki N. Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study. BMC Musculoskelet Disord 2024; 25:297. [PMID: 38627691 PMCID: PMC11020679 DOI: 10.1186/s12891-024-07433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. METHODS We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. RESULTS The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. CONCLUSIONS Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. DATA ACCESS STATEMENT The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan.
| | - Naoya Watanabe
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
| | - Kohei Shimoda
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Gyedu A, Loglo L, Ablorh K, Brobbey-Kyei IA, Donkor P, Mock C. Improvement in quality of trauma care at non-tertiary hospitals in Ghana during on-hours and off-hours with a trauma intake form: A stepped-wedge cluster randomized trial. Injury 2024:111569. [PMID: 38679559 DOI: 10.1016/j.injury.2024.111569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/22/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND We sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at non-tertiary hospitals in Ghana during on-hours (8AM-5PM weekdays) compared to off-hours (nights, weekends, and holidays). We also sought to assess the effectiveness of a standardized trauma intake form (TIF) with built-in decision support prompts to improve care and to assess whether this effectiveness varied between on-hours and off-hours. METHODS A stepped-wedge cluster randomized trial was performed with research assistants directly observing trauma care before and after introducing the TIF at emergency units of eight hospitals for 17.5 months. Differences in KPIs and mortality were assessed using multivariable logistic regression and generalized linear mixed regression. RESULTS Management of 4,077 patients was observed; 1,126 (28 %) during on-hours and 2,951(72 %) during off-hours. At baseline, four of 20 KPIs were performed significantly more often during off-hours. TIF improved care during both on- and off-hours. Seventeen KPIs improved during on-hours and 18 KPIs improved during off-hours. After TIF, six KPIs were performed more often during on-hours, but differences, though significant, were small (1-5 %). Examples of KPIs which were performed more often during on-hours after TIF included: airway assessment (99 % for on-hours vs. 98 % for off-hours), evaluation for intra-abdominal bleeding (91 % vs. 87 %), and spine immobilization for blunt trauma (90 % vs. 85 %) (all p < 0.05). At baseline, mortality among seriously injured patients (Injury Severity Score >9) was higher during on-hours (27 %) compared to off-hours (17 %, p = 0.047). TIF lowered mortality for seriously injured patients during both on-hours (27 % before TIF, 8 % after, p = 0.027) and during off-hours (17 % before, 7 % after, p = 0.004). After TIF, mortality among seriously injured patients was equal between on- and off-hours (8 % vs. 7 %, NS). CONCLUSIONS At baseline, KPIs of trauma care were slightly better during off-hours compared with on-hours, and mortality was lower among seriously injured patient during off-hours. A quality improvement initiative (the TIF) using built-in decision support prompts improved care strongly in both on- and off-hours and eliminated the mortality difference between on- and off-hours. Use of similar decision support prompts during initial trauma care should be promoted widely in other low- and middle-income countries.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Lord Loglo
- Konongo-Odumase Government Hospital, Konongo, Ghana
| | | | | | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
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Nichter B, Hill ML, Fischer I, Panza KE, Kline AC, Na PJ, Norman SB, Rowcliffe M, Pietrzak RH. Firearm storage practices among military veterans in the United States: Findings from a nationally representative survey. J Affect Disord 2024; 351:82-89. [PMID: 38280567 DOI: 10.1016/j.jad.2024.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Unsafe storage of firearms is associated with increased risk of suicide.. However, contemporary population-based data on the prevalence and correlates of firearm storage practices among veterans are limited. METHODS Data were from the 2022 National Health and Resilience in Veterans Study, a nationally representative sample of 2441 veterans. Analyses examined: (1) the prevalence of firearm storage practices; (2) sociodemographic, psychiatric, and clinical characteristics associated with storing firearms loaded and/or in non-secure location; and (3) associations between types of potentially traumatic events and storage practices. RESULTS More than half of veterans reported owning one or more personal firearms (50.9%). Among firearm owners, 52.9% reported some form of unsafe firearm storage practice (i.e., loaded and/or non-secure location), with 39.9% reporting that they stored one or more firearms loaded. After adjusting for sociodemographic characteristics, major depressive, alcohol and drug use disorders, direct trauma exposures, future suicidal intent, and traumatic brain injury were associated with storing firearms loaded and/or in a non-secure location (ORs = 1.09-7.16). Veterans with a history of specific forms of direct trauma exposure (e.g., physical assault) were more likely to store firearms unsafely. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Half of U.S. veterans who own firearms store at least one personal firearm loaded and/or in a non-secure location, with approximately four-in-ten keeping a loaded firearm in the home. These high rates underscore the importance of nationwide training initiatives to promote safe firearm storage for all service members and veterans, regardless of risk status, as well as for healthcare professionals working with veterans.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ian Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kaitlyn E Panza
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexander C Kline
- Naval Health Research Center, San Diego, CA, USA; Leidos, Reston, VA, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
| | - Mara Rowcliffe
- 321(st) Special Tactics Squadron, U.S. Air Force Special Operations Command, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Şahin S, Botan E, Gün E, Yüksel MF, Süt NY, Kartal AT, Gurbanov A, Kahveci F, Özen H, Havan M, Yıldırım M, Şahap SK, Bektaş Ö, Teber S, Fitoz S, Kendirli T. Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients. Neurol Sci 2024:10.1007/s10072-024-07511-x. [PMID: 38622450 DOI: 10.1007/s10072-024-07511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.
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Affiliation(s)
- Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
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Patel H, Tapert SF, Brown SA, Norman SB, Pelham WE. Do traumatic events and substance use co-occur during adolescence? Testing three causal etiologic hypotheses. J Child Psychol Psychiatry 2024. [PMID: 38618861 DOI: 10.1111/jcpp.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Why do potentially traumatic events (PTEs) and substance use (SU) so commonly co-occur during adolescence? Causal hypotheses developed from the study of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) among adults have not yet been subject to rigorous theoretical analysis or empirical tests among adolescents with the precursors to these disorders: PTEs and SU. Establishing causality demands accounting for various factors (e.g. genetics, parent education, race/ethnicity) that distinguish youth endorsing PTEs and SU from those who do not, a step often overlooked in previous research. METHODS We leveraged nationwide data from a sociodemographically diverse sample of youth (N = 11,468) in the Adolescent Brain and Cognitive Development Study. PTEs and substance use prevalence were assessed annually. To account for the many pre-existing differences between youth with and without PTE/SU (i.e. confounding bias) and provide rigorous tests of causal hypotheses, we linked within-person changes in PTEs and SU (alcohol, cannabis, nicotine) across repeated measurements and adjusted for time-varying factors (e.g. age, internalizing symptoms, externalizing symptoms, and friends' use of substances). RESULTS Before adjusting for confounding using within-person modeling, PTEs and SU exhibited significant concurrent associations (βs = .46-1.26, ps < .05) and PTEs prospectively predicted greater SU (βs = .55-1.43, ps < .05) but not vice versa. After adjustment for confounding, the PTEs exhibited significant concurrent associations for alcohol (βs = .14-.23, ps < .05) and nicotine (βs = .16, ps < .05) but not cannabis (βs = -.01, ps > .05) and PTEs prospectively predicted greater SU (βs = .28-.55, ps > .05) but not vice versa. CONCLUSIONS When tested rigorously in a nationwide sample of adolescents, we find support for a model in which PTEs are followed by SU but not for a model in which SU is followed by PTEs. Explanations for why PTSD and SUD co-occur in adults may need further theoretical analysis and adaptation before extension to adolescents.
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Affiliation(s)
- Herry Patel
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Susan F Tapert
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Sandra A Brown
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Psychology, University of California San Diego, La Jolla, CA, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- National Center for PTSD, White River Junction, VT, USA
- Department of Veterans Affairs Medical Center, La Jolla, CA, USA
| | - William E Pelham
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Mellum M, Saei R, Brattebø G, Wisborg T. Do emergency medical dispatchers choose the same response to serious injury in men and women - a qualitative study. BMC Emerg Med 2024; 24:60. [PMID: 38614978 PMCID: PMC11015548 DOI: 10.1186/s12873-024-00985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Recent research has indicated that sex is an important determinant of emergency medical response in patients with possible serious injuries. Men were found to receive more advanced prehospital treatment and more helicopter transportation and trauma centre destinations and were more often received by an activated trauma team, even when adjusted for injury mechanism. Emergency medical dispatchers choose initial resources when serious injury is suspected after a call to the emergency medical communication centre. This study aimed to assess how dispatchers evaluate primary responses in trauma victims, with a special focus on the sex of the victim. METHODS Emergency medical dispatchers were interviewed using focus groups and a semistructured interview guide developed specifically for this study. Two vignettes describing typical and realistic injury scenarios were discussed. Verbatim transcripts of the conversations were analysed via systematic text condensation. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. RESULTS The analysis resulted in the main category "Tailoring the right response to the patient", supported by three categories "Get an overview of location and scene safety", "Patient condition" and "Injury mechanism and special concerns". The informants consistently maintained that sex was not a relevant variable when deciding emergency medical response during dispatch and claimed that they rarely knew the sex of the patient before a response was implemented. Some of the participants also raised the question of whether the Norwegian trauma criteria reliably detect serious injury in women. CONCLUSIONS The results indicate that the emergency medical response is largely based on the national trauma criteria and that sex is of little or no importance during dispatch. The observed sex differences in the emergency medical response seems to be caused by other factors during the emergency medical response phase.
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Affiliation(s)
- Marlene Mellum
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway
| | - Raika Saei
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway
| | - Guttorm Brattebø
- Norwegian National Advisory Unit On Emergency Medical Communication, Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Wisborg
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway.
- Norwegian National Advisory Unit On Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, Hammerfest, Norway.
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89
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Nerlich AG, Panzer S, Lehn C, Friederichs J, Peschel OK. Traumatic fractures in an early 19th century museum skeleton suggest the homicide of an old Munich character: the history of "Finessensepperl" (Finesse Joseph). Forensic Sci Med Pathol 2024:10.1007/s12024-024-00811-w. [PMID: 38607512 DOI: 10.1007/s12024-024-00811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
The well preserved skeleton of Joseph Huber, a very well-known historical character of the 19th century Munich, also nicknamed "Finessen-Sepperl", is the starting point of the reconstruction of life and death of this historical individual. He was known as a postilion d´amour (love's messenger) of the Royal Bavarian capital with numerous comments and anecdotes and a few biographical sketches that indicate he remained well until the last few years of his life where requests for his duties lessened. The skeleton shows a small-sized male individual with almost complete loss of teeth, but otherwise very well-mineralized bone, having suffered from three episodes of trauma - an old-healed incomplete femoral neck fracture leading to severe osteoarthrosis, a clavicle fracture of the medial third with a few weeks old callus formation, and fresh serial rib fractures along with severe skull trauma with fractures of the os temporale and petrosum, presumably leading to intracranial bleeding and finally death. The type and distribution of these latter two injuries are in agreement with a murderous attack - which was retrospectively reported several years after his death, while the old-healed femoral neck fracture may have caused reduction in Joseph´s walking activities but not reduced requests for his services. Paleopathology not only identifies the terminal decline, but also previous diseases of this Old Bavarian character and thereby completes his story.
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Affiliation(s)
- Andreas G Nerlich
- Department of Forensic Histopathology, Paleopathology and Mummy Research, Institute of Legal Medicine, Ludwig-Maximilians Universität, Nussbaumstr. 26, D-80336, München, Germany.
| | - Stephanie Panzer
- Department of Radiology, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medizinische Universität, Salzburg, Austria
| | - Christine Lehn
- Department of Forensic Histopathology, Paleopathology and Mummy Research, Institute of Legal Medicine, Ludwig-Maximilians Universität, Nussbaumstr. 26, D-80336, München, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Oliver K Peschel
- Department of Forensic Histopathology, Paleopathology and Mummy Research, Institute of Legal Medicine, Ludwig-Maximilians Universität, Nussbaumstr. 26, D-80336, München, Germany
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90
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McCartney C, Martin-Smith J. Virtual reality headsets in plastic surgery trauma assessment. J Plast Reconstr Aesthet Surg 2024; 93:213-214. [PMID: 38705123 DOI: 10.1016/j.bjps.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Conor McCartney
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland.
| | - Jamie Martin-Smith
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland
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91
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Becciolini M, Bonacchi G, Stella SM, Tamborrini G. Intermittent flexor hallucis longus dislocation: ultrasound findings. J Ultrasound 2024:10.1007/s40477-024-00880-1. [PMID: 38602647 DOI: 10.1007/s40477-024-00880-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/12/2024] [Indexed: 04/12/2024] Open
Abstract
We report a case of intermittent dislocation of the flexor hallucis longus at its passage in the retro-malleolar area, related to a post-traumatic detachment of the retrotalar pulley from the medial tubercle of the talus. High-resolution ultrasound depicted the anterior dislocation of the tendon during dynamic stress, by asking the patient to flex his hallux against the examiner resistance, with the ankle in slight dorsiflexion. The tendon normally relocated after the dynamic maneuver. Tendon dislocation was associated with a painful snap.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy.
- Scuola Siumb di Ecografia Muscoloscheletrica, Pisa, Italy.
| | - Giovanni Bonacchi
- Misericordia di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy
- Scuola Siumb di Ecografia Muscoloscheletrica, Pisa, Italy
| | | | - Giorgio Tamborrini
- Swiss Ultrasound Center, Institute of Rheumatology, Basel, Switzerland
- Clinic for Rheumatology, University Hospital of Basel, Basel, Switzerland
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92
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Taşkın Ö, Dişel NR. From Tragedy to Resilience in a University Hospital: Characteristics of Patients in the Aftermath of the 2023 Turkey Earthquake. Disaster Med Public Health Prep 2024; 18:e59. [PMID: 38602095 DOI: 10.1017/dmp.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE This study focuses on adults affected by the February 2023 Turkey earthquakes, aiming to uncover demographic and clinical traits. METHODS A retrospective analysis of data from adult patients who sought emergency care between February 6 and February 21, 2023, following the earthquakes, was conducted. RESULTS Among 3072 patients, 1544 (50.3%) of whom were women, trauma (31.1%) was the most prevalent cause of emergency department presentations. The median age of all patients was 44 y (interquartile range [IQR] 31-61 y). Hatay province accounted for 65.2% of trauma patients as origin. Most of the patients (66.8%) presented to the emergency department by their own means, while this was opposite for trauma patients, of whom 54.5% was transferred by means of Ambulance Service. Half of the total trauma patients were rescued from the debris, and 75.9% sustained limb injuries. Crush syndrome affected 24.7%, and emergency hemodialysis was performed on 9.1%, whereas emergency surgery was performed on 22.8% of all trauma cases. Overall, 10.2% of trauma patients lacked any identification. The rate of emergency department admittions due to respiratory and cardiovascular diseases was higher at the time of the earthquake compared with the previous year (P < 0.001). CONCLUSIONS The insights gained from this study hold valuable implications for disaster response strategies, emphasizing the importance of preparedness, timely intervention, and comprehensive patient care.
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Affiliation(s)
- Ömer Taşkın
- Emergency Service, Yüreğir State Hospital, Adana, Turkey
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93
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Walton DM, Bobos P, MacDermid JC. Latent Profile Analysis of Canadian Military Veterans with Chronic Pain Identifies 5 Meaningful Classes through Self-Report Measures. J Pain 2024:S1526-5900(24)00437-1. [PMID: 38609027 DOI: 10.1016/j.jpain.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
The purpose of this study was to identify meaningful response patterns in self-report survey data collected from Canadian military veterans with chronic pain and to create an algorithm intended to facilitate triage and prioritization of veterans to the most appropriate interventions. An online survey was presented to former members of the Canadian military who self-identified as having chronic pain. Variables collected were related to pain, physical and mental interference, prior traumatic experiences, and indicators from each of seven potential drivers of the pain experience. Maximum Likelihood-based Latent Profile Analysis (MLE-LPA) was used to identify clinically and statistically meaningful profiles using the seven-axis variables, and Classification and Regression Tree (CART) analysis was then conducted to identify the most parsimonious set of indicators that could be used to accurately classify respondents into the most relevant profile group. Data from N=322 veterans were available for analysis. The results of MLE-LPA indicated a 5-profile structure was optimal for explaining the patterns of responses within the data. These were: Mood-Dominant (13%), Localized Physical (24%), Neurosensory-Dominant (33%), Central-Dominant with complex mood and neurosensory symptoms (16%), and Trauma- and mood-dominant (14%). From CRT analysis an algorithm requiring only 3 self-report tools (central symptoms, mood screening, bodily coherence) achieved 83% classification accuracy across the 5 profiles. The new classification algorithm requiring 16 total items may be helpful for clinicians and veterans in pain to identify the most dominant drivers of their pain experience that may be useful for prioritizing intervention strategies, targets, and relevant healthcare disciplines. PERSPECTIVE: This article presents the results of latent profile (cluster) analysis of responses to standardized self-report questionnaires by Canadian military veterans with chronic pain. It identified 5 clusters that appear to represent different drivers of the pain experience. The results could be useful for triaging veterans to the most appropriate pain care providers.
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Affiliation(s)
| | - Pavlos Bobos
- School of Physical Therapy, Western University Canada
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94
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Li CW, Huang RW, Lin CH, Hsu CC, Lin YT, Chen HC, Tang YB, Chen SH. Supercharge end-to-side nerve transfer from anterior interosseous nerve to augment intrinsic recovery in high ulnar nerve injuries of varying magnitudes. Asian J Surg 2024:S1015-9584(24)00569-4. [PMID: 38599967 DOI: 10.1016/j.asjsur.2024.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/21/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND High ulnar nerve injuries result in intrinsic muscle weakness and are inconvenient for patients. Moreover, conventional surgical techniques often fail to achieve satisfactory motor recovery. A potential reconstructive solution in the form of the supercharge end-to-side (SETS) anterior interosseous nerve (AIN) transfer method has emerged. Therefore, this study aims to compare surgical outcomes of patients with transected and in-continuity high ulnar nerve lesions following SETS AIN transfer. METHODS Between June 2015 and May 2023, patients with high ulnar palsy in the form of transection injuries or lesion-in-continuity were recruited. The assessment encompassed several objective results, including grip strength, key pinch strength, compound muscle action potential, sensory nerve action potential, and two-point discrimination tests. The muscle power of finger abduction and adduction was also recorded. Additionally, subjective questionnaires were utilized to collect data on patient-reported outcomes. Overall, the patients were followed up for up to 2 years. RESULTS Patients with transected high ulnar nerve lesions exhibited worse baseline performance than those with lesion-in-continuity, including motor and sensory functions. However, they experienced greater motor improvement but less sensory recovery, resulting in comparable final motor outcomes in both groups. In contrast, the transection group showed worse sensory outcomes. CONCLUSIONS Our findings suggest that SETS AIN transfer benefits patients with high ulnar nerve palsy, regardless of the lesion type. Nonetheless, improvements may be more pronounced in patients with transected lesions.
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Affiliation(s)
- Chun-Wei Li
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, College of Medicine, Keelung, Taiwan (No. 222, Maijin Rd, Anle District, Keelung City, 204, Taiwan
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan, Taiwan (No. 5, Fuxing St, Guishan District, Taoyuan City, 333, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan, Taiwan (No. 5, Fuxing St, Guishan District, Taoyuan City, 333, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan, Taiwan (No. 5, Fuxing St, Guishan District, Taoyuan City, 333, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan, Taiwan (No. 5, Fuxing St, Guishan District, Taoyuan City, 333, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan (No. 2, Yude Rd, North District, Taichung City, 404327, Taiwan
| | - Yueh-Bih Tang
- Department of Plastic Surgery, National Taiwan University Hospital, Taipei, Taiwan (No. 7, Chung Shan S. Rd, Zhongzheng District, Taipei City, 100225, Taiwan; Department of Cosmetic Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan (No. 21, Section 2, Nanya S. Rd, Banqiao District, New Taipei City, 220, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan, Taiwan (No. 5, Fuxing St, Guishan District, Taoyuan City, 333, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan (No. 1, Section 1, Ren'ai Rd, Zhongzheng District, Taipei City, 100, Taiwan.
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Navarro SM, Solaiman RH, Zhang J, Diaz-Gutierrez I, Tignanelli C, Harmon JV. Incidence of adult rib fracture injuries and changing hospitalization practice patterns: a 10-year analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02519-6. [PMID: 38592464 DOI: 10.1007/s00068-024-02519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Rib fractures are common after blunt thoracic trauma and can be associated with significant morbidity and mortality. We investigated trends of rib fracture injuries among adults presenting to United States (US) emergency departments, factors related to increased likelihood of hospitalization, and hospitalization practice patterns. METHODS We queried the National Electronic Injury Surveillance System database between 2012 and 2021 for all patients 18 years of age and older with rib fractures. These data were extrapolated to provide national estimates. Regression analysis was performed to identify trends for injury and risk factors for hospitalization. RESULTS We identified 32,233 adult patients with rib fractures; this extrapolated to a national estimate of 1,430,270 patients with rib fractures during the 10-year period. Between 2012 and 2021, there was a 52% increase in the incidence rate per 100,000 persons (R2 = 0.94, p < 0.001). Males accounted for 58% of patients with rib fractures, and 50% of patients were 65 years or older. Hospitalization was required in 38% of patients, and the hospitalization rate increased by 96% during the study period (R2 = 0.96, p < 0.001). When comparing hospitals of different sizes, a 20% greater increase in the odds of hospitalization over time was identified among patients presenting to "larger" hospitals compared to "smaller" hospitals. CONCLUSION The incidence of rib fractures and the associated hospitalization rates are both increasing nationally, with half of cases occurring in patients aged 65 years or older. Our findings emphasize the urgent need to implement evidence-based preventive measures and current management guidelines when managing the increasing caseload of rib fracture injuries.
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Affiliation(s)
- Sergio M Navarro
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
- Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | | | | | - Ilitch Diaz-Gutierrez
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Division of Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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96
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Bunting CP, Green JF. Ocular manifestations suggest osteogenesis imperfecta in a previously undiagnosed adult following poly trauma. BMJ Case Rep 2024; 17:e258217. [PMID: 38594201 PMCID: PMC11015251 DOI: 10.1136/bcr-2023-258217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
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97
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Park JS, Choi SJ, Kim MJ, Choi SY, Kim HY, Park YS, Chung SP, Lee JH. Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study. BMC Emerg Med 2024; 24:55. [PMID: 38584265 PMCID: PMC11000363 DOI: 10.1186/s12873-024-00978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Early identification of patients at risk of potential death and timely transfer to appropriate healthcare facilities are critical for reducing the number of preventable trauma deaths. This study aimed to establish a cutoff value to predict in-hospital mortality using the reverse shock index multiplied by the Glasgow Coma Scale (rSIG). METHODS This multicenter retrospective cohort study used data from 23 emergency departments in South Korea between January 2011 and December 2020. The outcome variable was the in-hospital mortality. The relationship between rSIG and in-hospital mortality was plotted using the shape-restricted regression spline method. To set a cutoff for rSIG, we found the point on the curve where mortality started to increase and the point where the slope of the mortality curve changed the most. We also calculated the cutoff value for rSIG using Youden's index. RESULTS A total of 318,506 adult patients with trauma were included. The shape-restricted regression spline curve showed that in-hospital mortality began to increase when the rSIG value was less than 18.86, and the slope of the graph increased the most at 12.57. The cutoff of 16.5, calculated using Youden's index, was closest to the target under-triage and over-triage rates, as suggested by the American College of Surgeons, when applied to patients with an rSIG of 20 or less. In addition, in patients with traumatic brain injury, when the rSIG value was over 25, in-hospital mortality tended to increase as the rSIG value increased. CONCLUSIONS We propose an rSIG cutoff value of 16.5 as a predictor of in-hospital mortality in adult patients with trauma. However, in patients with traumatic brain injury, a high rSIG is also associated with in-hospital mortality. Appropriate cutoffs should be established for this group in the future.
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Affiliation(s)
- Jun Seong Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Sol Ji Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - So Yeon Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea.
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98
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Kasraian L, Nader N, Hosseini M, Taheri Akerdi A, Paydar S, Abdolrahimzadeh Fard H. A novel scoring system for early prediction of massive transfusion requirement in trauma patients. Intern Emerg Med 2024:10.1007/s11739-024-03541-7. [PMID: 38583098 DOI: 10.1007/s11739-024-03541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/16/2024] [Indexed: 04/08/2024]
Abstract
Early resuscitation using blood products is critical for patients with severe hemorrhagic shock. We aimed to develop and validate a new scoring system, hemorrhagic shock transfusion prediction (HSTP) score, to predict the need for massive transfusion (MT) in these patients, compared to the widely used Assessment of Blood Consumption (ABC) score. Trauma patients admitted to Emtiaz Hospital in Iran from 2017 to 2021 were retrospectively included. Patients assigned a code 1 or 2 according to the Emergency severity index (ESI) triage system have been divided into MT and non-MT groups. MT was defined as receiving ≥ 10 units of packed cells (PCs) in 24 h. Demographic information, admission vital signs, and lab results available within 15 min were compared between the groups. A new predictive score was developed using logistic regression of statistically significant parameters. Out of 1029 patients, 651 (63.3%) required MT. An arrival, diastolic blood pressure < 79.5 mm Hg, absolute lymphocyte count > 1850/μL, base excess < - 4.25, and blood glucose > 156 mg/dL were independent predictors included in the HSTP score. The sensitivity and specificity were 74.36% and 53.87% for the HSTP score, compared to 31.03% and 76.16% for the ABC score. Moreover, the positive and negative predictive values were 77.88% and 49.03% for the HSTP score, versus 74.15% and 33.66% for ABC. The new scoring system demonstrated higher sensitivity and improved positive and negative predictive values compared to the ABC score. This score can assist physicians in making accurate transfusion decisions quickly, but further prospective studies are warranted to validate its clinical utility.
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Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Centre, Higher Institute for Research and Education in Transfusion Medicine, Shiraz, Iran
| | - Nima Nader
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Hosseini
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Taheri Akerdi
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Abdolrahimzadeh Fard
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Adegeest C, Moayeri N, Muijs S, ter Wengel P. Spinal cord injury: Current trends in acute management. Brain Spine 2024; 4:102803. [PMID: 38618228 PMCID: PMC11010802 DOI: 10.1016/j.bas.2024.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Introduction Traumatic spinal cord injury (tSCI) is a profoundly debilitating condition necessitating prompt intervention. However, the optimal acute treatment strategy remains a subject of debate. Research question The aim of this overview is to elucidate prevailing trends in the acute tSCI management. Material and Methods We provided an overview using peer-reviewed studies. Results Early surgical treatment (<24h after trauma) appears beneficial compared to delayed surgery. Nonetheless, there is insufficient evidence supporting a positive influence of ultra-early surgery on neurological outcome in tSCI. Furthermore, the optimal surgical approach to decompress the spinal cord remains unclear. These uncertainties extend to a growing aging population suffering from central cord syndrome (CCS). Additionally, there is a paucity of evidence supporting the beneficial effects of strict hemodynamic management. Discussion and Conclusion This overview highlights the current literature on surgical timing, surgical techniques and hemodynamic management during the acute phase of tSCI. It also delves into considerations specific to the elderly population experiencing CCS.
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Affiliation(s)
- C.Y. Adegeest
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - N. Moayeri
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S.P.J. Muijs
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P.V. ter Wengel
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
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100
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Song C, Liu W, Luo Y, Liu J, Jiang G, Wang R, He Z, Wang X, Mao W. Alterations in the immune landscape characterized by inflammatory activation and immune escape within 12 h after trauma. Immunobiology 2024; 229:152801. [PMID: 38593729 DOI: 10.1016/j.imbio.2024.152801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Trauma is statistically a significant cause of mortality among patients across countries. Nevertheless, the precise correlation between genetic diagnostic markers and the intricate mechanism of trauma remains indistinct. METHODS Our study exclusively centered on trauma patients and selected three trauma-related datasets from the Gene Expression Omnibus (GEO) database, all of which had blood samples collected within post-traumatic 12 h. Differential gene screening, the WGCNA and Cytoscape software were employed to analyze the two datasets, with a particular emphasis on the top 100 genes selected based on MCC algorithm scores. A logistic diagnostic model was constructed by analyzing the intersection genes in the third dataset, leading to the identification of diagnostic biomarkers with high efficiency. The global immune landscape of these patients was extensively investigated using a multidimensional approach. Meanwhile, the underlying pathological and physiological mechanisms associated with early trauma status are summarized by integrating existing literature. RESULTS Out of these two GEO datasets, 21 overlapping genes were identified and incorporated into in the logistic diagnostic model constructed in the GSE36809 dataset. A panel of 9 genes was uncovered as a diagnostic biomarker, and their expression and correlation were subsequently verified. Additionally, by virtue of various algorithms, the findings revealed an upregulation of neutrophil expression and a downregulation of CD8+ T cell expression, indicating characteristic early trauma-induced inflammation activation and immune suppression. The correlation observed between the feature genes and immune cells serves to validate the exceptional diagnostic capability of these 9 genes in identifying trauma status and their promising potential for patients who could benefit from targeted immune interventions. Drawing from these findings, the discussion section offers insights into the underlying pathological and physiological mechanisms at play. CONCLUSION Our research has discovered a novel diagnostic biomarker and unveiled its association with post-traumatic immune alterations. This breakthrough enables accurate and timely diagnosis of early trauma, facilitating the implementation of appropriate healthcare interventions.
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Affiliation(s)
- Chenghu Song
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Weici Liu
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Yu Luo
- Department of Emergency Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Jiwei Liu
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Guanyu Jiang
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Ruixin Wang
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China
| | - Zhao He
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China.
| | - Xiaokun Wang
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China.
| | - Wenjun Mao
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, China.
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