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Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

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World Journal of Emergency Medicine 2024年第1期15卷 3-9页

作者： Rashed Alremeithi Quincy K.Tran Megan T.Quintana Soroush Shahamatdar Ali Pourmand department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Center for trauma and Critical care Department of Surgerythe George Washington University School of Medicine&Health SciencesWashington DC 20037USA

BACKGROUND:traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare *** there have been advances in treatment modalities,survival rates for TCA patients remain *** narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating ***:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,*** search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English *** the search,943 articles were retrieved,and two independent reviewers conducted a screening ***:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable *** were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital *** thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt *** endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic *** implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality ***-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,*** the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ***:TCA remains a signifi cant challenge for emergency medical services due to its high m

关键词： traumatic cardiac arrest Emergency thoracotomy Resuscitative endovascular balloon occlusion of the aorta

Biliary complications associated with weight loss,cholelithiasis and choledocholithiasis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第4期15卷 1-8页

作者： Marcelo A Ribeiro Jr Gabriela K Tebar Helena B Niero Leticia S Pacheco department of surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates department of surgery Pontifical Catholic University of São Paulo-Campus SorocabaSorocaba 18030070SPBrazil

Biliary complications like cholelithiasis and choledocholithiasis are more common in bariatric surgery patients due to obesity and rapid weight *** with a body mass index>40 face an eightfold risk of developing *** surgery,especially after laparoscopic Roux-en-Y gastric bypass(LRYGB),30%of patients develop biliary disease due to rapid weight *** aim of this review is to analyze the main biliary complications that occur after bariatric surgery and its management.A review of the literature was conducted mainly from 2010 up to 2023 with regard to biliary complications associated with bariatric patients in SciELO,PubMed,and *** undergoing LRYGB have a higher incidence(14.5%)of symptomatic calculi post-surgery compared to those undergoing laparoscopic sleeve gastrectomy at 4.1%.Key biliary complications within 6 to 12 months post-surgery include:Cholelithiasis:36%;Biliary colic/dyskinesia:3.86%;acute cholecystitis:0.98%-18.1%;Chronic cholecystitis:70.2%;Choledocholithiasis:0.2%-5.7%and Pancreatitis:0.46%-9.4%.Surgeons need to be aware of these complications and consider surgical treatments based on patient symptoms to enhance their quality of life.

关键词： Bariatric surgery Complications Choledocholithiasis Cholelithiasis acute cholecystitis

Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

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World Journal of Orthopedics 2024年第6期15卷 539-546页

作者： Riya Savla Yen-Hong Kuo Nasim Ahmed department of surgery and trauma Hackensack Meridian School of MedicineNutleyNJ 07110United States department of Medical Sciences Hackensack Meridian School of medicineNutleyNJ 08753United States Office of Research Administration Hackensack Meridian Health Research InstituteNutleyNJ 077110United States department of surgery Department of Trauma and Surgical Critical CareJersey Shore University Medical CenterNeptuneNJ 07754United States department of surgery Department of Trauma and Surgical Critical CareHackensack Meridian School of MedicineNutleyNJ 07110United States

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of *** to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 *** To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of *** Using retrospective data review from the National trauma Data Bank,trauma Quality Improvement Project(TQIP)of *** database is own by the ACS and it is the largest database for trauma quality program in the *** matching analysis was performed for the *** There were 390 pediatric patients with open long bone fractures who were incl-uded in the *** completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 *** found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the *** Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

关键词： Pediatric trauma Open tibia fracture Irrigation and debridement Timing of intervention Surgical site infection

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

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World Journal of Stem Cells 2024年第4期16卷 324-333页

作者： Ilias E Epanomeritakis Wasim S Khan Division of trauma and Orthopaedic surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Division of trauma and Orthopaedic surgery Department of SurgeryUniversity of CambridgeCambridge CB20QQUnited Kingdom

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying *** treatment ultimately requires joint *** capable of regenerating cartilage could significantly reduce financial and clinical *** regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee *** has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to ***-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative *** vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,*** avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of *** this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee *** discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative *** underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

关键词： Knee osteoarthritis Mesenchymal stromal cells Adipose tissue Stromal vascular fraction Micro-fragmented adipose tissue Regeneration

Impacts of pancreatic exocrine insufficiency on gut microbiota

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2024年第4期25卷 271-279页

作者： Yulin GUO Feng CAO Fei LI department of General surgery Xuanwu Hospital of Capital Medical UniversityBeijing 100053China acute Pancreatitis Clinical Center of Capital Medical University Beijing 100053China

Pancreatic exocrine insufficiency(PEI)can be induced by various kinds of diseases,including chronic pancreatitis,acute pancreatitis,and *** main pathogenetic mechanism of PEI involves the decline of trypsin synthesis,disorder of pancreatic fluid flow,and imbalance of secretion *** studies have shown that PEI could induce gut bacterial overgrowth and dysbiosis,with the abundance of Lactobacillus and Bifidobacterium increasing the most,which could be partially reversed by pancreatic enzyme replacement *** studies have also confirmed the association between PEI and the dysbiosis of gut *** exocrine secretions and changes in duodenal p H as well as bile salt malabsorption brought about by PEI may affect and shape the abundance and composition of gut *** turn,the gut microbiota may impact the pancreatic exocrine acinus through potential bidirectional *** forward,more and higher-quality studies are needed that focus on the mechanism underlying the impact of PEI on the gut microbiota.

关键词： Pancreatic exocrine insufficiency Gut microbiota Gut microbiome Pancreatic enzyme replacement therapy

Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options

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World Journal of Orthopedics 2024年第6期15卷 501-511页

作者： Dario Regis Mattia Cason Bruno Magnan department of Orthopedic and trauma surgery Integrated University HospitalVerona 37126VenetoItaly

Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint ***,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic *** is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical *** most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of ***,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the *** spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after *** options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.

关键词： Dislocation Total hip arthroplasty Revision surgery Review Risk factors Complication

Pericytes protect rats and mice from sepsis-induced injuries by maintaining vascular reactivity and barrier function:implication of miRNAs and microvesicles

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Military Medical Research 2024年第1期11卷 1-18页

作者： Zi-Sen Zhang Yi-Yan Liu Shuang-Shuang He Dai-Qin Bao Hong-Chen Wang Jie Zhang Xiao-Yong Peng Jia-Tao Zang Yu Zhu Yue Wu Qing-Hui Li Tao Li Liang-Ming Liu State Key Laboratory of trauma Burns and Combined InjuryDepartment of Shock and TransfusionResearch Institute of SurgeryDaping HospitalArmy Medical UniversityChongqing 400042China

Background Vascular hyporeactivity and leakage are key pathophysiologic features that produce multi-organ damage upon *** hypothesized that pericytes,a group of pluripotent cells that maintain vascular integrity and tension,are protective against sepsis via regulating vascular reactivity and *** We conducted a series of in vivo experiments using wild-type(WT),platelet-derived growth factor receptor-β(PDGFR-β)-Cre+mT/mG transgenic mice and Tie2-Cre+Cx43^(flox/flox)mice to examine the relative contribution of pericytes in sepsis,either induced by cecal ligation and puncture(CLP)or lipopolysaccharide(LPS)*** a separate set of experiments with Sprague-Dawley(SD)rats,pericytes were depleted using CP-673451,a selective PDGFR-βinhibitor,at a dosage of 40 mg/(kg·d)for 7 consecutive *** pericytes,vascular endothelial cells(VECs)and vascular smooth muscle cells(VSMCs)were used for mechanistic *** effects of pericytes and pericyte-derived microvesicles(PCMVs)and candidate miRNAs on vascular reactivity and barrier function were also *** CLP and LPS induced severe injury/loss of pericytes,vascular hyporeactivity and leakage(P<0.05).Transplantation with exogenous pericytes protected vascular reactivity and barrier function via microvessel colonization(P<0.05).Cx43 knockout in either pericytes or VECs reduced pericyte colonization in microvessels(P<0.05).Additionally,PCMVs transferred miR-145 and miR-132 to VSMCs and VECs,respectively,exerting a protective effect on vascular reactivity and barrier function after sepsis(P<0.05).miR-145 primarily improved the contractile response of VSMCs by activating the sphingosine kinase 2(Sphk2)/sphingosine-1-phosphate receptor(S1PR)1/phosphorylation of myosin light chain 20 pathway,whereas miR-132 effectively improved the barrier function of VECs by activating the Sphk2/S1PR2/zonula occludens-1 and vascular endothelial-cadherin *** Pericytes are protective a

关键词： Pericyte Vascular reactivity Vascular permeability Cx43 Microvesicle

Health economics for intra-capsular hip fractures undertaking fixation

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World Journal of Orthopedics 2024年第1期15卷 30-38页

作者： Anatole Wiik Thomas Ashdown Ian Holloway department of surgery Trauma and OrthopaedicsLondon North West University HealthcareLondon HA13UJUnited Kingdom department of surgery Trauma and OrthopaedicsLondon North West University HospitalLondon HA13UJUnited Kingdom

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery *** operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for *** To determine the most beneficial method of fixation for patients with intracapsular hip *** A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation *** notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after *** A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective *** were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture *** was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation *** regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of *** were 9(19%)and 4(11%)patients respectively,who required *** was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring *** was predicted by initial fracture displacement and patient *** may need to be carefully considered for health economics and patient benefit.

关键词： Hip fracture Fixation Patient reported outcome measure Cost

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

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World Journal of Clinical Oncology 2024年第3期15卷 381-390页

作者： Maryam Makki Malak Bentaleb Mohammed Abdulrahman Amal Abdulla Suhool Salem Al Harthi Marcelo AF Ribeiro Jr department of surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates department of surgery College of Medicine and Health SciencesKhalifa UniversityAbu Dhabi 11001United Arab Emirates department of surgery Division of Hepato-Pancreato-Biliary(HPB)SurgerySheikh Shakhbout Medical CityAbu Dhabi 91888United Arab Emirates

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or *** tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced ***,several palliative treatment options are available for primary biliary tract *** include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary *** therapy is also commonly used for the palliative treatment of primary biliary tract *** involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract *** is another palliative treatment option for patients with unresectable or inoperable malignant biliary *** stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary *** interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract ***,biliary diversion only provides temporary relief and does not remove the *** biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.

关键词： Cholangiocarcinoma Palliative care Endoscopic treatment surgery Complications Interventional radiology