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Artificial intelligence and machine learning for hemorrhagic trauma care

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Military Medical Research 2023年第5期10卷 680-698页

作者： Henry T.Peng MMusaab Siddiqui Shawn G.Rhind Jing Zhang Luis Teodoro da Luz Andrew Beckett Defence Research and Development Canada Toronto Research CentreTorontoON M3K 2C9Canada Sunnybrook Health Sciences Centre TorontoON M4N 3M5Canada St.Michael’s Hospital TorontoON M5B 1W8Canada Royal Canadian Medical Services Ottawa K1A 0K2Canada

Artificial intelligence(AI),a branch of machine learning(ML)has been increasingly employed in the research of trauma in various aspects.hemorrhage is the most common cause of trauma-related death.To better elucidate the current role of AI and contribute to future development of ML in trauma care,we conducted a review focused on the use of ML in the diagnosis or treatment strategy of traumatic hemorrhage.A literature search was carried out on PubMed and Google scholar.Titles and abstracts were screened and,if deemed appropriate,the full articles were reviewed.We included 89 studies in the review.These studies could be grouped into five areas:(1)prediction of outcomes;(2)risk assessment and injury severity for triage;(3)prediction of transfusions;(4)detection of hemorrhage;and(5)prediction of coagulopathy.Performance analysis of ML in comparison with current standards for trauma care showed that most studies demonstrated the benefits of ML models.However,most studies were retrospective,focused on prediction of mortality,and development of patient outcome scoring systems.Few studies performed model assessment via test datasets obtained from different sources.Prediction models for transfusions and coagulopathy have been developed,but none is in widespread use.AI-enabled ML-driven technology is becoming integral part of the whole course of trauma care.Comparison and application of ML algorithms using different datasets from initial training,testing and validation in prospective and randomized controlled trials are warranted for provision of decision support for individualized patient care as far forward as possible.

关键词： Artificial intelligence hemorrhage Machine learning Trauma Injury

Tranexamic acid for major trauma patients in Ireland

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World Journal of Emergency Medicine 2022年第1期13卷 11-17页

作者： Kieran Walsh Francis O’Keeff e Louise Brent Biswadev Mitra National Trauma Research Institute the Alfred HospitalMelbourne 3004Australia Critical Care Research School of Public Health and Preventive MedicineMonash UniversityMelbourne 3004Australia Emergency&Trauma Centre Alfred HealthMelbourne 3004Australia Emergency Department Mater Misericordiae University HospitalDublin D07 R2WYIreland National Offi ce for Clinical Audit Ardilaun HouseDublin D02 VN51Ireland

BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.

关键词： Tranexamic acid Shock Ireland hemorrhage

De novo brain arteriovenous malformation formation and development:A case report

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World Journal of Clinical Cases 2022年第18期10卷 6277-6282页

作者： Huan Huang Xue Wang An-Na Guo Wei Li Ren-Hua Duan Jun-Hao Fang Bo Yin Dan-Dong Li Department of Radiology The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Department of Neurosurgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina

BACKGROUND Brain arteriovenous malformation(AVM),an aberrant vascular development during the intrauterine period,is traditionally considered a congenital disease.Sporadic reports of cases of de novo AVM formation in children and adults have challenged the traditional view of its congenital origin.CASE SUMMARY In this report,we have presented the case of a child with a de novo brain AVM.Magnetic resonance imaging and magnetic resonance angiography of the brain showed no AVM at the age of 5 years and 2 mo.Brain AVM was first detected in this child at the age of 7 years and 4 mo.The brain AVM was significantly advanced,and hemorrhage was seen for the first time at the age of 12 years and 8 mo.There was further progression in the AVM,and hemorrhage occurred again at the age of 13 years and 5 mo.Genetic analysis of this patient revealed a mutation in the NOTCH2(p.Asp473 Val)gene.CONCLUSION In short,our case has once again confirmed the view that brain AVM is an acquired disease and is the result of the interaction of genes,environment,and molecules.

关键词： De novo arteriovenous malformation Angiogenesis hemorrhage NOTCH2 Case report

Role of octreotide in small bowel bleeding

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World Journal of Clinical Cases 2022年第26期10卷 9192-9206页

作者： Anwar Khedr Esraa Elaraby Mahmoud Noura Attallah Mikael Mir Sydney Boike Ibtisam Rauf Abbas B Jama Hisham Mushtaq Salim Surani Syed A Khan Department of Internal Medicine BronxCare Health SystemBronxNY 10457United States Department of Medicine University of SharjahSharjah 27272United Arab Emirates Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Medicine University of MinnesotaMinneapolisMN 55455United States Department of Medicine St.George School of MedicineGrenadaWest Indies Department of Medicine Texas A&M University Health Science CenterBryanTX 77807United States

Gastrointestinal bleeding accounts for a drastic negative impact on the quality of the patients’lives as it requires multiple diagnostic and therapeutic interventions to identify the source of the bleeding.Small bowel bleeding is the least common cause of gastrointestinal bleeding.However,it is responsible for the majority of complaints from patients with persisting or recurring bleeding where the primary source of bleeding cannot be identified despite investigation.A somatostatin analog known as octreotide is among the medical treatment modalities currently used to manage small bowel bleeding.This medication helps control symptoms of gastrointestinal bleeding by augmenting platelet aggregation,decreasing splanchnic blood flow,and antagonizing angiogenesis.In this review article,we will highlight the clinical efficacy of octreotide in small bowel bleeding and its subsequent effect on morbidity and mortality.

关键词： Octreotide Small bowel hemorrhage Angiodysplasia Vascular malformations Hereditary hemorrhagic telangiectasia

Pre-emptive TIPSS in Acute Variceal Bleeding:Current Status,Controversies,and Future Directions

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Journal of Clinical and Translational Hepatology 2022年第6期10卷 1223-1228页

作者： Yu Jun Wong Wei Ling Danielle Ho Juan G.Abraldes Department of Gastroenterology and Hepatology Changi General HospitalSingapore Duke-NUS Medical School Singa-pore Division of Gastroenterology University of AlbertaEdmontonCanada

Acute variceal bleeding(AVB)is associated with signifi-cant short-term morbidity and mortality.Pre-emptive tran-sjugular intrahepatic portosystemic shunt(p-TIPSS)is recommended to prevent rebleeding in AVB patients with a high risk of rebleeding.Despite the benefit of prevent-ing rebleeding and de-novo ascites,the uptake of p-TIPSS remains low because logistic challenges in the real-world setting.In this review,we summarize the current evidence and controversies on p-TIPSS including patient selection for p-TIPSS,particularly in the setting of NASH cirrhosis and acute-on-chronic liver failure,the role of sarcopenia,renal impairment in the setting of p-TIPSS.Finally,we summarize both pharmacological and nonpharmacological strategies to optimize outcomes in patients undergoing p-TIPSS.

关键词： Transjugular intrahepatic portosystemic shunt hemorrhage Portal hypertension Cirrhosis

Isolated coagulopathy without classic CRAB symptoms as the initial manifestation of multiple myeloma: A case report

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World Journal of Clinical Cases 2022年第12期10卷 3822-3827页

作者： Ya Zhang Fang Xu Jing-Jing Wen Lin Shi Qiao-Lin Zhou Department of Hematology Mianyang Central HospitalMianyang 621000Sichuan ProvinceChina

BACKGROUND Multiple myeloma patients usually present with CRAB symptoms(hypercalcemia,renal disease,anemia and bone diseases)as initial manifestations.Bleeding symptoms are less common,most of which result from thrombocytopenia or infiltration of plasmacytoma.Relatively,coagulopathy is not so common,especially isolated coagulopathy without CRAB manifestations,which is very rare.Herein,we report a 54-year old female who was hospitalized for intermittent and recurrent mild oral mucosal hemorrhage without other bleeding symptoms for almost one month or typical myeloma features.CASE SUMMARY Two months before admission,the patient underwent implantation of a permanent pacemaker due to sick sinus syndrome.Prothrombin time and activated partial thromboplastin time were significantly prolonged.Factor X deficiency was demonstrated to account for the coagulation dysfunction.An M protein peak was shown by serum protein electrophoresis.26.11%of abnormal plasma cells were detected in bone marrow by flow cytometry,expressing CD38,CD138,CD56 and intracellular immunoglobulin Kappa light chain.Bone marrow biopsy also proved the presence of abnormal plasma cells,but Congo red stain was negative.The patient was finally diagnosed with multiple myeloma IgA-κtype.A literature review indicated that factor X deficiency was highly related to amyloidosis.Before bleeding signs,the patient had cardiac arrhythmia,enlargement of the heart,and progressive heart failure;thus,cardiac amyloidosis was suspected.CONCLUSION Bleeding related to coagulation dysfunction is uncommon in multiple myeloma,especially as the initial manifestation.Amyloidosis is a well-recognized cause of isolated acquired factor X deficiency.

关键词： Multiple myeloma Coagulation function hemorrhage Factor X Deficiency Case report

Liposome-Encapsulated Hemoglobin Vesicle Improves Persistent Anti-arrhythmogenesis through Improving Myocardial Electrical Remodeling and Modulating Cardiac Autonomic Activity in a Hemorrhagic Shock-Induced Rat Heart Model

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Current Medical Science 2023年第2期43卷 232-245页

作者： Bonpei Takase Yuko Higashimura Haruka Asahina Masayuki Ishihara Hiromi Sakai Department of Intensive Care Medicine National Defense Medical CollegeTokorozawa359-8513Japan Division of Traumatology Research Institute National Defense Medical College Research InstituteTokorozawa359-8513Japan Division of Biomedical Engineering National Defense Medical College Research InstituteTokorozawa359-8513Japan Department of Chemistry School of MedicineNara Medical UniversityNara634-8521Japan

Objective Shock heart syndrome(SHS)is associated with lethal arrhythmias(ventricular tachycardia/ventricular fibrillation,VT/VF).We investigated whether liposome-encapsulated human hemoglobin vesicles(HbVs)has comparable persistent efficacy to washed red blood cells(wRBCs)for improving arrhythmogenesis in the subacute to chronic phase of SHS.Methods Optical mapping analysis(OMP),electrophysiological study(EPS),and pathological examinations were performed on blood samples from Sprague-Dawley rats following induction of hemorrhagic shock.After hemorrhagic shock,the rats were immediately resuscitated by transfusing 5%albumin(ALB),HbV,or wRBCs.All rats survived for 1 week.OMP and EPS were performed on Langendorff-perfused hearts.Spontaneous arrhythmias and heart rate variability(HRV)were evaluated using awake 24-h telemetry,cardiac function by echocardiography,and pathological examination of Connexin43.Results OMP showed significantly impaired action potential duration dispersion(APDd)in the left ventricle(LV)in the ALB group whereas APDd was substantially preserved in the HbV and wRBCs groups.Sustained VT/VF was easily provoked by EPS in the ALB group.No VT/VF was induced in the HbV and wRBCs groups.HRV,spontaneous arrhythmias,and cardiac function were preserved in the HbV and wRBCs groups.Pathology showed myocardial cell damage and Connexin43 degradation in the ALB group,all of which were attenuated in the HbV and wRBCs groups.Conclusion LV remodeling after hemorrhagic shock caused VT/VF in the presence of impaired APDd.Similar to wRBCs,HbV persistently prevented VT/VF by inhibiting persistent electrical remodeling,preserving myocardial structures,and ameliorating arrhythmogenic modifying factors in the subacute to chronic phase of hemorrhagic shock-induced SHS.

关键词： artificial oxygen carrier hemorrhage lethal arrhythmia resuscitation heart rate variability

Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery:Two case reports

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World Journal of Clinical Cases 2022年第32期10卷 12015-12021页

作者： Daisuke Yunaiyama Yuki Takara Takehiro Kobayashi Mika Muraki Taro Tanaka Mitsuru Okubo Toru Saguchi Motoki Nakai Kazuhiro Saito Kiyoaki Tsukahara Yuri Ishii Hiroshi Homma Department of Radiology Tokyo Medical University HospitalShinjuku-ku 160-0023Japan Department of Otorhinolaryngology Head and Neck SurgeryTokyo Medical University HospitalShinjuku-ku 160-0023Japan Department of Emergency and Critical Care Medicine Tokyo Medical University HospitalShinjuku-ku 160-0023Japan

BACKGROUND The ascending pharyngeal artery(APhA)comprises the pharyngeal trunk(PT)and neuromeningeal trunk.The PT feeds the nasopharynx and adjacent tissue,which potentially connects with the sphenopalatine artery(SPA),branched from the internal maxillary artery(IMA).Due to its location deep inside the body,the PT is rarely injured by trauma.Here,we present two cases that underwent transcatheter arterial embolization(TAE)of the PT of the APhA due to trauma and iatrogenic procedure.CASE SUMMARY Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical check-up.The nasal airway was inserted as glossoptosis occurred during sedation.Bleeding from the nasopharynx was observed during the endoscopic procedure.As the bleeding continued,the patient was referred to our hospital for further treatment.Contrast-enhanced computed tomography(CT)demonstrated extravasation in the nasopharynx originating from the right Rosenmuller fossa.TAE was performed and the extravasation disappeared after embolization.Case 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our hospital.Contrastenhanced CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the nasopharynx.Angiography demonstrated an irregular third portion of the IMA.As angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA,additional TAE to the artery was performed.The bleeding stopped after the procedure.CONCLUSION Radiologists should be aware that the PT of the APhA can be a bleeding source,which has a potential connection with the SPA.

关键词： Arteries Catheters hemorrhage Injury Trauma Case report

Potential role of new technological innovations in nonvariceal hemorrhage

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World Journal of Gastrointestinal Endoscopy 2019年第8期11卷 443-447页

作者： David Friedel Department of Gastroenterology New York University Winthrop Hospital

The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.

关键词： NoN-variceal upper gastrointestinal hemorrhage Endoscopic hemostasis Gastric antral vascular ectasias Over-the-scope clips Endoscopic suturing