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Refining patient stratification and treatment decision-making in acute SMA occlusion 细化急性SMA闭塞患者分层和治疗决策
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-10-14 DOI: 10.1186/s13017-025-00653-z
Yingjian Ye, Yan Hu, Xianqun Ji, Junyan Zhang, Hui Xu, Peng An
This prospective multinational substudy of the AMESI project provides critical insights into managing acute SMA occlusion. By comparing endovascular versus surgical revascularization, the authors demonstrate that baseline illness severity, reflected by elevated lactate levels and mechanical ventilation requirements, dominates prognostic outcomes, with adjusted analyses confirming no independent mortality effect from treatment modality (surgery OR 1.59, 95% CI 0.57–4.37). Notably, unadjusted mortality rates varied substantially (endovascular-effective: 2.9% vs. surgical: 45.8%), primarily attributable to patient selection bias toward higher disease severity in the surgical cohort. The inability to identify reliable thresholds for endovascular efficacy underscores the necessity of individualized decision-making based on etiology and physiological status, challenging time-based intervention paradigms.
这项前瞻性的跨国亚研究AMESI项目为管理急性SMA闭塞提供了关键的见解。通过比较血管内与手术血运重建术,作者证明,乳酸水平升高和机械通气需求反映的基线疾病严重程度主导了预后结果,调整分析证实治疗方式没有独立的死亡率影响(手术OR 1.59, 95% CI 0.57-4.37)。值得注意的是,未经调整的死亡率差异很大(血管内有效:2.9% vs.手术:45.8%),主要归因于手术队列中患者选择偏向于更高疾病严重程度。无法确定血管内疗效的可靠阈值强调了基于病因和生理状态的个性化决策的必要性,挑战了基于时间的干预范式。
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引用次数: 0
Use of tranexamic acid in trauma surgical specialties: a narrative review 氨甲环酸在创伤外科专科的应用:述评
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-10-10 DOI: 10.1186/s13017-025-00649-9
Hannah M. Thomas, Huthayfa Kahf, Benjamin Bush, Jeffry Nahmias, Philip K. Lim
Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.
氨甲环酸(TXA)是一种众所周知的抗纤溶药物,越来越多的证据支持其在创伤患者中的应用。本综述评估了目前有关TXA的文献,以及TXA在多个创伤外科亚专科和背景下提高患者生存率和减少输血需求的潜在用途。利用PubMed (MEDLINE)和谷歌Scholar数据库对氨甲环酸在创伤外科专业的疗效和安全性进行文献综述,时间自数据库建立至2024年10月。选定的文章用英语撰写,包括综述、实验研究和基础科学文章。有相互矛盾的证据表明,TXA的死亡率效益,特别是在院前设置。然而,多项大型、高质量的研究表明,TXA是一种减少创伤后出血的有效药物。大量证据表明,TXA是一种安全的药物,大量研究表明,在创伤环境中使用TXA后,血栓栓塞事件的风险不会增加。此外,在几个国家进行的多项成本效益研究发现,TXA是创伤后的一种极具成本效益的干预措施。TXA是一种安全、有效、经济有效的减少创伤后出血的药物。需要进一步的研究来阐明创伤性脑和脊柱损伤后TXA的潜在益处以及TXA的最佳剂量和给药途径。
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引用次数: 0
Cumulative intra-abdominal pressure exposure and dynamic trajectories in ICU-admitted patients reveal prognostic determinants of severe acute pancreatitis 重症监护病房住院患者的累积腹内压暴露和动态轨迹揭示了严重急性胰腺炎的预后决定因素
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-09-29 DOI: 10.1186/s13017-025-00646-y
Maobin Kuang, Yaoyu Zou, Shixuan Xiong, Cong He, Nianshuang Li, Ling Ding, Xueyang Li, Huijie Zhang, Yupeng Lei, Xin Huang, Huifang Xiong, Lingyu Luo, Liang Xia, Wenhua He, Nonghua Lv, Jianhua Wan, Yin Zhu
Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP. This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005–2023) and 83 from MIMIC-IV (2008–2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose–response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP’s role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was employed to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed. Over a median inpatient follow-up of 17 days in the Jiangxi cohort, 200 (19.8%) patients died in hospital, while 208 (20.6%) and 329 (32.6%) developed IPN and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of adverse clinical outcomes. This is the first study to revealed that CumIAP is linearly positively correlated with death and PMOF, while exhibits a U-shaped relationship with IPN. Notably, patients with low baseline IAP and a rising trajectory exhibited worse outcomes than those with high baseline IAP and a declining trend. This is the first study to introduce CumIAP as a quantitative metric to assess the early IAP burden and its prognostic significance in SAP, overcoming the limitations of static IAP monitoring. RCS and regression analyses revealed a positive linear association between CumIAP and in hospital mortality/PMOF, and a U-shaped relationship with IPN, suggesting the possible presence of a risk threshold. LCGMM identified three IAP trajectory patterns; the "low baseline with rising trend" group (LPI-T3) had the worst outcomes, underscoring the value of dynamic over static IAP monitoring. Mediation analysis showed that CumIAP partly mediated the effects of hypoalbuminemia and ANC on o
腹内压(IAP)是严重急性胰腺炎(SAP)患者器官衰竭进展的关键驱动因素。然而,传统的静态IAP监测无法充分捕捉到损伤的动态演变。本研究旨在评估累积IAP暴露(CumIAP)和动态轨迹对SAP预后的影响。本回顾性队列研究分析了来自江西队列(2005-2023)的1008例icu住院SAP患者和来自MIMIC-IV(2008-2019)的83例患者。通过一系列IAP测量的时间加权积分来量化CumIAP。建立多变量Cox回归模型和限制性三次样条(RCS)分析CumIAP与死亡、感染性胰腺坏死(IPN)和持续性多器官衰竭(PMOF)之间的剂量-反应关系。中介分析评估了CumIAP在白蛋白(ALB)和急性坏死收集(ANC)相关结果中的作用。采用潜类生长混合模型(Latent class growth mixture model, LCGMM)识别IAP动态轨迹亚型,并分析各轨迹组与不良预后的关系。在江西队列中位17天的住院随访中,200例(19.8%)患者在医院死亡,208例(20.6%)和329例(32.6%)患者分别发生IPN和PMOF。回归分析显示,CumIAP每增加一个标准差,院内死亡和PMOF的风险分别增加37%和86%,与IPN的风险呈u型相关(非线性P = 0.004)。中介分析显示,CumIAP分别介导了24.26%和33.76%的ALB、ANC与院内死亡风险之间的关联。LCGMM识别出三种IAP轨迹:高压快速下降组(HRD-T1)、低压逐渐下降组(LGD-T2)和低压逐渐增加组(LPI-T3)。其中,与HRD-T1和LGD-T2相比,LPI-T3组受试者出现临床不良结局的风险显著增加。这是首次发现CumIAP与死亡和PMOF呈线性正相关,而与IPN呈u型关系。值得注意的是,基线IAP低且呈上升趋势的患者比基线IAP高且呈下降趋势的患者表现出更差的结果。这是首次引入CumIAP作为定量指标来评估SAP早期IAP负担及其预后意义的研究,克服了静态IAP监测的局限性。RCS和回归分析显示,CumIAP与院内死亡率/PMOF呈正线性关系,与IPN呈u型关系,表明可能存在风险阈值。LCGMM确定了三种IAP轨迹模式;“低基线有上升趋势”组(LPI-T3)的结果最差,强调了动态IAP监测比静态IAP监测的价值。中介分析显示,CumIAP在一定程度上介导了低白蛋白血症和ANC对预后的影响,表明IAP可能是SAP的一个重要中介途径和治疗靶点。
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引用次数: 0
Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025 奥山德龙治疗烧伤患者:2005年至2025年随机对照试验的系统回顾和最新荟萃分析
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-09-29 DOI: 10.1186/s13017-025-00648-w
Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui
Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an
严重烧伤诱导高代谢,导致蛋白质分解代谢,伤口愈合受损,感染风险增加。烧伤患者经常经历雄激素消耗,加剧了这些问题。奥雄龙,一种合成的合成代谢类固醇,已经显示出对抗这些代谢紊乱的希望。这项最新的荟萃分析评估了奥胺龙在烧伤患者中的疗效和安全性,结合了最近的研究、儿科人群、长期结果和联合治疗。这项符合PRISMA 2020标准的系统评价检索了9个数据库(PubMed、Embase、Cochrane、WOS、WHO-ICTRP、CNKI、VIP、万方、CBMdisc),检索了2005年至2025年间发表的随机对照试验,使用了有效的策略,结合了烧伤/创伤和雄激素类似物(如oxandronone、nandronone)的控制词汇(MeSH/Emtree)和自由文本术语。纳入的试验比较了烧伤患者的雄激素类似物与对照组(安慰剂/标准治疗),报告了≥1个预定义结果:(1)瘦体重(恢复阶段,烧伤后≥14天);(2)轻微副作用(肝功能障碍[ALT/AST≥2 × ULN]或水肿);(3)感染;(4)死亡率;(五)外科手术;(6)洛杉矶/回溯;(7)绝对LOS。进行了双独立筛选、数据提取和偏倚风险评估(每个结果的Cochrane RoB 2.0)。随机效应荟萃分析产生了连续结局的标准化平均差异(SMD)和95% ci的二分类结局的风险比(RR)。十四相关(2005 - 2025年;n = 2822例:1203 1619年干预与控制)证明显著减少外科手术(SMD =−1.25;95%可信区间2.45−−0.04;p = 0.04; I2 = 97.2%)和滞留时间规范化回溯(洛杉矶/回溯)(SMD =−1.07;95%可信区间2.43−0.29;p = 0.007; I2 = 98.1%),与增强合成代谢恢复就是增加体重增加(SMD = 0.58; 95%可信区间1.21−2.38;p < 0.001)和精益质量(SMD = 1.30; 95%可信区间0.47−3.24;p < 0.001;i2≥95.0%)。然而,没有观察到死亡率的改善(RR = 1.04; 95% CI 0.47-2.32; p = 0.913; I2 = 66.5%),感染率不变(RR = 0.83; 95% CI 0.67-1.02; p = 0.639),供体部位愈合无改善(SMD = - 1.48; 95% CI - 2.18 - 0.77; p = 0.116)。安全性分析显示治疗相关副作用(肝功能障碍/水肿;RR = 1.82; 95% CI 0.52-6.42; p = 0.34)无显著增加,成人转氨酶升高明显(19% vs 5%安慰剂;p = 0.002)。奥胺龙在烧伤治疗中具有临床应用价值,可显著减轻手术负担(SMD = - 1.25, p = 0.04),缩短住院时间(LOS/TBSA SMD = - 1.07, p = 0.007),促进合成代谢恢复(体重增加SMD = 0.58,瘦质量SMD = 1.30, p均< 0.001)。然而,极端异质性(I2≥95.0%)和时间限制需要谨慎解释。关键的是,它没有死亡率方面的益处(RR = 1.04; p = 0.913),不能减少感染(RR = 0.83; p = 0.639),并增加成人的肝毒性风险(19% vs. 5%; p = 0.002)。这些发现支持其在代谢康复中的辅助作用,但要求风险分层实施。
{"title":"Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025","authors":"Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui","doi":"10.1186/s13017-025-00648-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00648-w","url":null,"abstract":"Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p &lt; 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p &lt; 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p &lt; 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health-related quality of life after emergency abdominal surgery 急诊腹部手术后与健康相关的生活质量
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-09-02 DOI: 10.1186/s13017-025-00643-1
Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova
Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.
患者的生存和生活质量是评估治疗价值的关键因素。然而,关于急诊腹部手术后患者健康相关生活质量(QoL)的轨迹和关键决定因素的证据有限。我们使用EQ-5D-3L问卷对高危患者进行了为期8个月的随访,通过强化围手术期护理研究测量了患者的生活质量,总结了急诊腹部手术后患者的生活质量轨迹,并使用多变量回归模型将患者的人口统计学和临床特征、术前特征和手术后时间与他们的生活质量联系起来。在进一步的分析中,我们评估了术后患者特征的贡献。686例急诊腹部手术患者资料(50.4%为女性),平均年龄66.6岁(标准差12.8);50.1%以肠梗阻为手术指征),并对生活质量进行分析。术后不久(平均7.59天(SD 7.48)), EQ-5D-3L平均生活质量效用评分为0.21 (SD 0.46),在手术后中长期(即3至8个月),幸存者的平均生活质量效用评分为0.74 (SD 0.31)。患者的性别和术前死亡风险是术后短期生活质量的关键决定因素。除术后时间外,患者的性别、Charlson合并症指数、ASA身体状况和手术指征是影响术后中长期生活质量的主要术前预测因素。从术后特征来看,指数手术住院时间和生活质量测量前30天内的住院天数是中长期生活质量的进一步关键决定因素。患者个体、手术和恢复特征决定了急诊腹部手术后的生活质量,并有助于告知临床医生和患者讨论和评估腹部手术干预措施的价值。
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引用次数: 0
High platelet-to-red blood cell ratio and outcomes in trauma patients requiring massive transfusions 需要大量输血的创伤患者的高血小板/红细胞比率和预后
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-08-30 DOI: 10.1186/s13017-025-00645-z
Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu
Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.
不受控制的出血导致40%的外伤死亡。虽然更高的血小板与红细胞(PLT/RBC)输血比例可能改善预后,但最佳比例仍不清楚。本研究旨在确定PLT/RBC比值阈值及其对需要大量输血的创伤患者住院死亡率的影响。这项回顾性的多中心研究使用了2014-2018年国家创伤数据库(NTDB)的数据。在急诊室(ED)入院后24小时内大量输血的I/II级创伤中心的成年患者被纳入研究对象。将患者分为高血小板组(血小板/红细胞比值bb0 0.7)和低血小板组(血小板/红细胞比值≤0.7)。主要结局:24小时和30天死亡率;次要结局:输血相关不良事件。在9330例患者中(中位年龄37(26-54)岁;78.9%男性),46.1%的患者PLT/RBC比值较高。限制三次样条分析显示出非线性关系:死亡率在>.7时显著下降,在1.5以上稳定。经反概率加权治疗后,高plt组24小时死亡率(OR, 0.45; 95% CI, 0.42-0.48)和30天死亡率(OR, 0.66; 95% CI, 0.62-0.70)较低。然而,高比例组的不良事件发生率更高,包括肺栓塞、急性肾损伤和败血症。亚组分析证实,尽管不良事件增加,但生存获益一致。敏感性分析进一步支持了这些发现的稳健性。在这项多中心研究中,高PLT/RBC比率(>.7)与需要大量输血的创伤患者的生存率提高相关,降低24小时和30天死亡率。然而,它也增加了不良事件的风险,在比率超过1.5时观察到天花板效应。这些发现强调需要高质量的临床试验来验证高血小板/红细胞比率的益处,并优化创伤患者的输血策略。
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引用次数: 0
Variation and accuracy of intra-abdominal pressure measurement in different body positions: a prospective study 不同体位腹内压测量的变化和准确性:一项前瞻性研究
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-08-26 DOI: 10.1186/s13017-025-00644-0
Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain
Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m
最近的研究证实,腹内高压(IAH)经常发生在危重患者中,造成器官衰竭和死亡率增加的重大风险。准确测量腹内压(IAP)对于有效诊断、预防和治疗至关重要。以往的研究表明,使用传统Foley导尿管准确测量IAP需要在夹紧导尿管后向膀胱内填充最多25 mL的无菌生理盐水,由于膀胱填充量的变化,限制了持续监测IAP的能力。该导管可以不考虑膀胱填充量而连续测量IAP。主要目的是验证一种新型连续膀胱压力监测装置——创伤导尿管(Sentinel Medical Technologies, Jacksonville, Florida, USA)。对不同体位的ICU患者进行研究,通过比较使用创伤导管和FoleyManometer测量方法(SecurMeter, Deltamed, Viadana,意大利)获得的IAP读数之间的相关性、偏倚、精度和一致性来评估测量准确性。FoleyManometer测量方法作为金标准。本研究的次要终点是探讨不同体位对IAP的影响。纳入需要膀胱导尿的ICU成人患者(≥18岁)。使用创伤导管(IAPTG)和FoleyManometer方法(IAPFM)跨多个体位测量IAP,以获得广泛的IAP值,并研究体位对IAP测量的影响。采用相关性、一致性和Bland-Altman分析,对仰卧位、反向Trendelenburg位(15°、30°和45°)和床头(HOB)仰卧位(15°、30°和45°)的IAPTG和IAPFM进行两两分析。误差网格分析评估了与每个体位测量不准确相关的风险。采用受试者工作特征(ROC)曲线对创伤导管作为IAH检测系统的鲁棒性进行评价。研究了IAP随体位的变化,并与文献综述进行了比较。还记录了每个参与者的性别、年龄、体重指数(BMI)和序贯器官衰竭评估(SOFA)评分。纳入25例成人ICU患者,平均年龄63.6±11.6岁,BMI 28.3±3.7 kg/m2。平均IAP从仰卧位9.8±1.7 mmHg增加到逆Trendelenburg位10.4±1.5 mmHg, HOB抬高位14.9±1.6 mmHg。仰卧位、逆Trendelenburg位和HOB抬高位的相关系数分别为0.9、0.9和0.8。根据Bland-Altman分析,仰卧位显示出0.8和1.7 mmHg的偏差和精度。反向Trendelenburg和HOB海拔位置的偏差分别为- 0.3和1.5 mmHg,精度分别为1.5和1.6 mmHg。对于仰卧位、反向Trendelenburg位和HOB仰卧位,一致性的下限和上限分别为−2.5-4.2 mmHg、−3.2-2.6 mmHg和−1.6-4.6 mmHg,百分比误差分别为35%、28%和21%。与仰卧位(95.3%)和HOB抬高位(92.1%)相比,反向Trendelenburg位的一致性系数最高(100.0%)。误差网格分析显示,仰卧位和反向Trendelenburg位没有中等/高风险误差,HOB仰卧位有2.7%的中等/高风险误差。与金标准相比,在ICU患者中验证一种新的连续IAP监测装置的结果显示出优异的效果。将身体姿势从仰卧改变为反转Trendelenburg或HOB抬高会增加IAP。
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引用次数: 0
The synchronized pager explosions: an unprecedented pattern of injuries. 呼机同步爆炸造成了前所未有的伤亡。
IF 5.8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-08-19 DOI: 10.1186/s13017-025-00587-6
Alameddine Ramzi, Noureddin Baha', Mansour Ahmad, Joanna Saade, Wajiha Jurdi Kheir
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引用次数: 0
Prediction of infected pancreatic necrosis in patients with acute necrotizing pancreatitis based on ensemble machine learning model. 基于集成机器学习模型的急性坏死性胰腺炎患者感染性胰腺坏死预测。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-08-07 DOI: 10.1186/s13017-025-00642-2
Zefang Sun,Yan Fu,Jiarong Li,Baiqi Liu,Xiaoyue Hong,Chiayen Lin,Dingcheng Shen,Caihong Ning,Lu Chen,Xiaoping Yi,Gengwen Huang
BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).
背景研究集成机器学习(EL)模型在急性坏死性胰腺炎(ANP)患者感染性胰腺坏死(IPN)预测中的价值。方法对2011年1月至2023年12月湘雅医院收治的1073例急性坏死性胰腺炎(ANP)患者进行综合分析。根据IPN的发生情况将患者分为IPN组和无菌胰腺坏死(SPN)组。所有ANP患者随机分为训练数据集和验证数据集,比例为7:3。结合LASSO、随机森林、SVM等多个机器学习模型构建EL模型。为了验证EL模型的稳定性,选取湘雅第三医院的78例ANP患者进行外部验证,并构建Fagan nomogram来评估后验概率。结果通过LASSO回归,确定了31个危险因素,构建了EL模型。EL模型在训练数据集中的预测准确率为92.6%。在验证数据集中,预测准确率为91.5%。与LR模型相比,EL模型的AUC值更高(训练数据集:0.916 vs. 0.744;验证数据集:0.919 vs. 0.742)和净效益率。EL模型预测7 d、7 ~ 14 d和14 d后IPN的AUC分别为0.888、0.906和0.901。此外,外部验证结果进一步验证了EL模型的准确性(AUC: 0.883)。基于EL模型的Fagan模态图可以用来估计IPN预测的准确性。结论与LR模型相比,EL模型对IPN的预测效率更高,具有更高的预测价值和潜在的临床效益。此外,EL模型在IPN发作的不同阶段表现稳定,使临床医生能够及时调整治疗策略,最终改善患者的预后。试验注册本研究注册在www.researchregistry.com(唯一识别码:researchregistry10652)。
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引用次数: 0
Correction: Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries 更正:入院肌肉损伤指标在严重多发伤患者早期凝血功能障碍、炎症及急性肾损伤中的作用
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-08-06 DOI: 10.1186/s13017-025-00638-y
Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang

Correction: World Journal of Emergency Surgery (2025) 20:19

https://doi.org/10.1186/s13017-025-00593-8

In this article [1], Mengdi Jin was mistakenly listed as a co-first author.

The original article has been corrected.

  1. Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.

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  1. Liuquan Mou and Haideng Song are co-first authors.

Authors and Affiliations

  1. Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China

    Liuquan Mu, Kaige Li, Yushan Guo & Nan Jiang

  2. Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China

    Liuquan Mu

  3. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China

    Haideng Song & Mengdi Jin

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th

更正:世界急诊外科杂志(2025)20:19https://doi.org/10.1186/s13017-025-00593-8In这篇文章[1],金梦迪被错误地列为共同第一作者。原文已被更正。穆林,宋华,金敏,等。入院肌肉损伤指标在严重多发伤患者早期凝血功能障碍、炎症及急性肾损伤中的作用世界新兴医学杂志。2025;20:19。https://doi.org/10.1186/s13017-025-00593-8.Article PubMed PubMed Central谷歌学者下载参考资料作者说明牟柳泉、宋海登为共同第一作者。吉林大学中日联合医院创伤中心,吉林长春130033穆柳全,李凯歌,郭玉山等;山东大学威海市立医院吉鲁医学院急诊科,威海264200;吉林大学公共卫生学院流行病学与生物统计教研室,长春130021;金梦迪金梦迪authorsliuquan muluquan查看作者出版物搜索作者on:PubMed谷歌ScholarHaideng宋海登查看作者出版物搜索作者on:PubMed谷歌ScholarKaige金梦迪查看作者出版物搜索作者on:PubMed谷歌ScholarKaige LiView作者出版物搜索作者on:PubMed谷歌scholar玉山郭玉山查看作者出版物搜索作者on:PubMed谷歌scholar江南查看作者出版物搜索作者on:PubMed谷歌scholar通讯作者与江南通信。出版方声明:对于已出版地图的管辖权要求和机构关系,普林格·自然保持中立。开放获取本文遵循知识共享署名4.0国际许可协议,该协议允许以任何媒介或格式使用、共享、改编、分发和复制,只要您适当地注明原作者和来源,提供知识共享许可协议的链接,并注明是否进行了更改。本文中的图像或其他第三方材料包含在文章的知识共享许可协议中,除非在材料的署名中另有说明。如果材料未包含在文章的知识共享许可中,并且您的预期用途不被法律法规允许或超过允许的用途,您将需要直接获得版权所有者的许可。要查看该许可的副本,请访问http://creativecommons.org/licenses/by/4.0/.Reprints和permissionsCite这篇文章mu, L., Song, H., Jin, M.等人。更正:入院肌肉损伤指标在严重多发伤患者早期凝血功能障碍、炎症及急性肾损伤中的作用。世界新兴医学杂志,20,68(2025)。https://doi.org/10.1186/s13017-025-00638-yDownload citationpublish: 06 August 2025DOI: https://doi.org/10.1186/s13017-025-00638-yShare这篇文章任何你分享以下链接的人都可以阅读到这篇文章:获取可共享链接对不起,这篇文章目前没有可共享链接。复制到剪贴板由施普林格自然共享内容倡议提供
{"title":"Correction: Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries","authors":"Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang","doi":"10.1186/s13017-025-00638-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00638-y","url":null,"abstract":"<p><b>Correction: World Journal of Emergency Surgery (2025) 20:19</b></p><p><b>https://doi.org/10.1186/s13017-025-00593-8</b></p><p>In this article [1], Mengdi Jin was mistakenly listed as a co-first author.</p><p>The original article has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><span>Author notes</span><ol><li><p>Liuquan Mou and Haideng Song are co-first authors.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China</p><p>Liuquan Mu, Kaige Li, Yushan Guo &amp; Nan Jiang</p></li><li><p>Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China</p><p>Liuquan Mu</p></li><li><p>Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China</p><p>Haideng Song &amp; Mengdi Jin</p></li></ol><span>Authors</span><ol><li><span>Liuquan Mu</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Haideng Song</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Mengdi Jin</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Kaige Li</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yushan Guo</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Nan Jiang</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Corresponding author</h3><p>Correspondence to Nan Jiang.</p><h3>Publisher’s note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"96 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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World Journal of Emergency Surgery
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