简介：AbstractThe philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%—90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.

简介：客观：为了改进痊愈，与由craniocerebral损害复杂的腹的内脏的损害病人评价。方法：由craniocerebral损害复杂的腹的内脏的损害的176个盒子的临床的数据回顾地被分析。结果：在这个系列，44个盒子死了，死亡是25.0%。死亡的主要原因是与吃惊相结合的腹的内脏的损害和严重craniocerebral损害。结论：在早舞台由精确诊断改进痊愈率是必要的。腹的帕拉穿刺术和CT应该即时并且动态地被执行。优先级应该被给life-threateninginjuries的治疗。

简介：Objective:Toexplorethecharacteristicsofclosedabdominalinjuryinpregnancywomenanditstreatment.Methods:Theclinicaldataof37pregnancypatientswithclosedabdominalinjurytreatedinourhospitalfromJune1993toJune2003werecollectedandanalyzed.Results:Allthe37patientsweretreatedwithoperation.Amongthem2earlypregnancypatientswithintestinalruptureand1patientwithretroperitonealhematomaweretreatedunderlaparoscope;inother34pregnancypatientslaparotomywasperformed.Ofthe34patients8usedcesareansectionbecauseprematureseparationofplacentaandenlargedwombinterruptedthemanagementofintra-abdominalorganinjury.Inthe37patients33(89.1%)werecured,4(10.8%)die,postoperativecomplicationratewas16.2%(6/37).Twopatients(5.4%)sufferedfromabdominalcavityinfection,3(8.1%)frompulmonaryinfection,and1(2.7%)hadmulti-organfailure.Conclusions:Forpregnancypatientswithclosedabdominalinjury,besidesobstericdiseasesintra-abdominalinjuryshouldbegivenmuchattention.Accuratediagnosisandtimelytreatmentcangainthetimetosavethelifeofbothmotherandfetus.

简介：AbstractPurpose:The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.Methods:The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome.Results:The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach's alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.Conclusions:The study tool has a sensitivity to predict the BAT patients’ outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

简介：AbstractPurpose:Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.Methods:This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.Results:Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.Conclusion:There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

简介：AbstractPurpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.

简介：神经管原肠包囊是极其稀罕的先天的异例，经常在生命的开始的5年里介绍，并且被脊索的不完全的分离在胚胎开始的第三个星期期间从前肠引起。他们经常伴有针或胃肠的畸形，但是后者可能在成年人是不在的。尽管通常在胸定位了，神经管原肠包囊可以沿着全部脊骨被发现。我们在场一个24岁的女人为腹上部的疼痛，恶心，呕吐、低等级发烧和白细胞增多承认了。当她在11年岁时时，她在4年岁时为远侧的胰的loculated包囊经历了cystgastrostomy，它复发了。超声和计算机tomograghy(CT)扫描揭示了16厘米在身体和胰尾乘15厘米膀胱的质量，与6-7公里变厚的墙。实验室数据和胸X光检查是正常的，针的拍没显示出任何结构的畸形。病人经历了完全的包囊切除，并且在平静恢复以后，没有复发，在5年的后续期间仍然保持没有症状。包囊被发现包含1200mL苍白粘滞液体。它被一张原始单人赛分层的立方形的上皮盖住，与专业化窦的腺的实质和发育不全的原始胃粘膜一起。胃的身体类似于那些的焦点的腺的组也被看见。另外，睫的呼吸上皮，有鳞的组织变形的foci和粘蛋白的腺是在场的。包囊的墙包含了肌层，有plexogenic神经分册的神经胶质织物，Paccini像血球细胞的结构，增生的neuroganglionar元素和偶尔的psammomatous包围基质的身体，以及像成纤维细胞的区域。Cartilagenous织物没在包囊的任何部分被发现。Immunohistochemistry证实了S-100，GFAP，NF和NSE标记的神经原的元素的存在。胃的上皮主要显示出CK7和EMA免疫表示，并且没有CK10/13阳极板，呼吸上皮揭示了CK8和CK18免疫侧面，尽管积极房间被发现的既不CEA或法新社。到我们的知识，这是没有联系针的异例的腹地定位的神经管原肠包囊的首先报导的案例。

简介：目的损伤在死亡的领先的原因之中。钝腹的损伤(蝙蝠)的医药管理依靠判定剖腹术是谁强制的病人。这研究试图决定蝙蝠病人的符号，以及paraclinical数据，并且澄清精确性，敏感，特性，临床的腹的得分系统(CASS)的积极、否定的预兆的价值，一个新得分系统基于临床的符号，在预言一个蝙蝠病人是否需要剖腹术。完全，400个病人怀疑了从2007年3月20日在二所大学医院的紧急情况部门到达了德黑兰到2009年3月19日的蝙蝠的方法在这研究被包括。他们好久被评估，性，损伤的类型，收缩血压，格拉斯哥昏迷规模(GCS)，脉搏率，在损伤以后的表示的时间，腹的临床的调查结果，呼吸的率，温度，血红素(Hb)集中，在损伤的集中的腹的sonography(快)并且CASS。我们的大小显示出的结果那CASS有94%的精确性，100%，88%的特性，90%的积极预兆的价值和在在蝙蝠病人决定剖腹术的必要性的100%的否定预兆的价值的敏感。而且在我们的分析，收缩血压，GCS，脉搏率，Hb集中，在损伤以后的表示的时间，腹的临床的调查结果并且也快被显示在为剖腹术证实需要有用(P<0.05)。结论CASS是在对剖腹术以及在在蝙蝠病人为进一步的评估最小化辅助开销的需要的快速的察觉的一个有希望的得分系统，这样支持诊断的本利的比率和精确性。

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简介：AbstractPurpose:To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma.Methods:The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application.Results:Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan.Conclusion:Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.

简介：Background:Animpactofregularphysicalactivity(RPA)ontheabdominalmusclesmaybesignificantwhencomparingvarioussymptomaticgroups.However,thereislackcomprehensiveinformationinthisfield.Theobjectiveofthisstudywastoassessthelateralabdominalwallatrestandduringabdominaldrawing-inmanoeuvreinadolescentphysicallyactivegirlsindifferentbodypositions.Methods:Onehundredandforty-fourfemalestudents,13–17yearsofage,participatedinthestudy.Participantsweredividedinto2groupsbasedonaphysicalactivity(PA)statement.Measurementsofthethicknessoftheabdominalmusclesatrestandduringabdominaldrawing-inmanoeuvreweremadeinthesupineandstandingpositionsbyultrasoundimaging.Results:Comparedtothecontrolgroup,activitiesoftheobliquusinternusandtransversusabdominismuscleswerehigherintheregularPAgroupby8.9%(95%CI:3.1–14.7)and36%(95%CI:19.1–47.5),respectively.IntheRPAgroup,thetransversusabdominispreferentialactivationratiowasgreaterby0.03(95%CI:0.01–0.04),andthecontractionratiowasgreaterbyameanvalueof0.35(95%CI:0.18–0.46).Conclusion:RPAdoesnothaveanyeffectontherestingthicknessoftheabdominalmusclesinthesupineandstandingpositions.GirlsperformingRPAhaveagreaterabilitytoperformanindependentactivationandgreatercontractionsofthetransversusabdominis.

简介：Theincreaseinneurotrophicfactorsaftercraniocerebralinjuryhasbeenshowntopromotefracturehealing.Moreover,neurotrophicfactorsplayakeyroleintheregenerationandrepairofperipheralnerve.However,whethercraniocerebralinjuryalterstherepairofperipheralnerveinjuriesremainspoorlyunderstood.Ratinjurymodelswereestablishedbytransectingtheleftsciaticnerveandusingafree-falldevicetoinducecraniocerebralinjury.Comparedwithsciaticnerveinjuryaloneafter6–12weeks,ratswithcombinedsciaticandcraniocerebralinjuriesshoweddecreasedsciaticfunctionalindex,increasedrecoveryofgastrocnemiusmusclewetweight,recoveryofsciaticnervegangliaandcorrespondingspinalcordsegmentneuronmorphologies,andincreasednumbersofhorseradishperoxidase-labeledcells.Theseresultsindicatethatcraniocerebralinjurypromotestherepairofperipheralnerveinjury.

简介：Splenosisisectopicautotransplantationofsplenictissueaftersplenictraumaorsurgery.Themostfrequentlocationsarethesurfaceofvisceralperitoneumandparietalperitoneum.Liverandretroperitoneumarerarelyinvolved.Wepresenthere2casesofsplenosisinvolvingtheliverandretroperitoneumwithclinicalinformation,imagingfindings,andliteraturereview.

简介：客观：与胸或腹的损害调查polytraumapatients的早诊断和治疗。方法：有胸或腹的损害的所有polytrauma病人的数据回顾地在过去的10年期间被学习。结果:在现在的学习，有1540个polytrauma病人，为所有2368个损伤病人中的65.0%个的财务。这些病人，62.4%处于承认上的吃惊状态。起作用的率是15.0%(181/1206)并且79.9%(612/766)在有胸、腹的损害的病人(P<0.01)，5.2%(39/758)并且31.7%(142/448)在有钝、渗透的胸损伤的病人(P<0.01)，and72.4%(359/496)并且93.7%(253/270)在有钝、渗透的腹的损害(P<0.01)的病人分别地。处理腹的损害，angioembolization在43种情况中被执行，与42治好。全面死亡率是6.2%。并且在钝、渗透的亚群，死亡是7.9%(75/950)并且3.6%(21/590)，分别地(P<0.01)。大多数病人死了fromexsanguination。结论：“在损伤以后的第一个金色的小时”应该被掌握，自从在这个小时的治疗能极大地决定非常伤害的牺牲品是否能幸存。迅速的诊断和合适的治疗比这些更极大地作出贡献到牺牲品的幸存损害的真理。

简介：Objective:Toinvestigatetheclinicalefficacyofacupunctureintreatinghiccupsafterabdominalsurgery.Methods:Seventy-twopatientswithhiccupsafterabdominalsurgerywererandomlyallocatedto3groups,atreatmentgroup,acontrolgroupandacombinationgroup

简介：Thephenomenonofischemia/reperfusioninjuryisdescribedintheexperimentalmodelsofacutemyocardialinfarction(AMI),causingadditionalfunctionalandstructuraldamagetotheacutereperfusedmyocardium,andischemicpreconditioningreferstothemyocardialischemiaafteralongperiodofreperfusionbeforeoneorseveralshortoccasionalduplicationofmyocardialischemia/reperfusion1,whichcanincreasemyocardialischemictolerance.ThetherapeuticstrategiesforAMIhavefocusedonmyocardialischemia/reperfusioninjury,whichaccountsforasignificantpartofthefinalinfarctsize.Althoughexperimentsinthelast20yearshavereportedthatpharmacologicalinterventionsatreperfusionmightreducemyocardialreperfusioninjury,thiscouldnotbeconfirmedinhumanstudies.Analternativetochemicalmodifiers,postconditioning(briefrepeatedperiodsofischemiaappliedattheonsetofreperfusion)isanothermethodproventobeefficientinanimalmodelsandtobeconfirmedinrecenthumanstudies.Thissimplemethod,appliedinthefirstminuteofreperfusion,reducesthefinalinfarctsizeby30%-50%.Thisreviewwillfocusonthemechanisms,pharmacologicalpreconditioning,postconditioningtechnique,whichiseasilyapplicableinhumanpatientsinthesettingofAMI.

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简介：Thecingulum,theneuraltractconnectingtheorbitofrontalcortexwiththemedialtemporallobe,playsanimportantroleincognition(Bushetal.,2000).Itisalsoimportantinmemorybecauseitprovidescholinergicinnervationstothecerebralcortexafterobtaininginnervationfromthemedialseptalnucleus,the

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简介：AbstractBackground:Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2= 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2= 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P= 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t=-0.638, P= 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.