{"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}
Ran An , Xi-Xi Wan , Yan Chen , Run Dong , Chun-Yao Wang , Wei Jiang , Li Weng , Bin Du
{"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 , Xi-Xi Wan , Yan Chen , Run Dong , Chun-Yao Wang , Wei Jiang , Li Weng , 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> < 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}
Xiaoye Li , Shibo Xia , Liangxi Yuan , Lei Zhang , Chao Song , Xiaolong Wei , Qingsheng Lu
{"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":"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 (Q<sub>1</sub>, Q<sub>3</sub>) when the data is non-normal distributed. Categorical data are reported as <em>n</em> (%). A <em>p</em> < 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}
Zhaohui Hua , Baoning Zhou , Wenhao Xue , Zhibin Zhou , Jintao Shan , Lei Xia , Yunpeng Luo , Yiming Chai , Zhen Li
{"title":"Evaluating the effectiveness of immediate vs. elective thoracic endovascular aortic repair for blunt thoracic aortic injury","authors":"Zhaohui Hua , Baoning Zhou , Wenhao Xue , Zhibin Zhou , Jintao Shan , Lei Xia , Yunpeng Luo , Yiming Chai , Zhen Li","doi":"10.1016/j.cjtee.2024.08.002","DOIUrl":"10.1016/j.cjtee.2024.08.002","url":null,"abstract":"<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","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}
Yu-Zhen Tang , Wan Chen , Bao-Yun Xu , Gang He , Xiu-Cheng Fan , Kang-Lai Tang
{"title":"4-Octyl itaconate inhibits synovitis in the mouse model of post-traumatic osteoarthritis and alleviates pain","authors":"Yu-Zhen Tang , Wan Chen , Bao-Yun Xu , Gang He , Xiu-Cheng Fan , Kang-Lai Tang","doi":"10.1016/j.cjtee.2024.10.001","DOIUrl":"10.1016/j.cjtee.2024.10.001","url":null,"abstract":"<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</","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}
{"title":"Recent advances in the management of chronic ankle instability","authors":"Yimeng Yang, Yang Wu, Wenhui Zhu","doi":"10.1016/j.cjtee.2024.07.011","DOIUrl":"10.1016/j.cjtee.2024.07.011","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 35-42"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710847","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}
Qingpeng Song, Lili Bao, Xuejun Wu, Bingqi Liu, Maohua Wang
{"title":"Two cases of complex traumatic aortic dissection combined with multiple organ injuries","authors":"Qingpeng Song, Lili Bao, Xuejun Wu, Bingqi Liu, Maohua Wang","doi":"10.1016/j.cjtee.2024.08.001","DOIUrl":"10.1016/j.cjtee.2024.08.001","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 1","pages":"Pages 29-34"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989446","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}
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
{"title":"YOLOX-SwinT algorithm improves the accuracy of AO/OTA classification of intertrochanteric fractures by orthopedic trauma surgeons","authors":"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","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> < 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}