Background: Angiography with carbon dioxide (CO2) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO2 angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO2 angiography in angioembolization (AE) for trauma patients.
Methods: This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023.
Results: Within this period, 335 AEs were performed. CO2 angiography was performed in 102 patients (30.4%), and in 113 procedures. CO2angiography was used to provoke active bleeding which went undetected using ICM in 83 procedures, and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO2. The spleen had the highest detection rate of active bleeding by CO2 angiography among the organs. There were 4/102 (1.9%) patients with CO2 contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO2 angiography was not used. Vomiting was the most common complication of CO2 angiography in 10 patients (9.8%), whereas all were transient and did not require treatment.
Conclusions: CO2 angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.
{"title":"Carbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study.","authors":"Takaaki Maruhashi, Yutaro Kurihara, Ryoichi Kitamura, Marina Oi, Koyo Suzuki, Yasushi Asari","doi":"10.1007/s00068-024-02628-2","DOIUrl":"https://doi.org/10.1007/s00068-024-02628-2","url":null,"abstract":"<p><strong>Background: </strong>Angiography with carbon dioxide (CO<sub>2</sub>) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO<sub>2</sub> angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO<sub>2</sub> angiography in angioembolization (AE) for trauma patients.</p><p><strong>Methods: </strong>This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023.</p><p><strong>Results: </strong>Within this period, 335 AEs were performed. CO<sub>2</sub> angiography was performed in 102 patients (30.4%), and in 113 procedures. CO<sub>2</sub>angiography was used to provoke active bleeding which went undetected using ICM in 83 procedures, and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO<sub>2</sub>. The spleen had the highest detection rate of active bleeding by CO<sub>2</sub> angiography among the organs. There were 4/102 (1.9%) patients with CO<sub>2</sub> contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO<sub>2</sub> angiography was not used. Vomiting was the most common complication of CO<sub>2</sub> angiography in 10 patients (9.8%), whereas all were transient and did not require treatment.</p><p><strong>Conclusions: </strong>CO<sub>2</sub> angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1007/s00068-024-02621-9
Colin Christiaans, Sepp Hoogmoet, Wim Rijnen, Vincent Stirler, Erik Hermans
Objectives: To identify acetabular fracture patterns classified according to Letournel that are at risk of conversion to total hip arthroplasty (THA).
Design: A retrospective cohort study.
Setting: A Level-I trauma center.
Patients/ participants: Patients with an acetabular fracture, classified according to Letournel who were treated with ORIF (n = 280).
Interventions: Various surgical treatments for acetabular fractures.
Main outcome measure: The primary outcome was the rate of conversion to total hip arthroplasty.
Results: In this study, an overall conversion rate to THA of 13.9% within 2.2 years after initial surgery was found. Multivariate analysis revealed that several factors, namely, T-shaped fracture patterns (OR: 7.5, 95% CI 1.9-28.8, p = 0.003) and residual displacement (> 2 mm) (OR: 3.7, 95% CI 1.6-8.5, p = 0.002) are associated with an increased risk of conversion to THA. Furthermore, the risk of conversion to THA increases with 4.7% per gained year of age (OR: 1.047, 95% CI 1.0-1.1, p = 0,001). Other fracture patterns classified according to Letournel were not found to be independent risk factors.
Conclusion: The presence of T-shaped fracture patterns is found to be an independent risk factor for conversion to THA. Furthermore, age and degree of reduction are found to be independent risk factors, which is in line with existing literature. These finding should be taken into account when treating patients with T-shaped acetabular fractures.
Level of evidence: Prognostic study level III. See Instructions for Authors for a complete description of levels of evidence.
目的确定根据Letournel分类的髋臼骨折模式,这些模式存在转为全髋关节置换术(THA)的风险:设计:一项回顾性队列研究:患者/参与者:髋臼骨折患者根据Letournel分类的髋臼骨折患者,接受ORIF治疗的患者(n = 280):主要结果测量:主要结果是转为全髋关节置换术的比率:本研究发现,初次手术后 2.2 年内转为全髋关节置换术的总比例为 13.9%。多变量分析显示,T形骨折模式(OR:7.5,95% CI 1.9-28.8,p = 0.003)和残余移位(> 2 mm)(OR:3.7,95% CI 1.6-8.5,p = 0.002)等因素与转为全髋关节置换术的风险增加有关。此外,年龄每增加一岁,转为 THA 的风险就会增加 4.7%(OR:1.047,95% CI 1.0-1.1,p = 0,001)。根据Letournel分类的其他骨折形态未发现是独立的风险因素:结论:T形骨折模式是转为THA的独立风险因素。结论:研究发现,T形骨折形态的存在是转为 THA 的独立风险因素,此外,年龄和减径程度也是独立风险因素,这与现有文献一致。在治疗T形髋臼骨折患者时应考虑到这些发现:预后研究 III 级。有关证据级别的完整描述,请参阅 "作者须知"。
{"title":"Risk factors for conversion to total hip arthroplasty after acetabular fractures.","authors":"Colin Christiaans, Sepp Hoogmoet, Wim Rijnen, Vincent Stirler, Erik Hermans","doi":"10.1007/s00068-024-02621-9","DOIUrl":"https://doi.org/10.1007/s00068-024-02621-9","url":null,"abstract":"<p><strong>Objectives: </strong>To identify acetabular fracture patterns classified according to Letournel that are at risk of conversion to total hip arthroplasty (THA).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>A Level-I trauma center.</p><p><strong>Patients/ participants: </strong>Patients with an acetabular fracture, classified according to Letournel who were treated with ORIF (n = 280).</p><p><strong>Interventions: </strong>Various surgical treatments for acetabular fractures.</p><p><strong>Main outcome measure: </strong>The primary outcome was the rate of conversion to total hip arthroplasty.</p><p><strong>Results: </strong>In this study, an overall conversion rate to THA of 13.9% within 2.2 years after initial surgery was found. Multivariate analysis revealed that several factors, namely, T-shaped fracture patterns (OR: 7.5, 95% CI 1.9-28.8, p = 0.003) and residual displacement (> 2 mm) (OR: 3.7, 95% CI 1.6-8.5, p = 0.002) are associated with an increased risk of conversion to THA. Furthermore, the risk of conversion to THA increases with 4.7% per gained year of age (OR: 1.047, 95% CI 1.0-1.1, p = 0,001). Other fracture patterns classified according to Letournel were not found to be independent risk factors.</p><p><strong>Conclusion: </strong>The presence of T-shaped fracture patterns is found to be an independent risk factor for conversion to THA. Furthermore, age and degree of reduction are found to be independent risk factors, which is in line with existing literature. These finding should be taken into account when treating patients with T-shaped acetabular fractures.</p><p><strong>Level of evidence: </strong>Prognostic study level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1007/s00068-024-02624-6
Elaine P X van Ee, Esmee A H Verheul, Suzan Dijkink, Pieta Krijnen, Wouter Veldhuis, Shirin S Feshtali, Laura Avery, Claudia J Lucassen, Sven D Mieog, John O Hwabejire, Inger B Schipper
Background: This study explored if computerized tomography-derived body composition parameters (CT-BCPs) are related to malnutrition in severely injured patients admitted to the Intensive Care Unit (ICU).
Methods: This prospective cohort study included severely injured (Injury Severity Score ≥ 16) patients, admitted to the ICU of three level-1 trauma centers between 2018 and 2022. Abdominal CT scans were retrospectively analyzed to assess the CT-BCPs: muscle density (MD), skeletal muscle index (SMI), and visceral adipose tissue (VAT). The Subjective Global Assessment was used to diagnose malnutrition at ICU admission and on day 5 of admission, and the modified Nutrition Risk in Critically ill at admission was used to assess the nutritional risk.
Results: Seven (11%) of the 65 analyzed patients had malnutrition at ICU admission, increasing to 23 patients (35%) on day 5. Thirteen (20%) patients had high nutritional risk. CT-BCPs were not related to malnutrition at ICU admission and on day 5. Patients with high nutritional risk at admission had lower MD (median (IQR) 32.1 HU (25.8-43.3) vs. 46.9 HU (37.7-53.3); p < 0.01) and higher VAT (median 166.5 cm2 (80.6-342.6) vs. 92.0 cm2 (40.6-148.2); p = 0.01) than patients with low nutritional risk.
Conclusion: CT-BCPs do not seem related to malnutrition, but low MD and high VAT may be associated with high nutritional risk. These findings may prove beneficial for clinical practice, as they suggest that CT-derived parameters may provide valuable information on nutritional risk in severely injured patients, in addition to conventional nutritional assessment and screening tools.
Level of evidence: Level III, Prognostic/Epidemiological.
背景:本研究探讨了计算机断层扫描得出的身体成分参数(CT-BCPs)是否与重症监护病房(ICU)重伤患者的营养不良有关:本研究探讨了计算机断层扫描得出的身体成分参数(CT-BCPs)是否与重症监护病房(ICU)收治的重伤患者营养不良有关:这项前瞻性队列研究纳入了2018年至2022年期间入住三个一级创伤中心重症监护室的重伤患者(损伤严重程度评分≥16分)。对腹部 CT 扫描进行回顾性分析,以评估 CT-BCP:肌肉密度(MD)、骨骼肌指数(SMI)和内脏脂肪组织(VAT)。主观全面评估用于诊断入ICU时和入院第5天的营养不良情况,入院时的改良重症营养风险用于评估营养风险:在 65 名接受分析的患者中,有 7 人(11%)在入住重症监护病房时出现营养不良,到第 5 天增加到 23 人(35%)。13名患者(20%)营养风险较高。CT-BCP 与重症监护室入院时和第 5 天的营养不良无关。入院时营养风险高的患者的 MD 值(中位数(IQR)32.1 HU (25.8-43.3) vs. 46.9 HU (37.7-53.3); p 2 (80.6-342.6) vs. 92.0 cm2 (40.6-148.2); p = 0.01)低于营养风险低的患者:结论:CT-BCP 似乎与营养不良无关,但低 MD 和高 VAT 可能与高营养风险有关。结论:CT-BCPs 似乎与营养不良无关,但低 MD 和高 VAT 可能与高营养风险有关。这些发现可能对临床实践有益,因为它们表明,除了传统的营养评估和筛查工具外,CT 导出的参数可能为重伤患者的营养风险提供有价值的信息:III级,预后/流行病学。
{"title":"The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients.","authors":"Elaine P X van Ee, Esmee A H Verheul, Suzan Dijkink, Pieta Krijnen, Wouter Veldhuis, Shirin S Feshtali, Laura Avery, Claudia J Lucassen, Sven D Mieog, John O Hwabejire, Inger B Schipper","doi":"10.1007/s00068-024-02624-6","DOIUrl":"https://doi.org/10.1007/s00068-024-02624-6","url":null,"abstract":"<p><strong>Background: </strong>This study explored if computerized tomography-derived body composition parameters (CT-BCPs) are related to malnutrition in severely injured patients admitted to the Intensive Care Unit (ICU).</p><p><strong>Methods: </strong>This prospective cohort study included severely injured (Injury Severity Score ≥ 16) patients, admitted to the ICU of three level-1 trauma centers between 2018 and 2022. Abdominal CT scans were retrospectively analyzed to assess the CT-BCPs: muscle density (MD), skeletal muscle index (SMI), and visceral adipose tissue (VAT). The Subjective Global Assessment was used to diagnose malnutrition at ICU admission and on day 5 of admission, and the modified Nutrition Risk in Critically ill at admission was used to assess the nutritional risk.</p><p><strong>Results: </strong>Seven (11%) of the 65 analyzed patients had malnutrition at ICU admission, increasing to 23 patients (35%) on day 5. Thirteen (20%) patients had high nutritional risk. CT-BCPs were not related to malnutrition at ICU admission and on day 5. Patients with high nutritional risk at admission had lower MD (median (IQR) 32.1 HU (25.8-43.3) vs. 46.9 HU (37.7-53.3); p < 0.01) and higher VAT (median 166.5 cm<sup>2</sup> (80.6-342.6) vs. 92.0 cm<sup>2</sup> (40.6-148.2); p = 0.01) than patients with low nutritional risk.</p><p><strong>Conclusion: </strong>CT-BCPs do not seem related to malnutrition, but low MD and high VAT may be associated with high nutritional risk. These findings may prove beneficial for clinical practice, as they suggest that CT-derived parameters may provide valuable information on nutritional risk in severely injured patients, in addition to conventional nutritional assessment and screening tools.</p><p><strong>Level of evidence: </strong>Level III, Prognostic/Epidemiological.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The management of infected humeral shaft nonunion (HSN) remains challenging due to the lack of consensus and the potential for occult infection. The aim of this study was to evaluate a surgical strategy based on a two-stage treatment for suspected infection or a one-stage treatment for infection diagnosed retrospectively based on systematic bacteriological sampling.
Methods: We retrospectively reviewed 16 patients with a median age of 36 years who were treated for septic HSN: 9 patients underwent a two-stage procedure using the induced membrane technique, and 7 patients were treated in a single stage. Revision parameters included achieving bone union, its time frame, and a functional assessment based on joint motion and the Quick-DASH score.
Results: At a median follow-up of 47.5 months, 12 out of 16 patients were cured with acquired bone union and no septic recurrence. The median time to bone union was 5.5 months. Smoking and previous surgeries were adverse factors for bone healing. Radiological and functional outcomes were comparable between patients treated in a single stage and those treated in two stages.
Conclusions: This study confirms the relevance of one-stage surgery for HSN with occult infection and the value of systematic bacteriological sampling during the revision of humeral diaphyseal osteosynthesis.
{"title":"Treatment of infected humeral shaft nonunion and presumed aseptic nonunion with positive intraoperative cultures: a retrospective single-center study.","authors":"Gaetan Vanpoulle, Thomas Jalaguier, Thibault Druel, Arnaud Walch, Aram Gazarian, Laurent Mathieu","doi":"10.1007/s00068-024-02617-5","DOIUrl":"https://doi.org/10.1007/s00068-024-02617-5","url":null,"abstract":"<p><strong>Purpose: </strong>The management of infected humeral shaft nonunion (HSN) remains challenging due to the lack of consensus and the potential for occult infection. The aim of this study was to evaluate a surgical strategy based on a two-stage treatment for suspected infection or a one-stage treatment for infection diagnosed retrospectively based on systematic bacteriological sampling.</p><p><strong>Methods: </strong>We retrospectively reviewed 16 patients with a median age of 36 years who were treated for septic HSN: 9 patients underwent a two-stage procedure using the induced membrane technique, and 7 patients were treated in a single stage. Revision parameters included achieving bone union, its time frame, and a functional assessment based on joint motion and the Quick-DASH score.</p><p><strong>Results: </strong>At a median follow-up of 47.5 months, 12 out of 16 patients were cured with acquired bone union and no septic recurrence. The median time to bone union was 5.5 months. Smoking and previous surgeries were adverse factors for bone healing. Radiological and functional outcomes were comparable between patients treated in a single stage and those treated in two stages.</p><p><strong>Conclusions: </strong>This study confirms the relevance of one-stage surgery for HSN with occult infection and the value of systematic bacteriological sampling during the revision of humeral diaphyseal osteosynthesis.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1007/s00068-024-02632-6
Karl G Isand, Shoaib Fahad Hussain, Maseh Sadiqi, Ülle Kirsimägi, Giles Bond-Smith, Helgi Kolk, Sten Saar, Urmas Lepner, Peep Talving
Purpose: Emergency laparotomy (EL) encompasses procedures of varying complexity and urgency, undertaken in different clinical scenarios, leading to different risks of morbidity and mortality. We hypothesized that the increased mortality and longer postoperative length of stay (LoS) observed in frail patients are related to differences in indication for operation, a higher rate of sepsis, worse intraperitoneal soiling, and more advanced malignancy in this group.
Methods: This retrospective cohort study analysed patients entered into the National Emergency Laparotomy Audit database between January 1, 2018, and June 15, 2021, in Oxford. The primary outcome was 180-day survival analysed using multivariable Cox regression. The secondary outcomes, delay to surgery (DtS) and postoperative LoS, were analysed using logarithmically transformed multivariable linear regression.
Results: Of the 803 patients analysed, 396 (49.3%) were male. The median age was 66, and 337 (42%) were living with at least very mild frailty. Mortality hazard ratios for Clinical Frailty Scale grades 4 (3.93, 95% CI 1.89-8.20), 5 (5.86, 95% CI 2.87-11.97), and 6-7 (14.17, 95% CI 7.33-27.40) were not confounded by indication, sepsis, intraperitoneal soiling, or malignancy status. Frail patients experienced a 1.38-fold longer DtS and a 1.24-fold longer postoperative LoS, even after adjusting for indication, sepsis, intraperitoneal soiling, malignancy status, and DtS.
Conclusion: Our results indicate that frail patients have a poorer prognosis and longer postoperative LoS, independent of DtS, indication, sepsis, intraperitoneal soiling, and malignancy status. Patient frailty is also associated with longer DtS.
目的:急诊开腹手术(EL)包括不同复杂程度和紧急程度的手术,在不同的临床情况下进行,会导致不同的发病率和死亡率风险。我们假设,在体弱患者中观察到的死亡率升高和术后住院时间(LoS)延长与手术指征不同、脓毒症发生率较高、腹腔内脏污情况较差以及该群体中恶性肿瘤较晚期有关:这项回顾性队列研究分析了2018年1月1日至2021年6月15日期间牛津大学录入国家急诊腹腔手术审计数据库的患者。主要结果是使用多变量 Cox 回归分析的 180 天生存率。次要结果是手术延迟(DtS)和术后LoS,采用对数变换多变量线性回归进行分析:在分析的 803 名患者中,396 名(49.3%)为男性。年龄中位数为 66 岁,337 人(42%)至少患有轻度虚弱。临床虚弱量表 4 级(3.93,95% CI 1.89-8.20)、5 级(5.86,95% CI 2.87-11.97)和 6-7 级(14.17,95% CI 7.33-27.40)的死亡率危险比不受适应症、败血症、腹腔内脏污或恶性肿瘤状况的影响。即使在调整了适应症、脓毒症、腹腔内脏污、恶性肿瘤状态和 DtS 后,体弱患者的 DtS 和术后 LoS 分别延长了 1.38 倍和 1.24 倍:我们的研究结果表明,体弱患者的预后较差,术后LoS较长,这与DtS、适应症、脓毒症、腹腔内脏污和恶性肿瘤状态无关。患者的虚弱程度也与较长的DtS有关。
{"title":"Impact of frailty on outcomes following emergency laparotomy: a retrospective analysis across diverse clinical conditions.","authors":"Karl G Isand, Shoaib Fahad Hussain, Maseh Sadiqi, Ülle Kirsimägi, Giles Bond-Smith, Helgi Kolk, Sten Saar, Urmas Lepner, Peep Talving","doi":"10.1007/s00068-024-02632-6","DOIUrl":"https://doi.org/10.1007/s00068-024-02632-6","url":null,"abstract":"<p><strong>Purpose: </strong>Emergency laparotomy (EL) encompasses procedures of varying complexity and urgency, undertaken in different clinical scenarios, leading to different risks of morbidity and mortality. We hypothesized that the increased mortality and longer postoperative length of stay (LoS) observed in frail patients are related to differences in indication for operation, a higher rate of sepsis, worse intraperitoneal soiling, and more advanced malignancy in this group.</p><p><strong>Methods: </strong>This retrospective cohort study analysed patients entered into the National Emergency Laparotomy Audit database between January 1, 2018, and June 15, 2021, in Oxford. The primary outcome was 180-day survival analysed using multivariable Cox regression. The secondary outcomes, delay to surgery (DtS) and postoperative LoS, were analysed using logarithmically transformed multivariable linear regression.</p><p><strong>Results: </strong>Of the 803 patients analysed, 396 (49.3%) were male. The median age was 66, and 337 (42%) were living with at least very mild frailty. Mortality hazard ratios for Clinical Frailty Scale grades 4 (3.93, 95% CI 1.89-8.20), 5 (5.86, 95% CI 2.87-11.97), and 6-7 (14.17, 95% CI 7.33-27.40) were not confounded by indication, sepsis, intraperitoneal soiling, or malignancy status. Frail patients experienced a 1.38-fold longer DtS and a 1.24-fold longer postoperative LoS, even after adjusting for indication, sepsis, intraperitoneal soiling, malignancy status, and DtS.</p><p><strong>Conclusion: </strong>Our results indicate that frail patients have a poorer prognosis and longer postoperative LoS, independent of DtS, indication, sepsis, intraperitoneal soiling, and malignancy status. Patient frailty is also associated with longer DtS.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1007/s00068-024-02634-4
Florian Wichlas, Gerwin Haybäck, Valeska Hofmann, Amelie Deluca, Andreas Traweger, Christian Deininger
Purpose: Minimally Invasive Osteosynthesis (MIO) developed to be a key technique in orthopedic trauma surgery, offering a less invasive alternative for managing fractures in various anatomical regions. However, standardized guidelines for its application are lacking. This study aims to establish comprehensive principles for MIO to guide surgeons in treating different types of fractures and its locations.
Methods: A retrospective analysis including 57 fractures in 53 patients was conducted. All patients were treated with MIO. Study range - March 2017 to January 2022 at a Level-I trauma university hospital. The analysis covered various fracture types, focusing on surgical approaches, reduction techniques, plate insertion methods, and its outcomes. The efficacy and safety of MIO was evaluated by analyzing complications, fracture healing time, and necessary revision surgeries.
Results: MIO is a versatile and effective fracture treatment that minimized soft tissue damage and ensured stable osteosynthetic results. Articular fractures typically used a "one way up" plate insertion technique, while non-articular fractures applied an "inside-up-and-down" approach. Low complication rates confirmed the safety and efficiency of MIO.
Conclusion: This research established generalized principles for MIO, offering a systematic approach that can be applied for various fracture types and its locations, by overall enhancing the surgical efficiency as well as patient recovery, without compromising outcomes.
Level of evidence: This study is classified as Level III evidence according to "The Oxford 2011 Levels of Evidence".
{"title":"Advancing fracture management: the role of minimally invasive osteosynthesis in orthopedic trauma care.","authors":"Florian Wichlas, Gerwin Haybäck, Valeska Hofmann, Amelie Deluca, Andreas Traweger, Christian Deininger","doi":"10.1007/s00068-024-02634-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02634-4","url":null,"abstract":"<p><strong>Purpose: </strong>Minimally Invasive Osteosynthesis (MIO) developed to be a key technique in orthopedic trauma surgery, offering a less invasive alternative for managing fractures in various anatomical regions. However, standardized guidelines for its application are lacking. This study aims to establish comprehensive principles for MIO to guide surgeons in treating different types of fractures and its locations.</p><p><strong>Methods: </strong>A retrospective analysis including 57 fractures in 53 patients was conducted. All patients were treated with MIO. Study range - March 2017 to January 2022 at a Level-I trauma university hospital. The analysis covered various fracture types, focusing on surgical approaches, reduction techniques, plate insertion methods, and its outcomes. The efficacy and safety of MIO was evaluated by analyzing complications, fracture healing time, and necessary revision surgeries.</p><p><strong>Results: </strong>MIO is a versatile and effective fracture treatment that minimized soft tissue damage and ensured stable osteosynthetic results. Articular fractures typically used a \"one way up\" plate insertion technique, while non-articular fractures applied an \"inside-up-and-down\" approach. Low complication rates confirmed the safety and efficiency of MIO.</p><p><strong>Conclusion: </strong>This research established generalized principles for MIO, offering a systematic approach that can be applied for various fracture types and its locations, by overall enhancing the surgical efficiency as well as patient recovery, without compromising outcomes.</p><p><strong>Level of evidence: </strong>This study is classified as Level III evidence according to \"The Oxford 2011 Levels of Evidence\".</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1007/s00068-024-02609-5
Arlene Vivienne von Aesch, Sonja Häckel, Tobias Kämpf, Heiner Baur, Johannes Dominik Bastian
Purpose: To investigate how audio-biofeedback during the instruction of partial weight-bearing affected adherence, compared to traditional methods, in older adults; and to investigate the influence of individual characteristics.
Methods: The primary outcome measure of this randomised controlled trial was the amount of load, measured as the ground reaction force, on the partial weight-bearing leg. The secondary outcome was the influence of individual characteristics on the amount of load. Included were healthy volunteers 60 years of age or older without gait impairment. Participants were randomly allocated to one of two groups; blinding was not possible. Partial weight-bearing of 20 kg was trained using crutches with audio-biofeedback (intervention group) or a bathroom scale (control group). The degree of weight-bearing was measured during six activities with sensor insoles. A mean load between 15 and 25 kg was defined as adherent.
Results: There was no statistically significant difference in weight-bearing between the groups for all activities measured. For the sit-stand-sit activity, weight-bearing was within the adherence range of 15-25 kg (audio-biofeedback: 21.7 ± 16.6 kg; scale: 22.6 ± 13 kg). For standing, loading was below the lower threshold (10 ± 7 vs. 10 ± 10 kg). Weight-bearing was above the upper threshold for both groups for: walking (26 ± 11 vs. 34 ± 16), step-up (29 ± 18 vs. 34 ± 20 kg) and step-down (28 ± 15 vs. 35 ± 19 kg). Lower level of cognitive function, older age, and higher body mass index were correlated with overloading.
Conclusion: Audio-biofeedback delivered no statistically significant benefit over the scale method. Lower cognitive function, older age and higher body mass index were associated with overloading.
Trial registration: Not applicable due not being a clinical trial and due to the cross-sectional design (one measurement point, no health intervention, no change in health of a person).
{"title":"Audio-biofeedback versus the scale method for improving partial weight-bearing adherence in healthy older adults: a randomised trial.","authors":"Arlene Vivienne von Aesch, Sonja Häckel, Tobias Kämpf, Heiner Baur, Johannes Dominik Bastian","doi":"10.1007/s00068-024-02609-5","DOIUrl":"https://doi.org/10.1007/s00068-024-02609-5","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate how audio-biofeedback during the instruction of partial weight-bearing affected adherence, compared to traditional methods, in older adults; and to investigate the influence of individual characteristics.</p><p><strong>Methods: </strong>The primary outcome measure of this randomised controlled trial was the amount of load, measured as the ground reaction force, on the partial weight-bearing leg. The secondary outcome was the influence of individual characteristics on the amount of load. Included were healthy volunteers 60 years of age or older without gait impairment. Participants were randomly allocated to one of two groups; blinding was not possible. Partial weight-bearing of 20 kg was trained using crutches with audio-biofeedback (intervention group) or a bathroom scale (control group). The degree of weight-bearing was measured during six activities with sensor insoles. A mean load between 15 and 25 kg was defined as adherent.</p><p><strong>Results: </strong>There was no statistically significant difference in weight-bearing between the groups for all activities measured. For the sit-stand-sit activity, weight-bearing was within the adherence range of 15-25 kg (audio-biofeedback: 21.7 ± 16.6 kg; scale: 22.6 ± 13 kg). For standing, loading was below the lower threshold (10 ± 7 vs. 10 ± 10 kg). Weight-bearing was above the upper threshold for both groups for: walking (26 ± 11 vs. 34 ± 16), step-up (29 ± 18 vs. 34 ± 20 kg) and step-down (28 ± 15 vs. 35 ± 19 kg). Lower level of cognitive function, older age, and higher body mass index were correlated with overloading.</p><p><strong>Conclusion: </strong>Audio-biofeedback delivered no statistically significant benefit over the scale method. Lower cognitive function, older age and higher body mass index were associated with overloading.</p><p><strong>Trial registration: </strong>Not applicable due not being a clinical trial and due to the cross-sectional design (one measurement point, no health intervention, no change in health of a person).</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1007/s00068-024-02626-4
Arman Vahabi, Ali Engin Daştan, Omar Aljasım, Özgür Mert Bakan, Levent Küçük, Nadir Özkayın, Kemal Aktuğlu
Objectives: Hip fractures are increasingly common among the elderly population, who often present with a high burden of comorbidities necessitating preoperative stabilization. As a result, preoperative cardiology consultations are frequently conducted in clinical practice. The aim of this study was to investigate the additional recommendations provided by preoperative cardiology consultations and the impact of consultations on the management and outcomes of elderly patients undergoing hip fracture surgery.
Patients and methods: This matched cohort study was performed to retrospectively assess the clinical data of patients who were treated for hip fractures at our institution between January 2016 and December 2017. Individuals who were 60 years old or older with available clinical and radiological data were included. A total of 262 patients who met these criteria were included, with 192 undergoing cardiology consultation and 70 not. Through matching for age, sex, ASA grade, fracture type, and surgery type, two groups (Group A, preoperative cardiology consultation requested; Group B, preoperative cardiology consultation not requested) of 50 patients each were formed. The duration between hospital admission and surgery, recommendations provided by cardiology consultation, type of anaesthesia and surgery, length of hospital stay, incidence of medical and orthopaedic complications, and one-year mortality status were compared between the groups.
Results: The mean age of Group A was 78.5 (± 7.4) years, whereas that of Group B was 78.4 (± 7.4) years (p = 0.99). Both groups included 30 female patients and 20 male patients each. There were no significant differences in anaesthesia type or the incidence of medical or orthopaedic complications between the groups. However, Group A experienced a significantly longer duration between admission and surgery (5 [1/9] days vs. 3 [0/7] days; p = 0.00) and a longer hospital stay (7 [3/15] days vs. 5 [1/19] days; p = 0.01) than did Group B. The one-year mortality rate did not significantly differ between the groups (30% vs. 20%; p = 0.36). Notably, only 3 out of 50 patients received additional treatments following cardiology consultation beyond routine recommendations.
Conclusion: Preoperative cardiology consultations before hip fracture surgery rarely leads to a change in treatment. Additionally, these evaluations delay surgery and extend the hospital stay.
{"title":"Preoperative cardiology consultations for geriatric patients with hip fractures rarely provide additional recommendations and are associated with prolonged hospital stays and delayed surgery: a retrospective case control study.","authors":"Arman Vahabi, Ali Engin Daştan, Omar Aljasım, Özgür Mert Bakan, Levent Küçük, Nadir Özkayın, Kemal Aktuğlu","doi":"10.1007/s00068-024-02626-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02626-4","url":null,"abstract":"<p><strong>Objectives: </strong>Hip fractures are increasingly common among the elderly population, who often present with a high burden of comorbidities necessitating preoperative stabilization. As a result, preoperative cardiology consultations are frequently conducted in clinical practice. The aim of this study was to investigate the additional recommendations provided by preoperative cardiology consultations and the impact of consultations on the management and outcomes of elderly patients undergoing hip fracture surgery.</p><p><strong>Patients and methods: </strong>This matched cohort study was performed to retrospectively assess the clinical data of patients who were treated for hip fractures at our institution between January 2016 and December 2017. Individuals who were 60 years old or older with available clinical and radiological data were included. A total of 262 patients who met these criteria were included, with 192 undergoing cardiology consultation and 70 not. Through matching for age, sex, ASA grade, fracture type, and surgery type, two groups (Group A, preoperative cardiology consultation requested; Group B, preoperative cardiology consultation not requested) of 50 patients each were formed. The duration between hospital admission and surgery, recommendations provided by cardiology consultation, type of anaesthesia and surgery, length of hospital stay, incidence of medical and orthopaedic complications, and one-year mortality status were compared between the groups.</p><p><strong>Results: </strong>The mean age of Group A was 78.5 (± 7.4) years, whereas that of Group B was 78.4 (± 7.4) years (p = 0.99). Both groups included 30 female patients and 20 male patients each. There were no significant differences in anaesthesia type or the incidence of medical or orthopaedic complications between the groups. However, Group A experienced a significantly longer duration between admission and surgery (5 [1/9] days vs. 3 [0/7] days; p = 0.00) and a longer hospital stay (7 [3/15] days vs. 5 [1/19] days; p = 0.01) than did Group B. The one-year mortality rate did not significantly differ between the groups (30% vs. 20%; p = 0.36). Notably, only 3 out of 50 patients received additional treatments following cardiology consultation beyond routine recommendations.</p><p><strong>Conclusion: </strong>Preoperative cardiology consultations before hip fracture surgery rarely leads to a change in treatment. Additionally, these evaluations delay surgery and extend the hospital stay.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1007/s00068-024-02618-4
Anna H M Mennen, Jelle J Posthuma, Eline M Kooijman, Marjolijn D Trietsch, Eefje N De Vries, Frank W Bloemers, J Carel Goslings, Daphne Van Embden
Purpose: The purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum.
Methods: All women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36 months.
Results: A total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware.
Conclusion: Women with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed.
{"title":"The mode of delivery after operative fixation of pelvic ring fractures-a retrospective observational study.","authors":"Anna H M Mennen, Jelle J Posthuma, Eline M Kooijman, Marjolijn D Trietsch, Eefje N De Vries, Frank W Bloemers, J Carel Goslings, Daphne Van Embden","doi":"10.1007/s00068-024-02618-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02618-4","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum.</p><p><strong>Methods: </strong>All women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36 months.</p><p><strong>Results: </strong>A total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware.</p><p><strong>Conclusion: </strong>Women with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1007/s00068-024-02620-w
Matteo Maria Cimino, Alan Biloslavo, Hayato Kurihara, Gabriele Bellio, Matteo Porta, Silvia Fattori, Gary Alan Bass
Background: Appendicitis is the most frequent global abdominal surgical emergency. An ageing population, who often exhibit atypical symptoms and delayed presentations, challenge conventional diagnostic and treatment paradigms.
Objectives: This study aims to delineate disparities in presentation, management, and outcomes between elderly patients and younger adults suffering from acute appendicitis.
Methods: This subgroup analysis forms part of ESTES SnapAppy, a time-bound multi-center prospective, observational cohort study. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a defined 90-day observational period across multiple centers. Statistical comparisons were performed using appropriate tests with significance set at p < 0.05.
Results: The study cohort comprised 521 elderly patients (≥65 years) and 4,092 younger adults (18-64 years). Elderly patients presented later (mean duration of symptoms: 7.88 vs. 3.56 days; p < 0.001) and frequently required computed tomography (CT) scans for diagnosis (86.1% vs. 54.0%; p < 0.001). The incidence of complicated appendicitis was higher in the elderly (46.7% vs. 20.7%; p < 0.001). Delays in surgical intervention were notable in the elderly (85.0% operated within 24 h vs. 88.7%; p = 0.018), with longer operative times (71.1 vs. 60.3 min; p < 0.001). Postoperative complications were significantly higher in the elderly (27.9% vs. 12.9%; p < 0.001), including severe complications (6.9% vs. 2.4%; p < 0.001) and prolonged hospital stays (7.9 vs. 3.6 days; p < 0.001).
Conclusions: Our findings highlight significant differences in the clinical course and outcomes of acute appendicitis in the elderly compared to younger patients, suggesting a need for age-adapted diagnostic pathways and treatment strategies to improve outcomes in this vulnerable population.
{"title":"Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient.","authors":"Matteo Maria Cimino, Alan Biloslavo, Hayato Kurihara, Gabriele Bellio, Matteo Porta, Silvia Fattori, Gary Alan Bass","doi":"10.1007/s00068-024-02620-w","DOIUrl":"https://doi.org/10.1007/s00068-024-02620-w","url":null,"abstract":"<p><strong>Background: </strong>Appendicitis is the most frequent global abdominal surgical emergency. An ageing population, who often exhibit atypical symptoms and delayed presentations, challenge conventional diagnostic and treatment paradigms.</p><p><strong>Objectives: </strong>This study aims to delineate disparities in presentation, management, and outcomes between elderly patients and younger adults suffering from acute appendicitis.</p><p><strong>Methods: </strong>This subgroup analysis forms part of ESTES SnapAppy, a time-bound multi-center prospective, observational cohort study. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a defined 90-day observational period across multiple centers. Statistical comparisons were performed using appropriate tests with significance set at p < 0.05.</p><p><strong>Results: </strong>The study cohort comprised 521 elderly patients (≥65 years) and 4,092 younger adults (18-64 years). Elderly patients presented later (mean duration of symptoms: 7.88 vs. 3.56 days; p < 0.001) and frequently required computed tomography (CT) scans for diagnosis (86.1% vs. 54.0%; p < 0.001). The incidence of complicated appendicitis was higher in the elderly (46.7% vs. 20.7%; p < 0.001). Delays in surgical intervention were notable in the elderly (85.0% operated within 24 h vs. 88.7%; p = 0.018), with longer operative times (71.1 vs. 60.3 min; p < 0.001). Postoperative complications were significantly higher in the elderly (27.9% vs. 12.9%; p < 0.001), including severe complications (6.9% vs. 2.4%; p < 0.001) and prolonged hospital stays (7.9 vs. 3.6 days; p < 0.001).</p><p><strong>Conclusions: </strong>Our findings highlight significant differences in the clinical course and outcomes of acute appendicitis in the elderly compared to younger patients, suggesting a need for age-adapted diagnostic pathways and treatment strategies to improve outcomes in this vulnerable population.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}