Traumatic brain injury: Bridging pathophysiological insights and precision treatment strategies

Blood-brain barrier disruption and the neuroinflammatory response are significant pathological features that critically influence disease progression and treatment outcomes. This review systematically analyzes the current understanding of the bidirectional relationship between blood-brain barrier disruption and neuroinflammation in traumatic brain injury, along with emerging combination therapeutic strategies. Literature review indicates that blood-brain barrier disruption and neuroinflammatory responses are key pathological features following traumatic brain injury. In the acute phase after traumatic brain injury, the pathological characteristics include primary blood-brain barrier disruption and the activation of inflammatory cascades. In the subacute phase, the pathological features are characterized by repair mechanisms and inflammatory modulation. In the chronic phase, the pathological features show persistent low-grade inflammation and incomplete recovery of the blood-brain barrier. Various physiological changes, such as structural alterations of the blood-brain barrier, inflammatory cascades, and extracellular matrix remodeling, interact with each other and are influenced by genetic, age, sex, and environmental factors. The dynamic balance between blood-brain barrier permeability and neuroinflammation is regulated by hormones, particularly sex hormones and stress-related hormones. Additionally, the role of gastrointestinal hormones is receiving increasing attention. Current treatment strategies for traumatic brain injury include various methods such as conventional drug combinations, multimodality neuromonitoring, hyperbaric oxygen therapy, and non-invasive brain stimulation. Artificial intelligence also shows potential in treatment decision-making and personalized therapy. Emerging sequential combination strategies and precision medicine approaches can help improve treatment outcomes; however, challenges remain, such as inadequate research on the mechanisms of the chronic phase traumatic brain injury and difficulties with technology integration. Future research on traumatic brain injury should focus on personalized treatment strategies, the standardization of techniques, cost-effectiveness evaluations, and addressing the needs of patients with comorbidities. A multidisciplinary approach should be used to enhance treatment and improve patient outcomes.

Home-based strength and balance exercises for fall prevention among older individuals of advanced age: a randomized controlled single-blind study

OBJECTIVE

This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components.

METHOD

This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait.

RESULTS

The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average.

CONCLUSION

Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.

Results of therapy in children diagnosed with severe traumatic brain injury

The aim of this research is to enhance therapeutic outcomes in children diagnosed with severe craniocerebral trauma by evaluating the contributing factors involved in cerebral injury. The investigation focused on evaluating the impact of infusion therapy on the improvement of pediatric patients' conditions with SCCT, particularly by assessing hydrobalance indicators. Adaptive changes associated with the humoral stress response were evaluated through alterations in hormone concentrations (thyrotropin (TSH), cortisol (C), prolactin (P)). Concentrations of plasma protein and glucose were analyzed. A total of 804 children with isolated severe craniocerebral trauma (SCCT) were enrolled and stratified into retrospective (n = 474) and prospective (n = 100) cohorts. Children with negative hydrobalance exhibited a higher mortality rate compared to those with positive hydrobalance (24% vs. 10%, p ≤ 0.05). Positive hydrobalance, in conjunction with appropriate infusion therapy and rehydration, positively influenced the prognosis of severe cranio-cerebral trauma (SCCT). These findings can be applied in clinical practice to optimize the treatment of children with SCCT and improve their prognosis. The level of total protein was higher in conscious children after 48 h (59.9 ± 1.5 g/L, p ≤ 0.05) in comparison to deceased individuals (54.9 ± 1.6 g/L, p ≤ 0.05). Stress-induced hyperglycemia was associated with the severity of severe cranio-cerebral trauma. The study corroborated the significance of infusion therapy in the treatment of children with SCCT. Indicators of total protein, glucose, and P concentrations can serve as valuable tools for assessing the severity and prognostication of SCCT.

Thoracic Ultrasound in Pediatric Chest Trauma: Beyond the Basics

Chest trauma in children may result in variable injuries. Although radiographs represent the mainstay modality for triage, ultrasound may prove to be a useful diagnostic tool, having the potential to supplement radiographic findings and tailor ionizing imaging. There is growing evidence demonstrating the high accuracy of ultrasound in assessing several conditions related to pediatric chest trauma. Familiarity with the scanning technique, together with an understanding of the sound properties of solid tissue, air, and fluid, is essential for image interpretation. Herein, we present tips regarding a detailed sonographic technique, landmarks relevant to normal anatomy, and abnormal findings encountered in children with accidental thoracic trauma.

The impact of coronary outflow and non-Newtonian fluid property on aortic valve haemodynamics

The normal healthy aortic valve (AoV) has three leaflets, two of which have outflows to the coronary arteries. Blood flow through the coronary ostia will have an impact on AoV dynamics and the surrounding haemodynamics, leading to differential shear stress distributions at the aortic side of the three leaflets. In addition, aortic root haemodynamics may also be influenced by the non-Newtonian behaviour of blood which is known as a shear-thinning fluid due to the aggregation of red blood cells at low shear rate. However, the combined effect of coronary and non-Newtonian flow on AoV haemodynamics has not been studied in an anatomically realistic setting. In this study, strongly coupled fluid-structure interaction (FSI) analyses were performed on a natural, healthy AoV, with and without accounting for coronary outflows and non-Newtonian properties of blood. Our results showed that the influence of coronary outflow is more pronounced than employing a non-Newtonian model, and their combined effect is non-negligible, particularly on wall shear stress. Incorporating coronary outflow and non-Newtonian properties increased time-averaged wall shear stress (TAWSS) in the aortic sinus by up to 108.45%; it also increased TAWSS on the aortic side of valve leaflets by 41.04%, 44.76%, and 54.91% on the left, right and non-coronary leaflet, respectively. These results highlight the importance of incorporating coronary outflow and non-Newtonian properties when accurate predictions of wall shear stress and its related parameters are critical.

Association between metal mixture in urine and abnormal blood pressure and mediated effect of oxidative stress based on BKMR and Machine learning method

BACKGROUND

Exposure to heavy metals represents a significant risk factor for hypertension and blood pressure disorders. Notably, current evidence indicates that the key biological processes of oxidative stress, inflammation, and endothelial dysfunction are related to metal exposure and blood pressure dysregulation, ultimately contributing to cardiovascular pathogenesis. However, their underlying biological mechanisms remain incompletely characterized.

METHODS

A longitudinal study was performed among 45 healthy university students in Caofeidian, China. These participants were followed up in 4 seasons for physical examination and blood and urine samples collection between December 2017 and October 2018. we employed linear mixed effect model (LME), Bayesian kernel-machine regression (BKMR) and Machine learning (ML) to evaluate complex exposure-response relationships between multi-metal mixtures and blood pressure outcomes. Finally, we constructed the mediation analyses to analyze the potential intermediary roles of indicators in these association.

RESULTS

The analysis revealed significant associations between Cr, Mn, and Mo and elevated levels of 8-iso-prostaglandin-F2α (8-iso-PGF2α) and blood pressure (all P < 0.05), respectively. BKMR and ML further demonstrated both cumulative effects and interaction patterns within the metal mixture that collectively influenced blood pressure. Additionally, 8-iso-PGF2α is significantly positively correlated with SBP and was subsequently identified as a candidate mediator. Eventually, we found that the metals of Mn, Cr, and Mo were associated with SBP mediated by 8-iso-PGF2α with 24.6 %, 17.4 %, and 20.7 %, respectively.

CONCLUSIONS

These findings establish a mechanistic link between metal exposure and blood pressure dysregulation in young adults. Notably, the application of machine learning demonstrates novel utility in quantifying mixed metals on blood pressure and predicting the development of cardiovascular injury, providing a novel insight into environmental risk assessment methodologies.

Impact of obesity on clinical outcomes in patients with high-risk pulmonary embolism: A comparative analysis

Background

Pulmonary embolism (PE) is a life-threatening cardiovascular condition with increasing global incidence. Obesity is a significant risk factor for PE, although its reported relationship with outcomes is inconsistent. This study aimed to investigate the impact of obesity on clinical outcomes in patients with high-risk PE.

Methods

We conducted a retrospective analysis of US adult patients hospitalized with high-risk PE from 2016 to 2019 using the National Inpatient Sample database. Patients were categorized into three groups based on BMI: non-obese, obese (30 to < 40 kg/m2), and severely obese (≥40 kg/m2). We compared baseline characteristics, in-hospital procedures, and outcomes among these groups. Multivariable logistic regression models assessed the relationship between obesity levels and in-hospital outcomes.

Results

Of 752,660 patients with PE, 29,610 (3.9 %) were classified as high-risk. The distribution among BMI categories was: non-obese (77.1 %), obese (8.8 %), and severely obese (14.1 %). Severely obese patients were younger (mean age 55.7 vs. 66.1 years for non-obese, p < 0.001) and more likely to be female (63.2 % vs. 51.4 % for non-obese, p < 0.001). After adjustment, obese and severely obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.69, p < 0.001) and major adverse cardiovascular and cerebrovascular events (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.72, p < 0.001).

Conclusion

Our study revealed an "obesity paradox" in high-risk PE patients, with obese and severely obese individuals showing lower mortality and fewer complications despite higher comorbidity rates. These findings emphasize the need for tailored risk assessment and treatment strategies in obese patients with high-risk PE.

Complicated appendicitis presenting as anterior abdominal wall abscess in a diabetic patient: A case report

INTRODUCTION

Acute appendicitis is one of the most common surgical emergencies (8.6 % in men and 6.4 % in women), with varying presentations, including complications such as appendicular abscess. While the typical clinical course involves right lower quadrant pain and fever, rare complications can present with atypical symptoms, particularly in high-risk patients such as those with diabetes.

PRESENTATION OF CASE

A 55-year-old diabetic female presented with a 10-day history of worsening abdominal pain, foul-smelling discharge at the anterior abdominal wall below the umbilicus, and fever. Imaging revealed an appendicular abscess extending into the anterior abdominal wall. Emergency exploratory laparotomy showed a perforated appendix with a purulent collection in the peritoneal cavity extending to the anterior abdominal wall, requiring drainage and right hemicolectomy.

DISCUSSION

Perforated appendicitis (incidence of 20-30 %), particularly in diabetic patients, can lead to localized abscesses or soft tissue infections in atypical locations such as the abdominal wall. These rare complications are more likely in immunocompromised individuals, including those with diabetes, where the incidence of perforated appendicitis is notably higher. Early imaging with ultrasonography or Contrast Enhanced Computed Tomography is critical for identifying complicated appendicitis and guiding surgical intervention.

CONCLUSION

Anterior abdominal wall abscesses as a complication of perforated appendicitis are rare but significant. This case underscores the importance of early and accurate diagnosis, supported by imaging, to guide appropriate surgical management. Timely intervention can help prevent life-threatening conditions such as necrotizing fasciitis, improve patient outcomes, and reduce the risk of postoperative complications, particularly in high-risk populations.

Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury

OBJECTIVES

The shock index (SI) is widely used to screen for patients in shock, and the dSI is created by utilizing prehospital SI and emergency department SI to enhance predictive accuracy. However, few have compared dSI with prehospital SI and SI at ED, and even fewer have explored the directional changes in dSI. This study aims to evaluate the prediction accuracy of prehospital SI, SI at ED, and delta SI in trauma patients, proposing that the delta scoring systems provide a more precise tool for field triage.

PATIENTS AND METHODS

This study conducted a cohort analysis involving 48,524 patients from the trauma registry data at Tzu Chi Hospital. The three primary outcomes assessed were in-hospital mortality, intensive care unit (ICU) admission, and prolonged total length of hospital stay (≥ 30 days). The area under the receiver operating characteristic curve (AUROC) for these scores was calculated and compared using the DeLong test. The delta SI was calculated as the difference between prehospital SI and SI at the emergency department (ED). The dSI was categorized into five groups: dSI < -0.5, -0.5 ≤ dSI < -0.1, -0.1 ≤ dSI < 0.1, 0.1 ≤ dSI < 0.5, and 0.5 ≤ dSI.

RESULTS

Prehospital SI, SI at ED, and dSI were significant predictors of in-hospital mortality, ICU admission, and prolonged length of stay (LOS) of ≥30 days. Compared to prehospital SI and SI at ED, dSI demonstrated significantly higher AUROC values in discriminating major injury, prolonged ICU stay, and in-hospital mortality. The groups with dSI < -0.5 and dSI ≥ 0.5 exhibited a significantly higher risk of in-hospital mortality compared to other dSI group with adjusted odds ratio (aOR) of 2.170 and 2.976. A J-shaped relationship in aOR values was observed across different dSI ranges for in-hospital mortality. The dSI ≥ 0.5 group had an increased risk of in-hospital mortality among elderly patients, those with major or minor injuries, and both TBI and non-TBI groups. The dSI ≥ 0.1 demonstrated accuracies of 80.94 % for predicting ISS ≥ 16, 72.91 % for ICU admission, 87.14 % for prolonged LOS ≥ 30 days, and 89.33 % for predicting mortality.

CONCLUSIONS

The dSI demonstrated significantly better discriminative ability for major injury, prolonged ICU stay, and in-hospital mortality. A potential J-shaped relationship has been identified between dSI and mortality, indicating that both the dSI < -0.5 and dSI ≥ 0.5 groups have a significantly higher risk of in-hospital mortality. It is anticipated that dSI will be integrated into clinical practice for the field triage of trauma patients in the future.

Multidimensional excavation of the current status and trends of mechanobiology in cardiovascular homeostasis and remodeling within 20 years

Mechanobiology is essential for cardiovascular structure and function and regulates the normal physiological and pathological processes of the cardiovascular system. Cells in the cardiovascular system are extremely sensitive to their mechanical environment, and once mechanical stimulation is abnormal, the homeostasis mechanism is damaged or lost, leading to the occurrence of pathological remodeling diseases. In the past 20 years, many articles concerning the mechanobiology of cardiovascular homeostasis and remodeling have been published. To better understand the current development status, research hotspots and future development trends in the field, this paper uses CiteSpace software for bibliometric analysis, quantifies and visualizes the articles published in this field in the past 20 years, and reviews the research hotspots and emerging trends. The regulatory effects of mechanical stimulation on the biological behavior of endothelial cells, smooth muscle cells and the extracellular matrix, as well as the mechanical-related remodeling mechanism in heart failure, have always been research hotspots in this field. This paper reviews the research advances of these research hotspots in detail. This paper also introduces the research status of emerging hotspots, such as those related to cardiac fibrosis, homeostasis, mechanosensitive transcription factors and mechanosensitive ion channels. We hope to provide a systematic framework and new ideas for follow-up research on mechanobiology in the field of cardiovascular homeostasis and remodeling and promote the discovery of more therapeutic targets and novel markers of mechanobiology in the cardiovascular system.

The contemporary natural history of minor amputation among diabetic patients with peripheral arterial disease

OBJECTIVES

The growing prevalence of diabetes and concomitant peripheral arterial disease (DM/PAD) has led to an increase in patients at risk for adverse limb events in current practice. Despite a widespread perception that minor amputation may result in both limb salvage and preserved functionality, the natural history of minor amputations remains unknown. Thus, we sought to quantify the rates of subsequent major amputation and survival among DM/PAD patients with any prior minor amputation.

METHODS

We performed a retrospective cohort study using US Medicare claims from 2007 to 2019. We included patients with DM/PAD based on International Classification of Diseases, 9th and 10th editions, diagnosis codes. We excluded patients lacking continuous fee-for-service coverage or with incomplete demographic data. The primary exposure was prior minor (below-ankle) amputation. The primary outcome was major (above-ankle) amputation. Statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazards modeling.

RESULTS

We identified 12,257,174 patients (age 73 ± 11 years; 48% male; 76% White) with DM/PAD. Of these patients, 2.2% (n = 274,225) underwent prior minor amputation. Patients with prior minor amputation were more likely to be male (63% vs 47%; P < .0001), Black non-Hispanic (17% vs 13%; P < .0001), and rural (25% vs 21%; P < .0001) than those without prior minor amputation. The 5-year Kaplan-Meier cumulative incidence of major amputation was 27% (n = 58,613) of patients with prior minor amputation, compared with 1.4% (n = 129,872) of patients without prior minor amputation. After risk-adjustment, patients with prior minor amputations were 6.1-fold more likely to require a subsequent major amputation (hazard ratio, 6.11; 95% confidence interval, 6.04-6.18) compared with those without prior minor amputations.

CONCLUSIONS

This contemporary claims-based analysis demonstrates that approximately 25% of Medicare beneficiaries with DM/PAD and prior minor amputation will necessitate a major amputation within 5 years. Prior minor amputation carries a risk of major amputation comparable with de novo tissue loss and is a stronger predictor than any demographic or socioeconomic exposure. These results help to inform both clinical decision-making and anticipated real-world outcomes among those at greatest risk for limb loss.

Contemporary management of adult splenic injuries: What you need to know

ABSTRACT

The spleen is a frequently injured organ, with over 40,000 adult splenic injuries occurring yearly. It plays an important role in the body's immune system, so surgeons should make every effort to perform splenic salvage when able. In blunt injury, indications for emergent splenectomy have not recently changed and include hemodynamic instability and peritonitis. A computed tomography (CT) scan with intravenous contrast is the preferred imaging modality for hemodynamically normal patients and should be used to classify the grade of injury and identify active bleeding and its stigmata. Nonoperative management has been successful for all grades of blunt injury (80-95%), but it is the job of the surgeon to carefully select the patient, in the context of their age, other associated injuries, and splenic CT findings, so this success rate remains high. Angioembolization is an important tool for splenic salvage that should be used when an actively bleeding vessel is observed on CT scan. Both proximal and distal embolizations are effective with no data to suggest that one is superior to the other. All patients selected for nonoperative management require close monitoring, which can include interval CT scans for high-grade injuries. Penetrating splenic injuries differ from blunt injuries because they are more likely to be surgically explored on presentation and they have a higher operative splenorrhaphy rate.

Accuracy, reliability, and utility of the extended focused assessment with sonography in trauma examination in the setting of thoracic gunshot wounds

BACKGROUND

The extended focused assessment with sonography in trauma (eFAST) examination includes additional thoracic views beyond the standard focused assessment with sonography in trauma examination. Its validation has predominantly been conducted in blunt trauma cases. Our aim was to evaluate the eFAST examination in a targeted population with penetrating thoracic trauma.

METHODS

Patients with thoracic gunshot wounds who underwent eFAST between 2017 and 2021 were included from a local trauma registry. Performance metrics for each component of eFAST in each window and pathological condition were analyzed across the entire population, as well as within two cohorts: survived and deceased patients. Chest tube placement rates were compared within true-positive and false-negative (FN) eFAST results for subgroups with pneumothorax or hemothorax.

RESULTS

A total of 288 patients were included (male, 91% male; Injury Severity Score ≥15, 48%; and died, 17%). Thirty-nine percent required chest tube, and 18% required urgent thoracic surgical intervention. Although specificity was high (91-100%) for all components, the sensitivity was less than 50% for all thoracic views, except for "no cardiac motion" (100% sensitivity). Sensitivity for pericardial fluid was 47%; for pneumothorax, 22%; for hemothorax, 36%; and for peritoneal fluid, 51% in the total population. Comparing survived versus deceased cohort, the eFAST sensitivity was higher among deaths for all components. The majority of patients (>70%) with a FN eFAST for pneumothorax or hemothorax received chest tube.

CONCLUSION

The eFAST examination showed highly variable performance metrics among patients with penetrating thoracic trauma, with all thoracic components demonstrating high specificity but low overall sensitivity. Urgent interventions were frequently received in patients with FN studies.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level III.

Cyclodextrins as non-viral vectors in cancer theranostics: A review

Cancer ranks as the top cause of death following cardiovascular diseases. Identifying cancer patients at early stages presents significant challenges due to the asymptomatic nature of early-stage tumors. Conversely, the advancement of therapy resistance has led to a reduction in cancer treatment efficacy. Consequently, utilizing nanoparticles for the diagnosis and treatment of cancer can greatly enhance the prognosis and results for patients. CDs are recognized entities in the pharmaceutical domain and have been extensively used for therapeutic purposes in disease treatment. These non-viral vectors have shown efficacy in inhibiting both solid tumors and hematological malignancies through targeted drug delivery. CDs can enhance the administration of medications and genes in cancer treatment by ensuring their continuous release. The stimuli-responsive CDs have enhanced the targeted delivery of payloads at the tumor location, responding to the stimuli in TME such as pH, redox and light. CDs can serve as effective carriers that enhance the efficacy of phototherapy by improving the solubility and delivery of phototherapeutic agents, enabling integration with chemotherapy and immunotherapy. The administration of immunomodulators through CDs can enhance cancer immunotherapy and boost the infiltration of immune cells. Ultimately, CDs can aid in cancer diagnosis and the identification of biomarkers.

Necrotizing Fasciitis Caused by Gas-producing Methicillin-sensitive Staphylococcus aureus: A Case Report

Introduction

It is well known that diabetic patients have impaired wound healing, increased susceptibility to infection, and harbor tissue that supports the growth of gas-producing infections. Necrotizing fasciitis (NF) is an uncommon soft-tissue infection characterized by extensive necrosis of subcutaneous tissue and fascia with relative sparing of the skin and muscle tissues. The majority of gas-producing infections are polymicrobial in nature, and therefore, NF with Staphylococcus aureus as a single etiologic agent is exceedingly uncommon.

Case Report

This is a case of a 46-year-old male that developed gas-forming NF and abscesses from methicillin-sensitive S. aureus (MSSA) after a complicated course involving undiagnosed type 2 diabetes mellitus (T2DM), diabetic ketoacidosis, and bacteremia. The disease course presented relatively slowly with mild systemic symptoms, knee pain, erythema, and edema, but steadily progressed over days leading to an elevated level of care. Multidisciplinary care was necessary to treat the patient, including surgical and intravenous antibiotic therapies. The patient's care was prolonged due to decreased patient compliance with recommended therapies and difficulty with appropriate shared decision-making.

Conclusion

Although NF caused by monomicrobial infection with methicillin-resistant S. aureus has been previously reported, awareness of this condition remains limited, especially with concomitant gas formation. Physicians should have a high index of suspicion for NF with MSSA as a potential etiologic agent when treating patients with symptoms of a necrotizing soft-tissue infection, particularly those with underlying T2DM or a history of recent needle puncture. By engaging in shared decision making, health outcomes in these serious infections can be optimized.

Pattern of Ophthalmic Injuries in Patients With Maxillofacial Fractures at a Tertiary Care Centre in Central India

INTRODUCTION

Maxillofacial injuries are usually associated with ophthalmic injuries that may be mild to severe, and may even result in loss of integrity of the orbital skeleton and impairment of the visual apparatus.

AIM

To evaluate the pattern of ophthalmic injuries associated with maxillofacial fractures in patients who reported to a tertiary care hospital, associated with a medical college in M.P, India.

MATERIAL AND METHODS

The records of patients who sustained ophthalmic injuries with maxillofacial trauma from 1st January 2012 to 31st January 2024 and reported to the Department of Dentistry of a tertiary care hospital were evaluated. The data related to demographic characteristics, aetiology of trauma, type of maxillofacial fractures and pattern of ophthalmic injuries were gathered and analysed.

RESULTS

A total of 1575 patients with maxillofacial trauma reported to the institute during the study duration. The study sample comprised 1046 (66.41%) maxillofacial trauma patients who sustained ophthalmic injuries. Males were more commonly involved (85.85%) than females (14.15%). The commonly involved age group was 21-30 years with 34.32% of patients belonging to the age group. The most common aetiology was road traffic accidents, reported in 71.89% of patients. Zygomaticomaxillary complex (ZMC) fractures were evident in 73.52%, mandibular fractures in 50.19%, naso-orbito-ethmoidal (NOE) fractures in 19.41% and frontal bone fractures in 18.74% patients. Subconjunctival haemorrhage was seen in 79.83%, periorbital ecchymosis in 72.94% and periorbital oedema in 60.32% of cases. Retrobulbar haemorrhage was seen in 2.58%, traumatic optic neuropathy in 2.01% and retinal detachment in 0.86% of cases.

CONCLUSION

Ophthalmic injuries were seen frequently in 66.41% of cases with maxillofacial trauma, particularly in zygomatic complex fractures (73.52%). The findings emphasise that the competency of maxillofacial surgeons plays a vital role in comprehending the severity and management of post-traumatic ophthalmic consequences in maxillofacial injuries. Also, ophthalmological evaluation in maxillofacial trauma, particularly involving the midface should be considered mandatory.

Nutritional modulation of the mTORC1 pathway in muscle: differential effect according to muscle and sex

Numerous studies have focused on nutrient-driven regulation of muscle metabolism/homeostasis through the mammalian target of rapamycin complex 1 (mTORC1) pathway, but their results fail to converge, perhaps due to differences in mTORC1 pathway protein studied, muscle type, and/or sex. The aim of this work was to study the influence of these factors on mTORC1 pathway activation in response to food intake. Rats (16 male and 16 female) were fasted for 20 h and then were randomized into two groups: a postabsorptive group in which the animals were euthanized in the fasted state and a postprandial group in which the animals were euthanized 30 min after food intake (10 g). Plasma glucose, insulin, and amino acids were assayed. Muscles (extensor digitorum longus, tibialis, soleus, gastrocnemius and plantaris) were removed and Western blotted to analyze the activation of the mTORC1 pathway [phosphorylation of Akt, 4E-binding protein 1 (4E-BP1), and S6K1]. Levels of Akt, 4E-BP1, and S6K1 activation were compared between muscles and by sex in different nutritional states, and a Kruskal-Wallis test was performed to find statistically significant differences.Food intake led to an increase in plasma concentrations of glucose, insulin, and total amino acids (P < 0.0001). Levels of Akt, 4E-BP1, and S6K1 activation differed significantly between muscles and by sex and nutritional state. Different phosphorylation sites in the same muscle were not correlated with each other. These results suggest that mTORC1 activation level is sensitive to muscle type, sex, and nutritional state. Studies on this signal transduction pathway therefore require an individualized approach, considering all the factors that may affect it.NEW & NOTEWORTHY This work demonstrates the complexity of the regulation of the mTOR pathway depending on the protein, muscle, sex, and nutritional status studied. This systemic approach is very little/not considered in the articles.

Psoas muscle density predicts elective colorectal surgical outcomes more accurately than psoas muscle area or indexed area

BACKGROUND

CT measurements of psoas muscle density (PMD) and area (PMA) (with or without indexing to height-squared or body-surface-area) are used interchangeably as sarcopenia measures - it is unknown which best correlates with surgical risk.

OBJECTIVES

1.Determine the correlation between psoas muscle density, area, and indexed area; 2.Identify which psoas measures most strongly associated with surgical outcomes DESIGN: The University Hospital Geelong Colorectal database included all patients who underwent elective colorectal surgery from 2007 to 2014 (minimum five-years follow-up). Pre-operative CT scans were reviewed, psoas measures correlated with each other and with outcomes.

SETTING

University Hospital Geelong is a regional referral hospital in Victoria, Australia.

PARTICIPANTS

This database listed 552 patients, 120 were excluded as pre-operative CT-films were not accessible, leaving 432 patients included.

EXPOSURE

Psoas muscle density, area, and area indexed by height-squared and body-surface-area.

MEASUREMENTS

Pearson correlations investigated correlations between psoas muscle measures. Logistic regression and ROC-analysis investigated each psoas measures association with peri‑operative morbidity. Kaplan-Meier survival-analysis investigated the association of each psoas measure with long-term survival.

RESULTS

Mean age was 70.4 years, 41 % were female. Psoas muscle density correlated poorly with area (R2=0.15). Unindexed psoas muscle area correlated well with area indexed by height-squared (R2=0.950) and body-surface-area (R2=0.938). Long-term survival was associated with psoas muscle density (HR1.515(95 %CI 1.062-2.161)) and area (HR1.886(95 %CI 1.322-2.692)). Increasing psoas muscle density (reduced sarcopenia) was associated with decreased major-complications (OR0.963(95 %CI 0.938-0.989)) and peri‑operative mortality (OR0.903(95 %CI 0.847-0.962)), with ROC-curve AUC=0.829 indicating an accurate test. There was no association between psoas muscle area and major-complications (OR1.000(95 %CI 1.000-1.000)), nor peri‑operative mortality (OR1.000(95 %CI 0.999-1.001)), with ROC-curves AUC=0.507-0.521. Indexed area measures were not associated with outcomes.

CONCLUSIONS

Psoas muscle density and area did not correlate. Both were associated with long-term survival, but only density was associated major-complications and mortality. Indexing removed the correlation of area with long-term survival.

Characteristics of Fall Occurrence in Hospitals and the Factors Influencing Falls That Require Additional Medical Care: Based on an Accident Database

OBJECTIVE

This study aimed to analyze accident reports of hospitals across Japan, and identify the characteristics of fall occurrence in hospitals and the factors influencing falls that require additional medical care.

METHODS

Data on falls that occurred inside hospitals between 2012 and 2021 were collected from the Project to Collect Medical Near-Miss/Adverse Event Information database of the Japan Council for Quality Health Care. The data were analyzed using binomial logistic regression analysis (the reduced variable method, likelihood ratio) with the requirement/nonrequirement of additional medical care as the dependent variable.

RESULTS

Out of all falls that occurred between 2012 and 2021, 78.9% required additional medical care. Of these, 758 reported irreversible disability, and 57 reported deaths. Most falls occur in the hospital room or corridor. The orthopedic surgery and psychiatry departments were the most common departments associated with fall occurrence. Gait disturbance and dementia/amnesia were the most common conditions prevailing before the fall. Weekdays (odds ratio=1.151), mornings (odds ratio=1.117), and two-shift work schedules (odds ratio=1.261) were the determinants of falls requiring additional medical care.

CONCLUSIONS

Falls requiring additional care in Japanese hospitals were more likely to occur on weekdays and mornings. Staffing conditions, rather than months of experience and hours worked the week before, determined falls requiring additional medical care.

Enhancing Disaster surge capacity through reverse triage in Addis Ababa Ethiopia: A retrospective cross-sectional study

BACKGROUND

During disasters and emergencies, hospitals play a pivotal role in response efforts, particularly through the early discharge of inpatients who can be safely discharged to free up capacity. Reverse triage helps hospitals allocate resources efficiently and prioritize patient care according to medical necessity.

OBJECTIVE

To investigate the impact of reverse triage on the surge capacity of public hospitals in Addis Ababa, Ethiopia.

METHODS

This cross-sectional study was conducted in three public hospitals using convenience sampling. Data were collected from September 1 to 30, 2023. Descriptive statistics and binomial logistic regression were used to identify factors associated with hospital surge capacity.

RESULTS

A total of 296 participants were included, of whom 45.9 % were aged 13-34 years and 55 % were female. Of the participants, 69.3 % were admitted through the Emergency Department. The Reverse Triage Tool Leuven was used to assess patients for early discharge, with 58.4 % (95 % CI 52.6 %-64.1 %) qualifying. The percentage of patients eligible for early discharge was approximately 66.7 % (95 % CI 54 %-77.8 %) at Zewditu Memorial Hospital, 57.6 % (95 % CI 49.5 %-65.4 %) at Tikur Anbessa Specialized Hospital (TASH), and 52.8 % (95 % CI 40.7 %-64.7 %) at St. Paul Hospital, Millennial Medical College. Data indicates that obstetric patients have a significantly higher likelihood of early discharge (p = 0.008) with an Adjusted Odds Ratio (AOR) of 12.62 (95 % CI: 3.978-19.147), making them over 12 times more likely to be discharged early than those in medical units. Similarly, psychiatric patients also exhibit a significant early discharge association (p = 0.002) with an AOR of 6.62 (95 % CI: 3.978-9.147), indicating over six times greater likelihood compared to medical patients. Additionally, the age group 35-44 shows a significant relationship with early discharge (p = 0.027), increasing odds by 26 % per year of age. Surgical units also demonstrate a strong association with early discharge (p < 0.001).

CONCLUSION

This study highlights the effectiveness of reverse triage in identifying patients suitable for early discharge during disasters, thereby enhancing surge capacity and resource management in public hospitals. The regression analysis findings indicate that obstetric and psychiatric units significantly influence early discharge rates among hospitalized patients. This has crucial implications for hospital policies focused on optimizing bed usage and enhancing discharge protocols amid rising healthcare demands and resource constraints.

Role of Ischemia/Reperfusion and Oxidative Stress in Shock State

Shock is a life-threatening condition characterized by inadequate tissue perfusion leading to systemic hypoxia and metabolic failure. Ischemia/reperfusion (I/R) injury exacerbates shock progression through oxidative stress and immune dysregulation, contributing to multi-organ dysfunction. This narrative review synthesizes current evidence on the interplay between I/R injury, oxidative stress, and immune modulation in shock states. We analyze the classification of shock, its progression, and the molecular pathways involved in ischemic adaptation, inflammatory responses, and oxidative injury. Shock pathophysiology is driven by systemic ischemia, triggering adaptive responses such as hypoxia-inducible factor (HIF) signaling and metabolic reprogramming. However, prolonged hypoxia leads to mitochondrial dysfunction, increased reactive oxygen species (ROS) and reactive nitrogen species (RNS) production, and immune activation. The transition from systemic inflammatory response syndrome (SIRS) to compensatory anti-inflammatory response syndrome (CARS) contributes to immune imbalance, further aggravating tissue damage. Dysregulated immune checkpoint pathways, including CTLA-4 and PD-1, fail to suppress excessive inflammation, exacerbating oxidative injury and immune exhaustion. The intricate relationship between oxidative stress, ischemia/reperfusion injury, and immune dysregulation in shock states highlights potential therapeutic targets. Strategies aimed at modulating redox homeostasis, controlling immune responses, and mitigating I/R damage may improve patient outcomes. Future research should focus on novel interventions that restore immune balance while preventing excessive oxidative injury.

Response of Serum-Isolated Extracellular Vesicles to Focused Ultrasound-Mediated Blood-Brain Barrier Opening

OBJECTIVE

To characterize the response of extracellular vesicles (EV) in the serum of mice and Alzheimer's disease (AD) patients following focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening (FUS-BBBO) as a means to improve liquid biopsy.

METHODS

Blood was collected from C57BL/6 mice before, and one hour after FUS-BBBO, and from AD patients before, one hour after, and three days after FUS-BBBO. EVs were isolated from serum using the Exoquick precipitation solution and their concentration was quantified using nanoparticle tracking analysis. The transcriptomic and proteomic content of EVs from mice was assessed using RNA sequencing and mass spectrometry protein analysis respectively. Additionally, the release of EVs in mice was inhibited using the GW4869 drug to assess the role of EVs in the restoration of the BBB. Finally, the biomarker content of EVs in AD patients was detected using a Luminex multiplex assay.

RESULTS

We observed a 164±85% (95% confidence interval: 78.998 - 249.202) increase in murine EV concentration one hour after treatment, as well as an increase in EV RNA associated with FUS-BBBO neuroimmunotherapy. Inhibition of EVs reduced the inflammatory response and BBBO volume in mice. Patient EV concentration also increased one hour after treatment and was dependent on the volume of BBB opening three days post-treatment. Furthermore, EV isolation was found to significantly enhance (p<0.05) the detection of FUS-BBBO-induced amplification of AD and CNS biomarkers such as GFAP, beta-amyloid 42 and phosphorylated tau 181, exhibiting on average a 1.2 times higher log-fold change in biomarker levels in isolated EVs compared to total serum.

CONCLUSION

Overall, we hereby present the first evidence of altered murine and AD patient EV concentration and content in response to FUS-BBBO, providing evidence of EVs' role within FUS-BBBO neuroimmunotherapy as well as their utility in improving FUS-BBBO biomarker amplification. Our results pave the way for clinical applications of EV-based liquid biopsy in patients with neurodegenerative diseases following FUS-BBBO, as a way of noninvasively monitoring disease progression.

Microcirculatory dysfunction in patients with acute anterior myocardial infarction combined with new complete right bundle branch block

OBJECTIVE

This study sought to investigate clinical characteristics of acute anterior ST-segment elevation myocardial infarction (STEMI) patients complicated by new complete right bundle branch block (CRBBB) and evaluate the occurrence of microcirculatory dysfunction post-percutaneous coronary intervention (PCI).

METHODS

Retrospective analysis was conducted on 261 patients with acute anterior STEMI, differentiating 40 with concurrent new CRBBB (CRBBB group) from 221 without (no-CRBBB group). Data on demographics and hospitalization were collected, and clinical features and prognoses were compared. Post-PCI microcirculatory function was further characterized using coronary angiography-derived index of microcirculatory resistance (caIMR), thrombolysis in myocardial infarction (TIMI) grade flow, corrected TIMI flow frame count (CTFC) of the infarct-related artery, and ST segment regression in electrocardiograph (STR).

RESULTS

Age, Killip class, GLUC, TG, HDL, BUN, GFR, AST, ALT, WBC, TNI at admission significantly differed between groups (P < 0.05). Incidences of in-hospital major adverse cardiovascular events and LVEF showed significant disparities (P < 0.05). The CRBBB group exhibited higher CaIMR, lower TIMI flow, and STR (P < 0.05). Multivariate analysis indicated TIMI ≤ grade 2 (OR = 6.833, 95% CI: 1.009 ~ 46.287, P = 0.049), STR ≥ 50% (OR = 0.176, 95% CI: 0.051 ~ 0.606, P = 0.006), CTFC (OR = 1.079, 95% CI: 1.009 ~ 1.155, P = 0.027), and caIMR (OR = 1.120, 95% CI: 1.059 ~ 1.185, P < 0.001) were independently linked to new onset of CRBBB. Complicated of new CRBBB was strongly associated with elevated CaIMR in anterior STEMI patients. (OR = 5.065, 95% CI:1.793-14.308, P = 0.002).

CONCLUSION

In patients with acute anterior STEMI, those with new CRBBB are at an increased likelihood of experiencing microcirculatory dysfunction.

Computational analysis to assess hemodynamic forces in descending thoracic aortic aneurysms

Descending thoracic aortic aneurysm (DTAA) is a life-threatening disorder, defined as a localized enlargement of the descending portion of the thoracic aorta. In this context, we develop a fluid-structure interaction (FSI) computational framework, with the inclusion of a turbulence model and different material properties for the healthy and the aneurysmatic portions of the vessel, to study the hemodynamics and its relationship with DTAA. We first provide an analysis on nine ideal scenarios, accounting for different aortic arch types and DTAA ubications, to study changes in blood pressure, flow patterns, turbulence, wall shear stress, drag forces and internal wall stresses. Our findings demonstrate that the hemodynamics in DTAA is profoundly disturbed, with the presence of flow re-circulation, formation of vortices and transition to turbulence. In particular, configurations with a steeper aortic arch exhibit a more chaotic hemodynamics. We notice also an increase in pressure values for configurations with less steep aortic arch and in drag forces for configurations with distal DTAA. Second, we replicate our analysis for three patient-specific cases (one for type of arch) obtaining comforting results in terms of accordance with the ideal scenarios. Finally, in a very preliminary way, we try to relate our findings to possible stent-graft migrations after TEVAR procedure to provide predictions on the postoperative state. KEY POINTS: This study employs computational methods to assess hemodynamic forces in descending thoracic aortic aneurysms. We consider ideal cases by varying aortic arch type and aneurysm location. Our results show: chaotic hemodynamics for steep aortic arches; increase in pressure values for less steep aortic arches; high risk of plaque deposition in the aneurysmal sac for proximal aneurysms and near the neck for distal aneurysms. We also analyse three patient-specific cases, confirming the major outcomes found for the ideal cases. We try to suggest how our preoperative findings may correlate to assess the risk of stent-graft migration of a possible TEVAR procedure.

Current applications of indocyanine green fluorescence angiography in trauma patients and its potential impact: a systematic review

OBJECTIVES

Tissue viability assessment is one of the main challenges in trauma surgery. Vitality assessment using indocyanine green fluorescence angiography (ICG-FA) may improve surgical decision-making. This systematic review gives an overview of current applications of ICG-FA in surgical treatment of traumatic injury and its effects on the incidence of postoperative complications and intraoperative decision-making.

DESIGN

Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, EMBASE and MEDLINE were searched through 18 December 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary research reports regarding indocyanine green (ICG)-fluorescence in patients with traumatic injury were included. Exclusion criteria were use of ICG for treatment of burn wounds, traumatic brain injury or reconstructive surgery, absence of an English or Dutch full-text and non-primary study design.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers performed the search and screening process according to standardised methods. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies. Data were presented in text and overview tables.

RESULTS

Thirteen studies were included, of which six were case series/reports including three or fewer patients. Within the other seven studies, 301 patients received ICG-guided surgery. ICG was used for perfusion assessment in all studies. Injury types consisted of traumatic extremity and abdominal injury. All studies reported beneficial effects such as necrosis detection, determination of resection/debridement margins and reduction of debridement procedures. ICG could improve intraoperative decision-making and significantly decrease postoperative complications. No included studies reported ICG-related complications or adverse events.

CONCLUSION

The available literature regarding the use of ICG-FA in trauma surgery is limited, and comparability is low. Still, the results are promising and show a large potential of ICG-FA for better and more efficient treatment of trauma patients. Further research with larger samples and comparable conditions is thus necessary and highly recommended.

Extracellular Vesicle Glial Fibrillary Acidic Protein as a Circulating Biomarker of Traumatic Brain Injury Severity

Traumatic brain injury (TBI) remains a major global health challenge with a need for improved diagnostic and prognostic biomarkers. This study aimed to evaluate the biomarker potential of extracellular vesicle (EV)-encapsulated glial fibrillary acidic protein (EV-GFAP), neurofilament light chain (EV-NfL), total tau (EV-T-Tau), and ubiquitin carboxy-terminal hydrolase L1 (EV-UCH-L1) in TBI. A cohort of 93 trauma patients (75 with TBI and 18 without TBI) was analyzed. Patients were sampled on admission, as well as 15 and 72 h post-injury. Following initial method validation, EVs were isolated from plasma using size exclusion chromatography (SEC), and plasma levels and EV cargo levels of biomarkers were measured using an ultra-sensitive Single Molecule Array. EV-GFAP levels were significantly elevated in TBI patients compared to non-TBI trauma patients at admission and 15 h. A positive head CT was associated with 2.85 (95% CI: 1.18-6.91) fold increased EV-GFAP, whereas EV-NfL, EV-T-Tau, and EV-UCH-L1 levels were not affected. None of the tested EV biomarkers were associated with 1-year mortality or 6-12 months' functional outcome. Plasma-GFAP levels increased 3.4 (95% CI: 1.72-6.70) fold with a positive head CT but were not associated with outcomes. EV-GFAP shows potential as an early biomarker of TBI, but plasma-GFAP remains a practical and reliable alternative. Future studies should explore the potential complementary roles of EV-based biomarkers on alternative aspects of TBI pathophysiology and prediction of long-term outcomes. Studies should refine methods to enhance reproducibility and clinical applicability.

Incidence of opportunities for improvement in trauma patient care: a retrospective registry-based study

Introduction

Trauma is a leading cause of death in individuals aged 45 and younger, contributing significantly to the global disease burden. Local trauma quality improvement programs have been implemented to improve clinical practice and patient outcomes. Multidisciplinary peer reviews, included in quality improvement programs, aim to identify opportunities for improvement in trauma patient care and implement corrective measures. This study assesses the incidence and trends of these opportunities across clinically important trauma cohorts.

Methods

We conducted a retrospective cohort study using data from the trauma registry at Karolinska University Hospital in Solna, Sweden, between 2017 and 2022. Patients screened for opportunities for improvement were categorized into common trauma cohorts. Logistic regression was used to analyze trends in the occurrence of opportunities for improvement over the years in each cohort. The relationship between opportunities for improvement and trauma cohorts was also assessed.

Results

Out of 7192 patients included, 404 (6%) had at least one opportunity for improvement. A statistically significant decrease in opportunities for improvement per year was observed overall (OR 0.90; 95% CI 0.84 to 0.95). Significant decreases were identified in patients with blunt multisystem trauma without traumatic brain injury (TBI) (OR 0.82; 95% CI 0.72 to 0.93), isolated severe TBI (OR 0.61; 95% CI 0.41 to 0.91), and severe penetrating injuries (OR 0.68; 95% CI 0.50 to 0.92). The blunt multisystem with TBI cohort showed a non-significant increase. After adjusting for Injury Severity Score, only the blunt multisystem without TBI cohort remained significantly associated with opportunities for improvement (OR 1.69; 95% CI 1.24 to 2.31).

Conclusion

The incidence of opportunities for improvement in trauma care showed a significant decrease, indicating that the current trauma quality improvement program at Karolinska University Hospital may be effective in reducing opportunities for improvement. Patients with blunt multisystem trauma without TBI were at higher risk for opportunities for improvement compared with other trauma cohorts.

Level of evidence

Level IV: retrospective study with up to three negative criteria.

Rapid, moderate, or slow bleeding? CT analysis of abdominopelvic active vascular contrast extravasation classes and mortality outcomes

OBJECTIVES

Building on prior findings that active vascular contrast extravasation (AVCE) size is an independent predictor of in-hospital mortality in abdominopelvic hemorrhages, this study aimed to categorize AVCEs using latent profile analysis (LPA) and examine differences in patient characteristics, treatments, and outcomes.

METHODS

We retrospectively included consecutive adults with CT-detected AVCE between January 2019 and May 2022. LPA was applied to classify AVCEs based on size-related features, optimizing the number of classes predictive of 24-h and in-hospital mortality. These classes were compared using univariable analysis with post-hoc pairwise comparisons to identify significant differences. Cutoff values for categorization were derived from size parameters and changes across arterial (AP) and portovenous (PVP) phases.

RESULTS

LPA classified 223 patients with single-organ, traumatic, and nontraumatic AVCEs (mean age 59.8 ± 20.1 years, 123 men) into three groups-slow (n = 136), moderate (n = 75), and rapid (n = 12). Slow AVCEs showed smaller size parameters and minimal changes between AP and delayed phases. Rapid AVCEs frequently exhibited coexisting pseudoaneurysms, smaller areas on AP, lower mean attenuation differences in AP-PVP pairs, and were associated with lower systolic and diastolic blood pressures, requiring the highest quantity of packed red cells. Perimeter percentage changes between AP and PVP performed comparably to LPA classes and provided practical classification cutoffs.

CONCLUSION

LPA-based classification of AVCEs into slow, moderate, and rapid types revealed distinct size patterns and associated clinical outcomes, offering a robust framework for risk stratification and guiding management of abdominopelvic hemorrhages.

KEY POINTS

Question It is unclear if the size of active vascular contrast extravasation (AVCE) is predictive of mortality in patients with abdominopelvic hemorrhage. Findings AVCEs could be classified by latent profile analysis into three groups: slow, moderate, and rapid, based on size at multiphasic CT with distinct mortality risks. Clinical relevance Practical cutoff values of perimeter percentage changes of AVCE between arterial- and portovenous-phase CT were identified for AVCE classification, potentially guiding clinical prioritization and management of patients with abdominopelvic hemorrhage.

Admission braden scale is an effective marker for predicting pneumonia in critically ill patients with traumatic brain injury

Pneumonia is a common and serious complication among patients with traumatic brain injury (TBI), significantly impacting their prognosis. The Braden Scale (BS), a tool for assessing the risk of pressure ulcers, has been shown to effectively predict outcomes in various conditions. This study aims to evaluate the predictive value of the Braden Scale for TBI-related pneumonia and to develop a pneumonia prediction model for TBI patients in the intensive care unit (ICU). Clinical data of TBI patients who had a BS documented on ICU admission were retrospectively extracted from the Medical Information Mart for Intensive Care database. Restricted cubic spline (RCS) was employed to evaluate the nonlinear relationship between BS and pneumonia. Univariable and multivariable logistic analyses identified risk factors for TBI-related pneumonia, facilitating the construction of a nomogram model. The nomogram underwent internal validation through receiver operator characteristic (ROC) curve, calibration curve, and decision curve analysis. This study involved 2,175 TBI patients, among whom 516 (23.7%) with pneumonia. The total BS score and each subscale score of pneumonia patients were significantly lower than those of non-pneumonia patients (all P < 0.001). RCS analysis revealed a nonlinear L-shaped relationship between BS and the risk of pneumonia. Multivariable analysis identified eight risk factors for TBI-related pneumonia, including BS < 15, male, calcium, heart failure, chronic pulmonary disease, sepsis, respiratory, and temperature. By incorporating these variables, the predictive nomogram achieved an area under the ROC curve (AUC) of 0.803 (95% CI, 0.782-0.824) and had a well-fitted calibration curve and good clinical practicability. Furthermore, the predictive value of the nomogram surpasses that of common severity score, including the Glasgow Coma Scale (AUC = 0.530), Simplified Acute Physiology Score II (AUC = 0.588), Sequential Organ Failure Assessment (AUC = 0.610), and Acute Physiology Score III (AUC = 0.607). The admission BS is a simple and reliable indicator for predicting TBI-related pneumonia. Incorporating BS into predictive model may enhance the assessment of pneumonia risk in TBI patients, thereby facilitating the identification of high-risk populations and promoting timely intervention.

May-Thurner syndrome diagnosis and management with concurrent lymphedema

BackgroundMay-Thurner syndrome (MTS) is an anatomical anomaly characterized by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) presenting with left lower extremity swelling and venous hypertension. Persistent symptoms after MTS treatment often lead to referral for lymphedema workup to explore non-venous causes. We aimed to describe the presentation of MTS and the findings from the lymphedema workup.MethodsA retrospective review was conducted of patients with MTS and lower extremity lymphedema workup between 2013 and 2022 at a public academic hospital. Demographic data, diagnostic information, treatment details, and outcomes were collected. Descriptive statistical analysis was performed.ResultsOf 523 patients identified, 390(75%) were female, 133(25%) male with a mean BMI of 29.6 kg/m2. Mean age at diagnosis and symptom onset was 54.9(±17.1) and 47.6 (±18.2 )years, respectively. 465 patients (89%) were treated operatively with a combination of stenting, venoplasty, and thrombolysis while 47 (9%) were managed conservatively with compression garments and/or anticoagulation only. The LCIV was most commonly affected, followed by the left external iliac vein. The predominant symptoms were lower extremity deep vein thrombosis in 341 (65%) patients, lower limb edema in 286 (54%), and varicose veins in 129 (24.6%). Of six patients with lymphedema workup, three(50%) showed asymmetric or delayed uptake on lymphoscintigraphy and the remaining three had normal studies.ConclusionIn our study, May-Thurner syndrome was an uncommon but significant cause of lower extremity swelling and venous thromboembolism, especially in middle-aged females. Patients with persistent symptoms after intervention may benefit from diagnostic workup for lymphedema and treatment. More research is needed on the co-occurrence of lymphedema with MTS and its pathophysiology.

Etiology and Risk Factors for Splanchnic Vein Thrombosis in Non-Cirrhotic, Non-Neoplastic Patients: A Narrative Review

Splanchnic vein thrombosis (SVT) is a heterogeneous group of disorders affecting the portal, mesenteric, splenic, and hepatic veins. While frequently associated with liver cirrhosis and malignancy, SVT also occurs in non-cirrhotic, non-neoplastic patients. This narrative review evaluates the epidemiology and risk factors for SVT in this population. The prevalence and incidence of SVT in non-cirrhotic, non-neoplastic patients remain incompletely characterized, with estimates varying widely across studies. The clinical significance of SVT relates to potential complications, including intestinal ischemia, portal hypertension, and a possible underlying systemic disorder. Risk factors for SVT can be categorized into local abdominal conditions, thrombophilias, and systemic disorders. Local factors include inflammatory bowel disease, pancreatitis, abdominal surgery, and trauma. Thrombophilias, both inherited and acquired, are significant contributors to SVT risk. Systemic conditions associated with SVT include autoimmune disorders, pregnancy, hematological diseases, and infections. The complex interplay of these risk factors highlights the need for a comprehensive evaluation of SVT patients. Early recognition and management of these conditions can prevent potentially life-threatening complications and guide decisions regarding anticoagulation and long-term follow-up.

Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

The prognostic utility of the combined assessment of pre-hemodialysis systolic blood pressure (SBP) and pulse rate compared to their independent assessment is unclear. In this nationwide cohort study, we aimed to determine whether their combined assessment could enhance the prognostic utility in patients on maintenance hemodialysis using the Japanese Renal Data Registry database. Exposure was defined as a combination of SBP and pulse rate. Forty-eight levels of exposure groups were created: SBP (<100, 100- < 120, 120- < 140, 140- < 160 [reference], 160- < 180, and ≥180 mmHg) and pulse rate (<50, 50- < 60, 60- < 70 [reference], 70- < 80, 80- < 90, 90- < 100, 100- < 110, and ≥110 beats/min). The primary and secondary outcomes were 1-year all-cause and cardiovascular mortalities, respectively. Multivariate Cox proportional hazards models were used, and multiplicative and additive interactions were assessed. The combined model for mortality and cardiac mortality was statistically better than the separate SBP and pulse rate model. Lower SBP was associated with higher risk of all-cause mortality irrespective of pulse rate. Most categories of lower SBP or higher pulse rate vs. the 120- < 140 mmHg and 70- < 80 beats/min category had positive relative excess risk due to interactions, with similar findings observed for cardiac mortality. Combined assessment of pre-dialysis SBP and pulse rate may help the simple stratification of patients with excess risks that cannot be identified by separate SBP and pulse rate assessment.

Quantitative Perfusion Assessment Using Indocyanine Green in Lower Extremity Perforator Flaps

BackgroundIndocyanine-Green Fluorescence Angiography (ICG-FA) is widely used in reconstructive surgery, providing real-time visualization of flap perfusion. Accurate assessment of perfusion is especially critical in lower extremity reconstructions, where complications like necrosis and venous congestion can lead to poor outcomes, including amputation. Although ICG-FA is commonly available, its interpretation remains subjective and heavily reliant on the surgeon's experience. These challenges underline the importance of integrating objective, data-driven assessment tools into surgical practice.MethodsAs part of a larger, ongoing prospective study, three illustrative cases of lower extremity reconstructions using perforator-based fasciocutaneous flaps were selected. Intraoperative ICG-FA was performed using a surgical microscope with integrated fluorescence imaging. Fluorescence-time-curves (FTCs) were generated using specialized software, and associated quantitative perfusion parameters were compared across three cases: two patients with perfusion-related complications and one patient without complications.ResultsIntraoperative clinical assessment appeared satisfactory in all cases, and no changes in surgical management were made based on the subjective interpretation of ICG-FA. In contrast, quantitative analysis of ICG-FA revealed abnormal perfusion patterns in the two flaps that developed complications, identifying perfusion deficits not evident through conventional assessment.ConclusionThese findings suggest that FTCs derived from ICG-FA data can predict perfusion-related complications. Integrating quantitative ICG-FA analysis into clinical practice may yield a significant advancement in reconstructive surgery, especially in lower extremity reconstructions.Clinical trial nameICG Indocyanine Green in Reconstructive Surgery (ICG-R).ClinicalTrials.gov IDNCT06129669 (https://clinicaltrials.gov/study/NCT06129669?cond=NCT06129669&rank=1).

Validation of the FASILA Score for Predicting Interventions and Outcomes in Traumatic Abdominal and Pelvic Injuries: A Prospective Clinical Study

BACKGROUND

The FASILA score is a 7-point scale comprising the FAST (focused assessment with sonography in trauma), shock index, and serum lactate. We aimed to validate this score prospectively in patients with abdominal and pelvic trauma to predict the need for massive blood transfusion, laparotomy, and inhospital mortality.

METHODS

This prospective study included all adult patients who sustained abdominal and/or pelvic trauma. Pediatric patients, prehospital cardiac arrest, and severe head injury were excluded. Data were analyzed and compared with low (< 4) versus high (≥ 4) FASILA scores.

RESULTS

A total of 400 patients (mean age 36.3 ± 12.7; 90% male; and 96% had blunt trauma) were enrolled between 2022 and 2024. Patients with higher FASILA scores (19.3%) had higher rates of exploratory laparotomy and radiological interventions and received more blood transfusions. They also had longer hospital stays, higher rates of sepsis, and mortality (p = 0.001). The FASILA scores significantly correlated with shock index (r = 0.75), ISS (r = 0.38), SOFA score (r = 0.36), and abdominal AIS (r = 0.27), TRISS (r = -0.19), RTS (r = -0.26), and fibrinogen levels (r = -0.12). A FASILA score ≥ 4 had a high specificity (85.5%) and negative predictive value (80%) for predicting the need for surgery. The FASILA score was an independent predictor of blood transfusion (odds ratio 1.92 and 95% CI 1.43-2.58) after adjusting for abdominal AIS, ISS, SOFA score, and fibrinogen level. AUROC curves were better for the FASILA score than ABC score and "SI alone" for the prediction of MTP and surgical interventions.

CONCLUSION

The significant association between high FASILA scores and blood transfusions, surgical interventions, and mortality indicates its usefulness in early risk stratification in abdominopelvic trauma. Multicenter studies are recommended to enhance external validity across diverse populations and settings.

Differential Proneness to Obesity in Two Rat Strains with Diverse Immune Responses

Although obesity and metabolic syndrome (comprising at least three of the following traits-abdominal obesity, elevated blood pressure, triglycerides and glucose/insulin resistance, and reduced high-density lipoprotein cholesterol in serum) are known to impact immune system activity, these conditions are often not considered when immune response characteristics are investigated in various rodent strains. In this work, metabolic syndrome indices are compared in 3 month-old (young) and 6 month-old (adult) rats of Dark Agouti (DA) and Albino Oxford (AO) strains, while parameters of coagulation, inflammation and oxidative stress were determined in young animals. Study reveals that both young and adult AO rats are obese, intolerant to glucose with higher levels of triglycerides and lower levels of high-density lipoprotein cholesterol when compared to age-matched DA rats. Parameters of coagulation, inflammation and oxidative stress that may contribute to the worsening of metabolic syndrome during aging are also higher in young AO rats. Metabolic syndrome observed in young and intensified in adult AO rats should be taken into consideration when analyzing alterations in immune reactivity during aging in this rat strain.

Optimizing Flow-Controlled Ventilation: Impact of I:E Ratios and Oxygen Concentration in a Porcine Model of Total Airway Obstruction

BACKGROUND

Prehospital airway obstruction is a medical emergency requiring immediate intervention. When the insertion of a larger bore tube over an airway catheter is hindered by obstruction, flow-controlled ventilation (FCV) with expiratory ventilation assistance (EVA) may offer a solution by allowing for ventilation through the airway catheter. This method uses a continuous bidirectional flow, necessitating a high-pressure gas source, typically 100% oxygen. However, in prehospital or military settings, oxygen supplies and exact manual control may be limited. Therefore, evaluating FCV/EVA without 100% oxygen, and with variable inspiratory-to-expiratory (I:E) control is essential to ensure its feasibility in such environments. We hypothesized that arterial oxygenation with 21% oxygen would be feasible and would vary between different I:E ratios.

METHODS

In this randomized crossover trial, FCV/EVA with different I:E ratios and fraction of inspired oxygen were compared in total airway obstruction. 15 crossbred male specific pathogen-free swine, mean (standard deviation [SD]) weight 56.6 (2.1) kg were divided into groups; method A (n = 9) and method B (n = 6), anesthetized, muscle relaxed and desaturated <80%. FCV/EVA was performed for 15 minutes through an airway catheter in the obstructed airway.

RESULTS

In I:E 1:1 vs 1:2 with 21% oxygen, the mean difference of Sao2 was 33.8% (95% confidence interval [CI], 16.3-51.4, P =.0020) and Pao2 was 4.7 kPa (95% CI, 1.3-8.1, P =.0127). Paco2 decreased more in 1:1 than 1:1 with a pause and 1:2. Paco2 remained <5 kPa with small variability in 1:1 with 21% oxygen.

CONCLUSIONS

FCV/EVA with 21% oxygen was feasible and maintained oxygenation and ventilation for 15 minutes. An I:E ratio of 1:1 was superior to 1:2. This approach may offer a viable alternative in a totally obstructed airway in resource-limited settings where higher oxygen concentrations are unavailable.

Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis

BACKGROUND

Endotracheal intubation is essential for airway management in trauma patients but may cause hemodynamic instability and delay critical resuscitation measures. Recent studies have suggested that emergency department (ED) intubation may be linked with higher mortality compared to operating room (OR) intubation in trauma patients. However, it remains unclear if these findings apply to broader trauma populations, including both civilian and military patients. This study uses a nationwide trauma registry to test the hypothesis that ED intubation is associated with higher in-hospital mortality among major trauma patients, compared to OR intubation.

METHODS

Registry-based analysis of the Israeli National Trauma Registry evaluating major trauma (Injury Severity Score [ISS] ≥16) patients requiring hemorrhage control surgery between 2016 and 2023. ED intubation was the main exposure variable with in-hospital mortality serving as the primary outcome. Multivariable logistic regression and propensity score matching were applied to adjust for confounders, including injury severity, ED vital signs, penetrating injury, and blood product administration.

RESULTS

The study included 975 patients, 470 (48.2%) of whom were intubated in the ED. ED-intubated patients had significantly higher ISS and higher proportion of profound shock compared to those intubated in the OR. In-hospital mortality was more common among patients intubated in the ED (22.6%) as compared with those intubated in the OR (8.5%). In the unadjusted logistic regression, ED intubation was associated with higher odds of in-hospital mortality (OR: 3.13, 95% confidence interval [CI], 2.15-4.62). However, after adjusting for several potential confounders, the association became nonsignificant and was persistent across sensitivity subgroup analyses. Propensity score matching resulted in 1:1 matching of 271 patients in each group, balancing characteristics such as ISS, profound shock, Glasgow Coma Scale, and penetrating injury. After matching, the mortality rate was similar between groups (12.5% for ED intubation vs 12.2% for OR intubation). In the matched cohort, logistic regression demonstrated no significant association between ED intubation and in-hospital mortality (OR: 0.97, 95% CI, 0.58-1.61). ED intubation was associated with a greater than 2-fold increase in odds of ICU admission in adjusted and propensity score-matched analyses.

CONCLUSIONS

ED intubation was not significantly associated with increased in-hospital mortality after controlling for injury severity and shock. These findings suggest that while ED intubation may be more frequent in severely injured patients, its independent impact on mortality in patients undergoing emergent surgery remains unclear, warranting further prospective investigation.

A meta-analysis of the diagnostic test accuracy of artificial intelligence predicting emergency department dispositions

BACKGROUND

The rapid advancement of Artificial Intelligence (AI) has led to its widespread application across various domains, showing encouraging outcomes. Many studies have utilized AI to forecast emergency department (ED) disposition, aiming to forecast patient outcomes earlier and to allocate resources better; however, a dearth of comprehensive review literature exists to assess the objective performance standards of these predictive models using quantitative evaluations. This study aims to conduct a meta-analysis to assess the diagnostic accuracy of AI in predicting ED disposition, encompassing admission, critical care, and mortality.

METHODS

Multiple databases, including Scopus, Springer, ScienceDirect, PubMed, Wiley, Sage, and Google Scholar, were searched until December 31, 2023, to gather relevant literature. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool. Pooled estimates of sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated to evaluate AI's predictive performance. Sub-group analyses were performed to explore covariates affecting AI predictive model performance.

RESULTS

The study included 88 articles possessed with 117 AI models, among which 39, 45, and 33 models predicted admission, critical care, and mortality, respectively. The reported statistics for sensitivity, specificity, and AUROC represent pooled summary measures derived from the component studies included in this meta-analysis. AI's summary sensitivity, specificity, and AUROC for predicting admission were 0.81 (95% Confidence Interval [CI] 0.74-0.86), 0.87 (95% CI 0.81-0.91), and 0.87 (95% CI 0.84-0.93), respectively. For critical care, the values were 0.86 (95% CI 0.79-0.91), 0.89 (95% CI 0.83-0.93), and 0.93 (95% CI 0.89-0.95), respectively, and for mortality, they were 0.85 (95% CI 0.80-0.89), 0.94 (95% CI 0.90-0.96), and 0.93 (95% CI 0.89-0.96), respectively. Emergent sample characteristics and AI techniques showed evidence of significant covariates influencing the heterogeneity of AI predictive models for ED disposition.

CONCLUSIONS

The meta-analysis indicates promising performance of AI in predicting ED disposition, with certain potential for improvement, especially in sensitivity. Future research could explore advanced AI techniques such as ensemble learning and cross-validation with hyper-parameter tuning to enhance predictive model efficacy.

TRIAL REGISTRATION

This systematic review was not registered with PROSPERO or any other similar registry because the review was completed prior to the opportunity for registration, and PROSPERO currently does not accept registrations for reviews that are already completed. We are committed to transparency and have adhered to best practices in systematic review methodology throughout this study.

Advancing Alzheimer's disease therapy through engineered exosomal Macromolecules

Exosomes are a subject of continuous investigation due to their function as extracellular vesicles (EVs) that significantly contribute to the pathophysiology of certain neurodegenerative disorders (NDD), including Alzheimer's disease (AD). Exosomes have shown the potential to carry both therapeutic and pathogenic materials; hence, researchers have used exosomes for medication delivery applications. Exosomes have reduced immunogenicity when used as natural drug delivery vehicles. This guarantees the efficient delivery of the medication without causing significant side reactions. Exosomes have lately enabled the potential for drug delivery in AD, along with promising future therapeutic uses for the detection of neurodegenerative disorders. Furthermore, exosomes have been examined for their prospective use in illness diagnosis and prediction before the manifestation of symptoms. This review will document prior studies and will concentrate on the rationale behind the substantial potential of exosomes in the treatment of AD and their prospective use as a diagnostic and predictive tool for this condition.

Endorsement of reporting guidelines and clinical trial registration by tropical medicine and infectious disease journals: A cross-sectional study

BACKGROUND

Studies published in academic medical journals inform and influence healthcare decisions. Sufficient study reporting is primarily charged to researchers. However, journals can promote more complete reporting of their published studies. Recommending or requiring reporting guideline use and prospective trial registration may ensure published studies adhere to rigorous reporting standards. This study aimed to evaluate 'instructions to authors' pages of tropical medicine and infectious disease (TM/ID) journals to assess endorsement of reporting guidelines (RGs) for common medical study designs and clinical trial registration.

METHODS

Using a cross-sectional design guided by the Strengthening the Reporting of Observational Studies in Epidemiology checklist, we examined the top 100 infectious disease (ID) journals identified by the 2021 Scopus CiteScore tool and the 21 tropical medicine (TM) journals identified by Clarivate Web of Science. Each editorial journal staff was contacted for specific study designs accepted. Data were extracted from journals' 'instructions to authors' webpages with any discrepancies being resolved through consensus. We assessed adherence to RGs and clinical trial registration.

RESULTS

This study identified 293 TM/ID journals. Among the top 100 ID journals selected (Scopus CiteScore), 2 unfit journals were replaced. Among the 28 TM journals selected (Clarivate Web of Science), 5 were removed due to being duplicates and 2 were removed due to not being published in English. The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network was cited by 49% of journals, while 85% of journals referenced the International Committee of Medical Journal Editors (ICMJE). Consolidated Standards of Reporting Trials (CONSORT) was most cited (73%), Quality of Reporting of Meta-analyses was least (2.6%). Clinical trial registration was mentioned by 73% of the journals.

CONCLUSIONS

TM and ID journals demonstrated suboptimal endorsement of various RGs. Among our findings, however, CONSORT and clinical trial registration garnered over 70% endorsement. We propose journals streamline RGs, establish user-friendly 'instructions to authors' pages and mandate reporting guideline adherence. These insights inform future research on enhancing reporting guideline use and TM/ID research quality.

Pre-operative FNA in goiter with compressive symptoms: a systematic review and meta-analysis

OBJECTIVE

There are currently no firm recommendations regarding the necessity of preoperative FNA in patients with symptomatic goiter. Fine-needle aspiration (FNA) is an efficient and reliable method for determining the risk of malignancy of thyroid nodules, thus, it became the primary procedure for diagnosing neoplasms and guiding surgical treatment. We performed this systematic review of articles to establish the necessity of FNA in patients with compressive goiter.

METHODS

Following PRISMA guidelines, a systematic literature search was conducted using electronic databases. Included were studies dealing with euthyroid goiter and compressive symptoms in adult patients designated to undergo therapeutic surgery. Two reviewers independently extracted the data and assessed the risk of bias using the ROBVIS (visualization tool). Our main outcome measure was final histology compared to preoperative FNA.

RESULTS

The initial search identified 3304 relevant studies. After screening and quality assessment, 14 studies were included in the systematic review. The FNA accuracy of malignant and non-malignant nodules diagnosed correctly preoperatively, was 88.4%. In a meta-analysis which included both benign and malignant preoperative FNA results with subsequent postoperative histology, we observed a relative risk of 0.79.

CONCLUSION

Our data underscores the significant value of preoperative FNA when planning a thyroidectomy for patients with a goiter. The FNA results enable both the physician, and the patient to make informed decisions, consider a staged surgical approach if necessary, determine an appropriate follow-up strategy, and discuss potential complications based on the preoperative findings.

Association Between Metabolic and Inflammatory Biomarkers and Prognosis in Traumatic Brain Injury: A Focus on Short- and Medium-Term Mortality

Background

Traumatic brain injury (TBI) is a leading cause of disability and death worldwide, involving complex pathophysiological responses such as metabolic disturbance and systemic inflammation. This study aimed to evaluate the prognostic value of selected metabolic and inflammatory biomarkers in predicting short- and medium-term mortality in patients with moderate-to-severe TBI.

Methods

We conducted a retrospective cohort study of patients with TBI admitted between March 29, 2018, and July 31, 2023. Clinical data, including a panel of metabolic (eg, triglyceride-glucose index [TYG], APOB/A1 ratio) and inflammatory biomarkers (eg, neutrophil-to-platelet ratio [NPR]), were collected within 24 hours of admission. Mortality was assessed at 14 days, 30 days, and hospital discharge. Multivariate Cox regression models and ROC curve analysis were used to assess prognostic associations and model performance.

Results

A total of 2555 patients were enrolled, of whom 579 (22.67%) underwent surgical treatment. Multivariate Cox proportional hazards regression analysis revealed that the triglyceride-glucose index (TYG) was an independent predictor of short-term mortality in TBI patients, while the neutrophil-to-platelet ratio (NPR) and apolipoprotein B/A1 (APOB/A1) ratio were independent predictors of both short- and mid-term mortality. In addition, surgical treatment was associated with an increased risk of mid-term mortality, while tracheostomy significantly reduced mortality risk across all time points. Receiver operating characteristic (ROC) curve analysis showed that the regression model incorporating inflammatory markers had the highest areas under the curve (AUCs) of 0.904, 0.897, and 0.897, demonstrating superior performance in predicting short- and mid-term mortality. Additionally, in the subgroup analysis of non-operation patients, TYG and NPR had a more significant impact on mortality risk.

Conclusion

Metabolic and inflammatory biomarkers, including TYG, NPR, and APOB/A1 ratio, provide valuable prognostic information in patients with TBI. These markers may assist clinicians in early risk stratification and personalized treatment planning.

Influence of age-adjusted shock index trajectories on 30-day mortality for critical patients with septic shock

Background

Septic shock poses a high mortality risk in critically ill patients, necessitating precise hemodynamic monitoring. While the age-adjusted shock index (ASI) reflects hemodynamic stability, the prognostic value of its dynamic trajectory remains unexplored. This study evaluates whether dynamic 24-h ASI trajectories predict 30-day mortality in septic shock patients.

Methods

This retrospective cohort study extracted data from the MIMIC-IV (derivation cohort, n = 2,559) and eICU-CRD (validation cohort, n = 2,177) databases. The latent category trajectory model (LCTM) classified ASI changes within 24 h of intensive care unit (ICU) admission. The association between ASI trajectory categories and 30-day mortality was evaluated using Kaplan-Meier (KM) method and Cox proportional-hazard models, reported as hazard ratios (HRs) and 95% confidence intervals (CIs).

Result

Three distinct ASI trajectories were explored: persistently low (Classes 1), initial high ASI sharply decreasing followed by instability (Classes 2), and steady ASI increase (Classes 3). KM curve revealed significantly higher 30-day mortality in Class 2 (32.1%) and Class 3 (38.7%) than Class 1 (12.3%) (P < 0.001). After fully adjusting for covariates, Class 2 (HR = 1.68, 95% CI: 1.25-2.25, P = 0.001) and Class 3 (HR = 1.87, 95% CI: 1.26-2.77, P = 0.002) showed elevated mortality risks in the derivation cohort. Validation cohort results were consistent (Class 2: HR = 1.92, 95% CI: 1.38-2.68, P = 0.001) and (Class 3: HR = 1.66, 95% CI: 1.09-2.54, P = 0.019). Triple-robust analyses and subgroup analyses confirmed the reliability of the results.

Conclusion

Dynamic 24-h ASI trajectories independently predict 30-day mortality in patients with septic shock, with unstable or rising patterns signaling high-risk subgroups. This underscores the clinical utility of real-time ASI monitoring for early risk stratification and tailored intervention.

Association between stress hyperglycemia ratio and poor outcomes in Trauma surgery ICU patients

BACKGROUND

Patients in the Trauma Surgery Intensive Care Unit (TSICU) often experience severe stress responses, which may lead to the occurrence of stress hyperglycemia. The stress hyperglycemia ratio (SHR), a biomarker quantifying the relative severity of stress hyperglycemia, has garnered increasing attention. This study aims to investigate the association between SHR and poor outcomes in TSICU patients.

METHODS

A retrospective cohort study was conducted based on the Medical Information Mart for Intensive Care IV database. Patients in the TSICU were stratified into tertiles based on SHR values. The primary outcomes were 30-day and 365-day all-cause mortality, and the secondary outcome was hospital mortality. Kaplan-Meier survival analysis, logistic regression, Cox proportional hazards models, and restricted cubic spline analysis were employed to examine the relationship between SHR and poor outcomes. The potential incremental value of incorporating SHR into traditional disease severity scoring systems was also explored.

RESULTS

A total of 569 eligible TSICU patients were included. The 30-day and 365-day all-cause mortality rates were 20.7% (118 patients) and 32.5% (185 patients), respectively. Higher SHR was associated with significantly increased risks of 30-day, 365-day, and hospital mortality (HR/OR > 1, P < 0.05). Restricted cubic spline analysis demonstrated no significant non-linear relationship between SHR and mortality risk (P > 0.05). Furthermore, SHR provided incremental prognostic value when integrated into traditional disease severity scoring systems.

CONCLUSION

High SHR is significantly associated with increased all-cause mortality in TSICU patients, particularly among non-diabetic individuals. As a prognostic marker, SHR shows potential clinical utility for early risk stratification and management optimization.

Venous Thromboembolism After Bariatric Surgery: An Analysis of Predictors and Trends in Two Large Datasets

BackgroundDeep vein thrombosis and pulmonary embolism (collectively, venous thromboembolism [VTE]) cause significant morbidity after bariatric surgery. The aim of this study was to compare predictors of VTE after bariatric surgery in two national databases.MethodsThe core National Inpatient Sample (NIS) database and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use data Files from 2016-2021 were concatenated, and elective vertical sleeve gastrectomy and Roux-en-Y gastric bypass procedures were included. Trends in VTE were derived for inpatient hospital stays (NIS and MBSAQIP) and compared and 30-day rates only available in the MBSAQIP were also derived. Preoperative and perioperative factors were identified to construct a multivariable logistic regression model to identify predictors of VTE for each dataset.Results204,866 and 986,210 patients were identified in the NIS and MBSAQIP, and postoperative inpatient VTE rates were 0.11% and 0.10% (P > 0.05), respectively. History of pulmonary embolism (NIS odds ratio [OR] and 95% confidence interval: 3.21 [1.86, 5.53], P < 0.05, MBSAQIP OR: 1.83 [1.45, 2.32], P < 0.05) and increased age (NIS OR: 1.22 [1.02,1.45], P < 0.05, MBSAQIP OR: 1.06 [1.0, 1.11], P < 0.05) were the only factors associated with higher risk of VTE in both databases. There was no difference in in-hospital rates between databases aside from 2021. The MBSAQIP 30-day VTE rate was 0.30%; hence, most (67%) incidences of 30-day VTE occurred after discharge.ConclusionsOur analysis identifies critical risk factors for VTE after bariatric surgery. Most incidences of VTE occurred after the initial hospitalization, and the MBSAQIP underestimates 2021 VTE rates.

Prevalence of diabetes mellitus among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Abha, Saudi Arabia: cross-sectional study

BACKGROUND

Traumatic injuries among patients with diabetes mellitus (DM) are associated with extended hospital stays and higher mortality rates.

OBJECTIVES

This study aimed to estimate the prevalence of DM among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Saudi Arabia.

METHODS

A cross-sectional design was conducted among trauma casualties aged 18 years and older admitted to the Trauma Center of Asser Central Hospital, Abha, Saudi Arabia, for six months from July 1 to December 31, 2024. Data were collected using an interviewer-administered questionnaire. The questionnaire covered various aspects, including demographic information, smoking status, presence of chronic diseases, previous diabetes diagnoses, details of any accidents, diabetes diagnosis during the accident, and self-care practices.

RESULTS

Three hundred and eleven trauma casualties were included with a mean age of 46.7 ± 12.9. Of them, 60.8% were men. The study found that the prevalence of diabetes among trauma casualties was 8.7%, with 48.2% incidentally discovered during the current trauma. Among diagnosed patients, 33.3% had glycated hemoglobin (HbA1c) levels between 7.51-8.5%, 11.1% between 8.51-9.5%, and 22.2% exceeded 9.5%. The predictors of diabetes diagnosis included smoking (OR = 6.39, 95% CI = 2.08-19.63), lower levels of education levels (OR = 0.75, 95% CI = 0.58-0.96), and a positive family history (OR = 24.9, CI = 7.96-78.36).

CONCLUSIONS

The study found an 8.7% prevalence of diabetes among trauma casualties, with nearly half discovered during the event. Factors like smoking, education, and family history of diabetes were associated with diagnosis. Routine diabetes screening is crucial for early detection and management. Targeted interventions, such as multidisciplinary care teams and telemedicine, can improve diabetes management. Further research is needed to address cultural and socioeconomic factors.

Clinical Significance of On-Admission Fibrinogen Levels in Patients With Blunt Traumatic Brain Injury: A Retrospective Observational Study

BACKGROUND

Traumatic brain injury (TBI) is a major cause of morbidity and disability, which may be complicated by coagulation disturbances that exacerbate intracranial bleeding and worsen patient outcomes. Fibrinogen is a critical coagulation factor that is often depleted early following severe TBI. We aimed to explore the relationship between admission serum fibrinogen levels in patients with traumatic brain injury (TBI) and mortality.

METHODS

A retrospective analysis was conducted for patients with TBI admitted between 2016 and 2021. Comparative analyses based on on-admission serum fibrinogen levels (< 1.0 (critical low), 1.0-1.5 (low), and > 1.5 g/L) were performed. A multivariable regression analysis was carried out to predict mortality.

RESULTS

A total of 804 patients were included. Most patients were young males and were involved in motor vehicle crashes (60%) or falls (24%). The median fibrinogen level was 2.3 (IQR 1.8-2.9) and 1.9 (IQR 1.5-2.5) g/L in isolated (23%) and polytrauma TBI (77%), respectively. Fibrinogen therapy was administrated to 145 patients (in patients with fibrinogen levels ≤ 1.5). The most prevalent TBI lesions were subarachnoid hemorrhage (43%) and subdural hematoma (35%). The median Injury Severity Score (ISS) was 27 (interquartile range 19-34) and 75.7% had severe TBI. Hypofibrinogenemia was found in 26.5% of cases and was correlated with MTP and the severity of TBI. Fibrinogen therapy was given in 18% of the cohort (88% and 61% of the critical low and low fibrinogen group, respectively). The overall mortality rate was 21.8%. Mortality rates begin to rise at fibrinogen levels below 1.5 g/L, increasing by 263% at levels 1.0-1.5 g/L and by 630% at levels lower than 1.0 g/L (p < 0.05). The critical low level was an independent predictor of mortality (odds ratio 4.03 and 95% confidence interval 1.44-11.27) after adjustment for age, GCS, shock index, Injury Severity Score, fibrinogen therapy, serum lactate, and positive Focused Assessment with Sonography in Trauma.

CONCLUSION

This study demonstrates an association between admission serum fibrinogen levels and mortality in blunt polytrauma patients with TBI.

Spinal cord injury without radiographic abnormality (SCIWORA) in Tianjin, China: a single-center report of 101 cases

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

This study aimed to investigate the recent epidemiological characteristics of spinal cord injury without radiographic abnormality (SCIWORA) in adult patients at Tianjin Medical University General Hospital, China, from 2018 to 2022.

SETTING

Tianjin Medical University General Hospital.

METHODS

This study included all SCIWORA patients aged ≥ 16 years who were accepted by a general hospital from January 2008 to December 2022. Epidemiological characteristics including sex, age, occupation, etiology, segment of spinal injury, American Spinal Injury Association (ASIA)-ISCoS impairment scale at admission, severity, death and its cause, concomitant injuries and treatment choice were recorded.

RESULTS

A total of 101 patients met the criteria for the study. The average age at injury was 54.7 ± 12.3 years (males: 54.7 ± 12.2 years and females: 54.2 ± 12.8 years), with a range of 18-83 years, and the male/female ratio was 4.6:1. The main reason was low falls (53.5%). C4 was the most commonly involved segment. Fifteen (14.9%) patients experienced clinical complications; the most common complication was electrolyte disorder (4.0%), and the most common concomitant injuries were maxillofacial injury (29.7%), followed by head injury (9.9%). Regarding severity, ASIA grade C was encountered most frequently. Surgery was the main treatment choice (84.1%).

CONCLUSION

The epidemiology of adult SCIWORA has unique characteristics. Low falls were the major reason, and the proportion of males was higher. Retired individuals were those at higher risk, and the average age at injury onset was in the middle-aged and elderly range. Surgical treatment was the major treatment choice.

CLINICAL TRIAL APPROVAL

Not applicable.