Planned Reoperation for Severe Trauma

Reconstruction of the mandible after severe trauma is one of the most difficult challenges facing oral and maxillofacial surgery. The mandible is an essential element in the appearance of the human face that gives the distinctive shape of the face, holds. This paper aims to propose a methodology that allows the surgeon to perform virtual surgery by investing engineering programs to place the implant by default and with high accuracy within the mandible based on the patient's medical data. The current study involved a 35-year-old man suffering from a traffic accident in the mandible with multiple fractures of the facial bones. Basically, an identification of the steps required to perform virtual surgery and modeling images from the CBCT technology has been done by using the software proposed in the research. The implant model is designed as a mesh model, allowing the patient to return to a normal position. Moreover, an application of FEA procedures using the Solidworks simulation software to test and verify the mechanical properties of the final transplant.

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Interleukin 8 Elicits Rapid Physiological Changes in Neutrophils That Are Altered by Inflammatory Conditions

Journal of Innate Immunity ◽

10.1159/000514885 ◽

2021 ◽

pp. 1-17

Author(s):

Stefan Bernhard ◽

Stefan Hug ◽

Alexander Elias Paul Stratmann ◽

Maike Erber ◽

Laura Vidoni ◽

...

Keyword(s):

Systemic Inflammation ◽

Severe Trauma ◽

Induced Response ◽

Neutrophil Granulocytes ◽

Inflammatory Conditions ◽

Flow Cytometric ◽

Time Flow ◽

Flow Cytometric Measurement ◽

Detailed Kinetics

A sufficient response of neutrophil granulocytes stimulated by interleukin (IL)-8 is vital during systemic inflammation, for example, in sepsis or severe trauma. Moreover, IL-8 is clinically used as biomarker of inflammatory processes. However, the effects of IL-8 on cellular key regulators of neutrophil properties such as the intracellular pH (pHi) in dependence of ion transport proteins and during inflammation remain to be elucidated. Therefore, we investigated in detail the fundamental changes in pHi, cellular shape, and chemotactic activity elicited by IL-8. Using flow cytometric methods, we determined that the IL-8-induced cellular activity was largely dependent on specific ion channels and transporters, such as the sodium-proton exchanger 1 (NHE1) and non-NHE1-dependent sodium flux. Exposing neutrophils in vitro to a proinflammatory micromilieu with N-formyl-Met-Leu-Phe, LPS, or IL-8 resulted in a diminished response regarding the increase in cellular size and pH. The detailed kinetics of the reduced reactivity of the neutrophil granulocytes could be illustrated in a near-real-time flow cytometric measurement. Last, the LPS-mediated impairment of the IL-8-induced response in neutrophils was confirmed in a translational, animal-free human whole blood model. Overall, we provide novel mechanistic insights for the interaction of IL-8 with neutrophil granulocytes and report in detail about its alteration during systemic inflammation.

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Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

World Journal of Surgery ◽

10.1007/s00268-021-05980-1 ◽

2021 ◽

Vol 45 (5) ◽

pp. 1340-1348

Author(s):

Maryam Meshkinfamfard ◽

Jon Kristian Narvestad ◽

Johannes Wiik Larsen ◽

Arezo Kanani ◽

Jørgen Vennesland ◽

...

Keyword(s):

Injury Severity ◽

Trauma System ◽

Severe Trauma ◽

Emergency Procedure ◽

Emergency Thoracotomy ◽

Severity Scores ◽

Time Periods ◽

Low Volume ◽

Time Critical ◽

Over Time

Abstract Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

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Repair cell first, then regenerate the tissues and organs

Military Medical Research ◽

10.1186/s40779-021-00297-5 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Xiao-Bing Fu

Keyword(s):

Tissue Repair ◽

Cell Damage ◽

Ischemia Reperfusion ◽

Severe Trauma ◽

Basic Unit ◽

Basic Process ◽

Tissue Repair And Regeneration ◽

Healing Tissue ◽

Organ Repair ◽

And Function

AbstractWound healing, tissue repair and regenerative medicine are in great demand, and great achievements in these fields have been made. The traditional strategy of tissue repair and regeneration has focused on the level of tissues and organs directly; however, the basic process of repair at the cell level is often neglected. Because the cell is the basic unit of organism structure and function; cell damage is caused first by ischemia or ischemia-reperfusion after severe trauma and injury. Then, damage to tissues and organs occurs with massive cell damage, apoptosis and even cell death. Thus, how to achieve the aim of perfect repair and regeneration? The basic process of tissue or organ repair and regeneration should involve repair of cells first, then tissues and organs. In this manuscript, it is my consideration about how to repair the cell first, then regenerate the tissues and organs.

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Postoperative Rise of Circulating Mitochondrial DNA Is Associated with Inflammatory Response in Patients following Pancreaticoduodenectomy

European Surgical Research ◽

10.1159/000514661 ◽

2021 ◽

pp. 1-7

Author(s):

Niv Pencovich ◽

Nadav Nevo ◽

Roi Weiser ◽

Ekaterina Bonder ◽

Yoel Bogoch ◽

...

Keyword(s):

Mitochondrial Dna ◽

Inflammatory Response ◽

Delayed Gastric Emptying ◽

Clinical Course ◽

Severe Trauma ◽

Postoperative Fever ◽

Postoperative Course ◽

Cell Counts ◽

White Blood Cell Counts ◽

The Relationship

Introduction: Accumulation of plasma mitochondrial DNA (mtDNA) following severe trauma has been shown to correlate with the development of systemic inflammatory response syndrome (SIRS) and may predict mortality. Our objective was to investigate the relationship between levels of circulatory mtDNA following pancreaticoduodenectomy (PD) and the postoperative course. Methods: Levels of plasma mtDNA were assessed by real-time PCR of the mitochondrial genes ND1 and COX3 in 23 consecutive patients who underwent PD 1 day prior to surgery, within 8 h after surgery, and on postoperative day (POD)1 and POD5. The abundance of mtDNA was assessed relative to preoperative levels and in relation to parameters reflecting the postoperative clinical course. Results: When pooled for all patients, the circulating mtDNA levels were significantly increased after surgery. However, while a significant (at least >2-fold and up to >20-fold) rise was noted in 11 patients, no change in mtDNA levels was noted in the other 12 following surgery. Postoperative rise in circulating mtDNA was associated with an increased rate of postoperative fever until day 5, decreased hemoglobin and albumin levels, and increased white blood cell counts. These patients also suffered from increased rates of delayed gastric emptying. No significant differences were demonstrated in other postoperative parameters. Conclusion: Circulating mtDNA surge is associated with an inflammatory response following PD and may potentially be used as an early marker for postoperative course. Studies of larger patient cohorts are warranted.

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Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00344-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Takahiro Kinoshita ◽

Kensuke Moriwaki ◽

Nao Hanaki ◽

Tetsuhisa Kitamura ◽

Kazuma Yamakawa ◽

...

Keyword(s):

Cost Effectiveness ◽

Emergency Room ◽

Healthcare Costs ◽

Cost Effective ◽

Severe Trauma ◽

Third Party ◽

Trauma Patients ◽

Short Term ◽

The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

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Using a Culturally Proficient Leadership Lens to Effectively Serve Refugee Students

Journal of Cases in Educational Leadership ◽

10.1177/15554589211012428 ◽

2021 ◽

pp. 155545892110124

Author(s):

Corinne Brion

Keyword(s):

Middle School ◽

Cultural Proficiency ◽

Severe Trauma ◽

Refugee Students ◽

Cultural Wealth ◽

The Republic ◽

Culturally Proficient Leadership ◽

Different Cultures ◽

Culturally Proficient

This teaching case study takes place in an American middle school and tells the story of Dorah, a refugee student from the Republic of Congo who experienced severe trauma. At Lincoln Middle School, the principal and her teachers encounter difficulties serving their refugee students adequately because of their lack of cultural proficiency. This case aims to help leaders in diverse contexts understand how to embrace and advocate for different cultures, beliefs, and norms to increase the cultural wealth of their communities. To achieve this goal, I provide a cultural proficiency model and a trauma-invested framework.

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