Chinese Journal of Traumatology最新文献

{"title":"Multiomics analysis elucidated the role of inflammatory response and bile acid metabolism disturbance in electric shock-induced liver injury in mice.","authors":"Wenjuan Zhang, Luncai Yin, Hui Wang, Ce Long, Jin Liu, Ping Deng, Yang Yue, Jingdian Li, Mindi He, Yonghui Lu, Yan Luo, Siyu Chen, Jiawen Tao, Li Tian, Jia Xie, Mengyan Chen, Zhengping Yu, Zhou Zhou, Peng Gao, Huifeng Pi","doi":"10.1016/j.cjtee.2024.08.011","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.011","url":null,"abstract":"<p><strong>Purpose: </strong>Organ damage caused by electric shock has attracted great attention. Some animal investigations and clinical cases have suggested that electric shock can induce liver injury. This study aimed to investigate the potential mechanism of liver injury induced by electric shock.</p><p><strong>Methods: </strong>Healthy male C57BL/6J mice aged 6-8 weeks were romandly divided into two groups: control group and electric shock group. Mice in the electric shock group were shocked on the top of the skull with an electric baton (20 kV) for 5 sec, while mice in the control group were exposed to only the acoustic and light stimulation produced by the electric baton. The effect of electric shock on liver function was evaluated by histological and biochemical analysis, and a metabolomics and transcriptomics study was performed to investigate how electric shock might induce liver damage. All data of this study were analyzed using a two-tailed unpaired Student's t-test in SPSS 22.0 Statistical Package.</p><p><strong>Results: </strong>The electric shock group had significantly higher serum aspartate aminotransferase and alanine aminotransferase levels than the control group (p < 0.001), and the shock notably caused cytoplasmic swelling and vacuolization, mild inflammatory cell (mainly macrophages and monocytes) infiltration and acute focal necrosis in hepatocytes (p < 0.001). A total of 47 differential metabolites and 249 differentially expressed genes (DEGs) were detected using metabolomic and transcriptomic analyses. These differential metabolites were significantly enriched in primary bile acid biosynthesis (p < 0.05). Gene ontology functional analysis of the DEGs revealed that electric shock disturbed a key biological process involved in the inflammatory response in the mouse liver, and a significant number of DEGs were enriched in Kyoto Encyclopedia of Genes and Genomes-identified pathways related to inflammation, such as the interleukin-17, tumor necrosis factor and mitogen-activated protein kinase signalling pathway. Transcriptomic and metabolomic analyses revealed that bile acid metabolism disturbance including up-regulation of the taurochenodesoxycholic acid, chenodeoxycholic acid and taurocholic acid, and down-regulation of chenodeoxycholic acid clycine conjugate may contribute to the electric shock-induced inflammatory response.</p><p><strong>Conclusion: </strong>Electric shock can induce liver inflammatory injury through the interleukin-17, tumor necrosis factor, and mitogen-activated protein kinase signaling pathway, and the bile acid metabolism disturbance including up-regulation of the taurochenodesoxycholic acid, chenodeoxycholic acid and taurocholic acid, and down-regulation of chenodeoxycholic acid clycine conjugate may contribute to inflammatory liver injury following electric shock.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016105","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}

{"title":"Research progress of tourniquets and their application in the Russia-Ukraine Conflict","authors":"Shaojie Nie ,&nbsp;Kangkang Zhi ,&nbsp;Lefeng Qu","doi":"10.1016/j.cjtee.2024.07.010","DOIUrl":"10.1016/j.cjtee.2024.07.010","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 1-6"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632467","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}

{"title":"Protocolized approach saves the limb in peripheral arterial injury: A decade experience","authors":"Pratyusha Priyadarshini,&nbsp;Supreet Kaur,&nbsp;Komal Gupta,&nbsp;Abhinav Kumar,&nbsp;Junaid Alam,&nbsp;Dinesh Bagaria,&nbsp;Narender Choudhary,&nbsp;Amit Gupta,&nbsp;Sushma Sagar,&nbsp;Biplab Mishra,&nbsp;Subodh Kumar","doi":"10.1016/j.cjtee.2022.12.010","DOIUrl":"10.1016/j.cjtee.2022.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Outcomes of peripheral arterial injury (PAI) depend on various factors, such as warm ischemia time and concomitant injuries. Suboptimal prehospital care may lead to delayed presentation, and a lack of dedicated trauma system may lead to poorer outcome. Also, there are few reports of these outcomes. The study aims to review our experience of PAI management for more than a decade, and identify the predictors of limb loss in these patients.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of prospectively maintained database of trauma admissions at a level I trauma center from January 2008 to December 2019. Patients with acute upper limb arterial injuries or lower limb arterial injuries at or above the level of popliteal artery were included. Association of limb loss with ischemia time, mechanism of injury, and concomitant injuries was studied using multiple logistic regressions. Statistical analysis was performed using STATA version 15.0 (Stata Corp LLC, Texas).</div></div><div><h3>Results</h3><div>Out of 716 patients with PAI, the majority (91.9%) were young males. Blunt trauma was the most common mechanism of injury. Median ischemia time was 4 h (interquartile range 2–7 h). Brachial artery (28.5%) was the most common injured vessel followed by popliteal artery (17.5%) and femoral artery (17.3%). Limb salvage rate was 78%. Out of them, 158 (22.1%) patients needed amputation, and 53 (7.4%) had undergone primary amputation. The majority (88.6%) of patients who required primary or secondary amputations had blunt trauma. On multivariate analysis, blunt trauma, ischemia time more than 6 h and concomitant venous, skeletal, and soft tissue injuries were associated with higher odds of amputation.</div></div><div><h3>Conclusion</h3><div>Over all limb salvage rates was 77.9% in our series. Blunt mechanism of injury and associated skeletal and soft tissue injury, ischemia time more than 6 h portend a poor prognosis. Injury prevention, robust prehospital care, and rapid referral to specialized trauma center are few efficient measures, which can decrease the morbidity associated with vascular injury.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 62-68"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10581922","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}

{"title":"A novel arterial coupler with non-return snap-fit connection approach optimized arterial end-to-end anastomotic technique: An experimental study","authors":"Hong-Bo Guo ,&nbsp;Mo-Fei Wang ,&nbsp;Ren-Qi Yin ,&nbsp;Kang-Kang Zhi","doi":"10.1016/j.cjtee.2024.09.006","DOIUrl":"10.1016/j.cjtee.2024.09.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;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. Although 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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 &lt;em&gt;in vitro&lt;/em&gt; and &lt;em&gt;in vivo&lt;/em&gt; experiments. &lt;em&gt;In vitro&lt;/em&gt;, 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 &lt;em&gt;in vivo&lt;/em&gt;, 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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 &lt;em&gt;in vitro&lt;/em&gt; 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 &lt;em&gt;vs&lt;/em&gt;. 16.38 ± 1.04 min), clamp time (8.80 ± 1.41 &lt;em&gt;vs&lt;/em&gt;. 14.14 ± 1.57 min), and total operation time (46.64 ± 2.38 &lt;em&gt;vs&lt;/em&gt;. 51.96 ± 3.65 min). The results of electromagnetic flowmeter, vascular Doppler ultrasound, a","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 13-21"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480426","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}

{"title":"Acute portal vein thrombosis in an isolated, blunt, minor liver injury near the porta hepatis","authors":"Onchuda Wongweerakit,&nbsp;Osaree Akaraborworn,&nbsp;Burapat Sangthong,&nbsp;Komet Thongkhao","doi":"10.1016/j.cjtee.2023.09.003","DOIUrl":"10.1016/j.cjtee.2023.09.003","url":null,"abstract":"<div><div>Portal vein thrombosis (PVT) secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury, and it carries a high rate of morbidity and mortality. Moreover, acute asymptomatic PVT is difficult to diagnose. We present a young trauma patient with isolated minor liver injury associated with acute PVT. A 27-year-old man presented to the emergency department after a motor vehicle collision. His primary survey findings were unremarkable. His secondary survey showed a large contusion (7 × 7 cm²) at the epigastrium with marked tenderness and localized guarding. The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b (according to the American Association for the Surgery of Trauma classification) extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury. The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins, and a decreased size of the hepatic lacerations. A liver function test was repeated on post-injury day 4, and it revealed improved transaminitis. The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment. The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein. The patient received intravenous anticoagulant therapy for a total of 3 months. On the follow-up visits at 1 month, 2 months, 6 months, and 1 year after the injury, the patients did not have any detectable abnormal symptoms. PVT post-blunt minor liver injury is an extremely rare complication. If the thrombosis is left untreated, serious morbidity and mortality can ensue. However, its diagnosis in asymptomatic patients is still challenging. Periodic imaging is necessary for highly suspected PVT, especially in liver injury with lacerations close to the porta hepatis, even in cases of a minor injury.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 76-78"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41221794","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}

{"title":"FM1-Editorial board","authors":"","doi":"10.1016/S1008-1275(24)00159-7","DOIUrl":"10.1016/S1008-1275(24)00159-7","url":null,"abstract":"","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Page i"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173318","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}

{"title":"Guide for Author","authors":"","doi":"10.1016/S1008-1275(24)00165-2","DOIUrl":"10.1016/S1008-1275(24)00165-2","url":null,"abstract":"","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages I-V"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143171433","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}

{"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 (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.</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 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 <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 ΔScvO₂ (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 ScvO₂, with <em>R</em>^<em>2</em> = 0.063, <em>p</em> = 0.008. After the fluid challenge, the change in CI became the only contributing factor to ΔScvO₂ (<em>R</em>^<em>2</em> = 0.245, <em>p</em> &lt; 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, <em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>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.</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}

{"title":"Stent-graft implantation for late postpancreatectomy hemorrhage after pancreatoduodenectomy","authors":"Xiaoye Li ,&nbsp;Shibo Xia ,&nbsp;Liangxi Yuan ,&nbsp;Lei Zhang ,&nbsp;Chao Song ,&nbsp;Xiaolong Wei ,&nbsp;Qingsheng Lu","doi":"10.1016/j.cjtee.2024.08.009","DOIUrl":"10.1016/j.cjtee.2024.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>n</em> (%). A <em>p</em> &lt; 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients’ survival.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 7-12"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the effectiveness of immediate vs. elective thoracic endovascular aortic repair for blunt thoracic aortic injury","authors":"Zhaohui Hua ,&nbsp;Baoning Zhou ,&nbsp;Wenhao Xue ,&nbsp;Zhibin Zhou ,&nbsp;Jintao Shan ,&nbsp;Lei Xia ,&nbsp;Yunpeng Luo ,&nbsp;Yiming Chai ,&nbsp;Zhen Li","doi":"10.1016/j.cjtee.2024.08.002","DOIUrl":"10.1016/j.cjtee.2024.08.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 &lt;em&gt;vs.&lt;/em&gt; &gt; 25) and when the TEVAR was performed for BTAI (within 24 h &lt;em&gt;vs.&lt;/em&gt; 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&lt;sub&gt;1&lt;/sub&gt;, Q&lt;sub&gt;3&lt;/sub&gt;), and were compared using either the &lt;em&gt;t&lt;/em&gt;-test or the Mann-Whitney &lt;em&gt;U&lt;/em&gt; test. Categorical variables were expressed as &lt;em&gt;n&lt;/em&gt; (%), and comparisons were made between the 2 groups using the χ&lt;sup&gt;2&lt;/sup&gt; test or Fisher’s exact test. Statistical significance was defined as a 2-sided &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;In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores &gt; 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS &gt; 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) &lt;em&gt;vs.&lt;/em&gt; 2 (4.4%), &lt;em&gt;p&lt;/em&gt; &lt; 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q&lt;sub&gt;1&lt;/sub&gt;, Q&lt;sub&gt;3&lt;/sub&gt;)) compared to the immediate group (15 (12, 15) &lt;em&gt;vs.&lt;/em&gt; 13.5 (9, 15), &lt;em&gt;p&lt;/em&gt; = 0.039), while the creatinine concentration (median (Q&lt;sub&gt;1&lt;/sub&gt;, Q&lt;sub&gt;3&lt;/sub&gt;)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) &lt;em&gt;vs.&lt;/em&gt; 71.5 (58.3, 80.8), &lt;em&gt;p&lt;/em&gt; = 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%) &lt;em&gt;vs.&lt;/em&gt; 3 (10.0%), &lt;em&gt;p&lt;/em&gt; &lt; 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, &lt;em&gt;p&lt;/em&gt; = 0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this propensity-score matched anal","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 22-28"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047451","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}