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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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Protocolized approach saves the limb in peripheral arterial injury: A decade experience

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中华创伤杂志(英文版) 2025年第01期

作者： Priyadarshini Pratyusha Kaur Supreet Gupta Komal Kumar Abhinav Alam Junaid Bagaria Dinesh Choudhary Narender Gupta Amit Sagar Sushma Mishra Biplab Kumar Subodh Division of trauma surgery & Critical Care Jai Prakash Narayan Apex Trauma Centre All India Institute of Medical Sciences New Delhi India

Purpose:Outcomes of peripheral arterial injury (PAI) depend on various factors, such as warm ischemia time and concomitant injuries. Suboptimal prehospital care may lead to delayed presentation, and a lack of dedicated trauma system may lead to poorer outcome. Also, there are few reports of these outcomes. The study aims to review our experience of PAI management for more than a decade, and identify the predictors of limb loss in these ***:This is a retrospective analysis of prospectively maintained database of trauma admissions at a level I trauma center from January 2008 to December 2019. Patients with acute upper limb arterial injuries or lower limb arterial injuries at or above the level of popliteal artery were included. Association of limb loss with ischemia time, mechanism of injury, and concomitant injuries was studied using multiple logistic regressions. Statistical analysis was performed using STATA version 15.0 (Stata Corp LLC, Texas).Results:Out of 716 patients with PAI, the majority (91.9%) were young males. Blunt trauma was the most common mechanism of injury. Median ischemia time was 4 h (interquartile range 2-7 h). Brachial artery (28.5%) was the most common injured vessel followed by popliteal artery (17.5%) and femoral artery (17.3%). Limb salvage rate was 78%. Out of them, 158 (22.1%) patients needed amputation, and 53 (7.4%) had undergone primary amputation. The majority (88.6%) of patients who required primary or secondary amputations had blunt trauma. On multivariate analysis, blunt trauma, ischemia time more than 6 h and concomitant venous, skeletal, and soft tissue injuries were associated with higher odds of ***:Over all limb salvage rates was 77.9% in our series. Blunt mechanism of injury and associated skeletal and soft tissue injury, ischemia time more than 6 h portend a poor prognosis. Injury prevention, robust prehospital care, and rapid referral to specialized trauma center are few efficient measures, whi

关键词： Vascular trauma Extremity vascular injury Amputation Vascular injury repair Peripheral arterial injury

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Correlations of the expression of Cx43,SCF^(FBXW7),p-cyclin E1(Ser73),p-cyclin E1(Thr77)and p-cyclin E1(Thr395)in colon cancer tissues

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World Journal of Gastrointestinal Oncology 2025年第1期17卷 207-213页

作者： Rong-Gang Luan Ming-Da Liu Zi-Feng Deng Cong-Lan Lu Mei-Ling Yu Ming-Yu Zhang Rong Liu Ran An You-Liang Yao Dong-Bei Guo Yong-Xing Zhang Lei Zhao Department of Gastrointestinal surgery Air Force Hospital of Eastern TheaterAnhui Medical UniversityNanjing 230032Jiangsu ProvinceChina State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics School of Public HealthXiamen UniversityXiamen 361102Fujian ProvinceChina trauma surgery Air Force Hospital of Eastern TheaterAnhui Medical UniversityNanjing 230032Jiangsu ProvinceChina Department of Orthopaedics Air Force Hospital of Eastern TheaterAnhui Medical UniversityNanjing 230032Jiangsu ProvinceChina

BACKGROUND Previous cellular studies have demonstrated that elevated expression of Cx43 promotes the degradation of cyclin E1 and inhibits cell proliferation through ***,reduced expression results in a loss of this capacity to facilitate cyclin E *** ubiquitination and degradation of cyclin E1 may be associated with phosphorylation at specific sites on the protein,with Cx43 potentially enhancing this process by facilitating the phosphorylation of these critical *** To investigate the correlation between expression of Cx43,SKP1/Cullin1/F-box(SCF)FBXW7,p-cyclin E1(ser73,thr77,thr395)and clinicopathological indexes in colon *** Expression levels of Cx43,SCF^(FBXW7),p-cyclin E1(ser73,thr77,thr395)in 38 clinical colon cancer samples were detected by immunohistochemistry and were analyzed by statistical methods to discuss their *** Positive rate of Cx43,SCF^(FBXW7),p-cyclin E1(Ser73),p-cyclin E1(Thr77)and p-cyclin E1(Thr395)in detected samples were 76.32%,76.32%,65.79%,5.26%and 55.26%*** expressions of these proteins were not related to the tissue type,degree of tissue differentiation or lymph node ***43 and SCF^(FBXW7)(r=0.749),p-cyclin E1(Ser73)(r=0.667)and p-cyclin E1(Thr395)(r=0.457),SCF^(FBXW7) and p-cyclin E1(Ser73)(r=0.703)and p-cyclin E1(Thr395)(0.415)were correlated in colon cancer(P<0.05),and expressions of the above proteins were positively correlated in colon *** Cx43 may facilitate the phosphorylation of cyclin E1 at the Ser73 and Thr195 sites through its interaction with SCF^(FBXW7),thereby influencing the ubiquitination and degradation of cyclin E1.

关键词： Colon cancer Cx43 SCF^(FBXW7) Phosphorylation of cyclin E1 Sites of cyclin E1 Correlation analysis

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Incorporating red blanket protocol within code crimson:Streamlining definitive trauma care amid the chaos

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World Journal of Critical Care Medicine 2025年第1期14卷 14-19页

作者： Sohil Pothiawala Savitha Bhagvan Andrew MacCormick Emergency Medicine Woodlands HealthSingapore 737628Singapore trauma and Emergency Services Auckland City HospitalAuckland 1023New Zealand Department of General surgery Middlemore HospitalAuckland 2025New Zealand

The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary *** initial resuscitation of a patient in the emergency department(ED),Code Crimson activation facilitates rapid decisionmaking by multi-disciplinary specialists for definitive haemorrhage control in operating theatre(OT)and/or interventional radiology(IR)*** this decision has been made,there may still be various factors that lead to delay in transporting the patient from ED to OT/*** Blanket protocol identifies and addresses these factors and processes which cause delay,and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT,while minimizing delay in resuscitation during the *** two processes,Code Crimson and Red Blanket,complement each *** would be ideal to merge the two processes into a single protocol rather than having two separate *** these quality improvement strategies and coor-dinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.

关键词： Red blanket protocol Code crimson Haemorrhage trauma

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Acute portal vein thrombosis in an isolated, blunt, minor liver injury near the porta hepatis

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中华创伤杂志(英文版) 2025年第01期

作者： Wongweerakit Onchuda Akaraborworn Osaree Sangthong Burapat Thongkhao Komet Division of trauma and Critical Care Department of Surgery Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand

Portal vein thrombosis (PVT) secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury, and it carries a high rate of morbidity and mortality. Moreover, acute asymptomatic PVT is difficult to diagnose. We present a young trauma patient with isolated minor liver injury associated with acute PVT. A 27-year-old man presented to the emergency department after a motor vehicle collision. His primary survey findings were unremarkable. His secondary survey showed a large contusion (7 × 7 cm2) at the epigastrium with marked tenderness and localized guarding. The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b (according to the American Association for the surgery of trauma classification) extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury. The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins, and a decreased size of the hepatic lacerations. A liver function test was repeated on post-injury day 4, and it revealed improved transaminitis. The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment. The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein. The patient received intravenous anticoagulant therapy for a total of 3 months. On the follow-up visits at 1 month, 2 months, 6 months, and 1 year after the injury, the patients did not have any detectable abnormal symptoms. PVT post-blunt minor liver injury is an extremely rare complication. If the thrombosis is left untreated, serious morbidity and mortality can ensue. However, its diagnosis in asymptomatic patients is still challenging. Periodic imaging is necessary for highly suspected PVT, especi

关键词： Acute portal vein thrombosis Acute mesenteric thrombosis Blunt abdominal trauma Blunt hepatic injury Minor liver 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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Open wedge re-correction high tibial osteotomy in an elderly patient with a varus angulated non-united dome-shaped high tibial osteotomy

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2013年第11期14卷 1054-1058页

作者： Steffen SCHROTER Lukas KONSTANTINIDIS Tobias M. KRAUS Fabian STUBY Ulrich STOCKLE Thomas FREUDE Department of traumatology and Reconstructive surgery BG Trauma Center Department of Orthopaedics and trauma surgery University Medical Centre Freiburg

The high tibial osteotomy(HTO)is a wellestablished and commonly used treatment for younger and active patients with a medial unicompartmental osteoarthritis of the knee and varus *** aim of this technique is to shift the load to a functional lateral compartment in order to delay total knee *** dome-shaped HTO was introduced by Blaimont et al.(1975)and later popularized by Maquet(1980).Out of 118 cases,96 cases of overcorrection,13 cases of undercorrection,and 9 cases

关键词： HTO MPTA high

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Management of Maxillofacial Gunshot trauma in the Stomatology and Maxillofacial surgery Departments of Ouagadougou

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Open Journal of Stomatology 2023年第10期13卷 342-352页

作者： Mathieu Millogo Motandi Idani Arsène Coulibaly Michel Fabien Dargani Mahamadi Sanfo Tarcissus Konsem Department of Stomatology and Maxillofacial surgery Tengandogo University Hospital Ouagadougou Burkina Faso Department of Stomatology and Maxillofacial surgery Yalgado Ouédraogo University Hospital Ouagadougou Burkina Faso Department of Stomatology and Maxillofacial surgery Ouahigouya Regional University Hospital Ouagadougou Burkina Faso

Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.

关键词： Gunshot trauma Maxillofacial Facial Fracas Terrorism

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Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

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World Journal of Clinical Cases 2019年第14期7卷 1825-1836页

作者： Christoph Kolja Boese Philipp Lechler Michael Frink Michael Hackl Peer Eysel Christian Ries Department of Orthopaedic and trauma surgery University Hospital of CologneCologne 50931Germany Clinic for trauma and Hand surgery KreisklinikenAltotting 84503Germany Center for Orthopaedics and trauma surgery University Hospital Giessen and MarburgMarburg 35043Germany

BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

关键词： Antibiotic therapy Outpatient parenteral antibiotic therapy Inpatient parenteral antibiotic therapy Cost analysis Periprosthetic joint infection Parenteral

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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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