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We herein report two cases of patients that underwent prophylactic operations to prevent aortic injuries in association with fractured ribs. Penetrating aortic injuries induced by fractured ribs remain fatal. Prophylactic operations appear effective. However, the indication for such operations should be clarified further in the future.

In this study, nickel-doped aminosilica membranes containing pendant groups were prepared with 3-aminopropyltriethoxysilane (APTES), trimethoxy[3-(methylamino)propyl]silane (MAPTS), 3

Organosilica membranes are a promising candidate for pervaporation dehydration owing to their tunable molecular sieving characteristics and excellent hydrothermal stability. Herein, we report a facile modification using an atmospheric-pressure water vapor plasma to enhance the pervaporation performance of organosilica membranes. The surface of methyl-terminated organosilica membranes was treated by water vapor plasma to develop an ultrathin separation active layer suitable for pervaporation dehydration. The surface hydrophilicity was increased by water vapor plasma due to oxidative decomposition of methyl groups to form silanol groups. The plasma-modified layer had a thickness of several nanometers and had a silica-like structure due to the condensation of silanol groups. The plasma-modified organosilica membranes exhibited an improved molecular sieving property owing to the formation of highly cross-linked siloxane networks with a pore size of approximately 0.4 nm. The membranes also exhibited an excellent permselectivity in the dehydration of alcohols due to the nanometer-thick separation active layer with controlled pore size and increased hydrophilicity. The plasma-modified membranes showed high H

Graphene oxide (GO) has attracted attention as an excellent membrane material for water treatment and desalination owing to its high mechanical strength, hydrophilicity, and permeability. In this study, composite membranes were prepared by coating GO on various polymeric porous substrates (polyethersulfone, cellulose ester, and polytetrafluoroethylene) using suction filtration and casting methods. The composite membranes were used for dehumidification, that is, water vapor separation in the gas phase. GO layers were successfully prepared via filtration rather than casting, irrespective of the type of polymeric substrate used. The dehumidification composite membranes with a GO layer thickness of less than 100 nm showed a water permeance greater than 1.0 × 10−6 mol/(m2 s Pa) and a H2O/N2 separation factor higher than 104 at 25 °C and 90–100% humidity. The GO composite membranes were fabricated in a reproducible manner and showed stable performance as a function of time. Furthermore, the membranes maintained high permeance and selectivity at 80°C, indicating that it is useful as a water vapor separation membrane.

A 35-year-old man injured his right foot by slipping down 200 m into a crater on top of Mount Fuji, where some snow still remained. The next day the patient climbed up from the crater with his friend's assistance and began to descend the mountain; he met the Shizuoka police mountain distress rescue team at the 9th station. The Shizuoka police mountain distress rescue team transported the patient on foot to the snowless 7th station. The Shizuoka police aviation unit, flying a helicopter, then collected the patient. They transported the patient to the nearby Fujinomiya fire department station. The eastern Shizuoka physician-staffed helicopter emergency medical service landed there, and the patient was transported to Juntendo Shizuoka Hospital. On arrival, he had stable vital signs, but his right foot showed a dislocated fracture with frostbite. This is the first case report of collaboration between a helicopter emergency medical service and a police helicopter to rescue a victim from Mount Fuji. When managing victims in high-altitude settings, such as Mount Fuji, collaboration between multiple organizations is necessary.

This study presents a concept that focuses on the structure design of preceramic resin precursors by the sol–gel method for fabricating carbon–ceramic molecular sieving membranes.

Al doping densified and hydrophilized the pore structure of organosilica membranes, which resulted in improved permselectivity in humid-gas separation at moderate-to-high temperature.

Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB). Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance. Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival. Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

This work investigated the long-term hydrothermal performance of composite carbon-SiO2-ZrO2 membranes. A carbon-SiO2-ZrO2 composite was formed from the inert pyrolysis of SiO2-ZrO2-polybenzoxazine resin. The carbon-SiO2-ZrO2 composites prepared at 550 and 750 °C had different surface and microstructural properties. A carbon-SiO2-ZrO2 membrane fabricated at 750 °C exhibited H2 selectivity over CO2, N2, and CH4 of 27, 139, and 1026, respectively, that were higher than those of a membrane fabricated at 550 °C (5, 12, and 11, respectively). In addition to maintaining high H2 permeance and selectivity, the carbon-SiO2-ZrO2 membrane fabricated at 750 °C also showed better stability under hydrothermal conditions at steam partial pressures of 90 (30 mol%) and 150 kPa (50 mol%) compared with the membrane fabricated at 500 °C. This was attributed to the complete pyrolytic and ceramic transformation of the microstructure after pyrolysis at 750 °C. This work thus demonstrates the promise of carbon-SiO2-ZrO2 membranes for H2 separation under severe hydrothermal conditions.

A series of pendant–type alkoxysilane structures with various carbon numbers (C1–C8) were used to fabricate sol–gel derived organosilica membranes to evaluate the effects of the C/Si ratio and fluorine doping. Initially, this investigation was focused on the effect that carbon-linking (pendant–type) units exert on a microporous structure and how this affects the gas-permeation properties of pendant–type organosilica membranes. Gas permeation results were compared with those of bridged–type organosilica membranes (C1–C8). Network pore size evaluation was conducted based on the selectivity of H2/N2 and the activation energy (Ep) of H2 permeation. Consequently, Ep (H2) was increased as the C/Si ratio increased from C1 to C8, which could have been due to the aggregation of pendant side chains that occupied the available micropore channel space and resulted in the reduced pore size. By comparison, these permeation results indicate that pendant–type organosilica membranes showed a somewhat loose network structure in comparison with bridged–type organosilica membranes by following the lower values of activation energies (Ep). Subsequently, we also evaluated the effect that fluorine doping (NH4F) exerts on pendant−type [methytriethoxysilane (MTES), propyltrimethoxysilane (PTMS)] and bridged-type [1,2–bis(triethoxysilyl)methane (BTESM) bis(triethoxysilyl)propane (BTESP)] organosilica structures with similar carbon numbers (C1 and C3). The gas-permeation properties of F–doped pendant network structures revealed values for pore size, H2/N2 selectivity, and Ep (H2) that were comparable to those of pristine organosilica membranes. This could be ascribed to the pendant side chains, which might have hindered the effectiveness of fluorine in pendant–type organosilica structures. The F–doped bridged–type organosilica (BTESM and BTESP) membranes, on the other hand, exhibited a looser network formation as the fluorine concentration increased.

An 81-year-old woman was trying to reach something up high by stepping on the highest drawer of a chest of drawers. However, she fell off, and both of her both legs became trapped between the chest and the drawer. Her lower limbs and hips were stuck in an upside-down position, with her head and upper back on the floor. She was found in this awkward position by another person two days later. As the patient was hemodynamically unstable, she underwent venous infusion and bilateral tourniquets before rescue. On arrival, she was still in a shock state with hypoxia. Initially, she underwent tracheal intubation, and then the tourniquets were released one by one. She received a diagnosis of bilateral leg infections, ischemic left leg and multiple organ failure due to sepsis and unstable circulation, pulmonary embolism, and ischemic colitis with anemia. She underwent infusion of antibiotics, transfusion, noradrenaline, left lower limb amputation, renal replacement therapy, and then delayed right leg amputation. She was complicated with ischemia-reperfusion injury, ulcerative colitis and urosepsis during the hospital course, but she ultimately obtained a survival outcome after intensive care. This unique case adds another item to the list of documented etiologies of drawer-related injury and ischemia-reperfusion injury.

The nickel-doped bis [3-(trimethoxysilyl) propyl] amine (BTPA) derived membrane has a microporous coordinated network that has high potential to be an ideal separation barrier for methanol-toluene azeotropic mixtures via the pervaporation process. Ni-BTPA membranes were modified by employing a nickel dopant over amine groups in mole ratios (mol/mol) that ranged from 0.125 to 0.50. The incorporation of different amounts of nickel dopant into flexible amine-rich organosilica precursors of BTPA increased the rigidity and resulted in a porous structure with a large specific surface area (increased from 2.36 up to 282 m2 g-1) and a high pore volume (from 0.024 up to 0.184 cm3 g-1). Methanol-toluene separation performance by the nickel-doped BTPA (Ni-BTPA) membranes was increased with increases in the nickel concentration. Ni-BTPA 0.50 showed separation performance that was superior to other types of membranes, along with a high-level of flux at 2.8 kg m-2 h-1 and a separation factor higher than 900 in a 10 wt % methanol feed solution at 50 °C. These results suggest that the balance between the microporosity induced by amine-nickel coordination and an excessive amount of nickel-ion facilitates high levels of flux and separation of methanol.

Background Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis. Methods A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (high-target) and 65–70 mmHg (control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients’ condition. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥ 0.1 μg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines. The primary outcome is all-cause mortality at 90 days after randomization. Discussion The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients. Trial registration UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.

Although the regular administration of antihypertensive drugs is a risk factor for falls in older adults, whether their anti-inflammatory effects confer a survival benefit in older adults remains unknown. This single-center retrospective cohort study examined patients with trauma aged ≥ 65 admitted to our hospital between January 2018 and December 2020. Patients who had not received antihypertensive drugs before admission (i.e., AHT(−) group) and those who had received the drugs (i.e., AHT(+) group) were compared using a 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality and the incidence of complications during the hospital stay. In total, 637 patients were analyzed. After propensity score matching, each study group had 223 patients. No significant difference was observed in the primary outcome (28-day mortality: AHT(−) group, 3.6% vs. AHT(+) group, 3.6%; adjusted relative risk: 1.00, 95% confidence interval (CI): 0.38–2.62); only the in-hospital incidence of delirium was significantly low in the AHT(+) group (25.1% vs. 13.9%; adjusted relative risk: 0.55, 95% CI: 0.37–0.82). Overall, the regular use of antihypertensive drugs did not affect outcomes in geriatric trauma patients; however, the incidence of delirium was reduced in those regularly receiving antihypertensive drugs.

A smart glasses system is a computerized communicator with a transparent screen and video camera that can be worn as a pair of glasses. There have been no reports on the use of smart glasses in the prehospital setting.To conduct a preliminary investigation on whether smart glasses were smoothly used bidirectionally between the prehospital setting and the receiving hospital.From March 1, 2022, to March 31, 2022, one smart glasses unit was installed in an ambulance at one branch of the fire department near our hospital. The physician on the computer, who received video and voice transmission from the smart glasses when the ambulance was dispatched, evaluated the transmission status with regard to video reception, voice reception, and voice transmission. In addition, the activity time was compared between cases in which the smart glasses system was used (patient) and not used (control).During the investigating period, 12 cases were analyzed as patients. The rate of good video reception was 75%, the rate of good voice reception was 50%, and the rate of good voice transmission was 25%. There was no significant change in the activity time between the patient and control groups.We performed a preliminary investigation on the usability of smart glasses in the prehospital setting. Using smart glasses, patient information was shared by video and voice before arrival at the hospital, and did not affect the activity time. However, the instability of the communication status should be recognized.

A 47-year-old woman, who had been diving 6 times, panicked during diving training and surfaced suddenly after a 15-minute dive at a depth of 19 meters. She had nausea, vomiting, and headache immediately after surfacing. Decompression sickness (DCS) was suspected, and she was transported to the emergency room (ER) of our hospital by ambulance. Upon arrival, she had mild consciousness disturbance and hypoxia requiring oxygen. Her symptoms remained. She initially received 12 L per minute of oxygen and rapid infusion for DCS. However, ultrasound study showed no air bubbles in the inferior vena cava or portal vein. Trunk computed tomography (CT) showed infiltrative lesions in the bilateral lung fields without gas in any vessels. The diagnosis was drowning with alternobaric vertigo. She was treated with an antibiotic without recompression therapy. The patient's dizziness and vomiting subsided quickly. Her post-admission course was uneventful and she was discharged to her home on the 9th hospital day. We report a case in which ultrasound was useful for differentiating between DCS and drowning. When patients have symptoms after diving, confirmation of the presence of gas in the heart or vessels using ultrasound in the acute phase is important for the diagnosis of DCS.

Starting from room temperature (27 °C), graphene oxide (GO) was annealed stepwise at 100 °C, 200 °C and 300 °C and detailed structural characterizations like FTIR (Fourier transform infrared spectroscopy), XPS (X-ray photoelectron spectroscopy), XRD (X-ray powder diffraction) and Raman spectroscopy revealed that with increase in temperature, transformation from GO to rGO (reduced graphene oxide) took place and complete conversion was achieved at 300 °C. With increase in temperature, the functional groups like epoxy, ether, carbonyl and carboxyl were gradually reduced and at 300 °C, only the hydroxyl group became dominant. The gas sensing study was carried out using NH3 and alcohols in the concentration range of 125 ppb-700 ppm. It was observed that for lower ppm (5-50 ppm) the GO based sensors offered better selectivity towards NH3, while rGO exhibited better NH3 selectivity at higher concentrations (200-700 ppm). Possibly, presence of hydroxyl group is favorable for NH3 adsorption and therefore NH3 selectivity is better in rGO particularly at high concentrations. On the other hand, at low NH3 concentrations, presence of various types of functional groups in GO gives a resultant selectivity which is better compared to that of rGO.

In this study an easy template was devised for the fabrication and microstructural control of ligand-chelated, silica–zirconia-based composite membranes with a thickness of less than 400 nm. Hybrid materials with crosslinking between the organic moieties were successfully fabricated via the sol–gel co-condensation of 3-(trimethoxysilyl)propyl methacrylate and zirconium(IV) butoxide chelated via acetylacetone and allyl acetoacetate ligands using an azobisisobutyronitrile radical initiator as a crosslinking agent. Characterization of the films and gels via FTIR, XRD and thermogravimetry indicated that both the polymerization and hybridization of the networks was achieved. Gas permeation experiments showed that the organic crosslink-derived membranes possess molecular sieving properties (H2 permeance: ≈10−7 mol m−2 s−1 Pa−1; H2/N2 selectivity: ≈20–30) that are superior to those of non-crosslink-derived membranes (H2 permeance: ≈10−7 mol m−2 s−1 Pa−1; H2/N2 selectivity: ≈7–11). Quantitative analysis of the microstructures of the membranes based on the permeation behaviors of H2 and N2 revealed that organic crosslinking led to significant control of the microstructural characteristics of the membranes.

Hybrid microporous aminosilica membranes have been successfully synthesized via doping with Ag-, Cu- and Ni- into dense bis[3-(trimethoxysilyl)propyl] amine (BTPA) membranes, which creates micropores via the crosslinking between donor pairs of electrons in the amine moiety and electron acceptors in the empty “d” orbital of the transition metal. The formation of micropores within the coordinated covalently bonded compound was investigated via Ultraviolet-Visible spectroscopy (UV-Vis), Fourier Transform Infrared spectroscopy (FT-IR), X-ray Photoelectron Spectroscopy (XPS), X-ray Diffraction (XRD), Transmission Electron Microscopy (TEM), and the isotherms of N2 and CO2 sorption. Values for the surface area and pore volume of the metal-doped BTPA were both expanded by increasing the metal coordination affinity to 214 m2 g−1 and 0.185 cm3 g−1, respectively. The effect of metal doping on the membrane separation performance was evaluated using a single-gas permeation system and the activation energy of permeance was measured. Gas permeation was increased following the doping process due to the formation of a microporouse structure on the order of Ni-BTPA > Cu-BTPA > Ag-BTPA > BTPA, which corresponds to higher affinity for metal coordination. Permeation behavior was dominated by the molecular sieving effect that showed a high level of H2 permeance at 4.45 × 10−6 mol m−2 s−1 Pa−1 with a H2/SF6 permeance ratio that reached 15 500, which is indicative of a defect-free membrane. By comparison with Cu-BTPA (14.8 kJ mol−1), Ag-BTPA (19.5 kJ mol−1), and BTPA (31.1 kJ mol−1) membranes, the Ni-BTPA membrane showed the lowest value for CO2 activation energy (8.9 kJ mol−1), which can be ascribed to the microporosity that was formed by a higher coordination interaction. The nickel-doped BTPA achieved high levels of both permeance of N2 and selectivity for N2/SF6 at 3.75 × 10−7 mol m−2 s−1 Pa−1 and 1900, respectively.

Herein, TiO2 coatings were deposited on photodegradable polymers for protection from UV irradiation using the atmospheric-pressure plasma-enhanced chemical vapor deposition (AP-PECVD) technique. Polymethylmethacrylate (PMMA) and polycarbonate (PC) substrates were coated with titanium tetraisopropoxide as the precursor in an open-air atmospheric-pressure nonequilibrium argon plasma jet. The AP-PECVD-derived TiO2 coatings exhibited good adhesion to PMMA and PC. The TiO2 coatings could shield more than 99% of UV light in the wavelength range of 200–300 nm, without affecting the transmittance of visible light. UV irradiation tests on polymer films demonstrated that the degradation rates of PMMA and PC were significantly reduced by one-tenth after they were coated with TiO2 films.

Microporous silica membranes have shown promise as potential candidates for energy-efficient chemical separation. Herein, we report the ultrafast synthesis of silica membranes, on the order of minutes, in atmospheric-pressure, low-temperature plasma. Direct deposition in the discharge region of atmospheric-pressure plasma enables the immediate formation of a thin silica layer on a porous substrate. The plasma-deposited layer had a thickness of ∼13 nm and was confined to the immediate surface of the substrate. With an increase in deposition temperature, we observed an increase in the inorganic nature of the plasma-deposited layer and simultaneous improvement in the membrane performance. Consequently, the resulting membranes exhibited outstanding permeance for small-sized gas molecules, such as H2 (>10-6 mol m-2 s-1 Pa-1), with a high H2/SF6 permeance ratio of ∼6300, providing a nonthermal alternative for the fabrication of silica-based membranes.

Aim We performed a retrospective investigation to determine the factors, including vital signs, severity of traumatic anatomical abnormality and biochemical data, which are most useful for predicting the outcomes of trauma patients after admission. Methods A retrospective medical chart review was performed for all trauma patients who were admitted to our department from September 2017 to August 2019. These subjects were then divided into two groups according to whether they survived to hospital discharge or not. Results During the investigation period, 790 patients were enrolled as subjects (Death group, n = 34; survival group, n = 756). The injury severity score, serum glucose level, prothrombin time, international normalized ratio and fibrin/fibrinogen degradation product level in the Death group were significantly greater than those in the Survival group. A multivariate analysis showed that the fibrin/fibrinogen degradation product level was a significant predictor of a fatal outcome (odds ratio 1.00, 95% confidence interval 1.0008-1.0040, p value = 0.0008). Conclusions The fibrin/fibrinogen degradation product levels on arrival may be a better predictor of a fatal outcome in trauma patients than physiological or anatomical severity.

Objective We retrospectively investigated the actual conditions of burn patients evacuated by helicopter in comparison to those evacuated by ground ambulance using the Japan Trauma Data Bank. Methods This study was a retrospective analysis of the data recorded in the Japan Trauma Data Bank between January 2004 and May 2019. After propensity score matching for the method of transportation, the survival rate was compared between the 2 groups. Results During the investigation period, there were 4,627 burn patients (helicopter group, n = 276; ambulance group, n = 4,351). After propensity score matching, there were no significant differences between the 2 groups in any of the assessed variables, and the survival rate did not differ to a statistically significant extent. Conclusion After propensity score matching, the survival rate of the helicopter group did not appear to be superior to the ambulance group. Further prospective studies are needed to explore the proper indications for air transportation of burn patients, which could potentially improve outcomes.

We retrospectively investigated patients injured by falling/flying objects using the Japan Trauma Data Bank (JTDB). The study collected information of the JTEB from January 2004 to May 2019. The subjects were divided into two groups: the unexpected accident (UA) group included cases in which the patient was injured by an unexpected accident; the labor accident (LA) group included cases in which the patient was injured at work. A total of 1997 patients were enrolled as subjects (UA group, n = 383; LA group, n = 1134). In both groups, head injuries were the most frequent type of injury, followed by chest injuries. The median head abbreviated injury scale of the UA group was significantly higher than that of the LA group. In the UA group, the percentage of female patients, average age, and average TRISS value were significantly greater in comparison to the LA group. The frequency of emergency operations in the UA group was significantly lower in comparison to the LA group. The frequency of head injuries in the UA group was significantly greater than that in the LA group. The frequencies of upper extremity and lower extremity injuries in the UA group were significantly lower than those in the LA group. This is the first report to analyze trauma patients injured by falling/flying objects using the JTDB. Public health and emergency providers can use this information to anticipate the health-care needs after falling/flying object injuries.

Objectives: We evaluated the applicability of a machine learning based Low-density lipoprotein-cholesterol (LDL-C) estimation method and the influence of the characteristics of the training datasets. Methods: Three training datasets were chosen from training datasets: health check-up participants at the Resource Center for Health Science (N = 2664), clinical patients at Gifu University Hospital (N = 7409), and clinical patients at Fujita Health University Hospital (N = 14842). Nine different machine learning models were constructed through hyperparameter tuning and 10-fold cross-validation. Another test dataset of another 3711 clinical patients at Fujita Health University Hospital was selected as the test set used for comparing and validating the model against the Friedewald formula and the Martin method. Results: The coefficients of determination of the models trained on the health check-up dataset produced coefficients of determination that were equal to or inferior to those of the Martin method. In contrast, the coefficients of determination of several models trained on clinical patients exceeded those of the Martin method. The means of the differences and the convergences to the direct method were higher for the models trained on the clinical patients' dataset than for those trained on the health check-up participants' dataset. The models trained on the latter dataset tended to overestimate the 2019 ESC/EAS Guideline for LDL-cholesterol classification. Conclusion: Although machine learning models provide valuable method for LDL-C estimates, they should be trained on datasets with matched characteristics. The versatility of machine learning methods is another important consideration.

Purpose We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods This study was a retrospective analysis of the JTDB database. The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of transportation: the Heli group included cases transported by the HEMS, while the Ambulance group included cases transported by ground ambulance. Results During the investigation period, a total of 57,872 patients were enrolled as subjects, including 7238 in the Heli group and 50,634 in the Ambulance group. The average age, male ratio, average injury severity score (ISS), average revised trauma score (RTS) and survival ratio were significantly greater in the Heli group than in the Ambulance group. After performing a propensity score-matched analysis, there were no statistical differences concerning the age, sex, ISS, RTS between the two groups. However, the survival ratio in the Heli group remained greater than that in the Ambulance group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the RTS, transport by the HEMS, age, ISS and female gender were identified as significant predictors of a survival outcome. The HEMS was significantly associated with an increased survival ratio (odds ratio: 1.69; 95% confidence interval: 1.51–1.88) compared with a ground ambulance. Conclusion The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.

A 34-year-old man was transported by ambulance to our hospital after experiencing generalized convulsions. He had been of short stature since birth, and had been diagnosed with growth hormone deficiency, which was treated with growth hormone therapy from 10 to 14 years of age. He experienced convulsions two times at 32 and 33 years of age, respectively, with spontaneous recovery. He had no specific family history. On arrival, he had clear consciousness and sinus tachycardia. A physical examination revealed short stature. A biochemical analysis of venous blood revealed hypocalcemia and a low level of parathyroid hormone. Head computed tomography (CT) revealed diffuse hyperostosis of the cranial vault and truncal CT revealed cartwheel apperance in the thoracic vertebral bodies from Th9 to Th12. He was treated with levetiracetam, alfacalcidol and calcium agents. Next-generation sequencing suggested heterozygous large deletion of T-box transcription factor (TBX1) gene. This is the first report of hypoparathyroidism with cartwheel-like change in the thoracic vertebral body. The further accumulation of cases is necessary to determine whether this change is specific to hypoparathyroidism.