Purpose: A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. Methods: There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. Results: All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). Conclusion The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

A 4-year-old cat was referred for a suspected pulmonary mass. True diaphragmatic hernia presence was diagnosed via computed tomography (CT). There was a thin membrane covering the diaphragmatic defect. The membrane was thinner than the diaphragm. After contrast injection, the membrane was less enhanced than that of the normal diaphragm. The membrane was identified as a remnant of the parietal pleura. In addition, contrast-enhanced CT images provided clarity in viewing the herniated liver and falciform fat. A thinner membrane, covering the diaphragmatic defect, and attached to the thicker normal diaphragm, is considered a unique CT feature of true diaphragmatic hernia.
Animals ; Cats ; Child, Preschool ; Diaphragm ; Hernia, Diaphragmatic ; Humans ; Liver ; Membranes ; Pleura ; Rabeprazole ; Serous Membrane ; Tomography, X-Ray Computed

A 4-year-old cat was referred for a suspected pulmonary mass. True diaphragmatic hernia presence was diagnosed via computed tomography (CT). There was a thin membrane covering the diaphragmatic defect. The membrane was thinner than the diaphragm. After contrast injection, the membrane was less enhanced than that of the normal diaphragm. The membrane was identified as a remnant of the parietal pleura. In addition, contrast-enhanced CT images provided clarity in viewing the herniated liver and falciform fat. A thinner membrane, covering the diaphragmatic defect, and attached to the thicker normal diaphragm, is considered a unique CT feature of true diaphragmatic hernia.

Background: Inflammation induces dysfunction of endothelial cells via inflammatory cell adhesion, and this phenomenon and reactive oxygen species accumulation are pivotal triggers for atherosclerosis-related vascular disease. Although exosomes are excellent candidate as an inhibitor in the inflammation pathway, it is necessary to develop exosome-mimetic nanovesicles (NVs) due to limitations of extremely low release rate and difficult isolation of natural exosomes. NVs are produced in much larger quantities than natural exosomes, but due to the low flexibility of the cell membranes, the high loss caused by hanging on the filter membranes during extrusion remains a challenge to overcome. Therefore, by making cell membranes more flexible, more efficient production of NVs can be expected. Methods: To increase the flexibility of the cell membranes, the suspension of umbilical cord-mesenchymal stem cells (UC-MSCs) was subjected to 5 freeze and thaw cycles (FT) before serial extrusion. After serial extrusion through membranes with three different pore sizes, FT/NVs were isolated using a tangential flow filtration (TFF) system. NVs or FT/NVs were pretreated to the human coronary artery endothelial cells (HCAECs), and then inflammation was induced using tumor necrosis factor-α (TNF-α). Results: With the freeze and thaw process, the production yield of exosome-mimetic nanovesicles (FT/NVs) was about 3 times higher than the conventional production method. The FT/NVs have similar biological properties as NVs for attenuating TNF-α induced inflammation. Conclusion We proposed the efficient protocol for the production of NVs with UC-MSCs using the combination of freeze and thaw process with a TFF system. The FT/NVs successfully attenuated the TNF-α induced inflammation in HCAECs.

Background: To deliver therapeutics into the brain, it is imperative to overcome the issue of the blood-brain-barrier (BBB). One of the ways to circumvent the BBB is to administer therapeutics directly into the brain parenchyma. To enhance the treatment efficacy for chronic neurodegenerative disorders, repeated administration to the target location is required. However, this increases the number of operations that must be performed. In this study, we developed the IntraBrain Injector (IBI), a new implantable device to repeatedly deliver therapeutics into the brain parenchyma. Methods: We designed and fabricated IBI with medical grade materials, and evaluated the efficacy and safety of IBI in 9 beagles. The trajectory of IBI to the hippocampus was simulated prior to surgery and the device was implanted using 3D-printed adaptor and surgical guides. Ferumoxytol-labeled mesenchymal stem cells (MSCs) were injected into the hippocampus via IBI, and magnetic resonance images were taken before and after the administration to analyze the accuracy of repeated injection. Results: We compared the planned vs. insertion trajectory of IBI to the hippocampus.With a similarity of 0.990 ± 0.001 (mean ± standard deviation), precise targeting of IBI was confirmed by comparing planned vs. insertion trajectories of IBI. Multiple administrations of ferumoxytol-labeled MSCs into the hippocampus using IBI were both feasible and successful (success rate of 76.7%). Safety of initial IBI implantation, repeated administration of therapeutics, and long-term implantation have all been evaluated in this study. Conclusion Precise and repeated delivery of therapeutics into the brain parenchyma can be done without performing additional surgeries via IBI implantation.