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IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-11-20 DOI: 10.1016/S1008-1275(24)00121-4
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引用次数: 0
4-Octyl itaconate inhibits synovitis in the mouse model of post-traumatic osteoarthritis and alleviates pain. 伊塔康酸 4-辛酯可抑制创伤后骨关节炎小鼠模型中的滑膜炎并减轻疼痛。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-11-09 DOI: 10.1016/j.cjtee.2024.10.001
Yu-Zhen Tang, Wan Chen, Bao-Yun Xu, Gang He, Xiu-Cheng Fan, Kang-Lai Tang
<p><strong>Purpose: </strong>To investigate the pathological changes of the synovium in mice with post-traumatic osteoarthritis (PTOA) treated with 4-octyl itaconate (4-OI) and evaluate the therapeutic effects of 4-OI.</p><p><strong>Methods: </strong>In the phenotypic validation experiment, the mice were randomly divided into 3 groups: wild-type (WT) group, sham group, and destabilization of the medial meniscus (DMM) group. Through MRI, micro-CT, and histological analysis, it was determined that DMM surgery induced a mouse PTOA model with significant signs of synovitis. At 12 weeks post-DMM surgery, synovial tissues from the DMM group and WT group mice were collected for ribonucleic acid sequencing analysis. In the 4-OI treatment experiment, mice were randomly divided into the sham group, DMM group, DMM + 4-OI (50 mg/kg) group, and DMM + 4-OI (100 mg/kg) group. Von Frey tests and open field tests were conducted at intervals during the 12 weeks following the DMM surgery. After 12 weeks of surgery, the efficacy of 4-OI treatment on PTOA in mice was evaluated using MRI, Micro-CT, histological analysis, and quantitative real-time PCR. Finally, we utilized network pharmacology analysis to predict the mechanism of 4-OI in treating PTOA synovitis and conducted preliminary validation. Statistical analysis was performed using one-way ANOVA and the Kruskal-Wallis test.</p><p><strong>Results: </strong>The DMM surgery effectively induced a PTOA mouse model, which displayed significant symptoms of synovitis. These symptoms included a notable increase in both the number of calcified tissues and osteophytes (p < 0.001), an enlargement of the calcified meniscus and synovial tissue volume (p < 0.001), and thickening of the synovial lining layer attributable to M1 macrophage accumulation (p = 0.035). Additionally, we observed elevated histological scores for synovitis (p < 0.001). Treatment with 4-OI inhibited the thickening of M1 macrophages in the synovial lining layer of PTOA mice (p < 0.001) and reduced fibrosis in the synovial stroma (p = 0.004). Furthermore, it reduced the histological scores of knee synovitis in PTOA mice (p = 0.006) and improved the inflammatory microenvironment associated with synovitis. Consequently, this treatment alleviated pain in PTOA mice (p < 0.001) and reduced spontaneous activity (p = 0.003). Bioinformatics and network pharmacology analyses indicated that 4-OI may exert its therapeutic effects by inhibiting the differentiation of synovial Th17 cells. Specifically, compared to the lipopolysaccharide stimulation group, 4-OI reduced the levels of positive regulatory factors of Th17 cell differentiation (IL-1: p < 0.001, IL-6: p < 0.001), key effector molecules (IL-17A: p < 0.001, IL-17F: p = 0.004), and downstream effector molecules in the IL-17 signaling pathway (CCL2: p < 0.001, MMP13: p < 0.001).</p><p><strong>Conclusion: </strong>4-OI is effective in inhibiting synovitis in PTOA, thereby alleviating the associated painful sympto
目的:研究使用伊他康酸 4-辛酯(4-OI)治疗创伤后骨关节炎(PTOA)小鼠滑膜的病理变化,并评估 4-OI 的治疗效果:在表型验证实验中,小鼠被随机分为三组:野生型(WT)组、假组和内侧半月板失稳(DMM)组。通过核磁共振成像、显微 CT 和组织学分析,确定 DMM 手术诱导的小鼠 PTOA 模型有明显的滑膜炎症状。在 DMM 手术后 12 周,收集 DMM 组和 WT 组小鼠的滑膜组织进行核糖核酸测序分析。在 4-OI 治疗实验中,小鼠被随机分为假组、DMM 组、DMM + 4-OI (50 mg/kg) 组和 DMM + 4-OI (100 mg/kg) 组。在 DMM 手术后的 12 周内,每隔一段时间进行一次 Von Frey 试验和野外开放试验。手术 12 周后,我们使用 MRI、Micro-CT、组织学分析和定量实时 PCR 评估了 4-OI 治疗对小鼠 PTOA 的疗效。最后,我们利用网络药理学分析预测了 4-OI 治疗 PTOA 滑膜炎的机制,并进行了初步验证。统计分析采用单因素方差分析和 Kruskal-Wallis 检验:结果:DMM手术有效地诱导了PTOA小鼠模型,该模型出现了明显的滑膜炎症状。这些症状包括钙化组织和骨质增生的数量明显增加(p 结论:4-OI 能有效抑制滑膜炎的发生:4-OI 能有效抑制 PTOA 的滑膜炎,从而减轻相关的疼痛症状。
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引用次数: 0
Recent advances in the management of chronic ankle instability. 慢性踝关节不稳定治疗的最新进展。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-11-07 DOI: 10.1016/j.cjtee.2024.07.011
Yimeng Yang, Yang Wu, Wenhui Zhu

Ankle sprains are the most common lesion of the ankle joint which might result in chronic ankle instability (CAI). Significant strides have been taken to enhance our comprehension of the underlying mechanisms of CAI, as the exploration of novel surgical techniques and the identification of previously unrecognized anatomical components. The present review aims to provide an extensive overview of CAI, encompassing its pathophysiology, epidemiology, clinical assessment, treatment, and rehabilitation. Treatment of CAI requires a multifaceted algorithm, involving historical analysis, clinical evaluations, and diagnostic imaging. Surgical interventions for CAI primarily involve the anatomical and/or non-anatomical reconstruction and/or repair of the anterior talofibular ligament. Anatomical repair has exhibited superior functional outcomes and a reduced risk of secondary osteoarthritis compared to non-anatomical repair. Non-anatomical approaches fall short of replicating the normal biomechanics of the anterior talofibular ligament, potentially leading to postoperative stiffness. This review seeks to academically review and up-to-date literature on this issue, tailored for clinical practice, with the intent of aiding surgeons in staying abreast of this critical subject matter.

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引用次数: 0
Molecular mechanism underlying the protective effects of ischemic preconditioning in total knee arthroplasty. 全膝关节置换术中缺血预处理保护作用的分子机制。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-30 DOI: 10.1016/j.cjtee.2024.02.007
Yongli Wang, Bencai Du, Xueliang Han, Lianjun Qu

Propose: To investigate the molecular mechanisms underlying the protective effects of ischemic preconditioning (IPC) in patients undergoing total knee arthroplasty.

Methods: GSE21164 was extracted from an online database, followed by an investigation of differentially expressed genes (DEGs) between IPC treatment samples at 2 time points (T0T and T1T). Function and pathway enrichment analyses were performed on the DEGs. A protein-protein interaction network was constructed to identify hub genes according to 5 different algorithms, followed by enrichment analysis. In addition, long noncoding RNAs (lncRNAs) were identified between the T0T and T1T samples. Furthermore, a competing endogenous RNA network was predicted based on the identified lncRNA-messenger RNA (mRNA), lncRNA-microRNA (miRNA), and mRNA-miRNA relationships revealed in this study. Finally, a drug-gene network was investigated. Statistical analyses were performed using GraphPad Prism 8.0. Differences between groups were determined using an unpaired t-test. p < 0.05 was considered significant.

Results: A total of 343 DEGs at T0 and 10 DEGs at T1 were identified and compared with their respective control groups, followed by 100 DEGs between T0T and T1T. Based on these 100 DEGs, protein-protein interaction network analysis revealed 9 hub genes, mainly with mitochondria-related functions and the carbon metabolism pathway. Six differentially expressed lncRNAs were investigated between T0T and T1T. A competing endogenous RNA network was constructed using 259 lncRNA-miRNA-mRNA interactions, including alpha-2-macroglobulin antisense RNA 1-miR-7161-5p-iron-sulfur cluster scaffold. Finally, 13 chemical drugs associated with the hub genes were explored.

Conclusion: Iron-sulfur cluster scaffold may promote IPC-induced ischemic tolerance mediated by alpha-2-macroglobulin antisense RNA 1-miR-7161-5p axis. Moreover, IPC may induce a protective response after total knee arthroplasty via mitochondria-related functions and the carbon metabolism pathway, which should be further validated in the near future.

目的:研究缺血预处理(IPC)对全膝关节置换术患者的保护作用的分子机制:从在线数据库中提取 GSE21164,然后调查两个时间点(T0T 和 T1T)IPC 治疗样本之间的差异表达基因(DEGs)。对 DEGs 进行了功能和通路富集分析。根据 5 种不同的算法构建了蛋白质-蛋白质相互作用网络,以确定枢纽基因,然后进行富集分析。此外,还鉴定了 T0T 和 T1T 样本之间的长非编码 RNA(lncRNA)。此外,根据本研究中发现的lncRNA-信使RNA(mRNA)、lncRNA-微RNA(miRNA)和mRNA-miRNA关系,预测了竞争性内源性RNA网络。最后,还研究了药物基因网络。统计分析使用 GraphPad Prism 8.0 进行。组间差异采用非配对 t 检验:在 T0 和 T1 分别发现了 343 个 DEGs 和 10 个 DEGs,并与各自的对照组进行了比较,随后在 T0T 和 T1T 之间发现了 100 个 DEGs。基于这 100 个 DEGs,蛋白质-蛋白质相互作用网络分析发现了 9 个枢纽基因,主要与线粒体相关功能和碳代谢途径有关。在T0T和T1T之间研究了6个差异表达的lncRNA。利用259个lncRNA-miRNA-mRNA相互作用构建了竞争性内源性RNA网络,包括α-2-巨球蛋白反义RNA 1-miR-7161-5p-铁硫簇支架。最后,探讨了与枢纽基因相关的 13 种化学药物:铁硫簇支架可促进α-2-巨球蛋白反义 RNA 1-miR-7161-5p 轴介导的 IPC 诱导的缺血耐受。此外,IPC可能通过线粒体相关功能和碳代谢途径诱导全膝关节置换术后的保护性反应,这一点应在不久的将来得到进一步验证。
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引用次数: 0
Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries. 腹腔内压力监测在非手术治疗钝性肝脾损伤患者中的相关性。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-30 DOI: 10.1016/j.cjtee.2024.02.006
Vivek Kumar, Ramesh Vaidyanathan, Dinesh Bagaria, Pratyusha Priyadarshini, Abhinav Kumar, Narendra Choudhary, Sushma Sagar, Amit Gupta, Biplab Mishra, Mohit Joshi, Kapil Dev Soni, Richa Aggarwal, Subodh Kumar

Purpose: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.

Method: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance.

Results: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention.

Conclusion: As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.

目的:非手术治疗(NOM)已被证实适用于钝性肝脾损伤。有关作为非手术治疗一部分的连续腹腔内压力(IAP)监测的文献仍不明确。本研究旨在找出临床参数与 IAP 之间的相关性,以及它们对肝脾钝性损伤患者 NOM 的影响:2018年10月至2020年1月,在一家一级创伤中心进行了一项前瞻性横断面研究,包括174名因肝脾钝性损伤而接受NOM的患者。排除了血流动力学不稳定或使用呼吸机的患者,以及头部、脊髓和/或膀胱严重损伤的患者。研究对象主要为男性(83.9%),平均年龄为 32.5 岁。对 IAP 进行了连续监测,并测量了 IAP 与各种参数、干预措施和结果的关系。数据以频率(百分比)或平均值 ± SD 或中位数(Q1、Q3)表示。分类变量采用χ2检验或费雪精确检验,连续变量则酌情采用参数检验(独立t检验)或非参数检验(Wilcoxon秩和检验)。IAP < 12 与 p 结果的临床和实验室相关性:19.0%的研究对象患有腹腔内高血压(IAH)。腹内高压与损伤严重程度评分较高密切相关(p 结论:腹内高压与损伤严重程度评分较低密切相关:作为 NOM 的一部分,应持续监测 IAP。但是,不能仅根据 IAP 值来决定是否进行手术或非手术干预。
{"title":"Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries.","authors":"Vivek Kumar, Ramesh Vaidyanathan, Dinesh Bagaria, Pratyusha Priyadarshini, Abhinav Kumar, Narendra Choudhary, Sushma Sagar, Amit Gupta, Biplab Mishra, Mohit Joshi, Kapil Dev Soni, Richa Aggarwal, Subodh Kumar","doi":"10.1016/j.cjtee.2024.02.006","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.02.006","url":null,"abstract":"<p><strong>Purpose: </strong>Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.</p><p><strong>Method: </strong>A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q<sub>1</sub>, Q<sub>3</sub>) as indicated. χ<sup>2</sup> or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance.</p><p><strong>Results: </strong>Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention.</p><p><strong>Conclusion: </strong>As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Stent-graft implantation for late postpancreatectomy hemorrhage after pancreatoduodenectomy. 胰十二指肠切除术后晚期胰腺切除术后出血的支架移植术。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-29 DOI: 10.1016/j.cjtee.2024.08.009
Xiaoye Li, Shibo Xia, Liangxi Yuan, Lei Zhang, Chao Song, Xiaolong Wei, Qingsheng Lu

Purpose: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation.

Methods: This was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± SD when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p value < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients' survival.

Results: Pancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively.

Conclusions: With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.

目的:胰腺切除术后出血(PPH)是胰十二指肠切除术后一种危及生命的并发症。支架移植物植入术是治疗 PPH 的新兴疗法。本研究报告了采用支架移植物植入术治疗 PPH 的结果:这是一项单中心回顾性研究。在2020年4月至2023年12月期间,我们收集了1723例胰腺切除术病例,并筛选出12例胰十二指肠切除术后使用支架移植物植入治疗PPH的病例。我们对患者的医疗和放射影像进行了回顾性审查。对技术和临床成功率、并发症以及支架移植物的通畅性进行了评估。连续数据在呈正态分布时以均数 ± SD 表示,在呈非正态分布时以中位数(Q1、Q3)表示。分类数据以 n(%)表示。P 值 结果:发现胰瘘 6 例(50.0%),假性动脉瘤 3 例(25.0%),其中胰瘘合并假性动脉瘤 1 例(8.3%)。所有假性动脉瘤或造影剂外渗部位均成功排除,远端灌注通畅,因此所有病例均取得了技术成功。6 个月和 1 年的总存活率分别为 91.7% 和 78.6%。一名患者的小肠疝入胸腔,造成胸腔和腹腔广泛感染,在住院期间死亡。1例患者在为脾动脉植入支架后,胃十二指肠动脉残端发生再出血,经再次植入支架后成功治愈。术后 24.6 和 26.3 天分别观察到两例无症状支架移植物闭塞:在解剖结构合适的情况下,覆盖支架移植物植入术是治疗不同出血部位和原因的 PPH 的有效而安全的选择。
{"title":"Stent-graft implantation for late postpancreatectomy hemorrhage after pancreatoduodenectomy.","authors":"Xiaoye Li, Shibo Xia, Liangxi Yuan, Lei Zhang, Chao Song, Xiaolong Wei, Qingsheng Lu","doi":"10.1016/j.cjtee.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.009","url":null,"abstract":"<p><strong>Purpose: </strong>Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation.</p><p><strong>Methods: </strong>This was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± SD when normally distributed or as median (Q<sub>1</sub>, Q<sub>3</sub>) when the data is non-normal distributed. Categorical data are reported as n (%). A p value < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients' survival.</p><p><strong>Results: </strong>Pancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively.</p><p><strong>Conclusions: </strong>With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces. 在院前创伤护理中何时选择鞘内通路?以色列国防军的登记研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-11 DOI: 10.1016/j.cjtee.2024.08.008
Mor Rittblat, Nir Tsur, Adi Karas, Sami Gendler, Zivan Beer, Irina Radomislensky, Ofer Almog, Avishai M Tsur, Guy Avital, Tomer Talmy

Purpose: Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.

Methods: A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05.

Results: Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3).

Conclusion: Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.

目的:在院前环境中,及时进行血管通路对于抢救大出血的创伤伤员至关重要,但在失血性休克期间,由于外周血管塌陷,实现外周静脉(PIV)通路可能具有挑战性。有人建议尽早使用骨内(IO)装置作为替代方案。本研究探讨了与 IO 通道要求相关的损伤特征和因素:方法:一项基于以色列国防军创伤登记处的登记队列研究(2010 - 2023 年)纳入了院前接受 PIV 或 IO 入路的创伤伤员。研究纳入了至少有一次PIV或IO通路尝试记录的伤员,但排除了没有血管通路的伤员。同时需要 PIV 和 IO 的伤员被归入 IO 组。单变量逻辑回归评估了与 IO 入路相关的因素。结果以几率比(OR)和 95% 置信区间(CI)的形式报告,以 p 为显著差异:在 3462 名伤员(86.3% 为男性,中位年龄为 22 岁)中,有 3287 人(94.9%)接受了 PIV 入路,175 人(5.1%)尝试过 IO 入路。在 IO 组中,30.3% 接受了冻干血浆,23.4% 接受了低滴度 O 组全血,明显高于 PIV 组。IO 组的院前死亡率为 35.0%。单变量分析显示,PIV尝试次数增加(OR = 1.69;95% CI:1.34 - 2.13)和深度休克体征(OR = 11.0;95% CI:5.5 - 23.3)与IO接入有明显关联:结论:在院前环境中,严重休克征兆与 IO 接入需求密切相关,每次连续的 PIV 尝试都会增加需要 IO 转换的可能性。在输入低滴度 O 组全血或冻干血浆的同时,院前死亡率也较高,这表明在紧急抢救情况下应使用 IO。对于严重休克的创伤伤员,建议尽早考虑 IO。
{"title":"When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces.","authors":"Mor Rittblat, Nir Tsur, Adi Karas, Sami Gendler, Zivan Beer, Irina Radomislensky, Ofer Almog, Avishai M Tsur, Guy Avital, Tomer Talmy","doi":"10.1016/j.cjtee.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.008","url":null,"abstract":"<p><strong>Purpose: </strong>Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.</p><p><strong>Methods: </strong>A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05.</p><p><strong>Results: </strong>Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3).</p><p><strong>Conclusion: </strong>Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
A novel arterial coupler with non-return snap-fit connection approach optimized arterial end-to-end anastomotic technique: An experimental study. 新型动脉耦合器与非回流卡入式连接方法优化了动脉端到端吻合技术:实验研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-17 DOI: 10.1016/j.cjtee.2024.09.006
Hong-Bo Guo, Mo-Fei Wang, Ren-Qi Yin, Kang-Kang Zhi
<p><strong>Purpose: </strong>Hand-sewn anastomosis as the gold standard of vascular anastomosis cannot fully meet the requirements of vascular anastomosis in speed and quality. Various vascular couplers have been developed to ameliorate this situation. Most of them are mainly used for venous anastomosis rather than arterial anastomosis, even though it is generally acknowledged that in almost all operations involving vascular reconstruction, it is the arteries that need to be anastomosed faster and more accurately and not the veins. A dedicated device is needed for creating arterial anastomosis in an easy, timesaving, less damaging but reliable procedure. Therefore, we plan to develop a novel arterial coupler device and test pre-clinical safety and effectiveness.</p><p><strong>Methods: </strong>In this cohort study, the rationality of this novel arterial coupler was preliminarily tested by finite element analysis before it was manufactured. Several factors restrict the use of vascular couplers in arterial anastomosis, such as arterial eversion, fixation, etc. The manufactured arterial couplers underwent in vitro and in vivo experiments. In vitro, isolated arteries of beagles were anastomosed with the assistance of an arterial coupler, and the anastomosed arteries were evaluated through anti-traction tests. In animal experiments, the bilateral femoral arteries of 5 beagles served as a control group. After dissection, the femoral artery on one side was randomly selected to be anastomosed with a quick arterial coupler (QAC) (QAC group), and the femoral artery on the other side was anastomosed by the same person using an end-to-end suture technique with a 6-0 Prolene suture (suture group). The bilateral femoral arteries of 5 beagles were used for coupler-assisted anastomosis and hand-sewn anastomosis in vivo, respectively. Success rate, blood loss, anastomotic time, clamp time, total operation time, and patency rate were recorded. The patency of anastomosed arteries was assessed using vascular Doppler ultrasound, electromagnetic flowmeter, and pathological examination (6 weeks after surgery).</p><p><strong>Results: </strong>As a novel arterial coupler, QAC was successfully designed and manufactured by using poly lactic-co-glycolic acid raw materials and 3-dimensions printing technology. Its rationality was preliminarily tested through finite element analysis and related mechanical analysis methods. The isolated arteries were successfully anastomosed with the assistance of QAC in vitro testing, which showed good anti-traction properties. In animal studies, QAC-assisted arterial anastomosis has superior profiles compared to hand-sewn anastomosis in anastomotic time (7.80 ± 1.41 vs. 16.38 ± 1.04 min), clamp time (8.80 ± 1.41 vs. 14.14 ± 1.57 min), and total operation time (46.64 ± 2.38 vs. 51.96 ± 3.65 min). The results of electromagnetic flowmeter, vascular Doppler ultrasound, and pathological examination showed that QAC-assisted anastomotic arteries we
目的:手工缝合作为血管吻合的金标准,在速度和质量上无法完全满足血管吻合的要求。为了改善这种情况,人们开发了各种血管耦合器。尽管人们普遍认为,在几乎所有涉及血管重建的手术中,需要更快、更准确吻合的是动脉而不是静脉,但它们大多主要用于静脉吻合而不是动脉吻合。因此,我们需要一种专用设备,以简便、省时、损伤小且可靠的方式进行动脉吻合。因此,我们计划开发一种新型动脉耦合器装置,并对其临床前安全性和有效性进行测试:在这项队列研究中,我们在制造这种新型动脉耦合器之前,通过有限元分析对其合理性进行了初步测试。在动脉吻合术中使用血管耦合器受到多种因素的限制,如动脉外翻、固定等。制造出的动脉耦合器经过了体外和体内实验。在体外实验中,在动脉耦合器的辅助下吻合了小猎犬的离体动脉,并通过抗牵引试验对吻合动脉进行了评估。在动物实验中,5 只猎犬的双侧股动脉作为对照组。解剖后,随机选择一侧股动脉用快速动脉耦合器(QAC)进行吻合(QAC 组),另一侧股动脉由同一人使用 6-0 Prolene 缝线进行端对端缝合(缝合组)。5 只猎犬的双侧股动脉分别用于耦合器辅助吻合和体内手缝吻合。记录了吻合成功率、失血量、吻合时间、钳夹时间、总手术时间和通畅率。使用血管多普勒超声、电磁流量计和病理检查(术后 6 周)评估吻合动脉的通畅情况:结果:采用聚乳酸-共聚乙醇酸原料和三维打印技术,成功设计并制造了新型动脉耦合器 QAC。通过有限元分析和相关力学分析方法对其合理性进行了初步测试。在体外测试中,离体动脉在 QAC 的辅助下成功吻合,显示出良好的抗牵引性。在动物实验中,QAC 辅助动脉吻合术在吻合时间(7.80 ± 1.41 vs. 16.38 ± 1.04 分钟)、夹持时间(8.80 ± 1.41 vs. 14.14 ± 1.57 分钟)和总手术时间(46.64 ± 2.38 vs. 51.96 ± 3.65 分钟)方面均优于手缝吻合术。电磁流量计、血管多普勒超声和病理检查结果表明,QAC辅助吻合动脉的术后血流量(16.86 ± 3.93 vs. 10.36 ± 0.92 mL/min)和术后6周的血管通畅度均优于手缝动脉:结论:QAC 是一种设计精良、易于操作的装置,专门用于端对端动脉吻合术。结论:QAC 是一种设计精良、易于操作的装置,专门用于端对端动脉吻合术,应用该装置可缩短热缺血时间,改善吻合动脉的通畅性,从而改善预后。
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引用次数: 0
Reconstruction of Allen's type IV fingertip amputation via bilateral unequal-sized hallux osteo-onychocutaneous free flaps: A retrospective study with 5-year follow-up 通过双侧大小不等的同侧骨巩膜游离皮瓣重建艾伦第 IV 型指尖截肢:一项为期五年的回顾性研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-14 DOI: 10.1016/j.cjtee.2024.09.005
Xiu-Zhong Li , Xiu-Yun Wang , Yi-Min Zhou , Da-Zhi Yu , Hua-Gang Zhang , Shu-Jian Hou , Ke-Cheng Lao , Xiao Fan

Purpose

The reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique.

Methods

A retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD.

Results

The mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory.

Conclusion

Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.
目的:AllenⅣ型指尖截肢的重建是一项临床挑战。我们的团队设计了双侧不等大的同侧骨-腱-皮游离瓣,用于Allen's IV型指尖截肢的长期重建,并进行了一项为期5年的回顾性研究,旨在评估该技术的效果:方法:对我院2010年1月至2017年1月收治的13例Allen's IV型指尖截肢患者进行了为期5年的回顾性分析。这些患者均接受了双侧不等大的指骨骨膜游离皮瓣治疗。记录了手术时间、术中失血量和并发症,并计算了移植皮瓣的存活率。术后 5 年随访期间,记录指甲生长时间并观察手指外观。最后一次复诊时,记录了再造指尖和对侧正常指尖的长度、宽度和周长,再造指尖和对侧正常指尖的活动范围,Semmes-Weinstein 测试(用于评估触觉)和两点辨别测试结果。统计分析采用 SPSS 22.0 软件,数据以均数±标准差表示:平均手术时间为(5.62±0.51)小时,术中平均失血量为(34.15±3.13)毫升,移植皮瓣的存活率为 100%。5 年随访期间,平均指甲生长时间为(10.14 ± 1.98)个月,平均骨结合时间为(3.78 ± 0.91)个月。再造指尖的长度、宽度和周长分别为(31.52±3.73)毫米、(17.82±1.74)毫米和(59.75±3.04)毫米,与对侧正常指尖相比没有差异。重建指尖的活动范围为(12.15 ± 2.79)度,与对侧正常指尖的活动范围不同。通过 Semmes-Weinstein 测试和两点辨别测试评估的重建指尖的平均触觉分别为(0.39 ± 0.17)克和(7.46 ± 1.14)毫米,与对侧正常指尖相比没有差异。供区足的平均马里兰评分为(87.66±7.39)分,结果令人满意:结论:双侧不等大同侧骨髁皮游离瓣是重建Allen's IV型指尖截肢的有效方法,其外观令人满意,且感觉功能良好。
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引用次数: 0
Research progress of tourniquets and their application in the Russia-Ukraine Conflict. 止血带的研究进展及其在俄乌冲突中的应用。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-13 DOI: 10.1016/j.cjtee.2024.07.010
Shaojie Nie, Kangkang Zhi, Lefeng Qu

Against the backdrop of the Russia-Ukraine Conflict in 2022, this article reviews the characteristics of traumatic hemorrhage in modern warfare spanning the past century. It investigates several types of tourniquets used by the Russian and Ukrainian armed forces, including limb tourniquets and junctional tourniquets recommended by the Committee on Tactical Combat Casualty Care, tourniquets employed by the Armed Forces of the Russian Federation, and those used by the Armed Forces of Ukraine in the Russia-Ukraine Conflict. The analysis is conducted from perspectives, including the structure, usage methods, and limitations of different tourniquets. Additionally, the article synthesizes the research progress on tourniquets from 3 angles: battlefield adaptability, the impact of tourniquet application methods on patient outcomes, and training in tourniquet usage, offering insights from our team's perspective.

本文以 2022 年俄乌冲突为背景,回顾了上个世纪现代战争中创伤性出血的特点。文章研究了俄罗斯和乌克兰武装部队使用的几种止血带,包括战术战斗伤员救护委员会推荐的肢体止血带和连接止血带、俄罗斯联邦武装部队使用的止血带以及乌克兰武装部队在俄乌冲突中使用的止血带。文章从不同止血带的结构、使用方法和局限性等角度进行了分析。此外,文章还从战场适应性、止血带使用方法对患者预后的影响和止血带使用培训三个角度综合了止血带的研究进展,提出了我们团队的见解。
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引用次数: 0
期刊
Chinese Journal of Traumatology
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