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FM1-Editorial board
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/S1008-1275(24)00159-7
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引用次数: 0
Guide for Author
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/S1008-1275(24)00165-2
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引用次数: 0
Central venous oxygen saturation changes as a reliable predictor of the change of CI in septic shock: To explore potential influencing factors 中心静脉血氧饱和度变化是脓毒性休克患者 CI 变化的可靠预测指标:探讨潜在的影响因素
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/j.cjtee.2024.05.001
Ran An , Xi-Xi Wan , Yan Chen , Run Dong , Chun-Yao Wang , Wei Jiang , Li Weng , Bin Du

Purpose

Assessing fluid responsiveness relying on central venous oxygen saturation (ScvO2) yields varied outcomes across several studies. This study aimed to determine the ability of the change in ScvO2 (ΔScvO2) to detect fluid responsiveness in ventilated septic shock patients and potential influencing factors.

Methods

In this prospective, single-center study, all patients conducted from February 2023 to January 2024 received fluid challenge. Oxygen consumption was measured by indirect calorimetry, and fluid responsiveness was defined as an increase in cardiac index (CI) ≥ 10% measured by transthoracic echocardiography. Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption, arterial oxygen saturation, CI, and hemoglobin on ScvO2 and its change before and after fluid challenge. The Shapiro-Wilk test was used for the normality of continuous data. Data comparison between fluid responders and non-responders was conducted using a two-tailed Student t-test, Mann Whitney U test, and Chi-square test. Paired t-tests were used for normally distributed data, while the Wilcoxon signed-rank test was used for skewed data, to compare data before and after fluid challenge.

Results

Among 49 patients (31 men, aged (59 ± 18) years), 27 were responders. The patients had an acute physiology and chronic health evaluation II score of 24 ± 8, a sequential organ failure assessment score of 11 ± 4, and a blood lactate level of (3.2 ± 3.1) mmol/L at enrollment. After the fluid challenge, the ΔScvO2 (mmHg) in the responders was greater than that in the non-responders (4 ± 6 vs. 1 ± 3, p = 0.019). Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO2, with R2 = 0.063, p = 0.008. After the fluid challenge, the change in CI became the only contributing factor to ΔScvO2 (R2 = 0.245, p < 0.001). ΔScvO2 had a good discriminatory ability for the responders and non-responders with a threshold of 4.4% (area under the curve = 0.732, p = 0.006).

Conclusion

ΔScvO2 served as a reliable surrogate marker for ΔCI and could be utilized to assess fluid responsiveness, given that the change in CI was the sole contributing factor to the ΔScvO2. In stable hemoglobin conditions, the absolute value of ScvO2 could serve as a monitoring indicator for adequate oxygen delivery independent of oxygen consumption.
{"title":"Central venous oxygen saturation changes as a reliable predictor of the change of CI in septic shock: To explore potential influencing factors","authors":"Ran An ,&nbsp;Xi-Xi Wan ,&nbsp;Yan Chen ,&nbsp;Run Dong ,&nbsp;Chun-Yao Wang ,&nbsp;Wei Jiang ,&nbsp;Li Weng ,&nbsp;Bin Du","doi":"10.1016/j.cjtee.2024.05.001","DOIUrl":"10.1016/j.cjtee.2024.05.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Assessing fluid responsiveness relying on central venous oxygen saturation (ScvO<sub>2</sub>) yields varied outcomes across several studies. This study aimed to determine the ability of the change in ScvO<sub>2</sub> (ΔScvO<sub>2</sub>) to detect fluid responsiveness in ventilated septic shock patients and potential influencing factors.</div></div><div><h3>Methods</h3><div>In this prospective, single-center study, all patients conducted from February 2023 to January 2024 received fluid challenge. Oxygen consumption was measured by indirect calorimetry, and fluid responsiveness was defined as an increase in cardiac index (CI) ≥ 10% measured by transthoracic echocardiography. Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption, arterial oxygen saturation, CI, and hemoglobin on ScvO<sub>2</sub> and its change before and after fluid challenge. The Shapiro-Wilk test was used for the normality of continuous data. Data comparison between fluid responders and non-responders was conducted using a two-tailed Student <em>t</em>-test, Mann Whitney U test, and Chi-square test. Paired <em>t</em>-tests were used for normally distributed data, while the Wilcoxon signed-rank test was used for skewed data, to compare data before and after fluid challenge.</div></div><div><h3>Results</h3><div>Among 49 patients (31 men, aged (59 ± 18) years), 27 were responders. The patients had an acute physiology and chronic health evaluation II score of 24 ± 8, a sequential organ failure assessment score of 11 ± 4, and a blood lactate level of (3.2 ± 3.1) mmol/L at enrollment. After the fluid challenge, the ΔScvO<sub>2</sub> (mmHg) in the responders was greater than that in the non-responders (4 ± 6 <em>vs.</em> 1 ± 3, <em>p</em> = 0.019). Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO<sub>2</sub>, with <em>R</em><sup><em>2</em></sup> = 0.063, <em>p</em> = 0.008. After the fluid challenge, the change in CI became the only contributing factor to ΔScvO<sub>2</sub> (<em>R</em><sup><em>2</em></sup> = 0.245, <em>p</em> &lt; 0.001). ΔScvO<sub>2</sub> had a good discriminatory ability for the responders and non-responders with a threshold of 4.4% (area under the curve = 0.732, <em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>ΔScvO<sub>2</sub> served as a reliable surrogate marker for ΔCI and could be utilized to assess fluid responsiveness, given that the change in CI was the sole contributing factor to the ΔScvO<sub>2</sub>. In stable hemoglobin conditions, the absolute value of ScvO<sub>2</sub> could serve as a monitoring indicator for adequate oxygen delivery independent of oxygen consumption.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 43-49"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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 : 2025-01-01 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 ± standard deviation when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p < 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。
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引用次数: 0
Evaluating the effectiveness of immediate vs. elective thoracic endovascular aortic repair for blunt thoracic aortic injury 评估钝性胸主动脉损伤时立即进行胸腔内血管主动脉修补术与择期进行胸腔内血管主动脉修补术的效果。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/j.cjtee.2024.08.002
Zhaohui Hua , Baoning Zhou , Wenhao Xue , Zhibin Zhou , Jintao Shan , Lei Xia , Yunpeng Luo , Yiming Chai , Zhen Li
<div><h3>Purpose</h3><div>To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 <em>vs.</em> > 25) and when the TEVAR was performed for BTAI (within 24 h <em>vs.</em> after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q<sub>1</sub>, Q<sub>3</sub>), and were compared using either the <em>t</em>-test or the Mann-Whitney <em>U</em> test. Categorical variables were expressed as <em>n</em> (%), and comparisons were made between the 2 groups using the χ<sup>2</sup> test or Fisher’s exact test. Statistical significance was defined as a 2-sided <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) <em>vs.</em> 2 (4.4%), <em>p</em> < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q<sub>1</sub>, Q<sub>3</sub>)) compared to the immediate group (15 (12, 15) <em>vs.</em> 13.5 (9, 15), <em>p</em> = 0.039), while the creatinine concentration (median (Q<sub>1</sub>, Q<sub>3</sub>)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) <em>vs.</em> 71.5 (58.3, 80.8), <em>p</em> = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) <em>vs.</em> 3 (10.0%), <em>p</em> < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266–35.752, <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>In this propensity-score matched anal
目的:评估钝性胸主动脉损伤(BTAI)胸腔内血管主动脉修复术(TEVAR)的时机与预后之间的关系:这是一项单中心回顾性队列研究。根据损伤严重程度评分(ISS)(≤ 25 vs. >25)和为 BTAI 实施 TEVAR 的时间(24 h 内 vs. 24 h 后),将 2016 年 10 月至 2023 年 9 月期间在我院接受 TEVAR 的 BTAI 患者分为两类。分析包括所有通过全身 CT 血管造影确诊为 BTAI 后接受 TEVAR 治疗的患者。不包括接受开放式修复和非手术治疗的患者。在对各种因素进行倾向分数匹配后,对住院期间和随访期间的结果进行了比较。这些因素包括入院时的人口统计学特征、合并症、并发症、主动脉损伤的原因和部位、格拉斯哥昏迷量表评分、血管外科学会分级、血红蛋白浓度、肌酐浓度、休克、收缩压和心率。比较使用 SPSS 26 软件进行。连续变量以均数±标准差或中位数(Q1、Q3)表示,采用 t 检验或 Mann-Whitney U 检验进行比较。分类变量以 n(%)表示,两组间的比较采用 χ2 检验或费雪精确检验。统计显著性定义为双侧 P < 0.05:共有110名患者参与了研究,其中65名(59.1%)患者的ISS评分大于25分,32名(29.1%)患者立即接受了TEVAR。与即刻手术组相比,ISS>25组的围手术期总死亡率明显高于ISS≤25组(11 (16.9%) vs. 2 (4.4%),P 1, Q3)(15 (12, 15) vs. 13.5 (9, 15))。而入院时肌酐浓度(中位数(Q1,Q3))则明显高于即时组(90.5(63.8,144.0)vs 71.5(58.3,80.8),p = 0.012)。最终样本包括 52 名匹配的患者。与即刻手术组相比,择期手术组发生并发症的频率明显较低(16 例(50.0%)对 3 例(10.0%),P=0.012):在这项对因 BTAI 而接受 TEVAR 的患者进行的倾向得分匹配分析中,选择性 TEVAR 与较低的并发症发生率风险明显相关。在这项使用倾向分数匹配的研究中,因 BTAI 而接受择期 TEVAR 的患者的并发症发生率低于立即接受 TEVAR 的患者。
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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 : 2025-01-01 DOI: 10.1016/j.cjtee.2024.10.001
Yu-Zhen Tang , Wan Chen , Bao-Yun Xu , Gang He , Xiu-Cheng Fan , Kang-Lai Tang
<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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 the 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 polymerase chain reaction. 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. Difference was considered statistically significant at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 0.001), an enlargement of the calcified meniscus and synovial tissue volume (<em>p</em> < 0.001), and thickening of the synovial lining layer attributable to M1 macrophage accumulation (<em>p</em> = 0.035). Additionally, we observed elevated histological scores for synovitis (<em>p</em> < 0.001). Treatment with 4-OI inhibited the thickening of M1 macrophages in the synovial lining layer of PTOA mice (<em>p</em> < 0.001) and reduced fibrosis in the synovial stroma (<em>p</em> = 0.004). Furthermore, it reduced the histological scores of knee synovitis in PTOA mice (<em>p</em> = 0.006) and improved the inflammatory microenvironment associated with synovitis. Consequently, this treatment alleviated pain in PTOA mice (<em>p</em> < 0.001) and reduced spontaneous activity (<em>p</em> = 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: <em>p</em> < 0.001, IL-6: <em>p</em> < 0.001), key effector molecules (IL-17A: <em>p</em> < 0.001, IL-17F: <em>p</
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。
{"title":"4-Octyl itaconate inhibits synovitis in the mouse model of post-traumatic osteoarthritis and alleviates pain","authors":"Yu-Zhen Tang ,&nbsp;Wan Chen ,&nbsp;Bao-Yun Xu ,&nbsp;Gang He ,&nbsp;Xiu-Cheng Fan ,&nbsp;Kang-Lai Tang","doi":"10.1016/j.cjtee.2024.10.001","DOIUrl":"10.1016/j.cjtee.2024.10.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 the 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 polymerase chain reaction. 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. Difference was considered statistically significant at &lt;em&gt;p&lt;/em&gt; &lt; 0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), an enlargement of the calcified meniscus and synovial tissue volume (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), and thickening of the synovial lining layer attributable to M1 macrophage accumulation (&lt;em&gt;p&lt;/em&gt; = 0.035). Additionally, we observed elevated histological scores for synovitis (&lt;em&gt;p&lt;/em&gt; &lt; 0.001). Treatment with 4-OI inhibited the thickening of M1 macrophages in the synovial lining layer of PTOA mice (&lt;em&gt;p&lt;/em&gt; &lt; 0.001) and reduced fibrosis in the synovial stroma (&lt;em&gt;p&lt;/em&gt; = 0.004). Furthermore, it reduced the histological scores of knee synovitis in PTOA mice (&lt;em&gt;p&lt;/em&gt; = 0.006) and improved the inflammatory microenvironment associated with synovitis. Consequently, this treatment alleviated pain in PTOA mice (&lt;em&gt;p&lt;/em&gt; &lt; 0.001) and reduced spontaneous activity (&lt;em&gt;p&lt;/em&gt; = 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: &lt;em&gt;p&lt;/em&gt; &lt; 0.001, IL-6: &lt;em&gt;p&lt;/em&gt; &lt; 0.001), key effector molecules (IL-17A: &lt;em&gt;p&lt;/em&gt; &lt; 0.001, IL-17F: &lt;em&gt;p&lt;/","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 50-61"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 : 2025-01-01 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.
踝关节扭伤是踝关节最常见的损伤,可能导致慢性踝关节不稳定(CAI)。随着对新型手术技术的探索和对以前未曾认识到的解剖学成分的识别,我们对 CAI 潜在机制的理解有了长足的进步。本综述旨在广泛概述 CAI,包括其病理生理学、流行病学、临床评估、治疗和康复。CAI 的治疗需要多方面的算法,包括历史分析、临床评估和影像诊断。CAI 的手术干预主要涉及解剖和/或非解剖重建和/或修复距骨胫骨前韧带。与非解剖性修复相比,解剖性修复的功能效果更好,继发性骨关节炎的风险也更低。非解剖方法无法复制距骨胫骨前韧带的正常生物力学,可能导致术后僵硬。本综述旨在对这一问题的最新文献进行学术回顾,为临床实践量身定制,目的是帮助外科医生了解这一关键主题。
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引用次数: 0
YOLOX-SwinT algorithm improves the accuracy of AO/OTA classification of intertrochanteric fractures by orthopedic trauma surgeons YOLOX-SwinT 算法提高了创伤骨科医生对转子间骨折进行 AO/OTA 分类的准确性
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/j.cjtee.2024.04.002
Xue-Si Liu , Rui Nie , Ao-Wen Duan , Li Yang , Xiang Li , Le-Tian Zhang , Guang-Kuo Guo , Qing-Shan Guo , Dong-Chu Zhao , Yang Li , He-Hua Zhang

Purpose

Intertrochanteric fracture (ITF) classification is crucial for surgical decision-making. However, orthopedic trauma surgeons have shown lower accuracy in ITF classification than expected. The objective of this study was to utilize an artificial intelligence (AI) method to improve the accuracy of ITF classification.

Methods

We trained a network called YOLOX-SwinT, which is based on the You Only Look Once X (YOLOX) object detection network with Swin Transformer (SwinT) as the backbone architecture, using 762 radiographic ITF examinations as the training set. Subsequently, we recruited 5 senior orthopedic trauma surgeons (SOTS) and 5 junior orthopedic trauma surgeons (JOTS) to classify the 85 original images in the test set, as well as the images with the prediction results of the network model in sequence. Statistical analysis was performed using the SPSS 20.0 (IBM Corp., Armonk, NY, USA) to compare the differences among the SOTS, JOTS, SOTS + AI, JOTS + AI, SOTS + JOTS, and SOTS + JOTS + AI groups. All images were classified according to the AO/OTA 2018 classification system by 2 experienced trauma surgeons and verified by another expert in this field. Based on the actual clinical needs, after discussion, we integrated 8 subgroups into 5 new subgroups, and the dataset was divided into training, validation, and test sets by the ratio of 8:1:1.

Results

The mean average precision at the intersection over union (IoU) of 0.5 (mAP50) for subgroup detection reached 90.29%. The classification accuracy values of SOTS, JOTS, SOTS + AI, and JOTS + AI groups were 56.24% ± 4.02%, 35.29% ± 18.07%, 79.53% ± 7.14%, and 71.53% ± 5.22%, respectively. The paired t-test results showed that the difference between the SOTS and SOTS + AI groups was statistically significant, as well as the difference between the JOTS and JOTS + AI groups, and the SOTS + JOTS and SOTS + JOTS + AI groups. Moreover, the difference between the SOTS + JOTS and SOTS + JOTS + AI groups in each subgroup was statistically significant, with all p < 0.05. The independent samples t-test results showed that the difference between the SOTS and JOTS groups was statistically significant, while the difference between the SOTS + AI and JOTS + AI groups was not statistically significant. With the assistance of AI, the subgroup classification accuracy of both SOTS and JOTS was significantly improved, and JOTS achieved the same level as SOTS.

Conclusion

In conclusion, the YOLOX-SwinT network algorithm enhances the accuracy of AO/OTA subgroups classification of ITF by orthopedic trauma surgeons.
{"title":"YOLOX-SwinT algorithm improves the accuracy of AO/OTA classification of intertrochanteric fractures by orthopedic trauma surgeons","authors":"Xue-Si Liu ,&nbsp;Rui Nie ,&nbsp;Ao-Wen Duan ,&nbsp;Li Yang ,&nbsp;Xiang Li ,&nbsp;Le-Tian Zhang ,&nbsp;Guang-Kuo Guo ,&nbsp;Qing-Shan Guo ,&nbsp;Dong-Chu Zhao ,&nbsp;Yang Li ,&nbsp;He-Hua Zhang","doi":"10.1016/j.cjtee.2024.04.002","DOIUrl":"10.1016/j.cjtee.2024.04.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Intertrochanteric fracture (ITF) classification is crucial for surgical decision-making. However, orthopedic trauma surgeons have shown lower accuracy in ITF classification than expected. The objective of this study was to utilize an artificial intelligence (AI) method to improve the accuracy of ITF classification.</div></div><div><h3>Methods</h3><div>We trained a network called YOLOX-SwinT, which is based on the You Only Look Once X (YOLOX) object detection network with Swin Transformer (SwinT) as the backbone architecture, using 762 radiographic ITF examinations as the training set. Subsequently, we recruited 5 senior orthopedic trauma surgeons (SOTS) and 5 junior orthopedic trauma surgeons (JOTS) to classify the 85 original images in the test set, as well as the images with the prediction results of the network model in sequence. Statistical analysis was performed using the SPSS 20.0 (IBM Corp., Armonk, NY, USA) to compare the differences among the SOTS, JOTS, SOTS + AI, JOTS + AI, SOTS + JOTS, and SOTS + JOTS + AI groups. All images were classified according to the AO/OTA 2018 classification system by 2 experienced trauma surgeons and verified by another expert in this field. Based on the actual clinical needs, after discussion, we integrated 8 subgroups into 5 new subgroups, and the dataset was divided into training, validation, and test sets by the ratio of 8:1:1.</div></div><div><h3>Results</h3><div>The mean average precision at the intersection over union (IoU) of 0.5 (mAP50) for subgroup detection reached 90.29%. The classification accuracy values of SOTS, JOTS, SOTS + AI, and JOTS + AI groups were 56.24% ± 4.02%, 35.29% ± 18.07%, 79.53% ± 7.14%, and 71.53% ± 5.22%, respectively. The paired <em>t</em>-test results showed that the difference between the SOTS and SOTS + AI groups was statistically significant, as well as the difference between the JOTS and JOTS + AI groups, and the SOTS + JOTS and SOTS + JOTS + AI groups. Moreover, the difference between the SOTS + JOTS and SOTS + JOTS + AI groups in each subgroup was statistically significant, with all <em>p</em> &lt; 0.05. The independent samples <em>t</em>-test results showed that the difference between the SOTS and JOTS groups was statistically significant, while the difference between the SOTS + AI and JOTS + AI groups was not statistically significant. With the assistance of AI, the subgroup classification accuracy of both SOTS and JOTS was significantly improved, and JOTS achieved the same level as SOTS.</div></div><div><h3>Conclusion</h3><div>In conclusion, the YOLOX-SwinT network algorithm enhances the accuracy of AO/OTA subgroups classification of ITF by orthopedic trauma surgeons.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 69-75"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two cases of complex traumatic aortic dissection combined with multiple organ injuries 两例复杂的外伤性主动脉夹层合并多器官损伤。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-01 DOI: 10.1016/j.cjtee.2024.08.001
Qingpeng Song, Lili Bao, Xuejun Wu, Bingqi Liu, Maohua Wang
Traumatic aortic injury (TAI) is an acute, critical, and severe disease, and then combined with multiple organ damage, it is even more dangerous. TAI progresses very rapidly, with a pre-hospital mortality rate of 57%–80%, and even when arriving at the hospital, more than one-third of the patients die within 4 h, and it is the 2nd leading cause of death in individuals aged 4−34 years. In addition, the incidence of TAI combined with injury was 81.4%. Therefore, early diagnosis, expeditious surgery, and timely and effective multidisciplinary cooperation are essential for successful rescue. The authors report 2 patients with acute traumatic aortic dissection combined with multiple organ injuries and treated with emergency endovascular surgery to discuss their clinical characteristics and treatment experience, and to provide experience in the diagnosis and treatment of such patients.
创伤性主动脉损伤(TAI)是一种急性、危重的严重疾病,再加上多器官损伤,就更加危险了。创伤性主动脉损伤进展非常迅速,院前死亡率高达 57% - 80%,即使到达医院,也有超过三分之一的患者在 4 小时内死亡,是 4 - 34 岁人群的第二大死因。此外,TAI合并损伤的发生率为81.4%。因此,早期诊断、快速手术、及时有效的多学科合作是成功抢救的关键。作者报告了2例急性创伤性主动脉夹层合并多脏器损伤并接受急诊血管内手术治疗的患者,探讨其临床特点和治疗经验,为此类患者的诊断和治疗提供经验。
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引用次数: 0
Corrigendum to "Dexmedetomidine reduces hippocampal microglia inflammatory response induced by surgical injury through inhibiting NLRP3" [Chinese J Traumatol 22 (2019) 161-165]. 右美托咪定通过抑制NLRP3降低手术损伤诱导的海马小胶质细胞炎症反应[J].中华创伤杂志22(2019)161-165。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-12-28 DOI: 10.1016/j.cjtee.2024.12.001
Ji Peng, Peng Zhang, Han Zheng, Yun-Qin Ren, Hong Yan
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引用次数: 0
期刊
Chinese Journal of Traumatology
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