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An increase in heart rate variability can be an index for end point of resuscitation in trauma patients

Chinese Journal of Traumatology 2019年第3期22卷 134-137页

作者： Ali Foroutan shahram paydar Seyyed Taghi Heydari Leila Mohammadi Farnaz Rahbar Burn and Wound Healing Research Center Shiraz University of Medical SciencesShirazIran Department of Surgery Shiraz University of Medical SciencesShirazIran Health Policy Research Center Institute of HealthShiraz University of Medical SciencesShirazIran

Purpose: The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. Methods: Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups:‘end pointed’ group (n =13), patients' BDs instantly cleared after primary hydration;‘needs further resuscitation’ group (n=21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion;and ‘hydration minimal change’ group (n=9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. Results: A significant reverse correlation was found between the BD ratio and the HRV ratio (r=0.562;p= 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). Conclusion: Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.

关键词： Heart rate variability Trauma End point of resuscitation Shock

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Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma:A double-blind,randomized clinical trial

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Chinese Journal of Traumatology 2023年第2期26卷 116-120页

作者： Soleyman Heydari Hadi Khoshmohabat Ali Taheri Akerdi Fathollah Ahmadpour shahram paydar Department of Surgery Baqiyatallah University of Medical SciencesTehranIran Trauma Research Center Baqiyatallah University of Medical SciencesTehranIran Trauma Research Center Shahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran

Purpose:Patients with multiple traumas are at high risk of developing respiratory complications,including pneumonia and acute respiratory distress *** pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic ***-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway *** present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma ***:This randomized,double-blind,placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT *** excluded patients if they met at least one of the following conditions: 0.05).At the end of the study,the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12),left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56),left side = 25929.12 (47417.13),p = 0.228 and 0.082,respectively).Moreo

关键词： Acute respiratory distress syndrome Montelukast Leukotrienes Contusions Injuries

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Should we change our approach to resuscitating victims of femoral fracture?A clinical experience in a busy trauma hospital in Shiraz,Iran

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Chinese Journal of Traumatology 2021年第1期24卷 30-33页

作者： shahram paydar Ali Taheri Akerdi Sadra Nikseresht Hossein Abdolrahimzadeh-Fard Leila Shayan Zahra Ghahramani shahram Bolandparvaz Hamid Reza Abbasi Trauma Research Center Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran

Purpose Traumatic hemorrhagic shock is a life-threatening event *** brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α,*** primary treatment in these cases is hydration with crystalloids,which has both benefits and *** purpose of this study was to investigate the effects of fluid therapy on the hemodynamics,coagulation profiles,and blood gases in such *** In this cross-sectional study,patients were divided into two groups:femoral fracture group and non-femoral *** hemodynamic status,coagulation profile,and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h *** were analyzed by t-test and ANOVA with repeated data and paired samples *** A total of 681 trauma patients(605 men and 76 women)participated in this study,including 69(86.3%)men and 11(13.8%)women in femoral fracture group and 536 men(89.2%)and 65 women(10.8%)in non-femoral *** laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h *** gases decreased in the fracture group despite fluid therapy(p<0.003),and the coagulation profile worsened although the change was not statistically *** The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as *** there is evidence of clinical shock,excessive crystalloid infusion(limited to 1 L)should be avoided,and blood and blood products should be started as soon as possible.

关键词： Resuscitation Victims Femoral fractures Hemorrhagic shock

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Do clinical and paraclinical findings have the power to predict critical conditions of injured patients after traumatic injury resuscitation?Using data mining artificial intelligence

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Chinese Journal of Traumatology 2021年第1期24卷 48-52页

作者： shahram paydar Elahe Parva Zahra Ghahramani Saeedeh Pourahmad Leila Shayan Vahid Mohammadkarimi Golnar Sabetian Trauma Research Center Shahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran Technical and Vocational University ShirazIran Department of Biostatistics Shiraz University of Medical SciencesShirazIran Department of Internal Medicine School of MedicineShiraz University of Medical SciencesShirazIran

Purpose The triage and initial care of injured patients and a subsequent right level of care is paramount for an overall outcome after traumatic *** recognition of patients is an important case of such decision-making with risk of worse *** article is to answer if clinical and paraclinical signs can predict the critical conditions of injured patients after traumatic injury *** The study included 1107 trauma patients,16 years and *** patients were trauma victims of Levels I and II triage and admitted to the Rajaee(Emtiaz)Trauma Hospital,Shiraz,in 2014–*** cross-industry process for data mining methodology and modeling was used for assessing the best early clinical and paraclinical variables to predict the patients’*** modeling methods including the support vector machine,K-nearest neighbor algorithms,Bagging and Adaboost,and the neural network were compared by some evaluation *** Learning algorithms can predict the deterioration of injured patients by monitoring the Bagging and SVM models with 99%*** most-fitted variables were Glasgow Coma Scale score,base deficit,and diastolic blood pressure especially after initial resuscitation in the algorithms for overall outcome *** Data mining could help in triage,initial treatment,and further decision-making for outcome measures in trauma *** and paraclinical variables after resuscitation could predict short-term outcomes much better than variables on *** artificial intelligence modeling system,diastolic blood pressure after resuscitation has a greater association with predicting early mortality rather than systolic blood pressure after *** intelligence monitoring may have a role in trauma care and should be further investigated.

关键词： Traumatic injuries Data mining Artificial Intelligence

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Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria:Established novel criteria for trauma victims

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Chinese Journal of Traumatology 2022年第3期25卷 170-176页

作者： Hossein Abdolrahimzadeh Fard Salahaddin Mahmudi-Azer Qusay Abdulzahraa Yaqoob Golnar Sabetian Pooya Iranpour Zahra Shayan shahram Bolandparvaz Hamid Reza Abbasi Shiva Aminnia Maryam Salimi Mohammad Mehdi Mahmoudi shahram paydara Roham Borazjani Ali Taheri Akerdi Masome Zare Leila Shayan Mohammadreza Sasani Trauma Research Center Shahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran Department of General Surgery Kufa University of Medical SciencesNajafIraq Department of Intensive Care Medicine Trauma Research CenterShahid Rajaee(Emtiaz)HospitalShiraz University of Medical SciencesShirazIran Department of Radiology Medical Imaging Research Center.School of MedicineShiraz University of Medical SciencesShirazIran Department of Biostatistics Trauma Research CenterSchool of MedicineShiraz University of Medical SciencesShirazIran Student Research Committee Shiraz University of Medical SciencesShirazIran Trauma Intensive Care Unit Trauma Research CenterShahid Rajaee(Emtiaz)Trauma HospitalShiraz University of Medical SciencesShirazIran

Propose:In this study,we re-assessed the criteria defined by the radiological society of North America(RSNA)to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary ***:All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion,COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May *** patients(Group P)were then classified into two groups based on polymerase chain reaction tests(Group Pa for positive patients and Pb for negative ones).Moreover,44 patients from the prepandemic period(Group PP)were *** were matched to Group P regarding age,sex,and trauma-related *** radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA *** radiological findings were compared between Group P and Group PP;statistically significant ones were re-evaluated between Group Pa and Group Pb ***,the sensitivity and specificity of each significant findings were *** Chi-square test was used to compare the radiologica丨findings between Group P and Group ***:In the Group PP,73.7%of all ground-glass opacities(GGOs)and 80%of all multiple bilateral GGOs were detected(p<0.001 and p=0.25,respectively).Single bilateral GGOs were only seen among the Group *** Chi-square tests showed that the prevalence of diffused GGOs,multiple unilateral GGOs,multiple consolidations,and multiple bilateral consolidations were significantly higher in the Group P(p=0.001,0.01,0.003,and 0.003,respectively).However,GGOs with irregular borders and single consolidations were more significant among the Group PP(p=0.01 and 0.003,respectively).Of note,reticular distortions and subpleural spares were exclusively detected in the Group ***:We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma ***

关键词： Chest wall CT Contusion COVID-19 RSNA criteria Trauma

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