Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.

Treatment with analgesics after mouse sciatic nerve injury does not alter expression of wound healingassociated genes

Animal models of sciatic nerve injury are commonly used to study neuropathic pain as well as axon regeneration. Administration of post-surgical analgesics is an important consideration for animal welfare, but the actions of the analgesic must not interfere with the scientific goals of the experiment. In this study, we show that treatment with either buprenorphine or acetaminophen following a bilateral sciatic nerve crush surgery does not alter the expression in dorsal root ganglion（DRG） sensory neurons of a panel of genes associated with wound healing. These findings indicate that the post-operative use of buprenorphine or acetaminophen at doses commonly suggested by Institutional Animal Care and Use Committees does not change the intrinsic gene expression response of DRG neurons to a sciatic nerve crush injury, for many wound healing-associated genes. Therefore, administration of post-operative analgesics may not confound the results of transcriptomic studies employing this injury model.

Clinical analysis of patients with iatrogenic bile duct injury

BACKGROUND: The main cause of iatrogenic bile duct injury is misidentification of the common bile duct as the cystic duct. In this article, we summarize the experience in the treatment of 112 patients with iatrogenic bile duct injury. METHOD: Clinical data of these patients treated at 10 hospitals of Songhua river area, Heilongjiang province, China from January 1978 to January 2005 were analyzed retrospectively. RESULTS: In 55.4% patients (62/112), iatrogenic bile duct injury was due to misidentification of the anatomy of Calot's triangle before cholecystectomy. Their diagnosis was based on clinical features, celiac puncture and imaging examination in which ultrasonography was most sensitive, giving a diagnostic rate of 97. 5%. Six types of injury were identified according to their locations, and type Ⅲ damage was commonly seen ( 92/112 ). The curative rate in this group was 95.5% (107/112). Eighty-seven patients (77.7%) underwent Roux-en-Y choledochojejunostomy with a cure rate of 94.3% (82/87). CONCLUSION: The prevention of iatrogenic bile duct injury lies in identifying the topography of extrahepatic bile ducts. Roux-en-Y choledochojejunostomy is usually the treatment of choice.

Effect of FK506 on Expression of Hepatocyte Growth Factor in Murine Spinal Cord Following Peripheral Nerve Injury

This study is to investigate the effect of FK506 on expression of hepatocyte growth factor （HGF） in rats＇ spinal cord following peripheral nerve injury and to elucidate the mechanisms for neuroprotective property of FK506. Fifty male rats were randomly divided into normal group, injury group and treatment group. Models of peripheral nerve injury were established by bilateral transection of sciatic nerve 0.5 cm distal to piriform muscle. Then the treatment group received subcutaneous injection of FK506 （1 mg/kg） at the back of neck, while the injury group was given 0.9% saline. The L4-6 spinal cords were harvested at various time points after the surgery. Western blotting and immunofluorescent staining were used to detect the level and position of HGF in spinal cord. Immunofluorescent staining showed that HGF-positive neurons were located in anterior horn, intermediate zone and posterior horn of gray matter in normal spinal cord. Western blotting revealed that there was no significant difference in the expressions of HGF between the injury group and the normal group, while the expression of HGF was significantly higher in the treatment group than in the injury group 7 and 14 days after surgery. It is suggested that peripheral nerve injury does not result in up-regulation of the expression of HGF in spinal cord, while FK506 may induce high expression of endogenous HGF after injury thereby protecting neurons and promoting axonal outgrowth.

Mesenchymal stem cell-derived exosomes: The dawn of diabetic wound healing

Chronic wound healing has long been an unmet medical need in the field of wound repair,with diabetes being one of the major etiologies.Diabetic chronic wounds(DCWs),especially diabetic foot ulcers,are one of the most threatening chronic complications of diabetes.Although the treatment strategies,drugs,and dressings for DCWs have made great progress,they remain ineffective in some patients with refractory wounds.Stem cell-based therapies have achieved specific efficacy in various fields,with mesenchymal stem cells(MSCs)being the most widely used.Although MSCs have achieved good feedback in preclinical studies and clinical trials in the treatment of cutaneous wounds or other situations,the potential safety concerns associated with allogeneic/autologous stem cells and unknown long-term health effects need further attention and supervision.Recent studies have reported that stem cells mainly exert their trauma repair effects through paracrine secretion,and exosomes play an important role in intercellular communication as their main bioactive component.MSC-derived exosomes(MSC-Exos)inherit the powerful inflammation and immune modulation,angiogenesis,cell proliferation and migration promotion,oxidative stress alleviation,collagen remodeling imbalances regulation of their parental cells,and can avoid the potential risks of direct stem cell transplantation to a large extent,thus demonstrating promising performance as novel"cell-free"therapies in chronic wounds.This review aimed to elucidate the potential mechanism and update the progress of MSC-Exos in DCW healing,thereby providing new therapeutic directions for DCWs that are difficult to be cured using conventional therapy.

Acute kidney injury in severely injured patients admitted to the Intensive Care Unit

Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care Unit(ICU)for whom creatine kinase(CK)levels were available.Methods:For this retrospective observational study,we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili(FVL)University Hospital.Our primary outcome was the incidence of AKI.Multivariate regression analysis was used to assess risk factors for this outcome.Results:A total of 315 patients were included.The trauma mechanisms were blunt(n=130),penetrating(n=66)and blast(n=44)trauma.The median[interquartile range,(IQR)of injury severity score(ISS)was 21(16–29).AKI developed in 75 patients(23.8%).Multivariate regression analysis revealed that the thoracic abbreviated injury scale(AIS)value(median(IQR)in the AKI group:3(0–4)],Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score[median(IQR)in the AKI group:18(10–27)],CK greater than 5000 U/L,lactic acid concentration at admission,and dobutamine administration were independently associated with AKI.Conclusions:We found that age,APACHE Ⅱ score,thoracic trauma,lactic acidosis,and dobutamine administration were independently associated with AKI.Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

Clinical Use of Growth Factors in the Improvement of Skin Wound Healing

To discuss the normal mechanism of wound healing (WH), the role of growth factors (GF) in prec-linical and clinical studies and its importance in the healing of abnormal wound therapy. For search, we used the PUBMED and LILACS database, and the following descriptors: skin, wound healing, growth factor and clinical trials. We also prioritized the analysis of the Clinical Trials in the previous 10 years. Although there are many studies being conducted in the pre-clinical phase, we see that there are few studies in the clinical phase. 274 studies were identified, and 58 were selected. After tissue injury, repair occurs through coordinated biological actions that are healing. The importance of the study of healing in the skin is not only because of its anatomical location, easy access and exposure, but also because of its vital function. There is accumulating evidence that the process of healing after injury may be mediated by several GF. However, may this class of molecules even act effectively on the clinical response of this pathological condition? Many preclinical studies (in vitro and in vivo) reinforce the importance and efficacy of GF in the regeneration of damaged skin. Furthermore, recent studies have reported the use in adjuvant or not, of GF in clinical treatment to improve WH in humans. Therefore, we conclude that it seems to be effective by the use of GF in adjuvant or not in WH. However, it still seems to be necessary to carry out more clinical trials in phase I and II.

A SURVEY ON ACUPUNCTURE TREATMENT OF PERIPHERAL NERVE INJURY

By peripheral nerve injury, we mean theloss of neurosensory and neuromotor functionsinduced by various causative factors,manifesting paralysis of the limbs andmuscular atrophy. It falls into the category ofinjury of the muscle and tendon, and flacciditysyndrome in TCM. The following is asummary of documents in the recent 20

Antimicrobial Action and Scaring of 10%Green Banana Shell in Chronic Wounds

The percentage of diabetic patients with contaminated lesions increases from 3% to 10%. Treatment with herbal products shows benefits in their use, as well as antioxidant and antifungal activities. Objective: to evaluate the antimicrobial action of 10% banana peel gel and the contraction of diabetic and venous wounds. Methods: individual, analytical, interventional, longitudinal, prospective, randomized study from February to December 2015. Five patients were included in the study;3 with venous ulcer and 2 with diabetic wound. Application of 10% green banana peel gel and weekly samples were performed. After six days, the second collection was performed. The samples were seeded in the Mannitol salt agar culture medium, MacConkey agar and Saboraund agar with chloramphenicol for isolation of cocci and Gram-positive and Gram-negative bacilli;and fungi. The total counts of bacteria were determined by PCA (Plate Count Agar) and measurement of the lesion margin. There was a reduction of microorganisms with the use of the gel in 53.57% of the patients, and reduction of wound areas in 48.1%.

Study on the mechanism of microporous sheep ADM combined with hUCMSC in promoting wound healing

Objective:To explore the therapeutic mechanism of microporous sheep acellular dermal matrix(ADM)combined with human umbilical cord mesenchymal stem cell(hUCMSC)to promote the healing of full-thickness skin defect.Methods:hUCMSC was co-cultured on microporous sheep ADM to form composite biological dressings.Seventy-two nude mice were selected to make full-thickness skin injury models and randomly divided into 3 groups(hUCMSC+microporous sheep ADM group,sheep ADM group and iodophor gauze group),with 24 mice in each group.The wound healing rate of each group was detected at 14 d,21 d and 28 d after operation,qRT-PCR technique was used to detect the expression of Bax and Bcl-2 in the wound tissues,and the immunohistochemical staining technique was used to detect the expression of Collagen I and vascular endothelial growth factor(VEGF).Data were analyzed with one-way ANOVA and t test.Results:At 14 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(65.34±14.72)%,which was significantly higher than that of the iodophor gauze group[(37.54±10.21)%],and higher than that of the sheep ADM group[(49.08±11.16)%],the differences were statistically significant(t=19.52,14.72;p<.05).With the gradual healing of the wound,at 28 d after operation,the wound healing rate of the hUCMSC+microporous sheep ADM group was(98.63±15.41)%,which was significantly higher than that of the iodophor gauze group[(81.74±16.27)%],and higher than that of the sheep ADM group[(63.47±14.80)%],the differences were statistically significant(t=-16.42,20.35;p<.05).The expression of Bax in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly reduced,especially at 21 d after operation,the expression level was 0.25±0.06,which was significantly lower than the iodophor gauze group(0.53±0.16)and the sheep ADM group(0.41±0.12),the differences were statistically significant(t=3.52,-2.83;p<.05).The expression of Bcl-2 in the wound tissues of the hUCMSC+microporous sheep ADM group was significantly higher than those of the other two groups,especially at 21 d after operation,the expression level was 0.63±0.19,which was significantly higher than the iodophor gauze group(0.34±0.09)and the sheep ADM group(0.46±0.13),the differences were statistically significant(t=5.31,-6.07;p<.05).Immunohistochemical detection showed that the expression of Collagen I and VEGF in the hUCMSC+microporous sheep ADM group was slightly more than that of the sheep ADM group and the iodophor gauze group,but the effect was not remarkable.Conclusions:hUCMSC+microporous sheep ADM composite dressing can promote the healing of the full-thickness skin injury and reduce the production of apoptotic cells by carrying hUCMSC.

Effects of allogeneic mouse adipose-derived mesenchymal stem cell-microporous sheep acellular dermal matrix on healing of wound with full-thickness skin defect in mouse and the related mechanism

Objective:To explore the effects of allogeneic mouse adipose-derived mesenchymal stem cell(ADSC)-microporous sheep acellular dermal matrix(ADM)on wound healing of full-thickness skin defect in mice and the related mechanism.Methods:One Kunming mouse was sacrificed by cervical dislocation to collect adipose tissue from the inguinal region.Mouse ADSCs were isolated from the adipose tissue and cultured in vitro.Cells in the third passage were identified by cell adipogenic and osteogenic differentiation.The expressions of CD34,CD73,CD90,and CD105 were analyzed by flow cytometer.After one sheep was sacrificed with the skin of its back cut off,microporous sheep ADM was prepared by using acellular processing and freeze-thaw method.A round and full-thickness skin defect wound,with a diameter of 12 mm,was made on the back of each of 36 Kunming mice.The wounds were covered by microporous sheep ADM.The mice were divided into ADSC group and control group with 18 mice in each group according to the random number table method after surgery.A volume of 0.2 ml of DMEM/F12 culture medium containing 1×10^(6)ADSCs was injected between microporous sheep ADM and the wound of each mouse in ADSC group,while 0.2 ml of DMEM/F12 culture medium was injected between microporous sheep ADM and the wound of each mouse in control group.At post-surgery day(PSD)12 and 17,the wound healing rate in each group was calculated respectively;wound vascularization in 2 groups of mice was observed under the reverse irradiation of back light;and the granulation tissue in the wound in ADSC group was observed by means of hematoxylin-eosin staining.At PSD 7,the thickness of the granulation tissue in the wound was measured in each group of mice.At PSD 12 and 17,the immunohistochemical method was used to detect the expression of VEGF in each group of mice.The number of samples was 6 in each group at each time point in the above experiments.The data obtained were processed with t-test and factorial design ANOVA.Results:(1)After 7 days of adipogenic induction,red lipid droplets were observed in the cytoplasm with oil red O staining.After 21 days of osteogenic induction,black calcium deposition was observed in the medium stained with silver nitrate.The expression levels of CD73,CD90,CD 105 and CD34 in cells were 97.82%,99.32%,97.35%and 5.88%respectively.The cells were identified as ADSCs.(2)The wound healing rates of ADSC group at PSD 12 and 17[(78±6)%,(98±3)%]were significantly higher than those of control group at PSD 12 and 17[(60±9)%,(90±4)%,t=4.26,4.46,p<.01].(3)At PSD 7,no vessels obviously grew into the center of the wound in both groups of mice,while the granulation tissue already covered the wound in ADSC group.At PSD 12,the wound in ADSC group was more well-perfused than control group.At PSD 17,it was observed that large vessels were crossing through the whole wound in ADSC group,while large vessels were observed without crossing through the whole wound in control group.(4)In ADSC group,at PSD 7,the wound was covered with thin granulation tissue,and the granulation tissue was obviously thickened at PSD 12.At PSD 17,the granulation tissue was covered by epidermis.At PSD 7,the thickness of the granulation tissue in the wound in ADSC group[(0.62±0.05)mm]was significantly greater than that in control group[(0.31±0.04)mm,t=12.27,p<.01].(5)At PSD 12 and 17,the expression levels of VEGF in the wound in ADSC group[(80.7±2.2),(102.8±2.6)/mm^(2)]were significantly than those in control group[(59.5±2.4),(81.5±2.6)/mm^(2),t=15.95,14.14,p<.01].Conclusions:Allogeneic mouse ADSC-microporous sheep ADM can promote angiogenesis and the growth of granulation tissue in the wound with full-thickness skin defect in mice,thus accelerating wound healing.The mechanism is probably related with the increase in the expression of VEGF.

Marine biological injuries and their medical management:A narrative review

The marine environment can be extremely dangerous,and the harm caused by marine organisms when they contact the human body can be especially harmful,even deadly.Contact includes stings,bites,wounds,and consumption as food.In this article,the characteristics of the common marine biological injuries are summarized,the major marine organisms causing damage in China’s marine waters are described,and injury prevention and treatment methods are discussed.

Prevalence of musculoskeletal injuries and a proposal for neuromuscular training to prevent lower limb injuries in Brazilian Army soldiers:an observational study

Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.Methods: This observational(cross-sectional) study recruited a sample of 103 soldiers who required medical attention,from a total 202 new battalion soldiers. The medical records(paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury,and recurring injury.Results: A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.Conclusions: This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.

Sodium Danshensu promotes the healing of stage 2 pressure injury wounds in ischemia/reperfusion injury rat models:possible regulation of apoptosis and inflammatory response

OBJECTIVE:To investigate the protective effect and possible mechanism of sodium Danshensu(SDSS)against pressure injury caused by ischemia/reperfusion(I/R)injury.METHODS:Sprague-Dawley rats were randomly divided into five groups of eight rats each:control group,model group,10 mg/kg SDSS-treated group,20 mg/kg SDSS-treated group,and 40 mg/kg SDSS-treated group.We used two round ferrite magnetic plates of 15 mm diameter and 3 mm thickness to establish stage 2 pressure injury model rats.Each rat was subjected to five cycles of ischemia and reperfusion to induce pressure injury.One cycle consisted of 2 h of ischemia and 0.5 h of reperfusion,which meant that each cycle included2 h of pressure and 0.5 h of pressure relief.The outline of the wound was delineated by butter paper and marker pen,and histopathological changes were observed by hematoxylin and eosin staining.In addition,the number of apoptotic cells and the activity of caspase-3 were assessed by terminal deoxynucleotidyl transferase-mediated nick end labeling and caspase-3 assay kits,respectively.The expression of apoptosis-regulatory proteins and inflammatory mediators was investigated by enzyme-linked immunosorbent assay.RESULTS:Results showed that treatment with SDSS for 7 d after establishing the pressure injury model remarkably improved the healing rate of the wound.SDSS also inhibited the levels of tumor necrosis factor-α,myeloperoxidase,and intercellular cell adhesion molecule-1;decreased the number of apoptotic cells;increased the ratio of B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax);and regulated the expression and activity of caspase-3.CONCLUSION:Our results suggest that SDSS exhibits a treatment efficacy for pressure injury caused by I/R injury possibly by inhibiting apoptosis and inflammatory response.

Clinical application of serial operations with preserving spleen

AIM: To evaluate the clinical application of serial operations with preservation of spleen. METHODS: Serial operations with preserving spleen were performed on 211 cases in our hospital from 1980 to 2000. The patient's age ranged from 13 to 56 years, averaging 38 years. Diseases included splenic injury in 171 cases, portal hypertension in 9 cases, splenic cyst in 10 cases, and the lesion of pancreatic body and tail in 21 cases. RESULTS: All the cases were cured, and 129 patients were followed up from 3 months to 3 years with the leukocyte phagocytosis test, detection of immunoglubin, CT,(99m)Tc scanning and ultrasonography. The results were satisfactory. CONCLUSION: The operations with preserving spleen were safe, feasible, and worth of clinical application.

Research progress on combat trauma treatment in cold regions

Cold regions are a special combat environment in which low temperatures have a great impact on human metabolism and other vital functions, including the nervous, motion, cardiovascular, circulatory, respiratory, and urinary systems; consequently, low temperatures often aggravate existing trauma, leading to high mortality rates if rapid and appropriate treatment is not provided. Hypothermia is an independent risk factor of fatality following combat trauma; therefore, proactive preventative measures are needed to reduce the rate of mortality. After summarizing the basic research on battlefield environments and progress in the prevention and treatment of trauma, this article concludes that current treatment and prevention measures for combat trauma in cold regions are inadequate. Future molecular biology studies are needed to elucidate the mechanisms and relevant cell factors underlying bodily injury caused by cold environment, a research goal will also allow further exploration of corresponding treatments.

Spatiotemporal microRNA profile in peripheral nerve regeneration:miR-138 targets vimentin and inhibits Schwann cell migration and proliferation

While the peripheral nervous system has regenerative ability,restoration of sufficient function remains a challenge.Vimentin has been shown to be localized in axonal growth fronts and associated with nerve regeneration,including myelination,neuroplasticity,kinase signaling in nerve axoplasm,and cell migration;however,the mechanisms regulating its expression within Schwann cell（SC） remain unexplored.The aim of this study was to profile the spatial and temporal expression profile of micro RNA（mi RNA） in a regenerating rat sciatic nerve after transection,and explore the potential role of mi R-138-5 p targeting vimentin in SC proliferation and migration.A rat sciatic nerve transection model,utilizing a polyethylene nerve guide,was used to investigate mi RNA expression at 7,14,30,60,and 90 days during nerve regeneration.Relative levels of mi RNA expression were determined using microarray analysis and subsequently validated with quantitative real-time polymerase chain reaction.In vitro assays were conducted with cultured Schwann cells transfected with mi RNA mimics and assessed for migratory and proliferative potential.The top seven dysregulated mi RNAs reported in this study have been implicated in cell migration elsewhere,and GO and KEGG analyses predicted activities essential to wound healing.Transfection of one of these,mi RNA-138-5 p,into SCs reduced cell migration and proliferation.mi R-138-5 p has been shown to directly target vimentin in cancer cells,and the luciferase assay performed here in rat Schwann cells confirmed it.These results detail a role of mi R-138-5 p in rat peripheral nerve regeneration and expand on reports of it as an important regulator in the peripheral nervous system.

Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

Analysis of two naval pilots’ ejection injuries: Two case reports

BACKGROUND Recently,two naval pilots in a two-seat trainer jet were forced to eject urgently due to sudden mechanical failure during night-time training.They were both successfully rescued and sent to the hospital for emergency treatment.In this study,we investigate their ejection injuries and recovery process.CASE SUMMARY We analyzed the clinical data of the traumatic condition and recovery process from ejection injuries of two pilots who ejected from a failed trainer jet and survived.After being successfully rescued and sent to the hospital,they were diagnosed with multiple ejection injuries,including eye trauma,limb bone and joint injury,rib and spine injury,and so on.Both cases underwent fluid replacement,acid suppression,nutritional support,hemostasis,bone metabolism improvement,phlegm elimination,psychological measurement,blood circulation promotion and detumescence,physical therapy,and external fixation with braces for 1 mo before being discharged from hospital.They then recuperated in a sanatorium for 2 mo,and the related laboratory tests and supplementary examinations show that they recovered from all the above injuries.After successfully passing the psychological test and physical examination,they returned to flight duty 3 mo after ejection.CONCLUSION The causes and conditions of ejection injury in the pilots were very complex.Although they finally recovered quickly and were released,it also serves as a reminder that attention should be paid to pilots’ejection and parachute training in order to significantly reduce ejection injury and improve the ejection success rate.In addition,air defense support personnel should strengthen search and rescue and on-site emergency measures,and locate and rescue pilots in distress as early as possible to reduce subsequent injuries.

Comparative Analysis of Two Methods for the Assessment of Aesthetic Impairment Involving Teeth

Objective: To analyze and compare the effectiveness of two methods designed for the assessment of esthetic impairment in patients with missing teeth. Material and Methods: Two methods were addressed in this study: 7-level scale (7LS) and AIPE-Odonto/Brasil. Both tools are designed to assess esthetic dental impairment in civil and criminal Courts. One-hundred and thirteen dentists used the tools to assess dental esthetic impairment in four mock cases (one male and three females). The outcomes of their analyses were compared with pre-established gold-standard scores. Chi-square test was used to investigate the influence of dentists’ sex, age, time of experience and forensic knowledge with their outcomes. Results: Dentists’ outcomes were closer to the expected gold-standard scores when AIPE-Odonto/Brasil was used compared to 7LS (p < 0.05). Dentists’ sex, time of experience and forensic knowledge were significantly associated with the scores obtained with both tools (p < 0.05). Conclusions: Comparatively, AIPE-Odonto/Brasil was more effective for the assessment of esthetic dental impairment involving missing teeth compared to the 7LS.