Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its...Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.展开更多
An investigation was carried out by numerical simulation on a wind turbine airfoil and a blunt trailing-edge airfoil with and without vortex generators (VGs), and the performance of the airfoils was analyzed. By the s...An investigation was carried out by numerical simulation on a wind turbine airfoil and a blunt trailing-edge airfoil with and without vortex generators (VGs), and the performance of the airfoils was analyzed. By the simulation of airfoil DU 91-W2-250 it was verified that the numerical method and model were credible. Based on this airfoil, a new one with a blunt trailing edge of 6% chord was blended by symmetrically adding thickness, and its characteristics curves were obtained through computing at key angles of attack. Additionally, the pressure distribution on blended airfoil was analyzed by comparing to the airfoil without blend. The interaction of streamwise vortices induced by VGs with trailing vortex or separation vortex was considered, followed by the uncovery of how VGs can suppress the boundary layer separation.展开更多
Under the background of the energy saving and emission reduction, more and more attention has been placed on investigating the energy efficiency of ships. The added resistance has been noted for being crucial in predi...Under the background of the energy saving and emission reduction, more and more attention has been placed on investigating the energy efficiency of ships. The added resistance has been noted for being crucial in predicting the decrease of speed on a ship operating at sea. Furthermore, it is also significant to investigate the added resistance for a ship functioning in short waves of large modern ships. The researcher presents an estimation formula for the calculation of an added resistance study in short waves derived from the reflection law. An improved method has been proposed to calculate the added resistance due to ship motions, which applies the radiated energy theory along with the strip method. This procedure is based on an extended integral equation （EIE） method, which was used for solving the hydrodynamic coefficients without effects of the irregular frequency. Next, a combined method was recommended for the estimation of added resistance for a ship in the whole wave length range. The comparison data with other experiments indicate the method presented in the paper provides satisfactory results for large blunt ship.展开更多
Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal inju...Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar f展开更多
A high-order shock-fitting finite difference scheme is studied and used to do direc-tion numerical simulation (DNS) of hypersonic unsteady flow over a blunt cone with fast acoustic waves in the free stream, and the re...A high-order shock-fitting finite difference scheme is studied and used to do direc-tion numerical simulation (DNS) of hypersonic unsteady flow over a blunt cone with fast acoustic waves in the free stream, and the receptivity problem in the blunt cone hypersonic boundary layers is studied. The results show that the acoustic waves are the strongest disturbance in the blunt cone hypersonic boundary layers. The wave modes of disturbance in the blunt cone boundary layers are first, second, and third modes which are generated and propagated downstream along the wall. The results also show that as the frequency decreases, the amplitudes of wave modes of disturbance increase, but there is a critical value. When frequency is over the critial value, the amplitudes decrease. Because of the discontinuity of curvature along the blunt cone body, the maximum amplitudes as a function of frequencies are not monotone.展开更多
Background： Laparoscopic cholecystectomy （LC） has been a standard operation and replaced the open cholecystectomy （OC） rapidly because the technique resulted in less pain, smaller incision, and faster recovery. T...Background： Laparoscopic cholecystectomy （LC） has been a standard operation and replaced the open cholecystectomy （OC） rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury （BDI） in laparoscopic cholecystectomy （LC）. Methods： From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years （14-84 years）. The Calot＇s triangle was bluntly dissected and each duct in Calot＇s triangle was identified before transecting the cystic duct. Results： Two hundred and thirty-nine patients （1.1%） were converted to open procedures. The postoperative hospital stay was 2.1 （0-158） days, and cases （46%） had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases （0.09%） including 6 cases of common BDI, 2 cases of common hepatic duct injury, l case of fight hepatic duct injury, I case of accessory fight hepatic duct, 1 case of aberrant BDI l case ofbiliary stricture, 1 case ofbiliary duct perforation, 3 cases ofhemobilia, and 4 cases of bile leakage. Conclusion： Exposing Calot＇s triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BD1.展开更多
According to the mechanism of the arc plasma heating effect,and from a phenomenological perspective of view,the plasma actuation was simplified as heating energy injected into the supersonic flow field for the numeric...According to the mechanism of the arc plasma heating effect,and from a phenomenological perspective of view,the plasma actuation was simplified as heating energy injected into the supersonic flow field for the numerical research on controlling detached shock of the blunt body in non-center symmetrical positions.Besides,experimental research on the form and strength of detached shock wave control by plasma aerodynamic actuation in non-center symmetrical positions was conducted in a high-speed shock tunnel(M=2).The results showed that the detached distance of shock wave increased and the strength of normal shock wave ahead of the detached shock wave reduced when plasma actuation was applied.The control effect was greatly improved after the magnetic field was applied and the effect of upwind-direction flow was the best one.When the upwind-direction flow was applied with 1000 V voltage actuation,the distance of detached shock wave would increase from 3.4 to 7.6 mm and the time average strength of normal shock wave was weaken by 5.5%.At last,the mechanism of plasma actuation on controlling the detached shock wave was briefly analyzed.展开更多
BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The Ame...BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.展开更多
AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS: A total of 82 patients with colonic injuries caused by blunt trauma...AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury- related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is mostoften used for colonic injuries.展开更多
The hypersonic boundary-layer receptivity to slow acoustic waves is investigated for the Mach 6 flow over a 5-degree half-angle blunt cone with the nose radius of 5.08 mm. The plane acoustic wave interacts with the bo...The hypersonic boundary-layer receptivity to slow acoustic waves is investigated for the Mach 6 flow over a 5-degree half-angle blunt cone with the nose radius of 5.08 mm. The plane acoustic wave interacts with the bow shock, and generates all types of disturbances behind the shock, which may take various routes to generate the boundarylayer unstable mode. In this paper, two routes of receptivity are investigated in detail.One is through the disturbance in the entropy layer. The other is through the slow acoustic wave transmitted downstream the bow shock, which can excite the boundary-layer mode due to the synchronization mechanism. The results show that, for a low frequency slow acoustic wave, the latter route plays a leading role. The entropy-layer instability wave is able to excite the first mode near the neutral point, but its receptivity efficiency is much lower.展开更多
Introduction:Blunt thoracic aortic injury(BTAI)is rare in elderly patients.As the population ages and life expectancy increases,the frequency of this injury will increase,while the treatment and outcomes remain unclea...Introduction:Blunt thoracic aortic injury(BTAI)is rare in elderly patients.As the population ages and life expectancy increases,the frequency of this injury will increase,while the treatment and outcomes remain unclear.Methods:We retrospectively analyzed the collected data of patients>60 years old with BTAI to investigate the mechanism of trauma;time interval from injury to diagnosis;type and timing of surgical intervention;aortic arch pattern;choice of left subclavian artery reconstruction;endograft to treat BTAI;length of the endovascular procedure;endoleaks;complications including stroke,paraplegia,and renal failure;length of hospital stay(LOS)and intensive care unit stay(L.ICUS);and 30-day mortality.Results:Five elderly trauma patients were found to have BTAI.Four(80%)were males,the cohort mean age was68 years,the major mechanism of trauma was fall injury,and the associated injury was thoracic trauma.All patients were transferred to our hospital,and emergency computed tomography angiography showed BTAI in each patient.The average time interval from injury to diagnosis was 2.7 days.Two patients suddenly showed signs of instability in their vital signs and underwent immediate endovascular repair,while 3 patients underwent delayed endovascular repair.The injury site was located in the aortic isthmus just distal to the origin of the left subclavian artery;the aortic arch pattern was II(80.0%)in 4 cases and III in 1 case(20.0%).The choice of left subclavian artery reconstruction included chimney,double chimney,prefenestration,and chimney combined with in situ fenestration.Endografts to treat BTAI included the Ankura(Lifetech Scientific,Shenzhen,China)and the C-TAG(W.L.Gore&Associates,Flagstaff,AZ USA).The length of the endovascular procedure was 75.4 min;there were no endoleaks and no complications including stroke,paraplegia,or renal failure.The average LOS was25 days,and the average L.ICUS of 2 patients was 15 days,with no 30-day mortality.Conclusion:Elderly patients with fall injury should promptly exclude BTAI展开更多
BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Ab...BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and com展开更多
Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challengi...Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.展开更多
文摘Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.
基金supported by the National Natural Science Foundation of China (Grant No.50836006)
文摘An investigation was carried out by numerical simulation on a wind turbine airfoil and a blunt trailing-edge airfoil with and without vortex generators (VGs), and the performance of the airfoils was analyzed. By the simulation of airfoil DU 91-W2-250 it was verified that the numerical method and model were credible. Based on this airfoil, a new one with a blunt trailing edge of 6% chord was blended by symmetrically adding thickness, and its characteristics curves were obtained through computing at key angles of attack. Additionally, the pressure distribution on blended airfoil was analyzed by comparing to the airfoil without blend. The interaction of streamwise vortices induced by VGs with trailing vortex or separation vortex was considered, followed by the uncovery of how VGs can suppress the boundary layer separation.
基金Supported by the National Natural Science Foundation of China under Grant No.51079032 the Outstanding Youth Science Foundation of Heilongjiang Province,No.200908
文摘Under the background of the energy saving and emission reduction, more and more attention has been placed on investigating the energy efficiency of ships. The added resistance has been noted for being crucial in predicting the decrease of speed on a ship operating at sea. Furthermore, it is also significant to investigate the added resistance for a ship functioning in short waves of large modern ships. The researcher presents an estimation formula for the calculation of an added resistance study in short waves derived from the reflection law. An improved method has been proposed to calculate the added resistance due to ship motions, which applies the radiated energy theory along with the strip method. This procedure is based on an extended integral equation （EIE） method, which was used for solving the hydrodynamic coefficients without effects of the irregular frequency. Next, a combined method was recommended for the estimation of added resistance for a ship in the whole wave length range. The comparison data with other experiments indicate the method presented in the paper provides satisfactory results for large blunt ship.
基金The study was approved by Gertner Institute IRB committee(protocol#5138-19,ethical approval number 20187640).
文摘Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar f
基金the National Natural Science Foundation of China (Grant Nos. 10632050 and 10502052)
文摘A high-order shock-fitting finite difference scheme is studied and used to do direc-tion numerical simulation (DNS) of hypersonic unsteady flow over a blunt cone with fast acoustic waves in the free stream, and the receptivity problem in the blunt cone hypersonic boundary layers is studied. The results show that the acoustic waves are the strongest disturbance in the blunt cone hypersonic boundary layers. The wave modes of disturbance in the blunt cone boundary layers are first, second, and third modes which are generated and propagated downstream along the wall. The results also show that as the frequency decreases, the amplitudes of wave modes of disturbance increase, but there is a critical value. When frequency is over the critial value, the amplitudes decrease. Because of the discontinuity of curvature along the blunt cone body, the maximum amplitudes as a function of frequencies are not monotone.
文摘Background： Laparoscopic cholecystectomy （LC） has been a standard operation and replaced the open cholecystectomy （OC） rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury （BDI） in laparoscopic cholecystectomy （LC）. Methods： From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years （14-84 years）. The Calot＇s triangle was bluntly dissected and each duct in Calot＇s triangle was identified before transecting the cystic duct. Results： Two hundred and thirty-nine patients （1.1%） were converted to open procedures. The postoperative hospital stay was 2.1 （0-158） days, and cases （46%） had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases （0.09%） including 6 cases of common BDI, 2 cases of common hepatic duct injury, l case of fight hepatic duct injury, I case of accessory fight hepatic duct, 1 case of aberrant BDI l case ofbiliary stricture, 1 case ofbiliary duct perforation, 3 cases ofhemobilia, and 4 cases of bile leakage. Conclusion： Exposing Calot＇s triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BD1.
基金supported by the National Natural Science Foundation of China (Grant Nos. 51276197,51207169)
文摘According to the mechanism of the arc plasma heating effect,and from a phenomenological perspective of view,the plasma actuation was simplified as heating energy injected into the supersonic flow field for the numerical research on controlling detached shock of the blunt body in non-center symmetrical positions.Besides,experimental research on the form and strength of detached shock wave control by plasma aerodynamic actuation in non-center symmetrical positions was conducted in a high-speed shock tunnel(M=2).The results showed that the detached distance of shock wave increased and the strength of normal shock wave ahead of the detached shock wave reduced when plasma actuation was applied.The control effect was greatly improved after the magnetic field was applied and the effect of upwind-direction flow was the best one.When the upwind-direction flow was applied with 1000 V voltage actuation,the distance of detached shock wave would increase from 3.4 to 7.6 mm and the time average strength of normal shock wave was weaken by 5.5%.At last,the mechanism of plasma actuation on controlling the detached shock wave was briefly analyzed.
文摘BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.
文摘AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury- related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is mostoften used for colonic injuries.
基金Project supported by the National Natural Science Foundation of China(Nos.11472188 and11332007)the National Key Research and Development Program of China(No.2016YFA0401200)
文摘The hypersonic boundary-layer receptivity to slow acoustic waves is investigated for the Mach 6 flow over a 5-degree half-angle blunt cone with the nose radius of 5.08 mm. The plane acoustic wave interacts with the bow shock, and generates all types of disturbances behind the shock, which may take various routes to generate the boundarylayer unstable mode. In this paper, two routes of receptivity are investigated in detail.One is through the disturbance in the entropy layer. The other is through the slow acoustic wave transmitted downstream the bow shock, which can excite the boundary-layer mode due to the synchronization mechanism. The results show that, for a low frequency slow acoustic wave, the latter route plays a leading role. The entropy-layer instability wave is able to excite the first mode near the neutral point, but its receptivity efficiency is much lower.
文摘Introduction:Blunt thoracic aortic injury(BTAI)is rare in elderly patients.As the population ages and life expectancy increases,the frequency of this injury will increase,while the treatment and outcomes remain unclear.Methods:We retrospectively analyzed the collected data of patients>60 years old with BTAI to investigate the mechanism of trauma;time interval from injury to diagnosis;type and timing of surgical intervention;aortic arch pattern;choice of left subclavian artery reconstruction;endograft to treat BTAI;length of the endovascular procedure;endoleaks;complications including stroke,paraplegia,and renal failure;length of hospital stay(LOS)and intensive care unit stay(L.ICUS);and 30-day mortality.Results:Five elderly trauma patients were found to have BTAI.Four(80%)were males,the cohort mean age was68 years,the major mechanism of trauma was fall injury,and the associated injury was thoracic trauma.All patients were transferred to our hospital,and emergency computed tomography angiography showed BTAI in each patient.The average time interval from injury to diagnosis was 2.7 days.Two patients suddenly showed signs of instability in their vital signs and underwent immediate endovascular repair,while 3 patients underwent delayed endovascular repair.The injury site was located in the aortic isthmus just distal to the origin of the left subclavian artery;the aortic arch pattern was II(80.0%)in 4 cases and III in 1 case(20.0%).The choice of left subclavian artery reconstruction included chimney,double chimney,prefenestration,and chimney combined with in situ fenestration.Endografts to treat BTAI included the Ankura(Lifetech Scientific,Shenzhen,China)and the C-TAG(W.L.Gore&Associates,Flagstaff,AZ USA).The length of the endovascular procedure was 75.4 min;there were no endoleaks and no complications including stroke,paraplegia,or renal failure.The average LOS was25 days,and the average L.ICUS of 2 patients was 15 days,with no 30-day mortality.Conclusion:Elderly patients with fall injury should promptly exclude BTAI
文摘BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and com
基金Grants from the National Natural Science Foundation of China(Grant No.82270587)the Jinling Hospital Scientific Research Project(Grant No.YYZD2021011).
文摘Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.
