Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening

Background

Statistics from the National Trauma Data Bank imply that discretionary blood alcohol and urine drug testing is common. However, there is little evidence to determine which patients are appropriate for routine testing, based on information available at trauma center arrival. In 2002, Langdorf reported alcohol and illicit drug rates in Trauma Activation Patients.

Methodology/Principal Findings

This is a retrospective investigation of alcohol and illicit drug rates in consecutive St. Elizabeth Health Center (SEHC) trauma patients. SEHC Trauma Activation Patients are compared with the Langdorf Activation Patients and with the SEHC Trauma Nonactivation Patients. Minimum Rates are positive tests divided by total patients (tested and not tested). Activation patients: The minimum alcohol rates were: SEHC 23.1%, Langdorf 28.2%, combined 24.8%. The minimum illicit drug rates were: SEHC 15.7%, Langdorf 23.5, combined 18.3%. The minimum alcohol and/or illicit drug rates were: SEHC 33.4%, Langdorf 41.8%, combined 36.2%. Nonactivation patients: The SEHC minimum alcohol rate was 4.7% and the minimum illicit drug rate was 6.0%.

Conclusions

Alcohol and illicit drug rates were significantly greater for Trauma Activation Patients, when compared to Nonactivation Patients. At minimum, Trauma Activation Patients are likely to have a 1-in-3 positive test for alcohol and/or an illicit drug. This substantial rate suggests that Trauma Activation Patients, a readily discernible group at trauma center arrival, are appropriate for routine alcohol and illicit drug testing. However, discretionary testing is more reasonable for Trauma Nonactivation Patients, because minimum rates are low.     

ADHD symptoms in healthy adults are associated with stressful life events and negative memory bias

Stressful life events, especially Childhood Trauma, predict ADHD symptoms. Childhood Trauma and negatively biased memory are risk factors for affective disorders. The association of life events and bias with ADHD symptoms may inform about the etiology of ADHD. Memory bias was tested using a computer task in N = 675 healthy adults. Life events and ADHD symptoms were assessed using questionnaires. The mediation of the association between life events and ADHD symptoms by memory bias was examined. We explored the roles of different types of life events and of ADHD symptom clusters. Life events and memory bias were associated with overall ADHD symptoms as well as inattention and hyperactivity/impulsivity symptom clusters. Memory bias mediated the association of Lifetime Life Events, specifically Childhood Trauma, with ADHD symptoms. Negatively biased memory may be a cognitive marker of the effects of Childhood Trauma on the development and/or persistence of ADHD symptoms.     

35 例面部外伤合并海水浸泡的临床救治体会

目的:回顾35例面部外伤合并海水浸泡的治疗.方法:对35例病人采取包括清水、庆大霉素溶液清洗和抗感染等治疗.观察创面的感染情况和临床治疗结果.结果:35例患者外伤愈合良好,无感染、血肿,随访未发生瘢痕增生等并发症.结论:在面部损伤急诊处理中,应用整形外科技术对患者面部功能及形态的恢复有很大的帮助.     

NGF 与Neuritin 在脑外伤伴四肢骨折病人血清中的表达及意义

目的:通过检测脑外伤患者、脑外伤合并骨折患者、骨折患者及正常人外周血中NGF,neuritin不同时间段的表达,根据其含量的变化,判断与骨折愈合速度的相关性,寻找骨折愈合的关键因子。方法:收集单纯脑外伤、单纯骨折患者各80例、脑外伤合并骨折患者60例、健康体检人群20例。选取外伤后3天、10天、2周抽取所有实验对象的静脉血,应用ELISA技术测定标本中NGF与Neuritin的含量。结果:损伤后每个时间段里,患者血清中NGF、neuritin含量有不同程度升高,均高于正常对照组,其中又以脑外伤合并骨折组最高。血清NGF在骨折合并脑外伤组伤后第3天含量明显升高,为(0.86±0.21),伤后10天为(1.47±0.29),14天为(2.0 7±0.21),脑外伤合并四肢骨折组neuritin血清含量在伤后第3天略有升高为(83.47±18.85),10天(108.50±31.65),2周(91.86±21.12).脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,差别均有统计学意义(P<0.05)。结论:脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,说明与骨折愈合有着密切的相关性,两种因子可能在骨折愈合修复过程中共同起作用,从而,推测可能是脑外伤后骨折愈合加速的重要因素。     

Political Violence and Trauma in Argentina

Political Violence and Trauma in Argentina. Antonius C. G. M. Robben. Philadelphia: University of Pennsylvania Press, 2005. 467 pp.     

NGF与Neuritin在脑外伤伴四肢骨折病人血清中的表达及意义

目的：通过检测脑外伤患者、脑外伤合并骨折患者、骨折患者及正常人外周血中NG3F,neuritin不同时间段的表达,根据其含量的变化,判断与骨折愈合速度的相关性,寻找骨折愈合的关键因子。方法：收集单纯脑外伤、单纯骨折患者各80例、脑外伤合并骨折患者60例、健康体检人群20例。选取外伤后3天、10天、2周抽取所有实验对象的静脉血,应用ELISA技术测定标本中NGF与Neuritin的含量。结果：损伤后每个时间段里,患者血清中NGF、neuritin含量有不同程度升高,均高于正常对照组,其中又以脑外伤合并骨折组最高。血清NGF在骨折合并脑外伤组伤后第3天含量明显升高,为（0．86±0．21）,伤后10天为（1．47±0．29）。14天为（2．07±0．21）,脑外伤合并四肢骨折组neuritin血清含量在伤后第3天略有升高为（83．47±18．85）,10天（108．50±31．65）,2周（91．86±21．12）．脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,差别均有统计学意义（P〈0．05）。结论：脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,说明与骨折愈合有着密切的相关性,两种因子可能在骨折愈合修复过程中共同起作用,从而,推测可能是脑外伤后骨折愈合加速的重要因素。     

Cultures under Siege: Collective Violence and Trauma

Cultures under Siege: Collective Violence and Trauma. Antonius C. G. M. Robben and Marcelo M. Sudrez-Orozco. eds. Cambridge: Cambridge University Press, 2000. 285 pp.     

Empyema caused by Clostridium perfringens.

Trauma, chest surgery or other invasive procedures and underlying lung disease are often found to precede clostridial empyema. A case is described in which empyema caused by Clostridium perfringens was not associated with any of these factors.     

Noise-induced hearing loss: the future is hear

Cochlear Pharmacology and Noise Trauma: Prevention and Progress—a joint symposium organized by The Novartis Foundation and the European Commission Concerted Action Protection Against Noise²The Novartis Foundation, London, UK, 1–2 May 1998³     

Relationship between Obesity and Massive Transfusion Needs in Trauma Patients,and Validation of TASH Score in Obese Population: A Retrospective Study on 910 Trauma Patients

Background

Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT.

Methods and Findings

An observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2.92], p = 0.07. After adjusting for Injury Severity Score (ISS), obesity was significantly associated with MT rate (OR, 1.79[95%CI 1.00‒3.21], p = 0.049). The TASH score was higher in the obese group than in the non-obese group: 7(4–11) versus 5(2–10)(p<0.001). The area under the ROC curves of the TASH score in predicting MT was very high and comparable between the obese and non-obese groups: 0.93 (95%CI, 0.89‒0.98) and 0.94 (95%CI, 0.92‒0.96), respectively (p = 0.80). The grey zone ranged respectively from 10 to 13 and from 9 to 12 in obese and non obese patients, and allowed separating patients at low, intermediate or high risk of MT using the TASH score.

Conclusions

Obesity was associated with a higher rate of MT in trauma patients. The predictive performance of the TASH score and the grey zones were robust and comparable between obese and non-obese patients.     

A quality of life in chronic combat related posttraumatic stress disorder--a study on Croatian War veterans

The main objective of this study was to examine an association of various symptoms in chronic combat-related post traumatic stress disorder (PTSD) and the quality of life in this population. 248 Croatian male war veterans all diagnosed with chronic PTSD were consecutively enrolled in this study as they showed up at the routine check-up. They were given self report questionnaires Trauma Symptom Inventory (TSI-A) evaluating different PTSD symptoms and WHO Quality of Life-BREF assessing four different domains of the quality of life. After independent sample t- test was performed, the presence of each symptom defined by Trauma Symptom Inventory indicated the impairment of all four quality of life domains in a group of subject suffering from it, except of intrusive experience not being associated with the lesser quality in social domain. All quality of life domains were significantly correlated with various PTSD symptoms; however Pearson correlation factors ranged from small to medium value. As expected, PTSD symptoms are associated with lesser quality of life in the affected population. The further research is needed to show possible causal relationship between PTSD and, especially, physical health of these patients.     

Sources of Mortality in Bald Eagles in Michigan, 1986–2017

As bald eagle populations recover, defining major sources of mortality provides managers important information to develop management plans and mitigation efforts. We obtained data from necropsies on 1,490 dead bald eagles (Haliaeetus leucocephalus) collected in Michigan, USA, conducted from 1986 to 2017 to determine causes of death (COD). Trauma and poisoning were the most common primary COD categories, followed by disease. Within trauma and poisoning, vehicular trauma (n = 532) and lead poisoning (n = 176) were the leading COD subcategories, respectively. Females comprised a greater number of carcasses for most COD diagnoses. The proportion of trauma and poisoning CODs significantly increased in the last few years of the study in comparison to a select few years at the beginning. Trauma CODs were greater in autumn months during whitetail deer (Odocoileus virginianus) breeding and hunting seasons and in February, when aquatic foraging is unavailable and eagles are likely forced to scavenge along roadsides. Poisoning CODs were greatest in late winter and early spring months, when deer carcasses containing lead ammunition, which are preserved by the cold weather, also become a supplemental food source. The major infectious disease CODs, West Nile virus and botulism (Clostridium botulinum type E), were more prevalent during summer months. We recommend moving road-killed carcasses, especially white-tailed deer, from the main thoroughfare to the back of the right-of-way, and the transition from lead ammunition and fishing tackle to non-toxic alternatives to decrease these main anthropogenic sources of mortality for bald eagles, and other scavenger species. © 2020 The Wildlife Society.     

973项目与国家重点实验室互动模式探讨

本文着重阐述了国家重点基础研究项目(973项目)与国家重点实验室互动的专业特性和管理特性,并通过以国家973创伤项目与创伤烧伤与复合伤国家重点实验室在人才、实验设备、科技资源共享方面的运行模式,初步总结其管理、合作、互动的有利建设经验,有望更好地提高国家资源的整体整合,并为适应新世纪学科发展,对加强群体创新和组织管理创新进行了有益的思考。     

Trauma in the preceramic coastal populations of northern Chile: violence or occupational hazards?

One hundred and forty-four Chinchorro skeletons, stored at the Museo Arqueol?ogico San Miguel de Azapa in Arica, Chile, were examined to test the following alternative hypotheses concerning skeletal trauma: either observed trauma was a consequence of interpersonal violence, or was the result of work-related accidents. Trauma found in subadults was rare, with 1.8% (1/55) contrasted with 30% (27/89) in the adult population. The location of most adult trauma was the skull with 24.6% (17/69), followed by the upper extremities with 8. 7% (7/80), the trunk with 2.9% (2/68), and the lower extremities with the least trauma at 1.1% (1/89). Skull trauma corresponded to well-healed, semicircular fractures, with males being three times more affected than females at 34.2% (13/38) and 12.9% (4/31), respectively. Most fractures were nonlethal, appearing to have been caused by impacts from stones, suggesting interpersonal violence rather than accidents. This study indicates that the egalitarian, maritime, hunter-gatherer Chinchorro culture (circa 4000 years B.P.) may not have lived as peacefully as once thought.     

壳聚糖/ 魔芋葡甘露聚糖复合膜体内外促创面愈合研究

目的:制备壳聚糖/魔芋葡甘露聚糖复合膜,研究其促创面愈合作用。方法:壳聚糖溶液和魔芋葡甘露聚糖溶液混合后冷冻干燥制成复合膜。扫描电镜观察膜的形态和孔径,并研究比较膜的吸水率,水蒸气透过率,拉伸强度,断裂伸长率和体外降解率。建立大鼠皮肤损伤模型,敷以复合膜治疗,比较创面愈合率,观察创面组织染色结果,评价复合膜的促创面愈合作用。结果:壳聚糖/魔芋葡甘露聚糖复合膜具有三维网状结构,壳聚糖复合魔芋葡甘露聚糖后,膜的吸水率、拉伸强度和断裂伸长率提高,体外降解加速,水蒸气透过率改善。愈合实验表明壳聚糖/魔芋葡甘露聚糖膜具有促进创面愈合作用。结论:壳聚糖/魔芋葡甘露聚糖复合膜制备工艺简单,能有效促进创面愈合,具有成为创伤敷料的潜力。     

Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs

Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts.

Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.     

Incidence and Outcome of Early Acute Kidney Injury in Critically-Ill Trauma Patients

Objective

To determine the incidence and effect on mortality of early acute kidney injury in severely injured trauma patients using the Acute Kidney Injury Network creatinine criteria.

Design

A retrospective cohort study of severely injured trauma patients admitted to the shock trauma intensive care unit.

Setting

Texas Trauma Institute, a state designated level I trauma unit certified by the American College of Surgeons Committee on Trauma.

Patients

901 severely injured trauma patients admitted over a 15 month period to the shock trauma intensive care unit.

Interventions

Retrospective analysis of prospectively collected data abstracted from an electronic trauma database.

Measurements and Main Results

Of 901 eligible patients admitted to the shock trauma intensive care unit after traumatic injury, 54 patients (6%) developed acute kidney injury, of whom 10 (19%) required renal replacement therapy. The 30-day mortality rate for the entire cohort was 83/901 (9.2%). Patients with early acute kidney injury had a mortality rate of 16/54 (29.6%). When corrected for multiple covariates including injury severity scores, the development of early acute kidney injury was associated with a significantly higher risk of death at 30 days with an OR of 3.4 (95% CI 1.6-7.4).

Conclusions

Applying the Acute Kidney Injury Network creatinine criteria in severely injured trauma patients, the incidence of early acute kidney injury was 6%. After correction for injury severity, development of early acute kidney injury was independently associated with significantly higher 30-day mortality.     

Liquor Bilirubin Levels and False Prediction of Severity in Rhesus Haemolytic Disease

Liquor bilirubin levels gave a false prediction of outcome for the fetus in 80 out of 716 rhesus-sensitized women referred for treatment during 1965-9. Trauma caused by amniocentesis seemed to be responsible for an increase in the severity of immunization in a significant proportion of cases. In addition, contamination of liquor samples by plasma, particularly fetal plasma, completely invalidated liquor bilirubin estimations. Errors in estimation of gestational length were also found to be associated with misleading results and a poor fetal prognosis.     

Causes of mortality of wild birds submitted to the Charles Darwin Research Station, Santa Cruz, Galapagos, Ecuador from 2002-2004

Necropsy findings were reviewed from wild birds submitted to the Charles Darwin Research Station, Santa Cruz Island, Galápagos Archipelago between 2004 and 2006. One hundred and ninety cases from 27 different species were submitted, and 178 of these cases were evaluated grossly or histologically. Trauma and trauma-related deaths (n=141) dominated necropsy submissions. Infectious causes of avian mortality included myiasis due to Philornis sp. (n=6), avian pox (n=1), and schistosomosis (n=1).