Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial

SUMMARY OBJECTIVE: This study aimed to evaluate the effectiveness of cryotherapy in elderly patients with rib fractures due to blunt thoracic trauma. METHODS: In this prospective randomized controlled study, geriatric patients were assigned to groups to receive either coolant spray (n=51) or placebo spray (n=50). The visual analog scale scores of all patients were recorded before starting spray application (V0), as well as at 10th (V1), 20th (V2), 30th (V3), 60th (V4), 120th (V5), and 360th (V6) minute. The mean decreases in the visual analog scale scores were calculated. RESULTS: The differences between V0 and V1, V0 and V2, V0 and V3, and V0 and V4 mean visual analog scale scores measured in the coolant spray group were found to be significantly higher (p<0.001). In V1, V2, V3, and V4 measurements, the incidence of "clinical effectiveness" in the coolant spray group was significantly higher than in the placebo group (p=0.001). CONCLUSIONS: Coolant spray therapy can be used as a component of multimodal therapy to provide adequate analgesia due to rib fractures in geriatric patients.

Construction and Application of Rib Fracture Diagnosis Model Based on YOLOv3 Algorithm / 法医学杂志

OBJECTIVES@#The artificial intelligence-aided diagnosis model of rib fractures based on YOLOv3 algorithm was established and applied to practical case to explore the application advantages in rib fracture cases in forensic medicine.@*METHODS@#DICOM format CT images of 884 cases with rib fractures caused by thoracic trauma were collected, and 801 of them were used as training and validation sets. A rib fracture diagnosis model based on YOLOv3 algorithm and Darknet53 as the backbone network was built. After the model was established, 83 cases were taken as the test set, and the precision rate, recall rate, F1-score and radiology interpretation time were calculated. The model was used to diagnose a practical case and compared with manual diagnosis.@*RESULTS@#The established model was used to test 83 cases, the fracture precision rate of this model was 90.5%, the recall rate was 75.4%, F1-score was 0.82, the radiology interpretation time was 4.4 images per second and the identification time of each patient's data was 21 s, much faster than manual diagnosis. The recognition results of the model was consistent with that of the manual diagnosis.@*CONCLUSIONS@#The rib fracture diagnosis model in practical case based on YOLOv3 algorithm can quickly and accurately identify fractures, and the model is easy to operate. It can be used as an auxiliary diagnostic technique in forensic clinical identification.

Expert consensus on diagnosis and treatment of rib, sternum, and lung trauma (version 2022) / 中国胸心血管外科临床杂志

@#In order to further improve the treatment level of rib, sternum, and lung trauma in China, and to provide patients with a comprehensive, safe, scientific, and standardized treatment model, we convened a meeting of outstanding thoracic surgery experts in the field of trauma in China to demonstrate and solicit opinions widely, and in accordance with the principle of evidence-based medicine, based on the best published Chinese and English evidence, finally formulated this consensus. This consensus aims to solve the possible problems in the treatment of lung, rib, and sternum trauma to the greatest extent, and provide scientific and standard clinical solutions for the treatment of thoracic surgery trauma.

Mutations of PTCH1 gene in two pedigrees with bifid rib-basal cell nevus-jaw cyst syndrome / 浙江大学学报·医学版

Two male patients with bifid rib-basal cell nevus-jaw cyst syndrome (BCNS) were admitted to Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College due to radiological findings of multiple low density shadows in the jaw. Clinical and imaging findings showed thoracic malformation, calcification of the tentorium cerebellum and falx cerebrum as well as widening of the orbital distance. Whole exon high-throughput sequencing was performed in two patients and their family members. The heterozygous mutations of c.C2541C>A(p.Y847X) and c.C1501C>T(p.Q501X) in PTCH1 gene were detected in both patients. Diagnosis of BCNS was confirmed. The heterozygous mutations of PTCH1 gene locus were also found in the mothers of the two probands. Proband 1 showed clinical manifestations of low intelligence, and heterozygous mutations of c.C2141T(p.P714L) and c.G3343A(p.V1115I) were detected in FANCD2 gene. Proband 2 had normal intelligence and no FANCD2 mutation. The fenestration decompression and curettage of jaw cyst were performed in both patients. Regular follow-up showed good bone growth at the original lesion, and no recurrence has been observed so far.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are significant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To find commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classified into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the confidence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Tratamiento de punta nasal mestiza en rinoplastía secundaria / Treatment of mestize tip nose in secundary rhinoplasty

ANTECEDENTES: la nariz mestiza constituye un reto en la adecuada trasformación estética y funcional de la rinoplastia, más aún cuando esta se realiza en una segunda intervención y los tejidos nasales ya se encuentran alterados, no pudiendo hacer una adecuada reconstrucción de las estructuras anatómicas sin el uso de injertos cartilaginosos de otras áreas del cuerpo. OBJETIVO: el propósito de este trabajo es de evaluar los resultados obtenidos de una reconstrucción de la punta nasal, realizada en pacientes que ya fueron sometidos a una rinoplastia sea esta secundaria o cuaternaria. METODOLOGIA: estudio retrospectivo, de casos de pacientes que se sometieron a una nueva intervención para mejorar aspectos estéticos y funcionales nasales, que ya fueron operados en más de 1 oportunidad. HALLAZGOS: se tiene un universo de 10 pacientes en los que se realizó una rinoplastia secundaria o cuaternaria donde se utilizó injerto costal para conformar el esqueleto cartilaginoso y el uso de un injerto de extensión septal, todo esto para mejorar la estética y funcionalidad nasal.

Síndrome del nervio dorsal escapular en un adulto / Dorsalscapular nerve syndrome in an adult

Se presenta el caso clínico de un paciente de 47 años de edad, quien acudió al Servicio de Ortopedia y Traumatología del Hospital Docente Clinicoquirúrgico Joaquín Albarrán de La Habana por presentar dolor en el cuello irradiado al miembro superior izquierdo. En la exploración física se destacó atrofia de los músculos romboides de la escápula izquierda y deformidad alar, acentuada durante la maniobra. Se realizó radiografía y electromiografía; en la primera, se observó costilla cervical supernumeraria izquierda y, en la segunda, lesión del nervio dorsal escapular, por lo cual se diagnosticó síndrome del nervio dorsal escapular secundario a síndrome del escaleno anterior. Se indicó tratamiento fisioterapéutico y el paciente evolucionó satisfactoriamente.

The case report of a 47 years patient is presented, who went to the Orthopedics and Traumatology Service of Joaquín Albarrán Teaching Clinical Surgical Hospital in Havana due to a pain in the neck irradiated to the left superior member. In the physical exploration atrophy of the left scapula romboid muscles and alar deformity were notable, accented during the maneuver. Radiography and electromyography were carried out; in the first one, left supernumerary cervical rib was observed and, in the second one, dorsalscapular nerve leison, reason why the secondary dorsal scapular nerve syndrome to anterior scalene syndrome was diagnosed. Physiotherapeutic treatment was indicated and the patient had a favorable clinical course.

Desvendando a técnica de compressão torácica em pacientes em ventilação mecânica: uma revisão narrativa / A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review

RESUMO O manejo deficiente das secreções é uma das complicações mais frequentes em pacientes em ventilação mecânica invasiva. A depuração das secreções por meio da fisioterapia respiratória é um aspecto crítico do tratamento desses pacientes. A compressão torácica manual é uma das técnicas de fisioterapia respiratória mais praticadas em pacientes ventilados, mas seu impacto nos desfechos clínicos permanece controverso devido a questões metodológicas e ao pouco conhecimento sobre sua ação. Nesta revisão, apresenta-se uma análise detalhada dos princípios físicos envolvidos na execução da técnica de compressão torácica. Também investigam-se os efeitos fisiológicos observados em estudos experimentais e clínicos, que mostram que o uso de compressão torácica curta e vigorosa, baseada no aumento de fluxos expiratórios (diferença de fluxo aéreo inspiratório-expiratório > 33L/minuto), pode melhorar o movimento do muco em direção à glote. Por outro lado, o uso de compressão torácica suave e gradual ao longo de toda a fase expiratória não afeta os fluxos expiratórios, resultando em efeitos ineficazes ou indesejados em alguns casos. Mais estudos fisiológicos são necessários para entender os princípios da técnica de compressão torácica em pacientes ventilados. No entanto, de acordo com as evidências, a compressão torácica tem mais benefícios potenciais do que riscos, o que incentiva sua implementação.

ABSTRACT Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.

Research progress in pulmonary electrical impedance tomography for ventilation functional evaluation following multiple rib fracture / 中华创伤杂志

Multiple rib fracture is a common chest injury that can cause severe pain and seriously affect life quality of the patients. The traditional pulmonary function test can only assess changes in total lung volume and ventilation of the multiple rib fracture, but fails to reveal regional ventilation status in rib fracture area and ventilation differences within the whole lung. Instead, pulmonary electrical impedance tomography (EIT), as a novel bedside technique for ventilation monitoring, has advantages of non-invasiveness, non-use of radiative rays and dynamic visualization of regional ventilation, enabling to quantify ventilation defects and heterogeneity in space and time. Starting with the assessment of ventilation changes and research status of ventilation function in multiple rib fracture and the characteristics of EIT, the authors review the research progress in the evaluation of ventilation function following multiple rib fracture based on EIT, with the aim to provide new insight into the research on ventilation changes after multiple rib fracture.

Treatment of bifid ribs by gasless endoscopy using lift device / 中华胸心血管外科杂志

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Research progress in pain control and respiratory management in patients with flail chest / 中华创伤杂志

Flail chest is a severe chest trauma that is commonly associated with lung contusion, resulting in acute respiratory distress syndrome and respiratory failure, which brings challenges in clinical management. It has become a clinical consensus that surgical treatment of flail chest can rapidly restore thoracic stability, eliminate paradoxical breathing, and maintain stability of respiratory and circulatory functions. However, non-surgical interventions continue to be crucial in further improving the prognosis of patients with flail chest, such as pain management and respiratory management. In this study, the authors review the research progress in pain control and respiratory management during comprehensive treatment of patients with flail chest for better understanding of pain management and lung injury care, which may provide references for clinical treatment and further improvement of clinical prognosis and quality of life for patients with flail chest.

Efficacy comparison of early and late open reduction and internal fixation for severe rib fracture combined with respiratory failure / 中华创伤杂志

Objective:To investigate the effect of timing of rib internal fixation on early curative effect of patients with severe rib fracture complicated with respiratory failure.Methods:A retrospective cohort study was conducted on clinical data of 33 patients with multiple rib fracture complicated with respiratory failure admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xiamen University Medical College) from January 2018 to October 2019.There were 26 males and 7 females; aged 60-87 years [(67.9±6.7)years]. The time interval from injury to open reduction and internal fixation was within 3 days in 16 patients (early operation group) and over 3 days in 17 patients (later operation group). The number of fixed ribs, operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and lenghth of hospital stay were compared in the two groups. The numeric rating scale (NRS) pain score was assessed at postoperative 1, 3 and 7 days. Postoperative complications were detected as well.Results:All patients were followed up for 8-24 months [(16.5±4.3)months]. Number of fixed ribs was not statistically different between the two groups ( P>0.05). The operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and length of hospital stay in early operation group [(67.3±11.2)minutes, (103.9±28.2)hours, (5.2±1.9)days, (6.4±2.8)days, (12.5±3.5)days] were shorter than those in late operation group [(108.4±18.4)minutes, (160.8±89.3)hours, (10.1±2.3)days, (9.5±2.2)days, (18.0±4.5)days] ( P<0.05 or 0.01). The NRS score was (6.6±0.6)points, (3.3±0.6)points and (2.7±0.8)points in early operation group at postoperative 1, 3 and 7 days, significantly lower than those in late operation group [(7.4±1.1)points, (4.9±1.1)points, (3.9±0.7)points] ( P<0.05 or 0.01). The total complication rate was 25.0%(4/16) in early operation group, lower than 70.6%(12/17) in late operation group ( P<0.05). Conclusion:For severe rib fracture complicated with respiratory failure, early open reduction and internal fixation can effectively reduce operation time, duration of mechanical ventilation, lenghth of ICU stay, chest tube indwelling time and lenghth of hospital stay, early relieve pain and decrease complications rate when compared with late operation.

Efficacy comparison of 3D printing technology-assisted and conventional open reduction and internal fixation for multiple rib fracture / 中华创伤杂志

Objective:To compare the efficacy of 3D printing technology-assisted and conventional open reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 61 patients with multiple rib fracture admitted to Mindong Hospital Affiliated to Fujian Medical University and Fujian Provincial Hospital from July 2018 to March 2020. There were 44 males and 17 females, with age range of 18-73 years [(45.1±12.9)years]. Unilateral lung contusion and laceration occurred in 31 patients, while bilateral in 30. There were 19 patients accompanied by hempneumothorax and 16 by flail chest. Totally, 31 patients received 3D printing technology assisted open reduction and internal fixation (3D-assisted incision group) and 30 patients received conventional open reduction and internal fixation (conventional incision group). The incision length, operation time, intraoperative blood loss, postoperative 3-day visual analogue scale (VAS), duration of pain, indwelling time of chest tube, total length of hospital stay, postoperative bone callus formation time and rate of rib bone plate loosening were comapared in two groups. The short form 36 health survey (SF-36) score (ie, physical function, physical function, physical pain, general health, energy, social function, emotional function, mental health) preoperatively, at postoperative 6-month and at the last follow-up was compareted between two groups. Complications were observed at the same time.Results:All patients were followed up for 18-38 months [(26.4±5.5)months]. In 3D-assisted incision group, the incision length was (5.9±1.3)cm, with operation time for (84.6±7.8)minutes, intraoperative blood loss for (85.5±13.9)ml, postoperative 3-day VAS for (2.5±0.5)points, duration of pain for (5.9±0.7)days, indwelling time of chest tube for (3.4±0.7)days, total length of hospital stay for (7.0±1.0)days, postoperative callus formation time for (2.6±0.7)weeks and rate of rib bone plate loosening for 3.2%(1/31). By contrast, in conventional incision group, the incision length was (10.9±2.4)cm, with operation time for (127.1±12.5)minutes, intraoperative blood loss for (183.0±30.9)ml, postoperative 3-day VAS for (6.5±0.9)points, duration of pain for (11.2±1.8)days, indwelling time of chest tube for (7.8±0.8)days, total length of hospital stay for (15.1±1.2)days, postoperative callus formation time for (4.6±0.8)weeks and rate of rib bone plate loosening for 20.0%(6/30) ( P<0.05 or 0.01). There was no significant difference in preoperative SF-36 score between the two groups ( P>0.05). At 6 months after surgery, the subscores of SF-36 in 3D-assisted incision group were higher than those in conventional incision group except for "mental health" ( P<0.05 or 0.01). At the last follow-up, all the subscores of SF-36 in 3D-assisted incision group were higher than those in conventional incision group ( P<0.05 or 0.01). There were no obvious complications such as pulmonary infection or atelectasis. Conclusions:For multiple rib fracture, 3D printing technology-assisted open reduction and internal fixation is superior to conventional open reduction and internal fixation for it can shorten incision length, operation time, indwelling time of chest tube, total length of hospital stay and postoperative bone callus formation time, reduce intraoperative blood loss, relieve postoperative pain, reduce rate of rib bone plate loosening and improve quality of life of the patients.

Efficacy comparison of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture / 中华创伤杂志

Objective:To compare the efficacy of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 192 patients with multiple rib fracture treated in 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2020 to January 2022. There were 101 males and 91 females; aged 32-94 years [(51.5±16.6)years]. The patients underwent open reduction and internal fixation with nickel-titanium shape memory alloy embracer via standard incision such as anterior axillary longitudinal incision (standard incision group, n=96) or conventional incision such as posterolateral incision (conventional incision group, n=96). The incision length, operation time, intraoperative blood loss, number of fixed fractures, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time and length of hospital stay were compared in the two groups. The visual analogue scale (VAS) was used to evaluate pain at 1 month after operation. Postoperative complications were recorded. Results:All patients were followed up for 1-16 months [4.0(3.0, 10.5)months]. The operation time, intraoperative blood loss, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time, length of hospital stay and VAS at postoperative 1 month in standard incision group [(12.1±1.6)cm, (51.4±13.0)minutes, (191.5±16.8)ml, (2.8±0.6)days, (568.9±109.0)ml, (4.1±0.7)days, (11.4±1.7)days, (2.5±0.7)points] were better than those in conventional incision group [(13.7±1.9)cm, (62.0±8.8)minutes, (248.9±65.4)ml, (4.8±1.1)days, (655.9±121.9)ml, (5.2±0.9)days, (15.3± 1.7)days, (3.5±0.7)points] ( P<0.05 or 0.01). There was no statistical difference in the number of fixed fractures between standard incision group and conventional incision group (5.1±0.8 vs. 5.4±0.9) ( P>0.05). In standard incision group, there were 3 patients with poor wound healing, 5 with pulmonary infection, 3 with atelectasis and 3 with small pleural effusion. In conventional incision group, there were 11 patients with poor wound healing, 9 with pulmonary infection, 7 with atelectasis and 7 with small pleural effusion. The incidence of postoperative complications was 14.6% (14/96) in standard incision group and 35.4% (34/96) in conventional incision group ( P<0.01). Conclusion:For multiple rib fracture, standard incision is superior to conventional incision reduction in shortening the incision length, operation time, indwelling time of drainage tube, postoperative spontaneous ambulation time and length of hospital stay, reducing the intraoperative blood loss and postoperative thoracic drainage volume, alleviating the pain and reducing the postoperative complications.

Complete Box Fusion based on Ensemble Networks for rib fracture detection and localization / 解剖学报

Objective To propose a new rib fracture detection network Rib-Net to automatically and accurately detect and locate rib fracture and address the issue of missed diagnosis of rib fractures. Methods The public data set RibFrac Dataset was used to evaluate the performance of the Rib-Net, and the data set was divided into training set (420 cases), validation set (80 cases), and test set (160 cases). The Rib-Net was composed of the object detection integrated network Ensemble Detection Net (ED-Ne), Complete Box Fusion (CBF) module and the segmentation network 3D Unet. Firstly, Retina Unet, UFRCNN+ and Mask RCNN were integrated to form ED-Net to predict rib fracture candidate boxes. Secondly, a new CBF module was designed to fuse overlapping fracture candidate boxes to generate candidate boxes with accurate positioning and accurate confidence. Finally, Unet was used for rib fracture segmentation to achieve further precise localization of rib fractures. Results On the “MICCAI 2020 RibFrac Challenge: Rib Fracture Detection and Classification challenge”, our proposed Rib-Net’s detection results reached the best performance, and its recall rate, free-response receiver operating characteristic curve(FROC) value and Dice were 92.3%, 0.859 and 0.61, respectively. Conclusion The Rib-Net network can efficiently and accurately detect and locate rib fractures on chest CT images, effectively assisting doctors in making accurate diagnosis.

Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study / 中华创伤杂志(英文版)

PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

Genetic analysis of a pedigree of DYNC2H1 gene variation-caused short rib polydactyly syndrome type Ⅲ / 中华围产医学杂志

This paper reported the genetic analysis of a pedigree in which three affected fetuses with short limbs were revealed by first-trimester ultrasonography in three consecutive pregnancies. Tissues of the second aborted fetus were collected and analyzed by chromosome karyotype analysis and whole exome sequencing. The results indicated compound heterozygous mutations of EX64-EX83 Del and c.8190G>T in the DYNC2H1 gene. Real-time fluorescence quantitative polymerase chain reaction and Sanger sequencing further confirmed that the two variants were inherited from the father and the mother with normal phenotypes, respectively. EX64-EX83 Del was a likely pathogenic variant and c.8190G>T was a variant of uncertain significance. Based on the above results and the medical history, it was highly suspected that the fetus had autosomal recessive short rib polydactyly syndrome type Ⅲ caused by compound heterozygous variants. Real-time fluorescent quantitative polymerase chain reaction and Sanger sequencing results of the third aborted fetus were consistent with the second fetus. Given the same phenotypes of fetuses in the second and third pregnancy, it was strongly suggested that the heterozygous variations of EX64-EX83 Del and c.8190G>T in the DYNC2H1 gene were the pathogenic variants in this pedigree.

DYNC2H1 gene mutation analysis and prenatal diagnosis in two pedigrees affected with short rib-polydactyly syndrome type Ⅲ / 中华围产医学杂志

Objective:To investigate the molecular genetic etiology of two fetuses with short rib-polydactyly syndrome type Ⅲ (SRPS Ⅲ).Methods:Next-generation sequencing (NGS) was used to detect 226 known genes related to inherited skeletal dysplasia in two fetuses with SRPS Ⅲ diagnosed in the First Affiliated Hospital of Zhengzhou University in August 2015 and June 2020. Suspect pathological variants were verified in the pedigree members using Sanger sequencing. The prenatal genetic diagnosis of the high-risk fetus in pedigree one was conducted to identify the confirmed pathogenic variation.Results:The homozygous mutation of DYNC2H1 gene c.5881A>G(p.Lys1961Glu) was identified in the proband in pedigree one, and the parents were the carriers. The proband in pedigree two carried compound heterozygous mutations in the DYNC2H1 gene with c.10606C>T(p.Arg3536*) inherited from the father and c.8954T>G(p.Val2985Gly) from the mother. Autosomal recessive inheritance was confirmed in both pedigrees. Mutations of c.5881A>G(p.Lys1961Glu) and c.8954T>G(p.Val2985Gly) in the DYNC2H1 gene were likely pathogenic variants and had not been reported before. The prenatal diagnosis did not identify the DYNC2H1 gene c.5881A>G(p.Lys1961Glu) mutation in the fetus (Ⅱ-7) in pedigree one, which was confirmed by the umbilical cord blood sample after birth. Conclusion:DYNC2H1 gene mutation underlies the fetal skeletal dysplasia in the two pedigrees.

Efficacy evaluation of open reduction and internal fixation in the treatment of multiple rib fractures at different timing: a Meta-analysis / 中华创伤杂志

Objective:To evaluate the effect of early and late open reduction and internal fixation on multiple rib fractures.Methods:The related literatures of early and late open reduction and internal fixation of multiple rib fractures were searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang database, VIP database and China Biology Medicine database. The retrieved literatures were screened according to the inclusion criteria and exclusion criteria. The quality of the literature was strictly evaluated and Meta analysis was carried out by using Stata 15.0 software. The open reduction and internal fixation within 72 hours after injury (early operation group) and more than 72 hours after injury (late operation group) were compared in the incidence of pulmonary complications, chest pain improvement rate, duration of postoperative ventilator-assisted ventilation, postoperative chest X-ray improvement time, postoperative bed rest time, duration of postoperative chest tube retention, length of hospitalization, operation time and mortality rate.Results:A total of 11 studies with 712 patients were included. There were 360 patients in early operation group and 352 patients in late operation group. The two groups showed significant differences in the incidence of pulmonary complications ( OR=0.25, 95% CI 0.16-0.37, P<0.01), chest pain improvement rate ( OR=6.15, 95% CI 1.63-23.27, P<0.01), duration of postoperative ventilator-assisted ventilation ( SMD=-0.97, 95% CI -1.70--0.24, P<0.01), postoperative chest X-ray improvement time ( SMD=-15.91, 95% CI -18.42--13.41, P<0.01), postoperative bed rest time ( SMD=-11.07, 95% CI -12.31--9.84, P<0.01), duration of post-operative chest tube retention ( SMD=-0.98, 95% CI -1.77--0.20, P<0.05) and length of hospitalization ( SMD=-0.96, 95% CI -1.26--0.66, P<0.01). The operation time ( SMD=-2.44, 95% CI -4.89-0.02, P>0.05) and mortality rate ( OR=0.24, 95% CI 0.04-1.51, P>0.05) were not statistically different between the two groups. Conclusion:Early open reduction and internal fixation in the treatment of multiple rib fractures can reduce pulmonary complications and chest pain and shorten postoperative ventilator-assisted ventilation time, postoperative chest X-ray improvement time, postoperative bed rest time, duration of postoperative chest tube retention and hospital stay, but cannot shorten operation time or reduce mortality.

Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter / Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome

Resumen El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget-Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

Abstract Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to PagetSchroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.