简介：与多重损伤在病人为错误诊断探索特征，治疗结果和原因的目的，以便减少错误诊断的发生。从1997年8月被同意进入我们的部门到2008年8月的有多重损伤的3163个病人全部的方法A，回顾地被学习比较诊断和治疗的特征。有2117男性(66.93%)，有平均数的1046女性(33.07%)36.46年变老(范围，14-80年)。象一般地位，创伤的条件，诊断和治疗状况，预后和死亡那样的参数被分析。错误诊断组和正确诊断组之间的差别以阐明的损害，复杂并发症和治疗结果的严厉被比较错误诊断的原因和预防。结果在这研究的多重损伤的错误诊断率是16.19%。误诊的主要解剖地点是手足和骨盆(299个位置，39.50%)，腹的区域和骨盆的机关(148个位置，19.55%)，并且胸的区域(109个位置，14.40%)。在错误诊断组，ISS，一些医院停留，知觉的骚乱的率，批评盒子和吃惊，盒子是33.78吗？

简介：客观：为了在对待多重损伤探索技工al通风(MV)的重要性，主要与服的损害伴随了并且改进治疗水平。方法：受不了伴有主要服的损害的多重损伤的所有116个病人被分析。等级相关和Chi平方测试与GCS在MV之间被做，ISS，并且是否震惊。结果：MV与GCS被相关，ISS分数，并且是否显著地震惊。而且，什么时候GCSor=35，MV的比率是大约85%。结论：在伴有服的损害的多重损伤的治疗期间，原则“早MV，早撤退”并且“个人主义”应该被坚持。为伴有吃惊的病人，最佳偷看是很重要的。合适、活跃的MV是很重要的并且能显著地改进治疗水平。

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简介：AbstractPurpose:It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.Methods:This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.Results:Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).Conclusion:Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

简介：AbstractPurpose:This study aimed at exploring the application of trauma time axis management in the treatment of severe trauma patients by using the Medicalsystem trauma system.Methods:We performed a retrospective cohort study involving patients with severe trauma. Patients who were admitted before the application of the Medicalsystem trauma system were divided into before system group; patients who were admitted after the application of the system were divided into after system group. Comparison was made between the two groups. For normally distributed data, means were reported along with standard deviation, and comparisons were made using the independent samples t test. Categorical data were compared using the Chi-square test. The Mann-Whitney U test was used to compare nonparametric variables.Results:There were 528 patients admitted to the study during the study period. There was no significant statistical difference in the time from the start of trauma team to arrive at the resuscitation room between the two groups. The time from arrival at hospital to endotracheal intubation, to ventilator therapy, to blood transfusion, to completion of CT scan, to completion of closed thoracic drainage, to the start of operation, as well as the length of stay in resuscitation room and hospital were significantly lower after the application of the Medicalsystem trauma system. The mortality was decreased by 8.6% in the after system group compared with that in the before system group, but there was no statistical difference.Conclusion:The Medicalsystem trauma system can optimize diagnosis and treatment process for trauma patients, and accordingly improve the treatment efficiency and shorten the treatment time. Therefore, the Medicalsystem trauma system deserves further popularization and promotion.

简介：The20thcenturyisacenturyinwhichhumanmaterialcivilizationandmedicinedevelopedthemostrapidly,manycausesofdiseasesunknownbeforewerefoundmolecularly,manydiseasesorterminaldiseasesuncurablebeforewerecuredwithnewtherapeuticmethods,manyfatalcontagiousdiseasesthathadcausedcorpsoverthewildernesswerecontrolledeffectively,cathetertechniquesandoperationscouldbeusedanywhereinthehumanbodysolongastheywereneeded,andnewdiagnosticandtherapeutictechniquesemergedoneafteranother;medicalprogressmadeanever-lastingcontributiontohumanhealth.

简介：十二指肠的损伤由于增加的汽车事故和强烈事件经常越来越不平常却现在看见。十二指肠的损伤的管理能是复杂的，特别当对pancreatic-duodenal-biliary建筑群的巨大的损害同时发生时。甚至病人及时收到手术，多重手术后的复杂并发症和高死亡是普通的。更好知道并且设法十二指肠的损伤，我们由十二指肠的损伤，治疗，诊断和腹部的关键词在PubMed寻找了最近的相关文学。它证明因为诊断和管理是复杂的，死亡高，十二指肠的损伤应该及时并且机智地被对待。并且新技术的申请能帮助改进管理。在这评论，我们讨论了十二指肠的损伤的发生，诊断，管理，和复杂并发症以及死亡。

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简介：AbstractThroughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

简介：Objective:Toprobeintoeffectivesurgicalproceduresandimprovetheoutcomeoftreatmentforpatientswithseverehepaticinjury.Methods:Aretrospectivestudyinvolving113patientswithseverehepatictrauma(AASTgradeIVandV)duringthepast12yearswascarriedout.Ninety-eightpatientsunderwentsurgicaltreatment.SurgicalinterventionsincludinghepatectomyordirectcontrolofbleedingvesselsbyfingerfracturetechniquewithPringlemaneuver,selectiveligationofhepaticartery,retrohepaticcavalrepairwithtotalhepaticvascularocclusion,andperihepaticpackingweremainlyused.Results:Inthe98patientstreatedoperatively,thesurvivalratewas69.4%(68/98).Among40patientswithjuxtahepaticvenousinjury(JHVI),15werecuredwiththemaximumbloodtransfusionof12000ml.EightcasesofGradeIVinjurytreatednonoperativelywerecured.Thepercentageoffailureofnonoperativemanagementwas42.9%(6/14).Theoverallmortalityratewas32.7%(37/113),and57%ofthedeathswereduetoexsanguination.Conclusions:Reasonablesurgicalproceduresbasedonclassificationofhepaticinjuriescanincreasethesurvivalrateofseverelivertrauma.AccurateperihepaticpackingiseffectiveindealingwithJHVI.

简介：Thebrainishighlyplasticafterstrokeorepilepsy;however,thereisapaucityofbrainplasticityinvestigationaftertraumaticbraininjury(TBI).ThisminireviewsummarizesthemostrecentevidenceofbrainplasticityinhumanTBIpatientsfromtheperspectiveofadvancedmagneticresonanceimaging.Similartootherformsofacquiredbraininjury,TBIpatientsalsodemonstratedbothstructuralreorganizationaswellasfunctionalcompensationbytherecruitmentofotherbrainregions.However,thelargescalebrainnetworkalterationsafterTBIarestillunknown,andthefieldisstillshortofpropermeansonhowtoguidethechoiceofTBIrehabilitationortreatmentplantopromotebrainplasticity.Theauthorsalsopointoutthenewdirectionofbrainplasticityinvestigation.

简介：AbstractPurpose:Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).Conclusion:Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

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简介：AbstractPurpose:Alcohol has been associated with 10%—35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of "lockdown" on March 23, 2020. Restrictions were most significantly eased on June 1, 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as "trauma calls" to a London major trauma centre during April 2018 and April 2019 (pre-lockdown, n = 316), and 1st April—31st May 2020 (lockdown, n = 191) had electronic patient records analysed retrospectively. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38—1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs. pre-lockdown 179/316 (56.7%); OR: 0.40, 95% CI: 0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global "waves" of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

简介：Inthispaper,anovelmultipletrelliscodedorthogonaltransmitschemeisproposedtoexploittransmitdiversityinfadingchannels.Inthisscheme,auniquevectorfromasetoforthogonalvectorsisassignedtoeachtransmitantenna.Eachoftheoutputsymbolsfromthemultipletrellisencoderismultipliedwithoneoftheseorthogonalvectorsandtransmittedfromcorrespondingtransmitantennas.Bycorrelatingwithcorrespondingorthogonalvectors,thereceiverseparatessymbolstransmittedfromdifferenttransmitantennas.Thisschemecanbeadoptedincoherent/differentialsystemswithanynumberoftransmitantennas.Itisshownthattheproposedschemeencompassestheconventionaltrelliscodedunitaryspace-timemodulationbasedontheoptimalcyclicgroupcodesasaspecialcase.Wealsoproposetwobetterdesignsovertheconventionaltrelliscodedunitaryspace-timemodulation.Thefirstdesignuses8PhaseShiftKeying(8-PSK)constellationsinsteadof16PhaseShiftKeying(16-PSK)constellationsintheconventionaltrelliscodedunitaryspace-timemodulation.Asaresult,theproductdistanceofthisnewdesignismuchlargerthanthatoftheconventionaltrelliscodedunitaryspace-timemodulation.Theseconddesignintroducesconstellationswithmultiplelevelsofamplitudesintothedesignofthemultipletrelliscodedorthogonaltransmitscheme.Forbothdesigns,simulationsshowthatmultipletrelliscodedorthogonaltransmitschemescanachievebetterperformancethantheconventionaltrelliscodedunitaryspace-timeschemes.

简介：Objective:Toevaluatethetreatmentforpatientswithmajorvascularinjuriesassociatedwithtraumaticorthopedicinjuries.Methods:Atotalof196patients,agedfrom4-67yearswiththemeanageof29.88years,hadmajorvascularinjuriesassociatedwithtraumaticorthopedicinjuriesandweretreatedinourhospitalinaperiodof44years.Themostcommonmechanismoftraumawasblunttrauma(67.3%),openinjuriesaccountedfor32.4%and54.5%oftheinjurieswerelocatedinthelowerextremities.Thevascularinjuryfrequentlyhappenedinthefemoralartery(26.7%)andpoplitealartery(20.3%).Thetreatmentprincipleconsistedofaggressiveresuscitation,Dopplerimagingandstableboneinternalfixationwithsubsequentvascularrepairanddebridement.Thevascularrepairforinjuriesincludedend-to-endanastomosis(80cases,39.6%),interpositionalveingraft(94,46.5%),vasculardecompressionthroughfracturedistraction(18,8.9%),arterialligation(6,3.0%),veinpatch(2,1.0%),bypassgraft(2,1.0%),venousrepairincludingautogenousveingraft(9,24.3%)andligation(28,75.7%)andprophylacticalfasciotomy(15,7.4%).Postoperativeamputationwasperformedin16cases(16.3%).Results:Nointraoperativedeathwasobservedandallfracturesunitedwithin6months.Limbsweresalvagedin180patients(91.8%).Amongthesepatients,earlycomplicationswerefoundin19patients(9.7%)andlatecomplicationswereobservedin8patients(4.1%).Conclusions:Awell-organizedapproach,basedonaspecifictreatmentprinciple,notonlyimprovesclinicaloutcomebutalsodoesgoodtoexcellentfunctionalrecoveryforpatientswithsevereorthopedicinjuriesandconcomitantvascularlesion.

简介：AbstractPurpose:The reliability of trauma coding is essential in establishing the reliable trauma data and adopting efficient control and monitoring policies. The present study aimed to determine the reliability of trauma coding in educational hospitals affiliated to Shahid Beheshti University of Medical Sciences, Iran.Methods:In this descriptive cross-sectional study, 591 coded medical records with a trauma diagnosis in 2018 were selected and recoded by two coders. The reliability of trauma coding was calculated using Cohen's kappa. The data were recorded in a checklist, in which the validity of the content had been confirmed by experts.Results:The reliability of the coding related to the nature of trauma in research units was 0.75—0.77, indicating moderate reliability. Also, the reliability of the coding of external causes of trauma was 0.57—0.58, suggesting poor reliability.Conclusion:The reliability of trauma coding both in terms of the nature of trauma and the external causes of trauma does not have a good status in the research units. This can be due to the complex coding of trauma, poor documentation of the cases, and not studying the entire case. Therefore, holding training courses for coders, offering training on the accurate documentation to other service providers, and periodically auditing the medical coding are recommended.

简介：Objective:Toinvestigatethecorrelationbetweentraumaandpulmonarythromboembolism.Methods:Comminutedfracturesandextensivesoft-tissuecontusionatbothhindlimbsweremadebyafallingweightfromaheightin16rabbits.Lungperfusionscanningwasperformedtoobtaintheradioactivitycountsbeforetrauma,at1h,48hand96haftertrauma.Allthedataweredividedinto4groupsbasedontheabove4timepoints.Therabbitsweresacrificedwhenpositivefindingsonthepulmonaryperfnsionscanningappeared.Theirlungswereharvestedtobeparaffin-embeddedandstainedwithhematoxylin-erosinmethodforhistologicalexaminationofthromboembolism.TherandomizedblockdesignANOVAandthemethodofleastsignificantdifference(LSD)wereusedforstatisticalanalysisoftheradioactivitycounts.Results:Thehistologicalfindingsshowedthatpulmonaryembolismdevelopedin6ofthe16rabbits(37.5%).Fiveofthe6pulmonaryembolismrabbitspresentedneitherclinicalsymptomsnorpositivepulmonaryembolismmanifestationsinthelungperfusionscanning.Asignificantdifferencewasfoundinlungperfusionradioactivitybetweenthepre-traumatic,post-traumatic1hgroupsandpost-traumatic48hand96hgroups(P<0.05).Conclusions:Fracturesofthehindlimbsaccompaniedwithextensivesoft-tissuecontusionmaycausepulmonarymicro-embolismthatisnotsensitivetolungperfusionscanningandtendstohavenoclinicalsymptoms.Pulmonaryembolismdevelopmentmaytakemorethantwodaysaftertrauma.

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