血清胆红素与冠脉病变程度及血脂的相关性分析

目的分析血清胆红素与冠脉病变程度及血脂的关系。方法对冠状动脉造影术确诊的冠心病者和非冠心病者进行病例-对照研究。结果冠心病组血清胆红素水平低于非冠心病组,差异有显著性(P＜0.05)。多元逐步回归分析血清直接胆红素进入回归方程,提示血清直接胆红素与冠脉病变程度呈独立负相关,其相关强度与甘油三脂(TG)和空腹血糖(FBS)相似。血清胆红素与血脂直线相关分析提示血清胆红素与甘油三脂、总胆固醇(TCHO)和低密度脂蛋白胆固醇(LDL-C)呈显著负相关。结论血清直接胆红素水平与冠脉病变程度呈独立负相关,低血清胆红素是冠状动脉粥样硬化的危险因素,血清胆红素与甘油三脂、总胆固醇和低密度脂蛋白胆固醇呈负相关。     

阴囊外伤的超声评价

目的：应用高频超声评价阴囊及内容物外伤的超声表现,方法;对22例阴囊外伤声像图表现进行了研究,包括睾丸和阴囊内其他附属物的大小,形态,内部回声以及外伤局部的回声特点等。结果：阴囊及其内容物外伤的声像图取决于受伤部位和受伤程度,表现为睾丸血肿（7你）,睾丸挫伤（3例）,附睾头部血肿（2例）,附睾肿大（4例）,就鞘膜积液（5例）,睾丸周围血肿（1例）,结果：阴囊外伤的几种声像图表现具有各自的特征,结合病史,诊断准确可靠。     

Bilateral pneumothoraces secondary to an isolated midline zone 1 cervical stab injury

Penetrating neck trauma, though rare, carries a high morbidity and mortality risk if not recognized promptly, due to the presence of vital neurovascular and airway elements within a closed compartment. We describe the unique presentation of a high zone 1 anterior midline cervical stab injury with bilateral large pneumothoraces and extensive pneumomediastinum. Understanding the respiratory mechanics and a high clinical suspicion will help to recognize such complications of tracheobronchial injuries and their timely management is key to salvage of these patients.     

Assessment of instability in type B pelvic ring fractures

Pelvic ring fractures have increased in incidence and operative fixation over the past several decades. These are dynamic injuries but decisions on operative management are still often made on the basis of static imaging. Expert opinion varies greatly on which injuries require fixation and how much fixation. Examination under anaesthesia has been shown to guide management of pelvic injuries by more accurately assessing levels of instability.     

The efficacy of an anti-protrusio plate in patients with anterior column posterior hemitransverse and associated both column acetabular fractures

IntroductionAcetabular fractures in the elderly population are particularly challenging for orthopedic fracture surgeons to treat. Anterior column posterior hemitransverse (ACH) and both column (BC) fractures account for over 70% of these injuries in geriatric patients. Nonoperative management of these injuries has a mortality of about 79% and patients generally have a minimal chance of return to independent living. The aim of our study was to identify the degree of protrusio deformity geriatric patients with these injuries present with and if indirect reduction through a Stoppa approach was sufficient to improve protrusio deformity.MethodsPatients older than 60 years of age who had ACH and BC pattern acetabular fractures treated at the BIDMC in Boston, MA between 2015 and 2020 were included in this study. Pelvic AP and Judet views were reviewed at injury and each available post-operative follow up. We modified the femoral head extrusion index and used its inverse to measure the level of protrusio at each time point (-FHEI). Patient outcomes were also graded as excellent, good, fair and poor based on post-operative follow up.ResultsSixteen patients were included based on above criteria and average -FHEI at injury was 34.85% and decreased significantly to an average of 21.5% postoperatively and remained stable at all follow up points. At one year follow up (n = 2), the mean -FHEI was 18.15%. Most patients had good (4) or excellent (9) outcomes.ConclusionsWe present short term results of indirect reduction of ACH and BC acetabular fractures in geriatric patients using a PRO quadrilateral surface plate, which was largely successful in controlling the primary protrusio deformity seen in these patients. This allowed for restoration of the anterior column, with limited surgical morbidity through a relatively simple and straightforward surgical approach.     

Characteristics,Treatments, and Outcomes of Tibial Plateau Nonunions: A Systematic Review

BackgroundDue to the rare incidence of tibial plateau nonunions, current studies are limited to small sample sizes and patient demographics. The aim of this systematic review is to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes of tibial plateau nonunions.MethodsPubMed, Clinical Key, and MEDLINE were searched for articles published prior to August 2020 in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The authors used varying combinations of the following terms to identify relevant articles: “tibial,” “plateau,” “nonunion,” “non-union.” Studies were assessed for patient demographics, pre-revision nonunion characteristics, treatment, and post-revision outcomes.ResultsEight studies were included, yielding 31 tibial plateau nonunions (21 males, 10 females). The majority of nonunions were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). Schatzker class I and II nonunions were not attributed to neglect, contradicting previous suggestions. Time to union was 4.0 months, the most common treatments being autologous bone grafting (76.7%) and revision plating (63.3%).ConclusionThis study demonstrates the effectiveness of autologous bone grafts and revision plating for tibial plateau nonunions. Physicians may use these findings to guide decision making in the event of high energy plateau nonunions. Lastly, various limitations exist within the current literature, emphasizing the need for standardized reporting measures.     

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.     

Multi-Disciplinary Trauma Evaluation and Management Simulation (MD-TEAMS) training for emergency medicine and general surgery residents

BackgroundSuccessful trauma resuscitation relies on multi-disciplinary collaboration. In most academic programs, general surgery (GS) and emergency medicine (EM) residents rarely train together before functioning as a team.MethodsIn our Multi-Disciplinary Trauma Evaluation and Management Simulation (MD-TEAMS), EM and GS residents completed manikin-based trauma scenarios and were evaluated on resuscitation and communication skills. Residents were surveyed on confidence surrounding training objectives.ResultsResidents showed improved confidence running trauma scenarios in multi-disciplinary teams. Residents received lower communication scores from same-discipline vs cross-discipline faculty. EM residents scored higher in evaluation and planning domains; GS residents scored higher in action processes; groups scored equally in team management. Strong correlation existed between team leader communication and resuscitative skill completion.ConclusionMD-TEAMS demonstrated correlation between communication and resuscitation checklist item completion and communication differences by resident specialty. In the future, we plan to evaluate training-related resident behavior changes and specialty-specific communication differences by residents.     

Need for Testing and Supplementation of Vitamin D3 After Release of COVID-19 Lockdown in Patients with Increased Musculoskeletal Pain

AimsTo evaluate vitamin D3 levels in patients who presented with increased musculo-skeletal pain after release of lockdown period when compared to pre-lockdown status.IntroductionDuring this COVID pandemic, many countries have implemented lockdown measures and people have to work from home and many students and workers have to restrict themselves to home. During this period, their outdoor activities were limited. After the partial release of this lockdown many of them started to have some kind of physical activity and started experiencing body pains. We evaluated such patients for vitamin D3 levels and symptoms of fibromyalgia.MethodsThis is a retrospective analysis of patients from age group 18–60 presented to outpatient department or on telephonic consultation after partial release of lockdown. All patients who had mild back ache before lockdown and had symptoms exaggerated during this lockdown release were included. All patients were investigated for vitamin D3, PTH, thyroid profile, liver functional and kidney functional tests.ResultsOut of 120 patients presented to us in a period of 3 months, 31 patients had increased symptoms when compared to pre-lockdown status. 20 out of 31 patients had low vitamin D3 levels. 14 patients also developed symptoms of fibromyalgia.ConclusionThere might be many reasons for increased pain during lockdown, but we focussed specially only on vitamin D3 because of its association with increased symptoms of COVID-19. This is a gentle reminder to test for vitamin D3 levels and supplement if found deficient.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00376-8.