Chest Trauma Research Articles

Significance of Scapular Fracture Existence in Blunt Chest Trauma: A Retrospective Cohort Study.

Scapular fracture is a rare encounter in blunt trauma patients. The scapula is surrounded by strong groups of muscles offering good protection for the bone. Therefore, a high-energy trauma is needed to cause a scapular fracture. We aim to study scapular fractures and their relation to injury severity and mortality in blunt chest trauma (BCT) patients. We retrospectively collected data from all patients with BCT who were admitted to our hospital from December 2014 through January 2017. The injury details of all BCT patients were retrieved from the trauma registry of the hospital and were supplemented by patients' electronic files for missing information. Collected data included demography, mechanism of injury, vital signs, Glasgow Coma Score (GCS) on admission, injured body regions, management, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of hospital stay (LOS), and mortality. During the study period, 669 patients had BCT. Scapular fracture was present in 29 (4.3%) of the BCT patients. The scapular fracture was missed by chest X-ray in 35.7% of the patients; however, it was accurately diagnosed by computed tomography (CT) scan of the chest. Neck injury was significantly higher in patients with scapular fracture compared with patients without fracture (p < 0.001). ISS and NISS were significantly higher in patients with scapular fractures compared to other patients without fractures (p=0.04 and p=0.003 Mann-Whitney U test, respectively). Two patients with scapular fractures died due to severe associated injuries (the overall mortality was 9.6%). Scapular fracture in BCT patients indicates a high-energy type of trauma. Compared to a chest X-ray, CT scan was more accurate for the diagnosis of scapular fracture. Associated injuries are the main cause of trauma-related mortality rather than the direct effect of the fractured scapula. Particular attention and meticulous evaluation should be paid to head and neck injuries to avoid missing injuries.

Comparison between chest ultrasound (CUS) and chest radiography (CXR) in pneumothorax diagnosis: a literature review

Thoracic injuries include 25% of mortalities in traumatic cases and are associated with a 40% mortality rate. Early diagnosis of pneumothorax in thoracic traumas can decrease the mortality rate and the resultant burden significantly. Diagnosis accuracy is crucial for the management and treatment of pneumothorax since that carries significant morbidity and mortality rates. More than 90% of injury deaths occur in low- and middle-income countries, where the World Health Organization recognizes injuries as a neglected epidemic with the least prepared healthcare systems to handle the trauma burden. Over the past decades, computed tomography (CT) scans have been the gold standard for pneumothorax diagnosis. Even though this diagnostic tool is highly accurate in the detection of intrathoracic injuries, patients undergoing CT scan examination receive a high radiation dose. This study aims to review and comprehend the comparison between chest ultrasound (CUS) and chest radiography (CXR) as a diagnostic tool for pneumothorax. CUS is non-invasive, affordable, and does not pose an ionizing radiation risk. It offers dynamic procedures that can be done at the patient's bedside and can also be used to guide procedures. Previous systematic reviews and meta-analyses showed the diagnostic accuracy of CUS was higher than supine CXR for pneumothorax detection. Patients in some health care centers undergo percutaneous transthoracic needle interventions for ongoing care, including a follow-up chest X-ray (CXR) to detect pneumothorax. In spite of the adjustment for possible sources of heterogeneity, CUS is more sensitive and specific than CXR as the detection modality of pneumothorax. Some important factors, including operator experience, patient demographics, frequency, signs, and ultrasound probes, could be associated with the accuracy of CUS in identifying and diagnosing pneumothorax.

Radiologic diagnosis of pneumothorax in combat trauma

Background. Chest injuries during combat operations occupy a prominent place and often become the cause of mortality. Before the widespread introduction of imaging methods into clinical practice, the mortality rate for chest combat injuries exceeded 50 %. Objective: a comparative assessment of radiography and ultrasonography options in the diagnosis of pneumothorax that occurred as a result of combat trauma. Materials and methods. A comparative analysis of the radiography and ultrasonography results was carried out in 76 patients with pneumothorax due to chest combat trauma. Results. During X-ray in the supine position, the sensitivity of the method was 58.1 %, specificity — 72.7 %, accuracy — 64.5 %, positive predictive value — 73.5 %, negative predictive value — 57.1 %. The sensitivity of the method in the sitting position of patients was 71.9 %, specificity — 89.5 %, accuracy — 76.3 %, positive predictive value — 95.3 %, negative predictive value — 51.5 %. Ultrasound diagnosis of pneumothorax was based on identifying the “barcode” sign due to the lack of sliding of the visceral pleura during the patient’s inspiration. The sensitivity of ultrasonography in B-mode was 90.8 %, specificity — 81.8 %, accuracy — 89.5 %, positive predictive value — 96.7 %, negative predictive value — 60.0 %, and in combined B + M modes — 94.0, 88.9, 93.4, 98.4, 66.7 %, respectively. In the diagnosis of large pneumothorax, the sensitivity of radiography was 96.8 %, specificity — 100.0 %, accuracy — 96.9 %, positive predictive value — 100.0 %, negative predictive value — 50.0 %, respectively, and of ultrasonography — 96.7, 100.0, 96.9, 100.0, 66.7 %, respectively. Conclusions. Ultrasonography has greater sensitivity for diagnosing small pneumothorax than conventional radiography, especially in bedridden patients. Ultrasonography in combined B + M modes can be both a primary and a clarifying method for diagnosing pneumothorax in combat trauma.

Analysing the damping performance of automobile crash dummy ribs

Chest injuries are commonly encountered in traffic accidents, with ribs playing a crucial role in chest impact response. This study focuses on the damping performance of ribs and its influence on chest response during collisions. Employing mechanical bionics principles, the mechanical equivalence of ribs under collision impact was determined. Consequently, a rib impact dynamic model based on equivalent damping theory was developed. This model was integrated with a rib drop hammer impact test system, yielding a numerical solution for the equivalent damping ratio of the rib, quantified as 0.085. Additionally, to validate the accuracy of the rib impact dynamics model, a verification method based on the half-power bandwidth method was proposed. Through the implementation of the rib force hammer impact test, the equivalent damping ratio was determined to be 0.093, showing an 8.6% deviation from the result of the impact dynamics model. These findings not only confirm the validity of the rib equivalent damping theory within the impact dynamics model but also provide theoretical support for the design and improvement of dummy ribs and, potentially, the overall development of crash test dummies.

A CATASTROPHIC COMPLICATION OF A CHEST TRAUMA: A CASE REPORT

Abstract A 43 year old patient came to the Emergency Department of our hospital for a cardiology visit. The EKG revealed polymorfic ventricular tachycardia with a heart rate of 160 bpm so that he was admitted to the Intensive Care Unit. In 2005, he had a post traumatic myocardial infarction after a car accident treated with the implantation of one drug eluted stent on the descending artery. Three years later, a single–chamber ICD was placed. On admission in Intensive Care Unit, cardiac auscultation revealed normal heart sounds without murmurs. No lower extremity edema was observed. A transthoracic echocardiogram showed general hypokinesis with reduced global left ventricle systolic function and no pericardial effusion (EF=20%). The patient was haemodynamically stable, the blood pressure was of 130/80 mmHg. The device was also interrogated and it showed six ineffective attempts of antitachycardia pacing. After that, the patient was given an effective intracavitary shock. Moreover, the patient underwent coronary angiography which showed no disease progression and patency of the stent previously implanted on the proximal descending artery. The electrophysiological study was performed and subsequently 3 ventricular ectopic focuses were effectively ablated. Multiple DC shocks were delivered during the procedure and the atrioventricular bundle was damaged. In consideration of the clinical features and the left ventricular reduced ejection fraction, an indication to the implantation of CRT–D was given. Conclusions This case report describes a rare complication of a blunt chest trauma. A young patient with no significant past medical history suffered a dissection of the coronary descending artery resulting in ST–elevation myocardial infarction. The mechanism of coronary occlusion following blunt chest injury may be due to: shear force applied to the coronary arteries leading to intraluminal thrombosis; vascular rupture; embolism to the coronary arteries; fissuring of an atherosclerotic plaque with dislodgment of plaque material; vascular spasm at the site of the injury. Anyway, severe left ventricular dysfunction caused the developing of polymorfic ventricular tachycardia which was unresponsive to medical treatment and was treated with ablation.

Pursuing Clinical Predictors and Biomarkers for Progression in ILD: Analysis of the Pulmonary Fibrosis Foundation (PFF) Registry

IntroductionPulmonary fibrosis is a characteristic of various interstitial lung diseases (ILDs) with differing etiologies. Clinical trials in progressive pulmonary fibrosis (PPF) enroll patients based on previously described clinical criteria for past progression, which include a clinical practice guideline for PPF classification and inclusion criteria from the INBUILD trial. In this study, we compared the ability of past FVC (forced vital capacity) progression and baseline biomarker levels to predict future progression in a cohort of patients from the PFF Patient Registry.MethodsBiomarkers previously associated with pathobiology and/or progression in pulmonary fibrosis were selected to reflect cellular senescence (telomere length), pulmonary epithelium (SP-D, RAGE), myeloid activation (CXCL13, YKL40, CCL18, OPN) and fibroblast activation (POSTN, COMP, PROC3).ResultsPFF or INBUILD-like clinical criteria was used to separate patients into past progressor and non-past progressor groups, and neither clinical criterion appeared to enrich for patients with greater future lung function decline. All baseline biomarkers measured were differentially expressed in patient groups compared to healthy controls. Baseline levels of SP-D and POSTN showed the highest correlations with FVC slope over one year, though correlations were low.ConclusionsOur findings provide further evidence that prior decline in lung function may not predict future disease progression for ILD patients, and elevate the need for molecular definitions of a progressive phenotype. Across ILD subtypes, certain shared pathobiologies may be present based on the molecular profile of certain biomarker groups observed. In particular, SP-D may be a common marker of pulmonary injury and future lung function decline across ILDs.

Highly Biocompatible Composites as Cigarette Smoke Purifiers for Free Radical Scavenging and Pungent Odor Masking

AbstractThe modification of cigarette filters with nanozymes has gradually emerged as a promising strategy for reducing the harmful effects of smoking by eliminating excessive harmful free radicals and remediating oxidative stress‐induced pulmonary injury. However, currently, available nanozymes‐integrated filters usually ignore safety concerns and fail to address the pungent odor of smoke, making it challenging to develop an individual system with high safety and effectiveness while considering these important factors. Herein, a novel smoke purifier (CDs/ME@MOF) is developed by alternatively introducing carbon dots nanozymes with excellent free radicals scavenging activity and Menthone masking the miscellaneous gas into a biocompatible γ‐cyclodextrin‐based metal–organic framework. The CDs/ME@MOF can act as a profitable additive incorporated with cigarette filters to achieve over 90% scavenging efficiency for cigarette smoke radicals and reduce the odor irritation. In the mice model, the CDs/ME@MOF composites demonstrated the significant inflammation suppression, antioxidant levels promotion, and notable lung tissues protection effect through elimination of free radicals. This work highlights the potential of CDs/ME@MOF as a safe, environmentally friendly, and multipurpose additive for modifying cigarette filter.

Cardiovascular Disease and Inpatient Complications in Turner Syndrome: A Propensity Score Analysis.

Turner syndrome is a genetic disorder that occurs in female individuals and is characterized by the absence of 1 of the X chromosomes. This study examined the risk of cardiovascular disease and inpatient clinical outcomes in patients with Turner syndrome. Data were extracted from the Nationwide Inpatient Sample 2016 database. Propensity score analysis was used to match women with Turner syndrome and women without Turner syndrome admitted to a hospital in the same year to evaluate the risk of cardiovascular disease and inpatient clinical outcomes in patients with Turner syndrome. After 1:1 matching, 710 women with Turner syndrome and 710 women without Turner syndrome were included in the final analysis. Compared with women without Turner syndrome, women with Turner syndrome were more likely to have a bicuspid aortic valve (9.4% vs 0.01%; P < .01), coarctation of the aorta (5.8% vs 0.3%; P < .01), atrial septal defect (6.1% vs 0.8%; P < .01), and patent ductus arteriosus (4.6% vs 0.6%; P < .01). Patients with Turner syndrome were more likely to have an aortic aneurysm (odds ratio [OR], 2.46 [95% CI, 1.02-5.98]; P = .046), ischemic heart disease (OR, 1.66 [95% CI, 1.10-2.5]; P = .02), heart failure (OR, 3.15 [95% CI, 1.99-4.99]; P < .01), and atrial fibrillation or flutter (OR, 2.48 [95% CI, 1.42-4.34]; P < .01). Patients with Turner syndrome were more likely to have pulmonary arterial hypertension (OR, 2.12 [95% CI, 1.08-4.14]; P = .03) and acute kidney injury (OR, 1.60 [95% CI, 1.06-2.42]; P = .03) and to require mechanical ventilation (OR, 1.66 [95% CI, 1.04-2.68]; P = .04). Turner syndrome is associated with an increased rate of cardiovascular disease and inpatient complications. These findings suggest that patients with Turner syndrome should be screened and monitored closely for cardiovascular disease and inpatient complications.

Treatment of blunt thoracic trauma in a Level 1 Trauma Center

Blunt chest trauma has a significant high morbidity and mortality rate. In general, the treatment is conservative; in the case of hemothorax, pneumothorax, and hemopneumothorax chest tube drainage is often required. Immediate surgery is indicated in massive bleeding, tracheal and oesophageal injuries, and pericardial tamponade. Elective surgery should be performed in the case of retained hematoma, unresolved pneumothorax and flail chest. The first prioritized procedure is video-assisted thoracoscopy. The aim of this study is to analyze the treatment options and therapeutic results in reviewing 8,108 patients afflicted with blunt thoracic trauma. In over a three-year period 7,853 patients’ data were analyzed. Altogether 1,624 (20.68%) patients suffered severe injuries, such as sternal or rib fracture(s), pleural or lung injuries. In this group, a simple rib fracture (1-3) was diagnosed in 1,466 (90.27%), unilateral serial rib fracture (≥4) in 84 (5.17%), bilateral rib fracture in 16 (0.99%) and flail chest in 47 (2.89%) patients. In 11 (0.68%) cases, only parenchymal injuries without rib fracture were found. Altogether, 190 (11.70%) patients were afflicted with pneumothorax, hemothorax, or both, and only 86 (45.26%) of these cases required chest tube drainage. One immediate thoracotomy was needed to staunch massive bleeding and elective video-assisted thoracoscopy was performed in 6 cases. Lung contusion was diagnosed in 57 (3.51%) patients. The most frequent complication was pneumonia with a rate of 0.19% (15 patients). Empyema (3 patients), unresolved pneumothorax (1 patient), and retained hematoma (4 patients) occurred in 0.04%, 0.01% and 0.05% of the cases, respectively. Altogether, 13 (0.17%) patients succumbed at a mean age of 63.54±21.92 years. Three of these cases (23.08%) experienced multiple trauma and 12 (92.31%) suffered from concomitant chronic diseases. Patients with blunt chest trauma rarely required immediate operation. Overall, in the case of unresolved pneumothorax and retained hematoma, surgery is indicated, in which these cases video-assisted thoracoscopy is the first and primary option.

Design of energy-absorbing bionic workstation table for trains and research on occupant collision injury

Secondary impact is a significant contributor to occupant injuries in train crashes. To mitigate collision injuries, a workbench with energy-absorbing properties was developed, drawing inspiration from leaf-vein and honeycomb structures. A local collision model of a dummy compartment was established to evaluate the impact of different sandwich thicknesses on occupant injuries. By optimizing the wall thickness of the energy-absorbing sandwich, the optimal gradient parameters were determined. The assessment of occupant collision injury from the workstation table with a graded wall thickness sandwich was conducted using the LSTC Hybrid III 50th seating dummy. The results demonstrate that the workstation table influences the occupant's movement posture during a collision, preventing head impact with the tabletop. Apart from slightly elevated leg injuries in the dummy, which remained within permissible values, the head, neck, and chest injuries were reduced by 98.45%, 48.17%, and 81.18%, respectively.

Fatty acids metabolism in ozone-induced pulmonary inflammatory injury: Evidence, mechanism and prevention

Ozone (O3) is a major air pollutant that directly threatens the respiratory system, lung fatty acid metabolism disorder is an important molecular event in pulmonary inflammatory diseases. Liver kinase B1 (LKB1) and nucleotide-binding domain leucine-rich repeat-containing protein 3 (NLRP3) inflammasome not only regulate inflammation, but also have close relationship with fatty acid metabolism. However, the role and mechanism of LKB1 and NLRP3 inflammasome in lung fatty acid metabolism, which may contribute to ozone-induced lung inflammation, remain unclear, and effective strategy for preventing O3-induced pulmonary inflammatory injury is lacking. To explore these, mice were exposed to 1.00 ppm O3 (3 h/d, 5 days), and pulmonary inflammation was determined by airway hyperresponsiveness, histopathological examination, total cells and cytokines in bronchoalveolar lavage fluid (BALF). Targeted fatty acids metabolomics was used to detect medium and long fatty acid in lung tissue. Then, using LKB1-overexpressing adenovirus and NLRP3 knockout (NLRP3−/−) mice to explore the mechanism of O3-induced lung fatty acid metabolism disorder. Results demonstrated that O3 exposure caused pulmonary inflammatory injury and lung medium and long chain fatty acids metabolism disorder, especially decreased dihomo-γ-linolenic acid (DGLA). Meanwhile, LKB1 expression was decreased, and NLRP3 inflammasome was activated in lung of mice after O3 exposure. Additionally, LKB1 overexpression alleviated O3-induced lung inflammation and inhibited the activation of NLRP3 inflammasome. And we found that pulmonary fatty acid metabolism disorder was ameliorated of NLRP3 −/− mice compared with those in wide type mice after O3 exposure. Furthermore, administrating DGLA intratracheally prior to O3 exposure significantly attenuated O3-induced pulmonary inflammatory injury. Taken together, these findings suggest that fatty acids metabolism disorder is involved in O3-induced pulmonary inflammation, which is regulated by LKB1-mediated NLRP3 pathway, DGLA supplement could be a useful preventive strategy to ameliorate ozone-associated lung inflammatory injury.

Current expert-based opinions on endovascular treatment of blunt thoracic aortic injury: A state-of-the-art narrative review on indications, techniques, results, and challenges.

Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma which warrants prompt recognition with expedited management. Clinical manifestations of BTAI may not be straightforward to detect and may be misdiagnosed. Therefore, diagnosis of BTAI requires a high index of suspicion based on the mechanism of injury along with urgent transfer to centers with appropriate expertise and facilities. We provide an expert-based narrative review on endovascular treatment of BTAI highlighting indications, techniques, results, and challenges. Multiple imaging modalities can be used including computed tomography angiography, transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound. Whilst conservative pharmacological management can be a safe option in low-grade BTAI, thoracic endovascular aortic repair has become the gold-standard strategy in most cases, replacing open surgical repair. Nevertheless, it is important to account for patient demographics particularly age, severity of injury, choice of endograft including its type and size, and endovascular technique including landing zone and left subclavian artery revascularization. Overall, TEVAR in BTAI has been shown to be an efficacious strategy with favorable early outcomes. In contrast, less is known on the long-term clinical outcomes of TEVAR in BTAI. Hence, despite the optimal early technical and clinical success rates, concerns remain about the need for long-term surveillance. The exact timing of follow-up and the integration of different modalities that can also investigate potential downstream cardiovascular effects remain hot topics for future research. Finally, industry should focus on developing more compliant endografts to improve the stiffness mismatch between the endograft and the aorta to optimize results.

TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm: Case report and systematic review.

Blunt thoracic aortic injuries (BTAIs) involving the aortic arch are a challenging condition. Thoracic endovascular aortic repair (TEVAR) with fenestration, which expands the proximal landing zone, is able to exclude the injury while preserving blood flow in supra-aortic branches. Here we report a case of TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm and perform a systematic review. A 24-year-old man suffering a blunt thoracic injury and a left femoral fracture was sent to our hospital. A pseudoaneurysm was found in the aortic arch between the brachiocephalic artery and the left common carotid artery. The patient underwent emergent TEVAR with fenestrations of all supra-aortic branches, which excluded the pseudoaneurysm and preserved the patency of all branches. The orthopedic team then treated the femoral fracture. The patient's recovery was unremarkable. We performed a systematic review on TEVAR with fenestrations for BTAI. Six patients (75%) received TEVAR with single fenestration, 1 patient (12.5%) received TEVAR with two fenestrations, and 1 patient (12.5%) had fenestrations of all supra-aortic branches. Except one patient died in the perioperative, other patients survived without stent-related complications in the short-term follow-up. TEVAR with fenestration is feasible for treating BTAI involving the aortic arch in selected patients.

Passive activity enhances residual control ability in patients with complete spinal cord injury.

JOURNAL/nrgr/04.03/01300535-202508000-00024/figure1/v/2024-09-30T120553Z/r/image-tiff Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level. However, because of prolonged inactivity, initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway. A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation, as measured by surface electromyography. In this study, we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury. Eleven patients with chronic complete thoracic spinal cord injury were recruited. Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol. The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation. Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity, the difference was not statistically significant. These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.

Endovascular repair for acute aortic syndrome involving the descending aorta

This review paper delves into the acute aortic syndromes, with a particular focus on those affecting the descending thoracic aorta, including acute type B aortic dissection (aTBAD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), blunt traumatic thoracic aortic injury (bTAI), and ruptured aneurysm of the descending thoracic aorta (rDTA). These conditions present with sudden-onset symptoms such as severe chest or back pain, necessitating immediate medical attention. While traditional open surgical repair was historically the mainstay of treatment, advancements in endovascular techniques have revolutionized management approaches. Endovascular treatment offers advantages such as reduced operative time, blood loss, and hospital stay, making it a safer option for high-risk patients. However, it is crucial to carefully evaluate patients for endovascular suitability, considering the potential complications and risks associated with these techniques. This paper aims to provide an updated overview of acute aortic syndromes involving the descending thoracic aorta, analyze available therapeutic options, and review contemporary treatment modalities, shedding light on the technical aspects and considerations guiding clinical decision-making in this complex and life-threatening scenario.

Patient and clinician perceptions of blunt chest trauma management and recovery: a qualitative study

Purpose To explore patient and clinician perceptions of blunt chest trauma management and recovery, when discharged directly home from the Emergency Department (ED). Methods This was a qualitative study, completed in a trauma unit in Wales. Blunt chest trauma was defined as an isolated blunt injury to the chest wall, resulting in bruising or rib fractures. Data collection involved semi-structured telephone interviews and focus groups with patients and clinicians respectively. Data analysis was completed using reflexive thematic coding. Results Twelve patient interviews and three focus groups (23 clinicians) were conducted. In the interviews, seven males and five females participated, with a mean age of 54 years (range 28–74). Clinicians included nurses, doctors, and therapists. Two main themes emerged; 1) the ED experience and 2) recovery once home; each with a number of sub-themes. Results highlighted the significant impact of pain on recovery, and that there is a disjuncture between organisational perspectives of clinicians, and the individual personal perspective of patients. Discussion Recovery from blunt chest trauma for patients discharged directly home from the ED is a challenging and complex process. Protocol-driven care does not always lead to good patient experience, as it focuses primarily on hospital services and resources.

Nicorandil mitigates arsenic trioxide-induced lung injury via modulating vital signalling pathways SIRT1/PGC-1α/TFAM, JAK1/STAT3, and miRNA-132 expression.

Nicorandil, a selective opener of potassium channels, used to treat angina, has drawn attention for its potential in mitigating lung injury, positioning it as a promising therapeutic approach to treat drug-induced lung toxicity. This study aimed to explore the protective role of nicorandil in arsenic trioxide (ATO)-induced lung injury and to elucidate the underlying mechanistic pathways. We assessed the effects of nicorandil (15 mg·kg-1, p.o.) in a rat model of pulmonary injury induced by ATO (5mg·kg-1, i.p.). The assessment included oxidative stress biomarkers, inflammatory cytokine levels, and other biomarkers, including sirtuin-1, sirtuin-3, STAT3, TFAM, and JAK in lung tissue. Histological examination using H&E staining and molecular investigations using western blotting and PCR techniques were conducted. In our model of lung injury, treatment with nicorandil ameliorated pathological changes as seen with H&E staining, reduced tissue levels of toxicity markers, and exerted significant antioxidant and anti-inflammatory actions. On a molecular level, treatment with nicorandil down-regulated JAK, STAT3, PPARγ, Nrf2, VEGF, p53, and micro-RNA 132 while up-regulating Sirt1, 3, TFAM, AMPK, and ERR-α in lung tissue. The results presented here show nicorandil as a significant agent in attenuating lung injury induced by ATO in a rodent model. Nonetheless, further clinical studies are warranted to strengthen these findings.

Progress in the diagnose and treatment of pulmonary arterial thrombosis in situ

In situ pulmonary arterial thrombosis (ISPAT) refers to the formation of new blood clots in the pulmonary arterial system in the absence of pre-existing clots in the peripheral venous system. With the emergence and prevalence of COVID-19, ISPAT has become an increasingly important cause of pulmonary arterial thrombosis (PAT) alongside thromboembolism. Several factors such as hypoxia, inflammation, endothelial dysfunction, and hypercoagulable state can lead to ISPAT, which is associated with a number of conditions such as thoracic trauma, partial lung resection, pulmonary infectious disease, pulmonary vasculitis, connective tissue diseases, severe pulmonary hypertension, radiation pneumonitis, and acute chest syndrome in sickle cell disease. It is important to differentiate between pulmonary thromboembolism (PTE) and ISPAT for proper disease management and prognosis. In this review, we summarized the characteristics of ISPAT under different disease conditions, the methods to distinguish ISPAT from PTE, and the best treatment strategies. We hoped that this review could improve clinicians' understanding of this independent disease and provide guidance for the refined treatment of patients with PAT.

Navigating perils at the US-Mexico border: an illustrated exploration of trauma among southern border migrants

Surge in migrants at the US-Mexico border, intensified by Coronavirus disease 2019 (COVID-19), has led to over 2.7 million U.S. Border patrol encounters in 2022. This article explores trauma among Southern border migrants, categorizing injuries from desert crossing, border wall traversal, fleeing, and train travel. Desert migration poses risks from harsh terrain, extreme temperatures, and dehydration. The border wall, covering a quarter of the border, results in varying falls, correlating with increased morbidity at greater heights. Motor vehicle use introduces dangers, including high-speed chases and altercations, causing significant morbidity. "La Bestia," cargo trains, expose passengers to assault, coercion, and injuries during boarding attempts. The study details organ-based injuries, emphasizing distinct patterns in facial trauma, thoracic injuries, abdominopelvic injuries, and lower extremity injuries. Controlled and uncontrolled falls have diverse outcomes, with pediatric populations facing increased morbidity. In conclusion, migrants face serious risks, including heat-related illnesses, violent crimes, and traumatic injuries. Southern border migrants, often deported without complete care, represent an underserved population. This exploration sheds light on their unique healthcare needs, urging attention to their challenges in a concise manner.

Pathogenesis of Pulmonary Manifestations in ANCA-Associated Vasculitis and Goodpasture Syndrome.

Pulmonary manifestations of vasculitis are associated with significant morbidity and mortality in affected individuals. They result from a complex interplay between immune dysregulation, which leads to vascular inflammation and tissue damage. This review explored the underlying pathogenesis of pulmonary involvement in vasculitis, encompassing various forms such as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), and anti-GBM disease. Mechanisms involving ANCA and anti-GBM autoantibodies, neutrophil activation, and neutrophil extracellular trap (NETs) formation are discussed, along with the role of the complement system in inducing pulmonary injury. Furthermore, the impact of genetic predisposition and environmental factors on disease susceptibility and severity was considered, and the current treatment options were presented. Understanding the mechanisms involved in the pathogenesis of pulmonary vasculitis is crucial for developing targeted therapies and improving clinical outcomes in affected individuals.