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

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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trauma systems in Canada:striving for quality across an expansive landmass

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Emergency and Critical Care Medicine 2023年第3期3卷 89-93页

作者： Natasha G.Caminsky Evan G.Wong division of General and trauma Surgery McGill UniversityMontrealQuebecCanada

Although Canada has a universal health care program that provides free in-hospital services to all citizens,its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging,particularly to resource-limited rural *** article summarizes the strengths of the prehospital system,facility-based care,trauma network,trauma registry,rehabilitation,and governance/financing/quality assurance components of Canada’s trauma *** directions,including the use of telemedicine,standardization of practices,and resource optimization,are also ***’s trauma system is well developed,yet geography impedes equitable *** standardization and resource optimization are needed.

关键词： trauma referral trauma registry trauma systems Universal health care

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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

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Acute Care/trauma Surgeon＇s role in obstetrical/ gynecologic emergencies (The OBCAT Alert)

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World Journal of Emergency Medicine 2016年第4期7卷 274-277页

作者： Seong K. Lee Eddy H. Carrillo Andrew Rosenthal Rafael Sanchez Chauniqua Kiffin Dafney L. Davare division of Acute Care Surgery and trauma Memorial Regional Hospital Hollywood FL 33021 USA

BACKGROUND:Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic(OB/GYN) procedures and may require the surgical training of an Acute Care/trauma *** OB Critical Assessment Team(OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN *** sought to review and characterize the Acute Care/trauma Surgeon's role in these ***:We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to *** OBCAT is a hospital based alert system designed to immediately notify OB/GYN,anesthesiology,Acute Care/trauma,the intensive care unit(ICU),and the blood bank of a potential emergency during an OB/GYN ***:There were 7±3 OBCAT alerts/*** patients required Acute Care/trauma surgery intervention for *** patients required damage control packing during their *** loss averaged 6.8±5.5 L and patients received a total of 21±14units during deliveries with *** were 17 other surgical interventions not related to hemorrhage;seven of these cases were related to adhesions or intestinal *** additional cases required evaluation post routine OB/GYN procedure;the most common reason was for severe wound *** were three deaths during this study ***:Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming *** Care/trauma Surgeons have a key role in the treatment of these complex cases.

关键词： Obstetric hemorrhage Postpartum hemorrhage Damage control packing Acute care surgery OBCAT

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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

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Military Medical Research 2022年第2期9卷 193-204页

作者： Kai Wang Shi-Long Sun Xin-Yu Wang Cheng-Nan Chu Ze-Hua Duan Chao Yang Bao-Chen Liu Wei-Wei Ding Wei-Qin Li Jie-Shou Li division of trauma and Surgical Intensive Care Unit Research Institute of General SurgeryJinling HospitalMedical School of Nanjing UniversityNo.305 East Zhongshan RoadNanjing 210002China division of trauma and Surgical Intensive Care Unit Research Institute of General Surgerythe First School of Clinical MedicineSouthern Medical UniversityNanjing 210002China

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)*** impedance analysis(BIA)is a promising tool for monitoring fluid status and ***,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA ***:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)*** primary outcome was the 30-day primary fascial closure(PFC)*** secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after *** Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was ***:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer ***:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complicat

关键词： trauma Open abdomen Fluid overload Fluid resuscitation Primary fascial closure Bioelectrical impedance analysis

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Non-operative successful management of a perforated small bowel diverticulum

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World Journal of Gastroenterology 2014年第48期20卷 18477-18479页

作者： Melissa M Levack Maria Lucia Madariaga Haytham MA Kaafarani division of trauma Department of Surgery SurgicalCritical Care Massachusetts General Hospital Harvard MedicalSchool Boston MA 02114 United States

Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.

关键词： Jejunal diverticula Diverticulitis Small bowel perforation Antibiotics Abscess

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Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 601-610页

作者： Paulo N.Martins Julianna E.Buchwald Babak Movahedi Ulises Torres Timothy Emhoff Jennifer Walker Michael G.DeBusk Adel Bozorgzadeh Department of Surgery Division of TransplantationUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of TraumaUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of Cardiac SurgeryUniversity of MassachusettsWorcesterMA 01655USA

To the Editor:Complete traumatic transection of the suprahepatic inferior vena cava(IVC)has almost invariably a fatal *** are very few cases in the literature of patients that survived this type of *** we presented a case that was approached multidisciplinary(trauma surgeon,liver transplant surgeon,perfusionist,anesthesiologist,and cardiac surgeon)with a successful outcome including early recovery of all body functions and quality of life.

关键词： traumatic hepatic bypass

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A robotic-assisted approach is safe and effective for repairing giant epiphrenic diverticulum

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第3期5卷 116-120页

作者： Anna K.Gergen Akshay Pratap division of GI Traumaand Endocrine SurgeryDepartment of SurgeryUniversity of ColoradoAuroraCO80045USA

Epiphrenic esophageal diverticulum is a rare disorder accounting for<10%of all esophageal *** treatment may be necessary for larger diverticula causing significant *** this technical note,we describe a robotic-assisted approach to repair of a giant epiphrenic diverticulum.A 53-year-old female presented to the Department of Surgery,University of Colorado in January 2020 with a long-standing history of dysphagia and regurgitation associated with *** a thorough preop-erative workup,the patient underwent a robotic-assisted transhiatal approach with resection of the diverticulum followed by complete myotomy and Dor *** patient had no perioperative complications and demonstrated complete relief of symptoms at the 6-month follow-up.A robotic-assisted transhiatal approach is a safe and effective technique for the resection of large epiphrenic *** myotomy followed by an antireflux procedure is critical to reducing perioperative complications and maintaining long-term symptom *** prospective studies are needed to evaluate the specific morbidity risks associated with this approach.

关键词： Epiphrenic diverticulum Esophageal diverticulectomy Robotic surgery

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Long-term results of olecranon fractures treated using the XS nail? system

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中华创伤杂志(英文版) 2022年第6期25卷 336-344页

作者： H?chtl-Lee Leonard Spalteholz Matthias Raven Tim Friedrich Moghaddam Arash Friedl Wilhelm Aschaffenburg trauma and Orthopaedic Research Group Center for Orthopaedics trauma Surgery and Sports Medicine Hospital Aschaffenburg-Alzenau GGmbH Am Hasenkopf 1 Aschaffenburg Germany Center for Orthopaedics and trauma Surgery Leipzig division of Orthopaedics and trauma Surgery Rotkreuzklinik Wertheim GGmbH Wertheim Am Main

Purpose: Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail? (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed. Methods: This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail?. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel? 2016. Results: There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supina

关键词： Olecranon fracture Intramedullary nail Treatment DASH XS nail

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Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

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World Journal of Clinical Cases 2022年第26期10卷 9404-9410页

作者： Na-A Lee Eui-Sung Jeong Hyun-Seok Jang Yun-Chul Park Ji-Hyoun Kang Jung-Chul Kim Young-Goun Jo division of trauma Department of SurgeryChonnam National University Medical School and HospitalGwangju 61469South Korea division of Rheumatology Department of Internal MedicineChonnam National University Medical School and HospitalGwangju 61469South Korea

BACKGROUND In trauma patients,bleeding is an immediate major *** the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these ***,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt *** SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h *** had no medical *** investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the *** revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total *** the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate *** results suggested a high possibility of antiphospholipid *** with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two *** diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking *** A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

关键词： Wounds and injuries Wounds Nonpenetrating Antiphospholipid syndrome Renal artery obstruction Splenic infarction Case reports

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