Current status and development of traumatic brain injury treatments in China

Due to its high incidence, high disability rate, and high mortality rate, traumatic brain injury （TBI） poses a serious threat to human health. This manuscript describes the urgent problems currently existing in China＇s TBI treatment and proposes a scheme of a nationwide collaboration platform for the treatment of TBI so as to improve the overall level of TBl treatment in China, and reduce disability and mortality rates in TBI patients.

Dynamically monitoring tissue factor and tissue factor pathway inhibitor following secondary brain injury

Objective: To study the altering rule of coagulation function at molecular level in patients with secondary brain injury (SBI). Methods: Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) were studied in 32 patients 1, 2, 3 and 7 days after craniocerebral injury. Repeated cranial CT scans and platelet counts were made simultaneously. Same measurements were done in 30 normal adults except CT scan. Results: No obvious difference was found in age, sex and platelet count between the injured and the normal groups. TFPI/TF decreased markedly in the first week after injury in patients with SBI, but only decreased on the 7th day in the patients without obvious SBI. For the patients who developed delayed intracranial hematoma (DIH) or hematoma enlargement, TF rose only 1 and 2 days after injury, but TFPI had a tendency to rise again after a fall on the 3rd day. For those patients who developed no DIH, TF rose all the time within the 1st week. Conclusions: Decrease of TFPI/TF for a long time, especially within 3 days after injury, may be one of the most important reasons for SBI. High expression of TF for a relative short time and increase of TFPI after a fall within 3 days may be one of the important reasons for DIH or hematoma enlargement.

Traumatic Diaphragmatic Hernia Associated with Pelvic Ring Fracture

Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fractures.Since this condition is easily misdiagnosed in emergency cases,we reported two cases and analyzed the clinical symptoms,diagnosis,treatment,and outcome of this comorbidity.Based on these results,we recommended an appropriate method for diagnosis and treatment and proposed a contraindication in treating TDH associated with pelvic fracture.

Maxillofacial and concomitant serious injuries： An eight-year single center experience

Purpose： Maxillofacial injuries are frequently associated with multiple trauma and can determine func- tional and aesthetic bad outcomes.The severity ofmaxillofacial injuries may be considerable and can divert clinicians＇ attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department （ED） of the University Hospital of Messina （North-East Sicily, Italy） for maxillofacial traumas. Methods： We retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different in- stitutions, pediatric trauma patients and adult patients who were transferred in accordance with pre- existing agreements in case of paucity of beds were excluded. Finally we included 447 （0.2%） patients over the 8 years. Data were evaluated with emphasis on epidemiology （age, gender, mechanism of trauma）, primary survey and abnormalities and pattern of trauma. Results： The most frequent cause of maxillofacial trauma was road accidents （319 patients, 71.4%）, among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients： 443 （99.1%） patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries （x^2 = 557.2, p 〈 0.0001）. Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas （x^2 = 17.13, p 〈 0.0001 vs minor lesions）. All of the neglected lesions occurred in pauci- symptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hema- toma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms. Conclusion： Among the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit. diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial maior lesions.