An increase in heart rate variability can be an index for end point of resuscitation in trauma patients / 中华创伤杂志(英文版)

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.

new brace for maintaining the neck in a suitable position following tracheal reconstruction

Segmental resection and end-to-end anastomosis is the treatment of choice for patients suffering from tracheal stenosis for whom conservative management is not planned. A complication of this procedure is tension-induced anastomotic failure. To prevent this complication, maintaining the neck in full flexion by means of a suture between the chin and upper chest is a traditional approach. We have designed a new brace [Shiraz brace] that securely supports the neck in this position and decreases the bothersome use of the suture alone

Fatal motorcycle accidents in Fars Province, Iran: a community-based survey / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To identify the main characteristics of victims of motorcycle accidents in Fars Province, Iran.</p><p><b>METHODS</b>This cross-sectional study was conducted in Fars Province which has the fourth largest population of all 31 provinces in Iran from March 2009 to June 2010. We included data from all 542 recorded cases of fatalities due to motor vehicle accidents. Data were recorded from the forensic medicine registry consisting of demographic and accident-related information. Demographic information consisted of name, age, sex, status of fatal victim (motorcycle driver vs passenger) and educational level.</p><p><b>RESULTS</b>Of the 2 345 autopsy records from the forensic medicine archives, 542 (23.1%) gave the cause of death as motor vehicle accidents. Mean age of these victims was (31.4+/-6.5) years, and the male to female ratio was 28. Head injury was the most common cause of death in these victims, and overall they tended to have a low level of education. Motorcycle accidents frequently involved younger age groups (15-35 years), and head trauma related with non-use of a helmet was the most common cause of death.</p><p><b>CONCLUSIONS</b>Head injury is frequent among victims in the province we studied. This situation may be related to the victims' low socioeconomic status and little education regarding traffic laws leading to speeding and disregard of these laws along with their weak enforcement.</p>

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.</p><p><b>METHODS</b>This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011. The data were from the Fars Forensic Medicine Registry. In 4 923 recorded road traffic accident fatalities, 971 deaths were due to pedestrian accidents. The demographic and accident-related information were analyzed by SPSS version 11.5. P value less than 0.05 was considered significant.</p><p><b>RESULTS</b>The mean age of decedents was (47.2+/-26.2) years, ranging from 6 months to 103 years old. Males accounted for 69.8% of all deaths. Fatal accidents were most common in September; 56.1% of the fatal injuries occurred on intracity roads and 33.1% on extracity roads. Fatal head injuries were present in 60.54% of cases. Evaluation of the injury site and the cause of death found that they were significantly associated with age, interval between injury and death. Besides, the type of roads played an important role in mortality.</p><p><b>CONCLUSION</b>Although the clinical management of trauma patients has been improved in our country in the recent decade, decreasing the burden of injuries needs coordination among trauma system organizations.</p>

Xerografting as a novel procedure in the management of syngnathia

Congenital fusion of the maxilla and the mandible is a rare condition. The extent of the problem ranges from simple mucosal adhesion [synechia] to severe bony fusion [syngnathia]. Here we present a patient with zygomatico-mandibular fusion who was treated at neonatal and infancy periods at three different stages without tracheostomy. Having had recurrence for two times, porcine grafting was performed as a novel procedure to increase the chance of success. Ultimately the patient had uneventful outcome for 6 months after the last operation