PURPOSE: The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. METHODS: Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups: 'end pointed' group (n = 13), patients' BDs instantly cleared after primary hydration; 'needs further resuscitation' group (n = 21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion; and 'hydration minimal change' group (n = 9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. RESULTS: A significant reverse correlation was found between the BD ratio and the HRV ratio (r = -0.562; p = 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). CONCLUSION Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.
Adolescent ; Adult ; Aged ; Autonomic Nervous System ; physiopathology ; Crystalloid Solutions ; administration & dosage ; Fluid Therapy ; Heart Rate ; Humans ; Injury Severity Score ; Middle Aged ; Resuscitation ; methods ; Wounds and Injuries ; diagnosis ; physiopathology ; Young Adult

PURPOSETo evaluate the usefulness and information collecting ability of speckle tracking imaging techniques in the assessment of myocardial regional ventricular contractility in a rabbit model with blunt cardiac injury.

METHODSFifteen healthy New Zealand rabbits weighing (2.70 ±0.28) kg were anesthetized (3% pentobarbital sodium/i.v) and impacted using the BIM-II biological impact machine to induce myocardial contusion (MC). Hemodynamic parameters, such as heart rate, systolic pressure, mean arterial pressure, diastolic pressure and central venous pressure, were determined before and after MC. Further, parameters reflecting left ventricular functions, such as left ventricular end systolic pressure, left ventricular end diastolic pressure, isovolumic pressure (IP) and the maximal increasing/decreasing rate of left intraventricular pressure (±dp/dtmax), were also determined before and after MC. Left ventricular functions were determined either by two dimensional transthoracic echocardiography or by speckle tracking imaging for segmental abnormal ventricular wall motions.

RESULTSHeart rate, systolic pressure, diastolic pressure and mean arterial pressure decreased significantly but transiently, while central venous pressure markedly increased after MC. In contrast to significant changes in diastolic functions, there was no significant change in cardiac systolic functions after MC. The speckle tracking imaging demonstrated that strain values of different myocardial segment significantly decreased post impact, and that of the ventricular segment decreased from segment to segment.

CONCLUSIONSpeckle tracking imaging is useful and informative to assess myocardial regional dysfunctions post MC.

Animals ; Echocardiography ; Female ; Heart Injuries ; diagnostic imaging ; physiopathology ; Hemodynamics ; Male ; Myocardial Contraction ; Rabbits ; Ventricular Function ; Wounds, Nonpenetrating ; diagnostic imaging ; physiopathology

OBJECTIVES: The decrease or increase in sleep duration has recently been recognized as a risk factor for several diseases, including hypertension and obesity. Many studies have explored the relationship of decreased sleep durations and injuries, but few have examined the relationship between increased sleep duration and injury. The objective of this research is to identify the risk for injury associated with both decreased and increased sleep durations. METHODS: Data from the 2010 Community Health Survey were used in this study. We conducted logistic regression with average sleep duration as the independent variable, injury as a dependent variable, and controlling for age, sex, occupation, education, region (cities and provinces), smoking, alcohol use, body mass index, hypertension, diabetes, arthritis, and depression. Seven categories of sleep duration were established: < or =4, 5, 6, 7, 8, 9, and > or =10 hours. RESULTS: Using 7 hours of sleep as the reference, the adjusted injury risk (odds ratio) for those sleeping a total of < or =4 h/d was 1.53; 1.28 for 5 hours, for 1.11 for 6 hours, 0.98 for 8 hours, 1.12 for 9 hours, and 1.48 for > or =10 hours. The difference in risk was statistically significant for each category except for the 8 and 9 hours. In this study, risk increased as the sleep duration decreased or increased, except for the 8 and 9 hours. CONCLUSIONS: This research found that either a decrease or increase in sleep duration was associated with an increased risk for injury. The concept of proper sleep duration can be evaluated by its associated injury risk.
Adult ; Age Factors ; Aged ; Alcohol Drinking ; Arthritis/physiopathology ; Body Mass Index ; Depression/physiopathology ; Diabetes Mellitus/physiopathology ; Female ; *Health Surveys ; Humans ; Hypertension/physiopathology ; Male ; Middle Aged ; Obesity/physiopathology ; Odds Ratio ; Questionnaires ; Republic of Korea ; Risk Factors ; Sex Factors ; *Sleep ; Smoking ; Wounds and Injuries/*epidemiology ; Young Adult

OBJECTIVETo observe the efficacy of the treatment of refractory wound by VSD combined with platelet-rich plasma.

METHODSFrom April 2010 to June 2012,15 patients with refractory wound were treated including 11 males and 4 females with an average age of 35.2 years old ranging from 18 to 45 years old. The formation time of wound was from 6 to 24 months, which was unhealed after long-term medication or repeated treatment. The VSD combined with autologous platelet-rich plasma was applied to treat the wound. The wound healing was an indicator and treatment and clinical features were summarized.

RESULTSAll the patients were followed up for 3 to 8 months (means 5 months). The wound of all patients were healed without recurrence.

CONCLUSIONThe curative effect of VSD combined with platelet rich plasma for treatment of refractory wounds is obvious. It could reduce the treatment course and the treatment cost.

Adolescent ; Adult ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; methods ; Platelet-Rich Plasma ; metabolism ; Wound Healing ; Wounds and Injuries ; metabolism ; physiopathology ; therapy ; Young Adult

INTRODUCTIONToy-related injuries, a common reason for emergency department visits in the paediatric population, constitute a significant health burden in Singapore. Although government regulations imposed on toys and childcare-related items are in place, parents and caregivers still play a pivotal role in ensuring toy safety in children. We hypothesised that deficiencies in knowledge surrounding toy safety issues exist in our adult population.

METHODSWe conducted a cross-sectional questionnaire study at KK Women's and Children's Hospital, Singapore, to examine the current attitudes, knowledge and practices of the local population regarding toy safety. Hypothetical questions on toy selection were included in the questionnaire to assess respondents' ability to identify appropriate toys and discern potentially dangerous toys for a specified age group.

RESULTSThe scores of the 93 respondents showed that they were less able to identify appropriate toys for children in the 1-2 years (66.7%; 95% confidence interval [CI] 61.4%-72.0%) and 2-3 years age groups (69.9%; 95% CI 65.5%-74.3%) than for children in the 0-1 year (82.8%; 95% CI 79.9%-85.7%) and 3-5 years age groups (85.2%; 95% CI 81.2%-89.2%). Our survey also identified key areas for improvement (e.g. educational efforts and government regulation) in current practices in order to attain a higher level of toy safety.

CONCLUSIONOur study highlights the current knowledge deficit in toy safety issues and the need for improvements in regulation, education and surveillance in order to minimise the risk of toy-related injuries in children.

Adult ; Age Factors ; Child ; Child Welfare ; Child, Preschool ; Confidence Intervals ; Consumer Product Safety ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Needs Assessment ; Play and Playthings ; injuries ; Singapore ; Surveys and Questionnaires ; Wounds and Injuries ; etiology ; physiopathology

OBJECTIVECardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz.

METHODSFrom January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study.

RESULTSThe study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound).

CONCLUSIONOur results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.

Adolescent ; Adult ; Electrocardiography ; Female ; Heart Injuries ; mortality ; physiopathology ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Survival Rate ; Wounds, Penetrating ; mortality ; physiopathology

Isokinetic technology in testing and training is the most advanced practical technique in the evaluation of muscle function. This method is a continuous dynamic test in the full range of the joint motion which has strong pertinence at the aspect of assessing muscle strength, and is an objective and quantitative method for reflecting each point's muscle strength in the range of the joint motion. This article reviews the key concepts, brief history of development and influencing factors of isokinetic technology in testing and training, introduces the progress in the field of rehabilitation medicine and sport science, etc., and discusses the future exploration in forensic science.
Biomechanical Phenomena ; Forensic Medicine/methods* ; Humans ; Isometric Contraction/physiology* ; Joints/physiopathology* ; Muscle Contraction/physiology* ; Muscle Strength/physiology* ; Muscle Strength Dynamometer ; Muscle, Skeletal/physiopathology* ; Physical Education and Training/methods* ; Physical Exertion ; Physical and Rehabilitation Medicine ; Posture ; Range of Motion, Articular/physiology* ; Sports Medicine ; Wounds and Injuries/rehabilitation*

OBJECTIVE: To establish a 3D finite element model of the complete human thoracic cage, and to perform a biomechanical analysis. METHODS: The multislice computed tomography (MSCT) images of human thorax were obtained and used to develop a 3D reconstruction and a finite element model of the thoracic cage by finite element modeling software. The right hypochondrium area of the model was simulated to sustain the frontal impacts by a blunt impactor with velocities of 4, 6 and 8 m/s, and the distribution of stress and strain after the impact of the model was analyzed. RESULTS: A highly anatomically simulated finite element model of human thoracic cage was successfully developed with a fine element mean quality which was above 0.7. The biomechanical analysis showed that the thoracic cage revealed both local bending and overall deformation after the impact. Stress and strain arose from the initial impact area of the ribs, and then spread along the ribs to both sides, at last concentrated in the posterior side of the ribs and near the sternum. Impacts with velocities of 6 m/s and 8 m/s were predicted to cause rib fractures when the strain of the ribs were beyond the threshold values. CONCLUSION The finite element modeling software is capable of establishing a highly simulated 3D finite element model of human thoracic cage. And the established model could be applicable to analyze stress and strain distribution of the thoracic cage under forces and to provide a new method for the forensic identification of chest injury.
Adult ; Cadaver ; Computer Simulation ; Finite Element Analysis ; Forensic Medicine ; Humans ; Imaging, Three-Dimensional ; Male ; Models, Biological ; Multidetector Computed Tomography ; Stress, Mechanical ; Thoracic Injuries/physiopathology* ; Thorax/physiology* ; Wounds, Nonpenetrating/physiopathology*

OBJECTIVETo investigate the feasibility of computer simulation in maxillofacial firearm injury.

METHODSThe three-dimensional finite element models and simulations of 7.62 mm, 5.56 mm standard bullets projectile injuries to pig mandibular angle were established by using MIMICS, ANSA, LS-DYNA and LS-POST software. Based on the simulation results, the bullet hole diameters, energy loss values, energy loss rates, von Mises stress, effective strain, effective strain rate dynamic contours at different time points were used for biomechanical analysis.

RESULTSThe damage processe of 7.62 mm, 5.56 mm standard bullets projectile injury to pig mandibular angle were simulated successfully. The injury rate of 7.62 mm standard bullet and injury severity of the mandible were higher than that of 5.56 mm standard bullet.

CONCLUSIONSComputer simulation can simulate maxillofacial firearm injuries effectively and may become an important method for oral and maxillofacial firearm injuries analysis.

Animals ; Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Imaging, Three-Dimensional ; Mandibular Injuries ; physiopathology ; Models, Biological ; Software ; Stress, Mechanical ; Swine ; Wounds, Gunshot ; physiopathology

OBJECTIVE: To explore MSCT optimal examination time for patients with unconspicuous rib fracture. METHODS: Sixty-three patients with thoracic trauma from January 2009 to June 2011 were collected. They were examined by MSCT in the first week after trauma and re-examined during eighth weeks after trauma. The number of rib which had been found fractured in the first examination was compared to that in re-examinations. RESULTS: Patients with fine rib fracture often have different diagnostic results at different examination time after trauma. There was statistical difference between the number in the first week and the third week to the fifth week. CONCLUSION MSCT could show the pathophysiological changes of rib fracture objectively in the stage between the third week and the fifth week after trauma, which is optimal examination time for the fine rib fracture.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pleura/pathology* ; Radiography, Thoracic/methods* ; Rib Fractures/physiopathology* ; Thoracic Injuries/physiopathology* ; Time Factors ; Wounds, Nonpenetrating/physiopathology* ; Young Adult