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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher Department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for traumatology The Research Center in Cooperation with AUVAViennaAustria University Clinic of Dentistry Medical University of ViennaViennaAustria Department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria Department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria Department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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FK506 contributes to peripheral nerve regeneration by inhibiting neuroinflammatory responses and promoting neuron survival

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Neural Regeneration Research 2025年第7期20卷 2108-2115页

作者： Yuhui Kou Zongxue Jin Yusong Yuan Bo Ma Wenyong Xie Na Han Department of trauma and Orthopedics Peking University People’s HospitalBeijingChina National Center for trauma Medicine Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration(Peking University) Ministry of EducationBeijingChina trauma Medicine Center Peking University People’s HospitalBeijingChina Department of Orthopedics China-Japan Friendship HospitalBeijingChina

FK506(Tacrolimus)is a systemic immunosuppressant approved by the *** and Drug ***506 has been shown to promote peripheral nerve regeneration,however,its precise mechanism of action and its pathways remain *** this study,we established a rat model of sciatic nerve injury and found that FK506 improved the morphology of the injured sciatic nerve,increased the numbers of motor and sensory neurons,reduced inflammatory responses,markedly improved the conduction function of the injured nerve,and promoted motor function *** findings suggest that FK506 promotes peripheral nerve structure recovery and functional regeneration by reducing the intensity of inflammation after neuronal injury and increasing the number of surviving neurons.

关键词： FK506 inflammation motor neurons nerve regeneration neuron peripheral nerve injury sensory neurons

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Sex-dependent alterations in extracellular vesicles linking chronic spinal cord injury to brain neuroinflammation and neurodegeneration

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Neural Regeneration Research 2025年第2期20卷 483-484页

作者： Yun Li Junfang Wu Department of Anesthesiology&Shock Trauma and Anesthesiology Research(STAR)CenterUniversity of Maryland School of MedicineBaltimoreMDUSA

traumatic spinal cord injury(SCI)is a devastating exogenous injury with long-lasting consequences and a leading cause of death and disability *** in assistive technology,rehabilitative interventions,and the ability to identify and intervene in secondary conditions have significantly increased the long-term survival rate of SCI patients,with some people even living well into their seventh or eighth *** survival changes have led neurotrauma researchers to examine how SCI interacts with brain *** health and epidemiological data showed that patients with long-term SCI can have a lower life expectancy and quality of life,along with a higher risk of comorbidities and complications.

关键词： alterations inflammation injury

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trauma-induced“Macklin effect”with pneumothorax and large pneumomediastinum,disguised by allergy

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Frontiers of Medicine 2013年第3期7卷 386-388页

作者： Salomone Di Saverio Kenji Kawamukai Andrea Biscardi Silvia Villani Luca Zucchini Gregorio Tugnoli Departments of Emergency and surgery Emergency Surgery and Trauma Surgery UnitTrauma CenterMaggiore Hospital-Bologna Local Health DistrictBolognaItaly Department of Thoracic surgery Trauma CenterMaggiore HospitalBolognaItaly Accident and Emergency Trauma CenterMaggiore HospitalBolognaItaly

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs(NSAIDS).The triage nurse assigned the patient to Accident&Emergency(A&E)doctor as probable allergic reaction to *** X-ray(CXR),ordered after 24 hours,revealed a huge subcutaneous chest and neck emphysema without clearly visible *** chest CT scan showed a small left pneumothorax and a large amount of air in the *** patient was conservatively treated since he was eupnoeic and hemodynamically *** pathophysiology of pneumomediastinum was first described by Macklin in *** Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the *** this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

关键词： thoracic trauma differential diagnosis critical care pneumothorax pneumomediastinum CT scan pitfalls lung and airways physiology

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Rapid sequence induction(RSI) in trauma patients: Insights from healthcare providers

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World Journal of Emergency Medicine 2019年第1期10卷 19-26页

作者： Bianca M.Wahlen Ayman El-Menyar Mohammad Asim Hassan Al-Thani Department of Anesthesia Hamad General Hospital Clinical Research Trauma & Vascular Surgery Hamad General Hospital Clinical Medicine Weill Cornell Medical College Department of surgery Trauma Surgery Hamad General Hospital

BACKGROUND: We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction(RSI) among trauma ***: A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating ***: A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol(74.5%) and Etomidate(50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients(P=0.001). Emergency physicians preferred Etomidate(63.6%) and Ketamine(20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium(55.6% vs. 27.7%, P=0.01) in stable as well as unstable(43.4 % vs. 27.7%, P=0.08) ***: There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.

关键词： Rapid-sequence induction trauma Emergency physicians Anaesthetists Drugs

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Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

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World Journal of Gastrointestinal surgery 2023年第5期15卷 757-775页

作者： Husham Abdelrahman Ayman El-Menyar Ruben Peralta Hassan Al-Thani trauma surgery Hamad Medical CorporationDoha 3050Qatar trauma and Vascular surgery Hamad Medical CorporationDoha 3050Qatar

Background:Modern surgical medicine strives to manage trauma while improving outcomes using functional *** of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus *** anastomosis after traumarelated resection is associated with a high rate of *** ability of the surgeon’s bare eye to determine bowel viability remains limited,and the need for a more standardized objective assessment has not yet been ***,there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize traumaassociated *** green(ICG)coupled with fluorescence angiography is a potential solution for this *** is a fluorescent dye that responds to near-infrared ***:We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective ***:ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical ***,there is a paucity of information regarding the use of this technology to treat ***,angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions,leading to fewer cases of anastomotic *** has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient ***,there is no consensus on the ideal dose,time,and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical ***:There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical *** review will impro

关键词： trauma Indocyanine green Fluorescence angiography Perfusion imaging Fluorescence guided surgery Acute care surgery

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Advances in laparoscopy for acute care surgery and trauma

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World Journal of Gastroenterology 2016年第2期22卷 668-680页

作者： Matteo Mandrioli Kenji Inaba Alice Piccinini Andrea Biscardi Massimo Sartelli Ferdinando Agresta Fausto Catena Roberto Cirocchi Elio Jovine Gregorio Tugnoli Salomone Di Saverio Department of Emergency and General surgery and trauma surgery Unit C.A.Pizzardi Maggiore Hospital Trauma Center40133 BolognaItaly Division of trauma surgery and Surgical Critical Care Department of SurgeryUniversity of Southern CaliforniaLos AngelesCA 90033United States Department of surgery Macerata Hospital62100 MacerataItaly Department of surgery Adria Hospital45011 AdriaRovigoItaly Department of Emergency and trauma surgery Maggiore Hospital43126 ParmaItaly Departement of Digestive surgery and Liver Unit St.Maria Hospital05100 TerniPerugiaItaly

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers,for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a la

关键词： Laparoscopy Acute care surgery Singleincisionlaparoscopic surgery Natural orifice transluminalendoscopic surgery trauma

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Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

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World Journal of Emergency Medicine 2018年第3期9卷 203-210页

作者： Suresh Kumar Arumugam Insolvisagan Mudali Gustav Strandvik Ayman El-Menyar Ammar Al-Hassani Hassan Al-Thani1 trauma surgery Section Department of SurgeryHamad General HospitalDohaQatar Clinical Research Trauma Surgery SectionHamad General HospitalDohaQatar Clinical Medicine Weill Cornell Medical CollegeDohaQatar

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma ***:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and ***’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]*** room[TRI])and presence *** of *** regression analysis was performed to identify predictors of ***:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 *** group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of *** overall mortality was 7.5%,and was not associated with intubation location or pneumonia *** the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP *** regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the ***:In trauma,the risk of developing VAP is ***,the location of intubation and presence of chest injury could play an important role.

关键词： Ventilator-associated pneumonia trauma Mechanical ventilation Intubation location Intensive care unit

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Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

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World Journal of Emergency Medicine 2018年第2期9卷 105-112页

作者： Saeed Mahmood Omaima Mahmood Ayman El-Menyar Mohammad Asim Hassan Al-Thani trauma surgery Section Department of Surgery Hamad General Hospital (HGH) Doha Qatar College of Pharmacy Qatar University Doha Qatar Clinical Research Trauma Surgery Section Department of Surgery HGH Doha Qatar Clinical Medicine Weill Cornell Medical School Doha Qatar

BACKGROUND: Agitation occurs frequently among critically ill patients admitted to the intensive care unit(ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation ***: A total of 102 intubated patients were enrolled; of which 46(45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries(Ptrauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

关键词： trauma Intensive care unit Agitation Head injury Propofol Outcome

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Current role of extracorporeal membrane oxygenation for the management of trauma patients:Indications and results

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World Journal of Critical Care Medicine 2025年第1期14卷 42-48页

作者： Mohammed Abdulrahman Maryam Makki Malak Bentaleb Dana Khamis Altamimi Marcelo AF Ribeiro Junior Department of surgery College of Medicine and Health SciencesKhalifa UniversityAbu Dhabi 11001United Arab Emirates Department of surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates Department of surgery Sheikh Shakhbout Medical CityAbu Dhabi 91888ADUnited Arab Emirates Department of surgery R Adams Cowley Shock Trauma CenterUniversity of MarylandBaltimoreMD 21201United States

Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional *** allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon *** blood is then reintroduced into the patient’s circulatory *** process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant ***-venous(VV)ECMO primarily supports respiratory function and indicates respiratory ***,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related *** study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated ***,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and *** studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV *** plays a critical role in managing trauma patients,particularly those with acute respiratory *** research is necessary to explore the full potential of ECMO in trauma *** should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.

关键词： Extracorporeal membrane oxygenation treatments Multiple trauma Respiratory distress syndrome Cardiogenic shock Contraindications Anticoagulants

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