Chest Trauma Research Articles

Neurotrophic and synaptic effects of GnRH and/or GH upon motor function after spinal cord injury in rats

Thoracic spinal cord injury (SCI) profoundly impairs motor and sensory functions, significantly reducing life quality without currently available effective treatments for neuroprotection or full functional regeneration. This study investigated the neurotrophic and synaptic recovery potential of gonadotropin-releasing hormone (GnRH) and growth hormone (GH) treatments in ovariectomized rats subjected to thoracic SCI. Employing a multidisciplinary approach, we evaluated the effects of these hormones upon gene expression of classical neurotrophins (NGF, BDNF, and NT3) as well as indicative markers of synaptic function (Nlgn1, Nxn1, SNAP25, SYP, and syntaxin-1), together with morphological assessments of myelin sheath integrity (Klüver-Barrera staining and MBP immunoreactivity) and synaptogenic proteins (PSD95, SYP) by immunohystochemistry (IHC) , and also on the neuromotor functional recovery of hindlimbs in the lesioned animals. Results demonstrated that chronic administration of GnRH and GH induced notable upregulation in the expression of several neurotrophic and synaptogenic activity genes. Additionally, the treatment showed a significant impact on the restoration of functional synaptic markers and myelin integrity. Intriguingly, while individual GnRH application induced certain recovery benefits, the combined treatment with GH appeared to inhibit neuromotor recovery, suggesting a complex interplay in hormonal regulation post-SCI. GnRH and GH are bioactive and participate in modulating neurotrophic responses and synaptic restoration under neural damage conditions, offering insights into novel therapeutic approaches for SCI. However, the intricate effects of combined hormonal treatment accentuate the necessity for further investigation that conduce to optimal and novel therapeutic strategies for patients with spinal cord lesions.

Therapeutic Potential of N-acetylcysteine and Glycine in Reducing Pulmonary Injury in Diabetic Rats

Therapeutic Potential of N-acetylcysteine and Glycine in Reducing Pulmonary Injury in Diabetic Rats

Left Internal Thoracic Artery Injury in Percutaneous Epicardial Access for Catheter Ablation: Prevention and Management

Left Internal Thoracic Artery Injury in Percutaneous Epicardial Access for Catheter Ablation: Prevention and Management

Dietary Eicosapentaenoic Acid Improves Ozone-Induced Pulmonary Inflammation in C57/BL6 Mice

Ambient concentrations of the air pollutant, ozone, are rising with increasing global temperatures. Ozone is known to increase incidence and exacerbation of chronic lung diseases, which will increase as ambient ozone levels rise. Studies have identified diet as a variable able to modulate the pulmonary health effects associated with ozone exposure. Eicosapentaenoic Acid (EPA) is an n-3 polyunsaturated fatty acid (PUFA) consumed through diet that lowers inflammation through conversion to oxylipins including Hydroxy Eicosapentaenoic Acids (HEPEs). However, the role of dietary EPA in ozone-induced pulmonary inflammation is unknown. Therefore, we hypothesize increasing dietary EPA will decrease ozone-induced pulmonary inflammation and injury through the production of HEPEs. To test this, male C57BL/6J mice were fed a purified control diet or EPA-supplemented diet for 4 weeks and then exposed to filtered air (FA) or 1 part per million ozone for 3 hours. 24 or 48 hours post exposure, bronchoalveolar lavage (BAL) fluid was collected to assess airspace inflammation/injury and lung tissue was collected for targeted Liquid Chromatography-Mass Spectrometry (LC-MS/MS) lipidomics. Following ozone exposure, EPA supplementation did not alter markers of lung injury, but decreased ozone-induced airspace neutrophilia. LC-MS/MS targeted lipidomics reveal dietary EPA supplementation increased pulmonary EPA-derived metabolites including 5-HEPE and 12-HEPE. Additionally, EPA supplementation decreased pulmonary levels of pro-inflammatory Arachidonic Acid (AA)-derived metabolites. To evaluate if dietary EPA reduces ozone-induced pulmonary inflammation through increased pulmonary HEPEs, C57BL/6J mice were administered 5- and 12-HEPEs systemically prior to filtered air or ozone exposure. Pretreatment with 5- and 12-HEPEs reduced ozone-driven increases in airspace macrophages. Together, these data indicate that an EPA-supplemented diet protects against ozone-induced airspace inflammation which is, in part, due to increasing pulmonary concentrations of 5- and 12-HEPEs. These findings suggest that dietary EPA and/or increasing EPA-derived metabolites in the lung can reduce ozone-driven incidences and exacerbations of chronic pulmonary diseases.

No benefit from the addition of low-dose ketamine infusion to standard evidence-based care of patients with multiple rib fractures.

Multiple rib fractures from blunt thoracic trauma cause significant morbidity. Optimal current management includes multimodal analgesia, pulmonary hygiene, and early mobilization. Low-dose ketamine infusion (LDKI) has been proposed as an adjunctive analgesic in this setting. A prior study reported decreased pain scores with LDKI in patients with multiple rib fractures. We hypothesized that LDKI would decrease morphine milligram equivalents (MMEs) in patients with multiple rib fractures. A prospective randomized placebo-controlled trial was performed in adult (18 years or older) patients with three or more rib fractures. A prestudy power analysis calculated an 80% chance of identifying a 15% decrease in MMEs with 50 subjects. The study was approved by the institutional review board and informed consent obtained in all subjects. Demographic (age, sex) and injury specific information (Injury Severity Score, number of rib fractures) were obtained. Subjects were randomized 1:1 to receive continuous LDKI (0.1 mg/kg/h) or placebo infusion (0.9% NaCl) for ≤48 hours. All patients received a standard evidence-based multidisciplinary protocol for rib fractures management. Primary outcome measure was MME use or pulmonary complications. Statistical comparison of LDKI versus placebo was performed using the Mann-Whitney U test. All 50 enrolled subjects (placebo, 25; LDKI, 25) received study drug infusion. The two groups were well matched for age, Injury Severity Score, and number of rib fractures. We observed no differences in the Day 1 (p = 0.961), Day 2 (p = 0.373), or total MMEs (p = 0.946) between groups. Similar total MME use was observed when subjects who received ≥40 hours of study drug and were compared (p = 0.924). Use of LDKI did not alter subsequent need for opiate analgesics postinfusion, hospital length of stay, pulmonary complications, or need for readmission. The addition of LDKI to an established multimodal, evidence-based protocol for management of multiple rib fractures did not decrease opiate usage or impact pulmonary complications. Therapeutic/Care Managaement; Level I.

Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes.

Patients with traumatic out-of-hospital cardiac arrest (t-OHCA) require on-scene airway management to maintain tissue oxygenation. However, the benefits of prehospital endotracheal intubation remain unclear, particularly regarding neurological outcomes. Therefore, this study aimed to evaluate the association between prehospital intubation and favourable neurological outcomes in patients with t-OHCA. This retrospective cohort study used a Japanese nationwide trauma registry from 2019 to 2021. It included adult patients diagnosed with traumatic cardiac arrest on emergency medical service arrival. Glasgow Outcome Scale (GOS) scores, survival at discharge and presence of signs of life on hospital arrival were compared between patients with prehospital intubation and those with supraglottic airway or manual airway management. Inverse probability weighting with propensity scores was used to adjust for patient, injury, treatment and institutional characteristics, and the effects of intubation on outcomes averaged over baseline covariates were shown as marginal ORs. A total of 1524 patients were included in this study, with 370 undergoing intubation before hospital arrival. Prehospital intubation was associated with favourable neurological outcomes at discharge (GOS≥4 in 5/362 (1.4%) vs 10/1129 (0.9%); marginal OR 1.99; 95% CI 1.12 to 3.53; p=0.021) and higher survival to discharge (25/370 (6.8%) vs 63/1154 (5.5%); marginal OR 1.43; 95% CI 1.08 to 1.90; p=0.012). However, no association with signs of life on hospital arrival was observed (65/341 (19.1%) vs 147/1026 (14.3%); marginal OR 1.09; 95% CI 0.89 to 1.34). Favourable outcomes were observed only in patients who underwent intubation with a severe chest injury (Abbreviated Injury Score ≥3) and with transportation time to hospital >15 min (OR 14.44 and 2.00; 95% CI 1.89 to 110.02 and 1.09 to 3.65, respectively). Prehospital intubation was associated with favourable neurological outcomes among adult patients with t-OHCA who had severe chest injury or transportation time >15 min.

029. Management of Injury to The Right Lung Due to Penetrating Trauma to The Chest: A Case Report

Background: Thoracic trauma is a significant cause of mortality, in fact, many patients with thoracic trauma die after reaching the hospital. However, many of these deaths can prevented with prompt diagnosis and treatment. Less than 10% of blunt chest injuries and only 15 to 30% of penetrating chest injuries require operative intervention. Most patients who sustain thoracic trauma can be treated by technical procedures within the capabilities of trained clinicians. Case: We reported a case of 44-year-old female having a penetrating wound in her left chest because of her ex-husband stabbed her with a knife. The patient felt pain and the vital signs were stable, from the physical examination there were no abnormalities found. The surgeons did anterior thoracotomy and evacuated the knife within 2 hours since the patient arrived in the ER, and turned out the knife injured the right lung and there was bronchopleural fistula appeared. The surgeons did repair of the fistula and debridement of the wound and primary suturing carried out. The patient discharged 3 days after hospitalized with good clinical condition. Conclusion: This case report presents a successful management of a stable patient with penetrating chest trauma.

Diagnostic Value of Serum Clara Cell Secretory Protein Level in an Experimental Blunt Chest Trauma Model

Objective: Blunt chest trauma is a significant clinical problem leading to injury of the lungs that may be fatal. Experimental blunt chest trauma is well established in animal models. This study aimed to investigate whether Clara cell secretory protein (CC16) can be a biomarker in an experimentally created blunt chest trauma model. Material and Methods: A total of 30 rabbits were used in our study. A modified bilateral blunt thoracic trauma model was used to produce different levels of lung contusion. We divided the rabbits into four groups according to the energy level at which blunt thoracic trauma was applied. Blood samples were taken from the control and trauma groups to evaluate CC16 levels at 0, 12, and 24 hours. Results: The CC16 levels measured at the start of the experiment were significantly lower in the control and low-energy groups compared to the medium- and high-energy groups (p =.002). While there was a significant difference in CC16 levels measured at the 12th hour (p =.004), no significant difference was found among the groups at the 24th hour. Upon analyzing the change in CC16 levels over time within the groups, we observed that CC16 levels decreased from 0–12 hours and subsequently increased after the 12th hour. Histopathologically, we observed that the level of contusion increased in proportion to the severity of trauma across the different groups. Conclusion: With the designed platform, we created a reproducible experimental model of pulmonary contusion from blunt thoracic trauma in rabbits. Increased levels of CC16 following a lung contusion could serve as a foundation for clinical decision-making. Thus, CC16 has the potential to serve as a rapid and simple biochemical indicator for acute traumatic lung injury.

027. Successful Management of Penetrating Thoracic Injury With Impaled Object: A Case Report

Background: Penetrating thoracic injuries with impaled objects are rare but potentially life-threatening emergencies that require immediate medical intervention. These injuries pose significant challenges due to the risk of pneumothorax, hemothorax, and lung laceration. Prompt diagnosis and surgical management are essential to prevent severe complications. Case: A 28-year-old male was admitted to Adam Malik Hospital with a chief complaint of shortness of breath following an accident where a foreign object impaled his right chest. The injury occurred while he was repairing his motorcycle, and an explosion caused the object to penetrate his chest. The patient reported continuous right chest pain, worsened by breathing. On examination, he was alert with stable hemodynamics (BP: 130/70 mmHg, HR: 98 bpm, SpO2: 99% on 10L NRM), and a penetrating wound of 5x2x3 cm was observed in the right chest. Chest X-ray and clinical assessment confirmed a diagnosis of hemopneumothorax with an impaled object. Emergency thoracotomy revealed 800cc of hemorrhagic fluid, lung laceration, and a foreign body penetrating the right lung's superior and medial segments. The foreign body was removed, the lung was sutured, and a thoracic drain was placed. Conclusion: This case highlights the importance of timely surgical intervention in penetrating thoracic injuries. Hemodynamic stability and appropriate surgical techniques led to a successful outcome in this patient, demonstrating the effectiveness of rapid, multidisciplinary management in emergency thoracotomy.

Supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) versus retrograde intrarenal surgery for large volume isolated upper calyceal stones: a prospective randomized analysis

To assess outcomes of supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) and retrograde intrarenal surgery (RIRS) in isolated large volume upper calyceal stones (UCS). This was a prospective randomized study including patients with isolated UCS > 20mm. The patients were randomized into two groups: group (P) (SUGA-PNL) and group (R) (RIRS). Patients’ demographics, stones characteristics, operative, and postoperative outcomes essentially the stone free rate (SFR) and complications rate were documented. The stone clearance was defined as no fragments or residual fragments less than 2mm in the one month non contrast CT scan follow up. Eighty-nine patients opted to undergo the procedure according to the preoperative randomization. Four patients, 2 patients from each group, lost to follow up and other 2 patients were excluded from group (R) due to a tight ureter. Both groups were comparable as regards the preoperative demographics and stone characteristics. There were statistically significant differences regarding total operative time, the change in hemoglobin level, and postoperative pain score (P: 0.024, 0.010 and 0.032 respectively). The SFR was 88.1% in group (P) compared to 73.2% in group (R) (P: 0.019). Moreover, it did not differ significantly between both groups regarding the intraoperative and postoperative complications. No visceral and thoracic injuries were documented in group (P). On other side, 6 patients (14.6%) from group (R) had different grades of ureteral injury during access sheath placement. SUGA-PNL is a safe and effective treatment modality for UCS > 20mm with a higher SFR than RIRS.

Biocompatible Metal-Organic Framework-Based Fabric Composite as an Efficient Personal Protective Equipment for Particulate Matter-Induced Pulmonary Injury.

Efficient personal protection has emerged as a crucial approach for reducing pulmonary injury induced by particulate matter (PM). However, current personal protective equipments usually lack essential biosafety concerns and fail to own adsorbing/antioxidant/antibacterial function together, making it a challenge to develop an integrated platform with the above characteristics. Herein, a facile oxygen-free hydrothermal strategy is proposed to synthesize new copper-based metal-organic frameworks, Cu-HHTPs, (HHTP: 2,3,6,7,10,11-hexahydroxytriphenylene), with great adsorbing/antioxidant/antibacterial activity and high biosafety. The Cu-HHTPs can serve as an efficient additive incorporated with various fabrics including cellulose acetate (CA) membrane to achieve novel fabric composites, such as CA@Cu-HHTPs, with ideal scavenging outcome for the main components of PM. Evidenced by the animal experiments, CA@Cu-HHTPs can highly mitigate PM-induced adverse effects via adsorbing PM, scavenging ROS, and killing bacteria, leading to a significant reduction in lung permeability, inflammation and oxidative stress, and pulmonary infection. Last but not least, a two-week exposure of CA@Cu-HHTPs exhibits no obvious damage toward the animals by examining their long-term toxicity. Collectively, this study not only highlights the potential of Cu-HHTPs as attractive additives for the preparation of fabric composites, but also lays out a new concept toward the development of new-generation multifunctional personal protective equipment against PM.

Bilateral multiple ribs and sternum fracture causing central flail chest with respiratory failure

Bilateral thoracic blunt injuries in a patient may present with central Flail chest, and acute respiratory failure which is one of the life-threatening complications. We present a case of central flail chest caused by blunt trauma, successfully managed with operative rib and sternum fixation. A 35-year male with a central flail chest with acute respiratory failure caused by road-traffic accident who was managed initially with bilateral intercostal chest-tube drainage for significant bilateral hemopneumothorax and lung contusions. The patient was intubated and connected to mechanical ventilatory support with positive pressure ventilation for the internal pneumatic stabilization. There were multiple rib fractures anteriorly (first to seventh rib bilaterally) and fracture of the sternum - the flail chest, for which he underwent bilateral rib fixation and fixation of sternum with titanium reconstruction plate and screws on the 9th postinjury day. Tracheostomy was done along with fixation in the same sitting. Post-operatively, after 48 hours of positive pressure mechanical ventilation, the weaning was started and by the 4-5th day, the patient was on room air with a tracheostomy tube. The patient recovered uneventfully and was discharged on the eighth postoperative day.

Stapler-induced vascular injury during uniportal VATS lobectomy: lessons learned from a rare complication case

BackgroundDue to advances in video-assisted thoracic surgery (VATS), the majority of lung resections can be performed safely via VATS with low morbidity and mortality. However, pulmonary artery (PA) bleeding often requires emergency conversion to thoracotomy, potentially leading to a life-threatening situation. We report a case of pulmonary artery injury caused by an unexpected stapler-tissue interaction during uniportal VATS lobectomy, highlighting the importance of recognizing and managing such rare complications to improve patient outcomes.Case presentationA 63-year-old man underwent uniportal VATS left upper lobectomy for a suspected primary lung cancer. During the procedure, unexpected bleeding occurred from the third branch of the pulmonary artery (A3) after withdrawal of an unfired stapler. The protruding staple of the A3 stump was inadvertently hooked and stretched by the groove of the staple anvil. Although the bleeding was controlled by compression with the lung, the injured A3 stump required repair. Due to the extensive intimal injury near the central part of the left main pulmonary artery and the potential risk of fatal postoperative complications, we converted to open thoracotomy for definitive vascular repair by suturing. The patient had no postoperative complications and was discharged on postoperative day 8.ConclusionsThis case report provides valuable lessons regarding the rare stapler-related vascular injury during uniportal VATS lobectomy. It is important to note that even during non-vascular dissection, unexpected stapler-tissue interactions can lead to bleeding. To prevent the vessel stump entanglement with stapler components, maintaining separation between the stapler and staple stumps is crucial. In uniportal VATS, manipulation during stapler insertion is one of the most challenging phases for instrument interference, requiring increased caution to prevent complications such as the vascular injury described in this case. Thorough preoperative planning, specific intraoperative precautions, and adapted safety protocols that address the limitations of uniportal VATS are essential for effective management of potential complications. Although techniques for thoracoscopic vascular control exist, they are not always feasible and conversion to open thoracotomy should be considered when necessary to ensure patient safety.

Comparative analysis of compartment-specific immunothrombotic biomarker profiles in bronchoalveolar lavage fluid and serum of patients with pneumonia-related acute respiratory distress syndrome: A preliminary cross-sectional study.

Immunothrombosis has emerged as a potential mechanistic link underlying the development and progression of acute respiratory distress syndrome (ARDS), but understanding its specific profile in patients, both locally and systemically, is limited. The objective of this study was to characterize and compare the immunothrombotic signatures in patients diagnosed with pneumonia-related ARDS (p-ARDS) at both the pulmonary and systemic levels and to evaluate their clinical relevance. The study included 23 consecutive patients diagnosed with p-ARDS admitted to the intensive care unit at a tertiary university hospital from July 2022 to May 2023, alongside 40 concurrently hospitalized patients with common pneumonia as controls. Paired bronchoalveolar lavage fluid (BALF) and serum samples were collected from the participants for the analysis of 15 biomarkers to assess and quantify the pulmonary and systemic immunothrombotic signatures. The study results revealed significant pulmonary inflammation and systemic endothelial injury in p-ARDS patients compared to pneumonia controls. These observations were maintained after adjustment for severity of illness (Acute Physiology and Chronic Health Evaluation II scores). In terms of clinical relevance, inflammatory biomarkers (interleukin [IL]-6, IL-8) in BALF were found to correlate with PaO2/FiO2 ratio, while serum levels of a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS-13) and thrombomodulin showed associations with Sequential Organ Failure Assessment and Disseminated Intravascular Coagulation scores. In conclusion, this preliminary investigation identified compartment-specific variations in the immunothrombotic signature between patients with p-ARDS and those with pneumonia alone, with inflammatory responses predominantly localized in the alveolar compartments and coagulation/endothelial injury biomarkers more pronounced in peripheral blood.

The impact of obesity on pediatric orthopedic polytrauma patients

Objectives: The effect of obesity on fracture care and management in the adult population has been well documented in the literature; there is a scarcity of evidence-based research reporting the impact of obesity on pediatric orthopedic polytrauma patients. The aim of this study was to objectively investigate the impact of obesity on pediatric orthopedic polytrauma patients to optimize care and fracture management. Methods: A single-center retrospective cohort study of pediatric polytrauma patients aged 2–18 years old admitted to a level 1 trauma center was conducted over three years. Patients were categorized based on their body mass index (BMI). A logistic regression model was used to identify significant variables between the study groups. Results: A total of 60 patients were included in the analysis and divided into normal weight group (n = 36) and overweight/obese group (n = 24). A trend of lower injury severity score (ISS) was observed in the overweight/obese group compared to the normal weight group. Non-orthopedic injuries, including head, chest, and abdominal injuries, were found to be less in the overweight/obese group. Higher rates of spine and extremity fractures were reported in the overweight/obese group, as well as the need for surgical fixation (P = 0.05). No specific differences in complications, outcome, or discharge facility were found between the two groups. Conclusion: The paradoxical association between BMI and ISS/non-orthopedic injuries, in contrast to spine and extremity fractures, reflects the complex relationship between obesity and polytrauma patterns. Large multi-center prospective studies are needed to predict clinical outcomes in pediatric orthopedic polytrauma patients.

Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study.

Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses. In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH2O with positive end-expiratory pressure (PEEP) level of 0-cmH2O (PSV7PEEP0), PSV 0-cmH2O with PEEP 0-cmH2O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure-time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous. Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH2O s/min, median and interquartile range, IQR) was 256 (208-321) after extubation, 192 (127-281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235-347) at the end of PSV0PEEP0 and 262 (198-338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe. Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

Streamlining management in thoracic trauma: radiomics- and AI-based assessment of patient risks.

In blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications. The objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS). The study cohort consisted of 212 cases. We retrieved information on the cases from the hospital's trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics. To predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV 8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity. The study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance.

Novel Use of Obsidio Conformable Embolic in Thoracic Duct Embolization

AbstractChylothorax is a potentially serious condition resulting from thoracic duct injury. When chyle output remains high despite medical management, invasive interventions such as surgical ligation or percutaneous thoracic duct embolization (TDE) may be necessary. Obsidio is a novel conformable embolic agent that shares properties of both coil and liquid embolic agents. A 37-year-old man presented with left-sided chylothorax, refractory to medical management, following a high-speed motorcycle collision. The thoracic duct was successfully embolized using Obsidio placed between coil packs with fibered coils. This case report demonstrates the first successful use of Obsidio for TDE in a patient with traumatic chylothorax.

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study.

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with 'minor pelvic fractures'. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality-morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups-one screened for VTE and one without screening-were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p < 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Salvianolic acid B improves the microcirculation in a mouse model of sepsis through a mechanism involving the platelet receptor CD226.

Salvianolic acid B (SalB) demonstrates diverse clinical applications, particularly in cardiovascular and cerebral protection. This study primarily investigated the effects of SalB on sepsis. The model of sepsis via caecal ligation puncture (CLP) was established in male C57BL/6 mice. Therapeutic effects of SalB on hepatic and pulmonary injury, inflammatory responses and microcirculatory disturbances in sepsis were evaluated. Platelet aggregation and adhesion were measured via flow cytometry and an adhesion test. After overexpression of platelet-related activating molecules by 293T cells, the efficient binding of SalB and platelet CD226 molecules was further evaluated. Finally, neutralizing antibody experiments were used to assess the mechanism of SalB in alleviating the progression of sepsis. SalB mitigated hepatic and pulmonary impairments, reduced inflammatory cytokine levels and enhanced mesenteric microvascular blood flow in septic mice. SalB enhanced CLP-induced reduction of platelet count and platelet pressure cumulative volume. SalB reduced platelet adhesion to endothelial cells and platelet aggregation to leukocytes. A high binding efficiency was observed between SalB and the platelet adhesion molecule CD226. Ex vivo, interactions between SalB and platelets from CD226-knockout mice were markedly decreased. In vivo administration of CD226 neutralizing antibodies significantly delayed disease progression and enhanced mesenteric microcirculation in septic mice. In our murine model of sepsis, treatment with SalB improved the microcirculatory disturbance and hindered the progression of sepsis by inhibiting platelet CD226 function. Our results suggest SalB is a promising therapeutic approach to the treatment of sepsis.