Search

Abstract Collagen fibers, one of the key load-bearing components of the extracellular matrix, contribute significantly to tissue integrity through their mechanical properties of strain-dependent stiffening. This study investigated the effects of bacterial collagenase on the mechanical behavior of individual bovine lung collagen fibers in the presence or absence of mechanical forces, with a focus on potential implications for emphysema, a condition associated with collagen degradation and alveolar wall rupture. Tensile tests were conducted on individual collagen fibers isolated from bovine lung tissue. The rate of degradation was characterized by the change in fiber Young’s modulus during 60 min of digestion under various mechanical conditions mimicking the mechanical stresses on the fibers during breathing. Compared to digestion without mechanical forces, a significantly larger drop of fiber modulus was observed in the presence of static or intermittent mechanical forces. Fiber yield stress was also reduced after digestion indicating compromised fiber failure. By incorporating fibril waviness obtained by scanning electron microscopic images, an analytic model allowed estimation of fibril modulus. A computational model that incorporated waviness and the results of tensile tests was also developed to simulate and interpret the data. The simulation results provided insights into the mechanical consequences of bacterial collagenase and mechanical forces on collagen fibers, revealing both fibril softening and rupture during digestion. These findings shed light on the microscale changes in collagen fiber structure and mechanics under enzymatic digestion and breathing-like mechanical stresses with implications for diseases that are impacted by collagen degradation such as emphysema.

Objectives In this study, the absorption of heavy metals in the soil from smoking areas using indoor plants and electrical grounding was investigated to increase the utility of indoor plants for soil decontamination. Methods Soil from plant pots in a smoking area was collected for the experimental plant pot preparations. Some of the prepared pots were connected to electrical ground via an electrode. Kidney beans (Phaseolus vulgaris) were seeded, and their growth were observed. After 30 days of the cultivation, TOC (Total Organic Carbon), and metagenomics profiles in the soil was analyzed. To estimate the behavior of the heavy metals in soil and plants, Cadmium concentrations in the samples were analyzed using ICP-MS (Inductively Coupled Plasma-Mass Spectrometry). Results and Discussion The connection of the electrical ground to the plant pot induced the rapid growth of plant (48.2 ± 2.3% increase in stem growth), compare to the plant in the pot without the electrical ground. TOC analysis showed that the soil from the grounded pots showed the highest value, compared to the control soil (3.08 ± 1.22%), and the soil from the pot without ground connection (2.3 ± 0.1%). The ICP-MS analysis indicated that the plant body in the grounded pot had the highest cadmium concentration at 0.33 ± 0.018 μg/kg. Using the metagenomic analysis, biomineralization related bacterial species (Nocardioides sp., Streptomyces sp., Sphingomonas sp. etc.) were identified from the grounded soil sample. These results suggested that the indoor plant cultivation with the electrical ground connection as an electrical fertilizer enhances the cadmium absorption by plant, exudate secretion from the plant root, and bacterial flora change in the rhizosphere. Conclusion Cadmium in the soil from the smoking area was absorbed by indoor plant with the electrical ground. Therefore, the application of the electrical ground connection (earth) to the electrically insulated outdoor plant pots might enhance the plant growth rate and physiological activity. This application could be a novel soil decontamination method using plants.

Purpose Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

Pulmonary fibrosis is a deadly disease that involves the dysregulation of fibroblasts and myofibroblasts, which are mechanosensitive. Previous computational models have succeeded in modeling stiffness-mediated fibroblasts behaviors; however, these models have neglected to consider stretch-mediated behaviors, especially stretch-sensitive channels and the stretch-mediated release of latent TGF-β. Here, we develop and explore an agent-based model and spring network model hybrid that is capable of recapitulating both stiffness and stretch. Using the model, we evaluate the role of mechanical signaling in homeostasis and disease progression during self-healing and fibrosis, respectively. We develop the model such that there is a fibrotic threshold near which the network tends towards instability and fibrosis or below which the network tends to heal. The healing response is due to the stretch signal, whereas the fibrotic response occurs when the stiffness signal overpowers the stretch signal, creating a positive feedback loop. We also find that by changing the proportional weights of the stretch and stiffness signals, we observe heterogeneity in pathological network structure similar to that seen in human IPF tissue. The system also shows emergent behavior and bifurcations: whether the network will heal or turn fibrotic depends on the initial network organization of the damage, clearly demonstrating structure’s pivotal role in healing or fibrosis of the overall network. In summary, these results strongly suggest that the mechanical signaling present in the lungs combined with network effects contribute to both homeostasis and disease progression.

In this study, we aimed to develop a novel directional electromagnetic field (EMF) application method for promoting plant growth using a solenoid coil-based cultivation system. The emergence of plant shoots from seeds, shoot elongation, root proliferation, and plant growth hormones were monitored in the presence of a directional EMF using our solenoid coil system. To observe the effect of the directional EMF on seed germination, radish and sugarcane seedlings were cultivated in the system. At the seed germination stage, the EMF applied had no significant effect on germination or growth. However, after germination, shoot growth was sensitive to a directional EMF, as it was promoted by different conditions in a plant-species-dependent manner. The maximum growth promotion rates were 25.65% ± 4.21% and 38.57% ± 12.81% for radish and sugarcane, respectively. Similarly, plant root proliferation and indole-3-acetic acid (IAA) analyses indicated that directional EMF application was associated with root proliferation and hormone synthesis. Plant growth in the experimental system proved controllable; either growth stimulation or reduction were possible as the system operating conditions were made to vary. Our findings indicate that the application of a specific directional EMF could serve as an electrical plant stimulant (or electrical fertilizer).

Human precision-cut lung slices (hPCLS) prepared from fibrotic lungs recapitulate the pathophysiological hallmarks of fibrosis. These hallmark features can also be induced by treating non-fibrotic hPCLS with a fibrotic cocktail (FC). As a result, the fibrotic and fibrosis-induced hPCLS are rapidly emerging as preferred models for disease modeling and drug discovery. However, current hPCLS models are limited by tissue viability in culture, as they are usually only viable for one week after harvesting. Here, we demonstrate that the fibrotic hPCLS can be cryopreserved, stored for months, and then thawed on demand without loss of hPCLS viability or protein content for 14 days post-thawing. Cryopreservation also preserves the pro-fibrotic potential of non-fibrotic hPCLS. Specifically, when we treated the thawed non-fibrotic hPCLS with an FC, we observed significant pro-fibrotic cytokine secretion and elevated tissue stiffness. These pro-fibrotic changes were inhibited by the small-molecule tyrosine kinase inhibitor, Nintedanib. Taken together, our work indicates that a feasible solution to prolong the pre-clinical utility of fibrotic and fibrosis-induced hPCLS is cryopreservation. We anticipate that cryopreserved hPCLS will serve as an advantageous predictive model for the evaluation of pro-fibrotic pathways during acute and chronic toxicity testing.

Abstract Jakobshavn Isbræ, a major outlet glacier in Greenland, lost its protective ice shelf in 2002 and has been speeding up and retreating since. We image its grounding line for the first time with a terrestrial radar interferometer deployed in 2016 and detect its migration at tidal frequencies. The southern half of the glacier develops a floating section (3 km × 3 km) that migrates in phase with the tidal difference, up to a distance of 2.8 km, far more than previously expected. We attribute the migration to kilometer‐scale seawater intrusions, 10–20 cm in height, with the tide. The intrusions reveal that the glacier bed may be up to 800 m deeper than expected on the south side, which illustrates that our knowledge of bed topography remains limited for this glacier. We expect seawater intrusions to cause rapid melt of basal ice and play a major role in the glacier evolution.

Abstract Pulmonary contusion is an important risk factor for respiratory complications in trauma patients. Hence, we aimed to determine the relationship between the ratio of pulmonary contusion volume to the total lung volume and patient outcomes and the predictability of respiratory complications. We retrospectively included 73 patients with a pulmonary contusion on chest computed tomography (CT) from 800 patients with chest trauma admitted to our facility between January 2019 and January 2020. Chest injury severity was expressed as the ratio of pulmonary contusion volume to total lung volume by quantifying pulmonary contusion volume on chest CT. The cut-off value was 80%. Among the 73 patients with pulmonary contusion (77% males, mean age: 45.3 years), 28 patients had pneumonia, and five had acute respiratory distress syndrome. The number of patients in the severe risk group with > 20% of pulmonary contusion volume was 38, among whom 23 had pneumonia. For predicting pneumonia, the area under the receiver operating characteristic curves for the ratio of pulmonary contusion volume was 0.85 (95% confidence interval 0.76–0.95, p = 0.008); the optimal threshold was 70.4%. Quantifying pulmonary contusion volume using initial CT enables identifying patients with chest trauma at high risk of delayed respiratory complications.

Study Design This study was a retrospective case series. Purpose This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS). Overview of Literature LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes. Methods We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient’s demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined. Results In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p

Objectives The purpose of this study was to investigate the effect of plants on smoking area and its environment. For this purpose, two different smoking areas (with and without plants) were selected, and the number of smokers and spitting behaviors were monitored. Soil and leaves samples of each smoking area were taken to analyze the concentration of cadmium and distribution of soil microorganisms. Through this investigation, the role of plants in smoking area for the cadmium and microorganisms was estimated. Methods In the selected smoking areas, number of smokers and the number of spitting behaviors were monitored. Cadmium (Cd) concentrations of leaves, topsoil and rhizosphere obtained from the smoking areas were analyzed with inductively coupled plasma mass spectrometry (ICP-MS). The microorganisms in soil samples were analyzed using denaturing gradient gel electrophoresis (DGGE) and 16s rRNA amplicon sequencing based metagenomics. Results and Discussion In the case of smoking area with plants, number of smokers and number of total spitting behaviors were 176.67 ± 7.85 and 918.67 ± 40.8 times per hour, respectively. In smoking area without plants, the 153.67 ± 5.44 (smokers) and (829.8 ± 29.36 (spitting behavior) per hour were observed. Among the collected samples from the smoking areas, the highest Cd values (347.117 ± 24.542 μg/kg) were found in leaves of smoking area. In the case of smoking area without plants, the top soil samples showed the highest Cd concentration (295.77 ± 16.64 μg/kg). The results indicate that Cd released from cigarette ash, saliva and smoke can be accumulated in plants and soil. The results suggested that the presence of plants in the smoking area protect the accumulation of Cd in surrounding environments (soil and atmosphere). The metagenomic analysis of the soil samples showed that smoking and spitting behavior also affected microbial system in the smoking areas. The results showed that the microorganisms in smoking area were closely related to the heavy metal removing activities. Conclusion Results suggested that the cadmium distribution in the smoking areas was significantly affected by the presence of live plants. In addition, the presence of plants in the smoking area induced the difference species microorganisms. These results suggested that the presence of plants in smoking area can protect the spread of cadmium to the surrounding environment.

Purpose A trauma center project for treating patients with trauma has been established in Korea. A trauma team is activated based on the Centers for Disease Control and Prevention (CDC) field triage Step 1 for patient triage. Here, we determined if the currently applied criteria were appropriate for the triage of patients with trauma in Korea. Methods This retrospective study included patients who were taken to the regional trauma center from January 1, 2016 to December 31, 2019, and were registered in the Korean Trauma database. The rates for undertriage and overtriage were calculated from the in-field and in-hospital triage according to the CDC guidelines Step 1. Results Among the 9,383 patients transferred to the trauma center, 3,423 were directly transferred from the site and were investigated. The overall rates for undertriage and overtriage of these patients were 28.13% and 30.35%, respectively. For the patients who received in-field triage and were directly transferred to the trauma center, the rates for undertriage and overtriage were 27.92% and 32.39%, and 25.92% and 29.11% for in-hospital triage, respectively. The concordance rate of triage was 87.09%. Conclusion The current use of in-hospital triage physiological criteria as set out in the CDC guidelines Step 1, indicated an undertriage rate which was high and an overtriage rate within the acceptable range. Further studies on triaging patients with trauma are warranted. Improvements in the guidelines of the trauma center project are necessary and this needs to be supported by resources and training for field personnel.

Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.

Pancreatic injury is rare in pediatric cases of blunt abdominal trauma and nonoperative management is preferred in pediatric patients. There are more concerns about operative treatment observed in pediatric patients compared with adult patients. However, some pediatric cases require surgical treatment. If distal pancreatectomy is performed, the necessity of splenectomy should be considered, especially in pediatric patients. This study reports the case of a 17-month-old patient with a Grade 3 pancreatic injury following blunt abdominal trauma. The patient was successfully managed by spleen-preserving distal pancreatectomy. In conclusion, this surgical technique can be performed safely, and complications caused by splenectomy can be prevented using this technique.

Purpose The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0–1 (age and Injury Severity Score) or 0–3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0–11 points). Results The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P

Summary: Objective: The purpose of this study was to determine whether TAE negatively impacted perioperative outcomes in patients who underwent open surgery for pelvic trauma. Methods: We retrospectively reviewed the medical records and radiographs of patients who had open surgery for an acute pelvic trauma between February 2014 and May 2017. The patients were classified into two groups: those who underwent TAE and those who did not. We evaluated preoperative demographics and perioperative outcomes between the two groups. Injury type-specific comparisons were also performed. Results: A total of 136 patients (50 TAE and 86 non-TAE) were included in this study. There were significant differences in preoperative demographics including the type of injury, injury severity score, revised trauma score, surgical approach, initial blood pressure, and the amount of transfusion within 24 h between the two groups. However, no differences in perioperative outcomes were identified except for the amount of total transfusion. There were significant differences between the two groups in the injury type-specific comparisons, specifically in the amount of transfusion within 24 h in patients with pelvic ring injury and in the injury severity score in patients with acetabular fracture. However, there was no difference in perioperative outcomes between the groups for either injury type. Conclusion: In the present study, we were unable to identify negative effects of TAE on perioperative outcomes. Therefore, when considering open surgery subsequent to TAE, there is no evidence of increased risk for negative perioperative outcomes, especially with respect to bone healing and deep infection.

Background: Transcatheter arterial embolization (TAE) is an established approach for controlling hemorrhage in adults with acute abdominal and pelvic trauma. However, its application in pediatric trauma is not well established. This study aimed to evaluate the safety and effectiveness of TAE in a population of pediatric patients with blunt trauma. Methods: This retrospective study was conducted in pediatric patients (

Background Although spinal cord stimulation (SCS) can be a treatment option for intractable postherpetic neuralgia (PHN), obtaining proper stimulation at the thoracic dermatome is difficult. Dorsal root ganglion (DRG) stimulation may be an effective treatment for patients with insufficient efficacy in SCS only. Case A 54-year-old male with intractable PHN was referred to our clinic. Pain was localized to the distribution of the T1–3 dermatomes. SCS trial was conducted, and lead was placed within the epidural space over the C6–T1 level; however, the stimulation was inadequate for his pain site. Therefore, another lead was placed within the left T1 and T2 DRG for trial, and T1 DRG stimulation provided adequate stimulation. T1 DRG stimulation and SCS could cover the entire pain site with paresthesia, and his pain was decreased by over 50%. Conclusions DRG stimulation combined with SCS may be a good treatment option for intractable thoracic PHN.

Purpose The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea. Methods We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Results The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p

Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Purpose Severe pelvic fractures are associated with genitourinary injuries, but the relationship between pelvic trauma and concomitant urethral injuries has yet to be elucidated. This study evaluated the incidence, mechanism, site, and extent of urethral injuries in male patients with pelvic fractures. Methods A retrospective cohort study was performed involving patients with urethral injuries accompanying pelvic fractures who visited Pusan National University Hospital from January 1, 2014 to December 31, 2019. Demographics, mechanisms of injury, clinical features of the urethral injuries, concomitant bladder injuries, methods of management, and the configuration of the pelvic fractures were analyzed. Results The final study population included 24 patients. The overall incidence of urethral injury with pelvic fracture was 2.6%, with the most common mechanism of urethral injury being traffic accidents (62.5%). Complete urethral disruption (16/24, 66.7%) was more common than partial urethral injuries (8/24, 33.3%), and unstable pelvic fractures were the most common type of pelvic fracture observed (70.8%). There was no definitive relationship between the extent of urethral injury and pelvic ring stability. Conclusions The present study provides a 6-year retrospective review characterizing the incidence, mechanism, and clinical features of urethral injury-associated pelvic fractures. This study suggests that the possibility of urethral injury must be considered, especially in unstable pelvic fracture patients, and that treatment should be chosen based on the clinical findings.

The design of bioelectronic devices that enables accurate detection of biomolecules in ionic solutions at physiologically-relevant concentrations remains a challenge. Here, the authors report a ion-impermeable supported lipid bilayer-assisted field-effect transistor platform for biomolecule detection.

Globally, it is estimated there are more than 2.2 billion visually impaired people. Visual diseases such as retinitis pigmentosa, age-related macular degeneration, glaucoma, and optic neuritis can cause irreversible profound vision loss. Many groups have investigated different approaches such as microelectronic prostheses, optogenetics, stem cell therapy, and gene therapy to restore vision. However, these methods have some limitations such as invasive implantation surgery and unknown long-term risk of genetic manipulation. In addition to the safety of ultrasound as a medical imaging modality, ultrasound stimulation can be a viable non-invasive alternative approach for the sight restoration because of its ability to non-invasively control neuronal activities. Indeed, recent studies have demonstrated ultrasound stimulation can successfully modulate retinal/brain neuronal activities without causing any damage to the nerve cells. Superior penetration depth and high spatial resolution of focused ultrasound can open a new avenue in neuromodulation researches. This review summarizes the latest research results about neural responses to ultrasound stimulation. Also, this work provides an overview of technical viewpoints in the future design of a miniaturized ultrasound transducer for a non-invasive acoustic visual prosthesis for non-surgical and painless restoration of vision.

Purpose Management options for extraperitoneal bladder injury (EBI) associated with pelvic fracture are variable. Predictive factors of operative management (OM) in patients with EBI associated pelvic fracture have not been previously addressed. This study assessed the current epidemiology of blunt traumatic urinary bladder injury and evaluated relevant clinical findings of patients with EBI associated with pelvic fracture who received OM. Methods Patients with urinary bladder injury with or without pelvic fracture from blunt trauma from January 1, 2014 to December 31, 2019 were identified from the institute trauma registry (n = 12,891). Demographics, mechanism of injury, type of urinary bladder injury, pelvic fracture configuration, and management options were analysed in the study population (n = 9,894). Results Of the 1,400 patients who had pelvic and/or acetabular fracture, 32 (2.3%) had urinary bladder injury. Of the 8,494 patients without pelvic and/or acetabular fracture, 12 (0.1%) had non-pelvic fracture urinary bladder injury. The total incidence of urinary bladder injuries in the study population was 0.4% (44/9,894). Patients with EBI associated with pelvic fracture who underwent OM, had a higher frequency of high-grade pelvic injury (100% vs 0%, p = 0.015), concomitant pelvic surgery (75.0% vs 0%, p = 0.001), and non-lateral compression type pelvic fracture (62.5% vs 10.0%, p = 0.043) compared with patients who underwent non-operative management of EBI. Conclusions These data suggest that OM may be considered especially in patients with EBI associated with pelvic fracture with high grade pelvic injury, concomitant pelvic surgery, and non-lateral compression type pelvic fracture.

Purpose Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period. Methods The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded. Results Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group. Conclusion The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.

Purpose This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP). Methods From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group. Results During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively; p=0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively; p=0.40), and platelets (PLT) (15.4 vs. 17.0, respectively; p=0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively; p=0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively; p=0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively; p=0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively; p=0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively; p=0.003). Conclusions Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.

Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings.

Label-free trapping of nanoparticles via dielectophoretic forces is traditionally done with electrodes in a horizontal gap layout. Here, the authors present a vertical nanogap architecture, which allows for precise capture and spatiotemporal manipulation of nanoparticles and molecular assemblies.

Although South Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates of more than 30%. Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness. We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels, and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores. The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47 806) to 1.9% (1062/55 057) (p = 0.041). The establishment of the national trauma system was associated with significant improvements in the performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.

Background and Objectives: One of the most challenging tasks in a clinical setting is to differentiate between complex regional pain syndrome (CRPS) type II and traumatic neuropathic pain (NeP). CRPS is characterized by several dysautonomic manifestations, such as edema, hyper/hypohidrosis, skin color change, and tachycardia. This study compared the outcomes of autonomic function screening tests in patients with CRPS type II and traumatic NeP for diagnostic differentiation. Materials and Methods: CRPS type II was diagnosed according to the Budapest research criteria, while NeP was diagnosed according to the updated grading system suggested by the International Association for the Study of Pain Special Interest Group on Neuropathic Pain in 2016. Twenty patients with CRPS type II and twenty-five with traumatic NeP were investigated. Results: Twelve patients with CRPS type II presented abnormal results for the quantitative sudomotor axon reflex test (QSART). Abnormal QSART results were more common in the CRPS type II group. Conclusions: Analysis of QSART combined with other ancillary tests can help in the differential diagnosis of CRPS type II and traumatic NeP if factors influencing abnormal QSART are sufficiently controlled.

Acquired hemophilia A (AHA) is a rare disease where typically coagulation factor VIII is inhibited by autoantibodies. It occurs in patients with no personal or familial history of bleeding. In this case study a 61-year-old male presented with a huge psoas hematoma. He had no history of bleeding disorders. He was initially diagnosed with delayed traumatic hematoma. Despite conservative and surgical treatments, coagulopathy was not resolved and postoperative bleeding continued. Consequently, coagulation factor tests were performed and showed reduced activity of factor VIII (2.7%). In addition, factor VIII inhibitor was detected. The patient was diagnosed with AHA and administered recombinant factor VIII for 3 days which resulted in the cessation of bleeding. AHA can lead to a life-threatening hemorrhage, and needs to be considered in differential diagnoses in any patients presenting with unexplained and repeated bleeding, where there is no personal or familial history of bleeding disorders.

An isolated splanchnic artery injury due to blunt trauma occurs rarely because abdominal vascular injuries are typically associated with injuries to the surrounding abdominal structures, including solid organs or hollow viscus. Of the major abdominal vessels, the celiac artery is the least commonly injured by penetrating or blunt abdominal trauma. Furthermore, a celiac artery dissection due to blunt trauma is rarely reported and there is no clearly defined treatment method, even though endovascular and conservative treatments are accepted widely. On the other hand, endovascular treatment can be challenging if the celiac artery dissection involves its main branch, including the proper hepatic artery, left gastric artery, and splenic artery. This case study presents the treatment experience of a celiac artery dissection involving its main branch following dorsal blunt trauma. Furthermore, conservative treatment is proposed as a treatment option for this rare injury.

Purpose To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p

ObjectivesA clinical data warehouse (CDW) is part of our hospital information system, and it provides user-friendly ‘data search and extraction’ interfaces for query composition. We carried out a risk factor analysis for the extended use of opioids after coronary artery bypass grafting (CABG), taking advantage of the CDW system.MethodsFrom 2015 to 2017, clinical data from 461 patients who had undergone either isolated or concomitant CABG were extracted using the CDW; the extracted data included baseline patient characteristics, various examination results, and opioid prescription information. Supplementary data that could not be extracted with the CDW were collected via manual review of the electronic medical records.ResultsData from a total of 447 patients were analyzed finally. The mean patient age was 66.8 ± 10.9 years, 332 patients (74%) were male, and 235 patients (53%) had diabetes. Among the 447 patients, 90 patients (20.1%) took some type of opioid at the 15th postoperative day. An oral rapid-acting agent was the most frequently used opioid (83%). In the risk factor analysis for extended opioid use, duration of operation was the only significant risk factor (odds ratio = 1.004; 95% confidence interval, 1.001–1.007; p = 0.008).ConclusionsLonger operation time was associated with the risk of extended opioid use after CABG. CDW was a helpful tool for extracting mass clinical data rapidly, but to maximize its utility, the data should be checked carefully as they are entered in the system so that post-processing can be minimized. Further refinement of the clinical data input and output interface is warranted.

Dietary supplements of anthocyanin-rich vegetables have been known to increase potential health benefits for humans. The optimization of environmental conditions to increase the level of anthocyanin accumulations in vegetables during the cultivation periods is particularly important in terms of the improvement of agricultural values in the indoor farm using artificial light and climate controlling systems. This study reports on the measurement of variations in anthocyanin accumulations in leaf tissues of four different cultivars in Brassica rapa var. chinensis (bok choy) grown under the different environmental conditions of the indoor farm using hyperspectral imaging. Anthocyanin accumulations estimated by hyperspectral imaging were compared with the measured anthocyanin accumulation obtained by destructive analysis. Between hyperspectral imaging and destructive analysis values, no significant differences in anthocyanin accumulation were observed across four bok choy cultivars grown under the anthocyanin stimulation environmental condition, whereas the estimated anthocyanin accumulations displayed cultivar-dependent significant differences, suggesting that hyperspectral imaging can be employed to measure variations in anthocyanin accumulations of different bok choy cultivars. Increased accumulation of anthocyanin under the stimulation condition for anthocyanin accumulation was observed in “purple magic” and “red stem” by both hyperspectral imaging and destructive analysis. In the different growth stages, no significant differences in anthocyanin accumulation were found in each cultivar by both hyperspectral imaging and destructive analysis. These results suggest that hyperspectral imaging can provide comparable analytic capability with destructive analysis to measure variations in anthocyanin accumulation that occurred under the different light and temperature conditions of the indoor farm. Leaf image analysis measuring the percentage of purple color area in the total leaf area displayed successful classification of anthocyanin accumulation in four bok choy cultivars in comparison to hyperspectral imaging and destructive analysis, but it also showed limitation to reflect the level of color saturation caused by anthocyanin accumulation under different environmental conditions in “red stem,” “white stem,” and “green stem.” Finally, our hyperspectral imaging system was modified to be applied onto the high-throughput plant phenotyping system, and its test to analyze the variation of anthocyanin accumulation in four cultivars showed comparable results with the result of the destructive analysis.

Abstract The adverse effects of air pollution on respiratory health make air quality monitoring with high spatial and temporal resolutions essential especially in cities. Despite considerable interest and efforts, the application of various types of sensors is considered immature owing to insufficient sensitivity and cross‐interference under ambient conditions. Here, a fully integrated chemiresistive sensor array (CSA) with parts‐per‐trillion sensitivity is demonstrated with its application for on‐road NOx monitoring. An analytical model is suggested to describe the kinetics of the sensor responses and quantify molecular binding affinities. Finally, the full characterization of the system is connected to implement on‐road measurements on NOx vapor with quantification as its ultimate field application. The obtained results suggest that the CSA shows potential as an essential unit to realize an air‐quality monitoring network with high spatial and temporal resolutions.

Acute mediastinitis after gastric rupture due to blunt trauma is very rare. In such cases, the esophageal hiatus widens due to elevated intra-abdominal pressure, and spillage of gastric contents causes acute posterior mediastinitis. The present report describes the case of a 30-year-old man who injured his left flank, which resulted in gastric rupture. During emergency laparotomy, a ruptured stomach was observed and the abdominal cavity and posterior mediastinum were found to be filled with gastric contents. Following partial gastrectomy, multiple loculated fluids were detected around the esophagus. Irrigation and drainage around the esophagus were performed via video-assisted thoracic surgery. After surgery, the patient recovered from acute mediastinitis and was discharged without any significant complications. In patients with upper gastric rupture, acute mediastinitis should be suspected, and video-assisted thoracic surgery may be an appropriate treatment strategy in such patients.

Purpose The Essential Surgical Procedures in Trauma (ESPIT) course was developed as a model to teach necessary surgical procedures to trauma physicians. Its goals are to improve knowledge, self-confidence, and technical competence. Methods The ESPIT course consisted of five lectures and a porcine lab operative experience. The ESPIT course has been run seven times between February 2014 and April 2016. ESPIT participants completed a questionnaire to assess self-efficacy regarding essential surgical procedures in trauma before and immediately after taking the ESPIT course. Sixty-three participants who completed both pre- and post-course questionnaires on self-efficacy were enrolled in this study. Results The overall post-ESPIT mean self-efficacy score was higher than the pre-ESPIT mean self-efficacy score (8.3±1.30 and 4.5±2.13, respectively) (p5 years) were also statistically significant (p

The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emergency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. However, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the development and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.

An isolated pancreatic transection due to blunt trauma is a rare occurrence that usually requires surgical treatment. Non-surgical treatment for a pancreatic transection remains controversial because of its associated complications. On the other hand, non-surgical treatment has been used increasingly as a treatment option with promising results in recent years. A patient presented with a suspected pancreatic injury caused by a motorcycle accident. The computed tomography findings revealed an isolated pancreatic neck transection with a small amount of fluid collection. He was hemodynamically stable without signs of peritoneal irritation. Endoscopic retrograde pancreatography and stent insertion were performed. The patient had no significant complications and was discharged on day 18. The stent was removed on day 103 and the patient showed good recovery. For an isolated pancreatic transection, endoscopic intervention can be considered as an alternative with a good outcome in selected patients.

Background Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma. Methods Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed. Results During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P

We report a case of delayed presentation of small bowel ischemia following minor mesenteric injury after blunt abdominal trauma. Traumatic small bowel and/or mesenteric injury is rare, and minor mesenteric injury is usually managed conservatively. However, mesenteric injury may cause potentially fatal conditions such as hemorrhages or peritonitis in extremely rare cases and require laparotomy. We present a case of small bowel ischemia that occurred 3 days after minor mesenteric injury from blunt abdominal trauma.

Purpose: A peripherally inserted central catheter (PICC) provides effective, reliable intravenous access in patients who require long term therapy such as intravenous antibiotics, total parenteral nutrition, transfusion or inotropic agents. This retrospective study evaluated the usefulness of PICC in trauma patients by examining patient characteristics and common complications, including PICC related bloodstream infection. Methods: We reviewed the trauma patients who underwent PICC at Pusan National University Hospital Trauma Center from January 2016 to February 2017. Results: From January 2016 to February 2017, 32 patients underwent PICC. Total catheter insertion days were 875 days, and the average catheter indwelling time was 27.3±25.02 days. The most common indication for PICC was total parenteral nutrition (n=20, 62.5%), while the remainder was to ensure a long-term fluid administration route (n=12, 37.5%). Catheter related complications included infection (n=3, 9.4%; 3.42 per 1,000 catheter-days), catheter tip malposition (n=2, 6.3%), catheter dislodgement (n=1, 3.1%), insertion site leakage (n=1, 3.1%) and arm swelling (n=1, 3.1%). No statistically significant differences were found between those who developed bloodstream infection and those who did not. Conclusion: If the PICC is performed by correcting adjustable factors that increase the risk of infection, effective and reliable intravenous access can be maintained in patients who require long-term therapy without bleeding, pneumothorax, or other complications of central venous catheter insertion.

Abstract As a candidate for a rapid detection of biomaterials, terahertz (THz) spectroscopy system can be considered with some advantage in non-destructive, label-free, and non-contact manner. Because protein-ligand binding energy is in the THz range, especially, most important conformational information in molecular interactions can be captured by THz electromagnetic wave. Based on the THz time-domain spectroscopy system, THz nano-metamaterial sensing chips were prepared for great enhancing of detection sensitivity. A metamaterial sensing chip was designed for increasing of absorption cross section of the target sample, related to the transmitted THz near field enhancement via the composition of metamaterial. The measured THz optical properties were then analyzed in terms of refractive index and absorption coefficient, and compared with simulation results. Also, virus quantification regarding various concentrations of the viruses was performed, showing a clear linearity. The proposed sensitive and selective THz detection method can provide abundant information of detected biomaterials to help deep understanding of fundamental optical characteristics of them, suggesting rapid diagnosis way especially useful for such dangerous and time-sensitive target biomaterials.

Vehicle emissions are largely determined by the details of driving behaviours. Accordingly, emissions are often estimated by integrating micro-scale emission models into traffic simulations. Under this approach, it is essential to replicate the actual traffic situation being considered in an emission evaluation using a proper calibration procedure. Most previous research with respect to traffic flow has primarily focused on adjusting the complex combinations of parameters evaluated in these models, but it is not guaranteed that the use of widely used calibration measures can lead more accurate emissions estimates. Accordingly, we propose a systematic guideline for calibration to ensure reliable micro-scale emissions estimates. A calibration procedure is thus established in this paper based on various measure of effect (MOE) compositions (i.e., calibration levels) consisting of aggregated traffic data to identify the level that most reliably estimates micro-scale emissions. Five calibration levels of progressively more detailed measurements are first defined, valid calibration levels are identified, and the reliable calibration level is finally selected based on the available traffic data. The effect of vehicle type (i.e., light vs. heavy vehicles) composition on the estimated emissions is also evaluated for a well-calibrated simulation. We expect that a highly reliable estimation of emissions is possible using this more detailed traffic simulation calibration measurement.

Loss of function of the tumor suppressor p53 is known to increase the rate of migration of cells transiting the narrow pores of the traditional Boyden chamber assay. Here by contrast we investigate how p53 impacts the rate of cellular migration within a 2D confluent cell layer and a 3D collagen-embedded multicellular spheroid. We use two human carcinoma cell lines, the bladder carcinoma EJ and the colorectal carcinoma HCT116. In the confluent 2-D cell layer, for both EJ and HCT cells the migratory speeds and effective diffusion coefficients for the p53 null cells were significantly smaller than in p53-expressing cells. Compared to p53 expressers, p53-null cells exhibited more organized cortical actin rings together with reduced front-rear cell polarity. Furthermore, loss of p53 caused cells to exert smaller traction forces upon their substrates, and reduced formation of cryptic lamellipodia. In the 3D multicellular spheroid, loss of p53 consistently reduced collective cellular migration into surrounding collagen matrix. As regards the role of p53 in cellular migration, extrapolation from the Boyden chamber assay to other cellular microenvironments is seen to be fraught even in terms of the sign of the effect. Together, these paradoxical results show that the effects of p53 on cellular migration are context-dependent.

Hemorrhage is the major cause of death in patients with severe trauma. The early coagulopathy that occurs in patients with severe trauma, known as acute traumatic coagulopathy (ATC), has a major effect on morbidity and mortality. About a quarter of all patients with severe injury are reported to have coagulopathy at the time of arrival to hospital. The important mechanism of ATC is hyperfibrinolysis by up-regulation of activated protein C. Therefore anti-fibrinolytics are needed to treat trauma patients with ATC. Tranexamic acid (TXA) is a common anti-fibrinolytic broadly used in clinical practice. TXA is a lysine analogue and binds to lysine-binding site on plasminogen, interfering with plasminogen binding to fibrin. By inactivating plasmin, TXA can prevent hyperfibrinolysis. Clinical randomization of an anti-fibrinolytic in significant hemorrhage-2 proved TXA effective for patients significantly bleeding from traumatic injuries, reducing mortality in bleeding trauma patients without increasing the risk of thrombosis. The results of this trial led many trauma centers to include TXA in their major hemorrhage protocols. Early use of TXA is the simplest and most effective treatment to improve patient outcomes in trauma patients with significant hemorrhage. Therefore use of TXA should be considered in patients with major trauma.