Trauma Disease Research Articles

Problems of thoracic trauma: pulmonary contusion

The review considers the problem of pulmonary contusion in the intensive care clinic. The frequency of pulmonary contusion in patients with isolated thoracic injuries, polytrauma and its influence on the course of the traumatic disease and the mortality rate are given. The leading pathophysiological mechanisms that take place in pulmonary contusion are discussed. Quantitative evaluation of the severity of thoracic trauma and lung injury are briefly considered. Modern measures of intensive care in patients with pulmonary contusion are highlighted, with an emphasis on the need for respiratory support. The importance of respiratory support for the survival of patients with pulmonary contusion and the auxiliary value of pharmacological methods are emphasized.

The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

ObjectiveTranexamic acid (TXA) plays a significant role in the treatment of traumatic diseases. However, its effectiveness in patients with traumatic brain injury (TBI) seems to be contradictory, according to the recent publication of several meta-analyses. We aimed to determine the efficacy of TXA treatment at different times and doses for TBI treatment.MethodsPubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar were searched for randomized controlled trials that compared TXA and a placebo in adults and adolescents (≥ 15 years of age) with TBI up to January 31, 2022. Two authors independently abstracted the data and assessed the quality of evidence.ResultsOf the identified 673 studies, 13 involving 18,675 patients met our inclusion criteria. TXA had no effect on mortality (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.92–1.06), adverse events (RR 0.93, 95% Cl 0.76–1.14), severe TBI (Glasgow Coma Scale score from 3 to 8) (RR 0.99, 95% Cl 0.94–1.05), unfavorable Glasgow Outcome Scale (GOS < 4) (RR 0.96, 95% Cl 0.82–1.11), neurosurgical intervention (RR 1.11, 95% Cl 0.89–1.38), or rebleeding (RR 0.97, 95% Cl 0.82–1.16). TXA might reduce the mean hemorrhage volume on subsequent imaging (standardized mean difference, -0.35; 95% CI [-0.62, -0.08]).ConclusionTXA at different times and doses was associated with reduced mean bleeding but not with mortality, adverse events, neurosurgical intervention, and rebleeding. More research data is needed on different detection indexes and levels of TXA in patients with TBI, as compared to those not receiving TXA; although the prognostic outcome for all harm outcomes was not affected, the potential for harm was not ruled out.Trial registrationThe review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022300484).

Vagal indigestion in cattle: a retrospective study

This study aimed to carry out a retrospective study of vagal indigestion cases diagnosed in cattle admitted at the Garanhuns Bovine Clinic, Federal Rural University of Pernambuco campus. This syndrome, caused by dysfunctions of the vagus nerve and characterized by motility disorders of the pre-stomachs and abomasum, represented 5.5% (70/1279) of digestive cases diagnosed in a period of 10 years and had an unfavorable prognosis in 78.3% of cases. Type II vagal indigestion was the most prevalent, accounting for 40% of cases, followed by type I (24.3%) and types III and IV, which accounted for 18.6% and 10.0% of cases, respectively. Vagal indigestion in 67.1% (47/70) of cases occurred as a result of other illnesses, such as traumatic reticuloperitonitis (27.7%), lung diseases (12.8%), gastric impaction (10.6%), abomasal ulcer (10.6%), lymphosarcoma (6.4%), and liver abscesses (6.4%). Motor changes in the gastrointestinal tract, such as hypomotility, abdominal distension, and bloat, as well as their consequences, were the most frequent clinical signs. Laboratory, ultrasonographic, and anatomopathological alterations mainly originate from the primary illnesses present in each case. The approach of this disease is essential due to its clinical and economic importance for livestock to expand the knowledge of its etiopathogenesis, thus contributing to a more accurate diagnosis by veterinarians working in the field of internal medicine for cattle.

Volumetry of Hand and Forearm: A 3D Volumetric Approach.

Swelling and edema of the hand and forearm may occur in various traumatic and degenerative diseases. So far, no precise measurement protocol exists. The objective of this study was to evaluate an examination protocol with relevant regions of interest (ROIs) measured by a 3-dimensional (3D) scanner to achieve precise, reproducible, and objective measurements for an optimized detection of volumes of the hand and forearm. A 3D scan protocol was developed using an Artec, 3D scanner EVA to measure discrete hand volumes of healthy volunteers. Five areas were defined as ROIs, representing volumes of the finger, metacarpus, wrist, hand, and distal forearm. Contralateral limbs were used for volume comparisons and calculation of volume differences. For this study, 12 individuals (58.3% women, 24 hands and forearms) with a mean age of 27.1 ± 3 years were included. Mean volume values for left and right ROIs correlated with each other, with slightly higher volumes for the right upper extremity. Volume differences showed statistically significant results for the finger region (ROI I; P = .009), the metacarpal region (ROI II; P < .001), hand region (ROI IV; P = .001), and forearm region (ROI V; P = .006), with the exception of the wrist region (ROI III; P = .722). Our results demonstrate that this 3D volumetric approach is a reliable and objective tool for measuring volumes and circumferences in hand and forearm. Based on our determined ROIs, further studies are needed to explore the significance for clinical applications.

Регуляторные Т-клетки и T-хелперы 17-го типа с экспрессией эктонуклеотидаз CD39 и CD73 при тяжелой механической травме у детей

Frequent resulting disability and case mortality support the urgency of investigation of the immune response mechanisms triggered by severe injury (SI) in children. This study aimed to determine the informative immunological criteria of traumatic injury severity and prognosis in children (n = 43) based on the assessment of expression of CD39 and CD73 ectonucleotidase in populations of regulatory T cells (Treg, CD4+CD127lowCD25high) and T-helper 17 cells (Th17, CD4+CD161+CD3+) in SI cases grouped by the outcome (favorable (SIfav, n = 24), unfavorable (SIunfav, n = 17) and lethal (n = 2)). With the help of flow cytometry, we identified a pronounced decrease in the absolute number of Treg and Th17, as well as Treg and Th17 expressing CD39 and CD73, in the early post-traumatic period. In the SIfav and SIunfav groups the relative number of Treg and Th17 cells expressing CD39 differed significantly (p &lt;0.05); it was substantially higher form the first to the third day post injury in the SIunfav group. The level of Treg CD39 (44.4%) is a premise for an unfavorable outcome in children surviving an SI. In fatality cases, we registered extremely low ectonucleotidase expression rates: CD39+Treg — 9.52% (9.52–13.75) and CD39+Th17 — 0.92% (0.74–1.1). In the SIunfav group, the intensity of fluorescence (FL) of CD39 on Treg cells in the early post-traumatic period was higher than seen in the SIfav group. The threshold value for the average fluorescence intensity (FL) of CD39 on Treg was 8.25 c.u. In fatality cases, the Treg CD39 FL values were extremely low: 3.95 c.u. (3.7–4.67). The results of the study indicate that in children, the expression of CD39 and CD73 in Treg and Th17 populations is significantly associated with the severity of injury and outcome of the traumatic disease.

Changes in mean and variance of ophthalmic disease incidences during COVID-19 pandemic in Korea

This study undertook to determine the changes in the numbers of outpatient visits for various ophthalmic diseases during the COVID-19 pandemic compared with before. The monthly outpatient visits for 14 common ophthalmic diseases were enumerated based on the ICD-10 codes in Korean National Health Insurance Service data. The differences in the mean outpatient visits and disease variance ‘before’ and ‘during COVID-19’ were calculated. Subsequently, subgroup analyses according to age and sex were performed. The number of outpatient visits for conjunctivitis, scleritis & episcleritis, keratitis, cataract, diabetic retinopathy, and traumatic ophthalmic disease were lower during than before COVID-19 (all P < 0.001). The lower numbers of outpatient visits for ophthalmic disorders during COVID-19 were consistent across the age and sex subgroups. All ophthalmic diseases other than endophthalmitis showed no change of variation ‘during’ relative to ‘before’ COVID-19. In conclusion, during the COVID-19 pandemic, the ophthalmic outpatient visits decreased for infectious and inflammatory diseases, screening diseases, and traumatic diseases. However, COVID-19 is not considered to have had a significant effect on variation.

ENTERIC INSUFFICIENCY SYNDROME IN SURGICAL PATIENTS: OBJECTIVE REALITY OR A SYMPTOM OF THE DISEASE?

Acute surgical diseases and trauma in some cases are accompanied by the development of enteric insu ffi ciency syndrome, which aggravates the course of the underlying disease and increases mortality.The purpose of this scientifi c review is to focus the attention of clinicians on the emergence of enteric insu ffi ciency syndrome in the course of acute surgical pathology and traumatic disease, which requires the use of individualized treatment measures.Results. In acute surgical pathology and traumatic disease, a complex structural and functional reorganization of the intestinal epithelium occurs, which disrupts the interrelationships between the cells of the intestinal epithelium, the rejection of epithelial cells and, as a result, the penetration of bacteria from the lumen of the intestine into the lamina propria, their accumulation in the stroma of microvilli and translocation into the free peritoneal cavity. Morphologically it manifests itself in the form of erosion and ulcerative defect or phlegmonous enteritis. As a result, an endotoxemia syndrome is formed, which is the cause of the development of multiple organ failure in such patients Conclusion. The syndrome of enteric insu ffi ciency in acute surgical pathology of the organs of the peritoneal cavity and injuries is a clinically, laboratory and morphologically proven condition that has periods of progress and corresponding clinical symptoms.

Flood dermatoses: A literature review

The most frequent calamity in the world, flooding has killed around 53,000 people in just the previous ten years. Prior to 2011, flooding was the most frequent type of disaster on the planet, accounting for about half of all natural disaster victims and nearly US $185 trillion in economic losses. Flood dermatoses can be divided into four categories: (i) Inflammatory skin diseases (such as irritant contact dermatitis); (ii) Fungal and bacterial infections; (iii) Traumatic skin diseases; and (iv) Other miscellaneous skin diseases (such as an allergic reaction to an insect bite and psycho-emotionally aggravating primary skin diseases). Here we review and summarise a number of articles on flood related skin diseases in an effort to improve knowledge and recognition of these conditions for both dermatologists and general practitioners in order to provide the best and most appropriate management of these particular skin diseases in emergency situations.

An antioxidative sophora exosome-encapsulated hydrogel promotes spinal cord repair by regulating oxidative stress microenvironment

Spinal cord injury (SCI) is a severe traumatic disease because of its complications and multi-organ dysfunction. After the injury, the disruption of microenvironment homeostasis in the lesion demolishes the surrounding healthy tissues via various pathways. The microenvironment regulation is beneficial for neural and functional recovery. Sustained release, cellular uptake, and long-term retention of therapeutic molecules at the impaired sites are important for continuous microenvironment improvement. In our study, a local-implantation system was constructed for SCI treatment by encapsulating exosomes derived from Flos Sophorae Immaturus (so-exos) in a polydopamine-modified hydrogel (pDA-Gel). So-exos are used as nanoscale natural vehicles of rutin, a flavonoid phytochemical that is effective in microenvironment improvement and nerve regeneration. Our study showed that the pDA-Gel-encapsulated so-exos allowed rapid improvement of the impaired motor function and alleviation of urination dysfunction by modulating the spinal inflammatory and oxidative conditions, thus illustrating a potential SCI treatment through a combinational delivery of so-exos.

전ㆍ후기 노인의 손상특성이 NISS에 미치는 영향요인

The purpose of this study is to present policy proposals and health promotion programs for the prevention of traumatic diseases in the elderly by dividing the research subjects into early and late elderly. The data of this study were used in the 14th In-Depth Discharge Injury Survey in 2018. 7,993 patients aged 65 years or older were included among the total discharge injury patients. Data processing was analyzed with SPSS 23.0. As a result of the study, The incidence of injury was high in men(54.1%) of early elderly and in women(60.1%) of late elderly(p &lt;.001). A large number of injuries occurred in the early elderly due to transport accidents while moving, and in the late elderly due to falls during daily life(p &lt;.001). Early and late elderly had two metabolic syndrome factors at moderate injury(p &lt;.001). In NISS, the most common symptoms were mild(51.1%) in the early elderly and moderate(65.3%) in the late elderly(p &lt;.001). According to the NISS, in the early elderly, gender, route of admission, length of stay, metabolic syndrome disease, injury mechanism, place of injury and activity at injury were statistically significant(p &lt;.001). In the later elderly, gender, route of admission, length of stay, type of insurance, metabolic syndrome disease, injury mechanism, place of injury, and activity at injury were statistically significant(p &lt;.001). Therefore, the early and later elderly have different characteristics of injury according to the previous and later age groups, so customized prevention education and national policies and projects for the early and later elderly are required.

JUSTIFICATION OF THE FEATURES OF ANTIBACTERIAL THERAPY IN CIVILIAN AND COMBAT TRAUMA

Summary. Traumatism around the world is taking on unmanageable proportions. Suffice it to say that every year on a global scale, several million people die from traffic accidents and industrial and domestic injuries. Some die from the actual damage, and most die from purulent-inflammatory complications.&#x0D; The urgency of the problem. Treatment of inflammatory complications requires significant funds for antibacterial drugs, but their more considerable amount is insufficient given the resistance of the microflora.&#x0D; Aim. To substantiate the expediency of antibacterial therapy and methods of its application.&#x0D; Materials and methods. Several experimental studies were conducted on rabbits to reveal the inhibitory effect of antibacterial drugs that enter the internal organs with various administration methods.&#x0D; Results and their discussion. It turned out that after intramuscular administration, ceftriaxone accumulates in the organs of the abdominal cavity in an insufficient amount to inhibit the growth of microflora. After intravenous administration, ceftriaxone gets in the appendix in 60 % of the control after 1 hour, and after 2 hours, it decreases to 30 %, which is not very effective. After lymphotropic administration, the antibiotic accumulates after 1 hour in an amount sufficient for antibacterial action (70 %) and after 2 hours — in 95 %, which is evidence of the targeting and accumulation of antibiotics with such administration of the drug.&#x0D; Conclusions. Taking into account the significant disruption of microcirculation in the impression zone, the «mileage» of the vascular bed, the aggregation of formed blood elements in microvessels, and the formation of microthrombi, the intravenous method of drug administration in traumatic disease cannot be considered optimal. This need is met by the lymphotropic way of delivering antibiotics to various organs of the abdominal and thoracic cavities.

A Spiking Neural Network Based on Retinal Ganglion Cells for Automatic Burn Image Segmentation.

Burn is a common traumatic disease. After severe burn injury, the human body will increase catabolism, and burn wounds lead to a large amount of body fluid loss, with a high mortality rate. Therefore, in the early treatment for burn patients, it is essential to calculate the patient's water requirement based on the percentage of the burn wound area in the total body surface area (TBSA%). However, burn wounds are so complex that there is observer variability by the clinicians, making it challenging to locate the burn wounds accurately. Therefore, an objective, accurate location method of burn wounds is very necessary and meaningful. Convolutional neural networks (CNNs) provide feasible means for this requirement. However, although the CNNs continue to improve the accuracy in the semantic segmentation task, they are often limited by the computing resources of edge hardware. For this purpose, a lightweight burn wounds segmentation model is required. In our work, we constructed a burn image dataset and proposed a U-type spiking neural networks (SNNs) based on retinal ganglion cells (RGC) for segmenting burn and non-burn areas. Moreover, a module with cross-layer skip concatenation structure was introduced. Experimental results showed that the pixel accuracy of the proposed reached 92.89%, and our network parameter only needed 16.6 Mbytes. The results showed our model achieved remarkable accuracy while achieving edge hardware affinity.

Psychological defense mechanisms and coping strategies in people with disability and traumatic spinal cord injury with different levels of neuropsychiatric adaptation

BACKGROUND:Despite the multitude of publications on the mechanisms of psychological adaptation in people with spinal and spinal cord injuries, there is a shortage of complex studies that explore the features of these mechanisms depending on the level of neuropsychic adaptation.&#x0D; AIM:This study aimed to explore the relationships between the mechanisms of psychological adaptation and the level of neuropsychic adaptation in patients with traumatic spinal cord injury.&#x0D; Material and methods:Altogether, 80 patients with 3 years of traumatic spinal cord injury were examined: 65 (81.2%) were men, and 15 (18.8%) were women. The mean age was 37.511.61 years, and 46 (57.5%) patients had paraplegia and 34 (42.5%) had tetraplegia. The level of neuropsychic adaptation was determined using the I.N. Gurvich test: a person is considered psychologically adapted if the sum score ranges from 0 to 20, and a person is considered maladapted if the sum score is 20. Psychological defense mechanisms were assessed using the Lifestyle Index of PlutchikKellerman. To determine strategies for coping with stress, we used the Ways of Coping Questionnaire of Folkman and Lazarus.&#x0D; Results:According to the findings, 64.6% of the participants had manifestations of neuropsychiatric maladaptation due to aspects of personality development and personal background. Psychologically maladapted individuals had a higher intensity of defense mechanisms (regression, compensation/identification, substitution, and projection) and coping strategies (escapeavoidance, search for social support, and confrontation). Positive correlations were found between the total index of defense intensity and levels of maladaptive coping (escapeavoidance, confrontation, distancing, acceptance of responsibility, and self-control).&#x0D; Conclusion:People with traumatic spinal cord disease and symptoms of neuropsychiatric maladaptation tend to have a combination of an increased level of tension of psychological defenses with the actualization of regression, substitution, compensation/identification, and projection. People with traumatic spinal cord disease were also found to have a preference for coping strategies aimed primarily at avoiding the problem and reducing emotional discomfort.

Epidemiological characteristics of traumatic spinal cord injuries in a multicenter retrospective study in northwest China, 2017-2020.

BackgroundTraumatic spinal cord injuries (TSCIs) are worldwide public health problems that are difficult to cure and impose a substantial economic burden on society. There has been a lack of extensive multicenter review of TSCI epidemiology in northwest China during the Corona Virus Disease 2019 (COVID-19) pandemic.MethodA multicenter retrospective study of 14 selected hospitals in two provinces in northwest China was conducted on patients admitted for TSCI between 2017 and 2020. Variables assessed included patient demographics, etiology, segmental distribution, treatment, waiting time for treatment, and outcomes.ResultsThe number of patients with TSCI showed an increasing trend from 2017 to 2019, while there were 12.8% fewer patients in 2020 than in 2019. The male-to-female ratio was 3.67:1, and the mean age was 48 ± 14.9 years. The primary cause of TSCI was high falls (38.8%), slip falls/low falls (27.7%), traffic accidents (23.9%), sports (2.6%), and other factors (7.0%). The segmental distribution showed a bimodal pattern, peak segments were C6 and L1 vertebra, L1 (14.7%), T12 (8.2%), and C6 (8.2%) were the most frequently injured segments. In terms of severity, incomplete injury (72.8%) occurred more often than complete injury (27.2%). The American Spinal Injury Association impairment scale of most patients did not convert before and after treatment in the operational group (71.6%) or the conservative group (80.6%). A total of 975 patients (37.2%) from urban and 1,646 patients (62.8%) from rural areas were included; almost all urban residents could rush to get treatment after being injured immediately (<1 h), whereas most rural patients get the treatment needed 4–7 h after injury. The rough annual incidence from 2017 to 2020 is 112.4, 143.4, 152.2, and 132.6 per million people, calculated by the coverage rate of the population of the sampling hospital.ConclusionThe incidence of TSCI in northwest China is high and on the rise. However, due to pandemic policy reasons, the incidence of urban residents decreased in 2020. The promotion of online work may be an effective primary prevention measure for traumatic diseases. Also, because of the further distance from the good conditional hospital, rural patients need to spend more time there, and the timely treatment of patients from remote areas should be paid attention to.

Improved handling and embedding schemes for cultured murine neuroretinal explants

ABSTRACT Traumatic, inherited, and age-related degenerative diseases of the retina, such as retinal detachment, retinitis pigmentosa, and age-related macular degeneration, are characterized by the irreversible loss of retinal neurons. While current treatments aim to prevent neuronal degeneration, there are no available treatments to restore neurons after loss. Cultured murine neuroretinal tissue explants model retinal injury and offer a high throughput approach to identify experimental interventions capable of regenerating neurons. Formalin-fixed paraffin-embedded (FFPE) preparations of murine neuroretinal explants can be used to identify cells throughout the retinal layers to provide information on proliferation and activity following exposure to therapeutics. However, retinal explants are friable, particularly after ex vivo culture, sample handling and FFPE processing steps can result in tissue loss and damage. Friability also prohibits bisecting samples post-culture to display more than one region of interest for analysis. We developed a sample handling and embedding technique for cultured murine neuroretinal explants using HistogelTM in combination with a post-processing trimming step that eliminates tissue loss, increases cross-sectional retinal representation, and captures proximal and central retina on one slide to facilitate analysis of explants subjected to neurotrophic compounds.

N6-methyladenosine modification: A potential regulatory mechanism in spinal cord injury.

N6-methyladenosine (m6A), an essential post-transcriptional modification in eukaryotes, is closely related to the development of pathological processes in neurological diseases. Notably, spinal cord injury (SCI) is a serious traumatic disease of the central nervous system, with a complex pathological mechanism which is still not completely understood. Recent studies have found that m6A modification levels are changed after SCI, and m6A-related regulators are involved in the changes of the local spinal cord microenvironment after injury. However, research on the role of m6A modification in SCI is still in the early stages. This review discusses the latest progress in the dynamic regulation of m6A modification, including methyltransferases (“writers”), demethylases (“erasers”) and m6A -binding proteins (“readers”). And then analyses the pathological mechanism relationship between m6A and the microenvironment after SCI. The biological processes involved included cell death, axon regeneration, and scar formation, which provides new insight for future research on the role of m6A modification in SCI and the clinical transformation of strategies for promoting recovery of spinal cord function.

Single-cell RNA sequencing reveals the role of immune-related autophagy in spinal cord injury in rats.

Spinal cord injury refers to damage to the spinal cord due to trauma, disease, or degeneration; and the number of new cases is increasing yearly. Significant cellular changes are known to occur in the area of spinal cord injury. However, changes in cellular composition, trajectory of cell development, and intercellular communication in the injured area remain unclear. Here, we used single-cell RNA sequencing to evaluate almost all the cell types that constitute the site of spinal cord injury in rats. In addition to mapping the cells of the injured area, we screened the expression of immune autophagy-related factors in cells and identified signaling pathways by the measuring the expression of the receptor−ligand pairs to regulate specific cell interactions during autophagy after spinal cord injury. Our data set is a valuable resource that provides new insights into the pathobiology of spinal cord injury and other traumatic diseases of the central nervous system.

Development of a Three-Dimensional Nerve Stretch Growth Device towards an Implantable Neural Interface.

Because of rising traumatic accidents and diseases, the number of patients suffering from nerve injury is increasing. Without effective rehabilitation therapy, the patients will get motor or sensory function losses or even a lifelong disability. As for amputees, neural interface technology can be used to splice nerves and electrical wires together in a way that allows them to control an artificial limb as if it was a natural extension of the body. However, the means the need for an autologous nerve to stimulate axonal regeneration and extension into target tissues, which are limited by the supply of donor nerves. Based on the principle of mechanical force regulating axon growth, in this paper, we developed a three-dimensional nerve stretch growth device for an implantable neural interface. The device consists of three motors controlled by single chip microcomputer and some mechanical parts. The stability and reliability of the device were tested. Then, we used neurons derived from human pluripotent stem cells by small chemical molecules to explore the optimal three-dimensional stretch culture parameters. Furthermore, we found that the axons were intact through 10 rotations per day and 1 mm of horizontal pulling per day. The results of this research will provide convenience for patients treated through an implantable neural interface.

Eye Bank Records on Pediatric Keratoplasty.

PurposeTo report eye bank records for pediatric keratoplasty in Iran between 2006 and 2019.Methods In a retrospective study, all electronic records of the Central Eye Bank of Iran for pediatric keratoplasty between April 2006 and March 2019 were analyzed in terms of indications for keratoplasty, surgical techniques, their corresponding trends, and post-transplantation graft clarity.ResultsOur database included 2178 eyes from 2050 pediatric cases. The leading indications for keratoplasty included acquired nontraumatic diseases (75.8%), congenital abnormalities (12.7%), corneal regraft (8.3%), and acquired traumatic diseases (3.2%). Keratoconus was the most common acquired nontraumatic cause (58%) and more common in the age group 12 years than those 12 years (P 0.001). Congenital corneal abnormalities and regrafts were more common in the age group 12 years (both P 0.001). The most common surgical technique was penetrating keratoplasty (PKP, 90.9%) followed by deep anterior lamellar keratoplasty (DALK, 7.3%), Descemet stripping automated endothelial keratoplasty (DSAEK, 1.1%), anterior lamellar keratoplasty (0.5%), and keratolimbal allograft transplantation (0.2%). DSAEK was more common in the age group 12 years (P = 0.002), which, unlike PKP and DALK, showed a significant ascending trend over the 14-year period (P = 0.018). Post-transplantation graft clarity was 96.8%.ConclusionKeratoconus was the leading indication for pediatric keratoplasty in Iran. Although PKP was the predominant keratoplasty procedure for the treatment of pediatric corneal disorders, it showed a significant descending trend over the 14 years.

Modern approach to the choice of tactics for the treatment of femoral fractures in patients with associated injury

The work is based on the results of treatment of 233 patients with femoral injuries in concomitant trauma. Males predominated 65.4%. As a result of a road traffic accident, 61.4% of the victims were injured. The most common combination was a concomitant craniocerebral injury, and a fracture of the femur - 42.5%, multiple fractures of the limbs - 16.3% and with polytrauma - 15.0%. In 76.8% of cases, at the time of hospitalization, the condition of patients (ISS: 11.7–22.8). In 202 patients, in 88.7% of cases, in the treatment of femoral fractures, a surgical method was used - osteosynthesis. We have developed a tactic for the treatment of hip injuries, which was based on the severity of the condition and the severity of the injury. It was fundamental that all hip fractures should be stabilized using surgical methods in the early period of traumatic disease. Surgical interventions should be performed after the elimination of the dominant pathology, or after stabilization of hemodynamics.