Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health ...Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.Methods: This observational(cross-sectional) study recruited a sample of 103 soldiers who required medical attention,from a total 202 new battalion soldiers. The medical records(paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury,and recurring injury.Results: A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.Conclusions: This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.展开更多
The percentage of diabetic patients with contaminated lesions increases from 3% to 10%. Treatment with herbal products shows benefits in their use, as well as antioxidant and antifungal activities. Objective: to evalu...The percentage of diabetic patients with contaminated lesions increases from 3% to 10%. Treatment with herbal products shows benefits in their use, as well as antioxidant and antifungal activities. Objective: to evaluate the antimicrobial action of 10% banana peel gel and the contraction of diabetic and venous wounds. Methods: individual, analytical, interventional, longitudinal, prospective, randomized study from February to December 2015. Five patients were included in the study;3 with venous ulcer and 2 with diabetic wound. Application of 10% green banana peel gel and weekly samples were performed. After six days, the second collection was performed. The samples were seeded in the Mannitol salt agar culture medium, MacConkey agar and Saboraund agar with chloramphenicol for isolation of cocci and Gram-positive and Gram-negative bacilli;and fungi. The total counts of bacteria were determined by PCA (Plate Count Agar) and measurement of the lesion margin. There was a reduction of microorganisms with the use of the gel in 53.57% of the patients, and reduction of wound areas in 48.1%.展开更多
BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be consid...BACKGROUND In trauma patients,bleeding is an immediate major concern.At 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 cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE 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 ago.He had no medical history.Radiological 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 spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.展开更多
BACKGROUND Recently,two naval pilots in a two-seat trainer jet were forced to eject urgently due to sudden mechanical failure during night-time training.They were both successfully rescued and sent to the hospital for...BACKGROUND Recently,two naval pilots in a two-seat trainer jet were forced to eject urgently due to sudden mechanical failure during night-time training.They were both successfully rescued and sent to the hospital for emergency treatment.In this study,we investigate their ejection injuries and recovery process.CASE SUMMARY We analyzed the clinical data of the traumatic condition and recovery process from ejection injuries of two pilots who ejected from a failed trainer jet and survived.After being successfully rescued and sent to the hospital,they were diagnosed with multiple ejection injuries,including eye trauma,limb bone and joint injury,rib and spine injury,and so on.Both cases underwent fluid replacement,acid suppression,nutritional support,hemostasis,bone metabolism improvement,phlegm elimination,psychological measurement,blood circulation promotion and detumescence,physical therapy,and external fixation with braces for 1 mo before being discharged from hospital.They then recuperated in a sanatorium for 2 mo,and the related laboratory tests and supplementary examinations show that they recovered from all the above injuries.After successfully passing the psychological test and physical examination,they returned to flight duty 3 mo after ejection.CONCLUSION The causes and conditions of ejection injury in the pilots were very complex.Although they finally recovered quickly and were released,it also serves as a reminder that attention should be paid to pilots’ejection and parachute training in order to significantly reduce ejection injury and improve the ejection success rate.In addition,air defense support personnel should strengthen search and rescue and on-site emergency measures,and locate and rescue pilots in distress as early as possible to reduce subsequent injuries.展开更多
Objective:To explore the effects of allogeneic mouse adipose-derived mesenchymal stem cell(ADSC)-microporous sheep acellular dermal matrix(ADM)on wound healing of full-thickness skin defect in mice and the related mec...Objective:To explore the effects of allogeneic mouse adipose-derived mesenchymal stem cell(ADSC)-microporous sheep acellular dermal matrix(ADM)on wound healing of full-thickness skin defect in mice and the related mechanism.Methods:One Kunming mouse was sacrificed by cervical dislocation to collect adipose tissue from the inguinal region.Mouse ADSCs were isolated from the adipose tissue and cultured in vitro.Cells in the third passage were identified by cell adipogenic and osteogenic differentiation.The expressions of CD34,CD73,CD90,and CD105 were analyzed by flow cytometer.After one sheep was sacrificed with the skin of its back cut off,microporous sheep ADM was prepared by using acellular processing and freeze-thaw method.A round and full-thickness skin defect wound,with a diameter of 12 mm,was made on the back of each of 36 Kunming mice.The wounds were covered by microporous sheep ADM.The mice were divided into ADSC group and control group with 18 mice in each group according to the random number table method after surgery.A volume of 0.2 ml of DMEM/F12 culture medium containing 1×10^(6)ADSCs was injected between microporous sheep ADM and the wound of each mouse in ADSC group,while 0.2 ml of DMEM/F12 culture medium was injected between microporous sheep ADM and the wound of each mouse in control group.At post-surgery day(PSD)12 and 17,the wound healing rate in each group was calculated respectively;wound vascularization in 2 groups of mice was observed under the reverse irradiation of back light;and the granulation tissue in the wound in ADSC group was observed by means of hematoxylin-eosin staining.At PSD 7,the thickness of the granulation tissue in the wound was measured in each group of mice.At PSD 12 and 17,the immunohistochemical method was used to detect the expression of VEGF in each group of mice.The number of samples was 6 in each group at each time point in the above experiments.The data obtained were processed with t-test and factorial design ANOVA.Results:(1)After 7 days of adipogenic induction,red lipid droplets were observed in the cytoplasm with oil red O staining.After 21 days of osteogenic induction,black calcium deposition was observed in the medium stained with silver nitrate.The expression levels of CD73,CD90,CD 105 and CD34 in cells were 97.82%,99.32%,97.35%and 5.88%respectively.The cells were identified as ADSCs.(2)The wound healing rates of ADSC group at PSD 12 and 17[(78±6)%,(98±3)%]were significantly higher than those of control group at PSD 12 and 17[(60±9)%,(90±4)%,t=4.26,4.46,p<.01].(3)At PSD 7,no vessels obviously grew into the center of the wound in both groups of mice,while the granulation tissue already covered the wound in ADSC group.At PSD 12,the wound in ADSC group was more well-perfused than control group.At PSD 17,it was observed that large vessels were crossing through the whole wound in ADSC group,while large vessels were observed without crossing through the whole wound in control group.(4)In ADSC group,at PSD 7,the wound was covered with thin granulation tissue,and the granulation tissue was obviously thickened at PSD 12.At PSD 17,the granulation tissue was covered by epidermis.At PSD 7,the thickness of the granulation tissue in the wound in ADSC group[(0.62±0.05)mm]was significantly greater than that in control group[(0.31±0.04)mm,t=12.27,p<.01].(5)At PSD 12 and 17,the expression levels of VEGF in the wound in ADSC group[(80.7±2.2),(102.8±2.6)/mm^(2)]were significantly than those in control group[(59.5±2.4),(81.5±2.6)/mm^(2),t=15.95,14.14,p<.01].Conclusions:Allogeneic mouse ADSC-microporous sheep ADM can promote angiogenesis and the growth of granulation tissue in the wound with full-thickness skin defect in mice,thus accelerating wound healing.The mechanism is probably related with the increase in the expression of VEGF.展开更多
Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity s...Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.展开更多
OBJECTIVE:To investigate the protective effect and possible mechanism of sodium Danshensu(SDSS)against pressure injury caused by ischemia/reperfusion(I/R)injury.METHODS:Sprague-Dawley rats were randomly divided into f...OBJECTIVE:To investigate the protective effect and possible mechanism of sodium Danshensu(SDSS)against pressure injury caused by ischemia/reperfusion(I/R)injury.METHODS:Sprague-Dawley rats were randomly divided into five groups of eight rats each:control group,model group,10 mg/kg SDSS-treated group,20 mg/kg SDSS-treated group,and 40 mg/kg SDSS-treated group.We used two round ferrite magnetic plates of 15 mm diameter and 3 mm thickness to establish stage 2 pressure injury model rats.Each rat was subjected to five cycles of ischemia and reperfusion to induce pressure injury.One cycle consisted of 2 h of ischemia and 0.5 h of reperfusion,which meant that each cycle included2 h of pressure and 0.5 h of pressure relief.The outline of the wound was delineated by butter paper and marker pen,and histopathological changes were observed by hematoxylin and eosin staining.In addition,the number of apoptotic cells and the activity of caspase-3 were assessed by terminal deoxynucleotidyl transferase-mediated nick end labeling and caspase-3 assay kits,respectively.The expression of apoptosis-regulatory proteins and inflammatory mediators was investigated by enzyme-linked immunosorbent assay.RESULTS:Results showed that treatment with SDSS for 7 d after establishing the pressure injury model remarkably improved the healing rate of the wound.SDSS also inhibited the levels of tumor necrosis factor-α,myeloperoxidase,and intercellular cell adhesion molecule-1;decreased the number of apoptotic cells;increased the ratio of B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax);and regulated the expression and activity of caspase-3.CONCLUSION:Our results suggest that SDSS exhibits a treatment efficacy for pressure injury caused by I/R injury possibly by inhibiting apoptosis and inflammatory response.展开更多
Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care U...Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care Unit(ICU)for whom creatine kinase(CK)levels were available.Methods:For this retrospective observational study,we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili(FVL)University Hospital.Our primary outcome was the incidence of AKI.Multivariate regression analysis was used to assess risk factors for this outcome.Results:A total of 315 patients were included.The trauma mechanisms were blunt(n=130),penetrating(n=66)and blast(n=44)trauma.The median[interquartile range,(IQR)of injury severity score(ISS)was 21(16–29).AKI developed in 75 patients(23.8%).Multivariate regression analysis revealed that the thoracic abbreviated injury scale(AIS)value(median(IQR)in the AKI group:3(0–4)],Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score[median(IQR)in the AKI group:18(10–27)],CK greater than 5000 U/L,lactic acid concentration at admission,and dobutamine administration were independently associated with AKI.Conclusions:We found that age,APACHE Ⅱ score,thoracic trauma,lactic acidosis,and dobutamine administration were independently associated with AKI.Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.展开更多
Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate th...Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate the relationship between mechanism of injury,patient comorbidities and severity of injuries.Methods:The study included trauma patients from July 2016 to June 2018,who were admitted to Sina Hospital,Tehran,Iran.The inclusion criteria were all injured patients who had at least one of the following:hospital length of stay more than 24 h,death in hospital,and transfer from the intensive care unit of another hospital.Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries(49.0%),followed by falls(25.5%).The mean age of those who fell was significantly higher in comparison with other mechanisms(p<0.001).Severe extremity injuries occurred more often in the fall group than in the vehicle collision group(69.0%vs.43.5%,p<0.001).Moreover,cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls(27.8%vs.12.9%,p=0.003).Conclusion:Comparing falls with motor vehicle collisions,patients who fell were older and sustained more extremity injuries.Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls.Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.展开更多
Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns du...Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. Methods: This retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0—G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal—Wallis one-way analysis of variance were used for statistical analysis. Results: A total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%,n= 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (-1.04 ± 1.15) and Z-score (-0.84 ± 0.75) compared to healthy subjects were found. Conclusion: Fractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.展开更多
Objective: To analyze and compare the effectiveness of two methods designed for the assessment of esthetic impairment in patients with missing teeth. Material and Methods: Two methods were addressed in this study: 7-l...Objective: To analyze and compare the effectiveness of two methods designed for the assessment of esthetic impairment in patients with missing teeth. Material and Methods: Two methods were addressed in this study: 7-level scale (7LS) and AIPE-Odonto/Brasil. Both tools are designed to assess esthetic dental impairment in civil and criminal Courts. One-hundred and thirteen dentists used the tools to assess dental esthetic impairment in four mock cases (one male and three females). The outcomes of their analyses were compared with pre-established gold-standard scores. Chi-square test was used to investigate the influence of dentists’ sex, age, time of experience and forensic knowledge with their outcomes. Results: Dentists’ outcomes were closer to the expected gold-standard scores when AIPE-Odonto/Brasil was used compared to 7LS (p < 0.05). Dentists’ sex, time of experience and forensic knowledge were significantly associated with the scores obtained with both tools (p < 0.05). Conclusions: Comparatively, AIPE-Odonto/Brasil was more effective for the assessment of esthetic dental impairment involving missing teeth compared to the 7LS.展开更多
METHODS:In the present study,female SpragueDawley rats were randomly divided into four groups with 6 of each,including normal control group(NC),jumpinginduced muscle injury model group(JI),JI with electroacupuncture s...METHODS:In the present study,female SpragueDawley rats were randomly divided into four groups with 6 of each,including normal control group(NC),jumpinginduced muscle injury model group(JI),JI with electroacupuncture stimulation treatment group(EA),and JI with non-electroacupuncture stimulation group(NEA).Transmission electron microscopy,transcriptome sequencing and analysis,prediction of protein interaction networks,real-time polymerase chain reaction verification,and Western blotting were performed on the gastrocnemius muscle of ipsilateral lower limbs.RESULTS:The structural repair of injured gastrocnemius myofibers following jumping training in EA rats was better than that of NEA rats.A total of 136 genes were differentially expressed in EA rats relative to JI rats,with 55 genes upregulated and 81 genes downregulated.According to results of transcriptome analysis,and prediction of protein mutual interaction by the online STRING database,Heat shock protein beta-7(Hspb7)and myozenin2(Myoz2)genes were targeted.Expressions of Hspb7 and Myoz2 mRNAs were increased in EA rats relative to JI rats(P<0.05).The expression of Hspb7 protein was upregulated in EA rats relative to that in NC,JI,and NEA rats(P<0.01,<0.05,and<0.05,respectively).The expression of Myoz2 protein was upregulated in EA rats relative to that in NC and JI rats(both P<0.01,respectively).CONCLUSIONS:The present results suggest that electroacupuncture stimulation at Zusanli(ST36)could improve muscle healing following jumping-induced muscle injury,owing to the upregulation of Hspb7 and Myoz2 proteins.展开更多
Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for tr...Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres.This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country,intending to identify potential discrepancies in the outcome.Methods:This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand.All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included.Repeat laparotomies and trauma laparotomies in children were excluded.The primary clinical outcomes reviewed included morbidity,length of hospital stay,and mortality.All statistical analysis was performed using R v.4.0.3.Results:During the 9-year study period,204 trauma laparotomies were performed at Waikato hospital.The majority(83.3%)were performed during office hours(170/204),and the remaining 16.7%were performed after hours(34/204).And 61.3%were performed on a weekday(125/204),whilst 38.7%were performed on the weekend/public holiday(79/204).Most of the parameters in office hours and after hours groups had no statistically significant difference,except lactate(p=0.026).Most of the variables in weekday and weekend groups had no statistically significant difference,except pH,lactate,length of stay,and gastrointestinal complications(p=0.012,p<0.001,p=0.003,p=0.020,respectively).Conclusion:The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours,weekday or weekend.This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.展开更多
Purpose:To prepare for future possible communicable disease epidemics/pandemics,health care providers should know how the COVID-19 pandemic influenced injured patients.This study aimed to compare epidemiologic feature...Purpose:To prepare for future possible communicable disease epidemics/pandemics,health care providers should know how the COVID-19 pandemic influenced injured patients.This study aimed to compare epidemiologic features,outcomes,and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.Methods:This retrospective study was performed on data from the National Trauma Registry of Iran.All injured patients admitted to the hospital from July 25,2016 to March 10,2021 were included in the study.The patients were excluded if they had hospital length of stay less than 24 h.The injury outcomes,trauma mechanisms,and therapeutic and diagnostic procedures of the 2 periods:before(from July 25,2016 to February 18,2020)and during(from February 19,2020 to March 10,2021)COVID-19 pandemic were compared.All analyses were performed using STATA version 14.0 software(Stata Corporation,College Station,TX).Results:Totally,5014 patients were included in the registry.Of them,773(15.4%)were registered after the beginning of the COVID-19 pandemic on February 19,2020,while 4241 were registered before that.Gender,education level,and cause of injury were significantly different among the patients before and after the beginning of the pandemic(p<0.001).In the≤15 years and≥65 years age groups,injuries decreased significantly during the COVID-19 pandemic(p<0.001).The frequency of intensive care unit(ICU)admission decreased from 694(16.4%)to 88(11.4%)(p<0.001).The mean length of stay at the hospital(days)and at the ICU(days)declined as follow:8.3(SD=17.2)vs.5.5(SD=6.1),p<0.001 and 7.5(SD=11.5)vs.4.5(SD=6.3),p<0.022.The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows,respectively:ultrasonography 905(21.3%)vs.417(53.9%)(p<0.001),echocardiography 313(7.4%)vs.107(13.8%)(p<0.001),angiography 1597(37.7%)vs.534(69.1%)(p<0.001),MRI 166(3.9%)vs.51(6.6%)(p<0.001),surgery 3407(80.3%)vs.654(84.6%)(p<0.001),and internal/external fixation 1215(28.6%)vs.336(43.5%)(p<0.001).Conclusion:The pandemic affected the epidemiology of traumatic patients in terms of gender,age,educational level,and trauma mechanism.It changed the outcomes of injured patients:ICU admission,length of stay at the hospital and ICU decreased.The patients received more diagnostic and therapeutic procedures during the pandemic.To be more precise,more research is needed on the details.展开更多
Objective:To explore the therapeutic mechanism of microporous sheep acellular dermal matrix(ADM)combined with human umbilical cord mesenchymal stem cell(hUCMSC)to promote the healing of full-thickness skin defect.Meth...Objective:To explore the therapeutic mechanism of microporous sheep acellular dermal matrix(ADM)combined with human umbilical cord mesenchymal stem cell(hUCMSC)to promote the healing of full-thickness skin defect.Methods:hUCMSC was co-cultured on microporous sheep ADM to form composite biological dressings.Seventy-two nude mice were selected to make full-thickness skin injury models and randomly divided into 3 groups(hUCMSC+microporous sheep ADM group,sheep ADM group and iodophor gauze group),with 24 mice in each group.The wound healing rate of each group was detected at 14 d,21 d and 28 d after operation,qRT-PCR technique was used to detect the expression of Bax and Bcl-2 in the wound tissues,and the immunohistochemical staining technique was used to detect the expression of Collagen I and vascular endothelial growth factor(VEGF).Data were analyzed with one-way ANOVA and t test.Results:At 14 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(65.34±14.72)%,which was significantly higher than that of the iodophor gauze group[(37.54±10.21)%],and higher than that of the sheep ADM group[(49.08±11.16)%],the differences were statistically significant(t=19.52,14.72;p<.05).With the gradual healing of the wound,at 28 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(98.63±15.41)%,which was significantly higher than that of the iodophor gauze group[(81.74±16.27)%],and higher than that of the sheep ADM group[(63.47±14.80)%],the differences were statistically significant(t=-16.42,20.35;p<.05).The expression of Bax in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly reduced,especially at 21 d after operation,the expression level was 0.25±0.06,which was significantly lower than the iodophor gauze group(0.53±0.16)and the sheep ADM group(0.41±0.12),the differences were statistically significant(t=3.52,-2.83;p<.05).The expression of Bcl-2 in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly higher than those of the other two groups,especially at 21 d after operation,the expression level was 0.63±0.19,which was significantly higher than the iodophor gauze group(0.34±0.09)and the sheep ADM group(0.46±0.13),the differences were statistically significant(t=5.31,-6.07;p<.05).Immunohistochemical detection showed that the expression of Collagen I and VEGF in the hUCMSC+microporous sheep ADM group was slightly more than that of the sheep ADM group and the iodophor gauze group,but the effect was not remarkable.Conclusions:hUCMSC+microporous sheep ADM composite dressing can promote the healing of the full-thickness skin injury and reduce the production of apoptotic cells by carrying hUCMSC.展开更多
Introduction: Children safety car devices decrease injuries and death in children. A survey conducted in Brazil in 2009 revealed that only 36.1% of children safely transported. In 2010, a Brazilian law was implemented...Introduction: Children safety car devices decrease injuries and death in children. A survey conducted in Brazil in 2009 revealed that only 36.1% of children safely transported. In 2010, a Brazilian law was implemented, obligating the use of safety devices. The aim of this study is to evaluate the use of such devices after the law and the eventual reasons for non-use. Methods: A significant sample of Brazilian population aged 18 years or more, which normally carry children until 10 years old answered a survey between August 16 and 25, 2012. The study was conducted in two phases. The first one aimed to raise the proportion and profile of the target population, while the second investigated the children car safety device use (or not). Results: 622 interviews. Children’s transporters are young males (57%), living in a metropolitan area in the South region, concerned about safety and law supervision, with greater education level and income than non-transporters (31%) who are male with lack of information, living in a non-metropolitan area of the Northeast region that would be motivated to use the device by effective law fiscalization or threat of an accident. Conclusion: Two years after the law it is observed that education, income, age, gender and region of origin influence the use/non-use of the safety seats in Brazil. The accident threat and fiscalization are the main reasons for using the device, showing that the lack of information impairs the democratization of its use and the prevention culture has to be enhanced in the country.展开更多
Chronic wound healing has long been an unmet medical need in the field of wound repair,with diabetes being one of the major etiologies.Diabetic chronic wounds(DCWs),especially diabetic foot ulcers,are one of the most ...Chronic wound healing has long been an unmet medical need in the field of wound repair,with diabetes being one of the major etiologies.Diabetic chronic wounds(DCWs),especially diabetic foot ulcers,are one of the most threatening chronic complications of diabetes.Although the treatment strategies,drugs,and dressings for DCWs have made great progress,they remain ineffective in some patients with refractory wounds.Stem cell-based therapies have achieved specific efficacy in various fields,with mesenchymal stem cells(MSCs)being the most widely used.Although MSCs have achieved good feedback in preclinical studies and clinical trials in the treatment of cutaneous wounds or other situations,the potential safety concerns associated with allogeneic/autologous stem cells and unknown long-term health effects need further attention and supervision.Recent studies have reported that stem cells mainly exert their trauma repair effects through paracrine secretion,and exosomes play an important role in intercellular communication as their main bioactive component.MSC-derived exosomes(MSC-Exos)inherit the powerful inflammation and immune modulation,angiogenesis,cell proliferation and migration promotion,oxidative stress alleviation,collagen remodeling imbalances regulation of their parental cells,and can avoid the potential risks of direct stem cell transplantation to a large extent,thus demonstrating promising performance as novel"cell-free"therapies in chronic wounds.This review aimed to elucidate the potential mechanism and update the progress of MSC-Exos in DCW healing,thereby providing new therapeutic directions for DCWs that are difficult to be cured using conventional therapy.展开更多
To discuss the normal mechanism of wound healing (WH), the role of growth factors (GF) in prec-linical and clinical studies and its importance in the healing of abnormal wound therapy. For search, we used the PUBMED a...To discuss the normal mechanism of wound healing (WH), the role of growth factors (GF) in prec-linical and clinical studies and its importance in the healing of abnormal wound therapy. For search, we used the PUBMED and LILACS database, and the following descriptors: skin, wound healing, growth factor and clinical trials. We also prioritized the analysis of the Clinical Trials in the previous 10 years. Although there are many studies being conducted in the pre-clinical phase, we see that there are few studies in the clinical phase. 274 studies were identified, and 58 were selected. After tissue injury, repair occurs through coordinated biological actions that are healing. The importance of the study of healing in the skin is not only because of its anatomical location, easy access and exposure, but also because of its vital function. There is accumulating evidence that the process of healing after injury may be mediated by several GF. However, may this class of molecules even act effectively on the clinical response of this pathological condition? Many preclinical studies (in vitro and in vivo) reinforce the importance and efficacy of GF in the regeneration of damaged skin. Furthermore, recent studies have reported the use in adjuvant or not, of GF in clinical treatment to improve WH in humans. Therefore, we conclude that it seems to be effective by the use of GF in adjuvant or not in WH. However, it still seems to be necessary to carry out more clinical trials in phase I and II.展开更多
Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumat...Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults.The functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done.We only included complete TTA injuries.Children below 15 years,open injuries,associated fractures,and partial TTA were excluded.The data were obtained from hospital records.The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA.The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score.ANOVA test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 females.The mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)months.Fall on outstretched hand was the mode of injury.In 6 patients,diagnosis was missed on the initial visit.TTA were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular surface.An algorithm for treatment was recommended,i.e.transosseous suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and 4.All the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is simple.Surgical treatment results in excellent functions of the elbow.Since it is a single-center study involving a very small number of cases,a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.展开更多
Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of l...Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution ( LR), 7.5% sodium chloride solution ( HS ) and 20% albumin injection ( ALB ) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).Methods: Seventy-two severe trauma patients (ISS score 16-43) were divided into ISS≤25 and ISS＞25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.Results: Compared with LR group, the transfusion volume needed for maintaining systolic blood pressure ≥ 90 mm Hg was significantly decreased in HS and ALB groups (P＜0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P ＜ 0.05 -0.01 ). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P ＜ 0. 01).Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P ＜ 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS ＞25 than that of ISS ≤ 25 (P ＜ 0.05 ). MODS incidence and mortality were significantly higher in the group of ISS ＞ 25 than that of ISS ≤ 25 ( P ＜ 0.05 ). MODS incidence and mortality were lower in HS and ALB groups than LR group (P＜0.05).Conclusions: The up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.展开更多
基金funded by the Coordination for the Improvement of Higher Level(CAPES)scholarship
文摘Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.Methods: This observational(cross-sectional) study recruited a sample of 103 soldiers who required medical attention,from a total 202 new battalion soldiers. The medical records(paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury,and recurring injury.Results: A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.Conclusions: This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.
文摘The percentage of diabetic patients with contaminated lesions increases from 3% to 10%. Treatment with herbal products shows benefits in their use, as well as antioxidant and antifungal activities. Objective: to evaluate the antimicrobial action of 10% banana peel gel and the contraction of diabetic and venous wounds. Methods: individual, analytical, interventional, longitudinal, prospective, randomized study from February to December 2015. Five patients were included in the study;3 with venous ulcer and 2 with diabetic wound. Application of 10% green banana peel gel and weekly samples were performed. After six days, the second collection was performed. The samples were seeded in the Mannitol salt agar culture medium, MacConkey agar and Saboraund agar with chloramphenicol for isolation of cocci and Gram-positive and Gram-negative bacilli;and fungi. The total counts of bacteria were determined by PCA (Plate Count Agar) and measurement of the lesion margin. There was a reduction of microorganisms with the use of the gel in 53.57% of the patients, and reduction of wound areas in 48.1%.
文摘BACKGROUND In trauma patients,bleeding is an immediate major concern.At 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 cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE 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 ago.He had no medical history.Radiological 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 spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.
基金Supported by Key Projects of Medical Service Scientific Research of the Navy Medical Center,No.20M2302.
文摘BACKGROUND Recently,two naval pilots in a two-seat trainer jet were forced to eject urgently due to sudden mechanical failure during night-time training.They were both successfully rescued and sent to the hospital for emergency treatment.In this study,we investigate their ejection injuries and recovery process.CASE SUMMARY We analyzed the clinical data of the traumatic condition and recovery process from ejection injuries of two pilots who ejected from a failed trainer jet and survived.After being successfully rescued and sent to the hospital,they were diagnosed with multiple ejection injuries,including eye trauma,limb bone and joint injury,rib and spine injury,and so on.Both cases underwent fluid replacement,acid suppression,nutritional support,hemostasis,bone metabolism improvement,phlegm elimination,psychological measurement,blood circulation promotion and detumescence,physical therapy,and external fixation with braces for 1 mo before being discharged from hospital.They then recuperated in a sanatorium for 2 mo,and the related laboratory tests and supplementary examinations show that they recovered from all the above injuries.After successfully passing the psychological test and physical examination,they returned to flight duty 3 mo after ejection.CONCLUSION The causes and conditions of ejection injury in the pilots were very complex.Although they finally recovered quickly and were released,it also serves as a reminder that attention should be paid to pilots’ejection and parachute training in order to significantly reduce ejection injury and improve the ejection success rate.In addition,air defense support personnel should strengthen search and rescue and on-site emergency measures,and locate and rescue pilots in distress as early as possible to reduce subsequent injuries.
文摘Objective:To explore the effects of allogeneic mouse adipose-derived mesenchymal stem cell(ADSC)-microporous sheep acellular dermal matrix(ADM)on wound healing of full-thickness skin defect in mice and the related mechanism.Methods:One Kunming mouse was sacrificed by cervical dislocation to collect adipose tissue from the inguinal region.Mouse ADSCs were isolated from the adipose tissue and cultured in vitro.Cells in the third passage were identified by cell adipogenic and osteogenic differentiation.The expressions of CD34,CD73,CD90,and CD105 were analyzed by flow cytometer.After one sheep was sacrificed with the skin of its back cut off,microporous sheep ADM was prepared by using acellular processing and freeze-thaw method.A round and full-thickness skin defect wound,with a diameter of 12 mm,was made on the back of each of 36 Kunming mice.The wounds were covered by microporous sheep ADM.The mice were divided into ADSC group and control group with 18 mice in each group according to the random number table method after surgery.A volume of 0.2 ml of DMEM/F12 culture medium containing 1×10^(6)ADSCs was injected between microporous sheep ADM and the wound of each mouse in ADSC group,while 0.2 ml of DMEM/F12 culture medium was injected between microporous sheep ADM and the wound of each mouse in control group.At post-surgery day(PSD)12 and 17,the wound healing rate in each group was calculated respectively;wound vascularization in 2 groups of mice was observed under the reverse irradiation of back light;and the granulation tissue in the wound in ADSC group was observed by means of hematoxylin-eosin staining.At PSD 7,the thickness of the granulation tissue in the wound was measured in each group of mice.At PSD 12 and 17,the immunohistochemical method was used to detect the expression of VEGF in each group of mice.The number of samples was 6 in each group at each time point in the above experiments.The data obtained were processed with t-test and factorial design ANOVA.Results:(1)After 7 days of adipogenic induction,red lipid droplets were observed in the cytoplasm with oil red O staining.After 21 days of osteogenic induction,black calcium deposition was observed in the medium stained with silver nitrate.The expression levels of CD73,CD90,CD 105 and CD34 in cells were 97.82%,99.32%,97.35%and 5.88%respectively.The cells were identified as ADSCs.(2)The wound healing rates of ADSC group at PSD 12 and 17[(78±6)%,(98±3)%]were significantly higher than those of control group at PSD 12 and 17[(60±9)%,(90±4)%,t=4.26,4.46,p<.01].(3)At PSD 7,no vessels obviously grew into the center of the wound in both groups of mice,while the granulation tissue already covered the wound in ADSC group.At PSD 12,the wound in ADSC group was more well-perfused than control group.At PSD 17,it was observed that large vessels were crossing through the whole wound in ADSC group,while large vessels were observed without crossing through the whole wound in control group.(4)In ADSC group,at PSD 7,the wound was covered with thin granulation tissue,and the granulation tissue was obviously thickened at PSD 12.At PSD 17,the granulation tissue was covered by epidermis.At PSD 7,the thickness of the granulation tissue in the wound in ADSC group[(0.62±0.05)mm]was significantly greater than that in control group[(0.31±0.04)mm,t=12.27,p<.01].(5)At PSD 12 and 17,the expression levels of VEGF in the wound in ADSC group[(80.7±2.2),(102.8±2.6)/mm^(2)]were significantly than those in control group[(59.5±2.4),(81.5±2.6)/mm^(2),t=15.95,14.14,p<.01].Conclusions:Allogeneic mouse ADSC-microporous sheep ADM can promote angiogenesis and the growth of granulation tissue in the wound with full-thickness skin defect in mice,thus accelerating wound healing.The mechanism is probably related with the increase in the expression of VEGF.
文摘Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.
基金Supported by the Health Commission of Zhejiang Province(Exploring the Mechanism of Danshensu Anti-apoptosis Effect in Rat Models of Stage 2 Pressure Injury Based on PI3K/AKT Pathway,No.2019KY470)。
文摘OBJECTIVE:To investigate the protective effect and possible mechanism of sodium Danshensu(SDSS)against pressure injury caused by ischemia/reperfusion(I/R)injury.METHODS:Sprague-Dawley rats were randomly divided into five groups of eight rats each:control group,model group,10 mg/kg SDSS-treated group,20 mg/kg SDSS-treated group,and 40 mg/kg SDSS-treated group.We used two round ferrite magnetic plates of 15 mm diameter and 3 mm thickness to establish stage 2 pressure injury model rats.Each rat was subjected to five cycles of ischemia and reperfusion to induce pressure injury.One cycle consisted of 2 h of ischemia and 0.5 h of reperfusion,which meant that each cycle included2 h of pressure and 0.5 h of pressure relief.The outline of the wound was delineated by butter paper and marker pen,and histopathological changes were observed by hematoxylin and eosin staining.In addition,the number of apoptotic cells and the activity of caspase-3 were assessed by terminal deoxynucleotidyl transferase-mediated nick end labeling and caspase-3 assay kits,respectively.The expression of apoptosis-regulatory proteins and inflammatory mediators was investigated by enzyme-linked immunosorbent assay.RESULTS:Results showed that treatment with SDSS for 7 d after establishing the pressure injury model remarkably improved the healing rate of the wound.SDSS also inhibited the levels of tumor necrosis factor-α,myeloperoxidase,and intercellular cell adhesion molecule-1;decreased the number of apoptotic cells;increased the ratio of B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax);and regulated the expression and activity of caspase-3.CONCLUSION:Our results suggest that SDSS exhibits a treatment efficacy for pressure injury caused by I/R injury possibly by inhibiting apoptosis and inflammatory response.
基金supported in part by the National Institutes of Health John E.Fogarty International Center grant#D43 TW007560。
文摘Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care Unit(ICU)for whom creatine kinase(CK)levels were available.Methods:For this retrospective observational study,we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili(FVL)University Hospital.Our primary outcome was the incidence of AKI.Multivariate regression analysis was used to assess risk factors for this outcome.Results:A total of 315 patients were included.The trauma mechanisms were blunt(n=130),penetrating(n=66)and blast(n=44)trauma.The median[interquartile range,(IQR)of injury severity score(ISS)was 21(16–29).AKI developed in 75 patients(23.8%).Multivariate regression analysis revealed that the thoracic abbreviated injury scale(AIS)value(median(IQR)in the AKI group:3(0–4)],Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score[median(IQR)in the AKI group:18(10–27)],CK greater than 5000 U/L,lactic acid concentration at admission,and dobutamine administration were independently associated with AKI.Conclusions:We found that age,APACHE Ⅱ score,thoracic trauma,lactic acidosis,and dobutamine administration were independently associated with AKI.Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.
基金This study was funded by Sina Trauma and Surgery Research Center under the project of National Trauma Registry of Iran(NTRI).The contract number was 97-03-38-40539.
文摘Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate the relationship between mechanism of injury,patient comorbidities and severity of injuries.Methods:The study included trauma patients from July 2016 to June 2018,who were admitted to Sina Hospital,Tehran,Iran.The inclusion criteria were all injured patients who had at least one of the following:hospital length of stay more than 24 h,death in hospital,and transfer from the intensive care unit of another hospital.Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries(49.0%),followed by falls(25.5%).The mean age of those who fell was significantly higher in comparison with other mechanisms(p<0.001).Severe extremity injuries occurred more often in the fall group than in the vehicle collision group(69.0%vs.43.5%,p<0.001).Moreover,cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls(27.8%vs.12.9%,p=0.003).Conclusion:Comparing falls with motor vehicle collisions,patients who fell were older and sustained more extremity injuries.Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls.Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
文摘Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. Methods: This retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0—G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal—Wallis one-way analysis of variance were used for statistical analysis. Results: A total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%,n= 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (-1.04 ± 1.15) and Z-score (-0.84 ± 0.75) compared to healthy subjects were found. Conclusion: Fractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.
文摘Objective: To analyze and compare the effectiveness of two methods designed for the assessment of esthetic impairment in patients with missing teeth. Material and Methods: Two methods were addressed in this study: 7-level scale (7LS) and AIPE-Odonto/Brasil. Both tools are designed to assess esthetic dental impairment in civil and criminal Courts. One-hundred and thirteen dentists used the tools to assess dental esthetic impairment in four mock cases (one male and three females). The outcomes of their analyses were compared with pre-established gold-standard scores. Chi-square test was used to investigate the influence of dentists’ sex, age, time of experience and forensic knowledge with their outcomes. Results: Dentists’ outcomes were closer to the expected gold-standard scores when AIPE-Odonto/Brasil was used compared to 7LS (p < 0.05). Dentists’ sex, time of experience and forensic knowledge were significantly associated with the scores obtained with both tools (p < 0.05). Conclusions: Comparatively, AIPE-Odonto/Brasil was more effective for the assessment of esthetic dental impairment involving missing teeth compared to the 7LS.
基金Supported by Science and Technology Department of Henan Province Effect Mechanisms of Acupuncture to Promote the Repair of Injured Skeletal Muscle(No.212102310260)Study on the Relationship between Hspb7 Protein and JAK/STAT Pathway and Electroacupuncture Intervention in Muscle Injury based on mRNA-Seq Analysis(No.222102320072)Science and Technology Bureau o Kaifeng:the Effect of Platelet Plasma Injection on Patellar Tendon Fibrosis(No.2003006)。
文摘METHODS:In the present study,female SpragueDawley rats were randomly divided into four groups with 6 of each,including normal control group(NC),jumpinginduced muscle injury model group(JI),JI with electroacupuncture stimulation treatment group(EA),and JI with non-electroacupuncture stimulation group(NEA).Transmission electron microscopy,transcriptome sequencing and analysis,prediction of protein interaction networks,real-time polymerase chain reaction verification,and Western blotting were performed on the gastrocnemius muscle of ipsilateral lower limbs.RESULTS:The structural repair of injured gastrocnemius myofibers following jumping training in EA rats was better than that of NEA rats.A total of 136 genes were differentially expressed in EA rats relative to JI rats,with 55 genes upregulated and 81 genes downregulated.According to results of transcriptome analysis,and prediction of protein mutual interaction by the online STRING database,Heat shock protein beta-7(Hspb7)and myozenin2(Myoz2)genes were targeted.Expressions of Hspb7 and Myoz2 mRNAs were increased in EA rats relative to JI rats(P<0.05).The expression of Hspb7 protein was upregulated in EA rats relative to that in NC,JI,and NEA rats(P<0.01,<0.05,and<0.05,respectively).The expression of Myoz2 protein was upregulated in EA rats relative to that in NC and JI rats(both P<0.01,respectively).CONCLUSIONS:The present results suggest that electroacupuncture stimulation at Zusanli(ST36)could improve muscle healing following jumping-induced muscle injury,owing to the upregulation of Hspb7 and Myoz2 proteins.
文摘Purpose:Trauma centres have been proven to provide better outcomes in developed countries for overall trauma,but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres.This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country,intending to identify potential discrepancies in the outcome.Methods:This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand.All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included.Repeat laparotomies and trauma laparotomies in children were excluded.The primary clinical outcomes reviewed included morbidity,length of hospital stay,and mortality.All statistical analysis was performed using R v.4.0.3.Results:During the 9-year study period,204 trauma laparotomies were performed at Waikato hospital.The majority(83.3%)were performed during office hours(170/204),and the remaining 16.7%were performed after hours(34/204).And 61.3%were performed on a weekday(125/204),whilst 38.7%were performed on the weekend/public holiday(79/204).Most of the parameters in office hours and after hours groups had no statistically significant difference,except lactate(p=0.026).Most of the variables in weekday and weekend groups had no statistically significant difference,except pH,lactate,length of stay,and gastrointestinal complications(p=0.012,p<0.001,p=0.003,p=0.020,respectively).Conclusion:The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours,weekday or weekend.This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.
基金Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences(grant number:50495)。
文摘Purpose:To prepare for future possible communicable disease epidemics/pandemics,health care providers should know how the COVID-19 pandemic influenced injured patients.This study aimed to compare epidemiologic features,outcomes,and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.Methods:This retrospective study was performed on data from the National Trauma Registry of Iran.All injured patients admitted to the hospital from July 25,2016 to March 10,2021 were included in the study.The patients were excluded if they had hospital length of stay less than 24 h.The injury outcomes,trauma mechanisms,and therapeutic and diagnostic procedures of the 2 periods:before(from July 25,2016 to February 18,2020)and during(from February 19,2020 to March 10,2021)COVID-19 pandemic were compared.All analyses were performed using STATA version 14.0 software(Stata Corporation,College Station,TX).Results:Totally,5014 patients were included in the registry.Of them,773(15.4%)were registered after the beginning of the COVID-19 pandemic on February 19,2020,while 4241 were registered before that.Gender,education level,and cause of injury were significantly different among the patients before and after the beginning of the pandemic(p<0.001).In the≤15 years and≥65 years age groups,injuries decreased significantly during the COVID-19 pandemic(p<0.001).The frequency of intensive care unit(ICU)admission decreased from 694(16.4%)to 88(11.4%)(p<0.001).The mean length of stay at the hospital(days)and at the ICU(days)declined as follow:8.3(SD=17.2)vs.5.5(SD=6.1),p<0.001 and 7.5(SD=11.5)vs.4.5(SD=6.3),p<0.022.The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows,respectively:ultrasonography 905(21.3%)vs.417(53.9%)(p<0.001),echocardiography 313(7.4%)vs.107(13.8%)(p<0.001),angiography 1597(37.7%)vs.534(69.1%)(p<0.001),MRI 166(3.9%)vs.51(6.6%)(p<0.001),surgery 3407(80.3%)vs.654(84.6%)(p<0.001),and internal/external fixation 1215(28.6%)vs.336(43.5%)(p<0.001).Conclusion:The pandemic affected the epidemiology of traumatic patients in terms of gender,age,educational level,and trauma mechanism.It changed the outcomes of injured patients:ICU admission,length of stay at the hospital and ICU decreased.The patients received more diagnostic and therapeutic procedures during the pandemic.To be more precise,more research is needed on the details.
文摘Objective:To explore the therapeutic mechanism of microporous sheep acellular dermal matrix(ADM)combined with human umbilical cord mesenchymal stem cell(hUCMSC)to promote the healing of full-thickness skin defect.Methods:hUCMSC was co-cultured on microporous sheep ADM to form composite biological dressings.Seventy-two nude mice were selected to make full-thickness skin injury models and randomly divided into 3 groups(hUCMSC+microporous sheep ADM group,sheep ADM group and iodophor gauze group),with 24 mice in each group.The wound healing rate of each group was detected at 14 d,21 d and 28 d after operation,qRT-PCR technique was used to detect the expression of Bax and Bcl-2 in the wound tissues,and the immunohistochemical staining technique was used to detect the expression of Collagen I and vascular endothelial growth factor(VEGF).Data were analyzed with one-way ANOVA and t test.Results:At 14 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(65.34±14.72)%,which was significantly higher than that of the iodophor gauze group[(37.54±10.21)%],and higher than that of the sheep ADM group[(49.08±11.16)%],the differences were statistically significant(t=19.52,14.72;p<.05).With the gradual healing of the wound,at 28 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(98.63±15.41)%,which was significantly higher than that of the iodophor gauze group[(81.74±16.27)%],and higher than that of the sheep ADM group[(63.47±14.80)%],the differences were statistically significant(t=-16.42,20.35;p<.05).The expression of Bax in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly reduced,especially at 21 d after operation,the expression level was 0.25±0.06,which was significantly lower than the iodophor gauze group(0.53±0.16)and the sheep ADM group(0.41±0.12),the differences were statistically significant(t=3.52,-2.83;p<.05).The expression of Bcl-2 in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly higher than those of the other two groups,especially at 21 d after operation,the expression level was 0.63±0.19,which was significantly higher than the iodophor gauze group(0.34±0.09)and the sheep ADM group(0.46±0.13),the differences were statistically significant(t=5.31,-6.07;p<.05).Immunohistochemical detection showed that the expression of Collagen I and VEGF in the hUCMSC+microporous sheep ADM group was slightly more than that of the sheep ADM group and the iodophor gauze group,but the effect was not remarkable.Conclusions:hUCMSC+microporous sheep ADM composite dressing can promote the healing of the full-thickness skin injury and reduce the production of apoptotic cells by carrying hUCMSC.
文摘Introduction: Children safety car devices decrease injuries and death in children. A survey conducted in Brazil in 2009 revealed that only 36.1% of children safely transported. In 2010, a Brazilian law was implemented, obligating the use of safety devices. The aim of this study is to evaluate the use of such devices after the law and the eventual reasons for non-use. Methods: A significant sample of Brazilian population aged 18 years or more, which normally carry children until 10 years old answered a survey between August 16 and 25, 2012. The study was conducted in two phases. The first one aimed to raise the proportion and profile of the target population, while the second investigated the children car safety device use (or not). Results: 622 interviews. Children’s transporters are young males (57%), living in a metropolitan area in the South region, concerned about safety and law supervision, with greater education level and income than non-transporters (31%) who are male with lack of information, living in a non-metropolitan area of the Northeast region that would be motivated to use the device by effective law fiscalization or threat of an accident. Conclusion: Two years after the law it is observed that education, income, age, gender and region of origin influence the use/non-use of the safety seats in Brazil. The accident threat and fiscalization are the main reasons for using the device, showing that the lack of information impairs the democratization of its use and the prevention culture has to be enhanced in the country.
基金Supported by the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYGD18025.
文摘Chronic wound healing has long been an unmet medical need in the field of wound repair,with diabetes being one of the major etiologies.Diabetic chronic wounds(DCWs),especially diabetic foot ulcers,are one of the most threatening chronic complications of diabetes.Although the treatment strategies,drugs,and dressings for DCWs have made great progress,they remain ineffective in some patients with refractory wounds.Stem cell-based therapies have achieved specific efficacy in various fields,with mesenchymal stem cells(MSCs)being the most widely used.Although MSCs have achieved good feedback in preclinical studies and clinical trials in the treatment of cutaneous wounds or other situations,the potential safety concerns associated with allogeneic/autologous stem cells and unknown long-term health effects need further attention and supervision.Recent studies have reported that stem cells mainly exert their trauma repair effects through paracrine secretion,and exosomes play an important role in intercellular communication as their main bioactive component.MSC-derived exosomes(MSC-Exos)inherit the powerful inflammation and immune modulation,angiogenesis,cell proliferation and migration promotion,oxidative stress alleviation,collagen remodeling imbalances regulation of their parental cells,and can avoid the potential risks of direct stem cell transplantation to a large extent,thus demonstrating promising performance as novel"cell-free"therapies in chronic wounds.This review aimed to elucidate the potential mechanism and update the progress of MSC-Exos in DCW healing,thereby providing new therapeutic directions for DCWs that are difficult to be cured using conventional therapy.
基金Sao Paulo Research Foundation (FAPESP) Coordination of Superior Level Staff Improvement (CAPES)
文摘To discuss the normal mechanism of wound healing (WH), the role of growth factors (GF) in prec-linical and clinical studies and its importance in the healing of abnormal wound therapy. For search, we used the PUBMED and LILACS database, and the following descriptors: skin, wound healing, growth factor and clinical trials. We also prioritized the analysis of the Clinical Trials in the previous 10 years. Although there are many studies being conducted in the pre-clinical phase, we see that there are few studies in the clinical phase. 274 studies were identified, and 58 were selected. After tissue injury, repair occurs through coordinated biological actions that are healing. The importance of the study of healing in the skin is not only because of its anatomical location, easy access and exposure, but also because of its vital function. There is accumulating evidence that the process of healing after injury may be mediated by several GF. However, may this class of molecules even act effectively on the clinical response of this pathological condition? Many preclinical studies (in vitro and in vivo) reinforce the importance and efficacy of GF in the regeneration of damaged skin. Furthermore, recent studies have reported the use in adjuvant or not, of GF in clinical treatment to improve WH in humans. Therefore, we conclude that it seems to be effective by the use of GF in adjuvant or not in WH. However, it still seems to be necessary to carry out more clinical trials in phase I and II.
基金This study has been approved by the institutional research committee(GMCKKD/RP2017/IEC/106).
文摘Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults.The functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done.We only included complete TTA injuries.Children below 15 years,open injuries,associated fractures,and partial TTA were excluded.The data were obtained from hospital records.The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA.The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score.ANOVA test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 females.The mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)months.Fall on outstretched hand was the mode of injury.In 6 patients,diagnosis was missed on the initial visit.TTA were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular surface.An algorithm for treatment was recommended,i.e.transosseous suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and 4.All the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is simple.Surgical treatment results in excellent functions of the elbow.Since it is a single-center study involving a very small number of cases,a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.
文摘Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution ( LR), 7.5% sodium chloride solution ( HS ) and 20% albumin injection ( ALB ) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).Methods: Seventy-two severe trauma patients (ISS score 16-43) were divided into ISS≤25 and ISS＞25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.Results: Compared with LR group, the transfusion volume needed for maintaining systolic blood pressure ≥ 90 mm Hg was significantly decreased in HS and ALB groups (P＜0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P ＜ 0.05 -0.01 ). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P ＜ 0. 01).Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P ＜ 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS ＞25 than that of ISS ≤ 25 (P ＜ 0.05 ). MODS incidence and mortality were significantly higher in the group of ISS ＞ 25 than that of ISS ≤ 25 ( P ＜ 0.05 ). MODS incidence and mortality were lower in HS and ALB groups than LR group (P＜0.05).Conclusions: The up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.
