Purpose To investigate the current status of monoclonal anti-tetanus toxin antibody used for passive immunization in the prevention and management of post-traumatic tetanus in China, and to provide evidence for the selection of passive immunization agents for tetanus prophylaxis. Methods This retrospective, multicenter, real-world survey included patients who received a monoclonal anti-tetanus toxin antibody (siltartoxatug injection) for passive immunization following traumatic injury at participating hospitals across China between March 1 and August 20, 2025. Patients with incomplete registration data or at least 1 missing key variable were excluded. Demographic, clinical, wound-related, payment, and follow-up information was collected. According to the National Clinical Practice Guideline for Non-neonatal Tetanus Prevention and Treatment (2024 Edition), patients were classified into high- and low-risk tetanus exposure groups based on vaccination history, booster interval, wound characteristics, and immune status. Demographic, clinical, and wound-related characteristics were compared between the 2 groups. Statistical analyses were performed using IBM SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were presented as frequencies and percentages and compared using the chi-square test or Fisher's exact test, as appropriate. All statistical tests were two-sided, and a p value < 0.05 was considered statistically significant. Results A total of 423 hospitals from 28 provinces, autonomous regions, and municipalities participated in the survey and provided case data. Among 1474 patients who received monoclonal anti-tetanus toxin antibody for passive immunization following trauma, no tetanus cases were documented during the available observation period; however, follow-up duration was not standardized across centers, and the protective efficacy of the monoclonal antibody could not be definitively evaluated. Conclusion Standardized wound assessment and appropriate selection of passive immunization agents are crucial for tetanus prevention. Monoclonal anti-tetanus toxin antibody represents an effective and promising option for passive immunization against tetanus.
Tetanus is an acute, life-threatening disease caused by Clostridium tetani infection through breaches in the skin or mucous membranes, typically following traumatic injury. While human tetanus immunoglobulin (HTIG) is the preferred passive immunizing agent, documented cases of prophylaxis failure are rare despite theoretical possibilities. We present a case of generalized tetanus that developed 1 month after HTIG administration following trauma. This report highlights the potential failure of HTIG prophylaxis and analyzes its contributing factors to inform clinical practice.
PURPOSE:The introduction of intraoperative CT (iCT) has provided a new tool that may improve outcomes in the surgical management of maxillofacial fractures (MFFs). This systematic review and meta-analysis evaluated the clinical value of iCT in MFFs and identified the fracture types and circumstances in which it provides notable benefit. METHODS:PubMed, Scopus, and ClinicalTrials.gov were searched for clinical studies published or registered from January 2020 to November 2025. Random-effect models pooled the intraoperative CT revision rate and post-operative bilateral orbital volume difference across various fracture types. RESULTS:Eighteen studies (1165 patients; 12 cohorts, 1 case-control, and 5 case series) were included across zygomaticomaxillary complex, orbital, mandibular, and nasal fractures. Of these, 11 studies (n = 493) provided extractable quantitative data for the intraoperative revision meta-analysis, which yielded a pooled revision rate of 36% (I2 = 77%), with a fracture-type gradient (orbital 58% > other MFFs 49% > zygomaticomaxillary complex 26%; subgroup p < 0.001). High revision yield in orbital fractures suggests that iCT may enhance intraoperative verification of reduction and implant positioning during orbital reconstruction; however, evidence for post-operative volumetric symmetry remains limited and largely derived from observational studies. Mean iCT acquisition time was 4.2 to 18.9 min, and comparative data suggested no significant increase in total operative time. CONCLUSIONS:Overall, iCT appeared most valuable when 3-dimensional reduction accuracy or implant seating could not be confidently assessed before closure, especially in orbital reconstruction and anatomically constrained, symmetry-critical MFFs.
PURPOSE:Non-union fractures of the lower extremity remain a major clinical challenge due to high mechanical loading, compromised vascularity, and limited soft-tissue coverage. Platelet-rich plasma (PRP) has emerged as a biological adjunct to enhance bone healing; however, its efficacy in non-union fractures is still debated. This review aimed to synthesize available evidence on reported outcomes of adjunctive PRP use in non-union lower extremity fractures. METHODS:A comprehensive literature search up to 31st October 2025 was performed in PubMed, ScienceDirect, ProQuest, Cochrane, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews guidelines. Eligible studies included adult patients with non-union tibial or femoral fractures treated with PRP as platelet gel, platelet concentrate, or composite graft, compared with standard treatment or without PRP. The primary outcome was time to radiographic union, while radiographic non-union and complications were evaluated as secondary outcomes. Random-effects models with the DerSimonian-Laird method were used to calculate pooled effect sizes, and heterogeneity was assessed using I2 statistics. RESULTS:Seven studies involving 230 patients were included. Heterogeneous PRP-augmented surgical strategies significantly reduced time to radiographic union by 2.59 weeks compared with control (95% confidence intervals: -4.14 to -1.05; p < 0.001, I2 = 0%). Subgroup analysis showed a consistent direction of effect across randomized and observational studies. The pooled analysis of radiographic non-union showed a non-significant trend favoring PRP (odds ratio: 0.35; 95% confidence intervals: 0.11 - 1.08; p = 0.07; I2 = 0%). Complication outcomes were inconsistently reported, and available data did not identify a clear signal of serious PRP-related harm. CONCLUSION:Heterogeneous PRP-augmented surgical strategies, including PRP gel, platelet concentrate, and composite graft, were associated with a modest reduction in time to radiographic union in lower extremity non-union fractures. Adequately powered trials using standardized PRP protocols and clinically meaningful outcomes are required.
Purpose Severe trauma is a major cause of death and disability. Among its complications, multiple organ dysfunction syndrome (MODS) is a key late-stage condition, which is closely associated with post-traumatic cytokine storm. At present, there is a lack of reliable models for effective prediction of MODS, and the understanding of the dynamic changes of post-traumatic cytokines remains limited. This study is primarily designed to develop a predictive model for post-traumatic MODS, with a secondary aim of characterizing the features of the post-traumatic cytokine storm. Methods This is a study protocol. A prospective, multicenter, observational longitudinal study was designed. A total of 600 patients with severe trauma who have an injury severity score > 15 will be enrolled. Serum samples will be collected at 4 time points: within 8 h, 24 h, 72 h, and 168 h after injury. The temporal changes of key cytokines including interleukin-18, interferon-γ–inducible protein 10, monocyte chemoattractant protein-1, eosinophil chemotactic protein, monocyte chemoattractant protein-4, C-X-C motif chemokine ligand 12, macrophage inflammatory protein-3α, interleukin-1 receptor antagonist, cystatin C and myeloid-related protein 8/myeloid-related protein 14 will be quantitatively analyzed. The primary outcome of the study is the occurrence of MODS. Based on this, a combined multi-factor prediction model will be established and verified, and the characteristics of post-traumatic cytokine storm will be systematically described. Discussion This multicenter prospective study will provide robust evidence for the development and validation of a cytokine-based model for early prediction of MODS after severe trauma and further clarify the temporal evolution of post-traumatic cytokine storm.
PURPOSE:Trauma remains the leading cause of death among individuals aged 1 - 46 years worldwide, with 5.8 million annual deaths. While trauma centers reduce mortality by approximately 25%, the core components constituting an effective trauma system and their specific impacts on preventable deaths require further elucidation, particularly in newly developing systems. METHODS:This retrospective study analyzed trauma admissions from January 1, 2013, to December 31, 2024, at a tertiary hospital in Shenzhen, Guangdong province, China. All the major trauma patients (injury severity score ≥16) who died were included for death review. A multidisciplinary panel reviewed all trauma deaths using standardized audit forms based on World Health Organization definitions and the Advanced Trauma Life Support guidelines. Outcomes were compared between the pre-trauma center period (2013 - 2018) and post-trauma center period (2019 - 2024). Data were analyzed using SPSS version 25.0. RESULTS:Among 17,192 trauma admissions, 1503 were major trauma patients (injury severity score ≥16), with 82 trauma deaths identified. Preventable or potentially preventable deaths accounted for 17 cases (23.2% of trauma deaths). Following trauma center establishment, trauma deaths among major trauma patients significantly decreased from 41 to 16 (p < 0.001) when excluding deaths on arrival. A total of 151 management errors were identified; delayed adequate treatment was the most common error in preventable deaths (10/16, 62.5%). CONCLUSION:The establishment of a trauma center with 8 core components: pre-notification systems, multidisciplinary trauma teams, Advanced Trauma Life Support-based resuscitation protocols, optimized trauma bays, massive transfusion protocols, damage control surgery principles, trauma audit meetings, and a dedicated trauma services framework, was associated with significantly reduced trauma mortality. These findings provide a practical and replicable framework for trauma center development in comparable healthcare settings.
PURPOSE:The ankle is the main interface between the ground and body during ambulation, standing, and any sports exercise. Ankles should be able to absorb impact-loading forces from body weight and exercise pressure, adapt to uneven ground, and allow efficient propulsion. The estimated lifetime incidence of ankle injuries is 1 out of every 10 people. Most ankle injuries occur during sports activities. The epidemiologic trends associated with chronic ankle instability suggest that current rehabilitation approaches may be inadequate. Therefore, it is uttermost important to seek alternative rehabilitation modalities, as the current conventional rehabilitation is not effective. METHODS:This retrospective study utilized a single-blinded 3-arm parallel-randomized controlled clinical trial to assess the efficacy of various rehabilitation modalities for ankle injuries. Seventy-five participants with ankle injuries were randomly assigned to 1 of 3 groups: a control group receiving standard rehabilitation, a virtual reality (VR) group utilizing VR technology, and a mixed group combining VR with kinesiotape interventions. Each group included 25 participants who underwent 2 weeks of rehabilitation activities specific to their assigned treatment. The single-blinded design ensured that participants were unaware of their treatment assignment, minimizing bias in their responses. This methodology facilitates a comparative analysis of rehabilitation strategies, offering insights into the effectiveness of innovative approaches such as VR and kinesiotaping for ankle injury recovery. The R statistical software was used to complete the analysis. One-way ANOVA analysis was utilized to compare the statistical differences between the 3 groups. RESULTS:Seventy-five ankle injury patients were recruited, and 96% of them finished the study. The ANOVA results show that ankle injury rehabilitation via VR and/or kinesiotape application had significant effects on reducing ankle pain, ankle edema, and anthropometric measurements compared with the control group. The VR treatment modality has positive effects on reducing the distal edema limb circumference compared to both control and mixed groups at p < 0.05. CONCLUSION:Physical rehabilitation via immersive VR and/or kinesiotape application is considered the main rehabilitation modality for ankle injury compared to conventional physical rehabilitation.
The current manuscript describes a technical modification for above-knee amputation in the setting of multiple retained distal femoral implants. By performing a controlled circumferential osteotomy utilizing a Gigli saw around a retrograde intramedullary nail, lateral locking distal femoral plate, and total knee arthroplasty femoral component, the distal femur and retained implants were removed simultaneously with the distal femur. This approach may help avoid sequential implant-by-implant dissection and extensile exposure in carefully selected patients. Soft-tissue balance was obtained with adductor myodesis and quadricepsplasty. This method provides a pragmatic option for complex revision cases with exposed hardware, infection risk, fixed contracture, or nonfunctional limb status when limb salvage is no longer feasible. Removing complex revision arthroplasty and fixation components can be technically challenging; in selected cases, this technique may offer a practical approach to en bloc implant removal.
Purpose The introduction of intraoperative CT (iCT) has provided a new tool that may improve outcomes in the surgical management of maxillofacial fractures (MFFs). This systematic review and meta-analysis evaluated the clinical value of iCT in MFFs and identified the fracture types and circumstances in which it provides notable benefit. Methods PubMed, Scopus, and ClinicalTrials.gov were searched for clinical studies published or registered from January 2020 to November 2025. Random-effect models pooled the intraoperative CT revision rate and post-operative bilateral orbital volume difference across various fracture types. Results Eighteen studies (1165 patients; 12 cohorts, 1 case-control, and 5 case series) were included across zygomaticomaxillary complex, orbital, mandibular, and nasal fractures. Of these, 11 studies (n = 493) provided extractable quantitative data for the intraoperative revision meta-analysis, which yielded a pooled revision rate of 36% (I2 = 77%), with a fracture-type gradient (orbital 58% > other MFFs 49% > zygomaticomaxillary complex 26%; subgroup p < 0.001). High revision yield in orbital fractures suggests that iCT may enhance intraoperative verification of reduction and implant positioning during orbital reconstruction; however, evidence for post-operative volumetric symmetry remains limited and largely derived from observational studies. Mean iCT acquisition time was 4.2 to 18.9 min, and comparative data suggested no significant increase in total operative time. Conclusions Overall, iCT appeared most valuable when 3-dimensional reduction accuracy or implant seating could not be confidently assessed before closure, especially in orbital reconstruction and anatomically constrained, symmetry-critical MFFs.
The success of replantation for amputated limbs is limited by the short safe preservation time of static cold storage and issues like ischemia-reperfusion injury. Normothermic machine perfusion (NMP) represents a revolutionary advancement with the potential to overcome these limitations, demonstrating considerable potential in extending preservation time, improving preservation quality, and enabling viability assessment. This study comprehensively reviews the technical principles and theoretical advantages of NMP. Through comparative analysis with static cold storage and hypothermic oxygenated machine perfusion, its unique value is elucidated. The review then focuses on summarizing experimental research findings from large animal models and human amputated limb models. Finally, it discusses future research directions, such as perfusate optimization, assessment system development, and exploration of NMP as a therapeutic platform, along with prospects for clinical application.
Ogilvie's syndrome, characterized by acute colonic pseudo-obstruction without mechanical blockage, typically affects the elderly or postoperative patients but is rarely reported after orthopedic trauma surgery. We described a 73-year-old man who developed persistent vomiting and abdominal distension following open reduction and internal fixation of tibial fractures and percutaneous pedicle screw fixation for thoracolumbar compression fractures. Imaging revealed diffuse intestinal dilation, predominantly involving the colon, without obstruction. Conservative management with bowel rest and supportive care led to gradual symptom resolution over 2 weeks. This case highlights that Ogilvie's syndrome can complicate postoperative recovery in orthopedic trauma patients. Early imaging to exclude mechanical obstruction and vigilant monitoring are essential to guide conservative treatment and prevent serious complications such as perforation.
PURPOSE:Pigs have long been used as an animal model for fibula flaps. However, the vascular anatomy of the pig fibula has not been described comprehensively. This study was designed to explore the vascular anatomy of the pig fibula and explore the feasibility of using pigs as animal models for surgical training. METHODS:Twenty fresh cadaveric hindlimbs from hybrid pigs (Shanghai White pig) were used in this study. The arteries were infused with black lard. The origin, course, and branches of the vessels nourishing the fibula were observed in 15 samples. The primary parameters included variability in vessel anatomy and measurements. Surgical procedures to harvest the fibula flap were performed on 5 samples. RESULTS:Three types of fibular arteries branch into the fibula, all of which are located behind the interosseous membrane. The pig fibular artery exhibited high variation and was classified into 3 types according to its branching patterns. The operation was performed in the lateral position through the posterior-lateral intermuscular septum. The fibular arteries were easily exposed. After the osteotomy was performed, the fibula was rotated outward to isolate the medial and posterior sides of the fibula in turn. CONCLUSIONS:Although the fibular arteries of pigs and humans are distinct, possibly due to evolutionary and/or functional adaptations, pigs can be used as an animal model for surgical training of fibula flaps.
PURPOSE:To evaluate the clinical efficacy of the PVCA (The degree of cervical vascular injury is defined mainly based on 4 dimensions: Penetration site, injured Vessel, Clinical manifestations, and Associated injuries.) classification in guiding management of cervical vascular trauma. METHODS:The PVCA classification system was further developed based on various clinical classifications of carotid artery trauma, incorporating prior clinical experience in managing massive cervical hemorrhage. We retrospectively analyzed 43 patients with cervical vascular trauma treated at 4 tertiary centers between January 2022 and December 2024. Patients with confirmed cervical vascular trauma were included, while patients with incomplete clinical data, loss to follow-up, or concurrent life-threatening injuries that precluded definitive vascular management were excluded. PVCA classification was applied to guide management. Outcomes, including choice of surgical approach, hemostasis success, vascular repair integrity, neurological recovery, and complications, were assessed. Descriptive statistics were used to summarize baseline characteristics and outcome measures. Continuous variables were presented as mean ± standard deviation, and categorical variables as frequencies and percentages. Group comparisons were performed using the χ2 test or Fisher's exact test, based on expected frequencies. RESULTS:A total of 43 patients (mean age (42.58 ± 10.77) years; 62.8% male) were classified by PVCA (P1: 14.0%, P2: 69.8%, P3: 16.3%; V1: 62.8%, V2: 23.3%, V3: 7.0%, V4: 7.0%; C0: 20.9%, C1: 69.8%, C2: 9.3%; A0: 95.3%, A1: 4.7%). All patients underwent successful intervention (open surgery: 53.5%, endovascular: 32.6%, hybrid: 14.0%), with 100% hemostasis and improved cerebral perfusion. PVCA dimensions demonstrated differential guiding value for surgical approach. Penetration site (P) was the strongest determinant (p < 0.001): 76.7% of P2 patients received open surgery, while 66.7% of P1 and 85.7% of P3 underwent endovascular repair, with hybrid procedures reserved for cases complicated by hematoma or retained foreign bodies. Injured vessel type (V) also significantly influenced strategy (p = 0.026): all V3 lesions were managed by open ligation, and 66.7% of V4 injuries required hybrid surgery. Clinical manifestations (C) and associated injuries (A) had no independent effect on surgical choice (p = 0.390 and p = 0.386). Perioperative complications occurred in 4 patients: 3 cranial nerve injuries (all in the P2 zone, 10.0% vs. 0% in other zones; p = 0.046) and 1 hyperperfusion syndrome. Nerve injuries were confined to the P2 subtype, with a significantly higher rate in A1 patients (100.0%, 2/2) than in A0 patients (2.4%, 1/41) (p = 0.048). Hyperperfusion syndrome occurred exclusively in the C2 subtype (25.0%, 1/4 vs. 0/39 in C0/C1). Overall complication rates were significantly elevated in A1 (100.0%) and C2 (25.0%) subtypes (p = 0.048 and p = 0.042, respectively). At a mean follow-up of (15.53 ± 3.90) months, asymptomatic >50% in-stent restenosis was detected in 2 patients (4.7%); no other stent or vessel complications were observed. CONCLUSION:The PVCA classification system effectively guides surgical decision-making in cervical vascular trauma, with penetration site (P) as the strongest determinant of surgical approach and injured vessel type (V) further refining strategy. By also identifying high-risk subtypes for complications-P2 for cranial nerve injury, and A1/C2 for overall adverse events-the system enables tailored intervention and targeted complication prevention, ultimately optimizing individualized management and improving clinical outcomes.
PURPOSE:The objective of this study was to evaluate the role of teriparatide in promoting mandibular fracture healing. METHODS:In this prospective cohort study, 12 patients belonging to American Society of Anesthesiologists status II, who required open reduction and internal fixation of mandibular fractures were categorized into exposure group 9 (52.94%) fractures and non-exposure group 8 (47.06%) fractures. Following open reduction and internal fixation, patients in the exposure group were administered 28.2 μg of teriparatide subcutaneously, twice a week for 4 weeks, while the non-exposure group did not receive any treatment. The groups were followed up and reviewed for a period of 6 weeks to assess fracture healing. The primary outcome parameters were postoperative pain, levels of serum osteocalcin and pro collagen type 1 N-terminal propeptide (P1NP) and bone density on CT. The secondary outcome parameters were requirement of analgesics and mouth opening. Pain was assessed using numerical pain rating scale. Serum osteocalcin and P1NP were assessed pre-operatively and on the 30th post-operative day. Bone density was assessed pre-operatively and on the 6th post-operative week. The data was analyzed for descriptive and analytical statistics (comparison of means and proportions). To analyze the data SPSS (IBM SPSS Statistics for Windows, Version 26.0, Armonk, NY: IBM Corp. Released 2019) is used. Significance level is fixed as 5% (α = 0.05). RESULTS:All patients were pain-free by the 3rd and 7th post-operative day, in the exposure and non-exposure groups, respectively (p < 0.001). Mean post-operative serum osteocalcin and P1NP levels were higher for the exposure group (p = 0.011; p = 0.105, respectively). The mean bone mineral density was significantly increased in the exposure group (p < 0.001). CONCLUSION:Within the limitations of this study, it can be inferred that teriparatide effectively reduces post-operative pain and facilitates bone formation and mineralisation.
Floating knee injuries involving distal femoral articular fractures with concomitant segmental tibial fractures are uncommon but challenging high-energy injuries. Optimal outcomes depend on individualized fixation strategies, adequate exposure during the procedure, and preservation of soft-tissue biology. We reported a 52-year-old male sustained a road traffic accident resulting in an AO 33-C3 distal femur fracture with intra-articular extension and an ipsilateral AO 42-C2 segmental tibial fracture, classified as modified Fraser type IIb. A fragment-specific approach was undertaken. Tibial tuberosity osteotomy via the Swashbuckler approach provided improved visualization of the distal femur. Articular reduction was secured with an anteroposterior lag screw and a medial locking compression plate applied in bridging mode. The proximal tibial segments were stabilized with percutaneous lag screws, and the displaced distal shaft fragment was fixed using a limited contact dynamic compression plate through a minimally invasive percutaneous plate osteosynthesis technique. The osteotomized tuberosity was reattached with a cannulated cancellous screw. Postoperative recovery was uneventful. Early non-weight-bearing mobilization began on postoperative day 2, with protected weight-bearing allowed by 2 months and full weight-bearing by 3 months. At 6 months, radiographs confirmed solid union without implant-related complications and the patient achieved near pain-free knee motion and independent ambulation. This case highlights the value of tailored fixation and selective tibial tuberosity osteotomy to achieve anatomic reduction and stable reconstruction in complex floating knee injuries. Coordinated rehabilitation further contributed to favourable functional and radiological outcomes.
PURPOSE:The clinical benefit of intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI) remains controversial. This study compared functional outcomes between ICP guided therapy and conventional management in routine trauma practice and explored whether treatment effects differed across clinically relevant patient subgroups. METHODS:We conducted a retrospective cohort study of 1112 patients with severe TBI (Glasgow coma scale (GCS) score 3 - 8) admitted to a tertiary trauma center between January 1, 2004 and December 31, 2024. Patients were managed either with ICP monitoring and targeted therapy (n = 408) or conventional management guided by clinical assessment and neuroimaging (n = 704). Functional outcomes were assessed using the Glasgow outcome scale-extended at 7 days, 3 months, and 6 months. Multivariate logistic regression was used to identify independent predictors of favorable outcome at 6 months. Prespecified subgroup analyses were performed according to injury type, initial GCS score, and neurosurgical emergency status. RESULTS:Baseline characteristics differed between groups, with the ICP monitoring group demonstrating a higher frequency of diffuse brain injury (58.8% vs. 27.3%, p < 0.001), chest injury (25.5% vs. 9.1%, p = 0.009), hypoxia at admission (7.8% vs. 0%, p = 0.017), and anemia at admission (7.8% vs. 0%, p = 0.017). Despite receiving more intensive therapies, including sedation, vasopressors, osmotherapy, and induced hypothermia, functional outcomes did not differ significantly between treatment strategies at any time point. At 6 months, favorable outcomes were observed in 78.9% of patients in the ICP monitoring group and 78.7% in the conventional management group (p = 0.973). In multivariable logistic regression analysis, increasing age (adjusted odds ratio (OR): 0.93, 95% confidence interval (CI): 0.89 - 0.98, p = 0.010), initial GCS score 6 - 8 (adjusted OR: 10.71, 95% CI: 2.48 - 46.28, p = 0.001), absence of diffuse brain injury (adjusted OR: 11.57, 95% CI: 1.14 - 117.20, p = 0.038), absence of subdural hematoma (adjusted OR: 2.60, 95% CI: 2.74 - 11.29, p = 0.009), and absence of neurosurgical emergency conditions (adjusted OR: 23.65, 95% CI: 1.91 - 292.91, p = 0.014) were independently associated with favorable outcome. ICP monitoring was not independently associated with favorable outcome (adjusted OR: 2.42, 95% CI: 0.40 - 14.49, p = 0.334). No significant interactions were observed in prespecified subgroup analyses. CONCLUSION:In this real-world cohort of patients with severe TBI, ICP-guided therapy was not associated with improved functional outcomes compared with structured conventional management.
PURPOSE:To analyze the clinical characteristics, management, and visual outcomes of patients with retained posterior segment intraocular foreign bodies (IOFBs). METHODS:This was a retrospective, non-comparative, single-institutional case series conducted in a tertiary care center in North India, enrolling 17 patients with penetrating eye injuries and retained posterior segment IOFBs. Ocular evaluation included best corrected visual acuity (BCVA), slit lamp biomicroscopy, indirect ophthalmoscopy, and preoperative ultrasonography for poor media clarity. All patients underwent 23-gauge pars plana vitrectomy for IOFB removal, which was achieved using diamond-coated forceps or a magnet. Statistical analysis included both parametric and non-parametric tests, with p < 0.05 considered significant. RESULTS:The mean age of patients was (34.0 ± 10.9) years, with 94% being males. Construction-related work was the most common cause of trauma (41%). Metallic IOFBs accounted for 76.4% of cases, with a mean size of (4.85 ± 3.52) mm. Traumatic cataracts (70.5%) and vitreous haemorrhage (70.5%) were frequently observed. Anatomical and functional success was achieved in 94% of cases. Preoperative BCVA (2.37 ± 0.74 logMAR) showed a statistically significant improvement postoperatively (1.32 ± 0.81 logMAR). Initial poor BCVA (p < 0.001), delayed surgery (p = 0.016), and a retinal IOFB location (p = 0.023) were associated with significantly worse visual outcomes. CONCLUSION:Despite the severity of penetrating trauma involving IOFBs, prompt management with pars plana vitrectomy yielded a high rate of successful anatomical and functional outcomes. However, initial poor visual acuity, delayed surgery (beyond 48 h), and retinal IOFBs are significant predictors of a poorer prognosis. A proactive approach involving early intervention and preventive measures, such as protective eyewear, is highly recommended.
PURPOSE:Autonomous medical rescue on high-altitude plateaus faces formidable challenges, as extreme environmental conditions, including hypobaric hypoxia, severe cold, and inaccessible terrain, critically degrade human physiological resilience and logistical accessibility. The "platinum 10 min" window becomes even more stringent, demanding rapid triage and precise resource allocation under severe infrastructure deficits. Existing multi-agent reinforcement learning approaches struggle to reconcile discrete tactical maneuvering with the continuous precision required for medical resource allocation, leading to sub-optimal logistics and coarse treatment decisions. METHODS:To address these limitations, we propose ISMRG2 mSAC (injury severity-medical resource collaborative guided multi-agent soft actor-critic), a framework integrating a hybrid discrete-continuous action space with a severity-aware attention mechanism. By leveraging a maximum entropy objective, ISMRG2 mSAC incentivizes diverse exploration strategies, mitigating premature convergence to local optima. The hybrid architecture facilitates a "micro-dosing" strategy, enabling agents to continuously modulate drug administration proportional to injury severity rather than relying on fixed dosages. RESULTS:Extensive evaluations demonstrate that ISMRG2 mSAC achieves a survival rate of 84.2% and a drug efficiency ratio of 0.83, significantly outperforming baselines such as multi-agent deep deterministic policy gradient and independent proximal policy optimization. Qualitative analysis further reveals that agents balance operational agility with safety, adopting a high-speed rescue policy that trades off marginal collision risk for superior mission completion time and logistical sustainability. CONCLUSION:The proposed ISMRG2 mSAC framework effectively bridges the gap between discrete maneuver control and continuous medical resource allocation in extreme high-altitude rescue scenarios. Its severity-aware attention mechanism and hybrid action space enable fine-grained, adaptive treatment decisions, yielding substantial improvements in both casualty survival and drug utilization efficiency over existing multi-agent reinforcement learning methods.
PURPOSE:Diabetic foot osteomyelitis (DFO) presents substantial therapeutic challenges due to refractory healing and high recurrence rates. While platelet-rich plasma (PRP) demonstrates wound-healing potential, its efficacy in DFO management requires further exploring. This study aimed to evaluate the clinical efficacy of PRP in DFO management. METHODS:This is a retrospective cohort study compared surgical outcomes between DFO patients receiving conventional therapy (n = 63) vs. PRP-augmented treatment (n = 68) during January 2020 and January 2025. Primary endpoints included wound healing rates (quantified at 7, 14, 30, and 90 days) and hospitalization parameters including duration of hospitalization, treatment costs, and microbial profiles. Secondary analysis evaluated Wagner grade 4 subpopulations. Baseline characteristics were analyzed using descriptive statistics. The wound healing rate at each time points between PRP and control group was compared by the analysis of covariance RESULTS: PRP administration resulted in a significantly higher 7-day wound closure rate compared to the control group (88.10% ± 10.37% vs. 83.51% ± 10.85%, p = 0.015). In patients with Wagner grade 3, the PRP group exhibited a significantly greater healing rate at 7 days (98.64% ± 2.40% vs. 94.95% ± 5.19%, p = 0.018) while no statistical difference was found at other time points (14 days: 99.71% ± 0.73% vs. 98.86% ± 2.24%, p = 0.193; 30 days 99.83% ± 0.58% vs. 98.00% ± 7.28%, p = 0.386; 90 days 99.67% ± 1.15% vs. 99.36% ± 1.89%, p = 0.626). Moreover, among those with Wagner grade 4, the PRP group demonstrated consistently superior healing outcomes across all time points (7 days: 89.94% ± 8.35% vs. 78.33% ± 12.20%, p = 0.006; 90 days: 99.93% ± 0.37% vs. 98.33% ± 4.08%, p = 0.008). Treatment with PRP was also associated with a 13.3% reduction in the mean hospitalization duration ((28.47 ± 10.43) days vs. (32.85 ± 11.50) days, p = 0.029), despite incurring higher treatment costs ($6740.44 ± $3048.42 vs. $5370.97 ± $3600.43, p = 0.025). No adverse events related to PRP application were observed. CONCLUSIONS:The present study demonstrates that PRP significantly accelerated the wound healing process in DFO patients, especially in Wagner grade 3 and 4 cases. Despite the associated increase in cost, PRP treatment led to a marked reduction in hospital stay. These findings suggest that PRP may constitute a promising therapeutic strategy for DFO management, offering improved clinical outcomes while maintaining an acceptable safety profile.
Brugada syndrome, a rare cardiac disorder stemming from mutations in sodium channels, manifests as ventricular arrhythmias, potentially culminating in sudden cardiac death. This case involves a 37-year-old male with a right type 3C open elbow fracture-dislocation and brachial artery injury, who presented with ST-segment changes in avR, v1, v2, and v3. After induction with general anesthesia, postoperative evaluation and cardiac consultation revealed a diagnosis of Brugada syndrome, specifically displaying a Brugada type 1 pattern. The electrocardiogram pattern of Brugada syndrome can mimic acute myocardial infarction, posing a challenge for anesthetists to recognize this rare cardiac condition in emergency situations. Given its association with ventricular arrhythmias and sudden cardiac death, prompt identification is crucial for appropriate management. This case emphasizes the potential misdiagnosis of Brugada syndrome as traumatic myocardial injury in emergency care.
